Valley of the Shadow

I don't know a specialty in medicine more difficult on the emotions than oncology. There is something about cancer, the disease and its effects on people, that is simply so wearing. Hope is persistently grasped for, undermined, needing to be re-defined. Almost all encouraging words are qualified, tentative, temporary. Light in the darkness can often seem a dim bulb indeed.

Every oncologist I know is a warrior. Every one fights for their patients and against the disease with a determination and ferocity of greater-than-themselves proportions. And it is for oncologists this battle on two fronts. On the one hand, against the disease, against the cellular madness that is cancer, the terror cancer creates. Oncologists know first hand about the personal "war on terror" going on in their patients. Which is why on the other hand they are fighting for their patients, "for" both in the sense of "on behalf of...," and in the sense of "continually to preserve the personhood of..." as the disease tends to reduce people to their diagnosis. They tend to become what they "have," and lose who they are. The oncologists I know strive to keep hold of the person, to support them in being who they are, even as they fight with them against what they have, that which would rob them of who they are.

Some oncologists do better at battling the disease than saving the personhood of the person. And really, who can fault them? The disease if often more real to them than to the patient. The numbers, the pathology reports, the CAT scans and MRIs-- these can seem abstract to the patient, but this is how the oncologist comes to know the Enemy and Its activity. They are intelligence reports. They are measures, of success, of progress, and for some, even of failure. This is medicine at its most modern.

There is a price paid by oncologists who balance their disease-fighting with their patient care. When it comes to fighting just the disease, oncologists lose many battles, even when they more than occasionally win a war. But when it comes to patient-care, it isn't a "battle" which is lost, but a person, or a part of a person-- an organ, or a capacity, or dimunition of spirit, and sometimes a life altogether. There is a lot of grief experienced by oncologists.

How well do oncologists grieve? Well, it depends on the doctor of course, on the quality of the physician's person, on their character, on their emotional make-up. But basically, most oncologists grieve like the warriors they are-- meaning not well. Grief does not become a warrior.

Nor does discouragement. Sitting in an oncologist's office and watching the parade of people, each engaged in their own struggles and experiencing whatever degree of challenge to their vitality and their life that they are, I imagine what it would be like to spend my days facing this seemingly endless line, looking into their faces, searching for the light in their eyes, listening, listening, listening-- and working to find the right words of response, the right shadings, so that the greys are distinguished, and even might display of promise of becoming vivid. I can scarcely imagine anything more exhausting.

Yet, oncologists are among the most caring people I know! Whence comes their Heart?

Well, for one thing, oncologists have what I believe to be a rare ability to gather and store encouragement. So whether it be from an improvement in the numbers or an "observable" decrease in the size of a tumor, or whether it be from a shift in a patient's attitude or a word of appreciation, oncologists vaccuum up these bits and pieces and cultivate them. They make large whatever evidence of encouragement there might be.

And for another, I believe that oncologists have the even more rare spiritual ability not to fear Evil. They walk ever and constantly through the Valley of the Shadow, sometimes the Shadow of Illness, sometimes the Shadow of Death. And while they might face fears, their own and those of their patients and their families, it seems to me that they do not fear Evil. Cancer has its own morality; when it invades us, we discover more about our own. It would be easy to see cancer as Evil incarnate, in its mindless, relentless assault. Even so, oncologists do not fear It. In fact, they fear little-- or so it seems to me. (Whatever their fears are, they keep them to themselves!)

But the fear of Evil is particularly insidious because it undermines one's determination to do all one can, to utilize every resource, even to do to another what under other circumstances would be unthinkable or repugnant. To be an effective oncologist, one must be at peace with one's own capacity for evil, and indeed unafraid of the ways Evil is made manifest period. In my estimation, the oncologists I know evidence this capacity.

Knowing as I do that oncologists, like the rest of us, may or may not believe in God or even a Higher Power of their own definition, I have come to believe that nonetheless, the "rod and staff" of the Divine provides their own comfort. For the Source pours out comfort and peace on all-- even those who may not acknowledge the Source.

And in the end, it does not matter that the Source be acknowledged, least of all to the Source Itself! It matters only that oncologists continue to fight the good fights that they do-- and that we appreciate them for their dedication, their determination and their great Heart.