Storytelling in Cancer Care
A ladybug, that’s what she wore affixed to her outfit every day. It wasn’t real, of course; rather, a broach, and she had all different types of them, some big, some small, some shiny, some not, but the best one was big, broad and blingy – which she wore when she was feeling her best.
I remember the first day she came into the clinic, she was thin, tall, ashen-colored and fearful – chronically ill. Over a few days, we got to know each other, and as she began to trust me, I told her the story of her immune system. That day, she was there with two family members, and I narrated for them the amazing story of the immune response and how it was designed to attack cancer cells. I could tell she was captivated, and I was reminded of how potentially healing a story could be.
“The macrophages and monocytes are like the infantry, they’re out on the front lines patrolling – looking for evil-doers, especially those that try to disguise themselves,” I said. “The dendritic cells (DCs) are also of that group, and along with the other antigen-presenting cells, are the first ones to engage, kill and extract information from cancer cells. For the most efficient immune response to occur – the type that can yield long-term immunity to cancer cells – you first have to get information from those cells. That’s called Phase I.”
Storytelling is compelling. There are several types of stories in medicine:
Metaphor: which can allow patients to imply, in their words, insights into their well-being.
Feelings-emotions: often, the most frequent expressions of well-being in storytelling.
Patient self-talk: patients who write their stories primarily to “detoxify” their personal cancer experience, or to provide information and hope for others and of receiving empathic encouragement for themselves.
Meaning for life: patients who find a new or altered meaning for life through their cancer journey describe better well-being.
Advice: to and from others, taking messages of hope, which usually contain existentially validated wisdom or spirituality.
“Phase II of the immune response is just as important as Phase I, and as usual, you cannot get to Phase II without Phase I,” I continued.
“The DCs extract vital information from the cancer cell – information that is readily available but well-protected when the cancer cell is alive. Such information is taken directly from the surface of the cancer cell and processed by the DC who prepares the information and heads back to immune headquarters ready to report.” I continued, and at that point, the patient and her family members were so engaged that they wanted no time to pause for questions.
“Once back at headquarters, the DCs encounter the T cells – the ‘Generals’ of the immune system. The DCs give a Powerpoint presentation to the Generals, wherein they tell the T cells a story. This story is about what happened out in the rest of the body, how the cancer cells were found, the battle which then ensued, and how the DCs were ultimately triumphant.”
“What happens after that!?” The patient exclaimed in a question-asking-sort-of way.
“Well, the DCs have their prize – the critical information they’ve brought to the T cells, and the presentation they give is the ultimate expression of their being – it’s what they were meant to do – it’s why they exist,” I continued.
“And, once the T cells have that information, the T cells meet and develop a global search-and-destroy plan to get and kill the other, similar cancer cells in the body.”
“What do the dendritic cells look like?” the patient asked.
“They look like cells with long projections that reach out and grab the cancer cells,” I said.
That’s when she told me: “For me, they look like ladybugs. I have always loved ladybugs and that’s what my immune cells, the ones that are going to kill my cancer cells, look like.”
The next day was the first day she came back to the clinic wearing a ladybug broach.
In medicine, regardless of what the case, the cause, the patient, the medical team – no matter what – the doctor needs to tell the story of someone’s case to them. To understand the story of their current health issues takes some background, which is exactly how I like to run my practice of naturopathic oncology.
First off, I need to hear the patient’s story – how things started and what his or her journey was until coming into my office.
From there, it’s my turn to get information, most often about the patient’s biochemistry and physiology through lab testing, responses to treatments, as well as via feedback from our staff, so I can best sit with a patient and tell the individual’s story, from my point of view. I find that this makes highly complex medical subjects and lab investigations easier to understand for patients.
After all, the highest precept of a physician is to be a teacher.