Interview: Love in the Time of Cancer: An Interview with Jim Zervanos with Curtis Smith

Jim Zervanos is the author of two memoirs, That Time I Got Cancer: A Love Story and Your Story Starts Here: A Year on the Brink with Generation Z (2024), and the novel LOVE Park. His award-winning short stories and essays have been published in numerous literary journals, magazines, and anthologies. He completed the Narrative Medicine Workshop at Columbia University and is a graduate of the MFA Program for Writers at Warren Wilson College and Bucknell University, where he won the William Bucknell Prize for English and was an Academic All-American baseball player. He teaches at a high school in the suburbs of Philadelphia, where he lives with his wife and two sons and has risen in the baseball pantheon as coach of two Little League teams.

Curtis Smith: Congratulations on the new book. I’m always interested in a book’s journey, especially in the indie press world. Can you tell us how this project ended up with Koehler Books?

Jim Zervanos: Thanks, Curt. For years I’d been sending my several unpublished books to agents, before sending them to independent presses. An earlier version of That Time I Got Cancer: A Love Story was well received by two agents, who each gave me excellent advice and welcomed a revision. The one agent said that the book was too long and that I needed to figure out what it was about; he suggested that my title at the time, The Luminous Interval, was lovely but obscure—just like the book. The other agent agreed that the book was too long and went on to tell me what, in her view, my book was about. Quite simply, she said, it was about two things: how I handled my ordeal with cancer; and how my relationships with my friends, family, and doctors sustained me through it all. It was not, she said, about my life prior to my illness. Indeed, I had incorporated a whole subplot related to the trials and triumphs of my life as a writer, all in a strained effort to add depth and breadth to my story. Her advice was liberating. It was as if she were giving me permission to unburden myself—and the book—of all that personal backstory, and just to let the book be about this one extraordinary experience.

So I cut everything unrelated to those two things:  Love and Cancer—the title I gave to that first revision I optimistically returned to those two agents a year later. I awaited their enthusiastic responses, debating which of them I would choose, should both offer representation. Meanwhile, I had begun noticing, more and more, on social media, my expanding world of author friends and fellow MFA alumni enjoying publication of their books with small presses. These were writers whose work I admired and whose lives—and sudden middle age—I could identify with. When both agents offered their apologies and wished me well, I returned to my submission regimen, but I also queried some of those small presses that had published the books of my peers. By now I had finished a second memoir, about being a teacher of teenagers and the father of two young sons. Within three months, Koehler Books offered to publish That Time I Got Cancer: A Love Story, and days later Vine Leaves Press expressed interest in the same book. I informed VLP that I had just accepted an offer for my first memoir, and, in the same email, I pitched the second memoir. The editor welcomed a look at the new book and weeks later offered to publish it. It was a thrilling time, and now I’m looking forward to the 2024 publication of Your Story Starts Here: A Year on the Brink with Generation Z.

CS: I was familiar with your fiction. Was this your first dive into nonfiction—or had you been working with nonfiction all along? Does the process of writing nonfiction differ from your fiction writing? And if so, how? Did you find any unique challenges in terms of process and/or craft?

JZ: This was my first significant dive into nonfiction. I waited nearly a year after I first got sick, and another six months after the cancer was in remission and I was feeling healthy, before I started writing about the experience. My memory was vivid, and I felt a surge of interest in recording everything I could recall, from that first night in the ER, when I was told “This could be fatal. We just don’t know what this is,” to, a year later, when I was told that it was time for me to accept the symptoms that restricted much of my usual physical activity.

When I first started writing, my approach was to dispassionately document the clinical story, as if for safekeeping, should my own future health depend on an accurate account of the eventful year. When I shared the first few installments with my two best writer friends, explaining that my intention was only to document “that time I got cancer,” their response was encouraging and playfully mocking. The one friend teased, “You’re writing a book. These are called chapters,” understanding that I was reluctant to think my “illness story” could attract a larger audience. The other friend correctly predicted, “I think you just found your title.” Before long, it became obvious to me that the clinical story was inextricably tangled up with the personal story; of course, it was the emotional experience, the love story—and how I reflected upon it now—that would elevate the clinical story to the level of a “memoir.”

