Cancer

Marlboro Man lives

Big Tobacco money is being spent differently than before, but it's still targeting our youth.

A smooth-looking sailor winks joyfully while an auburn-haired lovely flicks a Bic and fires up a Camel for the lucky lad. Two lonesome, studly cowboys ride the range at the foot of the snowcapped Rocky Mountains, an iconic picture of the eternally young and eternally immortal Marlboro Man.

From the backs of magazines such as Details, Sports Illustrated and Road & Track, these ads regularly reach young testosterone-charged readers. And, from slick sailors to old cowboys, tobacco ads exert more influence than ever these days, according to marketing experts and psychiatrists. While the percentage of Americans who smoke has decreased in the past 35 years, the percentage of American teens who smoke has risen in the past 10, and skyrocketing smoking rates worldwide show no signs of slowing down.

This appears to contradict the common perception that the Marlboro Man and his ilk are on the ropes. (Even the ad described above shows a very small cowboy figure as compared with the full-page Marlboro Man close-up of yesteryear.) The latest round of legal jousting has forced tobacco companies, previously banned from television and radio, to recuse themselves from billboards and print advertisements in youth markets.

With one marketing arm tied behind their backs, Philip Morris, R.J. Reynolds and the other tobacco merchants have struggled with free-falling stock values and public outcry from anti-smoking advocates. Standard & Poor’s downgraded its recommendation on Philip Morris shares from “avoid” to “sell” on Dec. 28 because of the precarious position of the company.

Philip Morris and the other tobacco companies have passed only halfway through a brutal legal meat grinder that could cost them $200 billion or more in payments to the states over the next 25 years. And that could represent only the beginning of an endless litany of payouts that stretches ad infinitum. A Florida court now holds the key to what could be a painful $300 billion class-action payout to infirm smokers in the Citrus State — the first of what could be many other class-action lawsuits.

The decline of smoking in the United States has been long and slow. Since 1964, the percentage of Americans who smoke has dropped from 65 percent to 25 percent, according to the Center for Advancement of Health. Add to that a marked decline in cigarette purchases over the past year (which most economists say resulted from higher prices caused by legal fees and settlement costs) and the business of addicting citizens to cigarettes seems destined for doom.

Anti-smoking advocates attribute the past year’s declines and the long-term trend to more anti-smoking campaigns, rising health concerns and more expensive cigarettes. (The tobacco companies announced a 13-cent wholesale price increase the second week in January, the latest in a series of hikes.) On Jan. 19, virtually all the tobacco companies announced dramatically lower earnings due to declining consumption of the nic sticks in America and stagnant demand worldwide.

So why have a number of stock analysts started to claim that tobacco stocks are underpriced and a great buy? Why are more teens picking up the cancer sticks than in past generations? And why are anti-smoking activists in a huff about the numerous legal loopholes that they claim the tobacco companies are using to keep their business growing apace?

Although killing your customers is generally not a good business practice, the tobacco companies are expert marketers and smart businesspeople. And they appear poised for a solid business run in subsequent decades.

Witness the numbers. After decades of decline, the percentage of adult Americans who smoke is no longer going down, according to an article in the December Journal of the American Medical Association. On top of this, smoking rates outside the United States have skyrocketed and continue to climb, according to the World Health Organization.

“I think the tobacco industry is a very simple business,” says Bill Godshall, executive director of SmokeFree Pennsylvania and a leading expert on tobacco industry issues. “These guys can raise the price of cigarettes to 10 or 15 bucks a pack and they could still make a profit. People will pay $150 a day for their heroin or cocaine habits. So at $2 a pack, cigarettes are very underpriced.”

Most important for tobacco company shareholders, throughout the 1990s the percentage of U.S. teenagers who smoke has grown. According to the JAMA article, between 1991 and 1997 smoking prevalence among high schoolers increased from about 30 percent to 36.5 percent. These young smokers, in particular, represent the future of the tobacco merchants as dutiful customers who will not die of lung cancer in the near term.

“If the cigarette companies can get kids to start smoking at a young age, because cigarettes are so addictive, you are talking about getting a lifetime customer for your brand. So it is very important for cigarette brands to get a high percentage of the youth market. From an economic standpoint it makes perfect sense,” says Michael Siegel, an associate professor of public health at Boston University.

