Dr. Roy Sessions will be authoring a series of articles for Tidelines. He is a Seabrook resident who specializes in cancer related health conditions. Please click to read his first article followed by his bio-sketch.
According to a Greek fable, the god Zeus bequeathed a box to Pandora (the first mortal woman) that contained all of life’s blessings and curses. With this gift came the admonition that the box should remain closed. Despite this simple condition, Pandora’s curiosity bested her – she opened the container, and out flew the miseries and misfortunes which have afflicted man since: disease, despair, pain and other evils. But last of all came hope, like a little bird bearing a message of consolation for mankind. The moral of the story is that mortals must have hope. So it is with cancer patients, within whom there is no greater psychological force.
Let’s talk about this word, especially as it pertains to the subject of cancer. Common to all definitions of hope is the expectation that there is something better yet to come. Specific to cancer, however, one logically might assume that the apogee is hope for cure with all else paling- right? Consider that such may not be the case! In my opinion, the goal of the oncologist (cancer specialist) should be to maximize the chance for cure, but while doing so, also maintain a strong emphasis on the individual’s quality of life.
At the risk of thinking differently from the traditional line of curing the cancer at any cost and of returning the patient to society, cured but incapacitated no longer seems to be an automatically accepted strategy. I will go even farther and strongly challenge the notion that “cure” at this expense is ever desirable. I say this dogmatically, with the clear recognition that it is the patient, not the doctor, who should determine the acceptability of extreme treatment.
Critical to all of this is a frank discussion with one’s oncologist. It is a discussion in which the patient comes to understand exactly what is involved with the recommended treatment, and conversely, what the consequences are without it. Lack of patient comprehension of such consequences often results from the oncologist’s lack of communicative skills, or worse, from a lack of concern or time commitment. When talking about something this important, it’s essential to distinguish between a monologue and real communication. The latter involves patient comprehension; a monologue is merely the doctor talking. And, although the doctor may have given an explanation, that does not mean that it was understood by the patient.
Because of embarrassment or other factors, patients are often reluctant to admit a lack of understanding. Simply put, it’s the doctor’s responsibility to pick up on this flaw in the equation, and to overcome it. On the most practical level, communicative skills are not only about the ability to articulate, but also about the ability to read body language and countenance; thus, the doctor recognizing when he is not getting through.
If one rejects the notion of cure at any cost, then it follows that we should redefine hope to include less dramatic goals. And in the modern spirit of autonomy and self-awareness, the patient, rather than the doctor, should be the author of the revised script. As I look back on my career, I question some of the radical operations that I performed after which the patient, even though cured, had an extraordinarily difficult lifestyle. Patients often were not grateful for what I had done, and in fact not infrequently they regretted having agreed to undergo the operation.
In fairness to the medical profession, however, it should be pointed out that not too long ago, we had a limited arsenal of scientific management strategies to combat cancer. Generations of surgeons, including myself, were devoted to bigger and more effective operations which is not the case today. Even though substantial operations still must sometimes be done, strategies of prevention therapy with organ preservation and acceptable functionality are more the norm.
What about redefining hope, if not for cure, what else? In the preceding paragraph, I talked about quality of life. Well, the sequel to that line of thought is quality of death. Hope can be for a good death, in which acceptance of the inevitable is achieved as one passes through the final stages of life. Essentially, this is what the hospice concept is all about, in which acceptance leads to tranquility, and even though fearful, death is often rendered non-terrifying.
Hope can be for the opportunity to reassert love and friendship or to mend interpersonal bonds that are in disrepair. Hope can be for the time to tend to certain goals; for example, walking a daughter down the aisle, living out a long-held fantasy or getting finances in order. Hope can be for a tranquil passage out of this life, unencumbered by machines, surrounded by family and friends, and even for death at home. Ideally, the hour of death should be a time of spiritual sanctity; a time for communion with those left behind.
With regard to dying at home, contemporary lifestyles in the United States often preclude this; in fact, about 80% of deaths that occur each year in this country are either in a hospital or a hospice facility. This despite the fact that when asked, a high percentage of patients say they would prefer otherwise.
So hope is a versatile word, not necessarily blatant and out front, but often like a mist amorphously insinuated throughout the interstices of the psyche. Critical to the full realization of hope, no matter how defined, is the absolute trust of one’s doctor. Of course, the antithesis to this statement is that a doctor’s inability to connect in this realm can stymie the patient’s ability to find this state of nirvana.
In my next blog, I’ll explain what I mean by this with a discussion of the link between trust and hope, and why this most valuable of bonds between patient and doctor should be sacrosanct. In that discussion, I’ll draw a distinction between false and real hope, and interweave them with the trust to which I refer.
Roy B. Sessions, MD, FACS
Seabrook Island, SC
Author’s Note: This essay is a variant of a similar essay published in the journal, Psychology Today.
Bio-sketch for Roy B. Sessions, MD. FACS
Doctor Sessions was born in Houston, Tx. in 1937, and was raised in the New Orleans area. After attending college and medical school at Louisiana State University, he interned in San Francisco. Following internship, Sessions served as a US Naval Medical Officer for two years on active duty, and then 4 years in the Naval Reserves. After active duty, he did his surgical residency at Washington University School of Medicine in St. Louis – Barnes Hospital.
Following residency, Sessions took his first academic job in 1969 at the Texas Medical Center in Houston, where he became vice chairman of his department and taught for 11 years. He then became a Professor of Head and Neck Surgery at Memorial Sloan Kettering Cancer Center in NYC, and Cornell Medical School.
He remained at Sloan Kettering until 1989, when he became Professor (with tenure) and Chairman of Head and Neck Surgery at Georgetown University School of Medicine, Washington D.C. Sessions held that position until 1999, when he left to return to NYC as the Departmental Chair at Beth Israel Medical Center and Interim Director of the Beth Israel Cancer Center.
Doctor Sessions retired from active practice in 2008, when he and his wife, Mary, moved to Charleston, then to Seabrook. They have four children, all of whom are involved in their own careers. Although he has retired, Sessions teaches two days a week at The Medical College of Charleston. During his active academic career, he was responsible for over 140 scientific publications and five textbooks.