John McCain did not 'lose' his battle with glioblastoma — because cancer is not a war

Tall,

Near the end of the piece you linked in your original post is this paragraph:

Dr Baig said...
In spite of these potential downsides, metaphors will continue to flourish inside the walls of hospitals and clinics. This is not necessarily a bad thing: Metaphors help physicians make the esoteric world of medical science and research accessible to the uninitiated. And for patients, Reisfield and Wilson remind us, “metaphors can impose order on a suddenly disordered world, helping them to understand, communicate, and thus symbolically control their illness.” [ emphasis mine ]

Some of our email discussion was not intended for the forum, nor does it serve what I see as its purpose. I have no objection to the parts you have shared from your side of the discussion and I hope you will be satisfied with a similarly abbreviated recounting of mine.

Whether the use of the "battle" metaphor for cancer is, or is not, appropriate for society as a whole, it does seem to offer some solace to men who come to HealingWell for support. I often use the metaphor to comfort widows. "I'm sorry for your loss." I say, "He fought a good fight." The reason I think it helps is because caregivers often feel like they should, somehow, have done more, and by saying that the deceased "fought the good fight" I am subtly reassuring them that what could be done, had been done. I'm not sure what purpose it serves to debate it on HealingWell, which I see as primarily a support site, except as an entertainment for those of us who love a good debate.

I can see how your family history with the Holocaust gives you a different point of view. But understanding your viewpoint is not sharing it. We may have to simply admit that when we hear the words "He lost his battle with cancer" it means different things to us. I understand why you might hear a rebuke because the man lost the battle but I hope you can also understand that I hear praise because he fought it courageously.

PDA-

What does "fought it courageously" mean? What would it imply if he did not fight it courageously? When one has cancer, one can make a decision to treat or not treat (I'm not talking about active surveillance, here). Is either decision courageous? When my mother was dying of uterine cancer, at some point she decided no more chemo or other life-extending treatments. She only accepted pain killers. Was that courageous or not? She certainly was not "fighting" - she welcomed death. Does that imply a deficiency of character? I prefer not to judge, a judgement that the war metaphor forces us into. It's just how she wanted to live her last days. We respected her decision.

In my blog, I try to put things in terms that any patient can understand, and I do so without metaphor (I hope!). It's not so hard.

John T

Metaphors can be powerful, as many narratives are. In fact, I am saying the opposite of what you contend. I am saying that people with illnesses ought not be judged as winners or losers. If I read your previous post correctly, you contend that you went to war against your disease and came out a winner. That smacks of Social Darwinism -- the better man won. And what of all those who did not win their battles - are they worse men than you? I refuse to think of you as a winner, or those who die of illness as losers. If that makes me "morally superior" to those who would pass judgement, than I hope I can live up to that.

BillyBob@388 said...
. Again I am at a loss, unable to understand, the angst caused by the use of these common words and phrases. I would have never imagined that it could be a problem, a source of offense. But that sort of thing seems to be how it is these days. One wrong word, and Oh boy. Lot's of offended folks these days.

Exactly, BB,

I don't think this thread should get a lock, but I think we should let it rest, if we can. Being offended is a CHOICE. Commonly a phrase is used to "take offence". I can choose to be offended by something that is said, or written, or I can choose NOT to be offended. Either way, I choose my response. It's not automatic, and just because I find something offensive, doesn't mean everyone will (or should).

Personally, I don't think the martial metaphors, at the individual level, imply anything about the person at a moral level. The decision at the end stage to end treatment and accept only palliative care is not giving up, it is accepting the inevitable--which in some ways could be seen as MORE courageous than giving in to the pressures to keep looking for the 'cure'.

Let us remember that the "fought the good fight" language is derived from what many people consider a sacred text (and was quoted at McCain's funeral, and is part of a longer text sometimes referred to as the Soldier's Benediction), and perhaps then we can understand the weight, and impact, and value of those words to many. Challenging the use of that language is not just a semantic quibble, it has deep and permanent meaning. Using it at the end of a man's long, productive life says a lot more about that life than how it ended. It's a way to honor that life, and to acknowledge all the fights, all the battles, all the struggles that made up that life.

