Voices of the Healers

A chapter at the end of But Hope is Longer profiles the two oncologists, surgeon, life coach and naturopath who all contributed to my healing in various ways. During treatment, I developed a relationship with each of them. Afterward, I wanted to find out what it was like from their vantage point. Why do they do this work? How do they see breast cancer? What about their relationships with their patients? How do they cope with losing some of them and what keeps them going in the face of loss?

Once I started to write, I asked if they would meet with me. I was thrilled when each agreed to give me some of their precious time. Here is an abbreviated and updated version of the chapter.

Dr. Shailendra Verma, Medical Oncologist
I will always be grateful to Dr. Verma for putting me on the treatment path that was best for me. He was in charge of planning my chemotherapy, monitoring my progress, and co-ordinating my overall treatment. A brilliant doctor and compassionate human being, he continued to monitor me with regular follow-up appointments until 2015, six years after my diagnosis.  

Dr. Joanne Meng, Radiation Oncologist
Dr. Meng is the kind of doctor and person who is always looking for ideas and strategies, medical and otherwise, to support her patients as they go through treatment. At every appointment, she takes the time to ask me what else is going on in my life. I still see Dr. Meng once a year seven years after my diagnosis. I was thrilled when she invited to me to speak about my experience as a patient to University of Ottawa medical students during their oncology unit.

Dr. Angel Arnaout, Breast Cancer Surgeon
After Dr. Arnaout had examined me at our first appointment at the Women’s Breast Health Centre, my sister Karen and I sat around a table with her in an adjoining room. She offered me the option of a lumpectomy rather than a mastectomy as it would yield similar results. While she confirmed that my cancer was triple negative, a particularly aggressive type of breast cancer, she also assured me that I had good reason to be hopeful. After firing my first surgeon, I was grateful to have an angel looking out for me.

Joyce Hardman, Life Coach
I went back to see Joyce Hardman, life coach, in 2008. It had been seven years since I’d first worked with her and a year before I was diagnosed. I valued her role in my life as a wise guide, mentor and powerful coach. When I learned I had cancer, I knew Joyce would have a great deal to offer, especially since she had accompanied several other women through breast cancer.

Dr. Leesa Kirchner, Naturopathic Oncologist
From the time I met Dr. Kirchner, I knew I wanted to work with her. She said she was drawn to working with cancer patients because she believes naturopathic medicine has something important to offer in addition to conventional medicine. With years of training and experience despite being in her mid-thirties, she was one of only a handful of certified naturopathic oncologists in Canada. I believed that her skills and the therapies she was recommending would serve me well to both fight my cancer and diminish the side effects of treatment. I also believed it  would complement the medical care I’d get through the cancer center. Along with healthy food and exercise, I would be doing what I could to get well.

Dr. Shailendra Verma, Medical Oncologist

Dr. Shailendra Verma graduated from Queen's University medical school in 1979. In 1985, after post-graduate training in Internal Medicine, Hematology, and Oncology, he began to practice at the Ottawa Hospital Cancer Centre and became an associate professor at the Faculty of Medicine, University of Ottawa. Since then, Dr. Verma has held many regional, provincial, and national responsibilities and posts. A committed advocate on behalf of breast cancer patients in policy, research, and treatment, he values above all the delivery of timely, evidence-based, and compassionate care of his patients from whom he continues to gather inspiration and insight.

Dr. Verma: When I started in oncology almost thirty years ago, it was a new specialty. I was drawn to it because it was on the cusp of discovery. It also spoke to me of a certain tenderness. I never had children, so it gave me the maternal and paternal flavors that I enjoy in medicine. Everyone I worked with, whether as a medical student, intern, or resident, seemed to comment on the compassion I brought into medicine. So I always felt that this was the right place for me to be, a place where there was a need for discovery, a need for care.

In the beginning, I did everything: breast cancer, leukemia, lymphoma, melanoma, and sarcoma of young patients. Breast cancer, by virtue of its volume, became my bread and butter so to speak. I was particularly drawn to breast cancer. Before we recognized it as not one but many illnesses, I described how the face of breast cancer was different in every clinic I went to. I’d see a young woman, an older woman, a mother, a widow, a lesbian, a teenager: it drew me because it was already a different disease for each woman. It became a very intimate illness for me.

