The Journey Through Cancer: Healing and Transforming the Whole Person
Three Rivers Press: 2006
Early in my senior year of medical school, my father was diagnosed with stomach cancer. It was a cool, fall evening—September 18, 1985—and I had just arrived home after a tiring day. Flopping down in a big chair to relax, I casually pressed the play button on my answering machine and was surprised to hear my father’s voice. He rarely called.
“Oh, Jeremy,” he said with some hesitation, “I think I’ve got a little problem. I had an endoscopy today and the doctor said I have a tumor in my stomach. Unfortunately, it’s malignant. Maybe you could give me a call.”
With my heart pounding I picked up the telephone and dialed his number. I knew this was not going to be a little problem. Not at all.
My father’s illness occurred at a time when—after many years of distance and great difficulty in our relationship—he and I were falling in love with each other. I was twenty-nine, and like so many men of my generation I had missed a close relationship with my father. He was a tough, distant, romantic dreamer who during my childhood years was so deeply involved in his own struggles that he was unable to function as a parent in any conventional sense. When I was twelve he left our family to pursue his own life and dreams. He eventually built a career in New York City as the owner of two respected repertory cinema theaters and married a French woman who was a film director. They lived a remarkably bohemian life and were well known in the film circles of New York and Europe.
Although I now understand so much more of what occurred during those years, his departure was extremely painful. Still, after many years of challenge and conflict, we had recently, magically, discovered a love for each other that felt as exciting as any love I had ever known. At last, after all these years, I was finally finding my father. And in the process, a deep, old, and hurtful wound was starting to heal.
As it turned out, his newly discovered cancer was an aggressive one. When his stomach was removed the next week we learned that the tumor had already spread into his liver and lymph nodes. “I’m sorry,” the surgeon said after the operation, “the tumor was very extensive, and I couldn’t get it all. I took out as much as I could. There was nothing more I could do.”
Thus from the beginning the situation looked quite bleak. Our entire family felt stunned and completely disoriented, as if we had all been suddenly thrown into a bad dream. I could hardly believe this was happening. And there was a knot in the pit of my stomach that would not go away.
As the gravity of the situation began to sink in, my father’s agony and the pain in my own heart and soul penetrated in a way I can hardly describe. After all these years we had finally found each other, and now he was dying. It was too much to accept.
From that time until just before his death three and a half months later, we were partners in trying to find ways to help him fight and live. There was no small irony in the fact that early on in medical school I had decided that I would become an oncologist and dedicate myself to helping individuals and families who were dealing with cancer. Now suddenly, and in a very personal way, I was about to learn more about oncology than I had ever imagined, and much more about the extraordinary journey taken by people with cancer.
As a senior at New York University School of Medicine I had access to the best hospitals and cancer specialists. My father also could afford the best medical care available. As we made the rounds of New York’s top cancer centers and oncologists, I became progressively more discouraged by what he was experiencing. He was almost always identified by his tissue diagnosis (high-grade gastric adenocarcinoma) and stage of disease (pathologic Stage IV, with extensive liver and lymph node involvement), rather than by who he was as a human being. He was not seen as a person with cancer. Rather, from the moment of his diagnosis he was instantaneously and forever more transformed into a cancer patient. I had somehow managed to get through three years of medical school without fully understanding how quickly and pervasively this happens, or the effects it can have on those who are sick and on their families. And because of my father’s particular diagnosis, he was invariably regarded as someone who was basically already dead. The words metastatic gastric cancer hung like an unpleasant odor in the room each time they were spoken, producing the same unmistakable frown on the face of virtually every oncologist he saw. Chemotherapy was offered, but with little enthusiasm, and always with a similar, unmistakable message—spoken or unspoken—that it probably wouldn’t do much good. Instead, it was often gently suggested that it might be best for him to “get his affairs in order.”
At no time did anyone even hint that my father himself could influence the outcome of what was happening to him. Nor were any ideas offered as to how he could at least improve the quality of the life he had left to live, regardless of how short a time that might be. Perhaps most distressingly absent of all were any suggestions of what he might do to deal with the mental, emotional, and spiritual aspects of all that he was experiencing: the tremendous fear and sense of loss associated with losing control of his body; the horrible sense of never being able to feel normal again; the loss of his stomach and the radically diminished ability to eat; the loss of his energy and strength; the end of life as he had known it before; and the impending end of his life altogether. Somehow, unbelievably, he was left totally on his own to deal with all of these issues.
