April 15, 2007 - The Only Constant

I've been struggling for a while to put into words what I'm feeling, as a cancer patient in remission, but it's like nailing the proverbial jello to the wall. I'm no longer sick, but I can't declare with complete confidence that I'm well, either. Not while I'm still going for scans every three months.

What is remission, anyway? It comes from the Latin remissio. Its primary meaning is forgiveness: the remission of sins. It can also mean forgiving or canceling a debt – or, a prison sentence. (In the hackneyed words of the film noir ex-con, does that mean we patients-in-remission have "paid our debt to society" – or, more accurately, to the stern gods of modern medicine?)

Running my finger down the list of alternative definitions of "remission" in my Shorter Oxford English Dictionary, I come to these ominous words:

"A reduction in force or intensity; a decrease or abatement of a condition or quality, esp. of heat or cold. MEDICINE. A lessening in the degree or intensity of an illness; the temporary disappearance of symptoms."

Oops. I wish I hadn't read that. I don't like seeing that word, "temporary" – not when it's closely followed by "disappearance of symptoms."

Of course, some cancer remissions go on for years and years, until finally – like some hide-and-seek kid emerging, blinking, into the light, hours after the seeker has given up and gone home – there comes the cautious assessment that there's nothing temporary about this remission at all.

Now that I've got my hair back, and have returned to my normal activities, I've been hearing more and more people ask, "You're cured, right?" (Some folks are very eager, indeed, to hear the "cure" word.)

I usually correct them, saying something like, "No, it's still too early to use that word. I'm in remission. I go for scans every three months. So far, so good." (I wonder, will I ever be able to use that word?)

I've been reading Jonathan Alter's political columns in Newsweek for years. I didn't know, until I saw one of his more recent contributions to the magazine, that he's a non-Hodgkin lymphoma survivor (in his case, it's the mantle-cell variety). Like me, he's in remission. His words capture the odd, in-between state I feel like I'm in these days:

"The only constant in cancer is inconstancy; the only certainty is a future of uncertainty, a truism for all of modern life but one made vivid by life-threatening illness. According to the latest projections, a third of all Americans will be diagnosed with cancer at some point during their lifetimes, most likely when they're old. Many will never achieve remission at all, while the lucky ones like me get to live with a sword of Damocles hanging over our heads. A friend compares his semiannual scans to visiting a parole officer. When the scans are clean, it's worth another six months of freedom, though with no guarantee of extra time for good behavior."

"Lucky," you say – with the sword of Damocles dangling over your head? You call that luck?

In truth, it is. For most blood-cancer patients, the doctors simply don't possess a rubber stamp with the word "cured" on it. My medical file is fated to grow thicker and thicker. Let's just hope it bulges with reports of clean scan results, rather than tracking sheets for new chemotherapy or radiation protocols.

You're right, Jonathan. For people like you and me, the only constant is inconstancy.