There are many sources of job satisfaction for doctors. One of the greatest professional privileges I have experienced is looking after the dying patient. Indeed some of cases that stand out in my memory are those involving palliative care.
I remember Jim, a most stoic and accepting patient, who died at home, under my care. He had prostate cancer for a number of years, but despite initial treatment success, the disease had recurred.
We had some great chats over a period of months about history, religion and philosophy. Inevitably some of the discourse was about cancer, covering both his personal journey and more general issues. One of these was the language we use around cancer.
Jim was upfront about his diagnosis. He found it relatively easy to talk about his impending demise. And he had some firm views about the unhelpful use of the language of war by relatives and some professionals.
While it can be traced back centuries, the modern use of military terminology in medicine received a boost when, in 1971, the then US president Richard Nixon publicly declared "war" on cancer and referred to it as a "relentless and insidious enemy". It has evolved pretty much unchecked since then. We speak to patients about "killer cells" and "magic bullets". We refer to "beating illness" and remind people to "keep up the good fight". Whatever else, don't give in.
Lack courage
It’s a blunt message: cancer will “beat you” because you lack courage. This is absolutely unfair to most patients. The meek, the mild or those who are depressed may be neither inclined nor able to respond to exhortations to fight back. And unable to respond, some people will feel they have “failed” themselves, their families and their medical team.
Jim was firmly of the view that language matters because it influences how people live with their illness and relate to those around them. Aggressive language may suit a small minority of people with cancer, he felt, but for most it is an unhelpful approach to a difficult diagnosis.
I was delighted to see that in a recent poll, carried out on behalf of Macmillan Cancer Support in the UK, the majority of people with cancer said they are fed up with the language of war. The YouGov poll of 2,000 people who have or had cancer also found “cancer-stricken” and “victim” were among the least-liked terms. Articles in the media and posts on social networks were found to be the worst offenders for using such language.
Factual words
The survey found a preference for factual words to describe people with cancer, their diagnosis, and when someone with the illness dies.
Karen Roberts, chief nursing officer at Macmillan Cancer Support, said: "These results show just how divisive simple words and descriptions can be. By drawing attention to this we want to encourage more people to talk about the words they prefer to hear, and stop the damage that can be caused to people's wellbeing and relationships."
A sensible approach to cancers should owe less to the language of the Pentagon and more to a local GP surgery
Commenting on the YouGov poll, Guardian columnist Simon Jenkins put it well when he wrote: "A sensible approach to cancers should owe less to the language of the Pentagon and more to a local GP surgery. It would comfort thousands of ordinary mortals, who want to handle this illness like any other."
Just be real
That’s it in a nutshell. Just be real. It was Jim’s way and it worked. He found it helpful to view serious illness as a journey. There will be bumps along the road; some parts will be downhill while others will take more effort. The journey will offer alternative routes, none of which are right or wrong.
More and more people are successfully treated for cancer as treatments improve. For some it is a chronic rather than a life-threatening illness.
So let’s stop the war talk.
You don’t want your friend with cancer to feel less worthy of your support, do you?
mhouston@irishtimes.com