Sunday, January 09, 2005

Cancer and the Wall of Apathy

. . . if someone had come and told me . . . that they would leave my life whole, it would have left me cold: several hours or several years of waiting is all the same when you have lost the illusion of being eternal.

-Jean Paul Sartre, "The Wall"

What happens to the emotional strength of a health care worker, be it doctor, EMT, nurse or other, who sees death day in and day out, year after year? How does one, after exchanging job descriptions at a cocktail party or in the bleachers, reply to this follow-up question:

"How do you do it?"

How do we do what? Do you mean jumping into the chaos of illness over and over again in an attempt to halt some poor soul's path toward the tomb? I'll be darned if I know...

Perhaps the answer will appear if we start out with more questions:

Are we health care providers blessed with divine guidance that fires our souls, or is it supreme patience that allows us to ignore the sorrow raining down all around as we go about our rounds? What motivates us to dare to attack the quagmire of cancer - must we deny the fact that we too are destined for death in order to help the dying?

What if our capacity to care, though is not a product of love, but of a hardening of the heart? What if our ability to cope with dying patients is not a manifestation of compassion, but of a deadening of the human senses - a cold chill of apathy? Such a phenomenon, called "psychic numbing" by Robert Jay Lifton, M.D., was seen after the atomic explosion in Hiroshima by many of the doctors caring for bomb victims.

With our relentless exposure to victims of cancer are we are at risk of growing insensitive to suffering? Does this then make us more efficient caregivers?

The quotation above is from Sartre's short story about a political prisoner named Pablo Ibbieta, who is sentenced to die at dawn by a firing squad during the Spanish Civil War. During the long dark wait he realizes that his death is imminent and begins to hallucinate that he has already died. He accepts his own death, and begins to interact with his cellmates and the doctor sent to observe him as a dead man would. Having lost the illusion of immortality, he finds life on Earth grotesque and absurd. He no longer cares what happens to himself.

So can the oncologist become guilty of an existential defense against the pain of caring for the dying. If he accepts the finality of death but rejects the goodness of our world, the worth of a human life, the joy each man and woman has been allotted by the spinner of our days, he lives as Pablo Ibbieta. Focusing on the inevitable death of his patients, he snuffs out the candle burning within that keeps fearful shadows from dominating his thoughts. Losing the illusion of being eternal, he compensates by adopting a callous weighing of life, as on the butcher's scale. Those who are marked as doomed are tossed aside as worthless scraps. His work, reflecting the staleness of his spirit, becomes mundane and blotched with indifference.

It takes all the power coiled within a health care professional to not let this cynicism ruin his or her pledge toward those in need. How one stores this power, measures the energy, and unleashes it against the Pandora's box of doubts fluttering about the mind when a patient falters or dies is a topic difficult to share. It is highly personal, idiosyncratic, and difficult to translate let alone teach. Those who have succeeded in a health care career understand how hard it is to share their emotions.

Anyone who has the capacity for unlimited compassion, however, must use it even if they cannot describe how they came to possess it so that the afflicted may receive the mercy they cry out for.

Unlike the character in Sartre's story, the oncologist or nurse or paramedic is not under an announced sentence of death. They go about their days with blissful ignorance of a day marked with their name on some distant calendar. For them life still has value. Let this be an inspiration for our good works to continue without estrangement or apathy. Let no bitterness from a patient's death seep into our hearts and poison us. Let us awake each morning with a vow to not waste the day wallowing in angst or indifference, but instead with a vow to use our time well, towards the benefit of one worse off than us.

Several years of waiting is all the same when you have lost the illusion of being eternal.

Several years of serving is not the same. It leaves a mark on the world that lasts long after the servant is gone.


At 9:11 AM, Blogger kdt said...

Sartre also wrote "No Exit," a short play in which four characters are in a hell that's quite different from the stereotypical inferno. Through his characters, the playwright questions the true nature of hell -- could it be endless routine, pleasure in excess or the elimination of hope?

I think life without compassion due to numbing of one's senses would fit into Sartre's definition.

At 4:10 PM, Blogger Omnibus Driver said...

I don't know how you keep going to the well and coming up with more compassion, but, having lost a father to leukemia and having a mother currently undergoing treatment for lung cancer, I can tell you that my family has been and will continue to be extremely grateful for everyone who has shown such compassion and caring for my parents. We have seen the best and worst of physicians and nurses. I can honestly say that because of the truly caring ones (and they FAR outnumbered the seemingly impervious ones), my father's last six months were much more rich, and my mother's treatment has been a much more positive experience.

Caring about quality of life and remembering that each patient is a person are marvelous gifts to both the patients and their families.

Whenever you feel like a failure because you could not save them, I would ask you to remember that there are many families that would thank you for giving dignity, caring and comfort, instead. I believe in angels. And I believe doctors like you are among them.

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