Another Plight

It pains me to have to add yet another name to the list of good people whose sickness and suffering I include in my daily meditation practice. This time I discover that a friend has prostate cancer. Anonymous, of course; I would not wish to be betraying any confidences, but there is no reason in the world to think that any readers of these words might know this friend. And I think that, from an entirely transpersonal view, his story raises an important and rather agonizing dilemma that we all might need to think about one day. I spoke to him yesterday on the telephone and heard about his struggle for the first time.

Here's what I heard: my friend was diagnosed a number of years ago on the basis of a high PSA count, and advised to submit to a biopsy. He did not like the doctor, nor did he trust him. He distrusts doctors and Western medicine generally, but he distrusted and disliked this one particularly because the doctor seemed careless, inattentive, and arrogant in his dismissal of the patient's concerns. And my friend had heard--rightly of wrongly, I don't know--that the interference of a biopsy tends to provoke the cancer into rushing to its own defense, increasing its energy and reinforcing its hold on the body. He refused the test.

My friend assured me that he has been what is casually called a "health nut" for years. He believes strongly in the body's power to restore itself to health, given the right diet and the right attention. After refusing the biopsy, he continued to take what he thought was good care of himself. But recently he started to feel that all was not well. He was suffering from a lack of energy, a general malaise. So he went back to the clinic where he had received his diagnosis, and was dismayed to be referred to the same doctor he disliked and distrusted in the first place.

After new tests, he learns that his PSA count is now alarmingly high. The doctor recommends once again what Western-trained doctors recommend when they find evidence of cancer: a biopsy, to be followed by chemotherapy and radiation--precisely the kind of things my friend most deeply mistrusts. He is now faced with a dire decision, and one that could clearly prove fatal, between what the (mistrusted) medical profession tells him and his own deeply rooted convictions. He says he is not afraid of dying, but he does seem torn. There are few of us who would consciously choose death when the extension life--at a relatively young age--is a viable alternative.

(This did not come up in our conversation, but I'm acutely aware that for many in this situation there is the added worry about the cost of treatment. I have, truthfully, no idea of this particular friend's situation on the health insurance front but I do know that, in this country, today, a disease like cancer can ravage a family's financial security as well as the patient's health. I do know, too, that the physical suffering of too many of our citizens is redoubled by the fear of financial devastation. This simply should not be.)

I myself am fortunate to be with a medical plan that has served our family well for years, and with a doctor who knows me and in whom I place my trust. Like my friend, I believe that Western medicine has its limitations--but then, fortunately, my doctor agrees with me on this point. He is open to discussion, and will think seriously about alternative treatments when asked. I believe, too, that hospital is the last place you want to be when you are sick, and am leery of the easy dispensation of drugs for whatever ails you. I lament the widespread practice of defensive medicine to protect doctors and hospitals from lawsuits; and, on the other hand, believe strongly in the kind of preventative medicine that is often overlooked in the obsession with "cure."

That said, I believe that if I were in my friend's place I would be inclined to follow the doctor's recommendation. Even acknowledging its limitations, Western medicine has proved and continues to prove itself remarkably effective in innumerable ways. It can perform what once would have been considered miracles. I hope, of course, that I will never have to face the kind of choice my friend now has to face, but I would be blind not to recognize that this could very easily happen. Considering the plight of all those friends to whom I send wishes for happiness and good health in my metta practice every morning, I count myself fortunate to have nothing worse to complain about than a sore knee and a touch of vertigo.

The broader dilemma I describe, between medical intervention and letting our human frailties run their course is one we are increasingly likely to have to face as we grow older. Indeed, these days, as death approaches and with an array of medical options for artificially prolonging life, it is virtually inevitable--whether I am able to make choices for myself, or my family have to make them for me. In the latter case, a living will and advance health care directive seem the only sensible course to take. That these legal instruments should have sparked the absurd "death panel" debate in the discussion of a national health care system is an unhappy indication of the apparently willful ignorance rampant in our society.

But I have begun to stray far off course. My original purpose, to which I should now return, was the simple expression of compassion for all those struggling with illness in all its multifarious forms. May they be restored to health and happiness.