Not so long ago, cancer seemed to be a taboo. People didn't talk about it or write about it. And then, like buses, along came not one but two fantastic and talented writers, each telling the public about their cancer experiences. They were John Diamond, writer of 'C: Because Cowards Get Cancer Too' in which he wrote about his experience with cancer in his neck and Ruth Picardie, a journalist who wrote about her terminal breast cancer in the Observer's 'Life' supplement. In a moment of extreme honesty, John Diamond revealed he had a teensy bit of jealousy that someone else was competing with him for the role of cancer columnist and that Ruth might actually be better than him. Their two books are actually very different.
Between the two of them, Diamond and Picardie introduced a new approach to dealing with terminal illness. Quite possibly if just one of them had been active at the time the impact would have been much reduced but the sheer coincidence of timing increased the national awareness. Picardie's writing dates to 1997, a time when people still tended to think that cancer was the kind of thing to hush up. People got it, went behind closed doors and were expected to just shut up and get on with the quiet process of disease and death. The date will also trigger some people to recall that Picardie was sick and writing at the time of Princess Diana's death – another event which opened a vein of public emotion that had rarely been seen before.
With Diamond and Picardie baring their souls in the press, British behaviour began to change irreversibly. Suddenly writing about deep and personal experience became a new way of dealing with cancer and other terminal illness. These writers changed the national mindset in a way that neither of them could have expected. All they were doing was what seemed right to them at the time. Neither did it with a drive to help others or to achieve some philanthropic goal – in each case they were writers and communicators by training and by trade and writing was what they did – not some type of contrived therapy.
The full mail-bags arriving at the offices of their newspapers soon showed the power of their writing. Readers who had cancer, readers who'd lost loved ones to cancer and members of the public who had no personal experience of the disease all picked up their pens and wrote to tell someone that they had never met that their words had moved them.
In 1994 at the age of 30, Ruth found a lump in her breast and was told that it was benign. Two years later after having her twin children by IVF, she realised the lump was growing and in October 1996 she learned it was indeed cancerous and that cancer had spread to her lymph glands. The lymph glands were only the start; her cancer spread very quickly, rampaging through her body and killing her in less than a year after her diagnosis. Given the speed of the disease, it's not a surprise that 'Before I say Goodbye' is a short book, running to just 116 pages of which the final twenty were written by her husband Matt Seaton. The brevity seems to contribute to the impact of Ruth's words in a 'less is more' kind of way. There's no prospect that the reader could get bored in such a fast-moving account.
The book starts in November 1996, just a month after diagnosis and ends in September 1997. Ruth is still writing up to just a couple of weeks before her death. We can see in the final weeks that the tumour in her brain has impacted on her writing – she's lost the use of capital letters and her sentences are short. Grammar pedants will love and admire that even near the end Ruth could still punctuate and use an apostrophe properly.
For a while Ruth tries every alternative therapy going until she realises that their promoters are a bunch of charlatans and con-merchants, preying on the fears and desperate search for results of the terminally ill. She tells us that chocolate and shopping are better therapy than all the caffeine enemas and herbal lotions and potions. Good friends are clearly the best therapy of all.
The structure is an interesting one with a mix of input and form. There are emails sent between Ruth and several of her friends interspersed with the five articles she wrote for Observer 'Life'. After the articles start the text interweaves some of the letters Ruth received from readers. Near the end, we get copies of the two hand-written notes Ruth wrote to her children a month before her death (I defy anyone to read these and not get a bit weepy) and eventually we read the 'After Words' of Matt Seaton.
I loved the email correspondence with her friends the best. With Jamie who has HIV and is 'in the closet' we learn that his T-cell count is pushing him ever closer to an official diagnosis of AIDS. Ruth discusses the nature of their illnesses, the taboos associated with them and the inevitable thoughts of death. With Carrie who lives in Hong Kong, she reports the gradual evaporation of any hope of recovery as each hospital appointment and scan brings worse news of the spread of her disease. With writer India Knight, she cracks girlie jokes about getting fat, craving chocolate and spending far too much money on expensive face creams and treatments. There are other friends who pop up here and there but these three are the core of the correspondence. Many of the emails are funnier than you might expect given the circumstances though a lot of the humour is very black. She jokes about therapy sessions surrounded by old ladies in wigs, calls a therapist who wants to give her vitamins and oxygen treatment a “money grabbing wanker”, gets crushes on doctors, and begs her friends to write about their problems and gripes because she's bored by going on about cancer.
Whilst I loved the emails with friends and was fascinated by the Observer articles, I felt some of the letters from readers were there to pad out this slim volume. It was important to include some to reflect the impact her articles had but perhaps there were a few too many. In many ways – sorry - I hated Matt Seaton's afterword. When I read a book like this I always want to know how it ended, what happened after the letters and emails stopped but in this case, his description of her last few weeks are too hard to read, not just for the descent into mental decline but for the oddly cold and mechanical way in which he delivers his thoughts. Sometimes it's better to end something like this with a moving and emotional post from the soon-to-be-dead person than to be confronted with the cold hard reality of the mental decline that dogged her last days. Seaton's apparent detachment in these final pages is quite possibly a very necessary coping mechanism but at times it seems rather cruel, cold and a great contrast to the open emotion of Ruth's own writing.
I was able to read this without any personal sense of connection to Ruth's disease because breast cancer has not really touched my life. I lost a cousin and an aunt 25 years ago but they were not people I really knew well. Most of the people I know who have had this - or whose relatives have been diagnosed - seem to have responded well to treatment. If I had breast cancer or if I had a friend or relative with it, I am pretty sure that this book would have really scared and upset me.
To anyone who does have breast cancer or is worrying about someone who does, I would suggest to think carefully about buying this book. I'm sure that the vast majority of breast cancer sufferers do very well. In Ruth's case the apparent misdiagnosis of her lump in 1994 and her subsequent IVF treatment seem to have contributed to the spread of her disease. Nobody reading this should assume that what happened to Ruth is going to be representative of every terminal breast cancer experience.
Read this as an inspirational book about the power of humour and positivity and recognise it as a book that changed our attitude to talking openly about disease but please don't assume that every woman with breast cancer will have the same experience.