The metaphor we use, almost universally, to describe the experience of illness is that of warfare.  Someone diagnosed with cancer is said to be “battling” cancer (as if the diagnosis itself implies a fight).  Family members often say that their hospitalized loved one is a “fighter” who “will never give up” or surrender.  Doctors refer to the most potent antibiotics as “big guns” that are prescribed to “kill the bugs” infecting the patient.  A national network of cancer hospitals advertises that they help patients “win the fight against cancer” by employing “care that never quits”.  Obituaries regularly note that the deceased died after a “long and valiant battle” against cancer or heart disease or mental illness.

The warfare metaphor is understandable given Western medicine’s general stance that illness and injury are problems to be solved and enemies to be overcome.  The image also appeals to the American cultural belief that if we work hard enough and strive valiantly enough, we will prevail, no matter what.  Thus the ill vow to “fight”, envisioning they will triumph over illness, much like Lance Armstrong (i.e. his surprising recovery from cancer, not his now tainted Tour de France victories).

But if the battle is not won, if the illness progresses despite the best efforts of the patient, family, physicians and caregivers, then the warfare metaphor leads us problematically down a road that narrows precipitously.  The only options left are continuing a fight that cannot be won or face defeat.  Such a “defeat” often feels humiliating because we assume that the patient and/or the doctors didn’t battle hard enough, long enough or wisely enough.  The prevailing warfare metaphor motivates some cancer patients to ask for, even beg for, another round of chemotherapy in order to continue the “fight”, when their oncologist says more chemo will not help and only cause harm.  We rarely leave room in the warfare metaphor for the realization that some battles cannot be won despite everyone’s best effort. A wise pediatric patient recognized this when he said, of his “battle” with cancer:  “We brought knives to the fight, but the cancer brought guns.”

There are, though, other metaphors which can be employed.  We are not, as we seem to feel, locked in to using only warfare imagery which offers only the polarities of victory or defeat.  Michael J. Fox, for example, says of living with Parkinson’s disease:

I don’t look at life as a battle or as a fight. I don’t think I’m scrappy. I’m accepting. I say ‘living with’ or ‘working through’ Parkinson’s. Acceptance doesn’t mean resignation; it means understanding that something is what it is and that there’s got to be a way through it. I look at it like I’m a fluid that’s finding the fissures and cracks and flowing through.

Another possibility is the metaphor of a journey.  With this image, having an illness takes us on a trip, a journey that will be marked by twists and turns, ups and downs, unexpected detours, smooth stretches of roadway, seemingly impassable rocky paths, enemies that threaten us as well loved ones who support us.  One is often changed even transformed by a journey.  We learn lessons along the way, lessons we may never have learned if we hadn’t been set on this challenging path. We weigh what we need to take and what is better left behind.  Sometimes, we have to abandon items we thought we would need but don’t, traveling lighter as we go.  Storms may arise which blow us far off course, off the map we’d been using to guide us, leaving us lost in an unknown land.

Yet we can, with effort and assistance, chart a new course and regain our bearings.  A journey provides us (and our loved ones) with lasting memories (rather than the regrets of a “battle” that was “lost”).  On a journey, we can appreciate the beauty we encounter and have deep conversations with those who travel alongside us (instead of the chaos and conflict that characterize a battlefield, strewn as it so often is with the destruction and detritus of war.) Long and difficult journeys wear us out, and sometimes we don’t know if we have it in us to keep on going.  The journey may end well, bringing us to our desired destination.  Or it may end before we expect it to; long before we reach the hoped for goal.  Either way, one doesn’t win or lose a journey but rather takes it a step at a time, trying to keep on going as best we can, watching for where the road takes us, hoping that in the end it leads us home.

Rob A. Ruff is director of chaplaincy services, Regions Hospital, St Paul, MN.