For Cynthia Ryan, a two-time survivor of breast cancer, profiling people with cancer who are homeless, a project she spent more than a year researching and writing, was a very public project and a personal quest.
Ryan is an associate professor of English in the College of Arts and Sciences at the University of Alabama at Birmingham who teaches students how to assess narratives about medicine and science that shape the ways in which people view important issues. She hopes her work, published Oct. 13, 2010, in CR: Collaborations, Results, the journal of the American Association for Cancer Research, has professional and societal implications.
"I want to make these invisible people visible, to make people recognize that there are cancer survivors who are off the national radar," says Ryan. "And I would like to see some kind of systematic change, so that if you don't have a job and live on the streets there are services to help you navigate the health-care system."
Most people who are homeless don't have insurance, Ryan says, and the lack of basic resources such as an address or telephone is a hurdle to applying for Medicaid. Hospitals that care for uninsured patients are frequently those with the fewest resources for outreach or plentiful clinic appointments. "The homeless have as much right to adequate health care as anyone else, but if we want that to happen, we need to address the sheer difficulty of navigating the system," she says.
Ryan writes that a newsletter from the Church of the Reconciler in Birmingham piqued her interest in the problem of homeless people with cancer.
"I felt like I had been inundated for so many years with the same stories about cancer. It gets old and frustrating, and this was something different," says Ryan, whose research about how the media covers breast cancer has been published widely. She was first diagnosed with breast cancer when she was 29; a second diagnosis came at 40.
Ryan spent months getting to know people in Birmingham who are struggling with cancer and the added burdens of not having a home, from a lack of transportation to a lack of food or a bed or, for some, a significant mental illness.
With photographs by noted photographer Sylvia Plachy, Ryan shares the lives of many people she grew to know well over the course of a year. Among them are Charles Geer, a stage IV colorectal cancer patient, who battles the stigma of being homeless with a security guard when he tries to enter a local clinic for therapy; and Edwina Sanders, a stage IV breast-cancer patient who ignored the lump in her breast for six years before entering a medical system in which she feels less than comfortable. Preparing to undergo surgery at a Birmingham hospital in February 2010, she told Ryan, "They might put me to sleep, and I might not wake up again."
Another reason to write her story, Ryan says, is to counter "the happy restitution narrative that has become the dominant story of cancer," she says.
"We see a lot of coverage of the disease and are led to believe we are part of one big community," she says. "It's sort of true, but it's also kind of a ridiculous idea," she says. "Everybody has a different experience, and now we know that the same type of cancer can have numerous subtypes. So why do we continue to portray cancer as a one-size-fits-all diagnosis or experience?"
When someone is diagnosed with cancer, she says, "there's pressure to identify with others who have cancer, but there are plenty of things that divide us as well."
In her article, Ryan presents both perspectives. By sharing stories about people who are part of a community often overlooked, and among them a smaller group struggling with an often fatal illness, she expands their identity and, in her own way, discovers a way to forge a bond with those walking through an-all-too-familiar disease.