09 July 2018

Cancer-treatment-Is-it-OK-to-say-no?

Guest blog from Dr Ruth Gawler
My dear 82 year old mum told me this week that following a mammogram she has been diagnosed with probable breast cancer and she does not want a biopsy or any treatment. 
Being her oldest daughter and a doctor, all this came as a bit of a shock; and it raises questions around the right and sensibility of refusing treatment.
Now mum told me her news in a matter of fact, unemotional way; as if she just wanted me to understand this was her decision and she was simply informing me. She has also told the family and is quite open about her diagnosis and choice. 
As it happens, I have another elderly patient who also is saying no, so this week let us examine what is behind these powerful choices - and their wider implications, but first,

                      Thought for the day - mid winter style


       An elderly American Indian was asked by a white man
       How it was he managed to wear so few clothes in Winter.
       “You white people,” he replied
        “Does your face get cold in winter?”
        “No.”
        “We Indians… all face!”  




My mother has been living in an aged-care facility for over 3 years due to relentlessly progressive immobility from a number of causes including longstanding kyphoscoliosis and arthritis, reflex sympathetic dystrophy, chronic muscle atrophy etc etc. 
Yet mum’s mind is clear as a bell, she has a formidable memory and the kind of well-informed, original conversation that has a string of visitors - family and friends - almost queuing to be engaged and entertained regularly. My mother is what they call a real live wire; well-informed, gregarious and with a great sense of humour. 
So, after she had called me with “the news” I went to visit her in her room on the 5th floor of her aged care residential facility overlooking St Kilda Rd. To my pleasant surprise, from her usual sitting position on her bed she greeted me with a big smile; obvious delight to see me all over her face. Her arms extended for a hug and a kiss; I put the shopping I had done for her on the floor, and we embraced. 
Now mum had also made it clear to me that she did not want my medical advice, and I was to refrain from giving my opinion on her medical situation. Not an easy call for someone like myself who has worked intensively with people managing cancer for nearly 2 decades. But, I could do it and had resolved just to talk about other things unless she raised the topic. 
Being a regular meditator makes this kind of plan relatively doable. After all, when we meditate we learn how to place our attention where we want, and to be aware when we are distracted. So it was just a matter of deciding to talk about other things and remembering the plan. 
As it happened, we did talk about many things, including the blanket she was knitting, her conversation on Skype with her sister in Israel, the potato latkes (fried classic Jewish potato cakes) that had been brought for her dinner, and the funny weather we were having.  
Then, at one point she repeated that although her mammogram had shown probable breast cancer she did not want a biopsy or any treatment. 
Like any daughter I was initially surprised and upset. 
Mum told me that she would not cope well with the medical procedures and it was not her wish at this time in her life to be going through more suffering than she already had. 
What would you call that? 
Stupid? Sensible? Crazy?  Self-aware? 
In shock? Denial? Depressed? Rebellious?  
Some would analyse her reaction as “scared of the medical system”, or “ill-informed”. 

Others may say that she has so many other health problems, her life may just be too hard to manage any longer. Mum has a “frozen foot” with severe constant neurogenic pain, recurrent digestive problems and a big swollen tummy, great difficulty walking and needing to shuffle along in a walking-frame, failing eyesight, and so on and so on. Maybe this recent “breast cancer diagnosis” just slipped into the list of all her other physical challenges.
And another factor - my dear mum has been pretty overtly rebellious since she divorced my dad when I was 15 (and had then exploded the lid of her life as a virgin-bride, hardworking mother of 3, and piano teacher who had cooked and cleaned for her family for 16 years). 
But given all this, it may still be quite possible mum is making a very reasonable, rational personal choice to not engage further with the medical industries on this matter. Mum is a double degree, university educated, highly intelligent, well-informed elderly lady with human rights. And here she is telling us all clearly in sound mind that it is her wish is to curtail further medical investigation and treatment.  
So many ways of looking at an old lady saying “No thanks!”
Now in my medical practice is a 78 year old highly educated Swiss lady who was diagnosed with Ovarian Cancer about 4 years ago. 
On medical advice she received chemotherapy that was not deemed to be curative but would “prolong her life and improve her quality of life”. 
She described this treatment to me as “a nightmare” of misery that left her with neurological deficits – numbness in her hands and feet, extreme tiredness, weakness and depression. 
Yet, she told me “it may have done some good because her cancer marker went down” and “maybe it was worth it” at the time.
Now a couple of years later after reading You Can Conquer Cancer and attending a cancer residential program she feels wonderfully well once more, and describes her life as “better than it has ever been”. 
She is eating a clean (organic) wholefood-plant-based meals, she is meditating regularly, using an infra-red sauna regularly, taking certain specifically recommended supplements prescribed by an expert and exercising regularly. 
Her mood and energy levels are excellent she tells me, and her relationships with her daughters and grandchildren are good. 
She has no sense of being unwell. 