So how do tobacco companies hammer their brands home to the youth? Indirectly and masterfully through the mass media, according to Siegel and others. Siegel and Harvard Business School professor Charles King tracked placement of cigarette ads in 36 magazines between 1986 and 1994. Naturally, tobacco companies do not advertise in true youth publications like Seventeen or Teen People. But of the 36 publications studied, 15 were classified as youth magazines with significant readerships under age 18 (such as Details, Road & Track and Cosmopolitan). The two professors also tracked which brands were advertised where.

Their study discovered that although youth cigarette brands accounted for only 43 percent of the cigarette advertising pages in adult magazines during that time, brands popular with young people (Camel, Marlboro) made up nearly 67 percent of the cigarette advertising pages in the magazines that appealed to youth. Translation? Marlboro Man or Joe Camel is far more likely to show up in the pages of Road &Track or Sports Illustrated than in the pages of Ladies Home Journal. And those ads are more likely to push promo goodies like T-shirts, cigarette lighters and backpacks — gimmicks that ensnare high schoolers at greater rates than adults.

Furthermore, according to Siegel, those very same ads push specific buttons. “The imagery they use is so attractive to youth. They use images of freedom, independence and control with photos of attractive and sexy models — things that appeal to the basic core values of adolescents. Cigarette companies have mastered the use of those images,” says Siegel.

How powerful are these images? According to multiyear psychological surveys that tracked students through high school undertaken by professor John Pierce of the University of California at San Diego, media images played a major role in the decision to smoke of approximately 34 percent of teenage smokers. “We have shown that before they start smoking, the kids who really liked the advertising start changing their beliefs. They stop believing it’s harmful to smoke. And they start believing they can quit when they want to,” says Pierce.

For their part, the cigarette companies have vehemently denied that they are targeting youth with these advertisements. Likewise, they have denied that a new crop of vanity publications funded by tobacco companies and put out by old-line magazine houses like Hearst Corp. are aimed at teenagers. These vanity pubs make little mention of where the buck stops but prominently feature ads for cigarette brands like — no surprise here — Marlboro and Camel.

While most anti-smoking advocates doubt the veracity of these denials, they freely admit that the tobacco companies are doing a good job marketing. “Our conclusion is that because of the high exposure of youth to cigarette advertising in magazines, it should simply be eliminated. We don’t see any other way,” says Siegel.

Nor does the market mastery of cigarette czars stop at print. Despite legal stipulations against paid placements of cigarette brands in movies, Hollywood continues to spout smoke. In a study released in November, researchers at the University of California San Francisco found that smoking in the movies has steadily increased in the past decade. (Some activists whisper that this product placement is being paid for but the tobacco companies deny it.)

In films from the 1970s and 1980s, characters smoked once every 10 to 15 minutes. But in movies from the 1990s, characters used tobacco on average every three to five minutes. “As in tobacco advertising, tobacco use in the movies is associated with youthful vigor, good health, good looks, and personal and professional acceptance,” wrote the researchers, Stanton A. Glantz and Theresa F. Stockwell. Furthermore, Glantz and Stockwell recorded a rise in smoking among upper-class characters in the movies, something they believe heightens the subtle connection between being rich and lighting up.

Glantz and Stockwell could find no particular reason for the rise in smoking, but other experts have posited that it could be a circuitous logic by which studios make more mass media characters smoke in order to identify with youth, who are smoking more. Regardless, the effect is the same. “In an era in which the tobacco industry is finding traditional advertising media increasingly restricted, the appearance of tobacco use in motion pictures is an important mechanism to promote and reinforce tobacco use, particularly among young people,” write Glantz and Stockwell.

Restrictions like those called for by Glantz, Stockwell and Siegel are not in the cards, however. Congress likely shot its wad last year on failed tobacco legislation and hardly anyone, save John McCain (who proposed the tobacco settlement bill that was killed last year), is willing to touch the issue again. Score another point for the tobacco marketers. The legalese of the tobacco settlement with the states signed last year has left many advocates fuming.

