For the past two weeks, I’ve been tackling the bins of belongings stored in our garage, a necessary task as we continue to prepare for a move.  Frankly, I’ve been shocked at how much of the boxes contained things that belong solely to me:  keepsakes I kept for reasons now not clear, photographs of sights seen on vacations, materials I used to use in my writing groups, and more than a few containers of journals, one dating back to high school, another to my undergraduate years, and many more,  prose and poetry that documented my life, especially those that documented particularly challenging or painful periods, a reminder to how writing has helped me heal and weather the difficult chapters of my life.

There was another carton, also filled with booklets of writing—not mine–but the stories and poetry written in the “Writing Through Cancer” workshops I’ve led over many years.  Some of my first group members’ writing was featured in both my books, A Healing Journey (2004) and When Words Heal (2006), but these were printed in booklets, compilations of the writing shared in the groups and printed for the participants at the end of each series.  I sat on the floor and through them yesterday afternoon, remembering faces, individuals’ cancer experiences, many who recovered, and some whose lives were taken by cancer.

The expressive writing workshops are intended to help people write about the experience of cancer, however raw and unwieldy, and in whatever way most natural to each.  Some write narratives, others write poetry, but the form is inconsequential.  What matters is the act of expressing what cancer is for each person, finding ways to make sense of the chaotic emotional experience of it, and supporting their efforts to better cope.  Invariably, a vibrant community of cancer patients and survivors forms through the writing and shared stories—all of it beginning with that word, “cancer,” the one that turns your life upside down and inside out.  Writing for those in the groups, as it has also been for me, provides refuge, release and a way to help heal from the emotional upheaval of cancer.

“Think of the time you first heard that awful word, “cancer.”  This is the prompt that most often begins our first session.  As you might imagine, the descriptions of the moment and of cancer are as unique as the people who come to write and share their

One writer used the simple form of an alpha poem, each line beginning with a letter in the word “Cancer:”

Caught off guard in the midst of my otherwise life,

Apocalypse entered and through me from the highest rooftop.

Nothing I already know about anything prepared me for the fall…

(K.M., 2013)

Another writer communicated the moment of diagnosis in a short three line haiku, powerfully communicating her experience in seventeen syllables:

In the white office

oncologist in white coat

I brace for the wave

(V.S., 2014)

Often, as the workshop progresses, many writers portray cancer through metaphor, by making a comparison with something else.  In many ways, the metaphor not only creates a striking image, but it helps to defuse cancer’s emotional potency.  For example, one writer described her diagnosis as entering a foreign country:

We have entered the country of Cancer

My body and I…

A foreign country



(J.E., 2010)

Yet another writer described her cancer experience in a humorous, yet powerful, piece entitled “Cancer Boot Camp,” beginning with the patient standing at attention:




Can Sir!

I Can Sir!

Yes I will heal it.  I can Sir!

Yes, I will survive it.  I can Sir!

(J. N, 2016)

“Cancer” also often becomes a character, allowing the writers to visualize it differently, even talk back to it.  Some cancers, this next writer tells us, are less common and more “hidden” in the body than others—and, thus, more frightening.

Some cancers arrive with fanfare,

trumpets, an engraved invitation…

But some cancers know how to hide.

They defy the eye, the scope, the scan.

They are not the usual suspects…

(K. M., 2013)


For another participant, cancer is “The Thief,” is stealthy and accomplished, who robs the writer of her security:

He is a thief.  Not an ordinary thief, who steals purses, jewelry or a car.  Instead he steals more person, more precious things.  Irreplaceable things…I see him finalizing his plan to steal my peace of mind, my security in believing I can control my health…                                                                        (N.S. 2014)

“If cancer is like a song sung off-key,” another group member wrote in a poem entitled, “The Metaphors of Cancer,” “then cancer interrupts the beautiful song of our hearts…”

If cancer is like a bird falling from the sky

Then cancer craves the immediate warmth of a gentle cupped hand

If cancer is a tremendous energy and force

That comes in the winter of our lives

Only to disappear after leaving its mark

Stimulating new growth

And hope

As we fight for Spring.

(T.E., 2014)

These are only a small sample of the many poignant, humorous, and powerful pieces of writing that are created and shared–all under a time limit!–in our expressive writing groups.  The writing that I  witness in those sessions is, undoubtedly, among the most moving  I’ve ever experienced.  Many participants come to the group saying, “I’m not a writer, but…”  And I quickly remind them that the great poet William Stafford had a wonderfully succinct way of describing a writer.  “A writer,” he said, “is someone who writes.”  And so they begin, finding a way to express what, in those first weeks after diagnosis, seems nearly unexpressible, and often surprising themselves by the beauty in their words, writing in ways that move us and touch our hearts.

Writing Suggestions:

How do you experience cancer?  What images and descriptions do you use?  Expand and explore them in a poem or short narrative.

Many times during the workshop, we begin by reading “Thirteen Ways of Looking at a Blackbird,” by Wallace Stephens, a collection of different ways of seeing or experiencing a blackbird.  Here is an excerpt:


Among twenty snowy mountains,   

The only moving thing   

Was the eye of the blackbird.   



I was of three minds,   

Like a tree   

In which there are three blackbirds.   



The blackbird whirled in the autumn winds.   

It was a small part of the pantomime.   


