Tuesday, January 6, 2015

Stuart Scott and fighting metaphors in medicine

ESPN sportscaster Stuart Scott's recent death has given the American public a chance to reflect on what it means to live with a cancer diagnosis. His speech at the ESPY awards in the summer of 2014 was widely hailed as an inspiration to people with cancer. Obviously, the Jimmy Valvano Award for Perseverance with the ties to cancer research (Jimmy V Foundation) and Scott's own public image as someone being treated for cancer made it a very poignant moment.



I encourage you to watch the whole video to best understand the context and tone of his delivery; a great speech by any measure (transcript here). What intrigues me is his mixture of language focused both on fighting cancer and maintaining quality of life. This speech has more layers than at first glance. It starts out with the very common fighting metaphors.

"But I listened to what Jim Valvano said 21 years ago. The most poignant seven words ever uttered in any speech anywhere. “Don’t give up, don’t ever give up”. Those great people didn’t. Coach Valvano didn’t. So, to be honored with this, I now have a responsibility to also not ever give up.
Coach Valvano’s words 21 years ago helping me and thousands of people like me, right now, direct benefits, that’s why all of this, why we’re here tonight, that’s why it’s so important."
A familiar refrain; in the ICU, in the rehab facility, in the ER, in the OR waiting room, in a home. Honestly, I hear this more from families and friends than I do from patients, which may have something to do with the reality the patient feels versus the ideal outcome the families wish for. Another reason could be because most people who are critically ill are not able to speak for themselves. (Pick a proxy!)

Scott uses this 'don't give up' attitude to emphasize supporting cancer research.  He does tie it to his own battle, but really the call to action is for people to recognize the importance of research. And after that connection, he transitions to a stronger focus on himself and quality of life, but still mixed in with a fighting metaphor.
"I also realized something else recently. You heard me kind of allude to it in the piece. I said “I’m not losing. I’m still here, I’m fighting. I’m not losing.” But I’ve gotta amend that. When you die, that does not mean that you lose to cancer. You beat cancer by how you live, why you live and in the manner in which you live.”
I honestly don't think we would have heard this approach 5 or 10 years ago. It would have just been left with the fighting words. "Fight, fight, fight. I'm making a comeback." When most people hear that, there is a sense of relief, 'Phew! I don't have to worry about him or her dying because they are fighting and maybe they'll be one of the lucky ones!" But Scott amended that fighting trope and much like he did in his job as a sportscaster he created something new for the public's ears, something special, something palliative. BOO-YA!

The most shared quote in news items about Scott is "When you die, that does not mean that you lose to cancer. You beat cancer by how you live, why you live and in the manner in which you live."
Fighting language. Fighting language! I'll admit I used to cringe at fighting language when used to describe someone's approach to disease.  I've published, tweeted, and shared articles which bemoan the overuse of fighting language in medicine. And I still have problems with it, but reflecting on Scott's speech in light of his death, and some of my own recent clinical experiences, I'm realizing we can use fighting metaphors instead of railing against them. Let's use them to fight for quality of life like Scott did.

The core of his speech focuses on his support from friends and family, a palliative notion if ever there was one.
"So, live. Live. Fight like hell. And when you get too tired to fight then lay down and rest and let somebody else fight for you. That’s also very, very important. I can’t do this “don’t give up” thing all by myself.
What you didn’t see in the piece is what’s gone on probably the last ten days. I just got out of the hospital this past Friday. Seven day stay. Man, I crashed. I had liver complications. I had kidney failure. I had four surgeries in a span of seven days. I had tubes and wires running in and out of every part of my body. And guys, when I say every part of my body: every part of my body. As of Sunday, I didn’t even know if I’d make it here. I couldn’t fight. But doctors and nurses could. The people that I love and my friends and family, they could fight. My girlfriend, who slept on a very uncomfortable hospital cot by my side every night, she could fight. The people that I love did last week what they always do. They visited, they talked to me, they listened to me, they sat silent sometimes, they loved me. And that’s another one of the components of the V Foundation. This whole fight, this journey thing, is not a solo venture. This is something that requires support."
Lots of fightin' words but the actions taken are all about caring for someone. Yes this last section starts out with tubes, wires and surgeries but that is about establishing the context, not the focus of the actions. The things that mattered to him was the visiting, talking, and listening.

And lastly, he let's people know that he is vulnerable, even though he is appears strong on stage, giving a speech few could give. This vulnerability is really a defining moment of the speech, and interestingly not one many of the articles choose to focus on.
"I called my big sister Susan a few days ago. Why? I needed to cry. It was that simple. And I know that I can call her, I can call my other sister Synthia, my brother Stephen, my mom and dad, and I can just cry. And those things are very important. I have one more necessity. Eh, it’s really two. Two very vibrant, intelligent, beautiful young ladies. The best thing I have ever done, the best thing I will ever do, is be a dad to Taelor and Sydni. (Yeah) [applause] It’s true. I can’t ever give up because I can’t leave my daughters.  My littlest angel is here. My fourteen-year-old. Sydni, come up here and give dad a hug, because I need one."
I think we could all fight a little harder for some hugs.

Photo credit: ESPN

Pallimed | Blogger Template adapted from Mash2 by Bloggermint