This year marks the 50th anniversary of Elisabeth Kübler-Ross’s influential book, On Death and Dying. In it, she wrote about grief not as a way to live without someone who has been lost, nor as the means to get over the loss of a loved; as she continued to develop her ideas, Kübler-Ross suggested that grief is the method by which we learn to live with the loved one who’s dying or dead. In this way, grief might be considered more presence than absence, a living with loss rather than a living without someone. The grief memoir is underpinned by this idea that the loss and, by extension, the loved one remains, influencing our lives even as our lives keep going, even as we adjust and circumstances change. In the case of terminal cancer, grief often begins with the dire diagnosis as we begin to experience the losing well before the death.
BOOKS DISCUSSED IN THIS ESSAY
Running Home: A Memoir, Katie Arnold (Random House, March 12, 2019) · The Unwinding of the Miracle, Julie Yip-Williams (Random House, February 5, 2019) · Can’t Help Myself: Lessons & Confessions from a Modern Advice Columnist, Meredith Goldstein (Grand Central, 2018) · A Real Emotional Girl, Tanya Chernov (Skyhorse, 2012) · The Long Goodbye: A Memoir, Meghan O’Rourke (Riverhead, 2011) · Afterimage: A Brokenhearted Memoir of a Charmed Life, Carla Malden (Skirt!, 2011)
“I take long, scalding showers, trying to wash Dad’s sickness off my skin,” Katie Arnold writes in her memoir, Running Home, out earlier this month. She goes on to describe her visit to a Japanese spa for a salt scrub, but “sadness is still there and I feel worse.” Arnold’s father is dying of kidney cancer, and the time she spends with him “adds a new layer of despair, so uncomfortable that it feels like its own disease.” This memoir talks of grief as akin to a disease itself. Indeed, in my own experiences with the illnesses and deaths of my parents, grief can be an encompassing shift like a secondary infection that loved ones develop. While grief is often discussed as an emotional response, it is often experienced as a physical side effect as well.
Meredith Goldstein writes of this physical side effect in last year’s Can’t Help Myself: Lessons & Confessions from a Modern Advice Columnist, revealing that her friend insisted she join a “caregivers support group because she saw that I was anxious and twitchy and that the smaller lines on my forehead were becoming ravines.” Goldstein has stopped washing her hair and tweezing the one stray hair on her face. Though her mother is the one who has colon cancer, it’s as if she too is sick. “Every minute felt wrong,” she writes. Even though her mother’s colon cancer wasn’t imminently dire, “every result was just a little worse than the one before,” and she was feeling the effects herself. As for many of us who’ve traveled weeks or years alongside someone with cancer that’s not going to be cured, the physical and emotional manifestations of grief begin long before Goldstein’s mother dies. “Things were always going in the wrong direction,” she says, and that often wore both of them out.
Though I was familiar with Kübler-Ross’s five stages of grief, I hadn’t thought of grief as a side effect of terminal illness until reading Arnold. Now, I re-see other memoirs through this lens. Meghan O’Rourke, in The Long Goodbye, writes of her mother who has terminal colon cancer, “I already missed her. I was incredibly aware that the Person Who Loved Me Most in the World was about to be dead.” Though O’Rourke links it to her mother’s impending radiation surgery, that realization of loss and the shift into grief often happens slowly over time as the result of steady decline. Grief took hold of O’Rourke as if it were an illness even as cancer took hold of her mother. She was learning to live with her absent mother even while her mother was alive.Any memoirist is the arbiter of what matters to the story, and maybe the point of any memoir is Arnold’s conclusion: “Being alive does not mean just not being dead.”
Carla Malden, in Afterimage, captures the process slightly differently. Of her husband’s decline from colon cancer, she writes, “It had been a year of continually lowering the bar.” She’s talking about herself here as much as she is referring to her husband lowering the bar. “First, wanting real, true, normal life in all its sweet ordinariness. Then, hankering for a semblance of normal life as we accommodated the treatment into our existence. Then, no pain. Then, just life. And so suddenly—not now, not this day, not this moment.” Grief arose in the confused moments immediately following diagnosis, as if she’d been infected with something residual, and the effects got worse before they got better. The presence of her husband was also his impending absence, just as his absence became his past presence in her life.
Tanya Chernov, in A Real Emotional Girl, writes poignantly of her abrupt shift in balance between hope and grief—a sudden onset, to use the language of disease—when she is handed an envelope with a medical bracelet to take from the cancer clinic back to her bedridden father at home. “I spread the sides apart and looked inside to see my father’s name printed on a ‘Do Not Resuscitate’ bracelet.” Chernov knew her father was terribly ill, of course, but in that moment, “Any remaining doubts of what the immediate future would hold for my family and me were unceremoniously expunged with the existence of that tiny piece of plastic.” Unlike Goldstein’s slide into grief with every worse result, Chernov realizes all at once “what I didn’t think I could face: that I was going to watch my father die.” She imagined the very moment of change from presence to absence before it happened, in part because it is not really a single moment in the mind. Having watched each of my parents die of cancer, I agree when Chernov says, “Watching someone you love die changes all the rules you thought the universe followed.” The moment of realization Chernov has, that it is her fate to watch her father die sooner rather than later, is akin to being diagnosed with grief and facing the confusion between presence and absence of the loved one.
