New Ways to Talk About Cancer: Comics, Cartoons, and the Graphic Novel

Nancy K. Miller is a literary scholar, memoirist, and the author or editor of more than a dozen books. Her new memoir, Breathless: An American Girl in Paris, will be published this fall.

In December 2011, she was diagnosed with stage III lung cancer. She started documenting the experience in cartoons using watercolor, collage, and photographic images. Most recently, she presented her cartoons about her experience of cancer at the 4th International Conference on Comics and Medicine held in Brighton, England, in July.

Miller has taught courses on autobiography and memoir, including memoirs told through the graphic novel format.

In an interview with journalist Sarah Glazer, she discusses why she is drawn to the cartoon format as a way of sharing her experience as a cancer patient and why the graphic novel format, in such best-selling cancer memoirs as Cancer Vixen by New Yorker cartoonist Marisa Acocella Marchetto, is becoming a powerful and budding medium for cancer patient artists. She describes her own work as, ‘outsider art,’ since she is a writer without artistic training.

Why did you decide to start creating these comics? Were you someone who drew before you were diagnosed with cancer?

In the fall of 2011, the months leading up to the diagnosis, I found myself doing a bit of doodling and drawing. I’m not really sure why. But once I had the diagnosis at Christmas, I almost immediately felt I would start focusing on the cancer. To the extent I verbalized it, I said, “There are so many cancer narratives; what could I possibly add?”

And I know it may sound odd, but in some ways, terrifying as it is, cancer has become a cliché of our culture. I had the sense that anything I wrote would already have been written by someone else, that my own language would not express the sense of shock that I felt.

So the main thing you wanted to convey was the shock at learning you had cancer?

I had entered a new world. I found myself remembering Susan Sontag’s Illness as Metaphor, which opens with a beautiful metaphor about how we are all born with two passports: one for the kingdom of the well and one for the kingdom of the ill. As it turns out, your ‘well passport’ is only good for so long. I felt I had suddenly passed into another kingdom.

The radicality and the strangeness of it made me not only want to draw but to paint. I guess I wanted to express something I couldn’t always put into words.

One of your cartoons is a version of Mexican painter Frida Kahlo’s famous 1939 painting, “The Two Fridas,‘ showing two versions of the artist connected by a bloody vein, with her bloody heart exposed through her clothing. Below that painting, you have drawn a panel with a mirror image of yourself—essentially ‘Two Nancys’ split by a cancerous lung, drawn in the form of a lightning strike. Can you explain what you were trying to do here?

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I felt I had become two people: I was myself and no longer myself. It was as though there were now two of me—the new ‘cancer me’ and the ‘well Nancy’ I had been.

That’s why, in some of the drawings, my ‘chemo bag face’ is floating above me. It’s always there as a constant reminder. That’s why the cartoon form is so perfect—that double consciousness can be represented as a thought bubble.

Before your diagnosis, you had already started teaching graphic memoir. To me, it’s surprising that a professor of literature would be teaching graphic novel. How did you make that leap from teaching text to teaching graphic narratives?

In part, that came about because I was teaching Holocaust literature and I included Art Spiegelman’s Maus.

Maus changed the status of the graphic narrative; that was the 1980s. The next graphic memoir to have that kind of worldwide recognition was Marjane Satrapi’s Persepolis, originally published in French. I’ve also taught both of these in courses on trauma and autobiography.

Were you also familiar with graphic illness narratives?

Not at the time. The most famous one, the gold standard, is David B.’s Epileptic (a memoir about growing up with a severely epileptic brother), also from France.

Recently, there’s been a dramatic proliferation of graphic illness memoirs. Last year at the graphic medicine conference in Toronto, writer-illustrator Rosalind B. Penfold discussed her narrative of domestic abuse, Dragonslippers: This is What an Abusive Relationship Looks Like, which is extremely powerful. It’s been translated into 20 languages. It’s one thing to teach these stories as an academic; these books enter people’s lives.

Strangely, I’ve only just read Cancer Vixen. In one of my favorite scenes, Marchetto is about to get a traffic ticket and tries to get out of it by waving her ‘cancer card’ in the policeman’s face. I love the cancer card image because it concretizes something everyone with cancer feels at some point:I shouldn’t have to wait on line. I have cancer!” It happened to me once in the immigration line at Heathrow Airport. It was during the early stages of chemo, I was exhausted, and I made my husband flag one of the supervisors to tell him I had cancer. They immediately took me over to ‘special assistance.’ Actually, at first I was a bit embarrassed, but the cancer card took care of that.

When I look at graphic medicine accounts, I’m struck by the fact that they discuss the impermissible; they often show the insensitivity of doctors. What is it about the comics format that tends to bring out these kinds of revelations?

These humiliations are physical; you are at the mercy of the doctors treating you. In one autobiographical drawing by Nick Wadley, ‘Man and Doctor,’ which I saw at the Brighton conference, the patient is lying on a bed in a vulnerable state. It’s a teaching hospital and all the doctors inspecting him look pompous; there are no words. You don’t need any words.