I’ve always advocated for any advance that might help in breast cancer. I played a role in every possible aspect of breast cancer: genetics, research, prevention, screening, pathology, markers, etc. I believe doctors have to be advocates for our patients, for everything from how money should be spent to how care should be delivered. If you’re passionate about it, you delve into every part of this disease so that the patient in 2020 gets even better care than in 2016.

Losing a patient is never easy. You grieve for them, you grieve with them, you love them. But you maintain the strength. You keep reiterating in your own mind “Could I have done something different? Was something overlooked?” But when nothing more can be done, what helps me the most is to witness myself not as hero, but as rock, the person that people can depend on. I don’t want to rush in there and save the life anymore, because I can’t.

There are times that you feel real pain. I don’t want my patients to develop metastatic disease. What helps me weather this is a sense of commiseration – bonding with them and reassuring them that I will do my best to come up with the next step in the plan or get the right person who can. I don’t think anyone can say, “I know everything about heart disease and I’ll stop you from having a heart attack.” It’s the same for an oncologist.

A lot of people express care for their caregivers. It’s a tender moment for me. I don’t walk into a room asking for a patient to be sad for me - that’s too much of a role reversal. On the other hand, it’s a remarkable progress of humankind that patient and physician can sit and talk to each other as two human beings, that there isn’t this separation of church and state so to speak. We need to respect the fact that many of our patients are sophisticated in their thinking, that they’re knowledgeable and have a mastery of so many things we don’t have as physicians.

I think we should be able to teach this, and I think it comes from recognizing two things. One: There’s no difference between the doctor and the patient. We are the same. There’s an artificial divide that’s been created, and people call that empathy, but it’s much more than that. Two: I, the physician, don’t know everything. If you enter the room with a bit of humility, there’s a huge calm that enters with you.

I had a high-school sports injury to my front tooth. When my dentist was finally taking out the tooth thirty-five years later, he said, “I don’t know how you do what you do as an oncologist. I said, “You’re pulling my tooth out, and you’re telling me you don’t know how I do it. Listen, there’s a lot of joy in my work, a huge amount of joy.”

Dr. Joanne Meng, Radiation Oncologist

Dr. Joanne Meng graduated from Memorial University medical school in 1988. She worked as a General Practitioner in Oncology for years before pursuing a residency in Radiation Oncology at the University of Ottawa. She became a member of the Ottawa Hospital Cancer Centre and an Assistant Professor at the University of Ottawa in 1999. She is very involved in resident training. Her main interest is to provide the best care she can to her patients.

Dr. Meng: I fell into oncology by accident. I’d worked as a family doctor and didn’t really like it. Then a job came up at the cancer clinic as a general practitioner in oncology (GPO). I enjoyed working with colleagues in radiation oncology, and thought, “I can do this, it’s interesting and I think I can help people.” I went into it that way, not because I ever set out to be an oncologist.

Cancer patients are complex. Whether they’re lung cancer or breast cancer patients, there is a complexity because they have cancer. However they respond to it, whether it’s, “I’m going to die from my lung cancer” or “I’m devastated because I have breast cancer,” my job is not a simple, “I’m taking your blood pressure because you have hypertension.” You can’t be just any kind of doctor to do oncology. When there is a diagnosis of cancer, it’s automatically perceived as life or death. So you enter into a relationship with the patient that’s completely different.

Breast cancer is more complex than other cancers. With other cancers, like lung cancer, the response from the patient is generally, “Yes, doctor, whatever you say.” But with breast cancer, it’s catastrophic to women’s lives. How does breast cancer impact a woman’s life? How does she reintegrate into her life afterward? Often during treatment, she’s in a fog, but afterward she’s frantic, which is why some oncologists want to stick to lung cancer. It’s so much harder when she feels her sexuality is on the line. She’s full of angst, she’s weeping, she’s put on 40 pounds, her husband is nowhere, her whole world has been turned upside down.

The thing that always strikes me about women with breast cancer is their desire to have the life they had before. They long for that. They want to know why they got sick, what they did to bring it on even though they took good care of themselves. There is a lot of self-blame. It’s not just patients with metastatic disease. Even women with a good chance of survival feel the rug was pulled out from under their feet. They long for what was, for their marriage and whatever it might have been. They talk a lot about that when you really ask them.

