“If one is forever cautious, can one remain a human being?”
I never leave my work behind completely. That is probably why I read the late Alexander Solzhenitsyn’s
book, Cancer Ward
while on vacation. (Thanks to Eileen who gave it to me!) Cancer Ward
is a semi-autobiographical work about a group of men in a Soviet hospital undergoing surgery, radiation therapy, and hormone treatments in 1955. Solzhenitsyn uses “cancer” as a metaphor for the deteriorating Soviet system and its effect on the citizens. Still, much of what he describes of the physicians and patients holds true in every time and place.
The book highlights the paternalism of both Medicine and the Soviet system. In the story, the patients’ clothes and shoes are taken from them as soon as they are admitted. Treatments are rendered without consent. Patients are not told how long they will remain in the hospital. Casual comments dropped by the staff are routinely misinterpreted. Even the compassionate doctors routinely hide diagnoses, prognoses, and test results from the patients.
One patient, Oleg Filimonovich Kostoglotov, an exiled former political prisoner, is wily enough to befriend several of the physicians and staff members. By borrowing medical books (“Strictly forbidden to the patients!”)
and slyly asking questions, he finally manages to understand his cancer and the potentially horrific effects of overtreatment. He cleverly talks his way out of the hospital before the treatments do more harm than good.
Oleg benefited only when he had plenty of good information and was able to hold someone’s attention long enough to get all of his questions addressed. Clearly, the more Oleg learned from the physicians, the more the physicians tended to see him, not as a patient, but as an equal. What a concept!
Solzhenitsyn is not alone in decrying paternalism in Medicine. As the literary critic Anatole Broyard
wrote in the months before he died of cancer: “Just as he orders blood tests and bone scans of my body, I’d like my doctor to scan me, to grope for my spirit as well as my prostate. While he inevitably feels superior to me because he is the doctor and I am the patient, I’d like him to know that I feel superior to him too, that he is my patient also and I have my diagnosis of him. There should be a place where our respective superiorities could meet and frolic together.”
When Medicine works, it becomes a partnership — a relationship of equals — that requires time, effort, and trust. Just as Oleg learned, and as patients and physicians continue to learn, forging this partnership can be a difficult, yet very rewarding, process.