June 20, 2005
To Call Forth That Spark
Kathleen Grant, MD
As an Oncologist, a cancer doctor, I am always thinking about helping people define their will to live. Individuals with families often define this in terms of their relationships, as in, "I've got to see ten-year-old daughter grow up."
Those who don't have strong relationships or gratifying careers may have a more difficult time marshaling their energy. So they need to be empowered as individuals. It's important to develop a sense you are important because you exist. The healing bond between physician and patient is in part an expression of hope and the will to live, in which the physician is saying, in effect, You are valuable as an individual, and I want you to get well.
Hope is part of that empowerment that says, I have a right to wish for more life, more health, more time to accomplish a goal. The goal doesn't have to be a physical achievement. Even a determination to look good after completing chemotherapy and to start dating again is an expression of life force. Each person needs to find a way to express this feeling.
It is important to distinguish between a person's physical limitations and his or her desire or ability to express life. Someone who has have a lung removed for cancer can still have the same vitality, even though that person is probably not going to climb a mountain. In January 1995, I served as one of the team physicians for a group of women breast cancer survivors who climbed the 23,000-foot Aconcagua Peak in South America. Called Expedition Inspiration, the purposes of the climb were to raise hope, public awareness, and rasearch funds.
I was very worried about the health problems that might arise in is group of cancer survivors - problems related to either their breast cancer or to their previous treatments. Being at high altitude is risky anyway; even completely healthy people can get seriously ill or even die at altitudes like those we were going to attempt. I was very preoccupied with watching for signs of illness, but remarkably little went wrong.
After the extensive chemotherapy and radiation treatments the women had received, the climb was an incredible physical achievement, never done before under such circumstances. Beforehand, there was no way to predict whether it was going to be safe or successful. One woman had a couple of bad days because of her arthritis, a side effect of her chemotherapy, but she was still able to complete the journey.
The opportunity to be on the climb helped many of the women to be less emotionally and physically passive. Some of the group had never really done anything physically challenging before. One woman had three firsts on the first day of the trip: she had never been on horseback before, and we had to cross a river by horse the first day; she had never slept in a tent overnight; and she had never urinated outdoors. This is a woman who is very daring and forceful in other ways - she's an attorney and certainly knows how to get what she wants - but participating in the climb opened up another dimension of what her life could be like.
For this group - and from what I have seen in caring for other cancer patients - just being alive is not enough. There is a need to continue achieving and stretching the limits. The determination to prove themselves physically was especially striking in the climbers. Many of the women talked about taking it to the edge and about how their diagnosis had changed their priorities, challenging them to experience events as vividly as possible.
I wanted to challenge and prove myself physically as well, because I've had some serious health problems - cancer and multiple retinal detachments. My participation in Expedition Inspiration, both as a climber and as a physician, helped me to further define my own goals. It certainly made me want to climb more mountains. I was obsessed with mountain climbing when I came back from that climb, and I'm still trying to figure out where that fits in my life.
Some of my favorite moments on Aconcagua were at night, when it was so quiet. At high altitude stars seem very close, and it was very calming to feel linked to the entire universe, despite our campsite being only a small dot in the landscape.
One of a physician's roles is to foster the will to live - to call forth - by giving patients examples of others who have done well and helping them find their own uniqueness in their period of crisis.
One of my patients with very serious breast cancer was hospitalized for her bone-marrow transplant the evening the documentary on Expedition Inspiration was shown on television. She wrote to me from her hospital room about the tremendous confidence watching the broadcast gave her for her own future.
I think the will to live is a natural component of being alive. All animals have it, and I often think of its source being in the primitive, parts of the brain rather than the intellect. When you are not challenged by the fear of dying, it's all too easy to just kind of sleep walk through daily routines, always getting frustrated at the little things in life. The threat of actually having life taken away can make a person suddenly want to prove a point to the world, or to change direction. Risk taking physically or emotionally is part of that.
The fact that this group of women, who had gone through chemotherapy and radiation treatments, were able to achieve this physical feat should make them justifiably proud.
I heard a priest-philosopher give a lecture a number of years ago. One of his points was that clinging to life was not good, and that at a certain point patients should move from hope to resignation. He described a woman with advanced ovarian cancer who talked with her goals and hope for further life. He didn't consider her a candidate for active treatment, but she focused on getting more chemotherapy.
The priest said to her, "Why do you want to do that?"
She said, "Well, at least it would give me hope."
"Hope for what?", he asked.
She looked at him and said, "Well, just hope."
She did receive further chemotherapy but died a few months later, apparently heartened by her belief that all appropriate therapy had been tried.
Hope is such a tiny word, because we throw it around and can't quite get to the kernel of its meaning. In many ways, our hope is for continued existence, for feeling alive. In oncology we really see very few suicides, perhaps because people have already come to grips with the precariousness of life, despite the paradoxes and painful moments.
The will to live is so strong and primal that it is a rare person who is ready to move on, away from life. The wish to remain, to be, is enough.
Reprinted by permission CancerSupportiveCare and
Inner Fire, Your Will to Live by Ernest and Isadora Rosenbaum, 1998