Postcard from Hanoi:
I have been an oncologist for some 35 years, treating adults with advanced cancer. Despite a far greater understanding of the disease, with the discovery of quite remarkable “targeted” therapies, most patients still die of this disease. Many are not suitable for these treatments, many don’t respond or respond poorly and briefly, and of course many simply present very late in the course of the cancer.
As an oncologist I am thus confronted by uncertainty, sadness, despair and grief on a regular basis, as are all the members of the oncology team, but at times leavened by the joy of success, the gratitude of families and the deep insights into the human “soul”.
Through my own adult life I have had a mixed relationship with death, particularly my own, beginning with a simple non-acknowledgment, then noticing an increasingly intrusive terror, with quite visceral reactions to certain patients as they moved towards their own demise under my care. I was in my forties at that time and would experience profuse sweating, tremors, nausea and a curious clouding of consciousness. I thought I may have malaria (a noble affliction) but to whom should I go for wise counsel? There was little wisdom to be found. Over time my symptoms evolved into a depression, but this only became clear to me years later, in retrospect.
Technically I had been suffering “thanatophobia”, that is “fear of death”. A common complaint, but rarely considered (in our society) since we prefer a “cultural denial”. Thus, more recently, over 15 years or so I have pursued a deeper understanding of death, my own and that of others. This universal phenomenon unites us all. As John Donne reminds us: “any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls: it tolls for thee”.
I have learnt much from Joan Halifax who wrote “Being with Dying: Cultivating Compassion and Fearlessness in the Presence of Death” and the late Stephen Levine who wrote both “Who Dies? An Investigation into Conscious Living and Conscious Dying” and also “A Year to Live: How to Live this Year as if it were your Last”. I have completed a one year course based on this latter book.
Death has now become less fearsome to me and more interesting! As Buddhism has told us for 2,600 years, a regular meditation on one’s own death will invigorate one’s life and shed some light on the true nature of the world and the meaning of our own experience.
The complete practice of oncology requires some exploration of one’s own mortality, to more deeply understand the experience of each patient, to be of service and, importantly, to learn. There is a long history in most cultures of a specific “companion to the dying”. Medical practitioners including oncologists are ideally placed to occupy this role.
Over the years I have been greatly supported by a mindfulness practice including regular meditation. Again, this cultivation of mindfulness, bringing one’s mind into the present moment with awareness and “heartfulness”, is an ancient Buddhist practice, taught also in other spiritual traditions and in more modern secular environments. This practice enables a deeper understanding of one’s inner emotional life, allowing one to be more “available” for patients, rather than locked within a defensive carapace. The risk of “burnout” and depression is far less.
Strangely (or perhaps not) these skills have never been a substantial part of medical education or the oncology specialty, with some notable exceptions such as the programme at Monash University in Melbourne and the long-running “The Healer’s Art” course developed by Dr Rachel Naomi Remen at University of California, San Francisco School of Medicine.
What about Vietnam?
I have had the privilege of visiting this astonishing country many times, firstly as a medical student in 1974, then more recently with colleagues, supported by the Hoc Mai Foundation, travelling to Hanoi to teach Medical English, oncology and other specialty topics. However, at a deeper level, I (and I suspect my colleagues also) travel to Vietnam to learn from this resilient, gracious and warm-hearted people. I feel there is a spiritual nature to the Vietnamese society, reflecting elements of Buddhism, Confucianism and Taoism.
It is helpful to leave one’s ‘ego” or one’s “sense of an important self” at home and thereby immerse oneself in this enriching and restorative culture. The Vietnamese (to my eye) seem to embody a friendly mindfulness, a universal respect, remarkable patience and lack the reactivity so often seen in more “Western” cultures.
I am looking forward to a further visit to Hanoi, to renew friendships and, importantly, to imbibe the pervasive spiritual vitality in that city that now has a direct positive impact on my work.
Jonathan Page, Medical Oncologist, Manly and The Mater Hospitals, Sydney, NSW.