Continuing To Live While Dying

Nina Riggs, breast cancer

In her book, The Bright Hour, Nina Riggs talks to us as a friend, keeping us up to date with what’s going on in her life and with her triple negative breast cancer. We don’t have to the building tension of wondering if she is going to survive or not because she lets us know in the prologue that she has eighteen to thirty-six months to live. This allows us to relax and be with her in her day-to-day life. She shares how she continues to live her life in between cancer treatments as she raises two young boys with her husband John. The writing is presented in snapshot moments.

She recounts the kinds of cancer her family has had, including her grandfather who had breast cancer and a mastectomy. Her dad’s older sister had the BRCA2 breast cancer mutation and developed breast cancer, and while Nina does not have the mutation, she learns that in families with the mutation, even family members who don’t have it are at greater risk of developing the disease than the general population.

Being the great-great-great granddaughter of Ralph Waldo Emerson, she quotes him now and then. Both of them are thinkers and writers. But she really finds companionship with Michel de Montaigne. In one place Montaigne sums up her situation when he says that “Death everywhere mingles with and is blended into our lives.” Later Nina would conclude that he wouldn’t have been a fan of chemotherapy because he didn’t like to cure one evil with another.

There is humor throughout, as when she makes a list of things that are worse than death – old grudges, severe constipation, the grimace on her husband’s face as he empties her surgical drain into a cup. Meanwhile, her mother has been battling multiple myeloma for eight years, and she dies in the book, but not before sharing her wry wit.

Her friend Ginny is diagnosed with the same kind of breast cancer a short time after Nina, and they support each other during their treatments. Like Elizabeth McCracken, who wanted to create thank you cards for people who give clueless responses after the birth of her stillborn baby, Ginny comes up with the idea of making morbid thank you cards for when people offer generic well wishes to someone with terminal cancer – “Thoughts and prayers are great, but Ativan and pot are better.”

Reviewers have described Nina’s book as “tender and heartwarming,” and this is true, but I don’t read cancer books because they are nice. When you have cancer, there is pain, gore, suffering, nausea, trauma, discomfort, and darkness filled with the dread of dying. Nina’s book also includes this reality.

We read about her cancer progressing, even though her doctors are trying different therapies, but the narrative never becomes too heavy. Nina will mention a setback, but then tell a related story that isn’t so bleak and, in a way, balance is restored.

Because of the invasiveness of cancer and the indignities of treatments, she loses her sense of who she physically once was. After the removal of one breast, she mentions her “obliterated sense of femininity, the skewing of self, the strangeness of the body.”

Nina doesn’t limit her focus to what she is dealing with. She’s also aware of what her doctors have to endure. The struggles of cancer patients can’t be easy on them. ‘What do they say to you,’ she wonders, ‘when they’ve done what they know to do and you still have cancer?’ Speaking of her oncologist, Dr. Cavanaugh, Nina says “in her ocean eyes I can see all the trenches and ledges of a cancer doctor.”

Late in the book, Nina notes that she finally checked the survival rates for women in her situation and doesn’t find them encouraging. When I was going through the steps of being diagnosed, before I knew which Stage I was in, I was given a booklet that had the average length of survival for each Stage, and I looked because I wanted to know the reality of what I was facing. In his book, Paul Kalanithi says that his doctor would not tell him where he was on the Kaplan-Meier curve because she didn’t want him to limit how he chose to live to align with set expectations. I have not checked my K-M curve because my diagnostic numbers were high on every test, and I don’t want to know the statistic of finality. I’m okay existing in the space between living and dying as I continue to do what I can to stay healthy.

There is a detail that unsettles me. The early diagnosis by her doctors was that her cancer was confined to one tiny spot, and treatments began. Somehow this spot metastasized and spread. This reality probably haunts all of us who have cancer because what is going to stop our cancers from metastasizing if our doctors don’t get it all? Paul died at age 37; Nina at age 39, both less than two years after they were diagnosed.

Nina’s book is a moving record of a gracious, loving, and funny person on her sojourn with cancer who has to wind her life down when other people her age are just hitting their stride.

What can we learn from Nina that we can use with our own cancers? She says: learn what to yield to and when, stay in the present with what is going on medically, do not extrapolate into the future, and do not hold what is going on too tightly or too loosely.

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Nina wrote an essay for the “Modern Love” column in the New York Times about trying to find the right couch for her family before she dies, paging through endless offerings on the Internet, trying to select the right covering and wood, and asking her family what they’d like. Of course they want different things, but she wants to continue to mother them after she’s gone.

Lucy Kalanithi read the column after Paul died, sent a note of support, and correspondence began between them. As she was nearing death, Nina told her husband John to contact Lucy for pointers on how to grieve. Besides sharing their grief, I imagine they bonded over how hard it was to watch someone they love struggle and die of cancer.

One of the great joys when we have cancer is finding people like Nina who understand and care. I think she would say, even if you’re dying, don’t forget to live each day.

© 2026 Mark Liebenow