Practical Radiation Oncology (2015) 5, 2-3
www.practicalradonc.org
Narrative Oncology
The gift of medicine Benjamin W. Corn MD ⁎ Tel Aviv Medical Center, Tel Aviv, Israel Received 14 August 2014; accepted 15 August 2014
It was one of those don’t-question/do-what-you’re-told memos. More of an edict than a memo, the message had been tagged with a little red flag and emailed to all hospital department chairs. They, in turn, put “the hurt” on their underlings. A mere 24 hours earlier, found guilty of bribery on several counts, Israeli Prime Minister Ehud Olmert had been sentenced to 6 years in prison. 1 Understandably taken aback by their leader’s unbecoming behavior, some Israeli citizens might also have experienced disappointment regarding the prime minister’s lack of resourcefulness in methods of accepting the payoffs. “Surely,” some of us opined, “he could have thought up something more dignified than to schlep away hundreds of thousands of shekels in shopping bags!” In other words, from the former head of “Start Up Nation,” 2 a citizen might have expected greater ingenuity! Then, from our hospital’s administration, in similarly uninspired response, The Memo established clear policy: NO GIFTS WILL BE ACCEPTED FROM PATIENTS. None. Nil. Nada. More than a decade ago, I left an oncology practice in America that was university based, but still lucrative. At the time, well-intentioned people (like my father-in-law) prescribed having my head examined. Despite their concerns, in many ways, I find work in Tel Aviv to be gratifying. One of my reasons, I herein confess, is the tendency of Israeli patients, at the end of their radiation therapy, to express gratitude by giving a tangible token of appreciation. Not that I’d ever suggest a gift. It’s just Israeli custom. What matters to me is that the gifts are obviously so heartfelt. Conflicts of interest: None. ⁎ Corresponding author. Tel Aviv Medical Center. E-mail address: [email protected].
Most often, I receive food. Chocolates, berries, chicken soup—all the goodies one would expect from a country inhabited by more than 3 million Jewish mothers. The second most common gift category is books. Noting gaps in my literary IQ, quite a few of my patients have taken on, as their personal mission, the task of stocking my shelves with Hebrew-language parallels to Dickens, Austen, and even Jonathan Franzen. Chiming in at number 3 is that ever-popular gift category, clocks: wall clocks, grandfather clocks, even a replica of Dali’s surrealist melting clock. The category isn’t surprising when, for many people who battle cancer, time can have a surrealistic quality, contracting to the here-and-now. As it happened, on that infamous day when The Memo hit my inbox, Achmed was just completing his radiation treatment for cerebral metastases. Nothing fancy. Just 10 fractions to the whole brain. A case that any first-year trainee could pull off. (Without a hitch. Without supervision. In July!) But no young doc for Achmed. An elder in his Arab village, Achmed traveled 120 km every morning from northern Israel so that I, a seasoned professional, could do the job. On that day, when the very last bit of dose was deposited in Achmed’s brain, 2 strapping young men informed me that I was invited to the village that evening. Although I make very few house calls, I quickly resolved to adopt a new rule of thumb: When summoned by the consigliere of a patriarch of the tribe, best not to refuse. When we arrived, a ceremony was being conducted to honor the “gifted professor” (who actually knew how to focus 2 beams from the side of the head on a target that was—shhhhh!—impossible to miss). It all appeared so touching, but truth be told, since I speak no Arabic, I sat through the 3-hour affair in a state of polite misery. As the celebration concluded, it seemed like they wanted me to approach the podium. The crowd understood
http://dx.doi.org/10.1016/j.prro.2014.08.012 1879-8500/© 2015 Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.
