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Wisdom from the Strangest Places

Wisdom from the Strangest Places
October 31, 2022 by

I’m sentimental about Halloween the way most people are sentimental about Christmas.

Fall foliage and pumpkins bring the tang of childhood to my tongue like nothing else. So I spend the month of October watching new horror movies or horror mini-series, if there are any good ones. And if there aren’t, then there’s always the classics—Halloween and The Shining—to enjoy again.

In recent years, the director Mike Flanagan has become a favorite, and his notable Netflix series The Haunting of Hill House is even popular among people who don’t generally like horror, mainly because he’s willing to expose the deepest, darkest secret of the horror genre.

And that secret, if you didn’t already know it, is this: horror isn’t actually about death, hate, or despair—it’s about life, love, and hope. All Mike does is make those themes of life, love and hope more apparent and accessible, while still scaring you.

So imagine my delight when, settling in to watch his newest mini-series The Midnight Club (which premiered on Netflix recently), twenty minutes into the first episode the main character (a young cancer patient) has a conversation with her doctor about how wrong-headed the “battle against cancer” rhetoric is.

DOCTOR: “The thing I didn’t understand when we talk about cancer, or any terminal illness really—look at the language we use. The language of battle. ‘We’re going to fight this thing. We’re going to fight with everything we’ve got. Be brave for the fight.’ And then people say, ‘They lost the battle’. It’s so backwards. I get it. To talk about the fight it’s active, it’s visceral. Don’t look at the hard part. Look at all these shiny sharp weapons we’ve developed for you to try. It’s about permission to leave the battlefield. To focus on living instead of fighting. We aren’t about a fight and it certainly isn’t losing a battle. Every living day here is a win.”

I couldn’t believe my ears. It might have been cribbed verbatim from past blog posts, or from conversations I’ve been hearing in the clinic lately.

Though it’s not my place to tell people how to think about their illness (especially since I’ve never had cancer) I’ve worried about the “battling cancer” rhetoric for years, for a lot of reasons. First, battle implies a certain casualness about casualties and collateral damage that’s never ok. Second, an “all-or-nothing” mentality doesn’t gel with what an actual course of treatment looks like, which requires flexibility and adaptation, advance AND retreat.

But most of all, I dislike it because it disrespects another aspect of the cancer experience for some—dying.

Though death isn’t the result we want, it can be experienced with dignity, comfort, and peace—if we face it honestly and with acceptance when it becomes inevitable. But that’s something an all-or-nothing mindset cannot do.

There probably are times when the metaphor of “fighting a battle” can be very helpful for people with cancer, and I’m not here to take that away from anyone. But like any metaphor, it oversimplifies reality to gain clarity. That means there are other ways in which it distorts or omits very important truths.

Most notable among them are:

  • There are ways to win, even when cure is impossible
  • People who die from cancer aren’t losers

Thanks for putting this message out there on blast, Mike. I couldn’t agree with you more.

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No Illusions

No Illusions
April 4, 2020 by

Though I’m an oncologist and not an infectious disease expert I’m getting bombarded with questions about the pandemic. Patients and staff are asking me and every one of my partners similar things, over and over:

How long until things go back to normal?

How much danger am I in?

Is it all going to be ok?

Though I’m supposed to have all the answers, I haven’t felt too sure of anything lately. It must show on my face, because recently one of my patients (a young woman living with incurable breast cancer) asked “how you doing there, doc?”

“Honestly, I’m not sure,” I said. “My regular routine is wrecked, I don’t feel as safe as I used to, and I don’t know what’s coming.”

“Welcome to my world,” she said, with a wry smile.

I suppose like everyone else in my privileged corner of the planet, where war is remote and epidemics are rare, I’ve been fooled into believing that the world is a safe place, that nature wants the best for us, and that we have control.

Somehow I’ve mistaken privilege for entitlement.

But the pandemic has stripped those illusions from me, just as cancer stripped them from my patient long ago. I’ve had to accept that there’s no such thing as safe – only safer. I’ve had to admit that I don’t have as much control as I’d like. And I’ve had to consider the very real possibility that I or someone I love might not survive.

And even if we and all our loved ones come through safely, somehow I doubt we can ever go back to the sleepy (and false) security of before. We may well divide our lives into distinct sections: “Before COVID” and “After COVID”, just as many patients have distinct lives before and after cancer.

And maybe we’re better off living without illusions of safety.

If life becomes more precarious, maybe it’ll also be more precious. Maybe in facing the truth of our mortality we’ll learn a deeper compassion for all survivors, everywhere – since every human breathing is a survivor of something. And if I’m spared, perhaps the me that comes after will have learned to live with more dignity and courage.

Maybe my patient will teach me.

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Dear Cancer Patient – Starting Chemotherapy

Dear Cancer Patient – Starting Chemotherapy
August 2, 2016 by

Dear Cancer Patient,

You’ll be starting chemotherapy soon, and you’re nervous – and after everything you’ve been hearing about it that’s understandable.

I’m not going to tell you that we don’t need to be careful with these drugs, or that there are no side effects, because that’d be a lie. But I’d like to wind back some of the overblown scary things you’ve been hearing:

First, just because you’re getting treated for cancer doesn’t mean you’re made of glass. For the most part, you can live life just as you did before. If there’s something specific you need to change, I or someone on my team will tell you.

Second, there isn’t now (and never was) a need to be a germaphobe. Wash your hands when and how you’ve already been taught, kiss the people you usually kiss, and go the places you usually go. It’s simply untrue that you should avoid crowds, or stop going to church, school or the movies. I’ve sometimes overheard well-meaning medical people tell patients that – while they talked in the middle of a crowded medical office. I wish they’d stop saying stuff like that.

Third, you probably don’t need to dramatically change your diet, assuming it was reasonably healthy to begin with (if not, take it easier on the greasy stuff for a while). But know that your taste buds and gut are going to be unpredictable for a while. Things might not taste the same, and some former favorites might send you dashing for the loo after a few hours – something those of us fond of raw seafood and volcanically-hot Thai are familiar with. For most people, it’s mildly inconvenient, but doesn’t cause lasting harm. Just pay attention to what triggers those episodes, and adapt. You’ll be fine.

There are two main reasons why chemotherapy gets a bad rap. The first is because it isn’t always clear to observers whether it’s being used to cure cancer, or delay the progression of incurable cancer. In the latter setting, people still decline gradually and ultimately die, it’s just a more gradual decline with the treatment in most cases.

The second reason is an ugly truth about cancer medicine’s past. Sometimes, oncologists got so carried away with trying to shrink tumors that they failed to pay attention to how it was affecting the individual patient. Sometimes, they’d keep treating even when patients were getting worse – because the tumor was shrinking.

Oncologists have been guilty of sometimes making the treatment worse than the disease – but times have changed. I promise you I’ll never do that, not here, not today, not EVER.

If treatment ever makes things worse instead of better, I’ll change your treatment.

 

Sincerely,                                                                                                                                                                           Your Devoted Oncologist

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