“If you read the fine lines in the settlement, it says the tobacco companies cannot do anything to market to kids as long as kids are not their primary marketing target. If kids are only half of their market, that’s not marketing to kids legally. That’s why they advertise on the back cover of TV Guide or in the swimsuit issue of Sports Illustrated. They are adult magazines but everybody, including kids, reads them,” says Godshall.

While their marketing acumen and ability to find loopholes are beyond doubt, the tobacco companies have never been slouches with numbers, either. For example, tobacco industry bellwether Philip Morris has steadily bought back large chunks of its own stock, a possible sign that it believes its stock is undervalued and likely to go up at some point.

Analysts believe that Philip Morris can boost earnings per share from $3.17 in 1998 and $3.30 in 1999 to $3.68 in 2000, according to First Call earnings estimates from late January. Over the past five years, Philip Morris has averaged earnings growth of 14 percent. What’s more, despite a seemingly turbulent future, these same analysts believe that Philip Morris will average 13 percent annual growth in earnings over the long haul in spite of impending sanctions. That’s growth from an already eye-popping level of $46.7 billion in gross tobacco sales, according to BusinessWeek.

Meanwhile, the tobacco companies have steadily shifted more of their production offshore and out of the clutches of U.S. politics. On foreign soil these factories and marketing operations will run with few of the checks installed against them in the United States. Their move plays to the fastest growing markets for the tobacco companies in the third world and Asia, where the majority of the world’s 5 trillion-plus cigarettes produced each year are smoked.

The very resiliency of the tobacco industry rankles the anti-smoking crusaders who want to eliminate all advertising. But the glorious economics of addiction also have their benefits. “The industry can continue paying the costs of litigation and the court awards by merely raising the price of cigarettes. The stockholders can still get their dividends to the same amount and even higher. And less people will smoke. We think the industry can pay and pay and pay,” says Godshall.

Alex Salkever is a surfer and writer living in Honolulu.

Kate Hudson’s cancer horror show

The bubbly actress's horrific movie, "A Little Bit of Heaven," turns terminal illness into a twee joke

Kate Hudson in "A Little Bit of Heaven"

Ladies and gentlemen, we are gathered here today to mourn a sad loss. A luminous, unique presence who ably graced our lives and then was snuffed out far too early. A moment of silence, please, for Kate Hudson’s career.

It seems like only yesterday we were beguiled by the lively, bohemian Penny Lane in “Almost Famous.” But it’s been a painful decade since, as I know many of you gathered here can bear witness. Those of you who steadfastly supported Hudson over the years, who paid good money for “Bride Wars,” for “How to Lose a Guy in 10 Days,” for “Raising Helen,” “You Me & Dupree,” “Fool’s Gold,” “My Best Friend’s Girl,” “Alex and Emma,” “Le Divorce,” and “Something Borrowed” — you know what I’m talking about. You’re heroes for sticking around this long. That’s why it’s both tragic and necessary to come to the end of our journey now, to let her go off to a better place. The D-list. It’s called “A Little Bit of Heaven.”

The movie, which opens in theaters Friday and is available on demand on iTunes, tells the story of Marley, a free-spirited young New Orleans advertising executive. Marley has good friends — including a pregnant lady and a gay black man, because she’s awesome. She has an adorable dog and a penchant for casual sex and whimsical bike riding. But no sooner can her pals offer a champagne toast celebrating the “youngest and hottest vice president” in her company’s history than things start to go terribly wrong. Like millions of helpless white people every day, Marley begins having visions of a cool African-American as God. There is no known cure. Once Marley starts chatting with Whoopi Goldberg in that ethereal, cloud-heavy set, you know she’s in trouble. She’s got terminal Movie Cancer. Naturally, this is the perfect opportunity for her to get in touch with her feelings, have many scenes of hugging her crying costars, and start banging Gael García Bernal. It’s a little weird because he’s supposed to be her oncologist.