(From:  The Collected Poems of Wallace Stevens, 1954)

After reading the poem, I invite the group to write their own poems, modeled after Stephens, but focused on cancer.  Trying writing your own poem in the manner of Stephens, describing thirteen different ways of looking cancer.


She is alive.  Although her doctors said

there was nothing to be done, she is home,

planting her summer garden, is not dead

and plans to eat everything she has grown…

She will live beyond the harvest and what will not grow

is her tumor, its flowers held captive

and still beneath her heart.  Only the live

wire of her will separates her now from

the future…it will come

sooner or later, but this is her time

to cultivate and seed.  She is alive.

(From: “Seed,” by Floyd Skloot, in The Cancer Poetry Project, V.1, 2001)

At first I was afraid, I was petrifiedRemember the 1979 hit, “I will survive,” by Gloria Gaynor?  Decades later, it remains one of the most famous of disco songs and singer Gaynor’s single biggest hit.  In 1981, I nearly wore out my vinyl recording of it, a gift from a friend as I struggled with traumatic loss and becoming a single mother of two daughters.  Night after night, as my children slept, I retreated to the living room, turned on the stereo, and as Gaynor belted out her lyrics, danced wildly around the room in the dark, trying, for all I was worth, to believe that I, too, would survive:  And I grew strong and I learned how to get along

We all must learn to survive the hardships that life presents, whether loss, life-threatening illness, trauma and hardship.  For those who must face a diagnosis of cancer, survival dominates each day:  surviving the surgeries, treatments, and, hopefully, the cancer itself.  The term “survivor” has become part of the cancer lexicon and defines anyone living with cancer, terminal or not.  Yet  it is a term that can describe anyone at different times in our lives.  The definition of “survivor” in The Oxford American Dictionary is “a person remaining alive after an event in which others have died,” such as those 9/11 survivors or those who survived the sinking of the Titanic.  It is also a term that the Oxford defines as “a person who copes well with difficulties in… life,” practically synonymous with being human.

A few years ago, as I was preparing for a “Writing Through Cancer” session at Scripps Green Cancer Center, Nadia, living with metastatic breast cancer, arrived early and quietly handed me an envelope.  “Wait to open it until everyone arrives,” she said.  A short time later, as everyone was seated, I opened N.’s card, surprised to see the words, “Happy Birthday” on the front of it.   It wasn’t my birthday or N’s.  “Wait and see,” she said.  “Everyone will have a birthday sometime.”  I opened the card and that’s when we heard Gloria Gaynor’s belting out “I will survive.”  Everyone in the room burst out laughing.  Nadia smiled.  “We’re all survivors,” she said.  Indeed we are.

What ignites our will to survive and helps us cope and keep going?  It’s different for all of us and yet, so much the same.  Hope is surely one of those things that keeps us going.  The support of friends and loved ones are also important to our will to survive.    I remember the December day in 2008 when my physician came to the hospital where I had been taken for observation and a battery of tests after passing out and collapsing on the sidewalk.  “We think it’s your heart,” she said, her gentle segue into the preliminary results of my tests.  I stared at her in disbelief and panic.

“Not my heart!” I cried.  “But I do all the right things.”  Tears filled my eyes.  “I can’t die yet,” I sobbed.  “I have a grandson ready to be born in two months.  I have to be there.”  The cardiologist arrived a short time later, and in a manner calm and reassuring, explained that I had heart failure, and as I began to cry, quietly smiled and said, “you’re going to live a long time, Sharon,” and we’ll make sure of that.”  Two months later, I held Nathan in my arms minutes after his birth.  Nathan, despite the love I have for all three grandchildren, has, perhaps, his grandmother’s heart most firmly in his grasp.

Ann, a beloved Scripps group member who died from metastatic cancer, demonstrated the courage and determination to live fully for as long as she could, filling her days with family, friends, travel, and joy.  She was determined to be on hand for her first grandchild’s birth, even though the odds were against her.  A month before her death, she was present for his birth and able to hold him in her arms for the time she had left.  I have no doubt that his impending arrival strengthened her will to live and experience the joy of his arrival.

During a session I led at the Stanford Cancer Center several years ago, I posed the question to the group of cancer writers:  “What keeps you intent on surviving cancer?” Ali, who has since recovered from colon cancer and now leads the Stanford group, wrote a poem entitled, “Why I Need to Survive,” using the words of her children, (who were quite young at the time):

Mommy, the trees look like boogers on sticks.
Mommy, can we walk to the sunset?
Mommy, how did God make the ocean?
Mommy, next time will you be my mommy?
Because I don’t want the other mommies.
I only want you.

John, another of the writers from my former Stanford group, survived acute lymphoblastic leukemia for a full five years after his diagnosis, intent on living as long as he possibly could.  He wrote poignantly, often humorously, and honestly about his cancer battle in the Stanford group and later, on his blog.  A year before his death, he sent me an essay titled “What I’ve Learned,” summarizing lessons learned during his cancer journey, ones that portrayed his will to survive despite a terminal disease.  Among the many bits of wisdom gained during his illness,  he reminded us that survival, no matter how lengthy, is about living fully, for as long as we have.  Among his survival tips were:

  • Work at what you love…
  • Travel light.
  • Do what the doctors tell you.
  • Offer support when you can and it will come back to you when you need it. ·
  • Cherish the ones you cherish.
  • In the end, all your physical beauty and prowess will leave you. You must still love that person in the mirror
  • We all will die eventually, so find a way to face death without fear. Don’t dwell on death, but enjoy each day as best you can.

