Instructions Not Included: How to Read Your Own Scans Without a Map or a God

There’s a woman in the waiting room at the cancer center who reminds me of Virginia Woolf.

Not because she looks like her—she doesn’t. Her face is plain, her cardigan pilled, her shoes orthopedic and sensible. But her presence arrests me. She’s still in a way that feels pre-electric. Not distracted-still, not phone-still—old-soul still. She holds an actual book in her lap, not a Kindle, and it rests there like a weight she’s decided not to carry all the way. Her eyes move slowly, deliberately, like she’s cataloguing each of us for a novel no one asked her to write. She sits with her ankles crossed, hands folded—not in comfort but in containment, like if she let them go they’d reveal something unseemly. When a nurse calls a name, she flinches—not like she’s startled, but like being summoned reminds her she still lives inside a body, still must answer to it. She doesn’t look sick, but she doesn’t look well either. She looks… unavailable. Like her spirit is elsewhere, whispering down hallways I’ll never walk. And in a room full of sweatpants and exhaustion, she’s dressed with a kind of intentional dishevelment—a cardigan that’s seen too many winters, hair pinned like she got halfway ready and lost interest. She glances at me just once, but it’s the kind of glance that feels diagnostic, not of my illness, but my interior. Like she knows pain that has chapters. I sit up straighter. Not from respect, but curiosity. She makes me feel like this isn’t a room for recovery—it’s a room for witness. I don’t ask her name. I don’t need to. She’s Virginia. Not the Virginia. But close enough to crack something open in me.

And maybe I only saw her because I was primed to. Maybe it started last summer, when I stumbled across a worn copy of Mrs. Dalloway tucked between the sisterhood of the traveling pants and the Book of Mormon on a farmhouse bookshelf belonging to Afton Bitton—a name that sounds like a folk singer but is actually my landlord’s late cousin. The book had underlines in red pen and someone had scrawled “why won’t she just say what she means??” in the margin. Was it one writer questioning another? I read it anyway. Slowly. Like swallowing something bitter that might still heal you.

Or maybe it was Nicole Kidman’s prosthetic nose in The Hours, still lodged in my brain from a decade ago, from some late-night binge of sad women movies I used to watch when I thought sadness was still glamorous. That version of Virginia—hunched, haunted, holding stones in her pockets—never really left me.

Or maybe this version of her, in the waiting room, is just the part of me that still needs to believe illness has depth. That this isn’t all paperwork and stool softeners. That if we’re going to be broken, we might as well be artfully broken.

And that’s when the blog post begins writing itself.

Not as a manifesto. Not as a trauma-dump.

But as an observation. A noticing.

Because that’s what Woolf did.

She noticed the world’s soft violence.

There’s a kind of stillness they don’t warn you about with cancer. Not the meditative kind. Not the kind you chase with deep breathing and goat yoga. This stillness is crueler. It comes in waiting rooms. Between scans. Between bowel movements. Between being a person and becoming a patient.

On this particular day, I was waiting to find out what my scans read.

To actually have them read to me—since in the course of my four years of being in and out of ER rooms and doctor’s offices, not one single physician has ever sat me down to show me what my scans look like. Not one has pointed to the tumor in my ass and said, “Ah, and there it is. See right here? This blob of fuzzy bright light? That’s the tumor. And it’s: shrunk, expanded, or stabilized since you started eating only the flesh of the animal kingdom.”

That’s what most of the television shows about cancer miss. Like The Big C, where Cathy is on a first-name basis with her oncologist, and they sit in his softly lit office with a high-resolution monitor where the brightness is crucial to see all the fine details of your scanned imagery. Nobody does this anymore. Not your oncologist. Not your radiologist. They just hand you a CD of your imaging you’ll have no way of viewing—because what personal computer made in the last five years even comes with a slot for a disc?

They will hand this obsolete disk to you like it’s a gift and expect you to map out the terrain of your own failing body on your own. An impossibility—I’ve tried.

So when they called to confirm me for “chemo class” this past Monday—a few hours where they explain how chemo works like it’s a job orientation—I told the scheduler I would not be attending unless someone sat with me and showed me my own scans. Pointed to the blob. Told me with certainty whether it had grown or shrunk or just loitered there, malignant and smug. I said, “I’m being charged for my last three scans because Medicaid refused to cover them. Said they weren’t medically necessary. And frankly, I have to agree with them—because if they were necessary, I’d expect someone to actually read them to me.”

I told her how appalled I was. How doctors can order $4,000 scans with no obligation to explain what they see. That I’ve been ruminating on this for months now, flashing back to the first scan I ever had in 2021, wondering if that radiologist in that state-run hospital ever even looked at my asshole—the literal shining star that brought me in with symptoms to begin with.

So I refused chemo class.

And somehow, my stubbornness prevailed. That’s what brought me to this waiting room early, where a woman named Teresa eventually pulled me aside to flip through my scans like they were a picture book for adults. And still—somewhere across the room, sat Virginia. Watching. Not judging. Not fixing. Just noticing.

I wonder what she’s here for.

She would have asked not what’s wrong, but where does it begin?

She wouldn’t be satisfied with “there’s a mass.” She’d want to see the contour of it, the shadow where her soul once lived. She’d want to know what her body was hiding from her—what secrets it had been keeping in the soft tissue, what grief had calcified into brightness on a screen.

And she wouldn’t ask gently.

She’d demand—with that clipped, elegant fury of someone who’s been underestimated all her life.

Not for the spectacle.

But because language matters.

Because naming things gives them shape.

Because pointing at the tumor is a way of saying: This is real. I see it. I am not afraid to look at what’s killing me.

And if the doctor dared to say, “It’s just standard practice,” she’d say,

“So was the corset.”

She would’ve written about the vending machine hum. About the antiseptic lemon smell that doesn’t quite mask the panic. About the chairs that squeak when you shift your weight and remind you that even your sitting isn’t casual anymore.

She would’ve written about the woman who flinches when her name is called.

Who looks like she’s been holding a sentence in for years.

Who might be me.

Who might be you.

Who might be Virginia.

And she would’ve ended it not with hope, but with recognition:

“Some of us are here to be treated. But some of us are here to watch. To write. To survive just long enough to say something true before the lights flicker out.”

A blog post by Rachel Smak on grief, loss, and lessons from stage 3C rectal cancer