Garrulous

One fringe benefit of this whole medical ordeal: I have a renewed respect for the power of words. Some of them now terrify me.

Despite what you might think, “cancer” itself isn’t among them. This is possibly because, like the disease itself, the word is so prevalent. There’s just no escaping it. In the last few days alone, I’ve heard radio reports on controversy over the new federal guidelines for breast cancer testing and on an odd and contagious strain of facial cancer decimating Australia’s Tasmanian devil population; I’ve watched television ads for local cancer treatment centers and the spot with Jennifer Aniston hugging the little bald girl with a brain tumor; and I’ve read stories on the new Lance Armstrong book and the benefits of acupuncture for cancer patients. I have bookmarked in my browser the website for Planet Cancer, an organization for young adults with cancer, and I’m now going to a local support group for the same where the word, of course, tends to come up. I listen to it drop from my own mouth several times a day: “When I had the cancer, blah, blah, blah…” When a doctor first uttered it in connection to me, it was like a mortar shell had blown up in my face, and in the following weeks, each mention reverberated like an aftershock – but the shock diminished after every occurrence. I’ve made a kind of peace with the word, which is just too monolithic to fight or ignore. If predicted rates of occurrence in the general population prove correct (1 in every 3 women, 1 in 2 men), I suppose everyone will come across “cancer” ever more frequently.

I no longer fear “cancer” but a few words associated with it – words that occasionally sneak up in online articles or leap out from the pages of reports sometimes handed to me by doctors or nurses – really get to me:

Carcinoma: a type of cancer perhaps most synonymous with the general definition of the disease, it is an invasive malignant tumor derived from epithelial tissue – the surface tissue lining the skin and most of the body’s glands, organs, and various passageways – that tends to spread to other areas of the body. The word is a derivation of the Greek karkinoma (“a cancer”), which is itself a mash-up of oma, a suffix meaning, simply, “tumor,” and a variation of karkinos, or “crab.” All this makes me think of a miniature crustacean skittering sideways over the surface of some soft bodily lining and then burrowing in, as if on a sandy beach, and making a second hard shell of the body part it has inhabited. Maybe this is how the Greeks thought of the disease? It’s not a pretty thought.

Squamous: as in squamous cell carcinoma, the type that had emerged from my tongue. Standing alone, squamous means to be covered with or formed of “squamae” (scales), to be scaly, or to resemble scales, which many simple surfaces and linings of the human body do, at least on the cellular level, although one might think first of fish or the cool, rugged hide of a snake. Probably because of its proximity to “squash” and its soft, squishy second syllable, the word makes me think of cooked root vegetables, carrots and beets and gourds that have been boiled and roasted and stewed. Things steaming and tender. Like a baked potato, which is what I sometimes think of when I hear the word “tumor,” probably because of that word’s nearness to “tuber.” Tumors, though, are more often like raw vegetables, fibrous and hard. When I reached in mouth and ran my finger my finger along it, my own felt cold and tough, unyielding and inhuman. Now that the tumor has been removed, my remaining tongue is again soft and pliant. During every follow-up appointment, my surgeon or his nurse practitioner pulls on gloves, reaches in my mouth and palpates it to make certain it is remaining that way. They warn me – the nurse practitioner especially – to stay vigilant against any hardening; a carcinoma (you’ll learn, should you look it up) “often recurs after excision.” There’s a phrase that chills me to the cold, hard bone.

But the word I fear and loathe above all others in the language, the one that makes me tense and my heart thump faster every time I see or hear it: metastasis.

Now, I rather like this word’s constituent parts. Meta just sounds nice, an Old World name you might find belonging to a pretty peasant girl in a headscarf. Although in modern English it is usually a self-referential term (“referring to itself or its characteristics, especially in a self-parodying manner” – the horror film Scream, for instance), in the original Greek it can indicate something more generally transcendent, meaning “after,” “higher,” or “beyond.” Stasis, again from the Greek, also sounds pretty and possesses a beautiful meaning: “a standing still.” More technically, it can be defined as “the state of equilibrium or inactivity caused by opposing equal forces,” more or less the same thing; while the meanings of the word are even more precise across different fields – in medicine, for instance, it refers to the stoppage of the normal flow of a bodily liquid, like blood – they all signal something frozen, unmoving. I tend to think of its use in science fiction and picture bodies in a state of suspended animation, a years-long slumber in coffin-like chambers on a spacecraft traveling across galaxies.