All of his family members and friends rallied to his side. However, we were also all dealing with our own pain, sadness, anger, grief, and disbelief. Despite our best efforts, we were unable to find peace of mind in the midst of this traumatic time.
Late one afternoon, after a particularly discouraging visit with his oncologist, my father and I were riding home through Manhattan in a taxi. Some tests had come back that day and the results were not good. Although his oncologist was well intentioned, and I am sure he meant no harm, the clinical, matter-of-fact way in which he had delivered such devastating information was hard to believe. It betrayed precious little awareness—if any—of the impact this was having on my father. And as usual, no meaningful or coherent follow-up support was offered.
During the ride home my father was more quiet and withdrawn than I had ever seen him. As we rode on in silence, I remember how strangely distant and gray the city looked. It was drizzling outside, and the rhythmic sound of the taxi’s windshield wipers was all I could hear above the pounding of my heart and the sense of foreboding in my gut. As we began to pass through Central Park, crossing Fifth Avenue at Seventy-second Street, my father suddenly looked at me and began to speak.
“Jeremy,” he said, his voice quiet and withdrawn, “I can now see that my doctors have given up on me.” He then paused before continuing, almost in a whisper, “How can I have any hope if my doctors have no hope?”
There was a look of resignation and defeat in his eyes that filled me with unimaginable sadness. I remember choking back tears as the deeper meaning of his words sank in.
And in that moment, I saw the light go out of my father’s eyes.
Looking back now, I understand that was the moment when my father gave up. Although in the coming weeks he fought on in many ways, I now see how in that moment of despair he decided that his battle had been lost.
How can I have any hope if my doctors have no hope?
His physician’s words were now echoing loudly in my own mind, with an unexpected intensity. I was learning—the hard way—how powerful a physician’s words could be and the enormous impact they could have on a patient, particularly someone with cancer.
I was also learning, more clearly and more personally than ever before, how the mind, heart, and spirit can profoundly influence the course of a patient’s illness, the course of his or her life, and all too often the course of his or her death.
Soon thereafter we began making the rounds of “alternative medicine,” embarking on a blind search for anything that might help my father have a chance to live. Prior to medical school I had spent six years exploring Eastern religions and philosophy. For four of these years I lived in an ashram, a spiritual community, where I studied yoga, meditation, and vegetarianism, and learned a great deal about a variety of holistically oriented healing approaches. In addition, between my second and third years of medical school I visited Nepal and India. On that trip, which would be the first of numerous subsequent journeys to the East, I began to study the ancient and profound medical traditions of India and Tibet—Ayurveda and Tibetan Medicine. I saw the immense power of these traditions to prevent and treat disease and to alleviate the suffering of human beings who are sick. So the next step seemed obvious. If conventional medicine couldn’t save my father, maybe Ayurveda could. Or perhaps Tibetan or Chinese herbs. Or perhaps acupuncture, or homeopathic medicine. Or perhaps some special diet. There had to be something that would work. And if there was, I was determined to find it. After all, this was my father, the one I’d never had before, the one I’d longed for all these years. I couldn’t just sit by and let him die.
After seeing a variety of alternative health practitioners, it became increasingly clear that they were well intentioned but remarkably limited in their knowledge of cancer. As a group they also tended to be extremely critical of conventional medicine, as fixed in their own beliefs as they accused the medical profession of being. The herbalists, naturopaths, and Asian medical doctors that my father saw were also emphatic that the chemotherapy he was now taking was “poisoning” him, or “destroying” his immune system. Most refused to treat him as long as he insisted on taking chemotherapy. Sadly, I realized that this was fundamentally no different from the cancer specialists who insisted that they didn’t want my father taking any “useless herbs” that might “interfere” with the chemotherapy—even while freely admitting that chemotherapy couldn’t cure him anyway.
It was unbelievably frustrating. I felt as if I were stranded in a medical Tower of Babel, surrounded by doctors and healers who were all speaking radically different languages, unwilling and unable to hear or understand one another. Despite our ongoing pleas, they could not or would not look beyond their own particular viewpoints to see if there was anything else that could be done to help my father. Nowhere, it seemed, was there anyone who could provide any meaningful, coherent guidance about where to go, what to do, or how to dig through the avalanche of conflicting information that was coming at us from so many different sources. No one, it seemed, could guide us all the way through the painful and confusing journey we were taking.
