Pitfalls of caring for cancer-afflicted celebrities
In a recently published book, titled The Cancer Experience, author Dr. Roy Sessions aims to stimulate a dialogue about matters related to cancer treatment as well as the spiritual aspects of hope and other factors relating to the plight of cancer patients and their families.
The following is an excerpt from the book's 13th chapter, discussing discussing matters related to providing cancer treatment to celebrity patients.
One of the pitfalls that some doctors encounter while caring for cancer-afflicted celebrities - whether they be captains of industry, financiers, athletes, politicians, show-business types, or even Mafia dons - is that they are frequently surrounded by aides and other members of an entourage who feel obligated and empowered to be protective. Additionally, the celebrity is often accustomed to people jumping on command, and the minions can be very demanding in seeking to create an environment of subservience around their boss.
A friend of mine spent four years as the U.S. president’s personal physician, and his travails in dealing with his patient’s subordinates vastly exceeded that of the boss. No physician should participate in the charade conjured up by such a team. Instead, the doctor should uphold the dignity of the profession and at all times do only that which is medically in the best interest of the patient and that which follows the highest of standards. A sense of protectiveness for the patient must be part of a physician’s credo and leadership skill set. Surprisingly, most patients recognize the value of such an attitude, just as do high-profile and powerful people, who, with proper handling, can also be some of the nicest and most grateful patients.
Physicians who take care of famous patients must be guarded about compromising care by catering to their whims because of their star power; they usually understand the word “no.” Especially in surgery, we scrupulously and compulsively follow certain routines for the simple reason that they are best for achieving the goals of the operation. While the physician can be impressed by someone’s accomplishments or fame, showing respect and deference by making allowances for issues of security and privacy, patient care should be standard state of the art, and it should be recommended and administered with the same leadership and take-charge approach that the oncologist routinely uses. Even people of substance and wisdom may unconsciously test the boundaries of control, but in the end, they usually respond with relief and appreciation when a physician takes charge and does not allow patient dominance. With that said, it is important for physicians to be certain of their own motives and ensure that their behavior is not designed merely to prove a point. There are occasions when the patient correctly questions the method recommended, sometimes for reasons of which the physician is unaware. Within the bounds of good medical care, the physician should be flexible, depending on the request. I will speak more about the power and control issues that relate to the physician-patient relationship, but at this point, suffice it to say that special patients should be leery of special treatment by physicians who are star struck.
No matter how elevated or important, most intelligent cancer patients want their cancer physician to demonstrate leadership with a thoughtful and cogent game plan for dealing with their tumor. This is not always an easy status to achieve, especially early in an oncologist’s career. I remember very well when I was a young attending surgeon on the faculty in the Texas Medical Center in the mid-1970s being asked to see a patient for a vocal cord cancer. R.C. was the quintessential Texas oilman in appearance and deeds. His name was the stuff of legend in Houston, and his family epitomized the very Texas tradition of supporting local institutions. They had done that through personal action and leadership, as well as with vast amounts of money donated to their beloved and world famous Texas Medical Center. The patient was dominant and charming, commanding attention whenever he walked into a room. His presence was like that of the proverbial 800-pound gorilla, a force impossible to ignore. R.C. had earned his measure of deference over Germany during World War II, and afterward in the tough world of the Texas oil industry. In the language that is uniquely Texan, this was an important person.
On that first visit, I walked into the exam room to find a large man engulfed in a cloud of smoke, as he sat with a large cigar clenched between his teeth. R.C. looked at me, and casually took the cigar out of his mouth, but kept it at a close distance in his hand. The slight smile that developed as I came forward is impossible to describe—neither welcoming nor sardonic, but anticipatory, and when combined with a perfectly elevated eyebrow, betraying real skepticism of this youngster who had just walked into the room. I could almost feel the words that were on his mind—“Your move, sonny. What ya gonna do about it” I didn’t have to be a psychologist to realize that I was in a control struggle of the first magnitude. The struggle continued with a handshake of epic proportions, undoubtedly designed to test my manhood.
“Doctor, it’s nice to meet you,” he said as he looked deep inside me.
I responded appropriately, while wondering how long it would be before
I got my hand back. During that time of subliminal combat, the eye contact was not unfriendly, but was intense. Finally, he asked as he handled the cigar like a thing of interest, “The smoke bother you?”
I didn’t take the bait. “No not at all,” I said. “Actually I like good cigars.” “Oh . . . well let me send you a box. They’re Cubans,” he said.
“Thanks, but I’ll pass,” I said, “I quit smoking some time ago, and having them around would be tempting.”
The smile warmed a tad, perhaps as a result of finding commonality with a physician who was also vulnerable to the seduction of nicotine.
I then got my hand back, and that is when I made my move for control of the situation, with some desire to also restore my dignity. “I do want you to put out your cigar, however. Medical Center rules, you know, and besides, it makes it a little hard to examine your throat.”
He laughed, extinguished the cigar, and said, “I’m sorry, Doctor. I should have thought of that.”
I thought, but of course didn’t say, “Sure, I’ll bet you hadn’t thought of it.” In the antismoking climate of today, this story seems almost unimaginable, but this was the mid-1970s, and even though completely inappropriate, his behavior was less unusual at the time, and let’s not overlook that he “was who he was,” so to speak. As I came to know this really fine man, he never would admit that his smoking in the exam room was an intentional provocation, although he did smile when the story came up.
Happily, R.C. was cured of his cancer and went on to live a number of years afterward, during which he and his family continued their generous support for the Texas Medical Center. To my chagrin, however, I never got him to quit smoking, although he never again lit up in the office. FurtherPatient more, I don’t think that he really believed that I had quit smoking; months after his treatment was completed, I received a box of Cuban cigars in the mail—sender unrevealed. Except for cheating on the smoking issue, this man had become a delightful patient and friend, and could not have been more of a gentleman, even if not an ideal patient.
While wanting leadership from their cancer physician, patients don’t often engage in the initial tug of war that I just described. Most powerful individuals do, however, want to hear a cogent plan of action, a grasp of subject matter, and decisiveness in their physician. They are comforted if they understand what they are told and, appropriately, annoyed if they do not. Physician flexibility must be tempered with experience, maturity, and firmness. I remember well a situation faced by a colleague of mine who was an esteemed surgical oncologist at a famous cancer center. He was a leading international authority on the cancer for which he was treating a very successful national politician. The person in question wanted to run for the presidency, but to reveal the need for a cancer operation would obviously have compromised his viability as a candidate. The patient and the patient’s minions opted to delay treatment until after the political process, a course that was strongly discouraged by my colleague. The politician was not nominated, and after almost a year of delay, eventually got around to taking care of the cancer. My friend operated, but things had progressed substantially, and the person went on to die from a malignancy that probably would have been cured if treated in a timely fashion. My colleague had cared for many important people, and although very fond of this particular patient, was thoroughly unimpressed by his star status. He had been adamant in his advice to operate earlier, but unfortunately the twin demons of vanity and ambition won over judgment, and good medical advice was ignored.
Excerpt from: The Cancer Experience: The Doctor, The Patient, The Journey (Ch. 13) Roy B. Sessions, MD
Rowman & Littlefield Publishers, INC ISBN: 978-1-4422-1621