Rabbit Gets Cancer

 

John Updike, lung cancer

First, a confession. Even though I was an English major years ago, I haven’t read much fiction after the shock of my first wife’s unexpected death in her forties twenty years ago, and this includes the works of John Updike. Only the directness of nonfiction and poetry have been able to penetrate the shell of reality.

I don’t know much about Updike’s cancer. Updike didn’t, either. He knew he had cancer for only one month before he died. I found half a dozen poems in his last poetry book, Endpoint and Other Poems (2009), published after his death. That’s a small amount of material to form any conclusions. The other poems in this collection were written over a number of years.

The situation. In the summer of 2008, Updike was diagnosed with bronchitis. In late November, because his cough wasn’t going away, Updike went into the hospital and was diagnosed with pneumonia. Just before Christmas, a needle biopsy indicated that it wasn’t pneumonia but Stage 4 lung cancer that had metastasized. He died a couple of weeks later on January 27, 2009. He had a short amount of time to write about having cancer, finish writings that were already started, say his goodbyes, and wrap up his life. He probably didn’t feel well or have much energy to do any of this.

Six poems in the “Endpoint” section of his book deal with his hospitalization and diagnosis. The poems are conversational, but not detailed about his medical care. If Updike had had time, would he have written more emotionally-charged poems about the trauma of cancer, or was his poetic style more along the lines of his “Colonoscopy” poem that appears in this collection that is whimsical? 

Mortality and aging had long been concerns of his, especially after he turned fifty, and he wrote poems about other people dying. Also in the Endpoint book is the poem “Requiem” where he speculates on his dying one day – “Were I to die…”

Because details are scarce, I don’t know if he had small cell or non-small cell lung cancer. One of the problems in diagnosing lung cancer is that this cancer doesn’t cause much pain, so it’s hard to notice it growing. Lung cancer is the leading cause of cancer-related deaths for both men and women because of this, and it’s easy to misdiagnose. 

In the last twenty years, treatment options for all kinds of cancers have greatly improved. If Updike were being treated today, his cancer may have been detected sooner, and today’s chemotherapy, immunotherapy, and targeted radiation could be tailored to his genetic makeup. One key drug that is used today is Keytruda, which wasn’t approved for use with lung cancer until 2015, seven years after his diagnosis.

I don’t know if Updike wrote any essays about his cancer or scribbled something in one of his journals, assuming he kept a writing journal. Prof. James Plath, of the John Updike Society, said Updike wrote up until a day or so before he died. Have these words been published somewhere, or were they only for the family?

These are the medical details I’ve gleaned from his cancer poems, and Updike conveniently dated them, although I don’t know if he continued to revise them after those dates:

11/02/08 “Euonymus” – Updike gets a chest X-ray for a persistent cold that is diagnosed as pneumonia. He wonders if pneumonia will be his end, but he’ll wait to find out.

11/06 “Oblong Ghosts” – Updike notices on his doctor’s screen that one lung is paler than the other. He views his pneumonia as a wake-up call because when he researches it, he discovers that old people (over 75) die from it. He’s 76 and wonders if death will enter via his lungs. My question - When you are used to sitting down every day and writing fiction based on your life, do you also pay more attention to your physical symptoms, or are you too busy writing?

11/23-27 “Hospital” – He mentions a half-deafening machine and dye in his blood. 

     I’m guessing this is an MRI because they are horrendously loud and use contrast dye, and it could have been used to detect lung cancer. Today, either a CAT or a PET scan is used for this. If these scan are abnormal, then a biopsy of the lung is done. Both of these scans are quiet.     

    In the poem, before he knows he has cancer, he writes about “desolation” and wanting the presence of his wife. He appears to be worried that his lung problem could be serious, and thoughts about death are on his mind. He’s thinking about those he loved who died, and how he brushed off the seriousness of a dire diagnosis for people he knew in the past. 

12/11 “The City Outside” – He speaks of Strontium 90 being injected.

  For what? Strontium 90 is injected to destroy cancer in the bones, but not for lung cancer, unless it was used in this way in 2008. So this is a mystery, especially if Updike doesn’t yet know he has cancer. He records his thoughts about the world going on outside while he watches from his hospital room. 

12/22 “Needle Biopsy” – This biopsy is on his adrenal gland and he mentions a CAT-scan. 

        He says the results won’t be known for several days as pathology evaluates it. Although he hasn’t said so, he probably knows at this point that he has cancer because a biopsy on the adrenal gland is only done to see if existing lung cancer has metastasized. The CAT scan was probably used to guide the needle in the biopsy. 

12/22 “Fine Point” – “Surely goodness and mercy shall follow me all the days of my life.” 

     This is Psalm 23:6, the “walking in the valley of death” psalm. This poem is also dated the day he had the biopsy so while he probably knows he has cancer, he wouldn’t have known it has metastasized and his life is on a short timeline. Perhaps shortly after this he begins chemotherapy. What he is doing here is acknowledging that things were now out of his control and he is seeking reassurance for whatever is coming.

What can we learn from John Updike’s experience with cancer? 

1 – Updike ignored his lingering cough and it developed into metastatic lung cancer. 

2 – Doctors misdiagnosed Updike’s situation. Twice. And he probably had top-notch doctors.

3 – Lung cancer is hard to diagnose in its early stages when it’s curable. 

4 – If you have a persistent cough, (or any ailment that hangs on) get it checked out. If one treatment doesn’t work, advocate for yourself and push to get a treatment that does.

My thanks to Prof. James Plath for some of this information. If anyone knows more details about Updike’s cancer, please let me know.

© 2026 Mark Liebenow