By Martha Lincoln, Ph.D.
Earlier this spring, I got hired to a tenure-track position at my dream department. After some celebrating, I started to strategize for the next steps of my career. I took a webinar with Dr. Karen – Surviving Your First Year on the Tenure Track). I took care of some practicalities like switching bills to auto-pay and catching up on my to-do list. And I scheduled a physical with my nurse practitioner – one less thing to think about during the academic year.
Everything was looking good, except for a breast mass that was getting bigger and annoying me. A previous biopsy had found it negative, so I wasn’t worried when my NP referred me to a specialist for a follow-up procedure. When she called me with the results, I didn’t understand why she asked if I was somewhere I could talk.
“Are you driving?” she asked. “Is it quiet there?”
A minute later, the five-year plan for research, teaching, and tenure that I had developed post-webinar caught fire and exploded.
I’m a medical anthropologist. My research explores how health care, disease, and concepts of the body express sociopolitical priorities and cultural meaning. So it felt like an almost embarrassing coincidence to be diagnosed with breast cancer, as if I’d become subject matter instead of scientist. And despite my expertise in the subject of illness, I didn’t know what my diagnosis meant – except that it would make it impossible to start teaching in the fall.
The news came at a curious time, right between things. I had a few months left to go at my postdoctoral position. At my university position, I had course assignments for the fall, but had barely started furnishing my office. Knowing that I was about to disappoint my new colleagues, who had worked hard to secure the tenure line and poured time into the search and my hire, it took me a while to figure out how to share the news.
When I did disclose my diagnosis, both at my postdoc and my university, I also regretted rupturing the illusion that I was up-and-coming and invulnerable. Suddenly I felt disabled, even though I didn’t have any physical symptoms. However, a succession of emails with my two human resources departments seemed to suggest that despite my status as a cancer patient, I might not be totally protected. My postdoc was expiring too soon to allow me to take paid leave, and at my new department I wouldn’t be eligible for benefits or leave, as I had yet to teach a single class.
Ultimately, I lucked out. I got reappointed at my postdoctoral position, and was permitted to start teaching in spring instead of fall. I’ll get to keep my postdoc insurance, whose unusually good schedule of benefits will keep me from going into thousands of dollars of medical expense-related debt. But from a financial perspective at least, it could have been much worse.
With that said, this has been no average summer of catching up on non-academic reading on the beach. I fell behind on publications and grant applications while I went to diagnostic appointments and managed the administrative parts of being ill. Though I wrote some essays that I’m proud of, work has mostly been on ice. During the diagnostic workup, some concerns arose about metastasis, prompting me to anticipate dying somewhat sooner than I’d previously intended. (Happily, that got resolved.) Now it’s September and the school year is underway, but I’m still in the middle of treatment.
I’ll be healthy and back to work soon, I trust. However, I anticipate stigma surrounding my future status as a cancer survivor – an identity that’s incongruous with most notions of what a university professor should be. Having cancer compels embodiment where we might prefer disembodiment, emotion where we privilege intellect, and transparency where we’d rather have occlusion. Indeed, having cancer is a deeply personal – even “human” – experience. In this way, I imagine that having this disease on the tenure track might be like being pregnant, or having kids, or having a relative who needs a lot of care. It might be like having chronic illness or mental illness or another type of disability.
However, cancer brings aspects of my future productivity into view in a way that can feel exposing. Though I’ve been extraordinarily fortunate to be supported by my colleagues, and though policy protects me from discrimination, I’m sensitive to the questions of future indeterminacy that my diagnosis compels. While I’ve always known that the tenure process will evaluate my work with an eye to the future, cancer presses this home in a way that feels morbidly personal. I imagine my colleagues and employers wondering things I’ve wondered too: Will my cancer kill me? Will it mess up my single-minded pursuit of success? Will I relapse and make everyone scramble to cover my commitments? (BTW: no, no, and I hope not.)
In university settings – where professionalism is virtually defined by the ability to keep personal and professional matters separate – cancer makes it impossible to maintain the secure, aloof façade of an academic persona. When Dr. Karen suggested I write something for her, I struggled about whether to use my name or not. Ultimately I wanted to use my name, so others would be able to contact me if they found themselves in a situation like mine. I also want to share the following suggestions.
Whether or not you are diagnosed with cancer (or another serious illness) in a tenure-track position, review your health insurance options carefully when choosing a plan. Ask yourself what benefits you would want if you had a medical emergency. In my case, having a PPO (Preferred Provider Organization) policy allowed me to move from the clinic where I was originally referred to a hospital that is a national leader in cancer care. Review details with your own situation in mind, bearing in mind that unexpected things can happen even if you are young and (apparently) healthy.
If you are on the tenure track and are diagnosed with a serious illness, think carefully about how you want to communicate regarding your situation to others – colleagues, students, and employers. Some members of your department and administration will need to know at least a little bit about your diagnosis, but you can still be strategic about disclosure. When you share information, consider making an explicit request for confidentiality.
Also remember that people may respond to your news in ways that you find unhelpful or upsetting. I found that it felt safer to control information more tightly when I was still unsure about my treatment and prognosis. As I knew more, I felt more secure about sharing details. I was also fortunate to have a chair who asked for my input in crafting the message he shared with the department about my situation.
If you are newly diagnosed, know that cancer is time-consuming, and can come to seem like a second job. It is likely to sap your energy and focus, distract you, and cause you free-floating anxiety. Anticipate that normal things will become difficult, and then potentially more difficult. Find shortcuts in the “activities of daily life” wherever possible (for example, using a grocery-delivery app instead of doing your own shopping), lower your standards and delegate tasks where possible, and ask your friends and family for help. If you’re going to need chemotherapy or radiation, ask your doctor to help you with a request to the DMV for a temporary-disability placard for your car.
