I have long been a strong proponent of patient attitude as a vital link between health and illness. Much of the available evidence indicates that patient attitude is also one of the most important factors leading to disability. In a previous column, I wrote about the factors that influence the development of disability in back injured workers. There is little evidence to suggest that such disability has much to do with the seriousness of the injury or the difficulty of the occupation. Rather, disability has to do with a number of psychosocial issues including life and job satisfaction, secondary gain, and locus of control. Like disability, it is my contention that recovery also has to do with such psychosocial factors.
A case in point was my mother-in-law, Dona Cooper. For the past four and one half years Dona has fought a battle with cancer. Last night, the cancer won. Dona was a fighter with a great attitude and, I believe, it was her attitude that kept her going so long. When Dona was first diagnosed with cancer she decided to fight back and, fight she did. Her initial treatment was the typical surgical removal followed by several months of radiation therapy. Her oncologists were pessimistic and assumed that it was not likely that she would survive more than 12 months or so.
In December of 1994, three years after the initial diagnosis, Dona came to California to visit with us for Christmas. Her condition had deteriorated to the point that she came off the plane in a wheelchair, unable to walk more than a few steps at a time. During her stay she developed a chest cold and was seen by a local GP. Through a series of referrals she was fortunate enough to find an oncologist, Dr. Yun Yen, who was willing to work with her. It was clear from the beginning that he understood the very important role of patient attitude and social support. In fact, he told Dona that the only reason he would consider such an aggressive intervention in a patient of her age (she was 67 at the time) with the type of cancer that she had was because of her attitude. He was very clear about the odds of recovery and/or improvement (30 percent chance), and asked Dona to take some time to decide if this is what she really wanted. Without hesitation, she stated that those were good odds and asked, "When do we begin?"
In January of 1995, under the direction of Dr. Yen, Dona entered a chemotherapy program at the City of Hope in Duarte, California. The treatment plan was to use a combination of medications for the next three months. At the end of that time Dona would be reassessed and based on her response (or lack thereof) a determination would be made regarding continuation of the treatment.
None of us knew what we were in for in the next few months. If you have ever experienced chemotherapy up close and personal you will appreciate what happens. The dosage is estimated in the beginning based on a number of factors including body size, age, and general health status. The procedure, which takes from two to eight hours, is usually performed on an outpatient basis. Dona was given the first infusion on a Wednesday and sent home the same day. By the time that I got home in the evening she was incredibly ill. Her whole demeanor had changed. She looked beaten. For the next few days she suffered terribly and, on Friday, I left town on business. I was only going to be gone for a couple of days, but when I left I wasn't sure she would still be alive when I returned. I thought this woman has survived the cancer for three years but I'm not sure she can survive the treatment.
Gradually, however, she recovered her strength. But something had changed. This was not the same person. She was now frightened and not at all looking forward to continuing the treatment. When the time came for her next infusion, Dona became ill before going to the hospital. She questioned whether it was worth what she knew was coming. Based on her reaction to the first treatment, the dosage was adjusted. Once again, she was sent home. This time a home health nurse was provided to look in on Dona daily. Each time the nurse came she would ask Dona how she felt on a scale of 0 to 10, 10 being worse. On one occasion she responded "10 and 1/2." I knew at that point that her attitude had to change or she would not survive.
With compassion and understanding, Dr. Yen admitted her to the hospital for the next treatment. In fact, he admitted her to the pediatric ward. It is my belief that this saved her life. She looked around at the young kids with no hair who were playing in the hallway while dragging their IVs behind them and decided, "If they can do it, so can I." She was back and the fight was still on!
But each time she received the chemotherapy, Dona's determination wavered. She became progressively more and more apprehensive about what she knew was to happen. Finally, she reached a point where she had decided to discontinue the treatments. After a great deal of agonizing she had made up her mind to return to Kansas and make the most of whatever time she had left. Although she didn't want to disappoint Dr. Yen, she was going to tell him of her decision. Fortunately, Dr. Yen had reevaluated her condition and was ecstatic to find that her tumor had begun to shrink. I'm not sure who was more excited, Dona or Dr. Yen.
Once again, she was back! This time for the duration. Encouraged by the news, she was again determined that she would beat the odds. We talked about what we would do when she recovered and she set a goal to visit England, a lifetime dream.
In August of 1995, Dr. Yen told us that the cancer was in remission. She was, as far as he could tell, cured. What the future would hold no one knew. But for the time being she was well. Dona, my wife and I spent 10 days in England as a celebration.
In October of 1995, Dona was told that the cancer was growing once again. She returned to California and began the chemotherapy regimen again. This time, however, there did not seem to be as much fight. Each treatment seemed to make her weaker. Shortly after the new year she developed an infection. She was again admitted to the hospital and this time she was released to a convalescent center. She now needed constant care. Dona had always asked Dr. Yen to tell her when he thought the fight was over. I think she knew that the end was in sight.
This past Sunday evening, Dona was admitted to the City of Hope for a final time. She always felt secure and safe there. As she was being wheeled through the hallway on the way to her room she used her last ounce of strength to give us a "thumbs up" sign. Dona, we'll miss you.
In our first discussions with Dr. Yen he stated that he was not sure whether the treatment would benefit Dona or not. But, he added, we learn something from each of our patients. Perhaps what we will learn from you will allow us to help someone else. I think there is a lesson in that for every clinician. Later, when Dona was in remission, we thanked Dr. Yen for his help. Without hesitation he stated, "I did nothing. You prayed and God listened." This is another lesson for each of us.
Sometimes, as chiropractors, we are very critical of the things that medicine does. Our view of health and health care is not always compatible. We sometimes feel that they treat disease and symptoms and not the whole person. I'd like to express my thanks to Dr. Yen and the City of Hope. They treated Dona's body and her spirit.
Please note, direct correspondence to:
Paul D. Hooper, DC
Los Angeles College of Chiropractic
16200 East Amber Valley Drive
Whittier, California 90609
(310) 947-8755, Fax (310) 947-5724
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