Metastatic breast cancer is grueling. You don’t look the same. You don’t feel the same. You’ve been at the doctor a hundred times. You’re on drugs all the time, brutal drugs, and you’re on chemo for life. Your husband’s worn out. Your family’s worn out. Mommy’s been sick for as long as your kids can remember.

I don’t always cope with the losses very well. But in oncology, you have to be prepared for failure and loss. We go into medicine expecting we’re never going to have failures. We’re the high achievers who’ve never failed. So when you do badly or when people die, you feel it keenly. It’s not necessarily that there’s something I could personally have done differently or that the system failed, but something failed.

Dr. Angel Arnaout, Breast Cancer Surgeon

Dr. Angel Arnaout is a Breast Surgical Oncologist at the Ottawa Hospital, Assistant Professor at the University of Ottawa and an Associate Scientist at the Ottawa Hospital Research Institute. She attended medical school at Dalhousie University and obtained her General Surgery training in Halifax. She went on to pursue an MSc in the Clinician Investigator/Surgeon Scientist Program at the University of Toronto with a Breast Surgical Oncology Fellowship at Sunnybrook Hospital and the Toronto Sunnybrook Regional Cancer Centre. Her clinical interests include improving the quality and access to care of breast cancer patients and oncoplastic breast surgical techniques.

Dr. Arnaout: I trained in general surgery. During my third year, I decided to do some research as part of my training. I wasn’t thinking about “breast.” The breast cancer research lab was the only lab still available so I went there for six months. Then six months turned into a year, a year turned into two and the next thing you knew it was what I was going to do for the rest of my life.

Ninety-nine percent of my work is in breast cancer surgery now. I do as much as I can in breast cancer work. My research is all on breast cancer. Breast cancer research is very exciting, one of the fastest growing research areas in medicine. The biology is exciting because it involves a lot of different angles and different types of molecular biology. It’s also exciting because of the advances in surgical techniques and the possibility of linking them to the outlook of the patient, to how she sees herself and her self-esteem. Ultimately, all the things that traditionally were never measured are now starting to be more important. We know that your cancer outcome improves if you feel better about yourself. The field of breast cancer is fascinating because you get the full spectrum of the basic science part, the hands-on surgical clinical part, and the psycho-social part. In the end, everything connects to improve the outcome for the patient.

We’ve moved past the old way of doing things when a patient would come in saying, “As long as you get rid of the cancer, I don’t care how I look or what consequences I have to suffer as long as I live longer.” We know this isn’t the whole truth, it’s only part of it. Ideally, the whole team is there at the outset, especially with patients whose cancers were locally advanced like yours. It’s important for the surgeon to see the patient before she starts treatment. This gives us a sense of the before and after, because what we do at the time of surgery will depend on the patient’s response to the chemo or hormonal therapy she has before surgery. Then we have the whole picture and we’re able to talk about the possible surgical options we can offer her.

In your case, I used a surgical technique during your lymph node dissection that, in addition to removing the remnants of cancer, preserved your arm-related lymph nodes. The hope with this technique was to help prevent lymphedema and salvage the range of motion in the affected arm. I believe it is important to take risks like that to take advantage of newer worldwide techniques, even though they may not be fully studied. But you have to be in a situation where you’re studying them yourself. You have to be on top of these things, doing your own clinical data and making sure you are strictly monitoring your patients.

I fully support complementary cancer care. None of us have all the answers. We certainly are not able to treat 100 percent of our patients effectively. You need something to top up what we do, which is where the naturopathic approach comes in.

In North America and Europe, we have mass screening programs. In many other countries this isn’t the case, so we are picking up more breast cancer here. That may be why the incidence of breast cancer is higher in Caucasian or white women compared to women from third world countries. The second thing is that non-white women don’t present to us as much because along with cultural taboos, denial, etc., they are less likely to be tapped into the medical system. So they often come to us presenting with a delayed advanced disease.