Can we agree to disagree on this, and yes, in the spirit of the man who's name appears at the topic heading, let it go? No one here is less honorable because of the disagreement--but if we let ourselves fall into the trap of needing to win or lose the debate--then the only person we dishonor is ourself.

Also, we are all in a war, and fighting a battle, against death. You may say you are not, but others may dispute that if you are observed to be doing everything in your power to prevent or delay death. True, some small % of us may at some point- if the level of suffering seems to out weigh the joys of living - choose to no longer fight. But either way we are still going to die, today or a little later.

But the vast majority of us, most of our lives, are in a battle against death that - barring the occurrence of certain faith related events that can not be discussed - we are all going to lose. Therefore, saying that old Joe lost his fight against whatever disease does not say anything about him that does not apply to 100% of the rest of the population(except for those very few who choose not to fight). If Joe becomes a loser because he lost his fight against whatever killed him, then the loser label also applies to whatever % of the population that tried to stay alive and failed to do so, all the billions that went before him. So, he may be in good company. So I still fail to see how any one gets offended by the use of these common phrases.

If you want to say I fought my cancer- and anything else that wants to kill me, that is fine with me, I don't care. If you prefer not to, that is also fine, I still don't care. But apparently, there are some who take offense.

Words really do matter, and they can affect us in ways that may not seem believable. I also believe words can affect us without our conscious awareness of the effect. I’m still with the group who doesn’t want themselves, or their cancer, compared to anything. But, I have seen many well-thought words in this thread and I have enjoyed it. I think the topic and discussion is helpful and appropriate for the board.

The "battle" thing is overdone, I agree. I prefer "fight", but no point in quibbling about semantics. It's the idea behind it.

We each choose our own course. Some choose to forego toxic treatments and enjoy the time they have left. A perfectly reasonable choice so long as it's informed.

When I went for my first body scan after DX the nurse asked why I was there. I said metastatic prostate cancer. She looked at me and said "you have to fight". It moved me.

Call it "battle", "fight" or, more in keeping with the times, "resist". Whatever.

Most everyone of us here is fighting their own fight. Why else are we here? Did we all of a sudden get this interest in prostate cancer?

The fight metaphor helps me. When I was going through chemo and forcing myself to do weights and aerobics it was the "fight" that motivated me.

Concerning Bohemond's concern about chain of command I say: "I'm the Commander in Chief". My ONC is the Four Star General. Other Dr's are respected advisors. It's no news that you must be your own advocate. My very good friend who is a Dr. told me "the people who are pains in the a** get the best results". Dr's I know in other specialties all agree.

"Fighting" motivates me to go see numerous Dr's, ask a lot of questions, and sometimes insist on treatments that are not "proven" by Phase 3 trials. With all the new drugs that have come out, most of which are limited to CRPC (I am still castrate sensitive) I'll likely be dead before mCSPC trial results. I had a RALP despite my ONC recommending against it, though he did not object if I chose that path.

I take inspiration from Winston Churchill quotes. "Never give in . . . never yield to the apparently overwhelming might of the enemy.”

And, I have a T Shirt with the quote "If you're going through hell keep going"

We lose sight of that when we approach this kind of topic with "the need to be right."
Michael

Here's an article by a woman who, as a physician as well, has had metastatic BC, and expresses her thoughts on some of the issues that have come up in this thread.

She doesn't deal so much with the semantic issues, as we have been doing, but her thoughts seem relevant, and maybe helpful.

The article is "I Am Sorry I Didn't Beat Cancer," (linked below) and some of her thoughts are

"... it felt like a failure as if I let down every one who thought I would (beat it)."

"As a doctor I understood that it was nothing that I did, to bring back my cancer. But I still felt a sense of shame."

" Besides coping with my illness, I was sad that I lost my “credibility” as a cancer warrior who had “beaten” cancer. I was not longer a “success story.”

Then she closes with the words

"And then I realized I really don’t need to “beat cancer.” I have to, however, beat life at its game, one day at a time. I am sorry I didn’t beat cancer but now it really doesn’t matter because I am busy kicking life and showing others how to reconcile with stage 4 breast cancer."

