Clean Margins: A Review of Cancer Is a Bitch (Or, I’d Rather Be Having a Midlife Crisis) by Gail Konop Baker

Full disclosure: I did not want to read Cancer Is a Bitch (Or, I’d Rather Be Having a Midlife Crisis). I suffer from what Henry James evocatively called “an imagination of disaster” and a marked tendency to catastrophize, not to mention a healthy strain of hypochondria. I have done misguided Google searches of vague ailments and symptoms and have diagnosed myself with various illnesses — including cancer. It’s always cancer that scares me the most: the idea that my body could betray me at the most basic, cellular level, the inconceivable thought that at any given time clumps of rogue cells could take up residence in vital organs and multiply, multiply, multiply, until there is no more self left, just the diagnosis and the disease.

Don’t get me wrong: I’ve organized dinner drop-offs for a friend after her mastectomy and again after reconstructive surgery; I’ve oohed and aahed over another friend’s wig (which really was gorgeous were it not for the heartbreakingly sparse hair it concealed). But somewhere behind the casseroles and the words of comfort is always the unbidden, unwelcome voice: How could this have happened to them? Why them and not me?

Gail Konop Baker did everything by the book, which is another reason I did not want to read Cancer Is a Bitch. She runs half-marathons, does yoga, eats organic food, practices deep breathing and meditation techniques, obsesses about electromagnetic fields and poly-methyl-para-whatevers in shampoo. Yet, Baker went for a routine mammogram and was diagnosed with ductal carcinoma in situ at 46. Who was to say that couldn’t happen to me? I take care of myself too; I’m healthy and eat well and exercise. Even holding the book felt like a tacit admission that one day — just like that! — I too could be the woman in the worn, pale blue hospital gown “strapped to a surgical bed by my boob,” the woman who “doesn’t know how to hold her face anymore,” how to smile, how to meet her own eyes in the mirror, how to look at her children without imagining their motherless future and welling with uncontrollable tears.

That’s the thing that got me: prior to the diagnosis, Baker was exactly like me — and like millions of other women who fret about growing older, help their kids with homework, buy organic carrots at Whole Foods, and squabble with their husbands. And post-diagnosis, she does what any of us would do: she has a complete meltdown. She balks at the word oncologist, calling it a “word for other people, older people, unlucky people. People who die.” She is flabbergasted at the brutality with which cancer invades her life and the immediacy with which it makes her other: “Cancer. . . meant, Fuck you and your comfort, your complacency, your petty concerns, your smug belief that you deserved to be lucky, to live unscathed.” All at once, she is “part of a club” she did not want to join; at a party, she notices the ghoulish curiosity with which another woman studies her, “wondering what I did wrong that she shouldn’t do.” She fights with her husband, who, in the richest of ironies, is a radiologist; she tries creating her own makeup from organic ingredients, planning to market the all-natural beauty products to “other vain hypochondriacal maniacs”; she channels Debra Winger in Terms of Endearment and weeps into her fist at the prospect of leaving her children. And that’s when I was sold: Baker writes so powerfully and honestly about having cancer and not wanting to have cancer that, in spite of my own neuroses, I couldn’t help but realize something that had eluded me before. Cancer doesn’t make you less you. You could have cancer and still be maudlin and hysterical and smart and funny and self-pitying and neurotic, only more so.

