Wednesday, February 24, 2010

IF YOU’RE GOING TO GET CANCER, YOURS IS THE ONE TO GET


Blogger Lori Hope (www.lorihope.com/blog) tried to post the following here last week as a comment on my February 15 piece, “Cancer Victim Loses Battle.” Unfortunately, the website’s software foiled her—and, from what I’ve heard, others, too. Anyway, here's her comment: 
Well put, Jeff! Years ago I wrote a radio commentary about a local journalist with breast cancer who, after a "valiant battle," "succumbed" to cancer. This was not a woman who would "succumb" to anything, nor was she a warmonger who would wage war against anything, even cancer. Sticks and stones may break bones, but our words are far more powerful, framing our and others' realities.

Thanks, Lori, and thanks also for reminding us how powerful language is. When patients are dissatisfied, nine out of ten times it’s because of poor communication, not the technical issues of medicine.

One source of poor communication is when we don’t think before we speak. I may be twisted, but I suspect marriage was invented primarily to address that failure, and only secondarily for companionship and procreation. How many times have I learned and relearned to consider twelve times what I plan to say to my wife before I open my mouth?

But I’m digressing. Two people told me this week that their healthcare practitioners, one a physician, the other a nurse practitioner, told them, “Don’t you worry. Let me do the worrying.”

I have at least three problems with such platitudes. First, if you’re going to advise someone not to worry, you may as well advise them not to itch, or for that matter not to get sick in the first place. Maybe Marcus Welby offered his patients such advice and by God, they stopped worrying, but in real life that doesn’t happen. It’s better to save one’s breath than waste it. More than two millennia ago, the sage Dionysius of Halicarnassus said, “Let thy words be better than silence, or else be silent.”

Another problem is that telling people not to feel what they’re feeling isn’t just a harmless inanity, it’s actually anti-therapeutic. It slams shut their emotional compass, invalidates their most potent internal healing mechanism.

Finally, it tends to halt the conversation. What can the patient reply? “Golly, thanks, I won’t worry. Too bad I didn’t think of that myself.” And once the conversation freezes, the suffering goes underground.

I know: let’s have a contest. What’s the most useless sentence you’ve heard in an examining room? I’ll offer some examples.

“If you’re going to get cancer, yours is the one to get.”
“You need to avoid stress.”
“This might hurt a wee bit.”
“You’re being a little paranoid, aren’t you?”

Saturday, February 20, 2010

ILLNESS’ BEST-KEPT SECRET

A friend moved from California to the midwest a year ago. He discovered he didn’t like it there. Accustomed to his life of construction and log-splitting, all he could find to do was to sit around and watch television. Physical activity had validated his existence, and now he felt he was dwindling away. He decided to drive back to California—in the middle of winter. On a lonely, icy, subzero Wyoming highway he got a flat tire.

Had it been me, I probably would have beaten my head on the steering wheel. He didn’t. As a matter of fact, he exulted. “Finally!” he said to himself. “I get to do something!” He joyously removed the tire and drove directly to California on his mini-spare.

It’s all perspective, isn’t it?

That's where sickness offers possibility. For all its griefs, it removes us from our usual, habitual vantage point and offer us a new view. Sometimes I see my life as a hockey game and sickness as exile to the penalty box where I can’t play, only observe. From there the game necessarily looks different, and I’m free to see versions I hadn’t noticed before.

Cancer, for example, is certainly a trail of tears rather than a walk in the park, but as time passes, subtle benefits often appear. People in support groups have told me for three decades variations of, “If it weren’t for having cancer, I wouldn’t have changed my life.” Rubbing up against mortality forced them to evaluate their moment-to-moment choices, and they made changes—in their habits, their relationships, careers, and especially attitudes.

A friend who’s had cancer muses about writing down these experiences and publishing them in an anthology called “The Hidden Benefits of Cancer.” Great, but it won’t be a bestseller. Who wants to read about the “good” side of a disease we fear more than the plague?

Besides, these lessons can’t be taught, only comprehended through real-time experience. Long ago I facilitated a support group in which a woman who’d been clear of cancer for four years spoke regularly about how her illness had changed her life for the better. At one meeting she told a freshly diagnosed man, “You may not realize it now, but believe me, eventually you’ll see your cancer as a blessing.”

Ooooo. My neck hairs stood up. He didn’t need to hear that then. Some truths are useful only at the right time.

Though premature revelations can be useless at best, the principle itself deserves wider discussion. We culturally see sickness as an unmitigated catastrophe, but how would we approach it if we valued the lessons it might offer?

Thursday, February 18, 2010

HAVING TROUBLE PLACING COMMENTS ON THIS BLOG?


Dear Friends,

I’ve heard from a couple of readers of this blog that they’re unable to post comments. When I try it myself it works, but that doesn’t help them. After searching through blogspot.com’s FAQs and help pages, I still can’t figure out how to rectify this.

We can’t let some simple technical bug stop our conversation. If you want to post a comment and can’t do it on the blog, e-mail me directly at jeffkane@theunion.net, and if it’s relevant I’ll post it.