Practical Radiation Oncology: January-February 2015
that I did not possess the rhetorical skills to address this audience, but Achmed wanted to make a formal presentation to me. As I plodded up the stairs, thoughts of The Memo danced through my mind, followed by cinematic frames of the director of human resources announcing to the entire medical staff that “Corn would be suspended without pay for 6 months because of insubordination.” Before I could relive the scene again, the handle of a massive cooler was thrust toward me. As I soon saw, the cooler contained a Leviathan-sized fish, caught the previous day by Achmed in the Sea of Galilee. It was clearly not a time to make quips about “the one that got away” or to mention the New Testament’s description of Jesus’ miraculous catch from that same body of water. It was also not a time to worry about The Memo’s consequences. The moment called for humility. And common sense. I thanked Achmed for his thoughtfulness and gestured toward the strapping young men to indicate that it would be their task to load the heavy cooler into my car. Our patients make many adjustments along their journey. They must contend with the stigma of not only their disease but also of being radiated. They get used to a new world over which they have little dominion. And they must make peace with the role of being the recipient. Recipients of daily treatment. Recipients of assistance to travel to the hospital. Receive. Receive. Receive. Depend. Depend. Depend. When a milestone such as the conclusion of irradiation is reached, one can understand how a
The gift of medicine
3
cancer patient might yearn to give something back after all they’ve received, especially if they have accepted our love. I realize that as a matter of policy, hospital administrators must impose safeguards to be certain that medical systems are not manipulated by protectionism and favorbrokers. Yet policies can benefit from nuance. Whether “nuance” in this case means permitting low-value, nonmonetary presents, gift-giving only at treatment termination, or some other solution, it’s not my privilege to decide. But I do believe that even esteemed policy makers in corner offices must practice sensitivity to the psychology of treatment trajectory. They, too, must help each patient reclaim personhood. At a time when so many health care professionals are searching for ways to avoid burnout, 3 isn’t it also reassuring to know that our patients have so much perspective to impart? Whether reminding us about the value of savoring time, or the restorative benefit of allowing us to receive from them, I’d have no guilt about carting away shopping bags full of such important lessons.
References 1. Bob YJ. Former Israeli Prime Minister Ehud Olmert sentenced to six years in prison. Jerusalem Post. May 13, 2014. 2. Senor D, Singer S. Start-Up Nation: The Story of Israel’s Economic Miracle. New York, NY: Twelve Publishers. 2009. 3. Shanafelt TD, Gradishar WJ, Kosty M, et al. Burnout and career satisfaction among U.S. oncologists. J Clin Oncol. 2014;32:678-686.
www.practicalradonc.org
Narrative Oncology
The gift of medicine Benjamin W. Corn MD ⁎ Tel Aviv Medical Center, Tel Aviv, Israel Received 14 August 2014; accepted 15 August 2014
It was one of those don’t-question/do-what-you’re-told memos. More of an edict than a memo, the message had been tagged with a little red flag and emailed to all hospital department chairs. They, in turn, put “the hurt” on their underlings. A mere 24 hours earlier, found guilty of bribery on several counts, Israeli Prime Minister Ehud Olmert had been sentenced to 6 years in prison. 1 Understandably taken aback by their leader’s unbecoming behavior, some Israeli citizens might also have experienced disappointment regarding the prime minister’s lack of resourcefulness in methods of accepting the payoffs. “Surely,” some of us opined, “he could have thought up something more dignified than to schlep away hundreds of thousands of shekels in shopping bags!” In other words, from the former head of “Start Up Nation,” 2 a citizen might have expected greater ingenuity! Then, from our hospital’s administration, in similarly uninspired response, The Memo established clear policy: NO GIFTS WILL BE ACCEPTED FROM PATIENTS. None. Nil. Nada. More than a decade ago, I left an oncology practice in America that was university based, but still lucrative. At the time, well-intentioned people (like my father-in-law) prescribed having my head examined. Despite their concerns, in many ways, I find work in Tel Aviv to be gratifying. One of my reasons, I herein confess, is the tendency of Israeli patients, at the end of their radiation therapy, to express gratitude by giving a tangible token of appreciation. Not that I’d ever suggest a gift. It’s just Israeli custom. What matters to me is that the gifts are obviously so heartfelt. Conflicts of interest: None. ⁎ Corresponding author. Tel Aviv Medical Center. E-mail address: [email protected].
