“In the future days which we seek to make secure, we look forward to a world founded upon four essential human
The first is freedom of speech and expression –everywhere in the world.
The second is freedom of every person to worship God in his own way– everywhere in the world.
The third is freedom from want, which, translated into world terms, means economic understandings which will secure to every nation a healthy peacetime life for its inhabitants –everywhere in the world.
The fourth is freedom from fear, which, translated into world terms, means a world-wide reduction of armaments to
such a point and in such a thorough fashion that no nation will be in a position to commit an act of physical aggression against any neighbor –anywhere in the world.”
This excerpt from President Roosevelt’s famous State of the Union Address is commonly thought to represent the essential freedoms that all citizens of the world have the right to enjoy. A recent conversation with one of my patients inspired me to write down what I consider to be the four essential freedoms of cancer patients, and with the reader’s kind permission I would like to share them now.
As a medical oncologist I spend much of my time attempting to calm the worries of patients who are often subjected to gratuitous observations on the state of their union by health care workers (doctors especially). I have commented on this before but I’ll state it again – some people in the healing arts profession interact with cancer patients like a motorist driving by a horrific accident – any feelings of empathy are swept away by the giddiness of schaudenfreude, or in the case of reckless driving, by righteous anger. Thus it is for people living with cancer, who often feel as if they are lying by the side of the road, waiting for some kind soul to notice them, to take the time to repsond to their cries, to help them stand up again, to point them in the right direction and stay with them in case they falter.
By my career choice and by my convictions, I am an advocate for cancer patients. Therefore I believe that I am qualified to state that (with apologies to F.D.R.) all persons living with cancer are entitled to four essential freedoms.
The first is freedom from prejudice. If you think most cancers aren’t worth the money and effort it takes to treat them, or if you think that treatment should not be given to the elderly, or to the poor, or to minorities, or to those whose cancer has relapsed – you are a figlio di puttana in my book. Stay away from my patients.
The second is freedom from ignorance. Don’t tell me you don’t know what to do with this patient, or that you’re just a “cutter” or a “country doctor.” That’s like telling a police officer “I never learned what that red light means, so can I be excused?” Physicians have an obligation to know how to diagnose illnesses and their complications, and if they’re not omniscient (like your narrator) then they need to go look up the answer – now, not later. You can always record that vitally important program you’re missing.
The third is freedom from insensitivity. Woe to those of us who just can’t seem to put ourselves in the shoes of our patients, for unless we have some understanding of the suffering that cancer brings on we are at risk for making idiotic or callous remarks, or for becoming stingy when prescribing pain medicines (yes, I know they are addicting, but not when used to treat cancer-related pain), or for conducting counselling sessions as if we’re late for a flight to meet the president. You get the idea. Remember: the patient is the one with the disease.
The fourth is freedom from abandoment. Good doctors stay with their patients until the end, whether the outcome is remission or death. When a tumor can no longer be contolled is often when patients need their doctors the most. Returning phone calls, answering questions, arranging for hospice care if indicated, mainly just being available in case of a problem is how we oncologists fulfill our obligation to the dying patient. We earn our reputation by standing in the front lines of patient care, not by twiddling our thumbs over a metal desk like some REMF.
The war against cancer has its victories and its defeats, but until the last of this vile disease is, in the words of George C. Scott as General Patton, “welcomed to the infernal region,” the least we can do as caregivers is to uphold these four freedoms faithfully. President Roosevelt ended his speech with these words, which will serve to close our monologue for today:
“Freedom means the supremacy of human rights everywhere. Our support goes to those who struggle to gain those rights and keep them. Our strength is our unity of purpose.
To that high concept there can be no end save victory”.