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)