Her words get us no closer to an answer to this debate, if there even is one, but I think her sentiments do contribute to the discussion.

/www.huffingtonpost.com/uzma-yunus/i-am-sorry-i-didnt-beat-c_b_10801274.html

Very Interesting debate, yesterday I told myself not to get into it, because to me it was not worth it. However upon further reflection, decided to put in my two cents. Like the ol song lyrics by Dave mason.. “There is no good guy, there is no bad guy, we just disagree” Hope that lightens this up.

TA, et all who are on that one side, I agree with your premise, can see your argument’s, (I think) and sometimes, I do feel that way, like “what am I doing to fight this, just taking some pills and getting regular check ups?" Is that really being courageous or fighting? To me with some explanation, it is, and I could not disagree with ya’ll more on the other side of this “battle” issue. Maybe I just choose to see things differently. As in-(don’t confuse me with the facts, my minds made up!)lol

To me Courage is not only defined in a battle situation, it is not about wining or losing a battle, it is sometimes found in everyday decisions, it is putting up with the thoughts that you are facing an inevitable conclusion to your life, it is consciously taking those chemo treatments even though you know that each one may be detrimental instead of helpful, and wondering if you took every step correctly or made every choice that you needed to. It is choosing to take care of my body nutritiously.

It is looking your wife in the eyes, and telling her that she must persevere without you one day, when before your diagnosis you had planned to live to be 100 with her at your side. It is being forced to retire early, because you know your best friend just passed at the age of 62, never being able to retire. It is the constant mind game of knowing that you will not see you grandchild get married or even graduate high school, and a million others thoughts to face, especially financially in the future.

I could go on and I know others just pooh pooh this "battle" term as applied to PC, and even cite prestigious article to the contrary. (Never did like Time Magazine.) I know advanced PC will likely kill me. Think and state, whatever you want, that is fine. But for me and for my family, just do not tell me I am not a cancer fighter because I am. Do not tell me I am not a Battle Brother, because I am, and I like that term. Do not tell me that I am not fighting a battle, because I am every day. DO NOT ever tell me that when I pass, I did not fight the good fight, because as another poster has already stated, those words are sacred to me.

All due respect to all posters, just wish that hopefully this thread will fade out as I think it has outlived it’s usefulness. Nice long thread here, and Ya’ll are as Capt. Kirk always says at he end of Star Trek “Engage(d)” (Go forward)
Wings

InTheShop said...
In 2007 my mother was diagnosed with pancreatic cancer. It had metastasize to her liver and scans showed it had invaded many other places. Three doctors, including a highly rated oncologist told me that she was beyond treatment. Mother agreed and she was moved to hospice and died six weeks later.

My mother had a strong religious faith and a strong belief in an afterlife. She didn't fight to live, but rather gracefully accepted that this was the end of her life here on earth and taught me a powerful lesion in how to die. Mother was always a peace maker would have been deeply offended if anyone said she was a "fighter."

Metaphors aren't one size fits all, don't paint all cancer patients with the same brush.

No one is saying she shouldn't refer to her "relationship" with cancer the way she saw fit.

But when my mom says...."I'm fighting cancer"....I'd just as soon keep people away from her who's gonna say to her....."That too bad". "Yeah. They've given me six months to live". "No. What I mean is...it's too bad you choose to call it a fight".

That's just not helpful. And that's what's happening when someone comes into a cancer forum and begins this kind of debate. If ya wanna go on CNN and debate it...fine. If ya wanna write opinion pieces in rags...fine. But coming into a cancer forum or going into a cancer ward and starting this kind of debate is confusing to me....at best lol.

I'd also just like to add....I haven't advocated for closing this thread. I also haven't said how I define my relationship with cancer. As far as I'm concerned....that's not even the debate.. It's no body's business.

But I do want a participation award (just kidding/just kidding!! ))

I don't believe anyone on here has dark motives. Not one person.

I've already said what I wanted to say. Just want to add that I am glad to see the thread reopened and enjoying reading the continued discussion. like those nights many years ago with one too many bottles of Boones Farm and maybe something less legal. Discovering the meaning of life but not able the next morning to remember what it was.