I write from oncology’s dirty margins.
In surgical pathology, a “dirty margin” signifies the presence of cancer cells beyond the defined boundary of excision. It marks incompleteness, residual threat, and the persistence of disease beyond containment. In the clinic, it is a technical term. In lived experience, it becomes existential. A dirty margin is not only a diagnostic fact; it is a temporal condition. It signals that cure is uncertain, that eradication may not be possible, that life must now be negotiated alongside disease rather than beyond it.
I have lived on margins before.
When I was a teenager. It was the height of the AIDS epidemic. Fear and uncertainty were constant companions. We did not know enough. We did not know who might fall ill next. We did not know what the future would hold for our community or for ourselves. Government responses were uneven. Public discourse oscillated between silence and stigma.
I began my professional life in New York City as an openly gay secondary school teacher at the beginning of my career, right after the AIDS epidemic. To be visibly gay in a classroom required courage and calculation.Footnote 1
I remember the quiet ambiguity of that time more than its drama. The not knowing. The waiting. The way conversations shifted when certain topics entered the room. I remember continuing to teach each day with a sense that knowledge itself mattered deeply. Education was steadiness. It was present. In the classroom, I taught literature, but I was also modelling endurance. I was living openly, refusing disappearance, demonstrating that uncertainty did not negate purpose. Knowledge was power. Learning was a possibility.
Living through that period forged my intellectual commitments. Queer theory, critical literacies, and poststructuralist feminism were not abstract fascinations. They were tools for understanding how bodies become politicized, how discourse shapes vulnerability, and how power circulates through institutions. They provided language for navigating ambiguity without surrendering to it.Footnote 2
From New York, my career expanded into new margins: international development and cross-border justice work. I worked with communities lacking access to legal representation, navigating systems not designed for their protection. I assisted minority populations whose knowledge and rights were routinely marginalized. That work broadened my horizon and deepened my conviction that those positioned at the edges of power often see its operations most clearly.
During this period, I returned repeatedly to AIDS prevention work. In Thailand, I contributed to the development of publicly accessible YouTube learning material for sex workers, designing graphics and printed resources intended to make knowledge accessible, clear, and affirming rather than moralizing.Footnote 3 The aim was not only risk reduction but also dignity. Language mattered. Imagery mattered. We sought to inject bright light through knowledge and communication, countering stigma with clarity. Sexuality was not something to be hidden; it was something to be understood. Education became prevention. Literacy became protection.Footnote 4
That work remains foundational to how I understand erotic life. Sexuality is never merely private. It is shaped by discourse, policy, and access to information. It can be regulated through silence or liberated through language.
In this piece, the private and the public are comingled. For most of my adult life, I have been in committed relationships with men. Long-term partnership provided a form of steadiness amid professional mobility, activism, and academic life. It offered a sanctuary of care, shared routines, and everyday intimacy to return to when work carried me across cities and countries. My twelve years of marriage, sustained through international relocations and professional transitions, provided a foundation for the ordinary architecture of partnership: friendships, routines, community, and the quiet comfort of belonging. Partnership became not only home, but also the ground from which we navigated cancer as both insiders and outsiders.
Throughout these professional decades, illness was something I initially encountered through others. Close family members died from cancer and deteriorated despite intervention. I made trips from Australia back to the U.S., trying to grab a little more time together. I witnessed hope and limitation coexisting in the same room. Part of me is still grieving them. Grieving the time we lost, and grieving the connection with distant loved ones. Their absence remains present in my own confrontation with mortality.
I did not imagine that cancer would become my own lived condition.
When the diagnosis came, it arrived first as Stage 3 and potentially curable. The word curable reorganized everything. It offered a horizon. It promised restoration. I underwent major surgery. I endured immunotherapy. I adapted to a body permanently altered. For a time, we lived with disciplined optimism.
Then metastasis. Stage 4. Treatment failure.
The arc of cure fractured, but life did not.
