Current methods of treating ovarian cancer are “a scandal,” a scholar says
Memoir of a Debulked Woman: Enduring Ovarian Cancer. By Susan Gubar. Norton, 296 pp., $24.95.
By Janice Harayda
Susan Gubar once hoped to die as swiftly as a relative found dead in her seat by ushers at the Metropolitan Opera House after a performance of Aida. She won’t get her wish.
Gubar was 63 years old and looking forward to retiring from an influential teaching career when she learned in late 2008 that she had Stage III epithelial ovarian cancer. Most women her age who develop the disease die within three years of the diagnosis. Doctors nonetheless treat them with draconian procedures that include “debulking” surgery, which reduces the size of tumors that can’t be removed completely. Such efforts, Gubar came to believe, may “destroy the pleasures of existence” for someone who gains few or no benefits from them.
Is the misery worth it? Gubar often sounds ambivalent as she describes the catastrophes that occurred during and after her debulking. Her calamities began with a bowel perforation during her operation. That mishap led to an ileostomy and to surgical drain irrigations that, she says, “exceeded any level of suffering I thought imaginable” and that morphine couldn’t touch. Afterward she kept “getting sucked into procedure after procedure, each with its ghastly physical repercussions.”
Gubar explains her repeated acquiescence partly by saying that she had two grown daughters who weren’t ready to lose her and that her treatments fostered a helplessness born of pain, fatigue, depression, and sedation. But you sense that there is more to it than that. Gubar calls herself a secular Jew “with no conventional religious faith to speak of.” Did she unwittingly turn medicine into her God? Did her lack of belief in an afterlife make it harder to let go of barbarous treatments? She asks but never satisfactorily answers the question: “how can those of us without firm religious convictions integrate the awareness and actuality of death and dying into our lives?” On the subject of faith, she offers what she acknowledges are “garbled” views such as: “I will love my family until death departs, and since death will never depart, I will love them always and forever.” What on Earth does “until death departs” mean?
In Memoir of a Debulked Woman Gubar interweaves her story with an overview of ovarian cancer in history and literature and with a polemic against the woeful state of treatments for it. This approach gives her book a breadth lacking in most illness narratives while depriving it of the sharp focus of cancer memoirs such as Joyce Wadler’s My Breast and Anatole Broyard’s Intoxicated by My Illness. Much of the writing is stilted, repetitive, and padded with irrelevant anecdotes about Gubar’s family and friends. It would have benefited from a few pages on how doctors in other industrialized countries treat ovarian cancer.
But what Memoir of a Debulked Woman lacks lacks finesse, it makes up for in importance. No first-person account offers a more comprehensive description of the dismal options for women with late-stage ovarian cancer or makes a more passionate case that the current methods of treating it are “a scandal.” And in an age of medical overkill, those women share many of the dilemmas of patients who have other cancers with low three-year survival rates and who must decide whether to have potentially soul-destroying treatments. This gives the book a relevance that goes beyond the disease at its center.
Gubar’s cancer is in remission, an article in USA Today said last month, so her treatments seem to have extended her life at least slightly beyond what she could have expected. But her memoir makes clear that the precious extra months have come at a price that not everyone would want to pay. Gubar says that, when she’s feeling cynical, she believes that fifty years from now “doctors will look back at the treatment of ovarian cancer today and judge it medieval.” Her book should hasten that process.
Best line: No. 1: “the state of contemporary approaches to ovarian cancer is a scandal.” No. 2: Gubar offers a good list of “the cockamamie conundrums confronted by people treated for ovarian cancer” (although “cockamamie” is too light-hearted a word for some of them). Among them: Debulking surgery calls for surgeons to remove, while a patient is under general anesthesia, any organs to which the ovarian cancer has spread. So women don’t know beforehand which body parts they will lose and can’t “decide that they would prefer not to … risk the high rate of postoperative complication.”
Worst line: No. 1: Gubar criticizes Joan Acocella (who called her an “amateur” who spouts “shocking nonsense” in The New Yorker) in a way that makes her look worse than Acocella. No. 2: One of many padded sentences: “The radiologist inserted the thick tube into the center of my right buttock: in the Midwest, ‘the butt’; in New York, ‘the tush’; in the South, ‘the bottom’; in fancy French, ‘the derrière’; in pseudo-science, ‘the gluteus maximus’; on the street, ‘the ass’; in Don’s jokey repetition of the nurse’s word, ‘the bee-hind.'”
Caveat lector: Gubar warns: “For those who have reason to believe or need to believe that their cancer is curable, please remember that this book is not about you.”
Published: April 2012
About the author: Gubar is the co-author of The Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination, a finalist for the 1980 Pulitzer Prize for nonfiction.
Read an excerpt from Memoir of a Debulked Woman.
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© 2012 Janice Harayda. All rights reserved.