The Kafkaesque Process of Cancer Diagnosis

Paul Putora and Jan Oldenberg in Nautilus:

The date of diagnosis? Do you mean a specific day?” The well-mannered older man with advanced lung cancer sighs, pauses, takes off his glasses, strokes through his gray, cared-for beard, and looks at me as if trying to decide whether or not I will be able to follow his thoughts. “Kafkaesque! That's what it is, Kafkaesque.” He was obviously pleased with his exclamation, which to be honest, did not help me much. Looking in my eyes, he felt my uncertainty, sighed again, not in an unfriendly or arrogant manner, but perhaps with a bit of disappointment that I was unable to share his moment of delight at finding a fitting expression. Few tasks are more challenging than breaking bad news, especially if a patient seems reluctant to engage in conversation. Any question posed by a patient provides an opportunity to get started. What made this situation unusual is that the question referred only to the time of diagnosis. This lovable bibliophilic man introduced me to the particular atmosphere in Kafka's work: “…instances in which bureaucracies overpower people, often in a surreal, nightmarish milieu which evokes feelings of senselessness, disorientation, and helplessness.”

The patient continued, “You understand that the many tests and the elusive information of the recent weeks remind me of Franz Kafka's words in his famous work Der Prozess, meaning both trial and process.” “The verdict does not come suddenly, proceedings continue until a verdict is reached gradually.” Another way to translate the sentence from German would be: “The verdict does not come suddenly, the process gradually transforms into the verdict.” The patient went on. “First there was this cough, not unusual for me, but a bit more pronounced than in recent months. One day I had to consult my general physician after I had tripped and broken a rib. I think my process/trial started as my first x-ray touched the backlight in my GP's office.

“A ‘shadow’ was visible. A CT scan was ordered the same week. A ‘mass’ is described—in my right lower lung. “My physician advised me not to think too much before cytology results were available; samples would be taken the next day. Of course, I was absorbed by frightening scenarios, including a painful death. How could I avoid these thoughts after losing friends whose processes/trials started with shadows and masses and culminated in the verdict of a death sentence? My trial had begun—consuming my days and my thoughts.”

“…without having done anything wrong he was arrested one fine morning.”

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