It’s not easy making entertainment out of cancer. Yet Showtime’s “The Big C” has mined the terrain to Golden Globe-winning effect. Llast year’s “50/50,” based on writer Will Reiser’s real experiences as a young person suddenly diagnosed with a potentially fatal diagnosis, became a critically acclaimed sleeper hit.  And when you’ve got a condition that will directly affect roughly 41 percent of us, there’s surely some dramatic and comedic resonance to be found in the subject matter. Speaking as someone who has had Stage 4 cancer and endured a clinical trial, and who believes firmly that anyone who’s been through all that ought to at the very least get to bang Gael García Bernal in the Big Easy, I am the ideal audience for this movie. Why, then, somewhere around the inevitable shopping spree montage, did I scrawl the words “WORSE THAN CANCER” in my notebook, and then underline them fiercely in the darkness?

Maybe it’s the way Bernal, as a doctor with seemingly zero ethical problem about sleeping with his terminally ill patient, says “schmuck” – because he’s supposed to be Jewish. Maybe it’s because Kathy Bates, as Marley’s mom, looks like she’s trying so hard with such unforgivable material. Maybe it’s because the biggest audience laugh of the whole movie came when Hudson said, with a straight face, “Come on, Doc. Level with me.” Maybe it’s because when Peter Dinklage, as a male escort, says the title of the movie, it turns out it’s his character’s nickname. Little Bit of Heaven. Oh, human suffering. Truly, this is what it looks like.

Mostly, brothers and sisters, I think we know why this movie causes a pain all the medical marijuana in the world can’t make a person forget. It’s Hudson. Hudson, whose character ostensibly goes through chemo, yet never loses a bouncy curl off her blond head. Who enters a trial but quits with a shrug about “quality of life.” Hudson, who, thanks in large part to director Nicole Kassell and first-time screenwriter Gren Wells, willingly put herself in a movie about cancer that seems to have been created by people who’ve only had cancer described to them. Hudson, who chose to place herself in the pantheon of life-affirming doomed sick girls like “Sweet November’s” Charlize Theron and “Autumn in New York’s” Winona Ryder and the mother of them all, “Love Story’s” Ali McGraw, and comes across as a shrill, affected parody of her hair-tossing Almay ad persona.

It’s an occupational hazard that any actress with marquee value will sometimes find herself in romantic schlock. Yet women like Renee Zellweger and Sandra Bullock have managed to balance their turkeys with riskier performances and a broader range of films. Hudson, in contrast, has remained frozen in time, forever doing variations on her young rebel with a heart of gold, Penny Lane. So let us remember Hudson today not as the husk of an actress she became, endlessly subjecting moviegoers to lazy dreck. Let us remember her as bright, fearless Penny. She’d want it that way. Let us move on, and spare ourselves the ordeal of further films in which a daffy blonde flashes a megawatt smile and recites terrible dialogue and dances adorably even though she’s, like, dying, you guys. For truly, life is much too short for such trials.

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Mary Elizabeth Williams

Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub.

Lessons of a baby bucket list

Avery Lynn Canahuati accomplished a lot in her six months of life. Imagine what the rest of us can do in a lifetime

Avery Lynn Canahuati (Credit: http://averycan.blogspot.com/)

What have you accomplished since November? What dreams have you fulfilled? In that time, Avery Lynn Canahuati threw out the first pitch at a baseball game, got a letter from the president and dressed up like a troll doll. She experienced deep love, and changed the lives of her family and friends. And that’s just what Canahuati got done in the first six months of her life. They were also the last.

Canahuati was born in Texas on Nov. 11. This past Good Friday, she was diagnosed with spinal muscular atrophy (SMA), a group of rare neuromuscular diseases that, in her case, were terminal. “We asked our doctors specifically if there is anything. Is there trial drugs, anything out of the country?” her mother, Linda, told CNN this week. So after “sitting around for two days crying and being devastated, since there is no cure and there is nothing we can do,” her father, Mike, decided to make the most of what was left of his daughter’s cruelly brief expected lifespan. Writing in Avery’s voice, he created a blog — and set a few goals.

“Imagine you’ve been diagnosed with an incurable genetic disease and you are told you will not only lose your ability to walk and move your arms, but you will die between now and the next 18 months. What would you do?” Avery’s blog reads. “This has become my reality. But before I die, there’s a few things I’d like to accomplish … this is my bucket list and my story.”