The final stage of development was to think of my memoir as I would a novel. Specifically, to think of its real-life story elements—plot, characters, narration, structure, you name it—as I would the story elements in a work of fiction. One great advantage of your book not being published on its first or second (or third or fourth) go-round is that with the passage of time comes increased objectivity and the emotional distance required to be your own ruthless editor. In the early drafts, it was imperative that I get every detail on the record. There were fascinating parallels and connections I didn’t dare cut; every scene, every doctor, every friend who paid me a visit, every clinical twist and turn seemed essential to the story. Everything was precious to me. But eventually I could edit with the reader in mind. I could see, for example, that the ups and downs of regulating my anticoagulation medicine did not make for compelling drama on the page, though it had been the cause for great concern at the time. I could see that there were scenes and even whole chapters, albeit with uniquely interesting interactions and insights, that did not advance the story and even distracted from its core. Inevitably, whatever scene or detail I did keep ended up being more interesting and effective once the redundant scenes or details had been cut.

At last, every chapter and scene found its own unique purpose. Every sentence, every word, was filtered through this more sharply focused perspective, where I could justify, and be pleased with, its existence and placement in the book. Doubtless my experience as a fiction writer and novelist helped me craft the memoir into shape.

CS: This is a very personal story—yet the journey isn’t a solitary one—and I’m wondering about how you handled bringing other people into the narrative. In the end, this is more than your story—much of it delves into the ways illness impacts those we love. Were there struggles here? How did you work through what to keep in and what to leave out?

JZ: At least one writer friend suggested that I consider writing a novel, not a memoir—reasonable advice, considering that as a fiction writer you’re always on the lookout for good material and now I had an extraordinary real-life experience I never could have imagined. As I wrote the story, sticking to the literal truth, I kept an open mind about what the book might become, understanding that fiction provides us freedoms of invention necessary to capture, or enhance, some larger Truth that the actual experience, an actual rendering of it, cannot achieve, for whatever reasons. I remained open to the possibility of writing a novel, but I never felt the impulse or need to break free from what happened, or to channel my story through a fictional persona; on the contrary, it was the actual experience—the recollection and rendering of actual events, along with the intimate, careful expression of my emotions, insights, and exchanges with friends, family, and doctors—that was liberating. There was no need for pretense or invention, certainly not to improve on the plot—to raise the stakes, create suspense, or dial up the drama; for better or worse, those story elements were already baked in.

Another motivation to fictionalize might be to protect or disguise other people’s identities, to avoid hurting feelings, damaging reputations, or destroying relationships. It may be the writer’s business if he wants to expose his own inner life, deepest secrets, and vulnerabilities; but he must be sensitive to the private lives of others—unless he’s asking for trouble, possibly in the form of a lawsuit. When I shared the first draft with my family, some of it caused a stir; it was unpleasant for them, as it had been for me, to revisit some of the more upsetting events and exchanges, which I had done my best to render not just accurately but sensitively. Some of these conversations about the book led to deeply honest expressions of sorrows and regrets. So powerful were these interactions that I was tempted to include these new episodes in the book! You can see how easy it is to get carried away… In the end, their feedback enlightened me to the unique experiences and perspectives of my parents, wife, siblings, and friends, who had all been doing their best under the duress of witnessing a loved one on the seeming brink of death. No one asked me to change or cut a single detail. I think they appreciated the crucial roles they played in a painful story that is ultimately life-affirming, and love-affirming. No doubt they shared in my gratitude that I was alive to write it. Their passionate responses helped me to write a better book, and they made me a better writer.

As for my doctors, the book is a celebration of the art of medicine, practiced, in my fortunate case, by brilliant but also honest and deeply caring human beings. Throughout the course of my illness and recovery, my doctors shared their hopes, fears, and vulnerabilities with me; they included me on their team, all in the interest of achieving our shared goal, the best possible outcome. They informed me when they did not have answers or even theories about my condition or its cause. They offered no guarantees and at times made it clear that whatever fate had in store for me might be terribly unpleasant. Their estimations and predictions were not always correct—fortunately, in some cases. But even when all seemed lost, no one gave up.