Writing Suggestions:

This week, explore the topic of survival.

  • Why do you need to survive?
  • What life difficulties, illness or heartbreak have you overcome or endured?
  • What keeps you going?
  • What ignited your will, that indomitable human spirit that refuses to give up or give in?


The fields, the lakes, the forests, and the streams,

Ocean, and all the living things that dwell

Within the daedal earth; lightning, and rain,

Earthquake and fiery flood, and hurricane…


–From “Mont Blanc,” by Percy Blythe Shelley

The Midwest has tornadoes; the eastern seaboard has its hurricanes and super storms.  A large part of the country just dug out from another snow storm, while here in California, we’ve gone from an extended period of drought to swollen rivers, dams, mudslides, sinkholes and flooded interstates, all due to “The Pineapple Express, a “river of moisture” that has moved in from the Pacific and continued to drench the West coast.  Ironically, the complaints about the drought have given way to complaints about the wet and stormy weather.  Yet, as my husband and I plan for a return to Toronto, he has few complaints about our wet and blustery California winter, rather, he has re-voiced his reluctance to live in a place that, despite all the things he likes about it, has “real” winter, in other words, snowstorms, ice and cold.

Wherever we live, it seems to be human nature to complain about the weather.  California, of course, is normally blessed with mild winters, a temperate climate and plenty of sunshine.  I grew up in the northern part of the state, however, where four seasons existed along with the expectation, in the summer, that we might have to ration water or smell the scent of wildfires in the nearby mountains.  We were used to it and grateful that, unlike much of the rest of the state, the earth was likely to move from time to time.

For much of California, earthquakes are a predictable occurrence, just as tornadoes or hurricanes in other parts of the country, and never far from conscious thought.  It’s the risk of living along the earth’s fault lines, whether the San Andreas, Hayward, Oak Ridge or any number of smaller ones, and yet the cities continue to expand despite the occasional warnings of “the big one” likely to occur in the future.  What we know is that sooner or later, the earth will heave, the ground will undulate beneath our feet and sometimes, it will result in disaster.  Think of those memorable earthquakes that have demolished highways and buildings, as the 1989 Loma Prieta and 1992 Landers quakes in Northern and Southern California.

This potentially destructive movement is created by the sliding boundaries or fault lines which define the earth’s tectonic plates. California has a great many of these faults, and even though the plates move past one another a couple of inches each year due to their irregularity, we’re often unaware of their motion.  But as the plates continue to push against each other, they sometimes lock and may not move for years.  Then stress builds along the fault, and when the strain threshold is exceeded, energy is abruptly released, causing the plates slip several feet at once.  Waves are sent out in all directions and felt as tremors, or at worst, a damaging earthquake.

Did you ever think there might be a fault line
passing underneath your living room:
A place in which your life is lived in meeting
and in separating, wondering
and telling, unaware that just beneath
you is the unseen seam of great plates
that strain through time? And that your life,
already spilling over the brim, could be invaded,
sent off in a new direction, turned
aside by forces you were warned about
but not prepared for?

From:  “Fault Line” by Robert Walsh, In:  Noisy Stones:  A Meditation Manual, 1992

Early in 2007, I began teaching a course on writing for healing through the UCLA extension’s Writers’ Program, initially entitling it “Writing from the Fault Lines.”   Like many writers, the metaphors I use are almost unconsciously influenced by the landscape that shaped me and in which I spent my life into early adulthood.  Living along the West coast fault lines encouraged Tony Pfannensteil, a Portland poet, to found  Fault Lines Poetry Journal and place the first call for submissions in the fall of 2011.  Hundreds of poems were submitted by writers living along the Cascadia earthquake zone on the West coast, extending from San Francisco north to Vancouver, British Columbia.  Poet Eileen Walsh Duncan described Fault Lines as poetry that “ will create upheavals. The meticulously crafted world of what a poem should be will implode, opening fissures deep within your psyche.”

When I first began writing out of my own pain and hardship, terms like “the vulnerable landscape of the psyche,” “fissures opening,” of “stress building beneath the surface of my exterior,” and of the sudden and painful “jolts” of unexpected loss and trauma were frequent descriptions that appeared on my pages, words that seemed most able to describe the sense of shock and traumatic events that exposed my raw and tumultuous emotional interior.  I felt, in those periods, as if my life was being shattered or broken apart.  What I experienced emotionally was, it seemed, much like the earthquakes so common in my home state.

I recall the period when I was first diagnosed with early stage breast cancer, occurring in the midst of a difficult emotional time in my life—the loss of my parents, an unhappy and stressful career, and estrangement from my siblings, all rendering me numb.  A few years later, I collapsed on the pavement and was diagnosed with heart failure.  I filled page after page of my journals with disbelief, unanswerable questions and even guilt, as if I was somehow at blame, and old scars began to open to painful losses I’d soldiered through and buried many years earlier.  My “real” story was less about a treatable cancer or a weakened heart.  The story I needed to write and understand laid beneath the surface, where old wounds were buried, building up pressure, and begging for release.

