Awareness movements for disease prevention can be loosely classified as attitudes of sympathy. But fear when water hits the deck makes them sublime. It’s not necessary, however, to be inside, to see what is light and what is shadow. There is glass, windows, and even if the handrails are closed, that too can be revealing. The ability to see, instead of merely looking, putting oneself in the other's place, is called empathy. Something that the Englishman John Donne summarized, in a more direct and consistent way, since the 17th century, in a definitive poem: "And therefore ask not for whom the bell tolls; it tolls for thee".
In a providential moment, more precisely on April 28th, 2019, the publication, only three days before, of an article in the renowned New England Journal of Medicine seemed like a fortuitous gift. I consider it a duty to share it. The author, the Australian Susan P. Walker, a professor of obstetrics and gynecology, had been surprised a year earlier after being diagnosed with breast cancer. Taking advantage of her personal experience combined with the theoretical knowledge that until then had served her only on one side of the front, she built up a generous reflection. Using a well-known graphic representation called the Receiver Operation Characteristic (ROC Curve), Dr. Walker puts on a vertical axis the forces that on the one hand are frightening and obviously threatening, but which also seek to preserve life, imposed by cancer and its treatments; on the other hand, horizontal, which will determine the days on this path: the treatment and its complications, the side effects, the interruption of work and the impact on relationships, the feeling of vulnerability, the fear that our identity will be lost. Parallel to what we learned about the pandemic, the need to flatten and lengthen the curve. The result is how the patient "really" feels. Of course, it will depend on certain factors such as the stage of the disease and the early diagnosis and start of treatment. This is one of the main objectives of awareness campaigns such as Pink October.
We need to face disease and invest in better therapies and, this is being done, a more precise and personalized medicine. The good news is that the area under this curve can be manipulated. While the disease remains daunting and the therapeutic options, even if they present permanent advances, follow specific indications, there is a growing and proven amplification of the opportunities to "flatten the curve”. Seeking to give quality to the days of treatment and to life itself – during and after treatment.
For example, it is now recognized that exercise is crucial to improving the survival and well-being of cancer survivors. Meditation and mindfulness can decrease the tide of agitation, insomnia and anxiety. When we are ill, we must avoid the trap of false expectations, some imposed by others, but many generated by ourselves. The value of kindness and empathy in health care is immeasurable. After a year and all the stages of treatment, Dr. Walker stated that she could not express how decisive all the kindness and wisdom of the people who cared for her was. So is the empathy of those who do not demand to hear good news all the time, which shows that it is not only the severity of the illness and the therapeutic power of the treatment that matter. She also learned the hard way that doctors are not superheroes; they are just as fragile and vulnerable as everyone else. "We all need to look beyond ourselves. Our families, our friends, and ourselves, we need ourselves. That will be the most decisive factor in flattening our curve and pushing it to the left. We must pay attention to everything that respects and can influence that flattening"
Not only for cancer, but also for other chronic diseases, as well as for this climate of strangeness, fear and wonder.
She concludes by telling us that, having completed all stages of treatment, her daughter asked if life was better. The uncertainties remain, but she still agrees. It reminds her of the early scenes from The Wizard of Oz, when the house finally settles after a tornado. Dorothy opens the door and the film, in black and white, suddenly becomes colorful. This is what it feels like. "Life becomes at once more vibrant and more daunting, richer and more challenging, more wonderful and more exhausting, safer and even more uncertain. Existence in its color spectrum”.