It helps, of course, that Baker writes like a dream: her prose snaps and dances with well-chosen wisecracks and snarky asides and then detours unexpectedly into profound and poignant observations. In spite of her aspirations “to be brave, to be big, to be gracious and cool, to be the Audrey Hepburn of cancer,” she laments the fact that the diagnosis makes her feel “ugly, cantankerous, mean, and old,” reminding her that she will never be twenty again, that “time has moved faster and less kindly than I expected.” She chronicles her experiences — from the shock of the diagnosis and the biopsy, to the surgery, to the setbacks and triumphs of the recovery that follows — with both stark candor and dry wit. She realizes that cancer is everywhere — the “brain tumor on the corner of Oakwood; kidney next to the country club; early-stage prostate on the top of Chestnut Hill; inoperable lung behind the elementary school.” A friend of hers is diagnosed with metastatic colon cancer, and Baker mourns; another friend, realizing how fragile and uncertain life can be, seizes a moment and embarks on a romance in honor of her friend. The two women giggle together over the juicy details that remind both of them, however briefly, of how exhilarating it is just to be alive. And through it all, Baker must come to terms with a new identity, look down and really see the breast that changed her life in such a fundamental way. When she does, she is startled by what she sees, the “ragged scars, the swollen flesh, the bloody scabs.” She writes, “I don’t recognize this breast, the skin that harbored tainted cells, this me. I want to protest. I want to tell the oncologist it isn’t fair. I want to ask him why I don’t get credit for all my good cells.”

Cancer Is a Bitch traces in unsparing detail Baker’s swings between abject bewilderment and rage, between a desperate yearning for certainty and, eventually, a rueful acceptance. Baker has no clue what to wear to her first appointment with her oncologist, wondering “why they didn’t send that information with the postcard appointment reminder.” After all, she reasons, “you get an instruction booklet with a toaster but no instructions for marriage or motherhood or cancer. Cancer especially.” And even as the cancer cells are excavated from her body — with clean margins, as her husband exultantly reports — her ordeal is far from over. Having been touched by cancer’s icy finger, she can never be the same. She wants guarantees, but the only thing her doctor can offer her is tamoxifen, which is in itself a cancer risk, albeit one that cuts her chances of a recurrence from 24 to 12 percent. She researches EMFs, parabens, and carcinogenic foods, ending up finally with the two items that are more or less safe to ingest: green tea and filtered water. She’s the first to admit that she wants someone to “tell me what to eat, to drink, how to breathe, where to put my foot,” but she’s smart enough to realize, at the same time, that there are no guarantees, that she could be hit by a car crossing the street outside the oncologist’s office.

Baker’s recovery is ultimately as much about excavating the cancer cells as about discovering who she is really — as a wife who has put her own aspirations on hold, as a mother, and as a daughter — and this last part is where her story wanders slightly off course. We learn about her parents’ acrimonious divorce and her difficult mother and profoundly unlikable stepmother, and, although I can see why those relationships have been included, they feel distracting somehow, almost like they belong in a different narrative. This is a cancer story, not an extended family story, and its power and raw emotional appeal are most intense when Baker focuses on the chaos that cancer has wrought in her own life and in the tight circle of her own nuclear family. There is emotional resonance and heartbreak aplenty when her 10-year-old son Alex asks with utmost gentleness “Does biopsy mean no puppy?” or when Baker tries to imagine her eldest daughter heading out to college without her.

Even though her cancer turns out to be highly treatable, Baker is forever marked, forever at the mercy of post-surgery and post-treatment health scares — suspicious spots on her liver, which turn out to be harmless hemangiomas, to name just one. Yet, she manages to find moments of grace, in her own wry way, in the intimations of her own mortality. Everything is “a little clearer and sharper, more intense,” she reflects, “with unexpected moments of pure exhilaration thrown in.” Rather than guess at a long-term prognosis, she delights in the here-and-now, grateful at a Valentine’s Day dinner a year after her post-op appointment that she is “here, with my shirt on, instead of topless at the oncologist’s office.” Everything is changed, and nothing has: “My kids fight and getting-into-college pressure looms again, and Mike and I have issues, and I still haven’t launched myself, and I have a bum breast and unpredictable cells and scars that will never fully heal,” she writes. In the end, the best Baker’s doctors have to offer is the dubious reassurance that she is “probably fine” — which is, in all honesty, probably the best anyone can say of any of us, cancer or no cancer. And in the end, that is Baker’s greatest gift to her readers. Certainly, she gives us her humor, her candor, her imperfections, her courage and her cowardice, but, above all, she gives us the reassurance that should we ever find ourselves on the wrong side of a cancer diagnosis, we would be in very good company indeed.