In my reading of international literature, there is a big push to increase awareness, to change the whole culture so this is not seen as something shameful. Because the breasts are a private part of a woman’s body, it is not something they want to share with others in many parts of the world. Often, the physicians are male, so not only does the patient feel shame at what is happening to her body, but she worries about having to go to a male physician. I think that is part of the reason why they are not presenting.

My main focus is to figure out ways to treat breast cancer. Not just to treat it from a medical point of view, but to treat it from a whole person perspective. That’s what keeps me going: the joy I get when a woman comes through my clinic, happy, cured, and looking better. I don’t think there’s any other disease where it is so intrinsically obvious that I will have such a big impact in patients’ lives.

Joyce Hardman, Life Coach

Joyce Hardman has been in full-time practice as a life coach since 1998. She has a MA in education and extensive training and certification in coaching. From her years as a workshop leader and holistic counselor, she brings wisdom and skills that include deep listening and the ability to understand and articulate the stages and challenges of human transformation.

Joyce: Coaching is about helping people discover their vision of happiness and supporting them to move in that direction. It’s about choosing one’s destiny more carefully and soulfully and moving toward it. It also has a spiritual component, because the most powerful way to move toward one’s destiny is to be in balance with the whole, to be in relationship with all of life.

In some situations, the route to happiness is at a basic level, and that will be the starting place of coaching. For example, someone wants to find a partner or a new job. They’re clarifying their dream, learning the skills of moving toward it. They’re finding out more about themselves as they notice what they might be doing that is getting in the way and learning how to deal with it. Slowly, they begin to get the spiritual part. But when they get a diagnosis of breast cancer, they are preoccupied with getting healthy and staying alive. They focus on what’s happening now rather than on some future scenario. The question isn’t “How do I get somewhere down the road in my life?”, but rather “What does it take to be whole?”

I remember telling you at the beginning that every woman I’ve seen go through this, even though she hated the cancer, has come away saying, “I’ve changed in a way I never would have changed before.” We put that on hold then because the first and necessary stage in this walk is to be angry and frustrated. What’s happening isn’t fair or just. There’s a sense that there is no caring underpinning to life. It’s a killer of faith, because of the certainties we take for granted. We make assumptions like, “I’m taking care of my body, so I won’t get sick.” Then we find out we have cancer, and what’s certain anymore? Our certainties crash. But the crashing is actually a gateway.

On the practical side, there’s the question of balance, of discovering what’s out of balance for us, what makes balance. In a way, people with cancer are separated from their regular lives. It’s a time when you want to create more balance so your healing will go well, so we look and ask, “where is the balance off here?” We each have different ways that our balance is off. Yours has always been around your need for spaciousness. For you, it’s the play between finding spaciousness and helping to change the world and connecting with people. You’ve been working with that tension all the way through and discovering lots of new territory.

The answer has a lot to do with self-love and self-care. It’s about moving away from living out of balance and diffusing our deep sense of guilt. As we move toward better balance and self-care, somehow everything seems to work better. We’re not fighting life so much.

Sometimes life brings us to a place where we decide to walk into something painful, like chemo. We have to leave an abusive husband or a toxic workplace to survive. And then that pain changes from the devil to an angel. It’s your angel because it is the absolute thing you must do. If chemo is the best treatment right now, it’s what you have to do to sustain your life. So it’s your angel because there is a bigger “yes, even though parts of you are screaming “no!”. The “yes” to the embrace of it, the trust that it is taking you where you need to go in your transformation, in your evolution, and even in your healing actually makes it so. Your body then goes “yes” as opposed to “no.”

There is such an allergy to rest for everyone, especially women. Women feel guilty about not going back to work, about not helping out more. It’s about how hard it is to rest, to pause, to stop. Once you rest, you discover how that very simple thing is so powerful. It’s not something to be afraid of, it’s not a waste of time. It’s like really good soil. 

Most women who get the diagnosis want to keep doing everything possible in the physical, emotional, and spiritual realms. They feel compelled to carry on because we’re the nurturers and caretakers. After chemo, they think they’re supposed to be washing the carpets because that’s what they do every May. But they forget how important it is to say, “I can only do what I can do. I also need to rest.” I’m there to remind them that this is a special year, as if you’re on a pilgrimage like the Camino. You don’t clean your carpets on the Camino.