I witness similar experiences in the writing groups I lead for men and women with cancer.   A diagnosis of brings you to your knees.  Life as you knew it is a thing of the past.  Yet beneath the surface, there are frequently other wounds, unresolved emotions, painful memories or traumatic events which have lain dormant, but, like the locked plates of the earth, building up pressure inside you.  Those events and emotions can be triggered by the most benign of writing prompts, and unleashed dams of old memories and painful emotions tumble onto the page.  Whether the cancer writing groups or the transformational writing course I continue to teach, writing for healing often takes us beyond the “presenting” hardship, into deeper territory and as people write, they begin to plumb the depths of their lives, bringing into the open what they were unable to do before.

Emotions can inspire you or hold you hostage.  Negative emotions–anger, fear or feelings of unworthiness–accumulate, just as pressure along the earth’s plates.  They weaken your ability to fend off illness, depression or disease.  Writing allows you, if you let it, to translate those negative emotions into words, make the connections between what you feel and why,  begin to understand or even forgive yourselves and others.  It is in the act of writing and sharing your stories that you may find a way to release the pressure of old wounds and begin to heal.

Writing Suggestion:

This week, think about the metaphors you use that are informed by the landscape and seasons where you live.   Whether fault lines or a different weather/landscape metaphor, use it to describe a difficult time in your life, whether cancer, loss, or other hardship, letting the metaphor take you deeper in your writing to explore what  lingers beneath the surface.

First of all, we believe in the magic of doctors and medicine.  The purpose of a talisman is to give us control over the things we are afraid of.  Doctors and patients are accomplices in staging a kind of drama in which we pretend that doctors have the power to keep us well.
— Alice Trillin, “Of Dragons & Garden Peas:  A Cancer Patient Talks to Doctors,” New England Journal of Medicine, 1981.

I’ve been thinking a lot about doctors.  Two weekends ago, I led my final day-long writing workshop for students, faculty and alumni of the Stanford Medical School.  It’s something I’ve been doing for nearly twelve years, thanks to meeting Audrey Shafer, MD, who is a driving force behind the medical school’s “Medicine and the Muse.”  I admit it was not only a joyful day of writing together, but an emotional one—saying good-bye to Audrey and the many individuals who’ve written with me at one time or another.  It was also a rare opportunity to move to the other side of the medical experience, from leading writing workshops for men and women living with cancer to those either treating patients, teaching or studying medicine.  In both cases, the writing has been powerful, deeply moving and honest, reminding me over and over of the power of story, of fostering compassion, listening and respect for one another’s stories.  I returned home full of gratitude for the honor to lead these workshops.

But that’s not all.  This past week, I had cataract surgery on my right eye, a relatively quick and straightforward procedure, but one that raised my anxiety nonetheless.  Yet I was lucky to have a surgeon recommended as one of the best.  And “best” went far beyond his technical skills.  My anxieties were assuaged by his warmth and compassion, willingness to listen but also to calm the nervousness I felt.  I was reminded again that the “magic” in medicine and the doctors who treat us, is more than their technical expertise.

I think of one gifted neurosurgeon who had a reputation of creating miracles.  Indeed, he saved more than a few lives, including my own.  As a teenager, I became mysteriously ill, and for a time, was diagnosed with mononucleosis, or mono, a glandular fever and infection caused by the Epstein–Barr virus (EBV).  But it wasn’t mono that was making me ill.  I began to have more disturbing symptoms over a period of weeks, and was shuttled from one physician to another before ending up in the office of a gifted young neurosurgeon practicing in an Oregon community about an hour’s drive from my family home.  I was fitted into his appointment schedule the same day I’d been referred, admitted to hospital that evening and, two days later, I in surgery for osteomyelitis of the skull and an abscess against the membrane of the brain.  I remember awakening the next morning, hearing my father’s whistle as he entered the room, his eyes glistening with tears.  “I’m sure glad to see you, Kid,” he said.

Six months later, I returned to have a metal plate installed in my forehead  by Dr. C. to replace the portion of skull that had been removed.  An earnest and grateful teen, I wrote Dr. C. a heartfelt thank-you note following both surgeries and from time to time over the years, a letter.  He always responded with a personal note of his own.  He died just a few years ago, and the tributes and remembrances of him were extraordinary.  Gifted in his medical practice, he was warm, compassionate and generous with all his patients.  I doubt any one of us doubted he possessed magic, because he inspired trust and the will to live in his patients.

Perhaps some of you saw the film “50-50,” a 2011 comedy-drama about cancer and survival, inspired by the experience of screen writer, Will Reiser.  In it,Adam, the main character, learns from his physician that the pain in his back is caused by a rare and possibly fatal spinal cancer.  His diagnosis is delivered by the doctor in a manner both impersonal and brusque while he points to the illuminated image of Adam’s spine and tumor and reviews the specifics in a nearly incomprehensible salvo of facts and medical terminology.  All the while Adam succumbs to shock and disbelief.  Although the comedy exaggerates the impersonal interaction between a physician and patient,  I’ve heard more than a few similar accounts between newly diagnosed cancer patients and their doctors.

The relationships we have with our doctors are complex, often profound.  Implicitly or directly, we’re asked to entrust our very lives with them.  We’re poked, prodded and examined by our doctors, as Molly Redmond describes in “The Cancer Patient Talks Back,” and it can sometimes have a de-humanizing effect:

I have suddenly crossed the boundary line
of the risky circle called cancer.
It has made me public property, like being largely pregnant.
People invade – an assault of connections… –
The medical cadre, too.
Either way,
I am covered with fingerprints, with labels.

