Commentary on Treatment’s Winter

It is a poignant image. A young woman’s frail body bears telltale radiation tattoos, demarcating the scorched bed where her right breast once lay. Her body, though ravaged by treatment, remains solid; her eyes vibrant and hopeful even as they bear the haunting gaze of one faced with her own mortality.

It is also a dignified image, striking in the unique tack it chooses. It resists both the conventional imagery so often invoked in the “fight against cancer” and the virtually ubiquitous pink-tinged euphemisms long associated with breast cancer. Instead, the patient in Chan’s work Treatment’s Winter peers out from darkness as if from a window, arm angled casually around an organic edge of blues and whites. As she extends her arm—a graceful, solid sketch against the stark background to her right—she seems to leave behind her body’s hunched frailty to gain new strength and wholeness. For what does she reach? Perhaps, for the earthy, complex yellow flower suspended in midair. This flower is a symbolic element in the painting, evoking an increasingly popular metaphorical paradigm—one that likens the body to a garden, and cancer treatment to winter’s dormancy.

As Susan Sontag¹ pointed out in her seminal treatise Illness as Metaphor, discussions of cancer and its treatment frequently employ battle imagery. The medical community often speaks of “fighting cancer,” and for some four decades, we have waged a formidable “war on cancer” in our search for a cure, employing a toxic “armamentarium” that frequently entails “collateral damage.” We have encouraged patients to keep up their “fighting spirit” in the face of “invading” cancer cells. Ultimately, though, the battle with cancer may be “lost” as a patient “succumbs” to his or her illness.

Patients and families can find such metaphors helpful, summoning virtues of courage and strength in the face of impossible odds. Yet for those undergoing cancer treatment, these images may also be unwelcome, evoking a sense of hostility to one’s own once-familiar body.² Furthermore, although ultimately beyond his or her control, responsibility for the outcome is paradoxically placed on the patient: someone with cancer dies because he or she did not “fight” hard enough. Similarly, breast cancer’s pink-ribbon campaigns have been criticized by Barbara Ehrenreich (and others) for espousing an “implacably optimistic breast-cancer culture”³ through its burdensome “tyranny of cheerfulness.”⁴ As a result, patients may be denied timely implementation of palliative care, pursuing curative treatment when that possibility is long past. An opportunity is missed to nourish different goals of care—namely, quality of life for the time remaining and provision for a peaceful, natural death.

Some are therefore turning to other metaphorical images,^1,5–7 including that of a garden. Gardening, an enjoyable pastime for many, is creation, an affirmation and celebration of life. A compelling metaphor, it focuses on the nurture and cultivation of plants (akin to that of a healthy body) rather than the eradication of weeds (or fighting cancer). Weeds are an appropriate analogue; hardy and pernicious, they continually crowd out healthy plants. Furthermore, thriving gardens need constant attention and work. In a well-tended garden with low stress, ample nourishment, and regular care, weeds have more difficulty gaining ground. When they do grow, one generously applies weed killer—a metaphor for chemotherapy. And during wintertime—an apt analogy for the cancer treatment period—weeds invariably die, even as other plants lie dormant. As one patient has written:

In dead December

My body stripped from within.

By May, I will bloom.⁸

This metaphor, like any other, has limitations. It is arguably too tame to fully capture the pain of patients’ experiences with cancer. Yet it does provide an alternative framework for facing treatment. In envisioning one’s body as a garden, the emphasis is placed on nurture and self-care, and acknowledges the role of winter as integral to this natural cycle.

We turn again to the flower in the painting. This vibrant element, removed from any recognizable context, speaks to the uncertainty—and possibility—of a future for the subject of the painting. At the same time, weightless and unencumbered, the flower seems to reach back, leading her forth in hope—for at least peaceful closure, if not cure. Just as the gardening metaphor offers a more grounded understanding of cancer and its treatment than do conventional metaphors, this painting illuminates such resources with a nuanced depth as only the arts can provide.

Acknowledgments: This project was a visual–narrative collaborative by Georgetown University Medical Humanities fellows Melissa Chan, MD, and Rebecca A. McAteer, MD, under the direction of Caroline Wellbery, MD, PhD. The painting, inspired by cancer survivor Stephanie Butland’s “Chemotherapy Haiku”⁸ [above, used with the author’s permission] and photographer Robert Houser’s project “Facing Chemo” (http://www.roberthouser.com/personal-work/facing-chemo), was the initial stimulus for this commentary, which then drew additionally from cancer metaphor themes in the literature. The author and artist wish to thank Dr. Wellbery for her advisory role and assistance in editing the commentary.

Rebecca A. McAteer, MD
R.A. McAteer is faculty physician, New York Medical College Phelps Family Medicine Residency Program, Sleepy Hollow, New York; e-mail: [email protected].