Pulitzer Prize-winning novelist John Updike died yesterday of lung cancer. He was 76, the same age as my father when he died of lung cancer. I’m sure the Updike family is cloaked in grief, just as mine was nearly eight years ago.
It’s unclear when Updike was diagnosed; he passed away in a Massachusetts hospice. As recently as November, the legendary author was out and about, promoting his new novel “The Widows of Eastwick.” He certainly doesn’t look seriously ill in this October video interview with the New York Times.
That’s the thing about lung cancer. It does its damage out of sight, surreptitiously, over decades, deep within the body's tissues. It’s typically quite advanced by the time it’s diagnosed, and there are few effective treatments for late-stage lung cancer. The illusion is that it kills quickly, but in fact, stealth, not speed is its defining feature; in the pantheon of malignancies it is a long-distance runner.
My father, like Updike, started smoking when the health risks of tobacco were still largely unknown. Luther Terry's watershed Surgeon General report documenting that smoking causes lung cancer was issued on Jan. 11, 1964, when Updike was 31 years old. Several photos that accompanied his obituaries The Guardian, The New York Times , New York Magazine show Updike holding a cigarette. In at least two, his elbow rests on his knee, his palm facing the camera, fingers curled casually around the thin white cylinder. The ashy butt and faint haze of smoke indicate the cigarette is not a mere prop.
When those pictures were taken (one in 1955, the others circa early 60s) Updike couldn't have known that cigarettes could - or would - eventually kill him. I have no idea if he later tried to quit or continued to smoke throughout his life. From my father’s experience, I know how difficult it is for smokers to give up their habit, especially if they started in their youth. Even though my father failed in this respect, his message to me and my sister from the time we were little was clear. “Don’t ever smoke,” he would tell us with urgency. “I wish I had never started.”
The truth is, most smokers don't die from lung cancer; Updike and my father were on the wrong side of the odds. According to the Fred Hutchinson Cancer Research Center (and many other sources), only 10 percent of lifetime smokers develop lung cancer.
But here’s the other half of the equation: Nearly 90 percent of people who get lung cancer are smokers. Translation: If you smoke, you’re basically playing Russian roulette with your health. You’re betting that you’re not in the minority of smokers predisposed, for whatever genetic reason, to developing lung cancer – and there’s currently no definite way to know if you’re in that unlucky subset.
Those numbers may help explain why, although lung cancer is the leading cause of cancer-related deaths for both men and women, it doesn’t attract the biggest research dollars or the most attention, let alone universal sympathy. Many advocacy groups attribute this second-class status to the stigma that surrounds lung cancer. Since smoking is a choice, many people blame lung cancer patients for their fate; patients themselves often feel guilty. I know my father did.
I haven’t observed the same kind of guilt – or blame – heaped on people with diseases linked to, say, obesity (high blood pressure, heart disease, some forms of cancer). Many who have lost loved ones to lung cancer, myself included, find this curious, and frankly inconsistent.
A couple of weeks ago, another death reported in the New York Times caught my eye. A 42-year-old physician - loving wife and mother of three young children - had died after an 18-month battle with lung cancer. Her death notice specified that she was a nonsmoker. I can understand why her family chose to point out that she didn’t contribute to her fatal illness by an unwise lifestyle choice. But I’d also like to think they may have wanted to signal that lung cancer can strike anyone, even nonsmokers. Advocacy groups believe that spreading such awareness could help boost research funding for the disease.
If you’ve lost a loved one to lung cancer, it doesn’t matter, in the end, whether or not they smoked. Your heart breaks just the same. You grieve.
And that's why this afternoon I struggled to stifle the urge I had when I spotted a young woman in her 20s having a smoke outside our office building. I want to shake her and shout: “Don’t you realize there might actually be a bullet in that chamber??”
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