Art informs medicine.

DOI: 10.1200/JCO.2009. 27.2708 There are no gallery hours because it is not a gallery. It is a medical oncology practice in a regional cancer center. The artist, whose paintings are now on display, has had her work previously exhibited at the Guggenheim, the Whitney, and the Brooklyn Museum of Art. “Her paintings,” a reviewer writes, “express some of what abstraction does best. The artist makes a conscious choice to explore the inner world of her experience. There are no given directions to this exploration. The artist creates new forms, shapes and nuances that focus on her own feelings in response to a landscape. ” Seated in one of the treatment chairs is a nurse who announces, “I am trying to make sense of what I see in this painting. ” A doctor standing within earshot appears ill at ease—shifting his weight back and forth. I look around. It is obvious that she has verbalized what others are feeling. The doctor asks, “What are we supposed to say to patients who tell us they don’t like the art? ” “Ask them what they don’t like about it,” I suggest. “What if a patient says they don’t understand what the artist is trying to say—then how do I respond? ” the nurse asks. “You can say it’s like being diagnosed with cancer—you don’t like it and you don’t understand it. ” “Are you implying that abstract art can be a way to open the conversation with patients about what it means to have cancer? ” the doctor asks. His facial expression suggests he has made an intuitive leap. The work of an artist is not unlike that of a patient. A patient, like an artist, has a choice of whether to explore the landscape of the lived world of illness. The artist, whose work is on exhibit, is here by appointment. She was diagnosed with ovarian cancer 2 years ago. Surgery and countless infusions of chemotherapy, with no sustained remissions, have not deterred her from continuing to work in her studio. Options for treatment are now limited as is her energy level. Her doctor has requested a medical humanist consult to assess this patient’s understanding of treatment options and prognosis. “I was not prepared,” she tells me, “to hear my doctor say ‘I hoped I would not have to have this conversation with you. ’” I know this conversation—it’s one that doctors don’t want to have and patients don’t want to hear. “And yet, I knew. ” she confesses. “What did you know? ” I ask. “Over time, the talk of cure became less and less until the word just faded from the conversation. ” “Did another word take its place? ” I ask. She pauses to think about my question before answering. “Treatable,” she says. “That’s the word which comes to mind. Up to now, if a treatment stopped working, there was always the next one. I had come to believe there always would be a next one. ” “What are your treatment options now? ” I ask. “I think my doctor said that there is a clinical trial I’d be eligible for but she didn’t sound hopeful. I now find myself confronted with the realization that my disease is incurable,” she tells me. Treatable. Incurable. I ask myself what do patients understand these words to mean? “I now realize any hope of prolonging my life is in my own hands,” she says. On her lap, in her hands, is a book—opened, the title is obscured. “What are you reading? ” I ask. “Are you familiar with the workings of a macrobiotic diet and its relationship to healing? ” she asks. I admit that I am not. “This is a book written by a woman who also has stage IV ovarian cancer,” she explains. “The reason she says she’s alive is because of a macrobiotic diet—not medicine. Did you know the earliest recorded use of the term macrobiotics could be found in the writings of Hippocrates? And, that the Greek translation for the word macro means great and bios signifies life? ” “No, I didn’t,” I answer. I ask myself what is a great life? Is hers? Is mine? Whose is? And who defines what is—what isn’t a great life? “The diet,” she says, “is based on a book written in the 18th century by a German physician and philosopher, entitled Macrobiotics: The Art of Prolonging Life. ” The words prolonging life elicit a lilt in her voice. And, I am reminded of what I have come to know throughout my years at the cancer center—for many patients alternative therapies can serve as a vehicle for hope. JOURNAL OF CLINICAL ONCOLOGY T H E A R T O F O N C O L O G Y VOLUME 28 NUMBER 12 APRIL 2