During an adventure riddled with so much good humor, so many images of smiling, laughing people that it’s damn near impossible to read about it without dissolving into a sobbing, balled-up wreck, Avery and her family went about achieving the feat of simply “celebrating life.” Avery’s objectives were as seemingly mundane as to “stay up past midnight” and “keep smiling even after surgery” — and as grand as raising a million dollars to fight SMA. Along with good-natured jokes about man-purses, hospital cribs that look like “Lockup: Texas Children’s” and insanely cute pictures of a smiling baby with a chick fuzz hairdo, are the harrowing realities of life with a fatal disease. There were tubes and operations and weight loss and reflux issues that affected her breathing and swallowing.

For all the items Avery got to cross off her list in just a few brief weeks — “eat ice cream,” “meet someone else with SMA” — there are many she didn’t. She didn’t, as she’d written she’d hoped to do, graduate college. Or get married. She didn’t play in a softball game or ride a Ferris wheel or attend a birthday party. She died suddenly on Monday afternoon, when, as her father wrote later, “one of her lungs collapsed and she went into cardiac arrest.” And one last time in Avery’s voice, he wrote that her final dream was “spreading awareness and helping to fund a cure for my friends.”

We live in a mortality-denying culture. Just this month, an Aflac WorkForces Report announced that “sixty-two percent of U.S. employees say it’s not likely they or a family member will be diagnosed with a serious illness.” Yet disease comes for many of us, and death comes for everybody. That’s not an abstract concept. It’s the truth. I didn’t always get it, either. But I certainly understand that much better now than I used to, after watching a few of my loved ones die over the past year while my best friend and I faced our own life-threatening cancers. And I’ve got to say, death really clarifies the hell out of one’s to-do list.

Avery’s goals were not her own, of course. They were the ones her parents set to maximize her remaining time. But it’s easy to see in her photos what a cheery, friendly baby she was, and the ways in which her sunny nature inspired others. It’s easy to see a mother and father who could have become embittered by a devastating twist of fate, who instead chose to fight fear with love, pain with compassion, who are trying to use their loss as a means of raising awareness and doing service for others. They did it in a matter of weeks. Think of what the rest of us could do with a few decades.

You shouldn’t have to wait for a diagnosis to consider the possibility that you are going to die. You are. Maybe even in the next six months. The question is: What will you do with the time you have left? Will you eat a cupcake, get a kiss? Avery did. Will you reach out and connect? Will you love and be loved? Will the ones you leave behind be able to call your life a “celebration” too? As Avery and her parents tell us, “You can live life dying or you can die living life.” Imagine you’re on the clock. Start acting like it. Go.

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Mary Elizabeth Williams

Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub.

Words we had after he died

When we lost my husband to cancer, my family's world went upside down. We made sense of it the best we could

(Credit: Tinga via Shutterstock)

On the day my husband died, our daughter Allison started screaming my name from her bedroom, where she’d taken refuge. I burst open the door, imagining she had hurt herself, but she was just standing there in the center of the room. “Mom. Mom,” she said. “You are a widow now. A widow. I don’t want you to be a widow. You can’t be a widow.”  I had to agree: It just didn’t seem possible.

I tried to hold her, but she was hyperventilating a bit. “I’m ‘the girl whose dad died when she was 13′?” she choked out. “Oh my God. That’s who I am now.  When people ask me what my dad does, or how we get along, or anything, that’s how I will have to answer: ‘My dad died when I was 13.’”

Words. Labels for things, for people. We spend our whole lives making sense of them, I guess. Figuring out which one is the best, most accurate choice.

So many words become insider jargon in families: We are the only ones who know that “black toast intolerant” means “lactose intolerant”; that “minimisize it” means “minimize it,” which big pot is the “pasta pot.” These special languages that families create are another way they are individualized, that a family becomes a unique organism of its own.

Of course “widow” cannot apply to me. That word applies to little old ladies in fairy tales or someone who lives far, far down the street. My daughter cannot be identified forever by this one event.

But she is, and I am a widow, and in the months immediately afterward, we preferred life in the anonymity of Philadelphia over our small South Jersey town where even going to the convenience store means acquaintances’ pseudo-counseling, or others who steal quick looks at us, then look away, as if we are contagious.

