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Blood biopsy update and living in the "long middle"

Dr. Villaruz, my oncologist, called me on Tuesday, March 31 about my blood biopsy results. I have been too busy to post this update until now. I was standing in line to ask the Provost a question during the Faculty Senate plenary when my phone rang (thankfully, it was silenced). When I saw the 412 area code, I knew it was UPMC. There were like 4 people in line ahead of me, so I stepped out to take the call. In sum: There is no evidence of cells with the EGFR mutation, which is what Tagrisso is targeting! So that is great news.

There are some other mutations, but apparently there is no way to determine if they come from cancer tumors versus benign sources. (Dr. Villaruz said something about a condition where the body generates mutations that aren’t cancerous. I was not at my computer, so I couldn’t write anything down. I’m still kind of vague on this point.) Since the nodule has grown 3mm since last August (now 13mm), Dr. Villaruz is going to consult with a radiologist about radiation. The plan is to meet with the radiologist at my regular appointment on April 16. So it seems my pulmonologist and oncologist were both right: Tagrisso is still working, but it’s a good idea to zap the nodule. I still don’t appreciate that my pulmonologist caused me emotional turmoil rather than first consulting with Dr. Villaruz.

When I got back into Faculty Senate, the line was gone and the time to ask questions was up! (These meetings often last 4+ hours, so they’ve started putting time limits on questions for administrators.) I objected to ending questioning, assured them that it would take less than 1 minute, and got my question in.

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Recently, someone posted an article from the Guardian in a lung cancer Facebook group: “I have stage four cancer – there will be no cure, but death isn’t necessarily imminent: this is how it feels to live in the long middle.” https://www.theguardian.com/society/2026/mar/22/i-have-stage-four-cancer-there-will-be-no-cure-but-death-isnt-necessarily-imminent-this-is-how-it-feels-to-live-in-the-long-middle The author captures so precisely what it is like to live in the liminal “long middle”: to have late-stage cancer and undergo constant treatment while also living a full life, thanks astonishing advancements in medical research.

To learn what it’s like to walk in my shoes – and those of anyone living with cancer as a chronic, incurable disease – please read this article. The author and I are ~1 year apart in age and were both diagnosed in 2022. Unlike her, I no longer struggle to breathe, I don't experience fatigue, I have not undergone surgery, and (unfortunately) I don’t have an in-person cancer support group. Otherwise, much of what she writes aligns with my own experience.

Here are some quotations that stood out to me:

“I am not a ‘survivor’ in the triumphalist sense of the word, nor am I imminently dying. I occupy the long middle – a rarely charted territory where the body remains fragile, treatment constant, and life does not so much move forward as stubbornly persist. This liminal state is a distinctly modern byproduct of a medical revolution….As a psychologist, I view this not just as a medical victory but as a profound existential shift: we have replaced the suddenness of the cliff with the tenuous permanence of the high ridge. Such a progression has inadvertently birthed a new demographic: the “chronically terminal”. We occupy an interstitial space, standing in the spectre of what is destined to take us, yet still burdened with the responsibility of being within the world.”

“While science is rebranding metastatic cancer as a 'manageable chronic disease', our social and psychological maps have failed to update. This progress has carved out a profound 'survivorship gap'. When you are cured, the world cheers; when you are dying, it mourns. But when you are simply maintaining, the world is at a loss. We navigate the “scanxiety” of the quarterly CT and the eerie, metallic hum of the MRI, planning for a future that medicine hands back to us one prescription at a time. We are playing in the 'extra time' of a match where the whistle refuses to blow, except the scoreboard has long since stopped working.

This absence of a final whistle necessitates a new, tempered kind of stamina. Here, strength is rarely about the “'ight'. Military metaphors such as 'battling' and 'warrior' are a leaden weight for those of us who cannot 'win' in the traditional sense.”

***My aside here: Please do not call me a warrior, survivor, or refer to my “battle with cancer.” I recoil when I hear these terms applied to me or others who didn't choose them. If these terms resonate with others, that's great, but they don't with me. We don’t use these terms for other diseases (heart disease warrior, diabetes warrior, autoimmune disorder warrior, etc.). Why are they reserved for cancer?

Back to the author: “Most of us live by chronos [time]: the quantitative time of the clock, the five-year plan and the corporate calendar. It is a predator that treats every passing second as a theft. But the long middle demands a migration toward kairos: a qualitative time. Kairos is not measured by the accumulation of minutes, but by the “rightness” of a moment. It is a frequency shift: moving from a life lived for the next milestone to one lived for the morning light of the kitchen table or the depth of a single conversation. In this state, time is no longer a resource to be spent, but a medium in which to dwell.”

“If the long middle offers a silver lining, it is the brutal sharpening of one’s discernment. It leaves only the essential, revealing that meaning resides entirely in the quality of our attention. To walk through a park, to watch the sunlight catch a river or to register the laughter of children against the thrum of a passing bus is to realise these are no longer background noise; they are the destination.”

“Living with stage four lung cancer has taught me that strength is not a metric of productivity or a narrative of 'recovery'. It is found instead in staying present within a life that no longer fits the frantic success stories we are sold. In a culture that fetishises the loud 'bounce-back', choosing to live gently, attentively and on one’s own terms is an act of quiet defiance. The long middle is not a waiting room, nor a preamble to a finish line; it is a demanding, vibrant and profoundly human place to be alive.

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