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The Art of Conversation
in Cancer Care
The Art
of Conversation
in Cancer Care
Lessons for Caregivers
Second Edition
R IC HA R D P. M C QU E L L O N , P H D
Comprehensive Cancer Center Wake Forest Baptist Health
M IC HA E L A . C OWA N , P H D
Loyola University New Orleans
1
3
Oxford University Press is a department of the University of Oxford. It furthers
the University’s objective of excellence in research, scholarship, and education
by publishing worldwide. Oxford is a registered trade mark of Oxford University
Press in the UK and certain other countries.
DOI: 10.1093/med/9780197500293.001.0001
This material is not intended to be, and should not be considered, a substitute for medical or
other professional advice. Treatment for the conditions described in this material is highly
dependent on the individual circumstances. And, while this material is designed to offer
accurate information with respect to the subject matter covered and to be current as of the
time it was written, research and knowledge about medical and health issues is constantly
evolving and dose schedules for medications are being revised continually, with new side
effects recognized and accounted for regularly. Readers must therefore always check the
product information and clinical procedures with the most up-to-date published product
information and data sheets provided by the manufacturers and the most recent codes of
conduct and safety regulation. The publisher and the authors make no representations or
warranties to readers, express or implied, as to the accuracy or completeness of this material.
Without limiting the foregoing, the publisher and the authors make no representations or
warranties as to the accuracy or efficacy of the drug dosages mentioned in the material. The
authors and the publisher do not accept, and expressly disclaim, any responsibility for any
liability, loss, or risk that may be claimed or incurred as a consequence of the use and/or
application of any of the contents of this material.
1 3 5 7 9 8 6 4 2
Printed by Marquis, Canada
To the staff and volunteers of the Cancer Patient Support Program
Comprehensive Cancer Center
Wake Forest University Baptist Medical Center Winston-Salem,
North Carolina
To our mothers: Kathleen McQuellon and Marie Cowan
To our wives: Cyndee and Kathleen
To our children: Meghan, Brendan, Kristin, Katrin, Mairin, Kendall,
and Rebecca
To our patients: They taught us how to walk together with courage in
mortal time.
In memory of Caleb Atticus Christensen-Cowan, beloved of God.
Contents
Acknowledgments ix
Prologue xiii
Introduction 1
Index 133
Acknowledgments
drafts and offering useful comments. Fr. Richard Chiles, Dr. Mary
DeShazer, Cyndee McQuellon, Kathy and Dr. Jerry McShane,
Cassie Campbell, Sue Stewart, Barry Maine, Jared Rejeski, Linda
Gitter, and Hy and Loretta Muss, all provided helpful insight.
Hundreds of people over the years have entered the chaotic world
of Cancerland with grace and courage. Thank you to the following
for showing the way: Trish Barron and Nathan Berolzheimer,
Maggie Brilhart, Drs. Greg Holmes and Katherine Roth, Lynn
Felder, Bill and Linda Garwood, Nell M., Kathleen and Robert
Niles, Dennis and Sandy O’Hara, Patrice Radke, Pam and Mark
Rabil and Bob Stone. Their courage and humor while confronting
serious illness continues to inspire.
Wake Forest Baptist Health is fortunate to have an outstanding
medical school dean and CEO in Dr. Julie Freischlag who is dedi-
cated to sustaining our patient promise, including patient-centered
medical care. Her extraordinary leadership of WFBH makes it all
possible.
Finally, the following endowed funds supported this project: The
Herbert and Ann Brenner Fund for Cancer Patients; The Kathryn
A. Millward Fund; The Barbara D. Smitherman Memorial Trust;
The Bertha Long CPSP Fund; The Higgenbotham Memorial
CPSP Fund, the Belk-Glenn Fund for Cancer Patients, The Mary
B. Driscoll Memorial Fund, and The Earline Health King Fund for
cancer patients. Their foresight and generosity provided the re-
sources to write this book.
RPM
Prologue
When Mary’s physician told her that her breast cancer had
returned and spread to her lungs and liver, her calm reaction
took him by surprise. The young physician in training felt that
Mary didn’t understand the seriousness of her predicament.
When I spoke with Mary in consultation, she was sitting at the
bedside in some discomfort but managing her pain reasonably
well. She understood that her cancer had now moved to her
liver and lungs and that it was not curable. She said that her
main physician was “the man upstairs,” but she also believed
2 The Art of Conversation in Cancer Care
that “God works through people like you and the doctors and
nurses.” She further stated that she trusted her doctors and
relied on their input. However, she was in the hands of God,
who would be the ultimate physician in her case. She was dig-
nified, humble, and unafraid of talking about what might lie
ahead for her. She had buried her father and cared for a brother
disabled by a stroke within the past year. She had grown fa-
miliar with the possibility of dying. Her caring physician was
not critical of her but, rather, puzzled by what seemed to be her
“denial” of her situation. She was prepared to discuss the limits
to her life, yet hopeful that she would be touched with a mir-
acle. For her, this was not denial but, rather, a deep faith in the
future, whatever it held.
Mary was calm in the face of her diagnosis, her physician was
puzzled by her response to life-threatening information, and the
consulting psychologist was struck by their differing responses.
This incident highlights the power of death’s multiple meanings to
shape feelings and behavior. Although only one person in this story
faces grave illness, all three—the patient, her physician, and the
consultant—are facing the reality of living with death’s possibility.
Mortality has a different meaning for each of them, as it does for
everyone it touches. These meanings color how people feel, think,
and communicate as they turn to face mortality together.
death, nor pushing the “death talk,” but rather courageous acknowl-
edgment and honest, sensitive engagement with a central fact of
life: All of our lives are time-limited. Mortal time is only a reminder
of that challenging, difficult truth, which each of us faces, more or
less consciously, throughout life. For the professional caregiver,
mortal time may be a daily companion; for others, opportunities
to befriend mortality will appear unpredictably over the course of
a lifetime.