Thanks,
Jeff Kane

Monday, February 15, 2010

WHAT TO DO WHEN YOU DON’T HAVE BANDAIDS

Today, on a run, I came across a friend who’s recovering from five operations for a horrendous arm injury. During these months of convalescence, she’s salvaged a few lessons.

While in the hospital, she told me, she became fascinated with a process used in her treatment. Called “negative pressure wound therapy,” it creates a partial vacuum at the wound site and so attracts more blood, with its healing elements, while it accelerates fluid drainage.

“That’s what real healing is,” she told me. “Real healing is from the inside out. The other direction, from the outside in, is just bandaids. Most of my doctors and nurses came at me from the inside, from their hearts. That and the WoundVac were my most powerful treatments.”

Twenty years ago the University of Chicago Medical Center sent a survey to people who’d been inpatients there. One of the questions was “What category of hospital personnel most influenced your recovery?” The categories listed included nurses, doctors, social workers, technicians, and “others (describe).” The most frequently checked was “others,” usually described as housekeeping staff.

The housekeeper’s the tired lady who rolls her mop bucket into your room and asks if she can just sit a bit before cleaning your floor. "Sure," you say, and she plops herself into a chair, sighs, and says, “Honey, why are you in here?” She doesn’t have any bandaids, only what’s inside.

Wednesday, February 10, 2010

CANCER VICTIM LOSES BATTLE


You see it in the papers all the time. In the news section, it’s “cancer victim.” In the obits, it’s the “victim” who “lost his/her valiant battle against cancer.”

How did such metaphors become our default language? Why not “Joe Blow, who has cancer…” or “Jane Doe, who’s presently cancering…”? If there must be an obituary, I’d like to see, for a change, “…coexisted with cancer as long as he could.”

When we view people who have cancer (or any other serious diagnosis) as victims, we coat them in helplessness. And if treatment is battle, then eventual death is inevitably defeat.

Fortunately, other perspectives are available. Matter of fact, hardly anyone I know who has a serious illness thinks of himself or herself as a victim. They express all kinds of takes. “I didn’t say, ‘Why me?’ when I was diagnosed,” said one. “I said, ‘Why not me?’” Some see it as, while no picnic, a challenge. Some accept the disease as a kind of symbiont, some as a minor bump in their road. A few are certain they brought it on themselves (victim, then, or perpetrator?). And of course, there are plenty of interpretations I’ve never encountered.

How do you “battle” a disease like cancer, anyway? Sure, you get oncological treatment aimed at killing errant cells. But is killing your major thrust or do you attend more to living fully in your measure of days? A friend who’s survived twenty-two years with stage four lung cancer—and is currently taking no treatment—tells me, “I’m not into killing anything. I don’t have the energy for it. I just let the cancer do its thing, and enjoy the life quality I can.”

Besides, the war metaphor is repulsive to a (hopefully growing) number of people. A friend who’s a Quaker found she couldn’t do the Simonton imagery exercise in which Pac-men chew up cancer cells. Instead, she “saw” sunlight inflate the cells and lift them gently away from her.

In considering approaches to sickness and its treatment, one size definitely doesn’t fit all. To be truly therapeutic is to honor people’s preciously individual views.

Thursday, February 4, 2010

REFUSING TREATMENT

A friend undergoing cancer treatment told me, “You know, this is pretty rough. In fact, it seems primitive to kill my cancer by almost killing me. I understand my doctors have my best interests at heart, but a hundred years from now today’s treatment will be considered really crude.” She went on to discuss the balance between the quality of her life and its abrasion by her treatment. “At some point,” she said, “I might just decide to stop my treatment.”

A few weeks ago, another friend with advanced cancer did exactly that. In our final conversation, while she was under intense treatment in the hospital, she said to me, “What would do me the most good now is just to go home.” She did, and died two days later with her family at her bedside.

I met another woman with stage 3 breast cancer about ten years ago, when she was just beginning her chemotherapy. After a single intravenous dose, she declared, “Wow, this definitely isn’t for me.” Her doctor encouraged her to at least get radiation. She tried that once, and pronounced the same verdict. I knew her over the next five or six years, as she led her life with no treatment at all. She did fine, as a matter of fact. I’ve lost track of her since.

What these people have in common, the issue of halting treatment, will arise in almost everyone who bears a life-threatening illness. Most don’t consider it until they realize, far down the road, that their life has gradually contracted down to numerous medical appointments and the tribulations of side effects. They begin to ask, “Am I really prolonging my life or simply prolonging my suffering?”

Common though this issue is, we don’t even have a name for it because it’s still semi-taboo. After all, who in their right mind wouldn’t keep treating their serious illness? Isn’t that giving up? A kind of suicide? A slap at one’s family?

Even given those criticisms, the issue persists. Like one man said, “I have to look at this. This is me we’re talking about.” Once we realize we’re in this situation, we recognize that we’re the only one who can resolve it. What makes it difficult is the wide panorama of advice from those around us, including practitioners and, most compellingly, relatives. 

If we decide summarily to forego treatment, our doctors might feel like they’ve failed (don’t kid yourself: this is not uncommon among doctors). And relatives might feel we’re self-centeredly abandoning them. If this issue concerns me and I want to avoid unnecessary grief, then, I’d better have a thorough conversation with all involved.