I have often bemoaned the frequency with which relatives tell me that their loved one is 'a fighter'. They have become for me empty, overused and hollow words.
Sometimes I hear 'they're a fighter' and honestly, I may as well be hearing something as benign as 'they love to read'.
Actually, I'd really prefer to hear the latter; that they love to read or sing or have a favourite bench in the park where they like to sit.
That is at least the sort of information I can feed constructively into a narrative and as cynical as I may have seemed in those lines above, I am a strong advocate of caring about a patient's narrative.
I do understand that when relatives use the 'fighter' phrase in my presence, they're generally trying to find hope in their situation; trying to convince me that their loved one can survive, trying to convince themselves, trying to get by.
Whatever the intention those words hold no meaning for me.
I thought that those words held no meaning for me.
I am standing outside a bedroom, with three consultants and a patient’s friend. The patient is young, in her thirties, only partially conscious and propped up on a pillow.
She has gaunt, hollow cheeks and I think if I asked her to hold her own head up unsupported, her neck would snap under that weight and her head would tumble away on to the floor. Her hair is thin and her elbows look far too large to be part of her frame.
There is a chance, and it is a small chance, that we could help her get better, but the burden of treatment is huge and we might just be sentencing her to death plugged in to our machines.
The consultants have talked back and forth for most of the morning; what is the right thing, the best thing, the kindest thing? What is the thing that she would want?
We don't know.
There aren't any family members to speak to and so I am in the corridor and this friend now stands with us and we update them. I watch the patient's wispy frame in the distance behind the friend who tells us that they understand, adding 'look, this isn't a surprise; she isn't really a fighter'.
She isn't a fighter.
'She just hasn't got that in her'.
And I am speechless in the wake of these words, uncomfortable, and I think that I wish they had said she was a fighter, or said nothing. I realise that there is something worse than hearing that vapid, hollow phrase that I have come to dislike so much, and it is hearing the opposite.
And inside boils a defensive retaliation; don’t say she’s not a fighter. And I know it doesn't matter at all either way. So actually, I say nothing at all.
And we take her to intensive care and I don't know the ending, yet.
By the Secret Doctor
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As someone who's had breast cancer - I hate the term fighter and you're so brave
I always felt punched by the word "fighting" as it implies that all those who were not capable of fighting their illness, somehow did not deserve to get better.
I find the word uncaring , somehow another symptom of a managerial/political style which belittles a show of weakness ...
I feel the same way about many of the "patient is responsible" narratives like the berating of exhausted patients on chemo or with depression that if they exercised, stopped eating cream cakes they would get better ....
However ...paradoxically, as I was reading through this,...I felt my shackles rise stubbornly as I read the relative's "she isn't really a fighter"
Why would I feel that?
Would we the doctors prefer to be the exclusive guardians of an illusive prognosis?
Would we feel any different if the patient herself shook her head and said " I don't have any fight" ? I think we would ...
Brilliantly observed and thought provoking as ever Secret Doctor.
Best term for all of this is about being positive. Fighting or otherwise or expressive in other ways..
Well as a grieving relative I would like to ask you this Have you ever watched a loved one in this situation? I'm not sure reading your obs.
My loved one was written off catastrophic brain injury after CPR no hope ageist assumptions so she was disconnected and abandoned for NHS ridiculous term comfort care (abandonment) well she fought the midaz the morphine she came around drugged of course and managed to shout she wanted to go home consultant came while she was crying and informed me she was dead already because she had suffered a cardiac arrest earlier and then ran out with a JD in tow. She died horribly an hour later because( comfort care) dispatch and no treatment would not help her. EOL pathway is certain road to death regardless of any improvement. What do you think? I think she had that 'small' chance, agree she was very poorly she had ROSC but she wasn't given 'that chance' Similar to Charlie Guard case (grey area) surely medics should lean towards chance, I tried I offered to pay, I begged. I was denied. Because the NHS is too powerful. Broken
Please don't think I'm belittling anyone's cancer "journey" but so may terms used refer to the struggle/ battle/ fight.
The BBC presenter Danny Baker subverted this by using a phrase like how he saw "my body is the battlefield where the quacks are fighting the cancer" (the term "quacks" was used affectionately) when dealing with his bowel cancer.
Patients need not be disinterested, passive victims and I believe there is evidence that positive mindset helps but this is NOT the same as being or not being a fighter.
Thanks for writing about this interesting word. I see it more as an expression of a patient's personality/characteristic or how they seem from another. Her friend sounded like she was reflecting on what she knew of the patient. She knew the patient pre-morbidly cf to yourself. You ask for her pre-morbid personality after all... My pet hates are "poor historian" and "acopia". These states can be changed with a more inquisitive doctor
Have been in similar situation with brother-in-law, who was exhausted with "fighting", but felt he had to 'for the sake of the family'. Ultimately, all suffered for longer.
I have an elderly relative who in the last 10 years has had 6 near death illnesses in hospital. He's been in icu 4 times. Intubated 3 times. Collapsed lung 3 times. Periods of prolonged delirium. Infections that cannot be identified. One cardiac arrest. Odontoid peg fracture. Head injuries. Hospital acquired pneumonias. Months and months of hospitalization. So when I was told he had pneumonia and septicaemia I knew he would be considered unlikely to recover by the local A&E staff. But our family know different. He remembers nothing about these admissions. It's his body that fights not his mind. I know him better than the hospital doctor. And yes i know he is a fighter.
Strong is another one that gets me - she's so strong. I have osteogenesis imperfecta. I'm not strong. The clue is in the name - Brittle Bones. Why do I have to pretend to be strong? And I am not brave or a fighter I just don't have any choice other than deal with the day to day risk. These words are so insidious that they consumed me and played a huge part in my developing a severe eating disorder. I was hospitalised for 3 years. I have come to realise that I had to make it obvious to everyone just how fragile, just how not-strong, I was. That was the function of the dysfunction Anorexia. It made me look fragile. Of course, people still told me I was strong...
I have to confess that the frequently used phrase "(s)he has lost her/his battle with cancer" irritates me intensely. Men and women die all the time of cancer as it remains one of the leading causes of death. The chemo and radiotherapy we use is brutal and nearly kills people as well. It is probably true that we medics "fight" cancer, although I think treat cancer is a better verb here, and are sometimes successful, but patients mental attitude makes no difference (I recall a BMJ paper from years ago looking at this very aspect in cancer patients, and a positive mind-frame made no difference to survival). People do not fight cardiovascular disease, they die of it. People die of dementia. Why is another of the degenerative diseases that kills us "fought" rather than accepted and treated in the way every other illness is?
My second son was a fighter.7/52 premature,in the incubator he was punching & kicking so that the perspex box to retain O2 would not stay in place. I was acutely aware during those 3 days that the resources involved would have saved many African children. Tom is now a philosophy graduate, an organic gardener,and a father himself.I think the fight was worth it. CEG Manwell
With the thanks of GOD who blessed us with this beautiful charming life and now about the topic is patient having the encouragement of the family to survive the life. If the patient has authority to read about <a href="www.essayhell.org/.../">superior papers</a> then the survival will be more easy and comfortable.