Cartoons like this are a form of revenge—they work because the experience is condensed down to its essence; and condensation is a crucial part of humor. A good cartoon quickly captures the feeling of the moment, the glaring disparity between the perspective of the patient and the attitude of the doctors.

There’s a tension between what you can say and what you can’t say as a patient—we’re conditioned to be respectful to doctors.

You’ve started creating cartoons about irritating questions people ask you when you tell them you have lung cancer. What is the most annoying question that people ask you?


“Did you smoke?” A significant percentage of lung cancers in women occur in those who have never smoked or who quit smoking in the past. That was my mother’s case—’a never smoker’ as the category is labeled; she died within months of the diagnosis at age 68.

Why is this the most annoying question?

Because of the question behind the question. I mean, you have cancer, what difference does it make whether you smoked or not? I’d like to say back, “Why are you asking that? Are you collecting statistics?” I feel the question as silent disapproval: “What did you expect? How dumb was that? Or, it just goes to prove smoking kills, but I’m safe.” It’s like a causality that you don’t share: “You got what you deserve. You’re over there with the people with bad families, bad genes.”

Sometimes I get so angry I say, “Well, my mother died of lung cancer and she never smoked.”

Does that surprise people?

Yes it does; people may know it abstractly, but they don’t think it. The equivalent would be when people thought AIDS was a ‘gay disease’: “You must have had unprotected sex. Why were you so stupid to have unprotected sex?”

No one blames you for having pancreatic cancer, but, “Did you smoke?” is okay to ask.

Will you start telling people those statistics now—about how most lung cancer patients aren’t smokers—when they ask you that question?

I did in my talk at the graphic medicine conference, but that was preaching to the converted.

In my new memoir, which I wrote before the diagnosis, I’m now very aware that I’m smoking all the time and so is everyone else. When I was making final revisions to the epilogue after the diagnosis, accounting for all the characters in the story, I was tempted to add, “And then I got cancer.” But, I finally decided against it because I was afraid of derailing the narrative.

I was torn. I’m an educator and a feminist. I’m not for silence. We want the truth about abortion to be known, and I did not hesitate to include a scene with my own abortion, so why not my cancer? It’s not resolved for me.

At the same time, except for the ending of the memoir, I feel a responsibility about educating people, especially about my treatment—maintenance therapy—because it is relatively new.

You have a cartoon ‘Telling’ which shows you across the desk from a graduate student. You are trying to decide whether to tell her you have cancer. How did this come about?


I work with graduate students. If a student signs up to write a dissertation with me—a process that can take several years—is it my duty to say, “I’m happy to work with you, but I have a serious illness and may not be around very long”? In the instance represented in the cartoon, which was a real situation, I could not bring myself to say it.

I’ve started realizing that, once you tell people you have cancer they see you through the cancer screen, and I don’t always want to be seen as a cancer patient. Sometimes I just want to be a teacher or a friend.

You’ve told me that almost all the first-person cancer narratives published so far are stories of triumph—someone battled cancer and won. But that’s not the whole story?

“I’m still alive, but it’s not going to get better,” is not a story anybody really wants to hear. That’s why Miriam Engelberg’s graphic memoir Cancer Made Me a Shallower Person is unusual. It ends on the note of, “I am never going to get better.”

No one with metastatic or stage IV disease will be able to say, “I’m recovered.” All anyone can say is, “I’m surviving.” And that, by definition, is not a very exciting plotline.

Should there be more memoirs without a triumphal end like Engelberg’s, and if so, how are we as readers supposed to respond?

We have to accept not to be bored. It’s the same problem with memoir generally: people want a redemption narrative; it was there from the beginning with The Confessions of St. Augustine.

It’s impossible to sell a memoir that ends with the author collapsed in a state of disarray or misery. I defy you to find one.

You think readers demand a redemptive end?

We live in a culture that wants it. You have to be cheerful…nobody wants to hear the bad news. We don’t want to deal with mortality.

What should the new narrative be? “I have advanced stage cancer and will never get better”?

There’s a new ‘chronic disease’ narrative about cancer emerging that’s supposed to be the good news for patients like me. It’s a movement in contemporary medicine, of transforming cancer into just another chronic disease: ‘Cancer is like diabetes.’

That doesn’t work for me. While it’s true that diabetes could kill you, it would take a modern miracle for cancer not to kill you. At least that’s how I see it. I feel that I received a death sentence with my diagnosis.

What is wrong with a redemptive ending to a cancer narrative?

Well, it tidies everything up. Anyone who doesn’t survive is a failure. But more generally, the redemption narrative narrows human destiny to a simple pattern of transformation and eliminates all the bad stuff, the mess that most of us live in—and with.


Sarah Glazer is an American journalist based in London. She is a Contributing Writer for the Washington, D.C.-based magazine CQ (Congressional Quarterly) Researcher, where she writes about social policy in the United States, and has written about European social policy for CQ Global Researcher. Her articles on publishing and translation have appeared in The New York Times Book Review and her articles on health have appeared in The Washington Post, Congressional Quarterly and Glamour.