Her Name was Karen: Illness as metaphor.
Karen worked as a staff nurse in the CCU at the hospital where I had been hired as the director for medical nursing. With astounding clarity, I can see her face and the variety of scarves she wore to cover her baldness. It took me some time to learn, more accurately notice, that Karen was dying of cancer. To be fair, it wasn’t just my self absorption but also because she was so filled with life, vitality and grit.
A brand new manager, experienced solely in the clinical side of academic medicine, I had worked as a clinical specialist at Ben Taub while waiting for a job to open up at Hermann Hospital in the famed Texas Medical Center in Houston Texas. For weeks, I took no real notice of Karen’s multicolored scarves nor thought about why she wore them. I had my dream job in my dream hospital and so I saw what I expected to see.
Until one day, Karen and I ended up working together to resuscitate a patient. Both of us surprised at the other. She at me because she saw an expert clinician in me, a (gasp) manager! And back then, I was an expert in critical care. Scarily so.
I at her because I took the time to ponder why the ubiquitous scarves. The obvious reason of cancer was belied by the serenity, peace and happiness that Karen radiated.
“Why do you always wear the scarves, Karen?” Surely you’re not a chemo patient, working full time as if you’ve all the time in the world?!
“Because the cancer has metastasized, I’ll not live to see the new year.”
Ever have people from your distant past show up in your psyche with astounding clarity?
That conversation occurred sometime during the early 80’s and yet I can vividly recall Karen’s expression, the tone of her words and the matter of fact manner that she uttered them. More than that, the stunning absence of fear or anger in this young woman who I guessed was somewhere in her late twenties or early thirties, my age.
In that peculiar intimacy that can develop between and among those of us who combat death, I said, “You’re not afraid.” The respect, admiration love I felt for this stranger flattened me. She felt it and glowed.
She nodded and said, “Not any more, I’m not.” Her appreciation at my comment apparent in her expression. We became friends of a sort, I looked forward to seeing her on my daily rounds through the units I was responsible for. Until the day came that she was no longer there, or anywhere.
I have learned not to question why these people and events from the past spontaneously appear, not at all because I understand why; instead, I am grateful for the sharp and vivid memory of Karen and the privilege of her friendship.
Illness as metaphor
Ours was one of those connections that brooked no artifice. I, Karen told me more than once, was one of the few people who was unafraid to talk with her about the reality she lived in: She would die…soon.
I felt impelled to talk with her about anything and everything…not just about death. Impossibly, she was one of the happiest people I knew. Happier, certainly, than any of her colleagues, or my then husband. And happiness, and the lack of it, are things I have thought and written about, a lot.
When I found and devoured Susan Sontag’s Illness as Metaphor, the first person I wanted to share it with was, of course, Karen. Like me, she read it in just a day or two and wholly identified with Sontag’s remarkable observations:
Two diseases have been spectacularly, and similarly, encumbered by the trappings of metaphor: tuberculosis and cancer. The fantasies inspired by TB in the last century, by cancer now, are responses to a disease thought to be intractable and capricious—that is, a disease not understood—in an era in which medicine’s central premise is that all diseases can be cured. Such a disease is, by definition, mysterious. For as long as its cause was not understood and the ministrations of doctors remained so ineffective, TB was thought to be an insidious, implacable theft of a life. Now it is cancer’s turn to be the disease that doesn’t knock before it enters, cancer that fills the role of an illness experienced as a ruthless, secret invasion—a role it will keep until, one day, its etiology becomes as clear and its treatment as effective as those of TB have become.
Susan Sontag Illness as Metaphor
Sontag produces a fascinating meditation about the cultural and mythical effects of nineteenth century tuberculosis and its uglier sister, twentieth century cancer. Although the book was published in 1978, her observations remain incisive, instructive, even disturbing, four decades later.
“The ideal of perfect health/’ Novalis wrote in a fragment from the period 1799— 1800, “is only scientifically interesting”; what is really interesting is sickness, “which belongs to individualizing.”
Writing from the perspective on one with the dread disease of cancer, author Sontag contrasts the treatments of TB and cancer:
Nineteenth- and early-twentieth-century physicians addressed themselves to coaxing their tubercular patients back to health. Their prescription was the same as the enlightened one for mental patients today: cheerful surroundings, isolation from stress and family, healthy diet, exercise, rest. The understanding of cancer supports quite different, avowedly brutal notions of treatment. (A common cancer hospital witticism, heard as often from doctors as from patients: “The treatment is worse than the disease/’) There can be no question of pampering the patient. With the patient’s body considered to be under attack (“invasion”), the only treatment is counterattack. The controlling metaphors in descriptions of cancer are, in fact, drawn not from economics but from the language of warfare: every physician and every attentive patient is familiar with, if perhaps inured to, this military terminology. Thus, cancer cells do not simply multiply; they are “invasive.” (“Malignant tumors invade even when they grow very slowly,” as one textbook puts it.) Cancer cells “colonize” from the original tumor to far sites in the body, first setting up tiny outposts (“micrometastases”) whose presence is assumed, though they cannot be detected.
Susan Sontag Free PDF Illness as Metaphor
Somehow Karen found the fortitude to resist the prevailing reality of her disease, its treatment and her own impending death. Rather than focusing on the fact that life would not be one of wife and mother as she had hoped, she chose to live out what I now know as “the sacrament of the present moment.“
Karen and I spoke about religion only once. Like most of our conversations, it was brief.
“Lin, are you religious?
“No, I walked away from all of that in college. Are you?”
Her smile was sympathetic, as if she expected that answer, Karen replied, “I’m Jewish.”
