Coming at it from different but overlapping directions, she and I worked together to heal body and spirit as best we could.— WILLIAM S. SHIMP, MD
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The ASCO Post is pleased to reproduce installments of Art of Oncology as published previously in the Journal of Clinical Oncology. These articles focus on the experience of suffering from cancer or of caring for people diagnosed with cancer, and they include narratives, topical essays, historical vignettes, poems, and photographic essays. To read more, visit ascopubs.org.
“You’ll never believe the strange offer I had today,” I told my wife over a late dinner. “One of my patients wants me to go to Montana with her to meet a man she calls her spiritual healer. She said you’d be welcome too, though I’m not feeling much enthusiasm about it myself.” For me, the invitation seemed strange and almost inappropriate, and I had nearly dismissed it. However, my wife is more inquisitive and free-spirited than me, and she wanted to know more.
“Well, Sandra has been on palliative chemotherapy for a long time for breast cancer,” I explained. “Every 3 or 4 months, she makes a pilgrimage of sorts to the Rocky Mountains. She comes from Blackfeet Indian heritage and has hooked up with a healer who conducts regular sweat lodge ceremonies for her. He has even given her an Indian name. She says he would like to meet her oncology doctor, face to face. He believes that her two healers must have some kind of synergy going.” My wife, whose sister had just run the breast cancer gauntlet, encouraged me to find out more. She wondered whether she might learn something that would help her sister. I had no similar expectations.
When I first met Sandra 3 years earlier, she had just been admitted in critical condition to the intensive care unit of our hospital. Complaining of bone pain for several weeks before developing profound mental changes, she had become somnolent and was found to have a serum calcium level of 17 mg/dL, along with diminished renal function. The admitting physician noted a right breast mass of which Sandra apparently was not aware. On biopsy, this proved to be an adenocarcinoma, and a nuclear bone scan showed widespread disease. She received fluids, diuretics, steroids, and pamidronate immediately, followed by urgent systemic chemotherapy. Responding nicely to these measures, within a few days, she was fully alert and feeling much better.
Sandra was 41 years of age and had just completed a marathon a few weeks earlier. She worked as a nurse at a nearby clinic. With her husband and three daughters in constant attendance during that hospital stay, we had difficult discussions about the widespread nature of her cancer, its incurability, and how we could only hope to control the disease for a time with chemotherapy. Reflecting my own limited expectations, I know I did not sound very hopeful or encouraging.
I came to know her well over the course of many subsequent visits to my office. She was proud of her Native American roots and grateful for having connected with the ancient healing methods of the Montana Blackfeet. She adhered to an organic diet and dosed herself freely with vitamins and nutritional supplements of all descriptions. During doxorubicin chemotherapy sessions, she meditated on her heart chakra in the hope of avoiding cardiotoxicity. She kept a journal and wrote poetry laced with optimistic reflections on the life lessons cancer was teaching her. And so, it went the way it sometimes goes in oncology; coming at it from different but overlapping directions, she and I worked together to heal body and spirit as best we could.
A Remarkable Outlier
The course of her disease was most unusual. As we sequenced our way through various chemotherapy regimens, each surprised me by working better and longer than it should have, especially doxorubicin. Although I viewed her as a remarkable outlier on the high end of the traditional survival curve, she was convinced it was her own nonconventional therapies that were extending the benefits of the chemicals—particularly the healing sweat lodge ceremonies in Montana. Who was I to say she was wrong?
It was in this setting that she relayed the invitation to accompany her to the mountains. Although at first I struggled with professional boundary issues, I finally became curious about the whole process and began to regard it as an opportunity to experience something quite out of the ordinary. Besides, I reasoned, the request for my presence had originated from the legendary Montana healer, not from my patient. And my wife was enthusiastic about the opportunity from day 1. So, we agreed to accompany Sandra, her husband, and some of her friends on the trip out west.