All that said, it was a rough ride, for all involved, and several of the many lawyers in my family, after reading the book, cautioned me to consider changing the names of the doctors. This advice was stunning to me—as if I should want to protect the identities of these master practitioners who, together, saved my life. Far from fearing their reactions, I fantasized that they would be pleased by their patient’s heartfelt and medically astute account. When I shared the book with the three doctors who were most crucial to my wellbeing, and to whom I dedicated the book, their reaction was pure delight. To my great satisfaction, they felt the gratitude and love I meant to convey. After reading the draft, they offered their full support on the road to publication, along with a handful of welcome tweaks of the medical details.

CS: I’m interested in the book’s starting point—we begin five or so years after your diagnosis—and then we go back to the illness’s start. What was your reasoning behind utilizing this structure?

JZ: My first draft wasted no time launching into the action in the opening sentence, in that shocking moment when backed-up blood surged into my neck and head. This was all told in the present tense, which I sustained for three hundred pages. I wanted the reader to feel that sudden sense of alarm, of seemingly imminent death, and then the relentless roller-coaster ride of emotions, of relief and terror, joy and sorrow. One of those early, interested agents told me I had succeeded all too well in my mission. It’s too much, he told me. Too hard. Too sad. You need to figure out, he said, how to create some emotional distance for readers. You need to give people a reason to want to spend an hour with your story before they go to bed at night—after their own long days.

I worked hard to follow his instructions, layering the story by developing the backstory, writing numerous pages about my life as a writer prior to falling ill. These were pages I really liked. I was creating emotional distance, all right; in fact, this new content was way out there. This was some serious “meta” stuff I was generating, or so I told myself. The draft tipped over 325 pages. That’s when the other interested agent told me, no, this is not what your story is about.

At this point, five years had passed since I’d gotten sick; a year since I’d finished my first draft. Another of the unexpected advantages of failing to publish your book on your first or fourth go-round: life happens, for better and for worse. My wife and I had drifted apart, and I’d hardly noticed. We’d moved on from our shared traumatic experience, but in different directions. Suddenly, I was seeing my cancer story through a very different lens, one that considered her unique pain in a way I hadn’t appreciated before—not that I ever could, not fully. But realizing this fact—that we had not, in fact, shared a traumatic experience, but had endured drastically different, or even opposite, traumatic experiences—was the first step toward starting over together.

All this came with an epiphany about how to reframe my book. I would write a prologue, establishing this new perspective at the outset, looking back at all that had happened five years earlier, healthy now but confronting the prospect of losing everything that I loved; at least that’s how it felt. We went to therapy. We let go of the past, or of the illusion that we could return to some idyllic version of it. There was no going back, in any case. There was only forward, the future. We had a choice to make. We chose to start over together. The future was uncertain. It was a mystery I welcomed. The five-year PET-scan was negative. I was officially in the clear. And now I had my epilogue. And the title clicked, at last: That Time I Got Cancer. It was all in the past tense now.

CS: Surviving a serious illness is a multifaceted affair—the medical side alone is daunting—but then there are the challenges of the interpersonal, work, insurance, and so much more. I’m wondering how long it took you to process all of these layers and organize them into a narrative that wove in all these different threads. Did you know from the beginning that you wanted to write about this? If not, when did it come to you? Were you writing during your sickness—and if so, was that process beneficial to your mental health at the time?

JZ: On that first night in the ER, I was told my condition could be fatal, cause unknown. For two weeks I lived in a state of dread, anticipating the real possibility that I might die soon, while also living in a state of heightened awareness of being alive, being in love, and being grateful, especially for the tremendous efforts of numerous brilliant doctors. I was not alarmed when I was told, after all, that there was nothing they could do to save my life. Then there was the miraculous surgery, followed by the shocking diagnosis; then chemo—all these developments intertwined with life-threatening complications.

At no time during these months did I think about writing. I had no interest in writing about my ongoing ordeal, or about anything else. I didn’t want to miss a single moment of my life. I wanted to be truly present, with my wife and one-year-old son, with my friends and family, and, when alone, with my breath and body. This was enough. It was more than enough. It was all I wanted. A psychiatrist had introduced me to meditation, and I embraced the practice. I wanted no separation between my conscious mind and experience. Writing breaks that spell; by its very nature, it creates separation from experience, by objectifying it into language. Don’t get me wrong, when I’ve got time to spare, there’s almost nothing I’d rather do than write, and make art, and I’m grateful for the privilege. But I had no time to spare. Instead, I channeled my mental energy into this newfound mission, of being fully awake, in a state of peaceful presence. Day in and day out. Every hour. Every minute. For months.

