Medicine and books: Before I Say Goodbye
Authors: Paul Keeley
Journal: BMJ (1998)

Ruth Picardie

Penguin, £5.99, pp 116

ISBN 0 140 27630 0

C. Because Cowards Get Cancer Too

John Diamond

Vermillion, £9.99, pp 240

ISBN 0 09 181664 5

The door into the private world of those with cancer has opened in recent years with the development of a confessional form of writing, often born of journalism, in which the subject’s experience of disease, especially life threatening disease, is the central narrative. This form represents a very public breaking of the taboos surrounding cancer and death.

In the Middle Ages, those who were terminally ill had the primers describing the Ars Moriendi—the art of dying well—to guide them through their last hours and the universal struggle with extinction. The modern patient with cancer has little but the warped images of the visual media, which can only work by showing illness as a soap opera battle bravely fought and have not the language to deal with fear and pain.

Ruth Picardie and John Diamond represent the most recent examples of the genre. Oscar Moore’s PWA related his experience of HIV and AIDS in the form of a collection of his pieces from the Observer, the journalist Jill Tweedie published her account of motor neurone disease before her death a few years ago, and Ben Watt produced a harrowing account of the development of a life threatening form of Churg-Strauss syndrome last year in the book Patient.

Picardie and Diamond’s books have some remarkable similarities. Both authors are young in terms of cancer (Picardie in her early 30s, Diamond in his early 40s), both are successful journalists on broadsheet newspapers, both married successful journalists with two young children, and both of them are by turns witty, acerbic, sceptical, and scared. The main difference lies in the outcome—Diamond has so far survived both his illness and its treatment, whereas Picardie’s death and its aftermath are described in the most moving detail by her sister, Justine, and her husband, Matt Seaton.

Picardie’s book takes the form of articles that were originally published in the Observer along with letters to and from friends and readers (including myself) moved by her experience. It concludes with a postscript by her sister and the thoughts and impressions of her husband. As a result, the writing is more fragmented but gives a wider view of her illness. She does not die alone; her illness and its end bring out the role of loved ones and friends and places her in the context of a loving family and close friends coming to terms with a tragic illness and death.

Diamond’s book is more of a piece, which is a reflection of his still being alive and able to order his account of his own illness. He is funny, self deprecating, and brutally honest about his experience of cancer and its treatment. As a good journalist, he is almost obsessive in recording the detail of his symptoms and treatment; as a man, he is not afraid to admit that he can be hopeful, fearful, bored, elated, and uncertain. He even refers to Picardie’s writing with disarming honesty in the light of his own experience.

These books make harrowing reading; both writers can be scathing about how patients are treated by the medical machinery and at the same time humblingly grateful for the NHS, and they make us face our own mortality as human beings. However, if we, as doctors, are to have caring, compassion, and advocacy as the core values of our practice of medicine we must listen to the voices of our patients’ experiences of serious illness. What they tell us about their illness and our practice may not be easy reading, but if it results in better practice then what they and their families have gone through is not lost or wasted.