The paradox persists. My clinical care has been exemplary. My oncologists and surgeons practice with skill, compassion, and integrity. They have extended my life and alleviated suffering. I trust them. At the same time, I have encountered systemic silences around ambiguity, around erotic life, around what it means to live meaningfully without cure as a horizon.
Gratitude and critique coexist.
Advanced cancer patients often inhabit cultural dirty margins. Cancer culture is symbolically organized around survivorship and cure.Footnote 5 Those living beyond cure occupy a more precarious narrative space. They are medically central yet culturally peripheral.
For minoritized scholars, this marginality compounds. As a queer academic, I have long navigated insider and outsider positions simultaneously. I have held leadership roles while also encountering epistemic exclusion. Cancer intensifies this dynamic. The body becomes both clinically central and symbolically displaced.
Simultaneously, I continue grieving others while living with my own prognosis. The deaths of family members from incurable cancers are not distant memories. They accompany me. Grief is layered. It is retrospective and anticipatory. I mourn them while imagining how others may one day mourn me. I mourn the time I lost with my partner, in our home and life we built together, and a foreclosed future.
Yet uncertainty has never extinguished purpose. It has sharpened it.
The central question of this article emerges from that layered experience:
How can a cancer pathography that holds praise and critique together queer and crip the clinic? What analytic work becomes possible when sexuality, ambiguous grieving, and institutional marginality are foregrounded rather than bracketed? What remains valuable in humanities methods under conditions that biomedical discourse might classify as treatment failure?
This article argues that minoritized autopathographies do more than recount suffering. They theorize it. They convert embodied marginality into analytic intervention. They reveal how cure culture narrows the horizon of value and how relational endurance, erotic life, and institutional labor expand it.
In writing from oncology’s dirty margins, I do not reject biomedicine. I complicate it. I hold gratitude alongside critique. I treat contradiction as a method. This is a queer gesture. It refuses the binary of good care versus bad care. It refuses the reduction of value to restoration alone.
The pages that follow situate this autopathography within scholarship on illness narrative, queer and crip theory, and contemporary critiques of cancer culture. They mobilize lived experience not as anecdote but as an analytic site.
Ultimately, I contend that such narratives transform suffering into meaning, pedagogy, and legacy. They become acts of queer resistance that teach us how to live and die with authenticity and love.
Writing from the dirty margins is not confession. It is a method. It is a critique. It is pedagogy.
And it is, perhaps, the trace I hope to leave.
1. Narratives, margins, and erotic silences
1.1. Pathography as resistance
Illness narratives have long functioned as a counter-discourse to biomedical reductionism. Arthur Frank’s typology of restitution, chaos, and quest narratives positions storytelling as an ethical act that restores voice to patients rendered objectified by clinical regimes. Anne Hunsaker Hawkins conceptualizes pathography as a genre that mediates between private suffering and public meaning. G. Thomas Couser extends this analysis, arguing that autopathography resists the medical colonization of identity.Footnote 6
Audre Lorde’s The Cancer Journals exemplify this resistant tradition. Lorde refuses prosthetic concealment and insists on the political visibility of the mastectomized body. Her work demonstrates that illness narrative can expose the gendered and racialized dimensions of care.Footnote 7 Similarly, Lochlann Jain’s Malignant interrogates cancer culture itself, revealing how optimism and survivorship discourse obscure structural inequities.Footnote 8
Together, these scholars show that pathography is not merely descriptive but critical: it challenges dominant scripts, reclaims subjectivity, and destabilizes biomedical authority.
Yet advanced cancer authored by minoritized scholars remains under-theorized. The “dirty margins” of oncology, where cure is improbable, generate a distinct narrative condition. The question is not restitution but endurance. What analytic work can pathography perform when cure is not the horizon?