Collaborative Care in Montana
A plane ride to Montana brought us to her healer. He was a man in his early 50s, tall and with a commanding presence. In his day job, he was a well-known sculptor, whose artistry and foundry had produced some marvelous bronze depictions of the culture and personalities of the American West. He welcomed me warmly, saying he was honored I had come to participate in Sandra’s ceremony. Gentle and soft spoken, yet brimming with intensity, he recounted his efforts to promote Sandra’s healing and asked me to tell him about mine. We talked for hours about our respective approaches and about Sandra’s solid commitment to each of our therapies.
That evening, his family welcomed us to its table for a hearty meal, during which we discussed the details of what was to happen in the sweat lodge the next day. Before bedtime, we were shown how to fill small leather pouches with ceremonial tobacco. These gifts would become offerings during the ceremony, visible signs of supplication to Wakan Tanka, the Great Spirit.
I am certain both healers helped her, but our relative contributions to the whole cannot be quantified.— WILLIAM S. SHIMP, MD
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The next morning, we bent and bound willow branches to construct a hemisphere that became the frame of the sweat lodge. This was covered with tarps and hides to create an igloo-like structure, with a low opening that required crawling on one’s knees to enter. In the center of the bare earth floor was a shallow pit that would hold the traditional hot rocks of the sweat lodge.
Shortly before noon, the preparations for the ceremony itself began in earnest. The healer began to weave a huge pile of logs and timbers into north-south and east-west intersections, to signify the four directions of the wind. Then, he ignited a bonfire to heat several melon-sized rocks that he had placed in its center. He continued to stoke the fire for several hours, as the rocks became red hot. At the same time, although some of us tied the tobacco pouches to the willow branch ceiling inside the lodge, others gathered aromatic sage and added it to the water that soon would be ladled onto the hot rocks. We loaded ourselves with plenty of fluids and electrolytes in preparation for the upcoming sweat.
By late afternoon, the preparations were complete. Dressed in shorts and tee shirts, we crawled into the lodge and seated ourselves in a circle on the bare earth. Using pitchforks and shovels, members of the healer’s family dropped several hot rocks into the central pit. Then, the healer entered bearing a 5-gallon bucket of sage water, closing the entry hide behind him. The heat started to build instantly as the ceremony began.
Conversational and Interactive Healer
I really do not know what I expected to happen next, though I imagined there would be supplications, chants, epic stories of suffering and bravery, perhaps some of them in a language I would not understand. Instead, the healer was conversational and interactive. We were invited to comment on why we had come and what we expected for our efforts. Most said they were there for strength and healing. The healer replied that the difficult ordeal of the hot rocks might help us with that. We would be stronger for meeting the challenge of the sweat lodge, he taught; then, he ratcheted up the heat by dousing the hot rocks with ladle after ladle of sage water.
Motivated mainly by curiosity, I felt like an uncomfortable spectator at this event of great purpose and intensity. The heat began getting to me as I sat cross-legged on the dirt, profusely sweating to the point of sitting in a mud puddle of my own making. My physical discomfort caused me to disengage from the ancient and modern stories, the motivational preaching, the music, and the supplications offered by the healer. After the first hour, I felt that I was reaching my limit. My attempts to drink water were thwarted by nausea, intensified with each sip.
Occasional moments of relief came when an assistant briefly parted the hide, allowing entry of fresh mountain air, as more hot rocks were carried to the pit. But then the heat would intensify again, more sage water would be poured, and things grew more difficult than ever. As I looked around me, I was impressed that everyone seemed to be coping better than me. The healer had their full attention and focus, whereas I had become completely distracted.
I began to play mind games in the hope of staying with the program. I wondered about the concentrations of oxygen and carbon dioxide in such an enclosed space. It was consoling to imagine that the healer, who continued to speak at great length, would be like our canary in the coal mine, whose sudden silence might warn us of impending asphyxiation. By lying down on the dirt, I learned there was a definite temperature gradient within the lodge; I wondered by how many degrees. Also, I discovered the bare earth itself was relatively cool, and I did not feel as nauseated lying down. Although other participants would occasionally lie down as well, I was the only one who needed to be recumbent for most of the ceremony.
