The Road Less Traveled
My guess is that there are very few oncologists actively practicing today who have a history of cancer. I know my old boss is a lymphoma survivor, but other than him I can’t think of any other cancer specialists in this city who can claim to have experienced first hand the very disease they have chosen to spend their career fighting. It is probably unnecessary to broadcast this information during an office visit anyway- the effect might be to turn the focus away from the patient. On the other hand, it is not surprising to find that doctors are discouraged from making comments like “I know how you feel” when counseling patients since this sounds like a phony patronizing platitude the second it escapes from the lips.
Doctors who actually have gone through the trauma of cancer, though, in my opinion have earned the right to use their experience to help patients. Using the memories of their own struggle against the horrid disease as a template, they can create an inspirational talk that is very likely to succeed in forming an authentic bond with the patient and help to relieve angst and sadness. I would be remiss if I did not honor these doctors for their dual roles as patient and healer. They know better than I what the definition of empathy is: what it is like to feel the tension of the examining room, to face the business end of a needle, to vomit, to face the closing of the day wondering what the next dawn will bring.
I know it sounds crazy but because of this sometimes I feel unqualified to counsel people living with cancer. No matter how many soothing words I regurgitate I can’t really know what they are going through, even though I observe them daily. Once I had a taste of what their pain must be like (”A Walk Down the Path of Pain“), but for the most part I am living as a spectator in their world. Are these feelings of inadequacy a variation of the imposter syndrome?
This vague sense of being a poseur made my recent visit with a young woman all the more difficult. She had just been diagnosed with inoperable rectal cancer and faced months of chemotherapy and biological therapy plus the annoyance of having an ileostomy. As I tried to explain the logistics of treatment she began to sob.
“It’s so hard,” she cried, shaking her head. Her shoulders quivered beneath her gown. “I want to give up.”
Giving up was not an option that I would even remotely consider. The latest treatments for colorectal cancer have acceptable toxicity profiles and have produced a significant prolongation of survival - not that I personally know what it is like to receive them, of course. How does a doctor translate this encouraging news into words that can comfort a grieving patient without sounding pompous or callow? How do I produce a homily to console my patient using such medical jargon?
One of the reasons I love my job is that there is very little repetition in it. No two encounters, even with the same patient, are exactly the same. This gives one the freedom to use the totality of the universe as raw material when devising a plan, or in this case desperately trying to come up with something to encourage a young woman facing a harsh future. In the entertainment world this is known as improvisational comedy. In my world it is called thinking fast, and since I am no fan of hackneyed phrases I stared blankly into the abyss until I was able to put this thought into words:
“Right now you think that you’ll never be the same as you used to be, but you know what? You can’t see as far into the future as your doctors can. Think of a point far, far away - down a road so long the end is out of sight. That point is the place of healing. You may not be able to see it but we can, and we know that once you reach it you will be healthy again. You’ll be able to care for your family, to work, to enjoy life again. In order to reach that point you must walk a hard walk down this road - a road of treatments that takes months to endure. Your doctors can’t carry you - we can only encourage you as you make your way day by day down this path. This is your passage to a better life than the one you have now. If you believe this place exists, you will make it there.”
I have no idea what it is like to live with cancer. I have no idea how I would react if I ever developed cancer. What I do know, however, is just as the poet John Keats described, a little negative capability can do wonders when trying meet the expectations demanded of a modern doctor.
Do you practice what you write?
Comment by poopie — April 26, 2005 @ 12:56 am
You seem to be facing the same dilemma that faces many a pastor or chaplain in the face of another’s inexplicable suffering. I think that absent an answer to the inevitable, unanswerable “why,” the best we can offer, whether as physical or as spiritual healers, is often nothing more than our presence — the assurance that whatever may befall the sufferer, they will not go through it alone. Sometimes the best answer is none at all … only our willingness not to abandon another person to the chaos.
Note that even God never gives Job an answer beyond who are you to ask me. (Not that I’d advise ever using that with a patient!) But in the end, God’s presence, the assurance that Job had not been abandoned, was sufficient for Job. What more would you say is reasonable to expect from another mere mortal?
Comment by Rev. Mike — April 26, 2005 @ 1:59 am
As a cancer survivor, I can’t speak for anyone but me. I didn’t care whether my doctor had experienced cancer. Even if he had, his experience would have been different than mine, so he still would not truly have been able to say “I know what your’re experiencing.”
I cared that he had the audacity to say the word “cure” in my first visit with him. I know you don’t get to say that word nearly as often as you would like, but I think you took the right approach in telling this woman that her vision was temporarily limited. Mine certainly was when I first heard the word “cancer”. It’s rather like being hit in the head with a very large heavy object in the way it impacts your ability to think.
Comment by Judy — April 26, 2005 @ 3:28 pm
I am a trained counselor although I still have 3,400 hours left until I can be licensed. Right now I am taking a break to stay at home and be a mom. I read your journal regularly.
In counseling we talk about appropriate self-disclosure. Obviously there is always a risk or counter-transference, but sometimes the benefits outway the risks. Doctors, nurses, psychologists, counselors, social workers are all first and foremost people. We all have a need to connect to eachother. In my personal opinion it is negligent not to mention you have a similar background. I believe patients have a right to know that the professional they are seeing has had a similar illness. Of course you need not give details. I think it is best to keep it simple.
On a personal note when I was on bedrest with my last pregnancy my OB told me that she had had a similar experience with her 3rd child. She didn’t go into detail, but just stated as a matter of fact that she had been on bedrest with her last pregnancy. I felt much more connected with her and listened a lot more intently to her advice.
On the flip side I also believe you do not have to have the same experience as a patient to help him/her.
Anyway my two cents.
Comment by Mollydog — April 26, 2005 @ 7:56 pm
In an odd bit of synchronicity, I just posted a message this morning on the cancer survivor’s board I frequent: I feel great!
The point of the message was to register my astonishment. My surgery was 6 months ago, and I felt so crummy for so long I forgot that I could — would — get better. And here I am!
I think you said exactly the right thing. Doctors, since they don’t have to walk that long hard road personally, are much better at envisioning the destination/cure. One of the most important things we as patients have to do is keep a positive attitude, and long-sighted doctors are a big help in that.
Comment by Joan — April 26, 2005 @ 8:13 pm
As a psychologist and lymphoma survivor who will never hear the word cure, but hopefully live a good while, Ive found my experiences in working with cancer patients pre and post diagnosis vastly different. Its way more difficult in many ways after as the issues brought into therapy are often quite similar to my own. The increased abilty to empathize with the patient’s experience can be helpful to the patient but overwhelming to the survivor therapist. Sometimes if Im not at a good place with my own disease, my caseload suddenly becomes full and I refer elsewhere as I worry about blurring the boundries and being emotionally overwhelmed. Its rough when the demons that wake the therapist in the middle of the night are those faced by the patient–scan anxiety, the whole works… But once or twice when I braved taking on another cancer patient its been a very rewarding experience on both sides. Sometimes I wonder who the therapy helped more.
Comment by Baci — April 27, 2005 @ 3:32 am
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Comment by testanchor666 — October 16, 2005 @ 1:43 am