Sunday, July 02, 2006

Can You Ever Be Too Optimistic?

Yesterday, I came across a new blog. The Cheerful Oncologist really grabbed my attention because, while I know all about being a patient, it isn't often that one gets to see what it's like to have to be the doctor dealing with this disease. While I was going through some of Dr. Hildreth's blog, I found this really excellent post that explains some of the techniques he uses to help patients understand what's happening to them and what they should expect given their individual prognosis.

Even though the specific scenarios he mentioned are different from my cancer, my case fits into the category of those that can be described by his (well-considered) third analogy. After I read the post, I also took a look at the comments that others left. Evidently, one responder (JB) disagreed with the sort of analogies that oncologists like Hildreth use. In this response, JB made a few statements that I definitely take issue with.

"I occasionally see a patient with nonresectable metastatic cancer who returns from an oncologic consultation with unjustified optimism"

and

"To an oncologist, keeping a patient with a liver full of cancer alive for 5 years is a great accomplishment (and don't get me wrong, it is amazing how much better you are doing compared to a few years ago), but to the patient, he's still dying of metastatic cancer. The only question is when."

You can (and probably should) read his comments in entirety by clicking on my link to Dr. Hildreth's post.

I responded on Dr. Hildreth's blog but I also wanted to put that response on my blog because 1.)I'm sure that JB isn't the only person who might have such views and 2.) I think that people with incurable cancers need to know that they needn't adopt his way of viewing what's going on with them. So, here is the comment that I left:

I love this post. I am an individual with a tumor that, so far, can't be "killed" but has been "on the canvas" for several years. I wanted to respond to what JB wrote about "unjustified optimism". I do appreciate the concerns she/he mentioned because of the need for patients to be able to give informed consent before the start of a new treatment, especially one that isn't expected to provide a cancer-free existence even at best. However, I do not believe that there is ever a situation where a person with cancer can have "unjustified optimism". Look how many oncological advances have occurred in just the past five years. If oncologists can help a patient with a "liver full of cancer" live for five years, it may be just long enough for that patient to be alive when the next advance comes along that may make it possible for them to live another five years.

If JB were to talk to some of us with incurable cancers, he might find out that we don't just view ourselves as "dying of cancer". When people ask me about my condition, I tell them that I am LIVING with cancer. To use my own analogy, I'd say that life with incurable cancer is like an ice cream on a summer day. To be sure, it will not last but it is definitely enjoyable while you have it. As a matter of fact, any of us (healthy or not) could frame our lives around the fact that life is temporary OR we can choose to focus on how wonderful it is to have been able to enjoy so much more of it than those before us would have ever thought possible.

So please, Dr. Hildreth, continue using these excellent analogies. Those of us with these hard-to-treat/untreatable cancers need to know that you don't need to be cancer-free in order to "win". In life, we don't usually get to pick all of the battles we'll have to fight; Sometimes, some people will have to deal with situations that will ultimately end in death. However, by fighting with all that modern medicine has to offer and remaining optimistic (even if it's only for the sake of those who love us) and brave, we DO win a life lived with dignity and that's even better than being cancer-free, if you ask me.

I am very interested to hear from anyone who has thoughts about or experiences with this, so please don't be afraid to disagree with me. I'd appreciate any insights on why it might be unethical to use analogies like Dr. Hildreth's.

6 comments:

Sweet Strength said...

...faith DOES and WILL move mountains. Unfortunately, we live in an age where faith and optimisim are linked with naivite...if only they knew.

Hold on Sis, and don't let someone's skewed and messed up understanding of a heaven-sent gift dissuade you or forget for one moment that faith CAN and WILL change things.

I wouldn't be alive today if that wasn't true.

May God bless you and your family.

Don Spencer said...

Hi, Tulip. Thanks for writing about this.

I have been thinking and blogging about optimism and cancer recently. In addition, I have found some very useful research that both you and the good doctor might find relevant. My recent blog entries listed below are directly related to the value of optimism, realistic or otherwise, in fighting cancer.

http://rtfax.blogspot.com/2006/06/unwanted-journey-day-0205-gratitude.html

http://rtfax.blogspot.com/2006/06/unwanted-journey-day-0209-optimism-and.html

http://rtfax.blogspot.com/2006/06/unwanted-journey-day-0211-cognitive.html

http://rtfax.blogspot.com/2006/06/unwanted-journey-day-0213-signature.html

Don Spencer said...

Hi, Tulip. Thanks for writing about this.

I have been thinking and blogging about optimism and cancer recently. In addition, I have found some very useful research that both you and the good doctor might find relevant. My recent blog entries listed below are directly related to the value of optimism, realistic or otherwise, in fighting cancer.

http://rtfax.blogspot.com/2006/06/unwanted-journey-day-0205-gratitude.html

http://rtfax.blogspot.com/2006/06/unwanted-journey-day-0209-optimism-and.html

http://rtfax.blogspot.com/2006/06/unwanted-journey-day-0211-cognitive.html

http://rtfax.blogspot.com/2006/06/unwanted-journey-day-0213-signature.html

belledame222 said...

>The only question is when.

Jesus Christ. That's, you know, *everybody.*

>As a matter of fact, any of us (healthy or not) could frame our lives around the fact that life is temporary OR we can choose to focus on how wonderful it is to have been able to enjoy so much more of it than those before us would have ever thought possible.>

...right.

Part of it is that in this culture, I think, there's a really strong denial of death.

And there's no framework that many people can grapple with that encompasses both optimism *and* acceptance of death.

I come from a family that is, I think, absolutely terrified of death, and illness, and suffering, and all sorts of nameless things that probably do break down to death, or rather annihilation. Whether this is linked to our agnosticism/atheism is something i have often wondered about. Lord knows there are plenty of religious folks who don't handle it any better.

All I know is that the "ruminate and worry endlessly on the worst possible scenario" approach does not result in a way of life that I want to emulate. And so, I keep searching for alternatives. Dr. Hildreth sounds like the sort of doctor I'd want to have.

Professor Zero said...

JB doesn't seem to think his patients are all that bright. Hildreth seems to give clear information. That's realistic.

I haven't had life-threatening health problems (yet), but I have had limb-threatening ones. The idea that I could possibly beat them, was helpful not just for my mood, but for doing everything I possibly could *to* beat them. I wouldn't call that denial.

Bint Alshamsa said...

I wouldn't call that denial either. I think that if you just tell someone that they are going to die and that's it, it's a lot harder to get them feeling motivated to at least improve their quality of life as much as they can.

I hate this attitude that some people have where they think that because you're physically disabled you have to walk around morose and depressed in order to prove that you're clear about your own condition.

By the way, I've seen how traumatic it can be to lose a limb or be facing the possible loss of one. To be honest, I think that there really isn't much difference in the amount of anxiety that one faces with a life-threatening illness. I still miss the bike I had in the fourth grade, so you'll never catch me downplaying someone's limb-threatening experiences.