book review - But Hope is Longer: Navigating the Country of Breast Cancer*

“I felt like a snake having to shed its old skin... I mourned each layer of myself as I imagined it loosening and separating from me before I sloughed it off and watched it fall to the ground: my resilient good health, my identity, my hopes for a vibrant future. The shedding of each successive layer left me even more naked, raw and vulnerable. At that point, I had no sense that there was any regeneration underway or that there would be anything to replace the parts of myself I was losing.”

-Tamara Levine, ButHope is Longer: Navigating the Country of Breast Cancer.

Being diagnosed with breast cancer changes you, irrevocably. In But Hope is Longer, Tamara Levine writes beautifully of her own transformative process. She also, in sections called Reflections, looks back on her experience with the benefit of time and a clear-eyed analysis. Finally, she interviews all of her caregivers from those at the cancer centre, to her naturopathic doctor to her life coach - bringing together their insights on treatment and patient care. The result is a book like no other.

For Tamara, the writing process began with a series of Healing Journey letters she wrote to family and friends. In these letters, she brings loved ones up to speed on what is happening with her but also shares her feelings, observations and the things she learns along the way. These letters helped Tamara to rediscover her love of writing and with these stories she shares her experiences from medical mishaps and mismanagement, getting on the right track, her celebration of friends, feelings about physical changes and the loss of her beloved father to leukemia. These are the pieces that very frequently left me with a lump in my throat.

In the sections she called Reflections, Tamara fill us in a bit more on what was happening during the times she wrote the letters. She also thinks back on the decisions she made, sometimes critically. Tamara doesn't mince words here, as she relays interactions with those closest to her and the experiences that were part of the treatment process. Most important of all, she concludes that the most serious flaw in breast cancer treatment in Canada is a lack of coordination across treatment areas (the caregivers themselves speak of working in “silos”) and makes the recommendation that this be addressed in the form of a “nurse navigator.”

“If we were to imagine a better process...what would it look like?...there is a centre for where women go for 'one stop shopping' for all the diagnostic and planning steps leading up to treating their breast cancer...We are warmly greeted by a nurse who has been specially trained for her role as 'navigator' who has taken the time to become thoroughly familiar with our file...she advises us as to what lies ahead, at least in the short term...She is available to us throughout the journey.”

This vision would transform the experience of cancer patients. I'm convinced it would also improve outcomes. I hope someone at my cancer centre who is in a position to create change reads this advice and takes it to heart.

The last thing Tamara does is interview her caregivers. Their comments are interspersed throughout and included in Voices of the Healers. Each one clearly cares about the outcome of every patient and all bemoan the lack of cooperation between treatment teams. In particular, I was struck by the willingness of the 'mainstream' oncologists and surgeon to engage with Tamara's naturopathic doctor as well as the humility and wisdom of each person who was interviewed. I've never seen the words of healers collected in this way and the result is powerful.

The very best of books stay with the reader and may even influence how they live their lives. As an ongoing cancer patient, I was very moved by But Hope Is Longer. I also initiated my own relationship with a naturopathic doctor (ND) after reading Tamara's book. My new doctor specializes in oncology and I'm very excited and grateful for this new relationship.

But Hope Is Longer is compulsively readable, full of clear, useful advice and includes the perspectives of those who spend their days thinking about how to better care for cancer patients. More than a breast cancer memoir, this is a book that everyone will want to read.

But Hope Is Longer:Navigating the Country of Breast Cancer (256 pages, $19.95) was released by Second Story Press in October, 2012. In Ottawa, it is available at Chapters, Octopus Books, Singing Pebble Books and Britton’s.  

*Originally published in the Glebe Report, on January 18, 2013.