Diseases are not wars to win, but journeys

I have often read obituaries about people and there is a thread that binds them. When a person dies of a disease, like cancer, or commits suicide, there are words that make their way into the obituary. Let us look at one such obituary, of a 54 year old man who died of complications of Esophageal cancer:

AL lost his battle with Esophageal Cancer early this morning. He leaves behind a wife and three children.

Here is another obituary, that of a 20 year old student, who committed suicide. He was diagnosed with PTSD and depression:

MO lost his battle with depression late last evening. A memorial service will be held at….

When talking about disease, it is functional to describe what patients feel when they suffer. When the disease, chronic or terminal finally causes the death of the patient, it is rational to describe their suffering as a battle lost, and those of us who watch patients coming to chemotherapy departments or outpatient clinics are familiar with the cycles of medical procedures, the explanation of risk, the long conversations about what is medical fact and what is not. For patients’ families, the tortuous journey of watching their loved ones suffer not just from the disease that is ailing them, but from the other myriad processes of daily life, the filing of paperwork and insurance claims, the changes in routine, the medications and instructions, is an effort that is best described in terms we understand all too well: War and Battle. Isn’t cancer an enemy? Isn’t mental illness an enemy? Isn’t the drive to survive worthy of being called a battle, besieged as they are with the processes of their own bodies, the medication and therapy?

The way we use language has changed. The desire to create impact, combined with the human desire to simplify things has resulted in diseases being equated to enemies, and suffering to a fight. Medicine is equated to a regiment of doctors, nurses and other healthcare professionals, all fighting towards the same goal, that of ending disease. The current pandemic has also seen Doctors being called “warriors” and hospitals being described as “frontlines”. I too have been guilty of using these metaphors, because metaphors allow the mind to bring to action a sense of romantic idealism. Who doesn’t want to called a warrior? Warriors inspire strength, wars inspire determination, and in this age where words are tools instead of modalities of communication, it is easy to be lost in the romanticism of militarized metaphors.

Cancer, for example, is not an enemy. It is a pathology, marked by its biological characteristics. Patients are not battling cancer, they are suffering from a disease, and we don’t empower patients by equating them to soldiers, we empower them through empathy. Disease, no matter what kind, is not helped by personification because personhood implies the faults of the human condition, the capacity for evil, the capacity of reason and most importantly, a certain rationality and agency. Disease is biology and pathology. Cancer, COVID-19, Depression, are not apparitions waiting in shadows to strike, but biological processes that have no master or agency of their own. It is easy to think in terms of personification, because our sense of morality would rather see an evil that has an explanation in terms we are most familiar with. It is admittedly easy to see cancer as an enemy, because the complexity of cancer, its diverse forms, the thousand other variables of how a patient’s body reacts to the cancer itself, is far too much to consider when we see our loved one’s suffer from symptoms, pain and grief.

It is not helped by our own inability to see our loved ones suffer. The human mind wants rationality, and it is simpler to see the cancer as an enemy because then, someone can be blamed for the interplay of cells, tissues and proteins that result in the suffering of our loved ones. However, we must remember that cancer is a disease, and it is not always curable, but it might be treatable, the symptoms might be alleviated through medication and patients might be given more time through surgery. Medicine is the sum of science and compassion, it is an effort towards healing the sick, and sometimes, it is an effort towards giving the terminally ill dignity as their general condition deteriorates. Emotionally charged language such as “battle against cancer”, or “fight against depression”, reduces patients’ suffering to easy to understand metaphors, and this reductionism is a disservice to the complicated and sometimes tragic journey that is disease.

As someone who has seen both sides of the hospital, as a patient and as a medical student, the unifying thread that binds these two sides is not some militarized determination towards fighting disease, but the search for compassion as a patient, and the search for being compassionate as a medical student. Doctors and nurses in hospital wards filled with COVID-19 patients are not fighting against an invisible enemy, but are providing care to patients in the face of lack of resources, a lack of concrete evidence, and a lack of a thousand things, but what doctors and nurses do not lack, is compassion. This human feat of entering a ward of patients who need oxygen, who need medication and symptomatic relief is not brave because the hospital ward is the frontline of a war, but because it is the refuge of the suffering, where compassion, humility, and empathy are the only motivations and sometimes the only tools when medical therapy is insufficient.

Equating medicine to an arsenal of weapons against disease instead of a system of understanding it treating patients removes the most crucial aspect of medicine, compassion. It overlooks the most important characteristic of the human condition, the capacity for empathy. An arsenal of weapons implies war, and war has no victors, only tragedies. In my conversations with patients, doctors, other medical students, the romanticism of war and the romantic adulation for doctors serves the desire for simplicity, but overlooks our own humanity. When a treatment regimen does not work, it is not attributed to the complexity of disease and the interaction of medication with the body, but is seen as a failure of the medical system and a personal failure of doctors. It removes doctors from their own human limitations, and discards the idea that not all things fall into the dichotomy of success and failure. Sometimes, the best care is objectively insufficient.

Disease is not an enemy, it is not an apparition of evil, it is not a shadowy figure that haunts the bodies of patients. It is a manifestation of biology and is not a fight to win, but a journey through suffering. Patients are not fighting battles, they are suffering and as doctors, we are not warriors but companions, navigating the journey of suffering together.

Medical Student, Debater and Researcher