Meanwhile, my father was growing weaker. He no longer had any appetite. Every day he lost weight and became steadily more fatigued. Soon it became hard for him to move from his bed. Despite pain pills, shots, herbs, and acupuncture treatments, he was having increased abdominal pain and was vomiting up almost everything he put in his mouth. Nothing was working. We were running out of options, and running out of time. Above all, it was heartbreaking and devastating to see such a vigorous, independent, energetic man deteriorating so quickly.
At this point I began to realize at a deeper level what was really happening. Slowly and reluctantly, I began to face what I had tried with all my heart and mind and soul to avoid: he was going to die, and in fact was already dying. My beloved father was dying, and there was nothing I could do to stop it.
This realization marked the beginning of a major transition in our journey together. For my father, there was a sense of even deeper resignation to the inevitability of his own death. Accepting it was almost a relief for him, because he didn’t have to fight anymore. But for me, facing it was extremely difficult because I didn’t want to let him go. Deep inside, my heart was crying out, “No! Not now! Not when we have finally found each other after all these years!”
But the reality was inevitable. I had to accept that any further attempts to “help” would only ease my own pain, not his. In fact, urging him to fight on would only add to his burden, not relieve it. He really did not want to struggle anymore. He was so exhausted, and life inside his ailing body had simply become too emotionally and physically difficult. Even the simplest things had become overwhelming, and he had finally given up. But I felt so frustrated, even angry. “How can you not want to keep on fighting to live?” my heart demanded. It often took every ounce of self-control not to scream these words out loud.
At this point, trying to hold on to him was like trying to hold water in my hand; like water, he was slipping through my fingers. This was agony. Intellectually, I knew I couldn’t hold on any longer, but emotionally I wasn’t ready to let go. No, not yet.
Then one day, in a moment of grace, I saw, and understood, and accepted that there was only one thing for me to do. I had to surrender completely to what was happening. No matter how much I wanted to or how hard I tried, I could not change the inevitable outcome. I realized that my greatest challenge now was to love my father as deeply and as fully as possible, while at the same time letting him go. To be there with him fully, but no longer pushing or pulling him in any direction. To let him do completely as he wished in the last days or weeks of his life.
What happened in those last few weeks was profound. It transformed me as a person—and as a physician—in ways that I could not have imagined. As my father’s own surrender and acceptance of what was happening deepened, I watched him go through a remarkable transformation—a spiritual awakening that I now recognize as a true healing journey. Though he died soon thereafter, he died with his eyes wide open, embracing the unknown with courage, grace, and love. Most important, our experiences together during the final days and weeks of his life—and in particular one special conversation we had—left no question in my mind that he reached the end of his time on earth with a deep understanding of himself, of life, of death, and of the nature of reality itself.
The incredible intensity of what I had shared with my father propelled me forward in my own journey. I began a deliberate search for greater understanding of all that had happened. I was filled with so many questions, and I felt that I simply had to find the answers—for myself, and for the many patients and families I would see and try to help throughout my life as a doctor.
Just as my experience with my father’s illness had been frustrating and painful, I knew other people must be enduring the same thing, or much worse. Few cancer patients have access to the resources that my father did: I was a senior medical student in New York and was knowledgeable about cancer and mainstream medicine. I was also well informed about alternative treatments and had access to many of the best. Furthermore, my father had the desire to explore any treatment option that could conceivably help him. Despite all these advantages, our journey had been excruciatingly difficult and confusing. What must other people go through, I wondered, when they do not have any of these resources to help them? I shuddered thinking of this and felt a deep resolve in my heart to do something about it.
Through my father’s experience, I had come to appreciate the profound and universal challenges faced by people with cancer, or any life-threatening disease. In the years since then, this has been repeatedly confirmed by the vast number of cancer patients and family members who have shared their lives, their stories, and their extraordinary journeys with me. So many important concerns had been left unaddressed by my father’s physicians during his illness. For instance, there was no meaningful advice about diet and nutrition. Except for recommending more pain and nausea pills, there were no suggestions of things my father could do to help ease his physical discomfort. And there was virtually no discussion of the intense emotional and spiritual issues a human being faces during such a profoundly challenging illness. These are aspects of cancer that the medical profession is only now beginning to address.
I saw too how inadequately my father’s problems had been handled by both the mainstream and alternative medical systems. It was extremely difficult to find care that was reliable, technically sophisticated, and medically sound—as well as open-minded and knowledgeable about other approaches to healing. Furthermore, it seemed even more difficult to find state-of-the-art medical care offered in an environment that addressed the needs and longings of the mind, heart, and spirit of patients and their families in ways that were meaningful, coherent, and responsible.
