Gastrointestinal oncologist John Marshall, MD, is well known for his candid observations about cancer treatment and research. In 2006, all the scientific intricacies and sociopolitical dramas of oncology coalesced in Dr. Marshall’s life when his 43-year-old wife, Liza, was diagnosed with breast cancer. Their journey into a new world after a cancer diagnosis is intimately captured in their new memoir, Off Our Chests: A Candid Tour Through the World of Cancer.

Hail to the Queen

Stories about cancer are frequent additions to the memoir genre, which makes breaking new ground difficult. However, Off Our Chests by John and Liza Marshall does just that in a couple of ways. For one, it is cowritten by an oncologist and his wife who is diagnosed with cancer. This alone adds a professional and personal intimacy that sets it apart. Moreover, the memoir is organized in alternating voices, as Liza describes her struggles throughout the course of her difficult treatment, juggling family issues and emotional turmoil, and John charts his own upending, balancing his oncology expertise with the needs of his sick wife.

BOOKMARK

Title:Off Our Chests: A Candid Tour Through the World of Cancer
Authors: John Marshall, MD, and Liza Marshall
Publisher: Ideapress Publishing
Publication Date: May 2021
Price: $26.95; hardcover

Off Our Chests is organized into six parts. Part 1, “Hail to the Queen,” is an interesting lead that begins with Dr. Marshall describing breast cancer’s dominance in oncology research funding. His perceptive, critical eye was opened early during his oncology fellowship when he realized that the time, energy, and enthusiasm expended in breast cancer were disproportionate to other malignancies, such as gastrointestinal cancers, which became his life’s work. “Take a minute to reflect on this. Have you ever thought about how a patient with cancer but not breast cancer feels when he or she sees all the pink paraphernalia, all of the resources dedicated to one cancer? They rarely express their resentment…. I feel strongly that we should help them find their voice,” writes Dr. Marshall.

Delivering Bad News Doesn’t Get More Personal Than This

In a cancer memoir, the inciting incident is the diagnosis. Although each medical drama typically shares the soul-jarring moment of hearing the words “You have cancer,” hearing it from your spouse who happens to be an internationally known oncologist is one factor setting Off Our Chests apart from the herd.

It was Thanksgiving week in 2006, and the Marshall family was preparing for the festivities. Liza woke up on Monday morning mentally configuring the logistics, getting the kids ready for school, making arrangements for the “feast” and the Thanksgiving pie distribution, a fundraiser she ran each year. The atmosphere was the kind of controlled chaos that tight-knit families like the Marshalls make look easy. Dr. Marshall had called home to go over some last-minute details for the holiday when a colleague, Dr. Liu, entered his office and handed him a pathology report. A few moments later it happened. My husband, the oncologist, told me “You have breast cancer.” Liza writes, “His voice was incredulous, choked.”

Dr. Marshall had just been handed a pathology report of his wife’s breast tissue specimen, which showed cancer cells in her lymph system. Early on in this compelling memoir, one senses that the Marshalls are as solid as a couple can be—lovers, best friends, parents, neighbors, and community citizens—which gives readers a lot to root for. It also strikes a sobering chord about this most democratic of diseases: one shouldn’t say “Why me?” but instead “Why not me?”

Serendipitous Love

As readers, we hope to quickly connect with the characters driving the narrative and here, the Marshalls shine. Dr. Marshall led a wild life while attending Duke University, so much so that his falling grades and rising social life had him on a path to academic ruin. Enter the serendipitous frat party where he falls head-over-heels for Liza, the girl who would become his wife and spark his rebirth. “I rediscovered my calling…to be a doctor. Not just any doctor, but a cancer doctor.”

Off Our Chests has momentum, a valuable trait in a genre that too often suffers from overwriting and extraneous content. As an oncologist dealing with patients who have a life-threatening disease, Dr. Marshall is well practiced in using nuanced communication techniques, especially when delivering bad news. As he notes: “In my practice, I used my emotional armor to protect myself against feeling the pain I was inflicting. Coping with the diagnosis was their problem not mine…. After that split second on the telephone with my wife, I lost my armor. I now felt what my patients were feeling.”

Liza Marshall was diagnosed with inflammatory triple-negative breast cancer, and, with a kind of perky honesty, she tells her story throughout the course of chemotherapy and radiation, including her participation in a clinical trial and an elective double mastectomy. She writes clearly and with authority, confidently walking the fine line between too much information and not enough. But this book shines brightest when she and her husband open the emotional aperture to the human travails of cancer. For instance, when faced with his wife’s mortality, Dr. Marshall realizes that he doesn’t even know how to balance a checkbook or turn on the television without Liza. Right before her surgery, the couple sets time aside to go over a few important things. Dr. Marshall writes: “Liza began her instructions. ‘Here is where I keep the passwords. You have to memorize them and then eat the paper they are written on.’”

Tough Love and Gratitude

Throughout his wife’s ups and downs during therapy, Dr. Marshall remains a stubborn thorn to the cancer industry’s business-as-usual ethos, pointing out where the oncology community has gone astray.

The chapters on Liza’s breast reconstruction are poignant and inspirational, as they deal with the emotional trauma of body image. She conveys intimate moments without affectation. “It was hard to feel alluring in my lacy nightgown with one side of my chest completely flat,” she writes.

The Marshalls finished this fine memoir during the height of the pandemic, in quarantine, which adds another layer of specialness to it. At the end, there were many small victories that added to a big success. As pointed out in Off Our Chests, the U.S. cancer care system is not without flaws—some serious—but the Marshalls are the first to be grateful for the “breast cancer industrial complex…that allowed Liza to be alive today.”

Liza and John Marshall looked deep into the abyss of cancer and wrote about it with candor and honesty. Off Our Chests is highly recommended for readers of The ASCO Post.