Susan is one of those needle-in-a-haystack-type folk who can make anyone smile. One of those people who make every day more worth living. Susan and I did high school track together – where she lit up every bus ride, every practice, and every race with her joviality. “LILI LADNER!” I still remember her shouting as practice began. She ran, or should I say galloped, towards me, arms flailing with lightheartedness, blonde wispy hair swept back by the wind, skidding to a stop in front of me.

“It is SO good to see you, MISSUS LILIANA LADNER!”

You can’t help but feel loved by Susan. In fact, you don’t have a choice.

When I went off to college, I realized how rare the Susans are in this world. Maybe it was when I laced up my shoes for a run with that nagging thought: I really don’t want to. Where was my Susan to tell me I was going to KICK SOME ASS? Or maybe it was when I was walking to the subway, head-down anonymous, jostled between warm damp bodies. Where was my Susan to tell me I was AN AWESOME INDIVIDUAL? You just don’t meet people who love living as much as Susan.

Several months into college, I got a phone call from Susan’s twin sister, Mary. I don’t remember where I was or what I was doing, but I remember her voice. She was quiet, uncertain.

She started off, “Lili, we need to talk.” I remember a pause and a breath. She continued, “Susan has cancer.”

Now I paused. Susan has C A N C E R?

That awful word haunted me – I didn’t want to taste its sourness. I was fed up with cancer. Although I was young when my grandmother lost her fight to cancer, I was reminded of her presence in fleeting moments. Somehow it felt like I grew up with her watching over me. On the anniversary of her passing, my mother would light a candle, drive to her cemetery, and we would hug, tight, until all the tears were squeezed out. Every time I had a balloon from a birthday party, I would take it home and let it go. I love you and I miss you, I’d whisper as I watched the balloon float up, into the sky, to Grandma. In my mind, her room in heaven had a glass floor so she could watch us grow up beneath her, and it was filled to the brim with balloons. So when I heard Susan had cancer, I was dumbfounded. Susan did NOT belong up there with all those balloons. Not yet.

Fast-forward a few years. I am in medical school, learning about the very cancer that has changed the path of Susan’s journey. I crave a deeper understanding of Susan’s story, of her fight against childhood leukemia at the brink of adulthood. I call her up, ask her how it started, and am transported to a brisk December on a tree-capped college campus.

“I was exhausted. It was really intense. Even walking was hard,” she recalls. She recalls taking pauses in random buildings on campus just to sit, gasp for air, and continue what felt like an uphill battle just to get to a dumb math class. Y=MX+B was not worth all that effort.

Susan reminds me, “I’ve been an athlete my whole life. When something goes wrong you just get up and shake it off.” And so she did. Susan managed to convince her friends that she was fine, she was just feeling under the weather. At the time, Susan was doing what felt normal for her, but reflecting on it later, she describes her almost fatal need to please those around her over herself.

She reflects, “At the time I didn’t care about my health. I had low self-esteem and was more worried about pleasing others than myself. Realizing that I almost died from cancer because I wasn’t willing to tell people that I was struggling definitely changed my perspective on life. Cancer gave me a little bit of feist.” I am taken aback. Hidden beneath her ever-willing, ever-positive persona is a dark voice pulling her down. Although I believe Susan walks on water, she is no more free from self-scrutiny than the rest of us.

This newfound feist may have been exactly what Susan needed. The Susan I know is a serial optimist. When someone proposes an idea, she’s on board and steering the boat, because who else but Susan to cheer you on. But since her diagnosis with cancer, I’ve noticed a dulling of her eagerness. When I hang out with Susan these days, Susan is more than willing to say no. I like seeing her take ownership of what she needs. It’s refreshing.

It wasn’t until months into the semester that Susan sought help for her crippling exhaustion. Well, sort of. She sought a note from the school primary care office to get an extension on her exams. When she went to her college primary care office for what she thought would be a simple checkup, the doctor asked her about a rash on her arms and legs. Her body had been coated in pinpoint red spots called petechiae for several weeks, but she thought it wasn’t a big deal. Her doctor thought it was.