(In:  The Cancer Poetry Project, Vol. 1, 2001)

Think about it:  How often do you have the chance to examine the “medical cadre” with whom we entrust with our lives?  How often do you stop to ask yourself, “What do I want in a doctor?”

Literary critic Anatole Broyard, did just that in his memoir, Intoxicated by My Illness and Other Writings of Life and Death (1993), as he reflected on his relationship with his doctor after receiving a diagnosis of metastasized prostate cancer:

The knowledge that you’re ill is one of the momentous experiences in life.  You expect that you’re going to go on forever, that you’re immortal…When the doctor told me I was ill it was like an immense electric shock.  I felt galvanized…and I was reduced to essence.  I began to look around me with new eyes, and the first thing I looked at was my doctor.

I had no reason to believe that he was not good.  He was in a good hospital…what turned me against him was what I saw as a lack of style or magic.  I realized I wanted my doctor to have magic as well as medical ability.  It was like having a “lucky” doctor.  

Broyard went on to ask, “Now that I know I have cancer of the prostate, the lymph nodes and part of my skeleton,” “what do I want in a doctor?”  He detailed several characteristics he would like in a physician, including a doctor who

  • understands that beneath my surface cheerfulness, I feel…panic,
  • was a close reader of illness and a good critic of medicine,
  • would be bonded with me for a brief space, survey my soul as well as my flesh to get at my   illness
  • can treat body and soul
  • gropes for my spirit as well as my prostate
  • knows that he is my patient too, and I have my diagnosis of him… 

The characteristics Anatole Broyard defined as the wish list for his physician got me to thinking about doctors who’ve cared for me in times of serious illness.  I realized I’ve been lucky having a gifted neuro-surgeon, cardiologist, eye surgeon and family physician—ones who have demonstrated the capacity and compassion to understand me as well as the diagnoses that forced me to put my life in their hands.

Writing Suggestion:

  • Why not ask yourself the question Broyard asked? “What do I want in a doctor?” Think of the medical experiences you’ve had, what you know about yourself, and what matters most to you.  List them.
  • Examine your current doctor-patient relationship. What is your diagnosis of your doctor?  What characteristics have been most important in establishing your trust?
  • Which doctors made you feel “lucky,” as if they possessed that little bit of magic? Why?

Postscript:  A Valentine for a Doctor

(As I thought about the prompt for this week and of the many doctors who’ve treated me over the years, I came up with a wacky idea.  I have, as I’ve written before, mild to moderate heart failure and have been treated since 2008 by a local cardiologist I greatly respect. I have, as it turns out, an appointment with him on Valentine’s Day–a day defined by the preponderance of hearts and appreciative sentiments.  Inspired by the obvious humor of seeing a heart specialist on February 14, I’ve written a humorous poem to be accompanied with a box of chocolates he can share in the cardiology department, my poem not defined by Cupid-esque mythology, but rather, gratitude for cardiology!)

Happy Valentine’s Day!


Inside every patient, there’s a poet trying to get out.—Anatole Broyard, 1990

Poetry and medicine share a long history, dating back to the Greek god Apollo, who was responsible for both healing and poetry.  Today, The use of metaphor, a poetic tool and figure of speech comparing two things seemingly unrelated, is common not only in poetry, but illness and everyday life.  Consider the sports talk that dominates this Super Bowl Sunday, one example of how metaphors permeate our everyday lives, in the language we use and in the way they influence our thoughts and actions.  For example, we use sports metaphors almost unconsciously to describe experiences in our daily life.  In the workplace, you strive to be  a “team player” or be encouraged to “run with a good idea.”  In budding romance, a boy might ” “make a pass at someone,” or in an emotional argument between two people, one is told he or she is “way out of bounds.”

There’s little doubt that our metaphors are visual and illustrative, but they also run the risk of creating stereotypes or confusion, even becoming clichés.   Some, like sports and military metaphors are so common in our daily language, they are used routinely to describe medical experience.  In “The Trouble with Medicines’ Metaphors,” (The Atlantic, August, 2014)  author Dhruv Khullar, MD, wrote:

The words we choose to describe illness are powerful. They carry weight and valence, creating the milieu in which goals of care are discussed and treatment plans designed. In medicine, the use of metaphor is pervasive. Antibiotics clog up bacterial machinery by disrupting the supply chain. Diabetes coats red blood cells with sugar until they’re little glazed donuts. Life with chronic disease is a marathon, not a sprint, with bumps on the road and frequent detours...  Military metaphors are among the oldest in medicine and they remain among the most common. Long before Louis Pasteur deployed imagery of invaders to explain germ theory in the 1860s, John Donne ruminated  on the “miserable condition of man,” describing illness as a “siege…a rebellious heat, [that] will blow up the heart, like a Myne” and a “Canon [that] batters all, overthrowes all, demolishes all…destroyes us in an instant.”

As Khullar points out, “…we’ve internalized these metaphors, so much so that we often may not recognize how they influence us.”  Yet metaphors help us understand one another.  They offer a way to make sense of the emotional chaos accompanying a cancer diagnosis and communicate our feelings to others. Khuller referred to a 2010 study that found physicians use metaphors in nearly two-thirds of their conversations with patients with serious illness.  “Physicians who used more metaphors were seen as better communicators. Patients reported less trouble understanding them, and felt as though their doctor made sure they understood their conditions.”

Metaphors get our attention.  They’re visual, sometimes visceral and offer us a shorthand route to emotions and a vivid way to communicate and understand the experience of illness.  They help the listener or reader understand and appreciate what we are experiencing.