1.2. Dirty margins: cure culture and exclusion
Contemporary cancer culture privileges survivorship and cure-oriented narratives. Pink ribbon campaigns, early detection rhetoric, and narratives of triumph saturate public discourse. While these frameworks mobilize hope, they marginalize those living beyond cure.Footnote 9
Jain’s critique of cancer optimism reveals how survivorship narratives discipline patients into gratitude and positivity. Recent scholarship between 2020 and 2025 further documents how advanced cancer patients experience symbolic exclusion within cure-oriented communities. Those who do not “beat” cancer often become culturally invisible.Footnote 10
The Out with Cancer project extends this analysis to LGBTQ+ populations, identifying elevated distress, invisibility, and unmet psychosocial needs. Empirical findings indicate that queer patients frequently encounter clinical environments insufficiently attuned to sexuality, identity, and relational complexity.
“Dirty margins” thus signify more than pathological residue. They describe a sociocultural condition in which certain cancer bodies are less narratively accommodated.
1.3. Queering illness and cripping the clinic
Queer and Crip theoretical models provide conceptual tools for interrogating cure culture. They provide lenses that connect marginalized groups who have shared parallel experiences of oppression. Queering illness destabilizes heteronormative temporality. Cripping the clinic resists linear progress narratives and recognizes alternative modes of living well. Queer and crip epistemologies value marginal knowledges precisely because they destabilize dominant frames.
Robert McRuer’s critique of compulsory able-bodiedness exposes how normative health operates as an ideological expectation. He argues for centering disabled experiences, challenging assumptions about diverse bodies, and promoting inclusive practices that embrace rather than purge disabled lives from clinical spaces. Alison Kafer’s political/relational model of disability reframes futures not organized around restoration. She critiques what she calls compulsory able-bodied futures, the assumption that only restored bodies count as desirable outcomes. The approach also acknowledges that concepts of disability always intersect with notions of race, class, age, gender, and sexuality. Eli Clare interrogates cure as a cultural compulsion rather than a neutral aspiration, interrogating why cure is positioned as the only meaningful endpoint. Eve Kosofsky Sedgwick’s reparative reading invites attentiveness to affective complexity rather than paranoid exposure alone.Footnote 11
To queer illness is to destabilize heteronormative temporality. To crip the clinic is to resist linear progress narratives and recognize alternative modes of living well.
“Treatment failure” becomes a particularly potent site for this intervention. Rather than signifying an endpoint, it may mark a shift in temporality and value. Living beyond cure destabilizes biomedical binaries of success and defeat. When restoration is no longer possible, “treatment failure” marks a shift in temporality and value.
1.4. Erotic erasure and pleasure’s politics
Despite growing scholarship on sexuality and illness, erotic life in advanced cancer remains marginal within both empirical research and cultural representation. Muñoz’s queer utopianism conceptualizes desire as horizon-oriented relationality. Lauren Berlant’s analysis of intimacy and cruel optimism illuminates attachment within constraint. David Halperin’s work on gay male sexual culture underscores the political significance of pleasure.Footnote 12
Recent empirical studies from 2023 to 2025 document persistent gaps in oncology’s engagement with LGBTQ+ sexual wellbeing. Reduced libido and intimacy challenges are acknowledged clinically but rarely explored relationally. Gay men’s pleasure narratives, in particular, remain underrepresented in survivorship literature.Footnote 13
This silence is not incidental. It reflects broader cultural discomfort with ageing, disability, and queer sexuality.
Queer and crip epistemologies value marginal knowledges precisely because they destabilize dominant frames.
Writing from both insider (academic, institutional leader) and outsider (queer, terminal patient) positions requires reflexivity. The methodological stance adopted here holds contradiction rather than resolving it. Gratitude and critique coexist. Praise and disruption are not opposites but a queer gesture.
2. Method: autopathography as queer-crip epistemology
This study adopts autopathography as a method. Against this backdrop, autopathography becomes a method. Following Hawkins, Couser, and Frank, this paper positions embodied narrative as an analytic practice.Footnote 14 Here, lived experience is mobilized not as an anecdotal illustration but as an epistemic site.Footnote 15
The methodological orientation is specifically informed by queer theory and crip theory. Rejects claims to neutrality and instead foregrounds positionality, embodiment, and power. Writing from the margins is therefore not merely descriptive; it is situated knowledge production that engages with, and produces, reflexive narrative accounts of diagnosis, treatment, and institutional life. The pathographic approach permits a mode of knowing that emerges from embodied marginality and insists that suffering can generate analytic clarity by means of analytic testimony.
