On the day Williams spoke with me, she had just lost another friend to cancer, a 24-year-old law school graduate who had begun a treatment program similar to the one that had saved Williams. “It sucks,” she told me. “It fucking sucks.”

Having been through treatment for breast cancer twice—and lost my mother to pancreatic cancer earlier this year—I understood that sentiment all too well. Here, Williams talks about living with late-stage disease, her experience with the sometimes hollow, feel-good culture of cancer activism, and how, despite all the bleakness, she found beauty.

Orenstein: Many cancer memoirs are written by people with early-stage disease who, no surprise, survive. How is your book different?

Williams: Even within the cancer community, a lot of advocacy groups don’t want to talk about people with Stage 4 disease. They want that inspirational story of “I kicked cancer’s butt!” If it’s a darker scenario, or just a more complicated one, you are ignored. That frustrated me as a person and as a reader. I wasn’t seeing stories about people who were living [with the disease] like I was.

Orenstein: What was it like to find out that you had Stage 4 cancer?

Williams: It was surreal. You leave your body for a time. When I hear about people who are Stage 4 for years … How do you basically live on death row never knowing whether you’re going to get a reprieve from the governor or if you’re going to get sent to the chair? And you can’t just stop doing your regular life. You have to take care of your kids. You have to do your job. You have to do your laundry.

Orenstein: You can’t sit around and wait to die.

Williams: Right. My kids and I got lice right after my second diagnosis. Maybe that’s why laundry is uppermost in my mind. I did so much laundry. And you want to do that everyday stuff, until you become really incapacitated. I certainly saw that with my friend Debbie. You want to hang out with your friends. You want to read a book. You want to do whatever you can.

Orenstein: Do you feel survivor guilt over your friend’s death?

Williams: Years ago I went to a reading by an author who had served in Vietnam. I hate the whole battle metaphor, that cancer is like war, but he said something great. He said, “You go to basic training with these guys. You go in the trenches with them. You see every horror imaginable together. Then one day one of them gets a bullet through him and you don’t. And you’re happy. And then you live with that for the rest of your life.” That’s what it is: It’s the guilt of being happy. I get to live my life. I get to listen to music and eat cake—and Debbie doesn’t. Of course I feel guilt. And that’s okay. It’s not my fault that I got sick or that I got better either, but I want to always respect that I have a privilege that so many, including people I loved, do not.