We spent weekends in Philadelphia, and even though we live 15 minutes away, we slept on the floor of my brother’s one-bedroom, three-story walk-up, rather than in our own beds in our own four-bedroom, three-story home.

The kids learned that word, “walk-up,” and the phrase “wiz wit,” to get cheese sauce and onion on their cheesesteaks, and though they already knew what a contortionist is, and what break dancing is, and what a bong is, they get to see all of these things in Rittenhouse Square Park,  mere blocks from my brother’s place.

They learn these words because I could not sit my children down and say, here are words that changed your life: PICC line, ascites, carcinoid.

When Don was in and out of the hospital, and I learned more and more about his disease, its treatments, their side effects, I thought about language a lot, how I now knew all these words I had never even heard before. The gastroenterology team had to be updated about what the oncology team had said, and the interventional radiology people needed to know his newest albumen levels. There was a note in Don’s chart, “Ask the wife.”

“The wife”: my old label.

I would sit in the hospital and think about when we were first looking to buy a house, and how I was so proud when I could “speak real estate.” We would go out each evening with our real estate agent and look at six, seven houses a night.  I sat on the window seat of one home, nursed our baby Allison, and Don did a slow walk around the perimeter of the yard.  He came in and saw us there, and said, “Oh, so this is the one.”  And everything felt right and rich and I wanted to go to sleep right there, on the bare wood of the empty house that just that moment had become our home.

Once the house was ours I would wander around Home Depot and marvel at the language spoken there, how I felt like some mole who had just come up from underground to discover a whole other world going on above. The “wife” label, the “mother label,” the “homeowner label” all new; none felt generic, at least to me, they were points of pride and exactly where I wanted to be.

About two months after Don died, the kids and I were at a friend’s beach house and we watched the new version of “Freaky Friday.”  In it, a widow remarries, much to the teen daughter’s (initial) dismay.  When the movie was over, Hayley, 11 years old at the time, said, “Mom. You can get married again. In three years. Don’t get married again for three years.”

Allison stood up and just started yelling at Hayley. “She can’t get married again in three years. She can’t get married again ever. I’m not going to have a stepdad.”  Christopher, only 5 years old, said, “I would like a dad, Allison.”  Allison yelled at him, too, and soon I was saying, over and over, “We don’t have to talk about this right now.”  And none of us could understand what the other was saying.

When Allison was 5 or 6, the boy from across the street, a year older and therefore much wiser, took it upon himself to teach her how to properly pronounce “yellow.” She said “lell-o” and I hadn’t had the heart to correct her. The charm of her mispronunciation mattered more to me. I listened from the kitchen as he broke it into two syllables and made her repeat, again and again, “Yell-oh, yell-oh.” I wanted to rush in and stop him but knew that I couldn’t, that it was time, that it was natural and organic and even lovely that another child would teach her.

In other words, I couldn’t stop her learning, like I can’t stop this, can’t take away this label, this horrifying application of the word “widow,” of the phrase “my dad died when I was 13.”

Life went on and when I’d be out with the kids one or the other would say, when it seemed like all the other families had a mom and dad, “I hope people don’t think we’re divorced.”  Divorce implies decisions, and no choice had been made in the shape of our family.  The use of “we” was endearing to me, and only made my heart break more.  We would go places with my brother Steven and waitresses or ride attendants or whomever would assume that Steven was my husband/their father, make some kind of reference like, “You’ll have to ask your father” when a child asked for more Coke; none of us corrected these ignorant strangers.  The kids were simply more comfortable when we had that male figure with us, when we looked “normal” to the outside world.  They needed my brother as a placeholder for what was missing.

I have my label and the kids have their phrase, “my dad died when I was 13,” or 11, or 5. I fill out forms and I get irritated when the choices are “married” “single” or “divorced.”  But when “widow” is an option — even now, seven years later — I think of that first day and Allison’s horror at the term. The kids are now old enough that they have to sometimes fill out their own forms.  They tell me they sometimes write “deceased” and sometimes just cross the father’s info section out. I didn’t know when to take off the wedding ring or what to do with it when I did.  I don’t know when the transition happens between being a widow and being widow-ed.  The label is the label no matter the verb tense.

