"Courageous" is the epitaph of many who succumb to cancer.
There is no better word. Cancer, referred to by some as the emperor of all maladies, commands an army of fear and a navy of pain. Courage is the defense against the dread of the diagnosis, buffers the ravages of the invader and mitigates the assaults of the brigade of surgery, radiation or powerful medicines.
For children with cancer and their parents, it is an especially frightful time. Death may not be a concept of the child, but it is to the parents. Substituted for the kids is the fear of needles, the painful pokes and jabs, missing friends or the horde of countless, unfamiliar grown-ups staring at them.
The phrase “courageous battle with cancer” is expressed frequently enough to be one word. With its common use, there is a risk people might feel it is trite.
But there is nothing trite about cancer.
Courage does not mean victory. The obituary is evidence of that. Therefore, what is a courageous battle? Is it a quiet persistence in the face of failure, or is it a boisterous, animated struggle of anger?
Courage is a relative term. It cannot be parceled out with a specific diagnosis. A person with pancreatic cancer can be as courageous or more courageous than someone with a bone tumor. It is also not an automatic label of someone who insists on the most radical forms of surgery or the most toxic drugs. Perhaps the most courageous are those who want no heroic measures at all.
In the fight against a fearful diagnosis, courage can be a trait of the foot soldiers and not just the patient. Parents at the bedside or huddled with their child in bed have to be stoic for two. Family and friends also display the attributes of perseverance, faith and joyful hearts when giving up, doubting and sorrow would be understandable.
Clinicians who watch over these patients demonstrate great patience, fortitude and compassion in an otherwise frightful world. Moving away from the oncology ward, I don’t know how caretakers and staff in burn units can get up and go to work every day knowing what they have to face. That is courage. It is an essential ingredient to healing.
Without taking an ounce of respect from those with cancer, one wonders about the other people and conditions that could quality for the title "courageous." Is there another word for those in renal failure or failure of the heart? Even if the condition is not fatal do we see the courage just in their struggles? What if the disease is not cancer, but of the mind? How do people with addictions or mood disorders manifest courage?
Can we use the word for those who just keep trying? Folks with weight concerns often may fail in their efforts to optimize their health. Since we have said that courage is not a medal only for the victors, what about their ongoing attempts? It is the 31st diet. It is the 12th time that an alcoholic has sworn off his booze. It is the promised last cigarette over and over again. It is a depressed person who, when tired and stressed, blows up after saying it would never happen again.
Confronting mental illness requires courage. It is not easy for a spouse to stick with a sick relationship when emotional loneliness is the consequence. Brave are those who confront the depression and emotional failures knowing that it is not only the biochemistry they must fight but also people’s conceptions and prejudices.
The courageous battle with cancer is a model for the rest of us free of malignancies. Others who are sick and wounded may also be worthy of the inscription.
A hymn sings, “We are all enlisted til the conflict is o’er; happy are we.” I would add "courageous are we" in the conflict of our own diseases, demons and disorders.
Joseph Cramer, M.D, is a board-certified pediatrician, fellow of the American Academy of Pediatrics, practicing physician for 30 years, a hospitalist at Primary Children Hospital and the University of Utah. He can be reached at email@example.com.