When you're diagnosed with cancer, you’re conscripted in a draft you cannot dodge. Almost as insidious as the disease itself is the language surrounding it, through which even dyed-in-the-wool pacifists get recast as warriors. There is no conscientious objection here. Malignancy turns lambs to lions, and then slaughters them anyway.

No other disease evokes such talk of conflict. Even the more prevalent illnesses lack oncology's arsenal of hoary battlefield cliches; there are no wars against emphysema or hypertension. Heart attacks may be a byword for seriousness and cause chest-clutching bodies to fall, but there’s no grand campaign against the clogging of coronaries. Cardiologists call the left anterior descending artery the widowmaker, yet more husbands are claimed by cancer than that sclerotic vessel.

No, only this diagnosis brings with it the vocabulary of aggressive self-defense. An obituary for a patient with cancer is just as — more? — likely to mention battle as a veteran’s. Post mortem, the corpse is held high as a Trojan Horse from which bellicose cells burst forth.

Some people receive double honors. The G.I. who stormed Normandy, dodging machine guns on the beachhead, will later receive plaudits when he tries to reverse the process and repel the invasion of his interior by would-be overlords. He might have survived the Nazis on D-Day but in the end he could still become cannon fodder for a trigger-happy doctor with abundant ammo and sloppy aim.

Tellingly, these metaphors of combat are most often deployed by civilians (myself included) who have never been in a firefight, have never been gashed by concertina wire or patched a bullet hole with soiled camo. Alopecia in the chemo ward isn’t equivalent to baldness in the barracks, where the shiny scalps reflect a much different sacrifice. When you’re fending off a malignancy, you’re not volunteering; you’re dragooned into the cause of self-preservation, pulling the wrong number in the genetic lottery. The ordnance now is measured in milligrams, not megatons. Medicine becomes materiel, and you’re not pulling the trigger.

So who, then, should we blame for all of this bombast? The oncologist is often the guiltiest, encouraging patients to “fight on” with all the knowingness of a non-combatant. Warlike rhetoric during treatment also makes the tonal shift to hospice all the more startling. Having emptied our magazines, suddenly we command our troops to lay down arms, fully aware that cancer will not respect a detente. Talk of heroism at the beginning of therapy leads our charges to believe that their end will be a blaze of glory. We promise a Sherman’s March towards exhausting every resource against their cancer. The future is binary: triumphant victory or burial in scorched earth. No wonder it seems so incongruous when we preach surrender, flip-flopping from Total War to a limp white flag.

It is beyond question that there is tremendous courage to be found in every infusion suite where patients receive chemo. But there is also remarkable bravery in the decision to say no, in the person who assesses the dual threats to their body -- the cancer and the oncologist -- and decides not to engage.

As an ersatz general prone to friendly fire, I have cared for thousands of patients with cancer, and I have never met a coward.

Mark Lewis1 Comment