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by Lawrence Goldie with Jane Desmarais, London & New York: Routledge, 2005, 156 pp., £19.99.
This book is the fruit of Lawrence Goldie's many years of work with cancer patients, beginning in the 1970s. This pioneering endeavour appears to have begun almost by chance. A distant relative at the Royal Marsden, who had had a distinguished war record, seemed to be composed, reflective and uncomplaining when faced with the diagnosis of lung cancer, even when he was moved to a ward with senile patients where no treatment was taking place. However, on one of his visits, Goldie was approached by the House Surgeon, who realized that he was a psychiatrist: the seemingly composed patient had asked for enough tablets to kill himself.
Goldie was shocked by the contrast, and, later, by the man's death of a heart attack after he had returned home in a state of miserable depression. ‘I never forgot’, he wrote, ‘what I thought was really quite tragic: that such a brave man, who fought in another country's army, should feel so hopeless, abandoned and useless that he would want to commit suicide’.
The whole of Goldie's approach to terminal patients is implied in this statement: it highlights this patient's individuality and strengths. It also highlights the central role that the emotional meaning of treatment can play in determining how far someone with cancer can use their personal resources in confronting the decisions that face them, even when they may expect to die quite soon. An extreme example concerns another patient whose cancer, although untreatable, was slow-growing and would not have been expected to cause symptoms for a further 2 years. This man apparently interpreted the radiologist's statement that there was nothing more to be done as meaning that he was about to die, and he did in fact die of a heart attack the following weekend.
One of the recurring themes of this book is the danger of assuming that there is one expected reaction to terminal illness. Professionals, Goldie