The Middle Place: Breast Cancer and Her Father's Bladder Cancer at the Same Time

Kelly Corrigan's title names a stage of life rather than a place. The middle place, as she defines it, is a sliver of time. It is where parenthood and childhood overlap. You are raising small children. You are also, still, somebody's kid.

She was thirty-six and living in California with a husband and two young daughters. She was writing a column. Then she found a lump in her breast.

Not long before that, her father George had been diagnosed with cancer at a late stage. He was in Baltimore, three thousand miles away. He was an Irish-American charmer. His high spirits had shaped how his daughter saw the world.

So the book runs on two tracks at once. Corrigan is a patient with her own chemotherapy schedule, and she is a daughter trying to manage her father's illness by telephone and airplane. The two roles do not take turns politely. They collide.

That collision is the reason the book exists. It is why the book still gets passed along fifteen years on. Most cancer memoirs have one patient in them. This one has two, and the narrator is one of them.

The memoir runs to roughly 290 pages in the original 2008 Voice edition. It braids two timelines. It does not divide into parts.

One timeline is the present. The lump, the biopsy, the diagnosis, chemotherapy, surgery, hair. Then the daily puzzle of small children during treatment. And the odd loneliness of a marriage where one person is ill and both are afraid.

The other is childhood. Long flashbacks tell of growing up in Philadelphia with George Corrigan: the coaching, the phone calls, the mottoes, the unearned confidence he handed out to everyone he met. These chapters are the book's engine. By the time her father's illness becomes urgent, the reader knows exactly what is at stake.

Her father's treatment runs through both. She describes it the way families live it: partial information, hopeful readings of it, second opinions. And the strain of a family split over how much to say aloud.

There is no medical apparatus. No glossary, no staging tables, no list of resources. Corrigan is a memoirist. The clinical content is whatever she was told.

The book was first published in 2008 by Voice, and a trade paperback followed from Grand Central Publishing in 2009. It sold in large numbers, mostly by word of mouth. Corrigan went on to write more memoirs about her mother and her father. That later work is worth knowing about. It means this book is a slice of the family, not a summary.

One situation is far more common than the books suggest: being the person getting care and the person giving it at once. This is the best-known account of it.

It is precise about the guilt in that position. The daughter who cannot fly out because she has an infusion. The patient who minimizes her own diagnosis so her parents do not worry. The sibling arithmetic about who does what.

It is also good on the daily grind of treatment with young children in the house. Naps, school pickup, the friend who organizes meals. And the way a four-year-old asks the blunt question everyone else is dodging.

And it is funny, which matters. Corrigan's comedy is not brave-face comedy. It is the family kind, used to hold a room together.

NCI's caregiver support guidance describes the same role changes the book stages. It names adult children becoming the main support for a parent as a common pattern. It also names helping with day-to-day activities, medications and doctor visits, and coordinating care from a distance. Corrigan's version simply has a chemotherapy schedule laid over the top of it.

One more thing it captures well: the way information moves through a family. Corrigan hears about her father's scans third-hand, from whoever answered the phone, and pieces the picture together from fragments. That is closer to most families' experience than the clinic's version, where everything is written down in one place. It is a good argument for agreeing early on who calls whom.

The treatment details are from the mid-2000s and are incidental to the story. Breast cancer treatment has changed a great deal since. Tumor biology is now used to decide who needs chemotherapy at all. Nothing here should be read as a description of what a person diagnosed now would be offered.

Her father's diagnosis and treatment come to us secondhand. They are filtered through what a family was told and what they chose to repeat. The book is not a source of information about bladder cancer, and Corrigan does not present it as one.

There is also a structural risk. Corrigan is charming and her father is hugely charming. So the book can make a very hard year read as easier than it was. Readers in the same position sometimes report feeling that they are coping badly by comparison. That comparison is not a fair one. A memoir is edited. A life is not.

Finally, it is a book about one kind of American family. Well off, insured, spread across the map, able to buy plane tickets at short notice. The logistics look different without that.

NCI's caregiver material is direct about the fact that this role has costs. It says caregiver stress has both physical and mental effects. Those include fatigue, weakened immune response, broken sleep and changes in mood.

Its guidance on self-care is unusually plain for a federal page. It says to find time to relax. It names at least fifteen to thirty minutes each day to do something for yourself. It says to keep your own medical appointments. It says to watch for depression or anxiety lasting more than two weeks. It says to exercise and to get enough sleep. It names support groups, counsellors, spiritual leaders and journalling as outlets. And it says to keep personal routines going rather than let them collapse.

On help, NCI is blunt: many caregivers regret not seeking assistance sooner. It suggests handing off household chores, childcare, rides to appointments and talking to other people. It also notes that accepting help can ease things for the patient. Otherwise the patient may feel guilty about all the caregiver is doing.

NCI's own caregiver pages do not cover the case of a caregiver who is also a cancer patient. That is Corrigan's situation, and it is a real gap. The palliative care guidance adds one thing. Palliative care teams include support for family members handling stress and duties. They also cover practical worries such as money, legal and insurance matters. That is one route to asking for help without having to invent the request. Becoming a parent's caregiver and reversing family roles covers the role change itself, and caregiver burnout covers the warning signs. Corrigan had breast cancer while her father had bladder cancer. The book is about being a patient and a daughter in the same year.

Because the book leaves her father's disease vague, the honest thing is to set out what the federal picture actually is.

NCI describes bladder cancer as occurring when cells in the bladder start to grow without control. Almost all bladder cancers are urothelial carcinoma, also called transitional cell carcinoma. It starts in the cells lining the urethra, bladder and ureters. Rarer types include squamous cell carcinoma, adenocarcinoma and small cell carcinoma. Cancers are also sorted by depth. They are either non-muscle-invasive, the more common kind, or muscle-invasive.

On risk, NCI states that using tobacco, especially smoking cigarettes, is a major risk factor for bladder cancer. MedlinePlus adds workplace chemical exposure, older age and family history. It notes that bladder cancer is the sixth most common cancer in the United States.

On symptoms, MedlinePlus lists blood in the urine, a frequent urge to urinate, pain when urinating, and low back pain. NCI notes that many bladder cancer symptoms also occur with less serious conditions, which is the usual reason people wait.

On treatment, NCI describes surgery as the main treatment. For early-stage disease that means transurethral resection with electrical cauterization. Other options are partial cystectomy, or radical cystectomy with a urinary diversion. NCI also lists intravesical immunotherapy, including BCG, put right into the bladder. Radiation, chemotherapy and targeted therapy are on the list too. Which of these applies depends on stage, grade, overall health and the person's own wishes.

Bladder cancer symptoms and bladder cancer treatment go through both in more detail than a memoir can.

It suits adults in their thirties and forties who are handling a parent's illness and their own. It suits them if they have felt that nobody writes about that.

It suits readers who want a family story rather than a medical one, and who like a narrator with jokes.

It does not suit someone looking for facts about breast or bladder cancer. The clinical content is thin and dated. It may also not suit a reader who finds warm, comic narrators grating during a hard stretch. Nor a reader caring for a parent they do not adore. Corrigan loves her father plainly, and not every family works that way.

• NCI — Bladder Cancer
• NCI — Bladder Cancer Treatment (PDQ), Patient Version
• MedlinePlus — Bladder Cancer
• NCI — Support for Caregivers of Cancer Patients
• NCI — Palliative Care in Cancer
• Hachette Book Group — The Middle Place

This page discusses The Middle Place for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care.