In all, we spent a little longer than 3 hours in the sweat lodge. I can honestly say those hours were the most physically demanding of my entire life. Covered with sweat and mud and crawling out from the lodge into the crisp mountain air, I felt weak, dizzy, and relieved. Glasses of lemonade and a meal of salty stew were welcome replacements for what we had lost during the ceremony. Most of the attendees went on to describe the event as inspirational, spiritual, challenging, strengthening, cleansing, affirming. For me, the only descriptor that came to mind was unbelievably difficult. (Subsequently, especially since the tragic sweat lodge deaths in Arizona this past year, I have had no trouble understanding how such a taxing physiologic experience can push the limits of human endurance—and how social pressure and a desire to tough it out can cause a person to suppress the wisdom of getting up and leaving a stressful situation.)
I will never know whether the sweat lodge had an impact on Sandra’s medical therapy or her survival, although she believed that healing and acceptance both came from multiple sources and wanted to employ them all. Just as she had faith in modern medicine and participated in it fully, she also had faith in her alternative healer, to the point of suffering the ordeal of the sweat lodge again and again, even as advancing cancer weakened her. She remained convinced of the synergistic value of both approaches.
A Different Way to Navigate the Bridge Between Body and Spirit
Over the years, I have given a lot of thought to what the experience meant to me. Initially approaching it as a skeptic and not with any personal need of being healed of disease, I did not have the faith or confidence that anything special would occur. Cancer had not pushed me into a corner. My life was not on the line. I was just curious, that was all. I wonder if it would have been different had I been ill. Now, many years later, I can recall every detail of the physical ordeal and a little of the content of the ceremony. I can certainly say it involved no small degree of suffering, apparently more for me than for the rest of the group.
Sandra, however, drew great inspiration and strength from the sweat lodge as part of an overall approach to her life with cancer. Though she sought healing, she was remarkably at peace living with her disease, which she saw as an opportunity to explore and align herself with the rhythms of the planet. After our time together in the sweat lodge, I came to admire her devotion to a philosophy that was quite foreign to me; I began to take more seriously her unique approach to disease and healing. She sensed my interest and provided me with a new poem or reflection from her cancer journal at each office visit. These pieces were remarkable, offering great insight into her vision of a peaceful transitional stage between life and death.
In the end, I saw my sweat lodge ordeal as her (and her healer’s) way of getting my full attention and exposing me to a broader approach to healing. I believe they were showing me a different way to navigate the bridge between body and spirit and moving me away from thinking in terms of that classic dichotomy in the first place. I believe these insights have helped me better understand and support patients who supplement their usual medical care with other healing strategies, especially as their disease wears on. I believe the gift of Sandra’s example showed me that walking the path to the edge of life need not be a totally negative experience.
Sandra died 1 year after our shared experience in the mountains. To this day, I consider it a great honor that I was invited to witness the work of her Montana healer. I believe my meeting with him was highly symbolic of Sandra’s belief in the merging of the old ways with the new and was her attempt to educate each of us in the ways of the other. I am certain both healers helped her, but our relative contributions to the whole cannot be quantified.
Her favorite creature was the red-tailed hawk. A friend of hers created a bronze sculpture of Sandra dressed in Native American attire with a hawk perched on her outstretched arm, in the manner of a falconer. One of these sculptures adorns our fireplace mantel. Living out in the country where red-tailed hawks are commonly seen, I think of her each time one soars overhead—and each time I stoke the fire.
DISCLOSURE: The author reported no conflicts of interest.
Acknowledgment: The author would like to thank Ellen Fritz, MA, and Ellen Michael, PhD, for their editorial and technical assistance.
At the time this article was published in the Journal of Clinical Oncology, Dr. Shimp was working at the Affiliated Community Medical Centers, Willmar, Montana.