Cancer.

Inspired by friends, patients, and several good books.

The big-C word. A four-letter word. A four-letter word that really has six letters. The unspoken syllables. A word that hits you in the chest like a professional baseball pitcher has just served you up their best efforts directly to the sternum. A word that is so heavy that you need two hands to hold it. A word that, if carried on your shoulders, will cause you to stagger. Cancer. But maybe it should be called can't, sir. Because suddenly you can't eat enough, can't go out, can't be exposed to germs, can't dream as big or as high or as long.

Cancer.

It's a word uttered daily. Multiple times. In my short stint as a pretend urology registrar, it was something that came up with half of my patients. We're going to try to remove all of the cancer. We got some of the cancer. You might have cancer. The cancer is impinging on your ureters, and now you need a procedure to open them. The cancer is winning. The surgery didn't get all of the cancer. You have cancer. That word. So heavy. Uttering it seems to steal all of the oxygen from the room. The lights go out a little bit inside. The silence that follows is deafening. No matter the temperature, everything suddenly feels so cold. The rest of the explanation is lost to the hefty new load.

In my current role, the sentence is often more bleak. The cancer is winning. The cancer is using all of your energy. The cancer eats your food and leaves none behind. The cancer makes you not want to eat. The cancer is terminal. The cancer has said check. mate.

We built a healthcare system for a time when infections killed more people than anything else. Where the target was obvious. Where, if you put the cells in your body in a line up, the bacteria would stick out like a dog in a line up of potential criminals. You can see the odd one out. And for a long time, we didn't have a way of treating that imposter. But then we discovered antibiotics and we found a quick fix to the infective agent. We created a system that treated things that could be fixed. Now, most people have diseases that we can't eradicate. We have cardiac failure and renal failure and chronic lung disease. We have arthritis and auto-immune diseases and vasculopathies. And we have cancer. We have diseases that can be stabilised, or whose progression we can slow but not halt. But we don't have cures. We don't have magic wands. And I feel, most days, like I get to say we failed. We can't make you invincible.

The problem with trying to cure cancer, any type of cancer, is that it's like trying to find Where's Wally in the crowd. You can search and search and never find the right target. Or you can draw a big box over a part of the page and hope for the best that he's in there. Cancer is a minx. You think you've found her but she slips out of your finger before you're even really sure you saw her at all. The red and white stripes you catch out of the corner of your eyes are just your imagination playing tricks. She's medusa with her many heads. And each time you feel like you're winning, two more heads turn up in the last one's place.

Cancer is magnificent. Cancer is impressive. Cancer is awe-striking. Cancer can live forever. Henrietta Lacks, who died in 1951 from cervical cancer, lives on in the cells of her tumour, which amount to an unimaginable 50 million metric tonnes in laboratories across the world. If her cancer were an entrepreneur's invention, it would have been a jackpot. Cancer is the ultimate successful rebel - she can turn off the OFF switch. She presses the big red buttons in our cells that say STOP and DO NOT PASS GO. She pushes past the boundaries of all those cells that know how to wait in line.  She's that driver who weaves through traffic. She's the banker who swindles the clients millions only to be found out when it's too late. She changes shape to get her way ahead. And the more successful she becomes, the less she looks like the cell she used to be. The less we recognise how useful and collegiate she once was. She grows and evades and conquers and steals the energy from the rest of her environment, depriving her co-workers of the fuel they need to keep the system going. She's so successful that she wipes out the local economy.

Cancer is scary. Cancer takes away our mortality while handing it back to us on a silver plater. It's weight seems greater than that of a heart attack or a stroke because it's rarely something we've done or not done. The blame cannot easily be attributed to some ill-trodden path. Our bodies have randomly, unwittingly, turned against us. And despite the many advances in the science of so many diseases, cancer is so broad in her attack, so varied in her morphology, that no single silver bullet solution can be found. The way ahead is murky, difficult and not always bound for success. A cancer cell in a line up might not look any more shady or suspect than the body next to it.

But it would be remise of me to tell this story without recognising the advances we've made in recent years. We've found some weaknesses in the armour of the cancer; weaknesses that our normal and healthy cells do not possess. We have new and sometimes surprising medications that can stop the progression in its tracks. We have surgical interventions and radiation therapies that halt progression. At least for a time. And, where cancer used to be a death sentence - a short struggle with a disease that quickly overwhelmed - cancer is now a chronic disease in much the same way we see heart failure or chronic kidney disease. We are making progress.

My grandfather died of cancer. I never really knew him, but I knew that there was something terribly wrong with his bowels and that he slowly dwindled. My high school best friend's mother is living with cancer. When my aunt was diagnosed with a localised breast cancer about five years ago, I rationalised away any life-threatening element because it was treatable and refused to acknowledge the enormity of it in her life. My aunt, the energiser bunny, the writer, the teacher, the intellectually curious and strong woman was not going to be struck down by some inconveniently abnormal cells. It feels like not a month goes past before I've heard of another friend or friend of a friend has been diagnosed with the word that holds weight like dark matter. I remember sitting with recently-diagnosed patients in my medical school years; patients who would tell me that they planned to work full time through their radiotherapy because they didn't want anybody to know, patients who gathered troops from multiple continents who could support them through the journey, patients who were excited about the prospect of shopping for wigs to suit all occasions. I feel, sometimes, the excitement that comes, even years later, when patients tell you they underwent treatment many years ago, that they had cancer but have been cancerfree for over a decade. I remember losing patients to cancer; some accepting, some resisting until the very end.

And we must all die in the end. We can't all live on forever as deranged, immortal, slippery cells. We succumb to our heart disease or our strokes or our cancer. We mustn't give so much weight to the disease that strikes fear into the hearts of many. And while our energy may be consumed fighting, we mustn't forget how to live while we chase away death.

Additional reads:
The Emperor of All Maladies: a biography of cancer
The Immortal Life of Henrietta Lacks
When breath becomes air

Post script:
Since writing this piece, my high-school-best-friend's mum sadly passed away. The cancer won. The cancer stole away a human being who held my best friend in her womb for nine months, and raised her to be the exceptionally caring, fun-loving, intelligent human being who has been part of my life for fifteen years. In her case, cancer was terrific in the old sense of the word. It was large and intense and terrifying, and caused great suffering to the many loved ones who surrounded her. She didn't forget to live while she fought. And she refused to give up. But the world is lesser without her. And without her, we keep fighting to reduce the burden of this journey for all those like her. She will be missed.

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