Writing Through Cancer

He opens the door

            and walks in,

his face and white coat

stiff with starch,

 

holds my hand, and

he says,

“I’m afraid.

 

I am afraid

you have cancer…”

From: “Diagnosis,” by Majid Mohiuddin, in The Cancer Poetry Project)

“Write about the moment when the doctor said, “Cancer.”  It’s usually the very first prompt I offer in a new series of my “writing through cancer” workshops.  That moment of confirmation, the seconds in which a physician delivers the words that will, in an instant, change your life forever, is something everyone in the group shares, an event that evokes strong emotions as it gets written about and described.

Writing that is most healing has some particular characteristics, as psychologist James Pennebaker and his colleagues have noted, among them, writing that is concrete, vivid, and gives detailed descriptions of trauma, distress and emotion.  When I ask group members to return to that first moment they hear the word, “cancer.” No one ever responds to this prompt with generalities.  And when they read what they’ve written aloud, it’s often emotional, as they remember their doctor’s words, “I’m sorry; you have cancer.”

While those words, “you have cancer,” are unfamiliar and terrifying to us, to the doctor, they are words delivered many times, to many people.  How difficult must it be to be the physician who delivers those words to a patient?  Not once, but so many times throughout one’s medical career?

The door seems impenetrable.

Today is arduous.

I have seen patients with cancers of pancreas,

Gastric, cervix, colon—all unresectable…

Why is it so difficult to enter this room?

(From:  “The Door,” by David H. Huffman, MD, in The Cancer Poetry Project)

This past weekend, I led an all-day writing workshop for faculty, alumni and students of the Stanford University Medical School in Palo Alto.  It’s a series I’ve led since 2005, as part of the Literature and Humanities program in the medical school.  One of the several exercises I offered to the group on Saturday began with a reading of a personal essay, “The Before,” written by Jennifer Frank, MD and published in the Journal of the American Medical Association.  In it, Frank offers her readers a rare—and poignant–glimpse into the doctor’s mind as she prepares to call a patient with the diagnosis no one wants to hear.

This is the before.  A moment suspended like a bubble floating on a warm summer breeze gently but inevitably toward the ground.  I feel the pop coming, an implosion of the very center of your life.  Anticipating what this moment would hold, I nevertheless hoped for something different.  To be able to eagerly dial your number and shout out the good news to you in a breathless rush.  “It’s not what we thought.  It’s not cancer.”

Instead I take a deep breath, pressing each number slowly, cautiously, drawing out the moment before the burst.  The burst of your plans and your dreams and your future.  I stall for time, asking if this is a good time, are you alone, do you have a pen and paper? …

I want to be straightforward but not blunt.  I want to be compassionate but remain professional.  I slow myself down, remind myself that the words I’m about to say are ones that I’ve said before, many times, but that the words I’m about to say are also ones you’ve never heard before… (In:  “A Piece of My Mind,” JAMA, March 7, 2012, v.307. no.9).

It’s difficult, when we are the patients, the ones receiving the diagnosis, to understand what is felt by the person delivering the bad news.  We may never completely understand what is behind the doctor’s mask, yet we need the practiced and steadfast hand of a professional to guide us through the upheaval, and help us find our way through a regimen of treatments.  “All I can offer is my hand,” Frank concludes, “…to hold you up, prevent you from going under until the sea calms and the path clears.”

“Write about the moments just before you had to deliver bad news to a patient or someone close to you,” I said to the group after we read Frank’s essay aloud.  “Write about how you felt and what was going through your mind.”  Everyone went to work, heads bowed, pens moving quickly across the page or fingers flying over keyboards.  Twenty minutes later, I invited everyone to read aloud.  It was a humbling experience.   While I know well the emotions in the narratives of cancer patients and survivors, those expressed in this group’s narratives were no less powerful.  Their stories and poems offered a glimpse behind the mask, a reminder of what it is to be human, to care, to feel, no matter whether patient or physician.  As Huffman expresses in “The Door,”

…I can only be forthright and compassionate. 

Why is it so difficult to enter this room?

Maybe someday I will be in that bed.

I hope that if that time comes

My doctor will be as truthful and considerate.

But if she hesitates at the door…

I will understand.

This week, write about that moment, the one just before you hear the words “you have cancer.”  Remember, if you can, what you were feeling, where you were sitting or standing, what you remember about your doctor’s voice, eyes, face.  Then write about that same moment again, only this time, shift the point of view.  Put yourself in your doctor’s shoes and write from her or his perspective.  Become the one who must deliver the bad news, this diagnosis, to you.  What the doctor might have seen as she or he looked at you or heard when you came to the telephone?  What might she or he have felt?  Write in as much detail as you can.  When you finish, compare both.  What happened in each?  Did anything change in the way you think about that moment? Did you discover any new insights or understanding?  What was it like to write from the doctor’s point of view?