Consider the poem, “The Ship Pounding,” by former poet laureate, Donald Hall.  He offers us a glimpse into the final months of poet Jane Kenyon (his wife) and her struggle with leukemia through metaphor, creating a visual image of a ship filled with passengers, heaving in rough waters:

Each morning I made my way   

among gangways, elevators,   

and nurses’ pods to Jane’s room   

to interrogate the grave helpers   

who tended her through the night   

while the ship’s massive engines   

kept its propellers turning…

At first, the narrator is hopeful:

The passengers on this voyage   

wore masks or cannulae

or dangled devices that dripped   

chemicals into their wrists.   

I believed that the ship

traveled to a harbor

of breakfast, work, and love.   

But Kenyon’s illness cannot be cured, evident in the final lines, as the narrator waits to hear his wife call and knows he must be ready to:

… make the agitated

drive to Emergency again

for readmission to the huge

vessel that heaves water month   

after month, without leaving   

port, without moving a knot,   

without arrival or destination,   

its great engines pounding.


(From “The Ship Pounding,” In Without, 1998))

Hall has given us a powerful image in his metaphor, and by comparing one thing to another, we see and understand it conceptually and emotionally.

When Anatole Broyard, whose book, Intoxicated by My Illness and Other Writings on Life and Death (1993), his experience of terminal prostate cancer, wrote:  Always in emergencies we invent narratives. . . Metaphor was one of my symptoms.  I saw my illness as a visit to a disturbed country. . . I imagined it as a love affair with a demented woman who demanded things I had never done before. . .   When the cancer threatened my sexuality, my mind became immediately erect. 

Arthur Frank, sociologist and author of At the Will of the Body:  Reflections on Illness (1991), a memoir of his experiences of cancer and heart attack, describes his illness and recovery as a “marathon.”  Not surprisingly, Frank is a runner, and the physical and mental demands of the marathon were apt comparisons to describe his experiences of illness.

Kat Duff, diagnosed with chronic fatigue and immune system dysfunction syndrome, wrote The Alchemy of Illness, (1993) exploring illness narratives as a way to gain insight into the nature of illness.   She compared her illness to a landscape, a wilderness, or coral reef, and health as an adventurous voyage through it.

Macklin Smith, diagnosed with leukemia, compares the hospital to a prison in his poem, “Independence:”

Even incarcerated men and women can achieve some independence
Through their choice of TV programming, wardrobes, even e-mail,
Depending on the warden’s policy and type of prison,
Although in the super-max federal system they cannot choose
Any of these things: they’re in solitary 23 hours a day, strip searched
prior to their hour of exercise, and never go outside, no
window, and they’re under artificial lighting night and day…

(In:  Transplant, 2002).

These are only a few examples of the metaphors others have used to describe and communicate their experience of illness, but, as Anatole Broyard reminds us, metaphors do not belong solely to the world of poetry and literature, rather,  “Metaphors may be as necessary to illness as they are to literature, as comforting to the patient as his own bathrobe and slippers.”

Writing Suggestion:

  • This week, explore the metaphors you use to describe your cancer experience—or any other difficult and painful chapter of life. What images do our metaphors convey?
  • Begin with a phrase such as “Cancer is a…” or “illness is like a…” and finish the thought, noting what image or word emerges.  Remember, write quickly, without editing.  Set the timer for five or ten minutes and keep your pen (or fingers) moving.
  • Once you’ve finished, read over what you’ve written.   What surprises you?  Do you discover any unexpected metaphors?  How do they help to describe and explain your experience of illness or hardship? Perhaps your metaphors can inspire a poem or a story that describes your experience of illness or hardship in greater detail.

 “The effects of moving are experienced in the body, in the imagination, in the realm of desire. What the eye sees, what the body feels, what the heart yearns for, what remains and what has been lost — these are difficult at first to describe.” ―Louise DeSalvo, On Moving:  A Writer’s Meditation on New Houses, Old Haunts and Finding Home Again, 2009.  

There are necessities in the process of relocating and moving across the country, and downsizing one’s belongings is a major one, but so is it, from time to time, in life. I’ve begun the process, yet despite annual spring cleanings, I am overwhelmed by how much “stuff” is stored in plastic cartons and cardboard boxes, stacked on shelves in our garage.  There are many and several containing mementoes of the past, I must open and go through, one by one.

Last week, however, I tackled the many books lining my shelves, deciding which to keep, which to donate or pass along to friends and writing groups.  I spent two days sorting through four bookcases in the front room, filling a few boxes marked “Keep,” with favorite volumes and leaving the discards on the shelf to box later.  It was a slow process, and I have yet to finish, because as I pulled the books from their shelves, I often paused and thumbed through the pages, noting what I’d underlined or pages I’d dog-eared, and re-reading those sections again.  Between the pages of others, I found old birthday cards and notes from friends.  I lingered over those too.  Each book, card, or note triggered a memory, reminding me of who I was then, during earlier periods of my life.

The smell of moving,

combing over flailed books—sea shells
beneath a forgotten tide.
Occasionally we’ll wrench something up,
not what we are looking for, and read it anyway.