From the pain of that experience a conviction began to grow within me that one day I would become the kind of oncologist that I wished so much had been available for my father: someone who understood Western science, but who also understood Eastern medicine and spirituality, as well as other models of healing and consciousness; someone who could look into the mind, heart, and spirit of a human being as intently as he could gaze at an MRI scan or pathology report; someone who provided love, support, wisdom, and hope. A physician who genuinely embraced and lived these philosophies, and who was a truly joyful, spiritually conscious, loving human being. This meant becoming not only a fully credentialed and experienced doctor but a true healer as well. A person dedicated to helping people awaken to their true selves—to the infinite and eternal aspect of their being that is timeless, dimensionless, and untouched by any disease or circumstance.
For more than twenty years, I have pursued that vision every day. The journey has taken me to many extraordinary places around the world, and through many inner landscapes as well.
Along the way I have been richly blessed. Among the blessings for which I am most grateful is the experience of an intense, extremely high-quality education. I received my undergraduate degree from Columbia University, followed by four years of medical school at New York University School of Medicine. I then had three years of internship and residency training in internal medicine at the University of California at San Diego Medical Center. This was followed by three more years of subspecialty training in hematology and oncology at the University of California at San Francisco Medical Center. These are some of the finest centers of medical education and training in the world. I deeply appreciate and give thanks for the knowledge I gained, the professional training I received, and the many extraordinary people I met.
I have also been blessed over many years by meeting and studying with some of the great spiritual teachers and leading-edge thinkers of our time. Each of them contributed profoundly to my growth and understanding, and their guidance and example has influenced my journey in deep and compelling ways.
All these experiences have profoundly inspired my work and vision for truly comprehensive, integrative medical care. Dedicated to this cause, I founded The Geffen Cancer Center and Research Institute in 1994, and directed it until 2003. It was one of the first cancer centers in the United States specifically created to provide a working model of complete, holistic care for people with cancer and their loved ones. The Center seamlessly integrated a wide array of conventional and complementary healing modalities in ways that were safe, practical, meaningful, and inspiring. The lives of thousands of patients and family members were profoundly impacted, as well the lives of our highly skilled and dedicated staff members.
In working closely with these individuals over a number of years, I began to see that every single question and concern encountered on the journey through cancer falls elegantly, and organically, into one of seven distinct, but intimately inter-related, domains, or levels, of inquiry and exploration. This is particularly true for those seeking a deep experience of healing and transformation in their lives.
I’ll never forget the morning when I awoke in a state of inspiration and clearly saw the pattern of the levels, “The Seven Levels of Healing.” I wrote them down and began sharing them with my patients and staff. Their feedback was uniformly affirming; the levels described and mirrored their own experience. It was like being handed a crystal clear map of the entire terrain of the journey through cancer. It also soon became evident that the map and its principles were indeed universally applicable, as well as being eminently practical and inspiring.
In the ensuing years, I developed The Seven Levels of Healing into a coherent, well-organized program that became the foundation of the care offered to our patients and their loved ones. I also had numerous opportunities to share The Seven Levels of Healing with a large number of groups and organizations around the United States. Through this process, and mostly due to the courage and honesty of so many heroic people navigating the journey through cancer, I discovered numerous, essential distinctions about medicine that further deepened and transformed my understanding of what it means to be human, and to heal.
The book you’re now reading is the result of this entire journey. The pages that follow present The Seven Levels of Healing program, which specifically addresses all the dimensions of who we are as humans—body, mind, heart, and spirit. In short, the whole person. It explores the critically important role that all of these dimensions of ourselves play in the healing process and the extraordinary opportunity we have to understand and embrace them. It also examines the significant role that complementary and alternative approaches to healing and wellness can, and should, play in the care of people with cancer. Finally, it explores the dimension of our true nature that is beyond what can be seen or named. As a physician and as a human being, I believe the vision of this program can truly benefit and inspire us in all areas of life. If you are a cancer patient, family member, or caregiver, you can use this program and draw upon its vision in your own journey, regardless of where you are physically, mentally, emotionally, or spiritually.
Ultimately, the insights I offer here are those I sought for myself—as well as for the countless patients and family members who have taught me so much, and whose journey through cancer has given so much inspiration and meaning to my own.