To this day, I devote myself to developing this practice more deeply—and yet, I have never been so skilled at resting in the present moment as I was during that time, when I came to understand that there is no life without death, no hope without fear; and beyond these pairs of opposites—beyond hope—there is acceptance and awareness—and, ultimately, the simple presence of being. It was not until I was months in the clear, cancer in remission, feeling healthy, that I began to feel drawn back to the story I had to tell. I had come out on the other side. Slowly, I returned to the routines of daily life—work, exercise, and, eventually, writing. Along with these welcome changes came the bittersweet recognition that the natural separation between consciousness and experience had returned. All I needed to do was open the door, and, just like that, I was back in the ER awaiting the results of those first x-rays, or hearing the hopeful words of my surgeon, or gazing out a twelfth-floor hospital window at the city of Philadelphia. I sat down at the kitchen table, ready to tell my story. As if, suddenly, I had time to spare.

CS: I think one of the hardest things for anyone facing a serious illness is navigating the system. Many of us were brought up with the mindset of not questioning our doctors—and thus, deferring to the system in general. Given what you’ve been through, what would your advice be?

JZ: Even after the terrifying presentation of my condition, when my neck and head were flooded with backed-up blood—obvious evidence that something had gone severely wrong inside my body—I wanted to believe I was okay. Minutes had passed. I felt okay. I could have pretended that what I had just experienced was not as bad as it seemed. But instead of going to the Phillies game, which had been the plan before that dramatic episode, I went to the ER, where six hours later I was told my condition could be fatal. Four days later, after a diagnosis proved elusive and I was told that maybe I would be okay after all, I could have found reassurance in such an optimistic outlook. As days passed, I could have ignored the increasing discomfort I felt or pretended it was all in my imagination. But I went back to the hospital. Three days after that, I was told there was nothing they could do; I could have packed my bag, gone home, and waited for the end. My wife and parents could have resigned themselves to grief. Instead, I kept asking questions. My father said, “We go on. Tomorrow more research.” By the end of that terribly dark day, I was visited by a courageous surgeon willing to try something radical. He told me, “There is always hope.” I chose to believe him.

One of my doctors told me I’d been dealt an unlucky hand. I never felt that way. On the contrary, I understood that I was the luckiest patient on the planet. Of course, it was unfortunate to get sick in the first place, but, after that, I had every advantage imaginable. As a public-school teacher, I had excellent insurance. I was young and fit. Because of my upbringing, I was interested in and inquisitive about matters of health. I trusted my doctors and the medical system, confident in myself to engage with them. I had the right mindset and mental discipline not to crack. I had a supportive wife and family. My father was a doctor who helped analyze my condition and marshal attention and assets. I got sick in a big city, where I was admitted to a leading hospital and was treated by world-class doctors who cared deeply about my outcome. This combination of good fortune is the medical equivalent of winning the lottery. Remove any one of these advantages and I could have had a different outcome. Others who confront such illness aren’t so lucky. But we can all share in the goal to make sure every patient gets as many of these advantages as I had.

So: Consider your health care. Get the best insurance you can afford. Be careful how you vote.

And if you should get sick: Be awake. Don’t despair. Ask questions. Don’t assume that every doctor knows the whole story. They may all have their own individual expertise, but none of them knows everything there is to know. The great doctors will tell you this. They will ask you to tell your story. Tell them everything you know, over and over again. You’re the only one who’s always in the room. Everyone else comes and goes. The great doctors will listen to you. They want you to share in the decision-making. Gone are the days of “the doctor is always right.” If your doctor isn’t listening to you, find another doctor.

CS: You also explore the spiritual side of the journey. Can you tell us about this aspect of the experience—and what you found there, either expected or unexpected?

JZ: The truth comes in glimpses. I’ve tried to capture some of these moments in the book. Out of context, they always seem inadequate and obscure. No matter what thought I follow, it falls apart. Or it collides with some other thought, and they negate each other. But that’s the answer, actually. The truth lies beyond those pairs of opposites, where contradictions come up against and cancel each other, and all you’re left with is space. Light. And when you find yourself at ease in this space, at rest in it, it is luminous. You’re free. Present.

