A pretty, flower covered folder now sits on my kitchen table, the word “cancer” hand written in pencil on its label.

I came home from my first colonoscopy on September 10th with multiple pieces of paper containing routine instructions on what to pay attention to in the 24-48 hours following the procedure, but also with a sheet of paper that said “likely malignant mass.” Whatever else was coming, I knew I would be having a lot more appointments, and a lot more sheets of paper. I might as well begin to get organized. Being sick in the United States requires a lot of extra administrative work.

It feels trite only because it is true, everyone in this situation says it only because it is true, and I too am going to say it only because it is true: nothing prepares you for this. I fell into a drugged sleep to the sound of assurances that whatever was wrong it almost certainly wasn’t cancer, and I woke up to my sweetheart holding my hand and my gastroenterologist saying, “we found something. It’s probably cancer.” From the way she said it, I knew there was no probably about it. She knew. Not everyone would be glad for such a straightforward delivery, but I was. I want to know what I am dealing with. I want the facts.

Unfortunately facts were difficult to come by for the next couple of weeks. There were far more tests than facts; blood draw, CT scan, MRI. Once there were facts there were appointments, so many appointments, covering and reviewing the same information from different angles. Medical oncologist, radiation oncologist, surgical oncologist, some of the smartest people I’ve ever met putting their heads together to discuss my case, to discuss whether and how they might cure me.

My medical oncologist said, in our first appointment, that younger patients sometimes have more difficulty adjusting to the reality of being a sick person. Older people have experienced that enough already that it is less jarring. “Sure,” I said. She is right. Except that I am also used to being a sick person. Years of learning to manage my fibromyalgia symptoms and years of therapy helping me process living with chronic illness means I have practice being a sick person. Fibromyalgia won’t kill you, though. It only makes you feel bad while you continue to live.

Two of my most beloved writers died in September, Wendell Berry and Annie Dillard. Losing their voices would have moved me at any time, but losing them in a moment when I am facing my own mortality has uncovered another layer of personal grief. I have struggled as a writer in recent years, even as I have believed that my best work is ahead of me. I am 42. In writer years, that is young. It is also young in cancer years.

In a world of 30-under-30 and 40-under-40 lists, with my increasingly aching joints, subtly greying hair, and wrinkles forming around my eyes and across my forehead, I have felt my age lately. But sitting in the waiting room at Duke Cancer Center, I feel like a small child. Routine screening colonoscopies don’t even begin until 45 (lowered from 50 due to an increasing number of cases like mine).

At 42, surely my colonoscopy would reveal something less serious. Ulcerative colitis, Crohn’s disease, another chronic illness to add to my growing resume of conditions. Or maybe there would be some pre-cancerous polyps that they could remove, telling me to come back in a year, that we’d watch things closely, catch anything else before it could become a problem.

Instead, I got diagnosed with stage 3 rectal cancer.

Since my diagnosis I have been journaling a lot, processing private grief and anger and sadness and confusion alongside moments of gratitude and love. I thought at first that might be all I wanted to do, to write alone in the quiet, dim light of morning. Pencil and paper, no word processing involved. Mortality doesn’t really feel reducible to “content.” And yet as the days have gone by, as a treatment plan has come together, I have found the dam that has held my words back leaking.

I have a history of depression going back to my teenage years. I have had a lot of ups and downs in my life. I have had days, months, even years when I was not particularly interested in living. I felt stuck, though I trudged on. In recent years, the combination of therapy, of proper medication, of a steady income and access to healthcare and workplace protections has allowed me to begin to live with a previously unknown freedom and joy. I have been happy. I learned that I am allowed to be happy. I want to be happy, still.

A few days after my diagnosis I made some decadent brown butter chocolate chip cookies. I had bookmarked the recipe years ago, but had never made them because the extra step of browning the butter always felt too fussy. I am in the mood to do everything fussy, now. Make the complicated cookies, drink from crystal stemware even if it’s only filled with boxed wine, wear my cutest outfit to the grocery store. If not now, when? This is a special occasion: I am here, today, alive. And oh, I do feel so alive these days, so in love with the world around me, with the life I have built brick by brick. I don’t want to lose it.

Nothing will ever be the same again though; in that sense maybe I already have.

My prognosis is relatively good as far as these things go, but as Hank Greene put it during his own bout of cancer, even the least bad cancer is still cancer. It’s all bad. This week I begin treatment, and I don’t know what comes after that. I have been struggling over the last few years to write about chronic illness, about pain, about wellness and disability. I have been trying to write about living with these things, and now? I am facing the question of life itself.