My hope is that we will find ways that cease to punish cancer patients with poison chemicals and rays, which make them the sacrificial lambs for society's unconscious focus on consumption rather than on co-creating a good life. Attacking the cancer and the patient gives the illusion that we are doing something. Instead, the real solution lies in building societal and environmental health.

Life was so thunderous for you. It was amazing for me to walk next to you through your transformational pilgrimage. It was like the Camino, only harder because you didn’t know if you were going to make it at times. The honesty in which you walked it: you weren’t mad just once, you were going to be mad a lot and you had to keep on letting go. The realization that it wasn’t a permanent fix, that you just had to keep doing it and claim space and boundaries, again and again. You had to simplify, simplify, simplify, and it kept going and going. It was a pounding learning for you. I respected how you did it, how you were willing to keep going. Sometimes it was as minimal as “Well I guess I’m still alive, so I’ll keep on going today.”

You even prepared yourself to be able to write this book, to take time to do something so internal, to take the ego-burn of being edited with impossible deadlines. We were coaching about this stuff years ago, to create boundaries so you could do inner work. And now you’re doing it.

Dr. Leesa Kirchner, Naturopathic Oncologist

Dr. Leesa Kirchner graduated as a naturopathic doctor in 2003 from the Canadian College of Naturopathic Medicine in Toronto and is a Fellow of the American Board of Naturopathic Oncology (FABNO). Leesa ran a successful general family practice before choosing to work on naturopathic oncology in 2006. As of 2015, she is no longer seeing patients but rather is focussing on training both Naturopathic and Medical doctors on the use of integrative medicine in cancer care.

Leesa: In my general practice, I had a thirty-year-old patient with Stage IV malignant melanoma who was told there was nothing more they could do. By then, I knew about the benefits of intravenous Vitamin C. As we were doing the drips, we had really in-depth discussions. He became a friend. He went back to work and his wife got pregnant. He had some good years after cancer, but he ended up with brain metastasis a few years later and died.  

During that time, I realized that as much as working with cancer was difficult, I had a hard time sympathizing with people who came in with minor problems. If they said, “I have to lose ten pounds,” I’d want to say, “Well, go run or something.” I found myself thinking, “You’re not dying, so get over it.” The connections I had with cancer patients were different, more powerful. I decided to work exclusively with cancer patients even though every part of my brain was saying, “Why are you picking the hardest thing on earth?” But I didn’t pick it, it picked me.

It’s tough when my patients want integrative treatment and their oncologists are negative about it. It scares them when they don’t have the approval of their oncologist, so they end up in an internal battle. Some raise the possibility of complementary care with their doctors, get shot down and say, “Forget it, I’m not telling you anything anymore.” Others say “I’m not doing anything unless I have 100 percent approval from my oncologist.” So it’s where people fit on the continuum and how they deal with it.

Since I’ve been focusing on oncology, I’ve seen a huge shift. Not only in oncologists’ attitudes, but also in patient education. Patients know naturopathic support is available, that it will help them, and they’re determined to get it. Oncologists know it’s happening. The bottom line is that people are doing it.

A patient told me her doctor had never seen anyone tolerate as many rounds of chemo as she had in her situation. It was beyond anything she should have been able to do, but it was because she was using so many complementary strategies. Another patient was working with me prior to having a bone marrow transplant. Her oncologist had said, “You should see a naturopath to work on your immune system, and I don’t know how.” When they started neuro-harvesting her cells, she had three times more cells than they had ever retrieved from anyone before. She was supposed to be in the hospital for two weeks. When she came out in two days, they said, “This is nine days quicker than our record.”

 A lot of the shift comes from stories like these. People are using complementary care, then they go to see their oncologists. The oncologists are seeing the difference for themselves.

I hope that in the future, our focus will shift from not only killing cancer cells, but also to supporting the body more completely throughout the treatment process. It will be about managing side effects, teaching the importance of exercise and diet, and keeping patients healthy both physically and emotionally. And hopefully, it will empower patients so that when treatment is over they are not simply waiting for the next CT scan to tell them if the cancer is back. It will give them tools to lower the risk of recurrence so they can move on with their lives proactively. My hope is that this becomes the norm in cancer care. I would like these basic things to be available to all patients, not just those who seek it out.