In this context, it’s helpful to remember that the Kübler-Ross stages were originally outlined to explain the emotional progression of someone diagnosed with a terminal illness, that the patient’s grief is considered central. A terminal cancer diagnosis makes that person aware that everything will be lost to them; the end is their end. Only later have the stages been applied to loved ones, as if we are affected by another version of that awareness of loss, horrible but less complete.
Julie Yip-Williams, in an early chapter (which also appeared at Lit Hub) of her recently published, posthumous memoir The Unwinding of the Miracle, describes her excruciating sense of loss within the first hours of being diagnosed with colon cancer. Yip-Williams cried not so much because she was going to die sooner than she’d thought possible but because she imagined her daughters without her. She imagines her own absence and immediately sees their loss of a mother as the primary long-term side effect of her illness. In fact, she cannot bear to spend time with them at first. She writes of her children as “casualties of the war I had begun fighting,” saying, “We were all victims of cancer, with them being the most undeserving.” Of course, they do not have cancer—they have grief.
Of all these memoirs—terminal cancer memoirs—Arnold’s invites comparisons with Cheryl Strayed’s Wild. Like Strayed, Arnold uses physical exertion—in her case, long-distance running—to treat her grief and restore an eventual equilibrium. In fact, her gorgeous descriptions of her body in motion through the physical world immerse the reader in her state of mind, so that we too are “high on my mountains, the world below reassuringly close and yet distance enough.”
Running a path works literally in this memoir but is also a metaphor for the journey through her anguish. Even Kübler-Ross referred to grief as having terrain. “When I began,” Arnold writes, “I did not have a map of where I was going or how I would get there or where there even was.” Goldstein talks similarly about this sort of upending when she writes, “The thing that surprised me most after my mother’s death was how much everyone else continued to live.” Everyone else had a there to be, and Goldstein had trouble seeing somewhere in the future to go. In my own life, my parents’ separate terminal cancer diagnoses thirty years apart rattled my own sense of the there I knew. For a long time in each case, I couldn’t make out a new there where I might end up without them—or where I could be present despite their absence.
Along with Yip-Williams, Arnold digs deeply into her own family’s past. As part of that digging, she shares family photographs and the timeframes they represent, allowing readers to grow up with her all over again, understand how her relationship with her father has been fraught, and realize that the loss of a parent is not only about that parent’s absence but about how we remember the story of our own lives. Arnold writes of the effects of her parents’ divorce in the 1970s, when “there wasn’t a road map for how to get divorced,” and of the goodbyes they’ve had since, in train stations and airline terminals, in front of schools and in driveways. She writes both of the past and of the present when she and her family clear out the hayloft filled with the stuff of nostalgia. In this process, “Dad is the arbiter of what stays and what goes.” In this memoir, the verb tense shifts to weave us back and forth, like following switchbacks up a hill, and the author is the arbiter of what stays and what goes. In other words, she shapes the presences and absences by telling the story of them.
Any memoirist is the arbiter of what matters to the story, and maybe the point of any memoir is Arnold’s conclusion: “Being alive does not mean just not being dead.” This statement suggests to me a conclusion akin to Kübler-Ross’s about what it means to live with someone’s absence. Or in Goldstein’s words, “There’s no such thing as closure, but there are continuations. Developments.” For these memoirs, a cancer diagnosis is a beginning, but the parent’s death isn’t the end of that story—the presence of the person’s absence is the rest of the story. These new books commemorate, perhaps unintentionally, Kübler-Ross’s ideas of fifty years ago.
Really, of course, a cancer diagnosis isn’t the beginning of the story. March is both Kidney Cancer Awareness Month and Colorectal Cancer Awareness Month and, therefore, an opportunity to note that Arnold’s father was diagnosed with kidney cancer and that Goldstein’s mother, O’Rourke’s mother, Chernov’s father, Malden’s husband, and Yip-Williams herself all were diagnosed with colorectal cancer. While there exist no screening tests for kidney cancer (and luckily, many instances of it are caught early enough for a good chance of long-term survival), there exists effective screening for colorectal cancer. As with most cancers, the earlier colorectal cancer is detected, the greater the chance of long-term survival; the five-year survival rate for localized colorectal cancer at about 90%. Malden’s husband was at higher risk for developing colon cancer, yet put off his colonoscopy, which left them both wondering briefly about what might have been otherwise. The colonoscopy is a cancer screening that also can be preventative, as polyps can be removed before they might lead to cancer.
As these memoirs suggest, individually and together, there’s no way to eliminate the risk of cancer and or be spared from grief. In addition, they call into question the popular notions that grief proceeds in simple, sequential stages. It’s messier than the popularized notion suggested by Kübler-Ross’s stages. The value of these stories, in part, lies in how they portray the common experience of grief as individual, as something more complex than a step-by-step process aimed at acceptance. The proliferation of memoirs like these is a rewriting into myriad ways to live with and understand grief. To use the words of Joshua Williams from the epilogue to his wife’s memoir, these books allow us to draw “back from the brink when it feels that all in your life is spinning out of control” even when that seems like the hardest thing to do.