RFS news highlights resources, issues, and news relevant to in-training members of the ACR. If you have a topic idea or would like to contribute to the blog, please email RFS Secretary Patricia Balthazar, MD.
Radiation Oncology Corner: The Healing Arts of Cancer Medicine
I recently spoke with Patrick W. McLaughlin, professor of radiation oncology and medical director for the University of Michigan’s community practices at Providence Hospital in Southfield and the Assarian Cancer Center in Novi, Mich. While McLaughlin’s primary focus is treating prostate cancer, and while he has achieved much acclaim for pioneering MRI-guided, vessel-sparing prostate brachytherapy, he has another passion that is outside the box of classic physician scientist and instead coincides with the healing arts of medicine.
McLaughlin first had the idea of “right brain, left brain, soul brain” nearly 20 years ago and has built a cancer center around this idea of treating patients with the art of science and of healing. When he first had this idea, he had to sell the concept to the medical community that one could provide an atmosphere of healing hearts without taking off scientific hats. As medicine got more scientific, we as physicians have lost the “heart” of medicine. McLaughlin and his colleagues have created a center that that can double as a sanctuary. The center provides engaging activities such as ceramics and art, yoga and meditation, and ultimately creates a healing environment that helps with stress. McLaughlin notes, “It’s an awakening being treated for cancer, even if you are cured. Nearly every patient says they don’t see life the same after this ordeal.”
How did the Assarian model come to fruition?
When I started in oncology there was a keen sense that something was missing. The donor for the Assarian Cancer Center was a family whose father had died of cancer. They knew they had received the best treatment available through the two major universities, but when it came time to donate to a cancer center they were vehement they wanted to change the experience for those who came after. The missing element was somewhat easy to define. We would care for patients for months or years, they would succumb and go through hospice, and at death the families would ask for all donation to go to hospice. Hospice met the glaring emotional needs that a system of excellent, evidence-based treatment had not. The Assarian model extends that kind of care back into the realm of curable, incurable, and transitional cancer.
To understand this missing element, The Death of Ivan Illich by Tolstoy should be mandatory reading for all oncology residents. One “specialist” after another comes to him without addressing the fact of his impending death, and all the questions that situation raises. A servant boy provides him solace.
I had spent my career logging stories of patients and families facing the challenge of each prognostic stage, so I had a clear sense of the shifting emotional, psychological, and spiritual challenges as lives are suddenly interrupted, disrupted, or even ended by a diagnosis of cancer. I have said many times that everything important I have learned about life has come from my patients. I advise every resident to keep a journal of stories of patients.
At the heart of the Assarian model is a recognition that each person needs a different thing to come to peace. Caretakers often provide the solace they would find helpful, but it may not reach the patient. This is yet another form of the challenge n=1.
The right brain, left brain, soul brain model came from the very personal journey to reconcile the healing tradition with modern science. So many fascinating discoveries from neuroscience provided a scientific coat rack we could hang many healing traditions on. The key to the sale to hard-nosed science was the fact that something may work, but we don’t understand how, and we make up theories. Some of the theories tied to yoga and Chinese traditional medicine are not compatible with western science. I always emphasized that we know that radiation works, but in the deepest sense we still don’t know how. Is it cell by cell kill or infrastructure disruption? Acupuncture works in rigorous scientific testing, but how is a mystery.
What inspired you to create this space of healing, combining science and the soul?
The greatest debate was whether to use the word healing at all, because of the connotation of miraculous, faith-based healing. It took work to distinguish what we mean by this word. Healing is maintaining a sense of wholeness in the face of a disrupting diagnosis. It is going ahead with life in spite of the diagnosis. It is realizing in the deepest center of being that you have freedom to go crazy, go hopeless, or to defiantly ignore as much as possible and go on with life. Two patients may have the same scan, the same prognostic situation, but one may be completely happy in spite of the situation, while another is mired down and overcome. Yet, the one who is mired down and overcome today may come waltzing in a few days later. This is all the healing miracle I need, and they need. The same holds true for the word soul. We may not define it as faith traditions do, but it is a term in use for centuries and remains very useful and powerful.
I find the window to humanity provided by a career in oncology more fascinating than the science and technology. That is saying a great deal, because the technology in our field is staggering, and the progress has sustained my fascination. I love radiation oncology and have pushed hard to improve technical performance in one domain (prostate cancer). The Assarian project is an all-out effort to address the other demand. I still find the notion that we have built a cancer center that not only treats the cancer but also treats the person as progress to a better, more holistic medicine.
In part 2 of this blog post, McLaughlin will discuss what sparked his interest in radiation oncology and share how he’s changed his practice to incorporate science and soul.
Chelsea Miller, MD, is a radiation oncology resident at Loyola University of Chicago.