Which reminds me of other titles I considered for the book. “The Luminous Interval” comes from the Nikos Kazantzakis quote I used for the epigraph: “We come from a dark abyss, we end in a dark abyss, and we call the luminous interval life.” When I was told that this title was too obscure, I simplified it to “The Light Between.” For me, the light refers not just to life between birth and death, but also to moments of clarity between two distractions. Consciousness between two thoughts. Between two anythings that keep us from the light, that disrupt our sense of presence. Speaking of which, I considered the titles “Present” and “Patient,” whose double meanings point toward the sense of being I experienced (not without innumerable disruptions) throughout my illness and which, since then, I’ve tried to sustain, through meditation, introduced to me by a psychiatrist days before surgery.

Since the question of “spirituality” calls to mind “faith,” I should say that, while all these concepts (presence, being, mindfulness, etc.) may have roots in Buddhism, it is not a tradition I grew up with; but everything I continue to learn about it, and from it, along with the practice of meditation, enhance, for me, the power of Christ’s example, which is not one of passive sacrifice, but one of active love, and which I see (and saw, as I confronted my mortality) as the embodiment of courage and surrender, another pair of seeming opposites that negate each other and, in their absence, reveal the light, of awareness, and of the simple presence of being.

 CS: I could spend the whole interview talking about The Tree of Life, which you allude to in the book. The first time I saw the movie, I was ambushed by tears I couldn’t explain. What about it touched you?

JZ: You’re reminding me that I want to see The Tree of Life again. I haven’t watched it since the year I was sick. And yet, what I love about it is what’s memorable years later. It’s what Terrence Malik also does brilliantly in The Thin Red Line, which features soldiers on a shared mission, interweaving voiceovers and a multitude of characters in distinct settings, creating a panorama of interconnected lives. In The Tree of Life, this style of storytelling works even more beautifully, I think, because the movie is essentially about this timeless interconnected quality of life, of lives. The human voices practically blend into one, reflecting a kind of collective consciousness, which the audience becomes a part of, along with the characters. That phenomenal opening sequence that starts with the Big Bang, the birth of the universe, then cellular creatures forming in primal goo, evolving into land creatures that become dinosaurs, and the scene I write about in the book, where a big dinosaur spares the life of a baby dinosaur—a moment I interpret as “the dawn of mercy”—and then, as if suddenly, human beings, in the twentieth century, mothers and fathers having children who run and play and climb trees and grow old and die…and then, at least on screen, live on for eternity, if only in the memories of their children and in the stories they tell.

What a way to remind us that the Big Bang never stopped, that we’re still living in it; the explosion goes on and on, and everything keeps breaking apart as we’re hurtling in space… But in Malik’s world the human spirit is eternal; it gives order to the chaos, so powerfully that, despite entropy, everything seems aimed in the same direction, back to the source, where life began and begins again…and throughout all this there’s no separating love from this evolutionary trajectory. In The Thin Red Line, the Jim Caviezel character surrenders himself, Christ-like, to countless warriors who will kill him, but he is already gone, selfless, ego-less, liberated, pure in spirit, the moment he decides to sprint away from his fellow soldiers, to be a decoy, to sacrifice his life to save theirs. That’s the ultimate journey: to transcend the self and to recognize and to live the truth that we are one. In an earlier version of my book, I preceded every chapter with a quote, one of which was by Malik: “The nuns taught us there are two ways through life, the way of Nature and the way of Grace. You have to choose which one you’ll follow.”

CS: What’s next?

JZ: First, thanks, Curt, for these excellent questions, which I’ve really enjoyed thinking about and responding to. I’ve got the other memoir coming out next March, 2024, Your Story Starts Here: A Year on the Brink with Generation Z, from Vine Leaves Press. Since finishing that book, I’ve written two short stories, which round out a collection. I also plan to polish an old novel, American Gyro, which I recently revised and hope to publish, along with the story collection. You can find out more at

Curtis Smith’s last novel, The Magpie’s Return, was a Kirkus Indie Pick of the Year for 2020. His next novel, The Lost and the Blind, will be released this September.

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