I have been dating someone for five years and I still choke on the word “boyfriend.” I could not even bring my tongue to the roof of my mouth for the word “love.” I asked my therapist why, when friends all around me profess love within the first two weeks of a new relationship. “What is wrong with me; why can’t I say it?” And she said, “Because you know what it means.”

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Kathleen Volk Miller is co-editor of Painted Bride Quarterly, co-director of the Drexel Publishing Group and an Associate Teaching Professor at Drexel University. She is a weekly blogger (Thursdays) for Philadelphia Magazine's Philly Post and is currently working on a collection of essays. Follow her @kvm1303.

Look at my scars

The remnants of my own illness have taught me that when it comes to difference, don't stare -- but don't turn away

(Credit: Natalia Klenova via Shutterstock)

“Do I freak you out?” she had asked.

It was the kind of question adults rarely pose. But Abigail (a pseudonym, like some other names in this piece) is 8, and she doesn’t have any qualms about being direct. The person she was asking, my daughter Beatrice, likewise didn’t hesitate in her reply.

Abigail is new to our school this year. She is in every way a typical second-grader, except that she was born without a left hand. It’s a trait that makes her undeniably noticeable, and so, sometimes, people ask questions. Sometimes Abigail has questions of her own. Sometimes, when you’re different, you want to know.

When Bea told me what Abigail had inquired about a few weeks ago, I’d winced a little, wondering how my child had answered. Had she passed whatever test Abigail was giving? I know how frank Bea can be, how she walks behind me when we’re out in public, checking whether the shiny, taut expanse of bare skin on my scalp is visible. “Mom, your bald spot,” she’ll say when we’re in a restaurant, fussing with locks to try to hide the five-centimeter circle where, a year and a half ago, I had surgery to remove cancer.

I know that Abigail’s question haunts many of us who are physically different, in ways both small and large, either by birth or circumstance. It plagues my friend with accident scars on his legs, who’s already nervous about summertime and exposing his flesh at the beach this year. Maybe it’s a small yet indelible birthmark on the chin. Or it’s a big burn. Or a missing limb. Does this make you want to look, or want to look away? Do we make you uncomfortable? Do we freak you out?

“It’s a thing that has to get explained,” says Natalie, a New York executive who’s had three serious melanoma surgeries and lives with ongoing psoriasis lesions. “For me, the anticipation of that is hard. I think people want to distance themselves from someone who’s had a traumatic event. Somehow you wind up having to reassure them that you’re not contagious, that they’ll be OK.”

Though she tries to be “very open about my illness, because I want people to get it,” Natalie admits she has nevertheless “some really upset moments” of unasked for attention. “I once had someone literally cross the road to ask what was wrong with my legs,” she says. “I was feeling really proud of myself for being brave enough to wear the skirt. And this woman came along and destroyed it.” She adds, however, “I don’t feel sorry for myself, and I don’t wear this as a badge. I just want to be looked at as the successful, independent woman I am — but I understand that some people can’t do it.”

It’s true that some people can’t, and there’s loss in there. I used to have a friend who liked taking pictures of his buddies, including me – right up until my diagnosis and my relatively minor disfigurement. Then he never took another photograph of me again. I wonder if I freaked him out.

My friend Frank, a West Coast entrepreneur, understands. A few years ago, Frank had radical surgery for bladder cancer that left him with what he calls a “Guinness Book of World Records scar” that starts at his sternum, loops around, and ends at his pubic bone. He also has a partial hernia that leaves him, in his word, “lumpy” under a shirt.

“I get a lot of people staring. I’m used to it,” he says. “It usually doesn’t bother me. I’m just a little self-conscious when people are peeking out the corner of their eyes in the locker room.” And, he recalls, “one time my wife and I were at Caesar’s Palace lying out in the super-bright, crystal-clear Vegas sun, and this woman next to us asked, ‘What happened to your stomach?’ She was pretty horrified when I told her.”

