Together with Sharon Bray – teacher and author of two books on writing and health – CKN welcomes you to our new Writing Series where Sharon helps readers tap into the healing power of writing during difficult times. As Sharon puts it, “Your stories matter. You are your stories. Our stories shape us and act as the lens through which we see the world. It’s through story that we make sense of our lives, reclaim our voices, and learn our words can touch others’ hearts.” Follow along with this bi-monthly series with Sharon and please send us your stories….they matter to us.
by Sharon Bray, Ed.D.
…the night’s speaker
a young surgeon, his slide-tray at his side…
snapping on his slides, projecting
our organs onto the wall,
touching them with his pointer
in blunt precision,
warning us again of lymph nodes
cells outside the prostate
that can end our lives.
(From: “Leaning Together in a Storm,” by Larry Smith, In: A River Remains, 2006)
Adam, the lead character portrayed in ”50/50,” a 2011 film about cancer and survival, has nagging back pain that ultimately sends him to the doctor. He ends up in an oncologist’s office to learn that his pain is due to a rare, and possibly fatal, cancer of the spine. While the film finds humor in unlikely places throughout his ordeal, “50/50” doesn’t spare the viewer the fear, upheaval, damage or losses triggered by a cancer diagnosis.
Adam first learns of his cancer diagnosis from an oncologist, portrayed as blunt and impersonal. The doctor brusquely details the specifics of Adam’s cancer in a salvo of facts and medical terminology, while pointing at the illuminated image of his tumor, oblivious to Adam, who is quietly succumbing to shock and disbelief. I watched this scene all too aware that some of the cancer survivors in my writing groups have described a similar experience.
“50/50” is based on a true story, and even though it’s classified as a comedy, it reveals issues that do sometimes exist in patient-doctor communication. Happily, training in the quality of the patient-doctor interaction has steadily increased in recent years, informed by research in narrative medicine and written accounts of the doctor-patient experience by those with cancer and other life-threatening illnesses. We now have greater opportunity to consider who our doctors are, why we choose the ones we do and the relationships we have with them during diagnosis, treatment and recovery.
Alice Trillin, a former education and film producer who died of lung cancer in 2001, examined the doctor-patient relationship in her article, “Of Dragons & Garden Peas: A Cancer Patient Talks to Doctors,” published in March 1981 in the New England Journal of Medicine.
Trillin acknowledged that the relationships patients have with their doctors are complex, and, in cancer treatment, often profound. Implicitly or directly, we’re being asked to entrust our lives with them, which sometimes leads to a tendency to endow our medical experts with larger than life qualities. We want to believe they can give us control over the things we fear. “First of all,” Trillin noted, “we believe in the magic of doctors and medicine… Doctors and patients are accomplices in staging a kind of drama in which we pretend that doctors have the power to keep us well.”
Think about it. We invest hope and trust in our doctors, wanting to believe we will be cured, or at least, cancer-free for a good long time. We’re examined by our primary doctors, poked and prodded, referred to a cadre of specialists, only to be prodded, pricked and examined again. Yet throughout it all, how often do we have the opportunity to examine them, to stop and ask ourselves, “What is it I want in a doctor?”
One cancer patient did just that. Anatole Broyard, a writer and book critic at the New York Times, died of prostate cancer in 1980, barely a year after his initial diagnosis. During that time, he wrote several essays reflecting on his life and illness. Thirteen years after his death, the essays were published in a small book entitled Intoxicated by My Illness and Other Writings on Life and Death. (1993). It’s well worth a read. Sometimes humorous, often critical, always insightful, my copy of Broyard’ s book is well worn and dog-eared, testimony to the wisdom found in his essays. In one of my favorite sections, he reflected on the relationship he had with his doctor.
Choosing a doctor is difficult because it is our first explicit confrontation of our illness…
The knowledge that you’re ill is one of the momentous experiences in life. You expect that you’re going to go on forever, that you’re immortal…When the doctor told me I was ill it was like an immense electric shock. I felt galvanized…and I was reduced to essence. I began to look around me with new eyes, and the first thing I looked at was my doctor.
I had no reason to believe that he was not good. He was in a good hospital…what turned me against him was what I saw as a lack of style or magic. I realized I wanted my doctor to have magic as well as medical ability. It was like having a “lucky” doctor.
“Now that I know I have cancer of the prostate, the lymph nodes and part of my skeleton,” Broyard asked, “what do I want in a doctor?” Here are a few of the characteristics he named, among them, a doctor who:
- understands that beneath my surface cheerfulness, I feel…panic
- is a close reader of illness and a good critic of medicine
- would be bonded with me for a brief space, survey my soul as well as my flesh to get at my illness
- can treat body and soul
- gropes for my spirit as well as my prostate
- knows that he is my patient too, and I have my diagnosis of him…
Broyard’s essay prompted me to reflect on my medical experiences and the doctors who cared for me during serious illness. I’ve been lucky. I still believe that the neuro-surgeon who operated on me in my teens must have possessed something close to magic, diagnosing what no other specialist had seen, operating two days later, and literally saving my life. I stayed in touch with him through adulthood and many moves—not for treatment, but in gratitude. He always responded with the same interest in me and the kindness I had known as a 15 year old.
I have asked the question, “What do you want in a doctor?” to the participants in my writing groups. The prompt always triggers writing that is strong, poignant, sometimes angry, and even humorous. For many, it’s the first time they have expressed their feelings about their doctors. I remember one woman’s writing, however, that went beyond the writing group session.
G had received the news no one wants to hear just a few days earlier. Her cancer had metastasized throughout her body, and she had, at most, only a few months to live. G had been a patient of her oncologist for over a decade, from initial diagnosis to this most recent. Her response to the question took the form of a letter addressed to her oncologist. In it, she described her pain and disappointment , due less to her terminal diagnosis, but because of the manner in which her doctor gave her the news. He was unusually distant, reported the test results in a cold and factual manner, avoiding eye contact or any show of compassion to his long-time patient, a significant departure from his usual behavior.
When the group met again the following week, G told us she had mustered up the courage to actually give—and read aloud—her letter to her doctor. The result was an honest conversation between them, her doctor admitting his struggle to maintain his professional composure and deliver a terminal diagnosis for his long-time patient. He apologized, and the result was an honest and compassionate conversation between them, one in which she felt reassured, confident he would see her through the last phase of her life with all the compassion and care that she had experienced from him over the years.
He goes out of his way every time to ask how
…I no longer go out of my way to
picture the mound of earth dug just my size.
(From “About Dr. G,” by Ann Emerson, In American Poetry Review, 2012)
Try writing: Combine the experiences you’ve had with your doctors during cancer treatment together with what you know about yourself—your needs and wants. What characteristics in your doctors are most important to you? Have you had any doctors who made you feel “lucky,” as if they possessed a bit of magic? Turn the tables and examine your doctor, just as Broyard did. Begin with the title, “What do I want in a Doctor?” and write for 20 – 30 minutes. Read it over. Were there any surprises or new insights?
Let us hear from you! CKN will select and publish your responses to the suggested writing prompts from Sharon. Send them to Karen Irwin. 500 word limit.
Sharon Bray, Ed.D., is the author of two books on writing and health: A Healing Journey: Writing Together through Breast Cancer and When Words Heal: Writing Through Cancer. Her blog site, www.writingthroughcancer.com, features weekly reflective essays and writing prompts for anyone writing out of illness, pain or life struggle. She leads a number of expressive writing workshops for cancer survivors and teaches creative nonfiction and transformational writing for UCLA extension Writers’ Program. She earned her doctorate from the University of Toronto.