Ending the War on Cancer
Transcriber: Jim Wang
Reviewer: David DeRuwe
A cancer center.
Just looking at this building
probably makes everybody
(Whispering) just a little bit nervous.
Now, imagine that you are 37 years old,
a wife to a loving husband
with a smooth on-air radio voice
and two boisterous young boys
that you’ve adopted together,
a job that is not just your job,
but your passion,
and you are standing outside this building
for the very first time.
You’ll have many trips inside
this building over the next six years,
a few surgeries - some big ones
and some smaller ones.
Inpatient admission
is at the hospital up the street.
There were even a few years there
where everything seemed stable
and seemed like it was working.
And then nearly six years
after your diagnosis, it wasn’t anymore.
Now, I don’t have to imagine this
because I know you, and I know your story.
Your name was Tenille.
And how do I know all of this about you?
Because I was your gynecologic oncologist;
I was the cancer doctor
that diagnosed you with stage four cancer.
I operated on you more than once.
I prescribed some treatments
that worked better than expected
for a period of time and others
that just didn’t seem to work at all.
And at age 43, six years after our first
meeting in this building, you died.
And in my mind and in my heart,
Tenille didn’t lose
her battle with cancer.
She didn’t succumb to her disease.
She lived every moment on this earth
as best she could - until she didn’t.
And she impacted
tons of people along the way.
And it’s her memory,
like so many others that I carry with me
that have made me passionate
about wanting to change cancer care
for the better.
Hearing the words “you have cancer”
for the first time
is probably one of the more terrifying
things we’ll experience in our lifetime.
Often, cancer diagnosis is the first time
we are faced with our own mortality,
and the language we use in cancer,
similar to the disease itself,
is complicated and overwhelming.
So as an oncologist, I use metaphors
all the time in my practice
to simplify the complexities
that surround cancer,
making it easier to understand.
And why wouldn’t I?
Studies have shown
that physicians who use metaphors
are viewed by their patients
as the best communicators.
War metaphors have been pervasive
in cancer care since Nixon
declared the war on cancer in 1971.
Maybe you’ve heard the slogan
“Finish the Fight”
or maybe told a loved one,
“Don’t give up. You’re a fighter.
You’re going to beat this.”
after their cancer diagnosis.
War metaphors are supposed to create
a steely mentality in the indivudual
to prepare for battle,
to attack,
to fight,
to win.
Typical emotions you may have
when entering a cancer center
for the first time,
but probably not the only emotions
that you’ll experience.
As an oncologist, I hate
the war metaphors that surround cancer,
and because of this, I’m extremely
conscious of the words that I use,
day in and day out, with my patients.
Our words shape the way
we think and the way we act.
And these war metaphors are affecting
my patients, your loved ones,
and maybe even you yourself in ways
that are often more harmful than helpful.
Because what is cancer, anyway?
Cancer is simply a cell
that forgot how to die.
It made a mistake
along the dividing process,
and it continues to grow
and spread unchecked.
It’s not a foreign invader on enemy soil.
Cancer is just us.
It’s a cell in our own body gone awry.
So when we talk of cancer,
as if it’s something to fight,
as a formidable foe that we can conquer,
what are we actually fighting?
Are we just fighting ourselves?
And cancer’s not just one thing.
Cancer is a billion different mistakes
in a million different places.
The simplistic idea that it can be beaten
or cured by a single silver bullet
is unfortunately
and heartbreakingly untrue.
These war metaphors
create artificial groups
that patients are forced to fit into.
You’re healthy or sick,
strong or weak,
alive or dead.
And this creates additional unnecessary
added stress for the patients
because they’re forced
to feel like they’re one or the other.
And when you’re sick from chemo
and not feeling very well in the moment,
this can create feelings
of failure and shame and self-blame
that often go undiscussed,
as to not create any attention
to your weaknesses.
And all the while,
a fighting, coping style
isn’t actually associated
with an improved survival,
just as telling someone “Just be positive”
may actually be the worst thing
to say in the moment.
Promoting solely
a positive attitude like this
leaves little room
for the full spectrum of emotions,
especially fear,
and shock,
and sadness.
The pervasive guilt
the war analogies
create about not giving up
leads patients down roads of treatment
that are less and less effective
and more and more riddled
with side effects.
And this affects
not just their quantity of life,
but their quality of life as well.
When we are so focused
on fighting and winning,
we make it seem as if death
only comes to those who
simply didn’t try hard enough.
And what about the patients
where cure isn’t an option?
What about those that won’t beat this?
Maybe they were diagnosed
and the cancer had already spread,
or maybe they’ve tried some treatments
that worked and others that didn’t.
If all we talk about is winning the war,
how do I talk to these patients
when they’re losing?
Now, this isn’t an easy
conversation to have.
We need to remember that death
is inevitable for all of us.
Sure, as a surgeon,
I can stave it off for a while
with surgeries and treatments,
but I can’t ultimately stop it.
All of my patients,
at some point, will die.
And so will I.
And this isn’t something most of us
want to even think about,
never might talk about,
but talking about dying doesn’t mean
it’s going to happen right then and there,
just as avoiding it
doesn’t allow us to live forever.
And still, I have to remember everybody
is going to struggle
with different aspects of this.
So I need to ask my patients,
“What are you worried about?”
and “What’s important to you?”
because it’s always different.
My job as an oncologist should be to open
this conversation and then listen.
To truly, really listen.
This is hard and cancer sucks,
but in this moment,
I’m not supposed to fix anything.
I’m supposed to listen
because it’s in these moments,
we talk most about life.
We talk about what’s important.
We talk about our values.
We talk about what we want and what we
need - maybe even what we can’t have.
We talk about hope.
We talk about living life with cancer,
not just fighting with it.
Because it’s in these moments,
my patients share with me
what living life with cancer is all about.
For one, it was important
she be home on her ranch
surrounded by her animals
and her loved ones
with the wide open spaces all around her
and the big blue sky above.
For another, it was her ticket
to her first trip abroad
to the German Christmas markets
with her youngest son.
Or maybe it’s a desire
for something as simple
as just one more cherry lollipop.
Or my dragging the ultrasound
over from labor and delivery
to allow a soon-to-be grandma,
the glimpse of her grandchild
for the very first time,
knowing she wouldn’t be around
to hold him when he was born.
Every one of my patients has had a story,
and as an oncologist, I have been gifted
to share that with them,
but I wouldn’t have had this opportunity
if I didn’t ask them what was important,
and then just listen.
Because embedded in these war analogies
is an impulse to fix the unfixable
and to deny our own mortality.
So what does it look like
when we leave the war out of cancer care?
What if instead, we just spoke plainly
about what was going on,
skipping all the metaphors
of wars and journeys,
talking directly and clearly
about everything involved
and all of the emotions:
the good, the bad, the happy,
the sad, and everything in between?
But most importantly,
what if we just listened?
Because everybody
knows someone with cancer.
Listen to your parent, your loved one,
your neighbor, your friend.
Listen and then try
not to explain it all away.
Validate them - what they say
and what they feel.
Trust yourself enough
to show that you love them.
This is hard, but it’s important
because our job with humans
is to sit with what’s hard,
feel awkward, and then stay.
Right there.
Because I promise
we will all be better for it.
Because some things in life
cannot be fixed.
They can only be carried.
(Applause)