An Excerpt from Dr Azra Raza’s Eye-Opening Book on Cancer

In The First Cell, Dr Azra Raza offers a searing account of how both medicine and our society (mis)treats cancer, how we can do better, and why we must. This is a book of wisdom and grace by an author who had to bear the terrible burden of being her own husband’s oncologist as he succumbed to leukaemia.

Q. How has being the wife of a cancer patient had an impact on your approach to treating your patients?

A. The experience forced me to revise my perception of reality in unexpected ways and to acknowledge my growing confusions. The war on cancer is very confusing. It is a war for the body, on the body, and by the body. Harvey taught me not to become emotionally involved with patients because feelings clouded judgment. I always questioned his advice because patients demand an emotionally invested, empathetic doctor. Why would I go through years of hard work in medicine to remain detached, dispassionate, distanced from my patients? But even I was taken aback when Harvey named me as his primary oncologist. Another issue was dealing with the simultaneous existence of hope and despair throughout his illness. I resorted to Freud who pointed out that normally, it is hope that gives subject to action. When there is no hope, hopelessness becomes a form of action. Ultimately, the only consolation is that there is no consolation. This served as a remarkable revision of the reality principle because once there is no hope one is forced to go on living day to day. As Harvey faced mortality head-on, the words meant to empower patients and their families—war, battle, fight, magic bullets—ended up detracting from the profound human experience.

 

Q. What does it mean “to do no harm” when the medication available to you is often harmful and fruitless?

A. While almost all drugs come with attendant toxicities, the question for cancer patients is a greater challenge because radiation and chemotherapies kill cancer cells along with normal cells, indiscriminately causing life-threatening and extraordinarily painful side effects. Paradoxically, these very poisons offer the only glimmer of hope for prolonging survival. The justification for our actions can be traced back to Summa Theologica, where Thomas Aquinas states the Principle of Double Effect: “Nothing hinders one act from having two effects, only one of which is intended, while the other is beside the intention.” As long as good is the intent, the possibility of a harmful side effect, even death, is acceptable.

 

Q. What advice do you have for patients with advanced cancer, their families, and those who want to go into the healthcare profession?

A. The best piece of advice is imparted by Antonio Gramsci in the Prison Notebooks: pessimism of the intellect and optimism of will. See the facts for what they are, not as you may want them to be, and instead of being broken, have more confidence in your capacity to see things through, to overcome the odds. The simultaneous existence of despair and hope, of pessimism and optimism; one realistic, the other brightening the darkest of times with resilience.

Many of my patients say something to the effect that they are not afraid of dying but of death. What is the actual experience of death? A surprisingly reassuring answer comes from the great French Renaissance writer Michel de Montaigne. In his essay on death, after he had a brutal fall from his horse and a near-death experience, Montaigne tells us calmly, “If you don’t know how to die, don’t worry; Nature will tell you what to do on the spot, fully and adequately. She will do this job perfectly for you; don’t bother your head about it.” 

 

To read more from this insightful account, order your copy of The First Cell by Dr Azra Raza today.