Then a door opens
and our leader rises
to introduce the night’s speaker
a young surgeon, his slide-tray at his side.
“Greetings, Gentlemen,” he grins
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 life.
(From: “Leaning Together in a Storm,” by Larry Smith)
A few years ago, I saw the film, “50/50.” Although classified as a comedy about cancer and survival, its portrayal of the physician-patient interaction reminded me of the different experiences we have with our medical professionals. 27 year-old Adam struggles to comes to terms a diagnosis of a rare spinal cancer. While he finds humor in unlikely places throughout his ordeal, all laughter aside, “50/50” doesn’t let the viewer forget about fear, upheaval, damage or the losses a cancer diagnosis produces in a person’s life.
When Adam’s physician tells him that the pain in his back is the result of a rare and possibly fatal spinal cancer, his manner is impersonal and brusque. He points to the illuminated image of Adam’s spine, the tumor, and delivers the news to him in a salvo of facts and medical terminology, all while Adam succumbs to shock and disbelief. I remember that scene, because despite exaggerating the contrast between Adam and his physician, I’ve heard more than one similar account between a newly diagnosed cancer patient and a doctor.
Until recently, doctor and patient communication resided in the domain of physicians, reflecting, in large part, their medical school training. Thankfully, there has been a steady increase in attention to and training in the quality of the patient-doctor interaction, informed by leaders such as Rita Charon in narrative medicine and the narratives of patients themselves. All this has been informative, not only for the medical professionals, but for the rest of us too–exploring who our doctors are, why we choose the ones we do and the nature of our doctor-patient relationships.
Alice Trillin, an educator and film producer who died of lung cancer in 2001, reflected on the relationships between doctor and patient in a March 1981 issue of the New England Journal of Medicine:
First of all, we believe in the magic of doctors and medicine. The purpose of a talisman is to give us control over the things we are afraid of. Doctors and patients are accomplices in staging a kind of drama in which we pretend that doctors have the power to keep us well.
–“Of Dragons & Garden Peas: A Cancer Patient Talks to Doctors”
The relationships we have with our doctors are complex, often profound, as Trillin noted. Implicitly or directly, we’re asked to entrust our very lives with them. We get poked, prodded and examined by our doctors, as Molly Redmond describes in “The Cancer Patient Talks Back,” and it can have a de-humanizing effect:
I have suddenly crossed the boundary line
of the risky circle called cancer.
It has made me public property, like being largely pregnant.
People invade – an assault of connections… -
The medical cadre, too.
I am covered with fingerprints, with labels.
(“The Cancer Patient Talks Back,” In: The Cancer Poetry Project, Vol. 1)
But how often do we have the chance to examine those in the “medical cadre” whom we entrust with our lives? How often do we stop to ask ourselves, “What do I want in a doctor?”
Literary critic Anatole Broyard, writing in the wake of his diagnosis of metastasized prostate cancer, did just that as 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. (From: Intoxicated by My Illness and Other Writings of Life and Death).
“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?” He detailed several characteristics he would like in his physician, among them:
- understands that beneath my surface cheerfulness, I feel…panic,
- was 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 got me to thinking about the doctors who’ve cared for me in times of serious illness. I’ve been lucky: a gifted neurosurgeon, cardiologist and many others—doctors who have demonstrated the capacity and compassion to understand me as well as the diagnoses that forced me to put my life in their hands.
Why not ask yourself the question Broyard asked of himself? Given the experiences you’ve had with your doctors, and what you know about yourself, what matters most to you? Examine your own doctor-patient relationship. What characteristics have been most important in your choice of a doctor in the past? Which doctors made you feel “lucky,” as if they possessed that little bit of magic? Why? What characteristics would you like to have in your doctor?
I want to escape this torture by words,
but ask instead, “And what about the
radiation seed implants they’re doing in Seattle?”
He turns on me like a cop. “We’re doing those now.
So it’s a question, how big is your ego?”
Some smile at this, other know
how cold the knife is, how his words
cut across our lives, our wish to live
each breath, see morning spread
across our lawn, our grandchildren’s faces.
We all have this unspoken need
to pace our life
like a heart beat.
In the end we let it go
trade our feelings for facts
we already know,
“It’s a game of numbers,”
he says again, and I wonder
if these others want to drive
this witch doctor from the room
and gather warmth from the fire
we sit around, share our stories
together of going on.
(In: A River Remains, by Larry Smith, 2006).