UCLA Journal of Radiation Oncology January 1, 2022 - Flipbook - Page 49
UCLA RADIATION ONCOLOGY JOURNAL
Ehud believed in finding the right word, which
was usually a simple one. (Rule 6: “Simplicity is
a virtue. Do not gaze when you can look, be atop
when you’re on, be ajar when you’re open.”) The
right word could make a sentence transcendent;
the wrong one could make a reader put down
the book, leave the bookstore, drive home, and
ask for a divorce. I remember an essay I wrote
about Flannery O’Connor in which I used the
word “morph.” Ehud circled it, crossed it out,
and wrote in all capital letters in the margin,
“NEVER.”
“Why?” I asked, as we reviewed the essay
together, thinking he might have an eloquent
explanation involving etymology.
“Because it sounds stupid. Just say it out loud
three times.”
I started to do so, but he held up his hand.
“Please,” he said. “Not in my presence.
In my second year in the program, Ehud
became sicker. He was bone thin. He bore
little resemblance to the man in the author
photo from his book published 10 years earlier.
In another workshop, while he was talking
about a story, one of his teeth fell out into his
hand. Afterward, he told me he felt terribly
embarrassed about it. I don’t remember
what I said to him, but I was thinking that
embarrassment was the last thing he should
be feeling. He was sick and yet still commuting
an hour to work every day, still reading and
rereading our stories, still passing on his
devotion to literature.
Ehud’s path was never going to be easy, but for
him, it was made even more draining because
of the way cancer is viewed in our society, as
an enemy that can be vanquished if only you
fight hard enough. He said in a 2007 interview,
“This expectation that you can beat it is selfdestructive. It’s a taunt, and that heroic attitude
is a burden.” Calling patients with cancer
heroes and reducing the complexity of the
patient experience to victories and losses in
battle—a tactic well suited to catchy slogans and
fundraising campaigns—ran counter to Ehud’s
sensibilities, which favored nuance, depth, and
ambiguity. He believed in negative capability, a
literary concept describing the capacity to hold
opposing ideas in your head without the need
to resolve the conflict or, more simply, being
at peace with uncertainty. In Ehud’s view, a
good story didn’t provide easy answers—Rule 7:
“From Chekhov, who is God: ‘You confuse two
things: solving a problem and stating a problem
correctly. It is only the second that is obligatory
for the artist.’”
Ehud and I never directly discussed his views on
the language of cancer, so what follows are my
own opinions, although they are based on what
I learned from him, as well as ideas I have since
gathered from colleagues and medical literature.
In the spirit of Ehud’s list about writing, here
are my suggestions for discussing cancer with
patients.
The 10 Most Important Things You’ll Ever Hear
From an Intern About the Language of Cancer
1. Listen to your patients. You are not as
important or interesting as they are.
2. Individualize your language to fit your
patient, just as you individualize your
treatment plan.
3. Think carefully before using war metaphors.
It becomes difficult to bring up palliative care
in the midst of total war. Likewise, patients
may feel pressured to live up to the image
of a heroic warrior who exhibits enough
grace under pressure to make a Hemingway
protagonist blush.
4. Be prepared when patients and their families
use combative terminology. “He’s a fighter,”
they might say. Without dismissing this
expression of faith in the patient’s mettle,
consider reframing the fight: “There are
many goals someone can work toward, such
as freedom from pain or more time at home
with family.”
5. Patients and families may think of palliative
care as surrendering. Start by defining
palliative care, comfort care, and hospice—
they are not synonyms, and misperceptions
are common. And try introducing palliative
care early, both the concept and the team. If
you wait until the end, you take the advance
out of advance care planning.
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