Most often, I receive food. Chocolates, berries, chicken soup—all the goodies one would expect from a country inhabited by more than 3 million Jewish mothers. The second most common gift category is books. Noting gaps in my literary IQ, quite a few of my patients have taken on, as their personal mission, the task of stocking my shelves with Hebrew-language parallels to Dickens, Austen, and even Jonathan Franzen. Chiming in at number 3 is that ever-popular gift category, clocks: wall clocks, grandfather clocks, even a replica of Dali’s surrealist melting clock. The category isn’t surprising when, for many people who battle cancer, time can have a surrealistic quality, contracting to the here-and-now. As it happened, on that infamous day when The Memo hit my inbox, Achmed was just completing his radiation treatment for cerebral metastases. Nothing fancy. Just 10 fractions to the whole brain. A case that any first-year trainee could pull off. (Without a hitch. Without supervision. In July!) But no young doc for Achmed. An elder in his Arab village, Achmed traveled 120 km every morning from northern Israel so that I, a seasoned professional, could do the job. On that day, when the very last bit of dose was deposited in Achmed’s brain, 2 strapping young men informed me that I was invited to the village that evening. Although I make very few house calls, I quickly resolved to adopt a new rule of thumb: When summoned by the consigliere of a patriarch of the tribe, best not to refuse. When we arrived, a ceremony was being conducted to honor the “gifted professor” (who actually knew how to focus 2 beams from the side of the head on a target that was—shhhhh!—impossible to miss). It all appeared so touching, but truth be told, since I speak no Arabic, I sat through the 3-hour affair in a state of polite misery. As the celebration concluded, it seemed like they wanted me to approach the podium. The crowd understood
http://dx.doi.org/10.1016/j.prro.2014.08.012 1879-8500/© 2015 Published by Elsevier Inc. on behalf of American Society for Radiation Oncology.
Practical Radiation Oncology: January-February 2015
that I did not possess the rhetorical skills to address this audience, but Achmed wanted to make a formal presentation to me. As I plodded up the stairs, thoughts of The Memo danced through my mind, followed by cinematic frames of the director of human resources announcing to the entire medical staff that “Corn would be suspended without pay for 6 months because of insubordination.” Before I could relive the scene again, the handle of a massive cooler was thrust toward me. As I soon saw, the cooler contained a Leviathan-sized fish, caught the previous day by Achmed in the Sea of Galilee. It was clearly not a time to make quips about “the one that got away” or to mention the New Testament’s description of Jesus’ miraculous catch from that same body of water. It was also not a time to worry about The Memo’s consequences. The moment called for humility. And common sense. I thanked Achmed for his thoughtfulness and gestured toward the strapping young men to indicate that it would be their task to load the heavy cooler into my car. Our patients make many adjustments along their journey. They must contend with the stigma of not only their disease but also of being radiated. They get used to a new world over which they have little dominion. And they must make peace with the role of being the recipient. Recipients of daily treatment. Recipients of assistance to travel to the hospital. Receive. Receive. Receive. Depend. Depend. Depend. When a milestone such as the conclusion of irradiation is reached, one can understand how a
The gift of medicine
3
cancer patient might yearn to give something back after all they’ve received, especially if they have accepted our love. I realize that as a matter of policy, hospital administrators must impose safeguards to be certain that medical systems are not manipulated by protectionism and favorbrokers. Yet policies can benefit from nuance. Whether “nuance” in this case means permitting low-value, nonmonetary presents, gift-giving only at treatment termination, or some other solution, it’s not my privilege to decide. But I do believe that even esteemed policy makers in corner offices must practice sensitivity to the psychology of treatment trajectory. They, too, must help each patient reclaim personhood. At a time when so many health care professionals are searching for ways to avoid burnout, 3 isn’t it also reassuring to know that our patients have so much perspective to impart? Whether reminding us about the value of savoring time, or the restorative benefit of allowing us to receive from them, I’d have no guilt about carting away shopping bags full of such important lessons.
References 1. Bob YJ. Former Israeli Prime Minister Ehud Olmert sentenced to six years in prison. Jerusalem Post. May 13, 2014. 2. Senor D, Singer S. Start-Up Nation: The Story of Israel’s Economic Miracle. New York, NY: Twelve Publishers. 2009. 3. Shanafelt TD, Gradishar WJ, Kosty M, et al. Burnout and career satisfaction among U.S. oncologists. J Clin Oncol. 2014;32:678-686.