By situating personal narrative within established theoretical frameworks, the project here seeks to generate conceptual insights into cure culture, erotic erasure, and institutional temporality.
Ethically, the method acknowledges vulnerability without collapsing into confession. It holds praise for clinicians alongside a critique of structural silences. It treats contradiction as productive rather than problematic. Within the genre of pathography, ethical considerations regarding self-narration and relational subjects are sutured into the writing process.
Autopathography here functions as queer-crip epistemology: a mode of knowing that emerges from embodied marginality and insists that suffering can generate analytic clarity rather than be reduced to a genre of personal testimony.Footnote 16
3. Treatment failure: cripping the clinic beyond cure
Two years ago, my cancer entered the clinical record as Stage 3 and potentially curable. The word curable reorganized everything. It created an altered horizon. Surgery was scheduled with urgency and confidence. The Ivor-Lewis procedure removed my esophagus and repositioned my stomach. Anatomy was rearranged in the name of survival. The language was clinical, precise, and almost elegant. Margins were examined. Nodes were counted. The critical metrics were defined by the boundaries that might provide containment.
Recovery, however, was not restoration. Eating became structured rather than instinctive. Appetite diminished. I lost substantial weight. Energy fluctuated unpredictably. Digestion requires calculation. The body I had inhabited for decades did not return; it recalibrated.
And yet my partner and I were hopeful. We treated those early post-surgical years as a reprieve and a gift. We travelled when my strength allowed. We drove along the coast with our beloved dog, Ziggy. We sought small, deliberate pleasures: a long lunch, visits with family from the United States, evenings hosting friends at our table. Life was not restored to normal, but it was full. We lived intentionally, sometimes forgetting the illness altogether. Even when survival statistics were sobering, hope persisted. It was not naïve. It was intentional. It was disciplined.
Immunotherapy followed surgery. Each infusion carried promise. The clinical arc remained intact: intervene, respond, restore. Side effects were endured because they were tethered to a cure. Discomfort had direction.
Metastasis fractured that direction. The scan that revealed the spread altered the grammar of the room. Immunotherapy was discontinued. Chemotherapy began. Language shifted from cure to management. “We will aim for stability.” “We will try to extend.” Eventually, the phrase “treatment failure” entered the conversation.
In biomedical terms, treatment failure signifies the limits of a protocol. It is a technical assessment of therapeutic efficacy. Yet its force exceeds its technical meaning. It reorganizes identity. The patient becomes someone for whom a cure is no longer plausible. The horizon contracts.Footnote 17
In that consultation room, silence expanded. My partner, Andrew, asked questions. I listened. I watched the doctor’s careful neutrality. I understood that this was not personal failure, nor professional failure. And yet the word lingered. Failure.
Biomedicine is structured around cure and restoration. Its temporal logic assumes linear progress: diagnosis, intervention, remission. When that arc breaks, its vocabulary thins. Cripping the clinic does not reject medicine but interrogates why cure is positioned as the only meaningful endpoint.
Living beyond treatment failure exposes the limits of this logic. My life did not end with metastasis. It changed. It darkened. It became more uncertain. But it continued. We continued to host dinners. We invited the family to visit. We travelled cautiously. We lived not because prognosis was favorable, but because presence remained possible.
My clinicians have been exceptional: their care precise, compassionate, and evidence-based. They have extended my life and alleviated symptoms. They have not withdrawn effort. My critique is not of individuals but of a structure that binds value to measurable response.