Cancer treatment and recovery last for months. I’ve found that my usual approach to getting through difficult times – battening hatches and buckling down – is inadequate, given the drawn-out, stressful, and unpredictable experience of getting care. I benefited from mental health support. Some hospitals may provide access to therapists, wellness practitioners, and social workers (who can help with the horrifying paperwork burden of cancer, and with access to other useful resources).
Remember that there are institutional policies to protect you. Contact the disability office on your campus to inquire about accommodations. Contact human resources to figure out your options for medical leave (under the Family Medical Leave Act) and short-term disability. Contact your department chair and dean to discuss the details of leave and request a stop on your tenure clock.
At the same time, remember that your department, HR representative, and administration may not have had a situation like yours in the past, and that there may be some improvisation required before all the details are settled. Expect many email exchanges, some of which you will have to initiate proactively, and some of which will need you to follow up by phone or in person. Some people will drop the ball. If you become frustrated, express dissatisfaction in ways that don’t sacrifice good will that you’ll need later.
If your coping mechanisms compel you to understand the medical details of your cancer, use institutional resources to access the most current and reputable literature. Consider asking colleagues with experience in medicine or science (or even your institution’s reference librarians) to help you access and interpret research. The rich humanities and social sciences literature on cancer supply other forms of context and meaning (c.f. Jain 2013, Livingston 2014, Lora-Wainwright 2013, Lorde 1997, Mukherjee 2010, Sontag 1978). Reading memoirs of illness and disability in academia can also be both useful and cathartic (c.f. Crosby 2016, Felstiner 2005).
If you are diagnosed, entertain the possibility that it will affect your focus and trajectory, intellectually and professionally, in ways that you cannot predict. For all that I’ve come to loathe the notion that cancer is somehow a spiritual experience, my diagnosis has undeniably shifted my relationship to my life and work. It has compelled me to ask what’s deathless in my field – or, rather, what gives me life. Your priorities and interests may also shift as a result of having cancer, potentially in ways that you will find wonderful.
Finally, remember that this won’t last forever. With luck, you will have one good shot at surviving cancer, and you will give it all the resources you can: finding the best health care, minimizing stress and commitments, setting priorities that serve you, and taking the time and resources you need to heal and recover. When it is over – god willing – you will get back on the tenure track, and move on.
~Martha Lincoln is Assistant Professor of Anthropology at San Francisco State University.
2016 A Body, Undone: Living On After Great Pain. New York: NYU Press.
Felstiner, Mary Lowenthal
2005 Out of Joint: A Private and Public Story of Arthritis. Lincoln, NE: University of Nebraska Press.
Jain, S. Lochlann
2013 Malignant: How Cancer Becomes Us. Berkeley, CA: University of California Press.
2014 Improvising Medicine: An African Oncology Ward in an Emerging Cancer Epidemic. Raleigh, NC: Duke University Press.
2013 Fighting for Breath: Living Morally and Dying of Cancer in a Chinese Village. Honolulu: University of Hawai‘i Press.
1997 The Cancer Journals: Special Edition. San Francisco: Aunt Lute Books.
2010 The Emperor of All Maladies: A Biography of Cancer. New York: Scribner.
2013 Illness as Metaphor and AIDS and its Metaphors. New York: Farrar, Straus & Giroux.
Thank you for this post Martha. This is such an under-discussed issue, and as you helpfully point out, one that’s not just limited to cancer but also many other chronic conditions. In academia our value and worth is quantified according to how much we can produce, and often we don’t have built-in accommodations for times when production isn’t possible. Academia is centered upon a very ableist model, even more so than many other professions. I am a graduate student who received a cancer diagnosis in my first year of graduate school. I was lucky and only needed surgery, so I was able to persevere, but it was an especially trying time during my first year. I have known fellow graduate students who had to drop out of their programs due to their mentors’ lack of understanding when it came to their chronic health issues, and I know some graduate students who were healthy coming into their programs but who later develop health problems due to unreasonable expectations of pace and performance. Graduate students who suffer prolonged health issues are especially vulnerable populations, since they often don’t have guaranteed funding from year to year and since tenure-track jobs are increasingly difficult to come by in today’s climate where positions are increasingly adjunct and lacking adequate benefits. I appreciate your story and am so glad you shared it with us. It’s helpful to know I am not the only one who has experienced these same feelings and frustrations.
Dear Martha and Eva, I want to thank you for sharing your stories. I would like to share my story to illustrate the dehumanizing consequences of the ableist model that academia centers around as Eva pointed it out. I went through a health crisis during my third year on the tenure track 20 years ago but the professional outcome for me was devastating. I have a minor physical disability which caused me great challenges in teaching a large lecture class at a time when technology was reduced to overhead projectors. However, this constituted a vulnerability that students cruelly exploited in completing course evaluations for the demanding course I taught and for which the curriculum provided inadequate basic prerequisite knowledge. After several years of harsh treatment at the students’ hands and little departmental support I suffered a total breakdown and was hospitalized for several months. But instead of helping prepare my return to teaching after a year on medical leave, the department chair forced me to resign to liberate my line so the visiting faculty hired to cover one of my courses could be hired permanently. So that was the very painful end of my academic career. Many years later after rebuilding myself I converted to a different field but am one of those social science Ph.D.s in the ranks of the adjunct workforce.