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The binary of illness/wellness is always porous, whether or not we notice. In Illness as Metaphor, Susan Sontag wrote, “Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.” I used to believe Sontag uncritically. Now I know that the two kingdoms don’t exist; it’s one kingdom, in a quantum state. We are all constantly both sick and well, sick/well, sick and well both, our body and immune system in conversation with a world rich in microbes, viruses, and bacteria, almost all of them either benign or beneficial, countless microbes in me here as I write and in you there as you read. The quantum state of sick/well. Let me take cancer, that disease so long synonymous with death. Cancer is not a binary. We’re willing to acknowledge this, but only when one has already crossed over into the sick category. Cancer has stages. Stage 1 cancer is still small, mostly easily treatable; stage 4 cancer is aggressive, malignant, deadly. Many prostate cancers require no intervention at all. They are subclinical. We live with them until something else kills us. Cancer is not black and white but gray, and further, there is no white to begin with. There is no absence of cancer as long as we have a body. We make cancerous cells every day our cells divide, which is to say every day. In order to keep living, and keep making—for example—new skin to push the outside world out, our cells have to divide. With each cell division, a cell will make mutations. Mutations are the raw material of cancer. Carcinogens and sunlight cause cancer because they cause mutations and damage to our DNA. But without cell division, no life. To risk cancer, to make it day by day, is to live. The absence of cancer is death. So cancerous cells are a normal part of life. In the popular imagination, we see the immune system as mainly protecting us from infectious disease, from bacteria and viruses. But just as importantly, our immune system protects us against cancer, the cells in our own body that mutate to become other, to pose a threat. At almost 40, I’ve certainly had cancerous cells in me, cells that mutate so they can divide and divide and divide. It’s my immune system that finds those cells and kills them so that I, a whole organism, can survive. But because I don’t have cancer doesn’t mean I haven’t had a cancer cell in me. I have, and survived it, so far.
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Joseph Osmundson (Virology: Essays for the Living, the Dead, and the Small Things in Between)