We saw this same word pop up in December, when celebrated civil rights leader US Rep. John Lewis of Georgia revealed his stage four pancreatic cancer diagnosis. Almost immediately, well-wishers who included former President Obama wrote to comfort Lewis and offer words of encouragement.
“If there’s one thing I love about @repjohnlewis,” Obama tweeted, “it’s his incomparable will to fight. I know he’s got a lot more of that left in him. Praying for you, my friend.”
The sentiment, of course, is heartfelt and moving. The idea is to evoke courage. But as an oncologist, I take issue with how we, as a society, are quick to speak of cancer treatment as a “battle” or “war” or “fight” the patient must win. The logic behind employing this common metaphor is understandable. After all, using superior force to destroy something as evil as cancer is a good thing.
Sadly, however, it is also counterproductive.
The words we use – in all things, but especially in medicine - are important. The connotation of “war” and the images it conjures in the mind’s eye are anxiety-inducing and potentially demeaning to the patient. Though we may not have first-hand battle experience, we “know” war. Based on news reports and movies, we appreciate the brutal images and traumatic noises associated with combat.
The metaphor of war also implies control that the patients do not have and creates guilt when the “battle” appears lost. It has the polar opposite of the desired mental and physical state-of-being for someone who is sick. For those who are ill, their family members and caretakers, our goal as providers is to promote dignity and assist with the patient’s journey dealing with and managing treatment and health. And addressing the courage it takes to make decisions when facing one’s mortality.
In a word: peace.
As surgeons and physicians, we may use our skills to try and conquer a disease, but our words, approach and demeanor must be used to heal, instill calm and foster that state-of-being where life flourishes—and that is a state of peace.
To understand why, imagine a person struck by a sudden and fatal heart attack. One moment he or she may be walking the dog, driving to work or washing the dishes, and the next he or she is succumbing to a swift but painful death. Heart attack victims have no time to say goodbye or sort out their affairs, and no say in what kind of palliative care they might receive.
A terminal cancer patient, on the other hand, may at least have the chance to depart on his or her own terms. Caring for these patients, I remain deeply touched by watching them prepare for the end, making sure their family members know just how much they were loved and seeing to every other necessary consideration before dying in peace.
Naturally, when told “you have cancer,” one immediately seeks all effective treatments with the desire of living (longer). Of course, the curse of cancer is unwanted, and it conjures fears of treatment toxicity and mortality that becomes real and imminent. But the journey associated with managing this disease is something that cancer patients have to do; some having to learn how to die.
The war metaphor throws a wrench in this otherwise natural human process. It sees death not as a part of the natural progression of life but rather as its opposite, and as something that can somehow be defeated and overcome. It also forces us to think in terms of winners and losers—this, after all, is the binary nature of war—which makes us all the more unlikely to accept that death may be near. Nobody likes to lose, and those of us who invest tremendous energy in imagining their medical treatment as a military campaign are sometimes too exhausted and depleted when they’re told that the fight will not end in victory.
So how to help these patients? In part, that’s a question that should be addressed by the culture at large. As anthropologists studying cross-cultural attitudes to death and dying have long noted, Americans are endowed with a strong sense of optimism that makes death much more of a taboo than it is in other cultures. So while our educators, entertainers and everybody else who shapes public consciousness have their work cut out for them if they wish to help us learn to accept the inevitable, we can all play a part simply by watching how we speak about terminal illness.
Instead of the anxiety and guilt associated with losing a battle, we can stress the fullness of the life lived and the gratitude for precious time spent together. We can share memories of happy moments, which does much to assuage the fear of the unknown experienced by a patient on the verge of passing away. And we can help those we love by talking about how they would like to be remembered, and make sure that their legacy continues to live on.
That said, the metaphor associated with the “war on cancer” as envisioned as a societal goal at irradiating this disease works. The efforts of many over time have had an impact, as evidenced by the American Cancer Society’s latest report showing a 2.2 percent drop in the cancer mortality rate from 2016 to 2017 – and 29 percent from 1991 to 2017. Obviously, those numbers are extremely encouraging, but at the patient level, the war metaphor is not helpful.
And so, to Mr. Lewis and Ms. Doherty, and to anyone facing the disease, I have only this to say: I hope the treatment you receive is effective, and that you continue to inspire us for years to come. But if it’s not, I hope that your final days are filled with love, comfort and joy, and I am sure that your spirit and courage will continue to inspire us for many generations to come. Life should not be just another battle, for you or for anyone else.
Dr. Louis Potters is deputy physician-in-chief of the Northwell Health Cancer Institute, chair of radiation medicine and professor at the Zucker School of Medicine at Hofstra/Northwell.
The views expressed in this article are the author’s own.
