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Death Is Not an Alternate Universe, in Cancer or COVID-19

Jennifer L. Lycette, MD

Disclosures

August 31, 2022

Some time ago, a patient said something that stuck in my mind. This person had been living with stage IV cancer for years, and the disease had finally advanced. They had accepted the situation but were grieving something else — the inability of their friends and family to talk about it with them. Every time they tried to speak to their loved ones about planning for end of life, they were met with toxic positivity. Comments like, "Keep fighting," "Don't give up," and even, blatantly, "Don't talk about dying." My patient felt isolated and alone.

As an oncologist, I sometimes forget how unique it is in our current society to discuss death and dying on a near-daily basis. This point was driven home to me one day, years ago, when I was consulting on a patient in the hospital and delivering the news of a diagnosis of stage IV cancer. The disease was, unfortunately, very far advanced, and the prognosis poor. In the middle of the consultation, my cellphone rang. I rarely answer my phone when I'm with patients, but for some reason, I felt compelled to excuse myself to answer the call. It was a family member calling with the bad news of a sudden death in the family. I could tell they didn't know what to say and were afraid to speak the words. I told them it was okay, that they could tell me, and I almost added, I live in the world of death and dying. Nothing you can say will shock me. It's okay.

After they told me the news, I consoled them, assured them I was okay, and then calmly returned to my patient's room and finished the discussion of their cancer and prognosis, helping them make a plan for hospice and their end of life. I remember thinking, maybe this isn't normal, to live in the world of death and dying — and be comfortable with it. To accept that it exists.

For the past two and a half years, the COVID-19 pandemic has made me feel similarly. The ongoing toxic positivity, ableism, and outright denial of our country's daily deaths and disability often make me feel that I exist in an alternate universe. I think that it might be why some oncologists have emerged as leaders in communication with the media and social media, such as Tatiana Prowell, MD, and Shikha Jain, MD.

I've been thinking about whether oncologists are people already more comfortable in the world of death and dying, and that's why we're drawn to our specialty, or if we become so during our training. The reality is it's probably both.

I have written previously on the parallels between the public's attitude toward cancer and COVID-19 and how it harms patients.

I recognize most of our society wants to pretend the world of death and dying doesn't exist, but I think that is what is abnormal. I wonder how our pandemic response might change if we didn't fear talking about it. If, like my first patient's friends and family, the CDC didn't shrink from frank, honest discussions of the inevitable consequences of the disease, which — yes — include death, so that we don't have to continue to feel isolated and alone, each person for themselves, during this now third year of the COVID-19 pandemic.

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About Dr Jennifer Lycette
Jennifer L. Lycette, MD, is a rural community hematologist-oncologist, mom of three, and recovering perfectionist who's writing her way back from physician burnout, one word at a time. Her essays have been published in The New England Journal of Medicine, The Intima, JAMA, JAMA Oncology, Journal of Clinical Oncology, The ASCO Post, and more. Her debut novel, The Algorithm Will See You Now, a speculative medical thriller, will be published by Black Rose Writing on March 2, 2023. Connect with her on Twitter @JL_Lycette or her website.

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