(From:  “Search for Robert Hayden,” by Charles Rowell, In:  The Listening, by Kyle G. Dargan, Ed. 2004)

My bookshelves are only the beginning of slenderizing and simplifying our possessions.  Daily, I eye the many boxes in our garage and return to the house feeling utterly overwhelmed by what I know will be a slow and difficult sorting through of each.  The boxes are filled with “stuff”—things once thought necessary for some later time, keepsakes, photographs , materials I’ve used for classes I no longer teach, journals, boxes of art supplies purchased for myself or for grandchildren visits, and things I’ve long forgotten, all waiting to be opened and dealt with.

It’s not going to be easy or fast.  Like my books, the boxes contain evidence of the past, keepsakes from places visited overseas, old journals full of my morning musings or comic sketches, drawings from children and grandchildren, even an old plastic luggage tag, labeled in my father’s handwriting, something I found after his death.  I know I will need time and solitude as I succumb to the memories contained in each box.

Unpacking the Boxes:  A Memoir of a Life in Poetry,  by former U.S. poet laureate, Donald Hall, begins with his description of unpacking of the seventy or eighty boxes stored in his home and cottage since 1994, shortly after his mother’s death and a year before his wife, poet Jane Kenyon, died from leukemia.  He writes:

For a longtime, I could not open them… From [the] … boxes my childhood rose like a smoke of moths–a 78 of Connee Boswell singing “The Kerry Dance”; all the letters I ever wrote my father and mother; photographs of my young parents on the boardwalk at Atlantic City; my father’s colorless Kodachromes of Long Island Sound, snapshots of cats dead for fifty years; model airplanes and toy cars and a Boy Scout manual, a baseball, and a baseball glove with its oiled pocket chewed by mice.  I felt the shock and exultation of exhumation… Remembered scenes flashed like film clips… (pp. 2, 3, 10)

Whether stacked in a garage or closet, tucked under the bed, we all have boxes filled with fragments and remembrances of our pasts. We turn to them sometimes, recalling feelings, smiles, nostalgia, even heartache, all reminding us of who we were then.  But there are other boxes, virtual ones, tucked into the far corners of our mind, taped shut, yet carried.  These are the ones we are reluctant to open, fearing what we might find.

Minefields of the Heart,  A Mother’s Stories of a Son at War, a memoir  by Sue Diaz begins similarly to Hall’s.  Her memoir is a touching portrayal of a mother’s experience of a son fighting in a distant and dangerous war.  Some boxes she describes are filled and housed under her bed; the others, virtual, memories and the horrible experiences of war that are in virtual boxes, housed deep in the mind and not  of war that are in virtual boxes—housed deep in the mind and not easily opened.  She begins her story by describing the boxes she and her son each possess:

This is a story about boxes. Mine contains news clippings about that day in Iraq — what led up to it and what came after. It’s a brown leather box where I’ve also stored notebooks, journal entries, essays published with my byline, photos, letters, and printouts of online conversations. A scrapbox of sorts, filled with bits-and-pieces connected mostly to R. and to the past few years.

My son has his box, too. It is the one that soldiers returning from war carry within themselves, the box that holds everything a combat vet has seen and felt and heard and done in the line of duty.

As the daughter of a World War II veteran, I know it’s not uncommon for vets to want to keep the lid on their memories. Opening up can take some time. Years, for some. Decades, for others. Many never do.

But it’s important to try. …

 Diaz also describes her experience of helping veterans tell their stories of the trauma and costs of war—some recent, others decades past:

What they’ve written in their spiral notebooks … has given me a glimpse into the boxes they have carried with them from places like Danang and Fallujah, Saigon and Sadr City. 

The words “Open at Your Own Risk” are stamped all over their boxes, because what’s inside can be scary as hell.

Scary as hell. Those are the boxes that contain memories of the difficult, painful events in our lives, whether trauma endured as a child, war, horrific events like 9/11, the bombing in Oklahoma City or the shock of hearing, “I’m sorry…  It’s cancer.”  Memories we’d rather push away than revisit again.

But it’s important to try.  We know that there real costs to health when traumatic, painful memories remain locked inside of us.  Healing may come in small steps, but to begin, we have to summon the courage to open the lids on those memories.  As Pennebaker’s groundbreaking research demonstrated, when we suppress negative emotions, it takes a toll on our health. Long buried trauma can have adverse impact on immune system.   Self-disclosure or expressive writing, even in the case of old emotional traumas, can help us heal.  His research on the healing benefits of writing spawned many expressive writing groups across the country over two decades ago, for many different individuals, including cancer patients and survivors.

Remember Pandora and the box she was warned never to open? How curiosity got the better of her, and as she lifted the lid, evil escaped and spread over the earth?  It’s a good metaphor for the boxes filled with painful or frightening memories we sometimes hesitate to pry open ourselves, because remember too, that after the evil escaped, Pandora discovered one last thing left lying at the bottom of the forbidden boxHope.

This week, explore the memories or mementoes tucked in your boxes, whether concrete and stored in your attic or garage, or memories pushed back into a far corner of your mind. Take one out. Open the lid. Explore the contents:  images, sounds, smells—and the emotions they evoke, and write exploring the memories and stories inside.

Early this morning, I checked my emails and scanned the Facebook posts appearing from yesterday’s massive protest women’s marches across the country.  I kept returning to the images of the hundreds of thousands of women and men around the world who united to make their voices heard.  One, a photograph of my granddaughter, marching alongside her parents was especially touching, reminding me the many years ago, when her grandmother and grandfather joined in civil rights and anti-war protests.  Whatever one’s political preference, the right to peaceful assembly and to speak out, remains one of the most precious of our democratic rights.

