Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

Laura Linney, the extraordinarily gifted and versatile actress, has been nominated for a 2011 Emmy in her role as Cathy Jamison in the unlikely comedy The Big C. She is both the star of this acclaimed Showtime series as well as an executive producer with a real voice in the creation of this program.

Cathy, a model Midwestern wife, mother and public school teacher has always been the “good girl.” Like so many other women in midlife, she had not taken time for self-knowledge or reinvention until the diagnosis of Stage 4 melanoma became the impetus for her transformation. In Season One, we followed Cathy as she chose to live life fully, opting not to tell her family about her diagnosis and refusing any treatment.

In the current season, Cathy realizes that she wants to live as long as she can. She begins to fight for her life with the conventional therapy available for Stage 4 melanoma patients, which fails. She then fights for acceptance into trials of experimental drugs. “I want that time,” she says.

This is a comedy, albeit one with a very dark shadow. Cathy’s metamorphosis into a free spirit, into a woman who becomes sexually alive and independent is perfect fodder for hilarious situations. Buying marijuana, getting high, dealing with emotionally complex situations, Laura Linney’s character rides a wild roller coaster, taking the audience along. Cathy deals not only with cancer and its treatment but also with the many people in her life who feel that the effect of her cancer on them is as important as her struggle to live life fully while fighting to stay alive. Over and over Linney uses her oversized gifts to let everyone know that her character is the star of this cancer drama, mining poignant and humorous situations with a vividness that few actresses can manage.

The audience is, of course, pulling for a miraculous outcome, yet we all know the house always wins in this one. Cathy’s illness is terminal and each of us brings our own relationship to mortality along as we follow her journey each week. The foreshadowing of death is ever present; “I am starring in my own Greek tragedy” is the way Cathy describes it at one point.

I know more than I care to know about the trajectory of patients with this diagnosis. I was one of hundreds of people who were BFF with a dynamo named Katherine. Once you were in her life, you never left. But she left us. She had all the risk factors for developing melanoma: fair skin, blond hair, blue eyes and years of sun worshiping and sun burns from childhood on. Her first melanoma was diagnosed when she was 35. Stage Zero and removed appropriately. The next one showed up when she was 41 and it was already Stage 4. Kathy entered into battle with grace and courage. She fought with every experimental program on the planet, including whole brain radiation after two brain operations at 42 and 43 failed to control the melanoma recurrence. Her last birthday was in October when she reached 45 and the closest of the BFF group were with her to celebrate. She died a few months later, just a little over four years after the Stage 4 melanoma was discovered.

Laura Linney’s Cathy says at some point in the second season: “I don’t want my death to be desolate. If that happens I will know that I have done something really, really wrong.” My friend Katherine’s death was certainly not desolate and she surely was not alone.

In August last year I had a normal looking, long standing mole removed from my right shoulder. My new skin cancer doctor, Dr. David Becker, removed it against my wishes because he thought it looked a bit different from the other pigmented lesions that decorate my fair skin. “You could be the poster girl for melanoma with your red hair, blue eyes and freckles everywhere,” he told me. Ten long days later he gave the doctor her diagnosis, “Stage Zero, melanoma in situ. You are one lucky woman”.

Still, I know all about this skin cancer that arises in the melanocytes, the cells that produce the pigment melanin that colors the skin, hair, eyes and moles. This skin cancer can be detected early sometimes but it doesn’t always look abnormal and it can begin in the eye, digestive tract, brain, vulva or vagina. It can start anywhere melanocytes can be found. And having had a melanoma, even a Stage Zero one, increases the chance that another will show up.

The complex character, Cathy, and my dear Katherine, both learned throughout the process of cancer diagnosis, cancer treatment and living with cancer that “knowing that life is going to end” has a way of focusing the time left in this life.

Everyone should watch The Big C. There is no better depiction of the stages of acceptance of a cancer diagnosis, no better presentation of the complicated relationships between medicine and patient, and of the experiences between patient and those who know and love her.

Laura Linney deserves more than an Emmy for this gift.[

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  • Kathy Rogers August 24, 2011 at 1:51 am

    Wow. I cannot remember the last time I read something that educated me, touched my heart, and spurred me to action (I have one of those benign-looking, “different” moles, too), all at once.
    Bravo, Dr. Pat.

  • S. Bewkes August 23, 2011 at 12:52 pm

    What a FABULOUS piece on every level!!! I have never seen this show but I am a huge Laura Linney fan – perhaps I might hulu it so I can see it from the beginning! And I’m making my full body dermatology check appointment today!! Thank you again for another thoughtful and poignant post!!