This is the 4th in an ongoing series of posts bringing a critical sociological and feminist lens to my own experiences with endometrial cancer.

Schedules and efficiency have always felt important to me. I’m one of those annoying people who arrives early at events, finishes assignments way ahead of due dates, and taps my foot impatiently as others procrastinate. Maybe that gives me a sense of control over the chaos of our world (a topic for a future post) or maybe it’s a traumatic response to my own mother’s untimely death a few months shy of completing her dissertation (a topic for a future conversation with a therapist). In any case, I’m finding it challenging to navigate time in cancer land.

Time and Relativity in Cancer Land

Time in cancer land moves in increments that are bewilderingly unassociated with the natural phenomena of the physical universe or the taken-for-granted cultural norms of my western, Jewish, and academic worlds. Real-world markers of time (start work, end work, drop off or pick up kids at school, get to the movie or concert when it starts, remember that the parking meter is for two hours only, submit tax returns on April 15, etc.) are replaced in cancer land by a kind of hazy timelessness in which the relevant markers of time are infusion day, CT scan day, meet with the oncologist day, get over the worst of the chemo side effects day, pain med time, optimal time of day for reaching a live person in the oncology office, and so on.

Even as I acclimate to these concrete aspects of cancer world time, I struggle with the big picture. For example, in addition to standard chemotherapy, I now am receiving immunotherapy. The doctor says that most patients tolerate it very well, but it does come with a whole package of potentially awful side effects that likely will emerge over some unspecified period of time. I understand that adding immunotherapy as a first-line treatment for “my” kind of cancer has become the norm, yet the key study (Eskander et al, 2023)supporting this approach showed an additional 4 months until recurrence of disease for about 40% of women in a clinical trial that was discontinued after 7.9 months largely due to disease progression. In my professional world as a sociologist this outcome doesn’t sound very impressive. But apparently in cancer world this is considered a significant breakthrough. I suppose when it’s my own countdown to the end I may feel differently.

The college physics professor who tried to explain to a classroom of 18 year olds that time is relative (an argument that went way over my head) turns out to have been right, though perhaps not quite in the way he intended. I now understand that time is a cultural construct. In American culture time is a commodity that we save, spend, pay for, or waste – just as we do with any other item of capital. In Jewish culture time is circular, cycling back to Shabbat on a weekly basis and to holidays of joy and days of communal mourning (such as 9 Av) on an annual basis. In academia we use an annual calendar that begins in September rather than January, features winter, spring, and summer breaks, and may represent a ticking time bomb for scholars hoping for tenure.

In cancer world, time is out of my control. And to be frank, that scares the crap out of me.

Time and Power

It turns out that even in cancer land you can take the girl out of the Sociology department, but you can’t take the sociologist out of the girl. So bear with me, please, as I share several examples that helped me understand the power of certain people to impose their time reckoning systems on others: mutually reinforcing calendrical and medical power in some pre-modern societies, requirements that immigrants and newly subjugated populations adopt the official calendar of their conquerors / “hosts”, “hospital time” as loss of personal autonomy during the height of the AIDS epidemic, and the power of medical institutions to narrow my complex past and future into a measurable present.

Anthropologist Alfred Gell observed that in many pre-modern societies calendrical expertise is vested in “the tribal elite of men [my emphasis] of wealth, elders, noted magicians, etc.” In the Trobriand Islands (famously studied by anthropologist Malinowski), for instance, knowledge of the lunar calendar was just “one aspect of the expertise of the tonowi, or garden magicians, whose eminent social position mainly rested on their semi-hereditary knowledge of spells and garden medicines.”

Moreover, Gell explained, “intertwining of calendars and power is not confined to the domain of the primitive, but equally extends to the processes of colonial subjugation. Not for nothing did the ancient Chinese bureaucrats say, when they had incorporated some new region into the empire, that its inhabitants had ‘received the calendar'”, a comment that puts me in mind of my Aunt Yetta, a refugee from the pogroms of Europe, who was required to work at her department store job on the Saturday Jewish Sabbath in order to feed and house her family in the free new Christian world of Philadelphia. (At the time, most shops were closed on Sunday, the Christian Sabbath.)

In her memoir Hospital Time, author Amy Hoffman reflects on experiences of time while serving as primary caregiver for a friend dying of AIDS in the early 1990s. Hospital time, Hoffman explains, was code for when her friend’s health deteriorated to the point at which he could no longer be cared for at home. A rebel and free-thinker, he was loath to enter a hospital environment in which he would have no power over his clothing, food, movement, space, and time. Hoffman describes the ICU where “a clock hangs on the wall opposite the bed. Big black numerals. One hand that moves in sudden ticks, minute by fucking minute … although its usefulness is debatable. [I]intensive care patients …are sleeping and waking at random, and the primal distinctions – ‘And it was day and it was night and God saw it was good’ [Genesis 1:5] – all that’s long gone [my emphases].”

The Future

I recently came across an article by British anthropologist Ronald Frankenberg arguing that, “Medicine as it is at present practiced in industrial society requires health workers and especially physicians to distance themselves in time from the experience of their patients by taking the present-tense account of perceived illness (the history), which they initially share, and translating it into timeless, almost disembodied, disease.” As I see it, because modern-day health care providers typically are not with the patient outside the setting of clinical appointments, time and space collapse into the office or operating room, into the present de-contextualized moment, erasing the patient’s understanding of why or how their condition came to be as well as their fears and concerns regarding the future.

And here is where we get to the crux of the matter. In cancer world we are discouraged from thinking about the future. I’ve learned that the question most disliked (feared) by oncologists is: How much time do I have left? But that’s all I want to know. I may resent the power differential between us, but I want – I need — the doctor / shaman / priestess to reveal my future, to tell me how much time I have on this planet, to please give me more time. However, like all my fellow wanderers in cancer world, I have to settle for the date of my next appointment, the length of the immunotherapy treatment, the time until I start radiation, the day on which the chemotherapy side-effects are likely to abate, and the (often paltry) statistical reports of clinical trials.

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Having quoted Amy Hoffman’s reflections on Genesis 1:5, I’ll close this missive from cancer land with my take on Psalms 9:12, which traditionally is read as an appeal to God to help us miserable mortals live wisely despite the shortness of human life and God’s capricious wrath which [H]e regularly puts on display to [His] creation: “Teach us to number our days, that we may gain a heart of Wisdom,” the text tells us. What the English translation leaves out, however, is that Wisdom (Hochma or Sophia) is portrayed as a female divine being throughout the ancient Near East and Hellenistic worlds. So, I for one, prefer hearing Wisdom speak on her own behalf in Proverbs 9:11, proclaiming: “For through Wisdom your days will be many, and years will be added to your life.”

Amen

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Sources:

Ramez N. Eskander, et al. 2023. Pembrolizumab plus Chemotherapy in Advanced Endometrial Cancer.
N Engl J Med 388(23): 2159-2170. DOI: 10.1056/NEJMoa2302312

Ronald Frankenberg. 1988. “Your Time or Mine?” An Anthropological View of the Tragic Temporal Contradictions of Biomedical Practice. International Journal of Health Services 18(1):11-34. doi:10.2190/GCUH-MG8G-JPKV-NLBQ

Alfred Gell. 2001. The Anthropology of Time: Cultural Constructions of Temporal Maps and Images. Oxford: Berg Press.

Amy Hoffman. 1997. Hospital Time. Durham, NC: Duke University Press.

Barbara Myerhoff. 1978. Number Our Days: A Triumph of Continuity and Culture Among Jewish Old People in an Urban Ghetto. NY: Touchstone.

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