The Roller Coaster Chronicles: An open letter to cancer patients everywhere
University of Michigan Comprehensive Cancer Center
Dear Readers: In response to my letter to cancer doctors last Tuesday, Dr. Gary Hammer, world-renowned adrenal cancer specialist at the University of Michigan Comprehensive Cancer Center, wrote this very beautiful and moving letter to cancer patients everywhere. Dr. Hammer expresses what those of us who are lucky enough to have doctors like him know: that by sharing our illnesses — no doubt surrendering their own comfort to do so — the physician's healing power transcends the science of medicine to help us heal in ways that no medicine ever could. I am deeply grateful to Dr. Hammer for giving us this rare view of the doctor/patient relationship and honored to share it with you.
You have asked questions about the unique aspects of the doctor-patient relationship. I will attempt to answer them as well as share my perspective on illness.
Life is indeed defined by relationships — feeling understood and feeling connected in our relations is trust.
You ask what you are trusting in me. Trust is earned. It is fair for all of us seeking care to expect competence, it is fair to seek excellence, it is fair to want the best. It is right to demand respect. It is right to demand honesty.
You ask that I not be too proud to call in colleagues if I run out of ideas. The Hippocratic Oath, a verbal decree by doctors to honor and respect human life, speaks to integrity. "Do No Harm." My interpretation of this most powerful phrase is that we must not be wrapped in solitary ego and hence filled with the imposter syndrome, afraid of being found out that we are fallible, imperfect and not all-knowing, afraid of what we don't know. A good doctor knows what he or she doesn't know, is not afraid of that fact and discloses it humbly. Owning our limitations is freeing and honors our shared humanity. Consulting with colleagues and other specialists who know more than me about a particular situation is absolutely essential and happens every day.
You ask if I will be honest with you without stealing your hope. Honesty and hope, at times, seem to be mutually exclusive reflections of imminent death versus certain cure. Rather, they are our forever present and forever fluid experience of our life with illness. I will honor both.
You ask if I'll give up on you if the going gets rough. A person doesn't "give up" on another person. While I might give up on a given therapeutic approach, I will never give up on you as a person. I will fight alongside you. I will surrender alongside you, but you — and only you — can decide if, when and how to engage your life, your experience of illness and ultimately your death.
You wonder how to trust members of my team whom you will never meet. The only way that you can feel confident in this dance is to trust me and our team. And it is a team. I promise to hold your best interest in the fore and to represent you to the team. Know that while I cannot formally speak for others, I will demand the very best from those I consult, from those on our team, from those we together entrust with your care.
You ask if I will treat you as more than a collection of cells that needs to be fixed. I reject the concept that doctors must disengage to provide "objective care." What does it mean to be objective anyway — cold, impersonal A+B=C? What good is that? On the contrary, conscious and emotional engagement not only facilitates healing and/or acceptance in the ill, it opens a space in the caregiver as well. In that vulnerable space where spirit mingles, life is transformed for the suffering, and life is transformed for those who bear witness.
You ask me to share your fear and you wonder how I do what I do every day. Perhaps the most frightening words a person might hear in his or her lifetime are "You have cancer." This truth revealed fractures our reality. It challenges our relationship to our inner world, forcing us to re-evaluate who we are.
However, embedded within this experience lived is a gift. The little-known secret is that the gift is not just for the afflicted but also for their entire circle of relationships, including spouse, children, friend and caregiver alike. The only requirements to receive this unique communion: vulnerability and presence.
As a physician engaged in the care of people with a particular rare cancer - where those under my care almost always die — I am thankful for the sharing of truths that have been unveiled to me by these men and women in this, their most vulnerable and internal sanctuary.
In this place of finding themselves dying, brave people have let me into their space where three truths seem to be unveiled again and again as defining gifts of sacredness. These truths can be embraced as three reflections of the word "presence:" conscious engagement, the experience of present time (the razor-sharp now) and the gift of emotional authenticity. Through these patients, I have come to an understanding that if we are fortunate to actually have time while we are ill, and we are brave enough, what happens as our vanity, our beauty and ultimately our physical identity is stripped away is that we are granted a chance to become our own sacredness — as it becomes all that is left.
Sadly, when people die suddenly, they rarely have the luxury of such time, such a place. But equally as tragic is that most folks never risk to venture to this vulnerable place while living when they do have time. Having our own death close by in life — be it through illness or conscious reflection — sharpens our internal lens by stripping away all that is not present, all that is not presence.
I thank these lovely people for helping me begin to see. It is indeed my experience with deeply reflective and engaged people suffering with cancer that is becoming, for me, a touchstone for such conscious intent.
While the unique bond between a doctor and a patient has often been described as a polarized relationship of doctor gives and patient takes, doctor talks and patient listens or patient questions and doctor answers — this is just silly. Trusting comes when both feel the presence of the other — and hence know the truth of the other.
Finally, you ask if I will treat your future as if it were my very own. Such is the truth of shared experience. I hear you and I see you.
My very best regards to you in this difficult time,
Gary Hammer, MD, PhD, is director of the Endocrine Oncology Program, within which are the Multidisciplinary Thyroid and Adrenal Cancer Clinics, at the University of Michigan Comprehensive Cancer Center. Hammer holds the Millie Schembechler Professorship in Adrenal Cancer. He is also the director of the University's Center for Organogenesis.