Monday, May 26, 2008

Let's Stop "Fighting" Cancer

Judy Foreman's column in today's Boston Globe addresses one of my pet peeves - the ubiquitous metaphor of "fighting" cancer.

The term has been all over the news in the context of Senator Kennedy's condition. Foreman explains what's wrong with the fight talk this way:
"Cancer is not a football game. It's more of an involuntary dance with a partner you didn't choose...

It's not that I think that Ted Kennedy should sail quietly off into the sunset with the word 'ACCEPTANCE' emblazoned on his shirt. Certainly not yet. I think that he should, and no doubt will, muster his considerable intellectual, emotional, spiritual, political, financial, familial, and social power to deal with his cancer on all fronts...

The fighting metaphor is insidious because it subtly and not so subtly implies that if you fight, you can 'win.' And if you don't fight hard enough, you 'lose' and are therefore a 'loser'...

So I would change the mantra [from 'Fight, Ted, fight'] to 'Breathe, Ted, breathe.' Sail your boat. Kiss your wife and your kids. Trust your doctors. Keep doing the work you love."

An old joke speaks to the world view behind all the talk about fight. "In India, death is seen as a potential step away from reincarnation and towards Nirvana. In Europe, death is seen as an existential tragedy we all must face. In the U.S., death is seen as optional."

In my practice, some people with terminal illnesses like to be thought of as "a fighter." For them the term is a good one to use. But in my experience this group is a minority. For some, an illness like cancer is "a wake up call" to fix unsettled areas of life. For others it is "a release."

Our uncritical use of "fight" and "battle" is related to the uncritical way in which we squander resources on low-yield and even no-yield health services. Even worse, it is related to what medical students and residents working in hospitals call "flogging" patients with treatments that no one wants but which take on a momentum of their own.

When I was growing up, boys were taught that only "sissies" give up the fight and say "uncle." That macho approach to life may be well suited to trench warfare, but it is not a good guide for a health system.