However, her cancer marker CA125 is slowly going up. Very slowly going up. This means that she is regularly advised to have “more chemotherapy” albeit something slightly different than the last course. 
It is with great personal effort, courage and resolve that she says “no thank you” to the “very compassionate and caring oncologist” who has been regularly taking care of her. She has had incredible difficulty doing this. 
This great, mature lady has studied the efficacy (effectiveness) of the treatment offered and she has had personal experience of similar treatment. This woman too is university educated and by the by, was a leader in her field of childhood education in her middle years. She is aware that her body is actually doing a good job of minimising the growth and impact of her metastatic cancer with all she is already doing to stay well. She also has the resources and support to manage this lifestyle long-term. 
Both my mum and my Swiss patient are old dames who have left the countries of their birth and childhoods, have seen wars come and go, families grow up and leave and make lives of their own, and been engaged, hardworking members of the communities they live in. 
Of course they are different in many ways but here they are in their twilight years saying “No thanks” to their doctors. 
Do they have this right?  
And could they be right to do so ? 
And if the answer is yes to both these questions, then why is it that we do not make it easier for them?


       Ruth's mother second from left with her two daughters on the right celebrate a milestone birthday.


Ruth Gawler's 
next meditation retreat - with Julia Broome

Meditation - Pure and Simple

Whether burnt out, dealing with physical or mental issues, this retreat provides a unique opportunity to be led and supported by a doctor well versed in Mind-Body Medicine who has a particular expertise with deep relaxation and healing.

Ruth will focus in this retreat upon the meditation techniques of Dr Ainslie Meares and Ian Gawler. 
The only meditation retreat Ruth is leading in 2018 that will be specifically focussed on meditation's therapeutic healing benefits.  

Combine deep relaxation techniques and mindfulness meditation to release the stress we carry in our bodies in this busy and complex modern world. Ideal for healing, rejuvenation and opening our awareness.

Ruth’s teaching style is one of openness and authenticity, and there will be plenty of opportunity for questions and discussion. Techniques covered in this retreat will be accessible and engaging for both beginners and more experienced meditators. This retreat is well suited to all Health Professionals. Certificates of Attendance for CPD points issued, on request at the end of this retreat.

DATES                                    September - Monday 10th to Friday 14th September 2018
VENUE                                   Yarra Valley Living Centre, Rayner Crt, Yarra Junction, Victoria
ENQUIRIES, BOOKINGS     The Gawler Foundation ClientServices@gawler.org
                                                 and 1300 651 211 - Call Mon-Fri 9-5pm





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8 comments:

  1. Yes, of course they have the right to opt for no treatment. I don't think anyone questions that ... do they? 'Is it wise, or fair to others?' is what many might ask. And it all depends upon the patient's values and priorities. I can understand some loved-ones urging her to take whatever treatment offers even a tiny chance of cure or semi-cure. But they may be doing this urging more for their own comfort than the overall wellbeing of the patient. Very oddly, the modern medical system (machine) is so prominent in society that the question can even arise about whether someone with an illness has rights over their course of action! Beautifully written piece Ruth.

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  2. It takes courage to decline conventional treatment, but I believe everyone has the right to do so and that their decision deserves respect. Your patients are fortunate in having your expertise to guide and support them iif they choose to explore “alternative” healing modalities - others who opt out of the orthodox system often have to go it alone. Thank you for this post and I hope things go as well as possible for your mother.

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    1. Courage indeed Jennifer, especially in the climate that exists today ...

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  3. Please support your Mom and continue to love her like before. My husband passed away with advanced kidney cancer 4 years ago. We made a conscious decision to stop chemotherapy and just follow the basics described in Dr.Gawler's book. He died in peace and relative comfort. Up to 2 weeks before he died, he was still mobile, though feeble. Modern cancer treatments are often painful and this is not a good way to spend the last few weeks or months of one's life.

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  4. This is what people sadly often miss - the drugs often enough are useful, but it can get to a point where they can destroy quality of life, whereas focusing on Lifestyle Medicine and good care can make for a good quality of death.

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  5. Thanks for sharing your news about your mother. Having loved ones pass over always gives me pause to contemplate my own life.

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  6. Very heart-warming.
    Thanks,
    Mum/Barb

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