I also received a photograph from Washington D.C. from a friend who made the trip to Washington to join the protest.  She lives with lung cancer and has written in my expressive writing groups for years.  She sent a few of us her selfie, decked out in pink, hat and tee-shirt, masses of marchers visible behind her.  It was a day of celebration and exhilaration as, after a divisive and troublesome period of political campaigns, women and men across the country mobilized in support of women’s rights—of human rights–and make their voices heard the day after the new president began his term.

I lingered over my friend’s photograph, inspired by her determination to travel across the country and join in the march at the capital and by her courage, like so many other men and women living with cancer have demonstrated in so many ways.  I recalled another Facebook photograph sent  recently by another member of my workshops, a woman who has written with me since 2009.  She lives with metastatic breast cancer and also, more recently, multiple sclerosis.  The photograph she sent was a celebratory one: her smiling face as she  completed a half marathon last week, another of her continuing participation in local walks or runs organized in support of the fight against breast cancer.  More than a few of us have been humbled by her courage and spirit in recent years.

When I think of the many marches in support of curing cancer it’s not just breast cancer that inspires people to participate.  Google “cancer walks and runs,” and you’ll find many different events and cancer organizations organized to publicize and raise funds for cancer research.   Survivors,  many living with metastatic cancer, and their friends and families participate, united in a fight for life and a cure for this relentless and dreaded disease–called “The Emperor of All Maladies”–which has reached nearly epidemic proportions.

According to the National Cancer Institute,  an estimated 1,685,210 new cases of cancer were diagnosed in the U.S. in 2016, and 595,690 people were projected to die from the disease.  It’s not just women’s rights that were highlighted in yesterday’s march, but among them, equal access for everyone to affordable healthcare.  Those already engaged in the battle against cancer, whether breast, lung or one of the many other cancers, know how very critical healthcare coverage is.

Killing a cancer cell in a test tube is not a particularly difficult task: the chemical world is packed with malevolent poisons that, even in infinitesimal quantities, can dispatch a cancer cell within minutes. The trouble lies in finding a selective poison—a drug that will kill cancer without annihilating the patient. (Siddhartha MukherjeeThe Emperor of All Maladies: A Biography of Cancer, 2009)

 Two weeks ago, I was asked by Cancer Resource Network, an online health magazine, if I would write a short statement about World Cancer Day, which occurs February 4, 2017.  I admit that I knew little about the event or its history and quickly looked for the website to learn more.  Established by the Paris Charter and adopted at the World Summit Against Cancer for the New Millennium in Paris, February 4, 2000, it’s a day for the world to promote research for a cure, the prevention of cancer, and upgrading patient services.  It is dedicated to informing and mobilizing the global community against the disease.  According to the website, 8.2 million people die from cancer worldwide every year, and 4 million of those between 30 and 69,  die prematurely.  It’s shocking.  Yet I doubt few people in the world have not been affected, in some way, by cancer.

In the United States, one in three women and one in two men will develop cancer during their lifetime. A quarter of all American deaths, and about 15 percent of all deaths worldwide, will be attributed to cancer. In some nations, cancer will surpass heart disease to become the most common cause of death.”   Siddhartha MukherjeeThe Emperor of All Maladies)

The World Cancer Day 2017 tagline is We can. I can.  It’s a call to action, intended to support how we, individually or collectively, can help “to reduce the global burden of cancer.”  As of this morning, the site’s “map of impact” shows 167 events happening around the world in support of World Cancer Day.

Just as the world witnessed the enormous solidarity in support of the Women’s March on Washington, the marches inspire us to consider what actions we can take beyond marches to ensure positive change,  whether for women’s rights or for the good of many different people in the world., including the prevention and cure of cancer.

How can you take action?  Just as cancer affects everyone in different ways, there are many ways to take action for families or communities that can have a positive impact on cancer, such as making healthy lifestyle choices, asking for support, advocating for yourself and others whose lives are affected by cancer, and making your voice heard by sharing you story of the cancer experience.

Whether in support of World Cancer Day or in the renewed energy generated by the Women’s March on Washington, we have much more to do.  Ask yourself, “What actions can I take individually or with others?”  There is still much to be done to a difference in our nation and our world.

I was deeply inspired by yesterday’s marches—but it’s only the beginning.  Just as the actions we take on a regular basis to ensure that basic human rights in this country are not violated, so too does finding a cancer cure require our ongoing involvement, advocacy and support in the fight for a cure.

Writing Suggestions:

  • This week, focus on the question: “What actions can I take?,” whether it is about cancer, human rights, or affordable healthcare, to name a few.  Then follow “what can I do” with “What I will do.
  • The Women’s March has inspired ten actions to take in the first 100 days of the new president’s term in office.
  • World Cancer Day is Saturday, February 4th. Why not get involved in a meaningful way?
  • Share your story. One of the actions suggested by the World Cancer Day site is advocate by sharing  your story–a way to offer support to others living with cancer and raise public awareness.  For starters, you can submit directly to the World Cancer Day site, or Cancer Knowledge Network, the online health magazine which encourages narratives (500 words) written in response my bi-monthly column, Writing Toward Wellness.  In fact, there are many possible cancer-related sites that invite cancer stories,  Health Talk Online, The Live Again Project, My LifeLine, and Caring Bridge, to name a few.