Category Archives: Health care

First World Problems

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I am quite fond of the acronym ‘FWP’. I will often throw it out there after someone asks me about a challenge at work, just to remind myself that my problems are so few and so incredibly small relative to those of the majority of the people on this planet.

Recently, I was made wholly aware of the fact that the challenges I have with my prosthetic leg are also rooted in the first world context.

I have spent a fair amount of time in South-East Asia as part of my professional life. Every time I return to this part of the world I am reminded of how much I take for granted the luxuries of the first world – education, health care, potable running water, roads, transportation infrastructure, a safe and secure food supply, security, a functioning justice system, the list goes on and on. And every time I’m in South-East Asia I try to put money into the local economy in the form of service consumption because it seems to be one of the easiest ways to get money into the hands of people who need it, particularly women.

So the last time I was in Indonesia I went for a local massage. The woman asked me to take off all my clothes, as you are expected to do in these places. I’ve had a few massages before in various locations including India, Sri Lanka, and Indonesia, so I’m used to having women ask what happened to my leg. It’s interesting that what people guess to be likely the cause varies by setting. In Sri Lanka and the United States, I am most commonly asked if I am a soldier, while in Indonesia and India the first guess is usually motor vehicle accident.

Traffic accidents are one of the leading causes of disability in places like Indonesia, and one only needs to step out onto the street to realize that there are a lot of accidents involving pedestrians. I can only imagine that with the standard and availability of health care, limb loss is a common outcome.

In this instance, when I told the woman that I had been very sick as a child she was quiet for a while, and then said something to the effect of ‘if you were a woman in Indonesia you would not leave your house.’ That was it  – no follow up, no explanation, just those words. Her simple statement broke my heart.

It is because I was born in the first world that I received the treatment and surgery necessary to survive childhood cancer. It is because I live in the first world that I have access to people like Jon Allen who equips me with best prosthetics available to live an active life. And while I have had the experience of feeling marginalized as a result of my artificial leg, never to the degree that this woman so plainly described for me. I can only imagine the poverty and trauma that can stem from limb loss in these types of settings. I hope, with naïve optimism, that my presence in places like Indonesia shows people that such social exclusion is not the only way of responding to limb loss.

Mostly though, at the end of this encounter I was conflicted with emotion that was equal parts gratitude and powerlessness.

Our Cancer Lexicon

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I believe that the language we use to describe the human experience shapes our perceptions of that experience as much as we shape the language itself. One of the areas in which I find the use of language quite disturbing is when we talk about cancer.

As an example, Jack Layton’s death from cancer was much talked about in Canadian media. The CBC ran an obituary entitled ‘Jack Layton’s legacy as a fighter’.

When he announced his diagnosis to the media Jack Layton himself said ‘I’m going to fight this cancer now so I can be back to fight for families when Parliament resumes.’

Now granted, my first-person experience with cancer was a long time ago. I had a total of 10 months of aggressive chemotherapy with surgery falling somewhere in the middle. Despite the passage time, one thing I am certain of is that the experience never felt like a battle, a fight, a war, a slugfest…. You get the idea. What I do remember is that when you get a diagnosis of cancer you are immediately swept into this torrent of events over which you have no sense of control, particularly as a child. In my case, the pathologists needed to argue over what type of bone cancer I had which meant there was a brief interlude between diagnosis and onset of treatment. During this time I can remember thinking about how my hair would fall out: one of the ironies of having cancer as a child is that you have no frame of reference for how bad the treatment is really going to be.

I do not remember anyone asking me if I wanted to pursue treatment. As a child, it was not my decision to make. Perhaps my parents were asked but it is one of those decisions around which you have little choice if you hope for your child to survive the illness.

In the case of a battle or fight or war at least one player has a choice about whether or not to pursue conflict. In the case of cancer, it is not like the cancer is making some sort of decision. And as the person it affects you are at the mercy of the disease in terms of the choices you have available.

Also, in the case of conflict I imagine there is an adrenaline rush, the sense that you are taking up some significant challenge or meeting a foe head on. I can tell you, I never felt like that. There was no rush. There was a sense of powerlessness. There were the tears on the days that I had to go to the hospital to be injected up with chemotherapeutics. I remember the nurses coming into my room in full isolation garb with the next bag of chemotherapy to be hooked up to the IV pump. Does that sound like a battle, or a fight, or a war, to anyone?

 © Cathie Coward

I think one of the major repercussions of the way we talk about cancer being a fight is that it implies that there are winners and losers. It suggests that on some level, if you die from cancer somehow the cancer has ‘won’ and you have ‘lost’ the battle. It ignores the fact that when you die the cancer also dies. It also implies that those who die of cancer do not fight as hard or as bravely or as fearlessly as those who survive.

If the experience of having cancer is to be viewed as a battle then the person with it is merely the landscape – that’s the best analogy that I have been able to come up with. On one side you’ve got the doctors, and their arsenal of drugs and treatments and symptom relievers and other modalities, while on the other side is the cancer. And the person with the disease is the landscape on which the battle goes down. The best you can hope for is that the landscape comes out the other side reasonably unscathed. And that after time to heal and rest it starts to look like what it used to. Regardless, the remnants of the battle remain and in many instances the repercussions of the fight that was waged become part of the landscape. And then there are the unfortunate instances where the landscape never recovers. But really the landscape has very little to say in the outcome and can only hope to see the other side of the fight.