Greetings from CancerLand: It's Not About the Jigsaw Puzzle

Alysa Cummings
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: September 5, 2008

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It’s a puzzle – a 750-piece jigsaw puzzle – spread out on a card table in the far corner of the waiting room, right next to the television. Rumor has it that one of the nurses picked up the jigsaw puzzle at her neighborhood Dollar Store and set it up for the patients the very next day.

It has quickly become the Radiation Oncology waiting room center of attention, competing only occasionally with CNN Headline News and Tyra Banks’ latest batch of wacky guests.

When (and if) all of these multicolored puzzle pieces get put together, two whales will breach, side by side, right out of the ocean, silhouetted dramatically against the setting sun. At least, that’s what the photo on the jigsaw puzzle box top promises.

After one month of diligently working this puzzle every morning, along with lots of other cancer survivors in Radiation Oncology, there are moments when I truly have my doubts. Do you think that all of the pieces are really here? Could some be lost? (I know that I’m not the only one who has been regularly checking the floor under the table for puzzle pieces that might have gotten away). But maybe that’s spoken out of sheer desperation, because for the last week there’s been one very noticeable empty spot in the upper left hand corner of the puzzle.

Yes, it’s just a Dollar Store jigsaw puzzle (with way too many different shades of ‘ocean blueness’ going on, if you ask me), but it’s starting to feel like so much more than that. Day after day, returning to the Radiation Oncology waiting room for their close encounter with the linear accelerator on the other side of the wall, patients have started hanging out at the card table. In fact, doing the puzzle is becoming a Radiation Oncology waiting room ritual. And like so many rituals, it features predictable comments and behaviors.

Here’s what happens every morning. The veteran fans of the whale puzzle immediately sit down in one of the four seats at the card table and pick up where the last puzzle solver left off. The straight edged pieces were clearly the first challenge; they gradually came together to form the all important puzzle frame. Some folks just enjoy sorting puzzle pieces into piles by color while others focus on one area and fill it in, piece by piece.

Jigsaw puzzle newbies, on the other hand, are more than a little curious about what’s going on in the corner, but still understandably cautious as they approach the card table for the first time. They peek down and typically shake their heads. Oh,I don’t know if I have the patience to do a puzzle with so many pieces in it. A moment passes. The newbie then tentatively picks up a piece, reaches down and tries to fit it into place. Hey, does this go here? Yes, it certainly does and the need to find another puzzle piece that fits (and another and another) becomes compelling. They sit down in an empty chair and get down to business. And so, a new jigsaw puzzle fan is born and joins the team.

Time passes quickly in the waiting room with patients working the puzzle until they hear their name called over the loudspeaker by the nurse, followed by her gentle message: You can change.

Sorting pieces. Turning them around. Scanning for shapes. Trial and error, fitting pieces into place and closing gaps. And as they focus on the jigsaw puzzle, the patients stop being strangers and start freely chatting with one another about what’s on their minds. While everyone’s journey through CancerLand is unique, the need to tell one’s story is universal and every bit as compelling as finishing the jigsaw puzzle. And who could be a better audience than someone who is going through a very similar treatment experience?

Heads down and close together over the jigsaw puzzle, with voices slightly above a whisper, the CancerLand conversation flows. One day the topic might be the side effects of radiation. I’m so itchy. I could just scratch my skin off. What are you using on your skin? I can’t find that cream anywhere. I wanted to walk last night but I’m just too tired. You know what I mean? Or comments about the staff they encounter day after day in Radiation Oncology. Isn’t she the sweetest thing? Do you mind that male tech? Hey, I have no vanity left. Plus he’s so professional. My doctor looks so young! I call him Doogie Howser, but not to his face. And sometimes they look ahead and set intentions for life after radiation ends. I have four treatments left. I’m going down the shore to celebrate. I’m 83. I’ll be happy with just five more years.

It’s just a puzzle on a card table in the corner of the Radiation Oncology waiting room. But it’s also a somewhat sacred space where cancer survivors meet and greet one another every morning like old friends and share their stories of getting through treatment. Day after day, small strangely shaped puzzle pieces drop into place, one after another and a colorful picture emerges.



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