At this stage, we pursue every possibility. Clinical trials are discussed. New drugs are considered. Hope mutates but does not disappear. Yet pain is real. Fatigue is real. Chemotherapy restructures days. There are mornings when standing feels like labor. There are nights when uncertainty is heavier than statistics.
Biomedicine struggles with this ambiguity. Conversations pivot toward measurable benefit: a four- to six-month extension, a percentage shift in progression-free survival. No one can offer a definitive timeline. No one can quantify what those months might contain. The future becomes probabilistic rather than narrative.
Empirical research reflects this structural tension. The Out with Cancer study documents heightened distress among LGBTQ+ patients, not necessarily because clinicians lack skill, but because relational and identity-based dimensions remain peripheral to consultation.Footnote 18 Scoping reviews published since 2020 similarly demonstrate that oncology encounters prioritize disease metrics while existential uncertainty remains under-addressed. Ambiguity is managed rather than explored.Footnote 19
There is also a politics embedded in the term “failure.” It frames therapeutic limitation as an endpoint rather than transformation. In this framing, life beyond cure becomes residual, statistically marginal. Michel Foucault reminds us that medical language does not simply describe bodies; it produces them as objects of knowledge.Footnote 20 To be classified within treatment failure is to be repositioned within a regime of visibility where prognosis risks superseding personhood. The scan becomes more authoritative than sensation. The metric outranks the lived day.
Yet lived time exceeds clinical time. Biomedicine measures progression in months and response percentages. Lived experience measures it in dinners shared, conversations held, sunlight in the garden, and the quiet persistence of partnership. When four to six months are discussed as a benefit, they are abstracted from texture. What is a month? It is a birthday. It is a road trip. It is an argument and a reconciliation. It is laughter that would not otherwise have occurred. Cripping the clinic requires re-sensitizing biomedicine to texture.Footnote 21
Ambiguity, in this sense, becomes pedagogical. Medicine often treats uncertainty as a deficit, something to be minimized. But ambiguity can generate ethical attentiveness. It forces presence. It destabilizes the illusion of control. Treatment failure becomes an unexpected teacher. It reveals that survival without cure is not a liminal existence but another mode of being, one that calls for relational depth rather than heroic restoration.Footnote 22
The absence of cure does not negate the presence of life.
To crip the clinic beyond cure is not to diminish medicine’s achievements. It is to widen its frame. Treatment failure need not equate to narrative failure. It can mark a shift from eradication to adaptation, from restoration to relational depth. It invites a redefinition of what counts as living well.
And it opens a further question. The body that medicine manages remains a desiring body. When survival becomes uncertain, what becomes of pleasure?
4. Pleasure kill: erotic life, ambiguous grief
Cancer not only alters prognosis. It alters erotic life.
Before illness, my body was disciplined and strong. The gym was ritual rather than vanity. Muscle memory anchors identity. Sexual desire was not incidental but animating. It energized intimacy, work, and creativity. As a gay man shaped by the AIDS epidemic, erotic life was never merely private. It was affirmation in the face of stigma, pleasure in the shadow of loss, resistance against moral panic. Desire was not separate from survival; it was part of it.
Cancer and chemotherapy reshaped that terrain. Libido did not disappear, but it quietened. Fatigue intruded. Anxiety occupied cognitive space. Desire competed with nausea, scans, and treatment schedules. Sexuality shifted from spontaneity to negotiation.
This is where ambiguous grieving becomes central. I have not lost desire entirely. I have not lost the capacity for intimacy. Yet something fundamental has shifted. Strength is different. Stamina is different. Confidence is different. The grief is subtle rather than dramatic. It appears in hesitation, in comparison between past and present, in the recalibration of what the body can offer and receive.
