Hope or no hope
About twenty years ago Alan, a middle-aged brother in Christ, was diagnosed with stage IV colon cancer. From what I saw and heard, it appeared to be a time of great hope in the field of oncology. New treatments were being developed and approved. People were living longer with conditions that would have been deemed fatal just a few years earlier.
Alan’s oncologist told him that forty percent of patients responded well to the new chemotherapy regimens. That didn’t sound like a very high number to me, but it was certainly better than the old zero percent five-year survival rate.
Alan was determined to do all he could to beat the dreaded disease. Chemotherapy extended his life by three years. Without the new treatments, he would have died within six months. He was thankful for that additional time.
A few years ago Henry, an acquaintance from church who had recently retired, was diagnosed with stage IV colon cancer. I don’t know if it was the same kind as Alan’s, but it couldn’t have been any worse.
Time had passed. The fever of hope that had prevailed during Alan’s chemo days had cooled off. I’m not sure exactly what happened. Maybe that forty percent who initially responded so well died within five years after all, like Alan did.
Henry was told right from the start that his cancer was terminal. Treatment has extended his life about a year beyond his original prognosis, but he’s now on hospice.
The impact
Whose shoes would you rather be in, Alan’s or Henry’s? I had enough contact with Alan and his family during his treatment to see the impact that the sense of hope, the idea that he could maybe beat his cancer, gave them all. They lived each day looking forward to the possibilities of the future.
They weren’t in denial. They’d been advised by his oncologist to be realistic (he might die) but hopeful (he might live). As far as I could tell, they were applying that philosophy.
Alan didn't have an easy time of it during his last three years. He hit many bumps in the road. But I’ve heard that cancer patients who have a positive attitude respond better to treatment and live longer. Did Alan’s hope contribute to the length and quality of his life? It appeared to. Is Henry’s lack of long-term hope shortening his life and diminishing its quality? I don’t know.
According to Fleming Rutledge, author of Advent: The Once and Future Coming of Jesus Christ, “A prisoner who knows he will be freed is a very different person from one who knows he will never get out. . . . If you know that your chemotherapy really might heal you, you can tolerate it a lot better than if it is just a last, desperate measure.”
Best practices?
I’m glad I’m not an oncologist. I’m not sure how I’d handle my stage IV patients. I know I’d want to be honest. That’s God’s will for us as His followers. But would I be tempted to offer hope even where there was none in order to give my patients a better life? Would I be capable of using that dreaded word “terminal,” knowing what the psychological impact could be?
From what I’ve heard, in the old old days doctors didn’t tell a patient that she was dying. The family would be informed, but not the victim. It was considered more humane. I wouldn’t want to go back to those times because of the deceit involved, but I wonder if there was a certain amount of wisdom behind that philosophy. A gentleness. A compassion.
Of course, a Christian facing a terminal diagnosis knows that death isn’t the end of the journey. He has hope even in the face of a fatal disease.
My heart, my gut wants to vote for the option of giving patients something to cling to. To campaign for doctors to be more like Alan’s than Henry’s. I want to see cancer sufferers being offered a chance to be upbeat, to live happier lives, to contribute to their own well-being.
I’ve known people who’ve miraculously survived a terminal diagnosis. Is it really right or best to tell someone that they have no future at all? Despite the statistics, do we really know who will live and who will die?
The spiritual impact
The other side of the coin: As a Christian, I can see the potential spiritual benefits of telling a person that he won’t survive an illness. We live in a death-denying culture. Few of us are willing or able to face our mortality head-on. A life-insurance ad on TV presents a spoof on this attitude. The narrator addresses those whose loved ones are going to die, because the viewer knows that that will never happen to him.
But when that terminal diagnosis comes, it’s a little harder to play pretend. Maybe some of those patients will turn their thinking toward eternity. Toward God. Toward heaven and hell. Maybe some of those souls will be saved before it’s too late.
My heart cries out to give cancer patients a little ray of hope, as Alan’s oncologist did. But my head realizes that the current practice is probably for the best.
What triggered all this internal wrestling? The shock and awkwardness of facing Henry’s wife as she told me what his doctor had said at the time of his initial diagnosis. I didn’t know how to respond.
I don’t know if it’s a specifically American thing or a general human thing, but most of us want to be able to offer words of hope and encouragement to someone facing difficult news: Look on the bright side. It might not be as bad as you think. Everything will be okay.
We have a hard time simply weeping with those who weep. Sharing their pain instead of trying to fix it.
I pray for the doctors who are dealing with these life-and-death situations every day. For their expertise. For the courage to speak difficult words to their patients. For compassion and mercy and wisdom. In the end, those attributes might be more important than whether or not they actually use the word “terminal.”
