The TCM cable channel is having a retrospective on the career of Elizabeth Taylor, showing several of her best films from the 1950s. It had been many years since I had seen her and Paul Newman in the film version of Tennessee William’s Cat on a Hot Tin Roof. She and Newman light up the screen, with able support from Burl Ives.
For those of you who haven't seen it, or have forgotten it, the film is a prolonged exploration of the toxic and corrosive effect of lying on human relationships. Burl Ives--Big Daddy as he is called in the film--is dying of colon cancer. This being the 1950s, neither his doctor nor his family will share the truth with him regarding his "spasms." "Mendacity is a system that we live in," says Newman's character, and everyone in the film hides something important from a spouse or family member, and often the characters lie to themselves. "My husband is not going to die,” says Big Daddy's wife, knowing full well that this is untrue. She also says, his pain notwithstanding, "Nobody's going to give my husband morphine."
I appreciate this film a great deal more now than when I first saw it, decades ago. Partly this comes from an increased appreciation of Tennessee William’s verbal artistry, partly because of the high level of acting, and the beauty of Taylor's Maggie the Cat. But the central truth of the work resonates with me in a way it did not in the past, probably because of my life experiences, both as an oncologist and as the son of a dying cancer patient.
We owe each other honesty in the face of death, and we rarely get enough of it. As late as the 1960s, the great majority of physicians failed even to inform their patients of their diagnosis, as reflected in the play. The film almost never says the word "cancer," even when the doctor and the family are talking behind Big Daddy's back. We moved beyond that taboo long ago. But we still have a ways to go, as numerous studies of end-of-life discussions make painfully clear. I know that I am not as good at this as I would like to be.
Burl Ives has a great summation towards the end of the movie: "There ain't nothin' more powerful than the odor of mendacity...You can smell it. It smells like death." Viewing this movie should be a required part of the curriculum for oncology fellows: check it out if you have never seen it.
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Comments
Mahvish Muzaffar, MD
Apr, 12 2011 4:35 PM
This scenario may be from 1950s movie, but it is real life in developing countries. I having worked in India as radiation oncologist and prsently in USA, dealt with similar problems. I used to be frustated at time becuase the family would not allow us to even mention word cancer in front of patient. The irony is the department had cancer department written on walls. I could see that patient knows he/she has cancer, family while "trying to sheild him fron cancer stress" is actually leaving him to suffer alone, as he cannot even talk about it. This all is done in the name of sheilding pt from the stress of cancer.I wish i could change that, at time family and even neighbors will make the decision of treating or not treating , while no one asks patient what he or she wants.
Katharina Pachmann, MD
May, 10 2011 6:07 PM
The scnario reminds me of the current situation with regard to the systemic part solid tumors the remaining tumor cells in the body after the primary tumor has been removed. It is acknowledged that millions of cells may have left the tumor and may be lingering around but the great majority of physicians does not want to know about numbers and their potential to monitor the remnant disease. We still have ways to go to face the truth.
Brian Richard Bird, MRCP
May, 11 2011 9:08 AM
Great post. Any thoughts on doctors being forced to bring patients to ICU who have exhausted chemotherapy options and are unlikely to benefit? Sometimes patients and their families are obsessed with fighting unwinnable battles. In Ireland we can refuse to administer futile treatment but I know from US Fellowship not the case there.