Pauline Boss describes ambiguous loss as “grief without closure,” where what is mourned is neither fully present nor fully absent. Erotic vitality under cancer treatment occupies precisely this space. It is not gone, yet it is altered beyond return. Ambiguous grief destabilizes binary thinking. It refuses the simplicity of lost versus intact. Erotic life under metastatic illness is both diminished and present, weakened yet meaningful.Footnote 23
José Esteban Muñoz’s conception of “queer futurity” illuminates this loss further. Erotic life projects possibility. It imagines oneself in relation to another body, another tomorrow. Cancer complicates that projection. The imagined future of erotic vitality contracts, but it does not collapse entirely. Even in advanced illness, desire gestures toward relational becoming. In this sense, erotic life remains a form of queer utopian impulse, a refusal to allow prognosis to monopolize the horizon.Footnote 24
Lauren Berlant’s notion of “cruel optimism” clarifies the attachment that persists to a former bodily self.Footnote 25 I remain attached to the strength and vitality I once embodied, even as I adapt to what is now possible. Yet attachment is not simply delusion. It can also be sustaining. The longing for pleasure, touch, and intimacy is not a denial of mortality; it is a refusal to allow illness to exhaust meaning. Intimacy becomes less about performance and more about presence. Pleasure becomes less about conquest and more about connection.
Oncology rarely addresses this dimension of embodied indeterminacy. While side effects such as reduced libido may be briefly mentioned, empirical studies consistently show that sexual wellbeing remains under-discussed in cancer care. This silence is particularly pronounced for LGBTQ+ patients, who frequently experience invisibility regarding identity and intimacy.Footnote 26 Recent reviews attribute this gap to limited clinical training and discomfort. Public accounts by physicians and patients alike reveal how sexual suffering is often minimized as secondary to survival.Footnote 27
For gay men, this silence intersects with a longer history of medicalized scrutiny. During the AIDS epidemic, gay male sexuality was framed as risk and contagion.Footnote 28 In oncology, it is often desexualized altogether. Once survival is threatened, pleasure is implicitly treated as expendable.
I resist that hierarchy.
What is at stake is not simply the inclusion of sexuality within oncology conversations, but a reorientation of what counts as knowledge. Erotic life is not an accessory to survival. It is epistemic. It teaches vulnerability, reciprocity, embodiment, and relational temporality. It structures how we inhabit ourselves as desiring subjects rather than managed patients. When libido shifts or capacity diminishes, the grief is not merely functional but ontological. It concerns being.
Naming this grief queers the clinic. It interrupts the assumption that bodies in treatment become neutral or post-sexual. It challenges the prioritization of tumor response over intimate well-being. It insists that desire does not evaporate under threat. In doing so, it transforms sexual loss from side effect to site of knowledge.
Ambiguous grieving also reveals adaptation. Intimacy becomes slower. Touch becomes deliberate. Presence becomes concentrated. Pleasure does not vanish; it recalibrates. Erotic life under treatment failure becomes an index of resilience rather than only deprivation.
When erotic life is excluded from the calculus of “quality of life,” there is a quiet violence that resides in the phrase. Oncology frequently invokes quality to justify intervention, yet sexual vitality is rarely integrated into that assessment. For queer patients whose histories include medical regulation of desire, this omission is not neutral. Silence is patterned.
To insist that erotic life matters even in the final stages of life is to challenge a deeply embedded hierarchy within biomedicine: that survival supersedes sensation, that extension outweighs intimacy, that cure outranks desire. Finding pleasure in late-stage illness is not indulgence. It is resistance. It asserts that bodies approaching death are not emptied of meaning. They remain desiring, relational, capable of tenderness and joy.
If treatment failure unsettles cure, pleasure unsettles erasure. Together, they expose how biomedical logic narrows value to survival metrics alone. By centering erotic life within this pathography, I argue that authenticity includes embodied desire, even, and perhaps especially, under decline.
The margins of the clinic resemble other institutional margins where bodies that deviate from normative expectations are managed rather than understood. It is to those margins that I now turn.
5. Academia’s margins: from seeking to being
Long before cancer rendered my body marginal within cure culture, I inhabited margins within the academy.
I began my academic career during the AIDS epidemic. To be openly gay in higher education at that time required calculation. Sexuality shaped professional life, often invisibly. To teach queer theory or center sexuality in scholarship was to risk marginalization. Silence was safer. Disclosure was strategic.