So Susan went home and did what we all do when we have a new pain, a weird itch, a funny rash. She consulted Dr. Google for a diagnosis. When you type in What causes petechiae? on Google, you get a short list. Infections, viruses, injuries, leukemia. Susan did what most of us fatalists do and convinced herself she had the worst one, the cancer one. That is, until she took a step back and looked at the statistics. Her likelihood of having leukemia was too low, too far-fetched.

She couldn’t have cancer.

There was no way.

Even the data agreed.

Susan got a blood test and results within the next day. Her college primary care doctor described her blood test results in order, starting with her low red blood cell count - to which Susan responded, “OH, I’m just anemic. I can have a hamburger!”

Without skipping a beat, the doctor moved right on down the list of numbers. When her doctor explained the elevated white blood cell count (124,000 to be exact), Susan was taken aback. Time slowed down as she began to piece together the words she was hearing.

Maybe I do have cancer.

The next few hours are fragments in Susan’s story. Whether from the shock of this new reality or the fatigue from her near-fatal anemia, Susan does not remember much. Her parents picked her up from college, whisked her away, and she was lying in a hospital bed hours later. Soon after, the diagnosis of T cell leukemia was made.

She describes how, after the whirlwind diagnosis, she felt numb, desolate. The reality was dire: Her body was destroying itself, from the inside out. And the only way to survive was to be poisoned until the bad cells were alive no longer. It was not a happy reality.

After she cried out all the tears left inside her, there was nothing left but emptiness to feel. For several days, Susan existed in a shell, a hollowed-out mirage of who she once was, until she learned how to feel and smile and be herself within this new awful reality. In fact, the sheer bleakness of it all was kind of ironic. The more she thought about her diagnosis, the more preposterous it felt.

Susan laments, “Cancer is a silly disease, because your cells one day are just like - instead of being a cell I’m just gonna to kill you. You can’t not have a little chuckle about that.” And so she did. Trying to grasp the idea that her DNA randomly mutated one day and now her blood was drowning in cancer was both overwhelming and hilarious. Somehow, laughing at the fact that her body was consuming itself was cathartic.

And her humor, like sickness, was contagious. Susan describes her hospital room in the pediatric cancer ward: “It was so sad. Those doctors are working with a bunch of little kids who have cancer, so the doctors’ lives must have been pretty dull. I figured it was my job to bring a little spice into their lives. So I did a lot of joking around. Right after I got diagnosed with T cell leukemia, I told my doctor, ‘So we’re certain it’s not the common cold?’”

Chemo may have cured Susan’s body, but humor kept her spirit alive. Whether joking with her physicians, herself, or her family, Susan built an armor of tomfoolery, a chariot of laughter. In fact, humor likely spared Susan from what otherwise may have been a cold, empty existence.

When someone is diagnosed with cancer, the people around them may struggle to provide consolation. How do you tell someone it’s going to be okay when that’s everything you want but nothing you can provide? How can you be there for someone you can’t really help? Perhaps you can encourage them to enjoy what little they can. The most common advice given to Susan was to appreciate the small joys in life. To Susan, this advice was utterly annoying. 

Susan describes, “They kept saying to enjoy the little things in life, but I already did. I decided I was going to focus on the Microscopic Things.”  Susan did, and still does, appreciate every microscopic moment in life. From her favorite breakfast cereal – Frosted Flakes – to a task as mundane as waking up in the morning, every moment is deeply felt by Susan. Though cancer may have made her more aware of her human limits, Susan’s superpower of loving life will never subside.

After years of chemotherapy, Susan was officially declared cancer-free in 2021. In the time since, she has graduated college and started a master’s degree in Education. She dreams of becoming a teacher. In this role I am certain that she will inspire many generations of glass-half-full, witty kiddos who don’t let anything slow their stride. Cancer was a minor roadblock in Susan’s journey and I, along with the many humans she has touched, will be on board for the rest of the ride.