These two words, so simple, innocent, restful even, on their own, become something hideous and toxic when wed. Metastasis. Muh-tas-tuh-sis. It sounds ugly and threatening, all the vowels flattening out like a snake on the prowl and ending with an awful hiss. And the meaning is even worse. “Beyond” + “a standing still” = “change.” Change. That doesn’t seem terrible at all until you recognize the nature of the change. Metastasis has been almost entirely appropriated by Medicine, and now its primary definition, the first and sometimes only definition you will encounter in almost any dictionary, will go something like this: “The transference of disease-producing organisms or of malignant or cancerous cells to other parts of the body by way of the blood or lymphatic vessels or membranous surfaces.” As I understand it, metastasis is the way many (most?) cancers kill. There are a few varieties, like those born in the blood, that accomplish this without spreading, but many need to migrate from their birthplace to realize their fatal potential. They begin in one spot as tumors that may take months or years to build and emerge but can move like wildfire once they’ve leaked cells into a nearby system of blood vessels or lymph nodes, which they ride into other areas of the body, into the lungs or liver, bones or brain, where they take root and take over, possibly unto death. It’s scary to hear that you have a tumor, but it’s terrifying to know that it has metastasized.

I felt uneasy after my surgeon called me a week before my operation to let me know that a PET scan had, unexpectedly, revealed a bright spot on the right side of my neck indicating something cancerous there, in one or more of the lymph nodes. This was unexpected because no one could feel in my neck any little bumps or lumps, any inflammation whatsoever of the nodes. Nevertheless, some cancer had definitely broken off from my tumor and made its way into them. In the consult a week earlier, the surgeon had labeled my cancer “Stage 2,” meaning, I believe (though I refuse to look this up to confirm), that it had not spread to the nodes; I wanted to ask him if I now qualified for an upgrade, but I didn’t, not really wanting to know the answer. For his part, the surgeon carefully avoided verbs like “spread” or “metastasize,” approaching the problem from a considerate distance with a picture and vague pronouns. “Something” had lit up on the right side of my neck in the scan. A tiny fuzzy spot brighter than the surrounding area on the film. “But we’re going to remove the lymph nodes on that side anyway,” the surgeon added.

“So… I shouldn’t worry?”

“No, no,” he said.

I did, of course, though not to the extent I might have if I had allowed myself to consider the full possible import of the “something” that had lit up on the scan. I had spent a week believing that my cancer was self-contained. A portion of my tongue was to be carved out, sure, but after that occurred and a bit of my wrist was stitched into the opening, the matter would be done with. I suspected now that maybe this wasn’t true, but I clung to the surgeon’s “anyway,” that casual adverb that assured me that this surprising and worrying bit of light would be contained and corrected by a process already planned out.

I didn’t break until later. I didn’t imagine cancerous cells speeding station-to-station through my lymph nodes on their way down to my lungs or liver, maybe out to the bones or up to the brain, where they would take root and flower and weed-like strangle my organs and kill me until I read a few words on a sheet of paper. One morning a few days after my weeklong stay in the hospital, after the tumor and nodes had all been removed, I looked over the half dozen papers given to me by a nurse upon my discharge. On one was a section briefly detailing my diagnosis and course of treatment to that point. A phrase near the end caused to me collapse in a shock, followed by an eruption of tears urgent enough to make my mother drive a half-hour to console me after I called: “Pathology revealed invasive squamous cell carcinoma, well to moderately differentiated, with two of ten lymph nodes positive for metastatic squamous cell carcinoma.”

I basically knew all of that already, but seeing it laid out in those cold clinical terms, with those hated words, made it, well, real.

After my mother arrived and I calmed down enough, we called the surgeon to see exactly what those words meant.