The AIDS epidemic intensified this precarity. Gay male bodies were publicly framed as contagious, irresponsible, and suspect.Footnote 29 Friends disappeared. Grief was ambient. Fear circulated not only in hospitals but in lecture theatres and staff rooms. Continuing to teach and research during that period demanded resilience and defiance. Marginality was not metaphorical; it was embodied, historical, communal.Footnote 30
This formation shaped my intellectual commitments. Critical literacies and transformative pedagogy did not emerge for me as abstract frameworks but as survival strategies. Knowledge from the margins was not peripheral to institutional life; it was necessary to its ethical future. To teach critically was to resist erasure. To research sexuality and power was to insist that embodied experience mattered.
Throughout my career, I have navigated insider and outsider positions simultaneously. I have held senior academic leadership roles, built programs, expanded access to education and opportunity, and influenced institutional strategy. At the same time, I have encountered epistemic exclusion, moments where queer scholarship was framed as niche rather than foundational, where affective and embodied knowledge was subordinated to technocratic expertise. The tension between recognition and marginality has been constant.
For many years, I sought broader institutional influence. I considered senior executive roles, including Deputy Vice-Chancellor positions, believing positional authority would amplify impact. That belief was sincere. Universities, like hospitals, respond to hierarchy. Structural change often appears to require formal power.
Yet my work was never confined to institutional advancement. Alongside academic leadership, I served as a director of BABSEACLE, a cross-border justice organization committed to advancing legal empowerment and access to justice across Southeast Asia.Footnote 31 I also became a founding trustee of Violence Prevention Australia, dedicated to transforming health and community systems to reduce violence.Footnote 32 These roles extended my commitment to justice beyond the academy. They were not adjuncts to my academic identity but further expressions of it.
In these spaces, impact operated differently. Change occurred through coalition, community engagement, policy influence, and sustained advocacy rather than formal academic rank. Leadership became relational and distributed. Influence travelled across borders, across disciplines, across sectors.
Cancer reframed the temporality of all this work. Facing Stage 4 disease recalibrates ambition. The question shifts from ascent to imprint. What remains if time contracts? What endures beyond title?
Jack Halberstam’s reframing of failure as resistance unsettles normative success metrics that equate upward mobility with value. Sara Ahmed’s analysis of institutional life shows how those who challenge dominant norms are often positioned as disruptive rather than transformative. Together, they illuminate how academia mirrors biomedicine in its productivity-driven logic: linear progression, measurable output, quantifiable prestige.Footnote 33
There is an uncomfortable symmetry between biomedicine and the contemporary university. Both privilege optimization. Both quantify performance. Both reward linear acceleration. In such systems, bodies and scholars who move more slowly, and whose trajectories are anomalous, are subtly (or not) devalued. Cancer renders this dynamic visible. Fatigue disrupts productivity. Hospital appointments interrupt schedules. The illusion of infinite predictable capacity fractures.Footnote 34
Yet the slowing imposed by illness has clarified something fundamental: impact is not synonymous with hierarchy. The desire to become Deputy Vice-Chancellor was never about prestige alone; it was about structural influence. But influence does not circulate only vertically. It moves laterally and relationally. It travels through mentorship, through curriculum design, through community partnerships, through justice initiatives, through policy shifts initiated quietly rather than announced loudly.
Stepping away from seeking a higher executive office is therefore not diminishment. It is reorientation. As a board member of the Victorian Academy of Teaching and Leadership, I contribute to shaping educators who influence thousands of young people.Footnote 35 Through BABSEACLE and Violence Prevention Australia, I have contributed to justice and prevention work that extends beyond campus walls. Leadership becomes distributed rather than concentrated.