He’s still sometimes horrified himself. “I look at myself every morning, and I think of all the horrible shit that I’ve been through because of this disease,” he tells me. But when he looks in the mirror, he also sees a mark of survival. “I’m working out and riding my bike to train, and if that doesn’t tell you how I’m doing, go ahead and ask me. I don’t think I look that bizarre. I think I look like a guy who’s had major abdominal surgery.”

As Frank knows, when you’ve been through something life-altering, the first person you have to get to accept your look is yourself. “The first time I saw myself afterward, I thought, That looks very interesting,” says Johan Otter. Johan is a master of understatement. Seven years ago, Johan was hiking with his daughter in Glacier National Park when he was mauled by a grizzly bear. His scalp was torn off; his eye was clawed. He had to wear a halo brace for 12 weeks and go through multiple grafts and surgeries to recover. And then, he says, he had to learn to “push through” his first time out in public again.

“You get used to it,” he says. Besides, he jokes, “I never have a bad hair day.” Otter admits he can still be somewhat surprising to strangers. “Once at Costco this woman said, ‘Oh my God, what happened to your head?’” he recalls. But though he admits, “I’m a vain person just like anybody else,” Otter says that “I’m always extremely proud of my scars. When you go through something like this, people see you with your true self. You learn that what matters is what’s inside.”

It’s not always easy in our perfection-driven culture — where a weight gain of five pounds can be treated as a life crisis and toothpaste brands wage war on dingy teeth and a “puffy face” means you’re no longer considered “pretty” – to believe that within battle scars and what others would call abnormalities, there is a raging, painful exquisiteness. It’s often hard to feel the sideways glances and puzzled stares. But it’s harder still to be overlooked entirely, to feel like the remnants of the trials we’ve endured are the things that make others unable to look at us. We want to be looked at not with pity, not with fear, not with morbid curiosity. Simply with clear and open eyes.

So when Bea told me her friend Abigail wanted to know if she was freaking her out, I hoped Bea had answered honestly. More than that, I hoped she answered kindly. I hoped she didn’t pretend she’d never noticed Abigail’s missing hand, or changed the subject altogether. “What did you say?” I asked her nervously. “I told her no,” she shrugged. “I said, ‘Why would I be freaked? I love you.’” And then I exhaled.

I know life for Abigail – and Natalie and Johan and Frank and everybody else wounded or scarred or born different — is more complicated than that. The things that make us stand out in the crowd define us in a million little ways. They can remind us of the most dramatic, heroic moments of our lives, and of every small indignity and cruelty that has happened since. But what Bea and Abigail got to in the span of one recess period was that life isn’t about seeing past each other’s imperfections. It’s about being unafraid to look at them directly. Because that’s where the love is — in the cracks and the sufferings and the challenges. Life isn’t flawless. But it can be very, very beautiful. That day at recess, Bea told me, she had kissed Abigail, right on the place where her arm stops at the wrist. And they played together until the bell rang, and it was time to go back to class.

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Mary Elizabeth Williams

Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub.

Confronting cancer webcast

Full videos posted for Salon Core conversation on "coming out of the sickness closet" VIDEO

My oncologist says that whoever came up with the phrase “the gift of cancer” has the worst taste in gifts she’s ever heard of. But though it’s not exactly a set of car keys under the seat, cancer has, for the past year and a half, been the gift I’ve been given. And from an initial malignant diagnosis of melanoma through surgery through a Stage 4 rediagnosis through a last-ditch, Phase 1 clinical trial to a recovery that has stunned the research community, I’ve shared this adventure with the readers of Salon. And along the way, you’ve given so much in return. You’ve told me your own experiences with illness, with the healthcare system, with grief and frustration, and with the ways a shattering experience — either your own or that of someone you love — can turn life around. Sometimes even for the better. So it was a unique privilege to get to talk to a few of you recently for a Salon webcast, and answer your questions on life here in Cancer Town. For those of you who couldn’t make it live, videos of the full webcast are posted below.

The connections we find in unlikely circumstances are what get us through them. They’re a gift. Thank you for it.


Mary Elizabeth Williams

Mary Elizabeth Williams is a staff writer for Salon and the author of "Gimme Shelter: My Three Years Searching for the American Dream." Follow her on Twitter: @embeedub.

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