I am not spiritual, or religious. Living in an atheist country that suddenly takes a turn towards militant Christian fundamentalism does that to you. I don’t believe in woo. I do believe that American doctors are overtreating their patients’ pain, and that American patients are too sensitized to it. Yes, the understaffed orthopedic VA surgery wards where post-op patients were screaming for their morphine may have led to the Kabuki of a nurse coming in every couple of hours to ask you about where your pain is, and what is the QUALITY of the pain, and howbadisitfromonetoten? But a cancer center is no VA. The ritual only reminds those with chronic cancer pain that yes, it is still there, and yes, it hurts more than it did 3 hours ago, and now they can’t finish reading their book because there is a twinge every couple of minutes while they are thinking about it.

Which is all a longwinded way of saying that I should not have enjoyed the pain and pallitavie rotation that much. There is spirituality, there is woo, there is a lot of pain. And yet I did.

These people know what they are doing. They have plenty of resources available to do it. And yes, they may “do Reiki”—nothing more than elaborate Kabuki for patients with advanced diseases—but there are times when that is exactly what the patients need. When 4am vital signs and checking for hepatomegaly every day just aren’t enough.

Some useful questions to ask your patients with any serious chronic disease, if and when you have some extra time in clinic:

  • Are you the same person now as you were before the diagnosis? How did you change?
  • What do you fear the most?
  • What do you hope for?
  • Who(m) do you rely on for support?1

The patients’ answers may surprise you.


  1. Whom” is gramaticaly correct, but interrpreted as pretentious by most patients. Use it judiciously. Yes, I realize that what I have written here is just as bad.