If I were to live longer, there is more I would build. The desire to reform institutions, to deepen justice work, to strengthen violence prevention frameworks, to expand critical pedagogy at scale remains strong. I had hoped that my legacy as a queer academic and leader might leave a trace: a visible disruption of heteronormative leadership models, a demonstration that authenticity and intellectual rigor are not mutually exclusive, a reminder that sexuality and scholarship can coexist without apology.
Academic life continues to embody possibility. Exciting and profound future transformations will reshape how knowledge is created, interpreted, and taught, simultaneously presenting opportunities for increased inclusion and increased marginalization.
These new developments belong beyond my time. Illness intensifies this reckoning. When time is no longer assumed, legacy shifts from aspiration to urgency. What remains is not rank but relationship. Not title but trace.
Biomedicine measures success through survival curves. Universities measure it through rank, grants, and outputs. Justice organizations measure it through policy impact and community outcomes. All privilege metrics. Queer and crip theory invite another calculus: relational flourishing, intellectual generosity, courage in public life, and authenticity sustained under pressure.
Legacy, then, is not accumulation but distribution. It is the dispersal of knowledge, care, and ethical commitment into other lives and systems. Students who flourish. Colleagues who lead. Policies that protect. Communities that are safer. These forms of endurance exceed CV lines.
Just as treatment failure does not equate to narrative failure, stepping away from conventional academic ambition does not equate to diminished worth. It may constitute a queer refusal of productivity’s tyranny and a redefinition of leadership itself.
From the margins of the clinic and the university, and from justice spaces beyond both, I have learned that endurance is relational. If my life is shorter than imagined, its significance resides not in titles attained but in those who carry forward care, courage, and knowledge.
In this sense, suffering becomes pedagogy. Ambition becomes service. Legacy becomes collective. And the trace I hope to leave is not one of position, but of authenticity and love enacted through institutions made more just.
In this minoritized pathography that enfleshes cancer’s dirty margins, I have aimed to explore tensions between gratitude and critique so as to produce a generative queer gesture. Offering praise for care providers while unsettling biomedical silences around sexuality and ambiguity is not a contradiction but resistance; it queers the binary of “good” versus “bad” care. For biomedicine, this approach could entail greater tolerance of ambiguity and permit the integration of sexuality and grieving into care; for the humanities, recognition of embodied, erotic, minoritized knowledges is central to reimagining illness and work. Ultimately, such narratives transform suffering into meaning, legacy, and pedagogy—acts of queer resistance that teach how to live and die otherwise.
6. Coda: Chris Walsh, message on WhatsApp, Jan. 2nd, 2026
Hi everyone, this message is much harder to write than I expected.
I wrote this at dawn under pink skies. Pink has always been strangely comforting to me—I’m not sure why it always has been, but it was a real comfort this morning. It helped me steady myself as I wrote, and it also comforted me to feel, as clearly as I can, that we have made the right decision.
After meeting with the oncology team yesterday and having some long, honest discussions, we have decided to stop active cancer treatment and focus on quality of life.
Unfortunately, the cancer has not responded to chemotherapy and has progressed quickly. The team’s view is that more chemotherapy or a clinical trial is unlikely to help and could do more harm than good, given how weak I am now. There is also a long wait for further biopsy results (which are being processed in Japan), and any additional treatment options available for my type of cancer have a very low chance of success.
So this is not about losing the fight. It’s about choosing comfort, time together, and how I want to live right now.
The doctors have been very open that time may be limited, though no one can say exactly how long. Our priority now is symptom control, being at home, and being surrounded by family.
We’re being discharged today and heading home so we can be with Ziggy. I’m hoping to call you soon—and I’ll share updates when I can.
With love,
Chris
Acknowledgments
This manuscript was assembled posthumously. The Guest Editors would like to thank Dr. Chris Walsh’s partner, Andrew Chong, for his invaluable assistance and generosity in making it possible for the manuscript to be located, assembled, and published. We would also like to acknowledge the invaluable contribution of colleagues and friends, including Lindsay Maynard and Elaine Sharplin.
Author contribution
Conceptualization: C.W.; Writing - original draft: C.W.
Open access
