Just before Passover 1972, Ben Corn's mother called him, his brother and sister to her bedroom, and told them: “Dad will not be with us at the Seder, he’s in the hospital and he’s not doing well.” A few hours later, they all arrived at Memorial Sloan Kettering Hospital in Manhattan.
“Dad was a successful lawyer, a student at Harvard and an outstanding athlete in college, and suddenly we saw him in bed, weak and thin,” recalls Corn. “The doctors told us he had metastatic prostate cancer.”
Corn, now Professor Ben Corn, was 11 years old. The tears still choke him up as he recalls his last moments with his father, when the walls of denial that his parents built around their children collapsed in one horrific moment. Suddenly they realized that all the business trips and their father’s frequent absences were actually hospitalizations. “At this point we realized that he was extremely ill, but even then the doctors did not tell us that the prognosis was so dismal.”
A little more than a week later, on the last holiday days of Passover, the phone rang in the family's apartment.
“We are a religious family and we do not talk on the phone during the holiday, but we all knew what this conversation meant. There were four telephones in the house, and the four of us picked them up simultaneously.”
On the other end, the doctor said: “Mrs. Corn, we are sorry to tell you that your husband has passed away. Can we do an autopsy?” In fact, the doctor used the words “has expired” - a sterile, formal and insensitive expression whose exact meaning is “out of date”, as if it were a container of cottage cheese to be removed from the supermarket shelves.
After the trauma of his father's death, Ben swore to himself that he would become a doctor when he grew up and he would find a cure for prostate cancer. Indeed, right after high school he was accepted into a prestigious accelerated medical program in Boston. He remembers one case that drove him to find his true purpose.
"I was a student and I accompanied a senior physician who had to inform a cancer patient that his tumor had spread, that there were metastases in his brain, and that he had only three months left to live.” We went into the room and without making eye contact she said to the patient, 'It’s brain cancer. You need radiation treatments.’ Six years after the death of my father I realized that things had not really changed as far as the communication between doctors and patients with terminal illness was concerned. At that point I said to myself, 'I don’t know how I’ll do it, but I’m here to educate my colleagues that that is not how to talk to patients, that those days are over. This is my true calling as a doctor.'"
Corn, now aged 58 and a senior oncologist and radiotherapy specialist at Shaare Zedek Medical Center in Jerusalem, has not discovered the winning drug for prostate cancer. In fact, it is still one of the most common cancers among men over the age of 50. But in more than one sense, the 11-year-old boy, and later the medical student, fulfilled the mission that he outlined for himself: Corn conceptualized and leads a special program aimed at giving hope to the most difficult patients, those who suffer from cancer that has spread and know that their time is limited. And he does so using seemingly simple means, which for some reason have been squeezed out of the doctor-patient communication models over the years: listening, straight talk, basic human respect, compassion.
Talk about it
Before choosing to focus on his impressive Hope Project, Corn worked hard to develop a brilliant career. After graduation, he began his residency in oncology at the University of Pennsylvania and built a reputation as a specialist in the treatment of brain tumors and the reproductive system. At the age of 36 he became a full professor.
“In the United States, when you receive a professorship, you are entitled to six months of sabbatical,” he says, “I wanted very much to be in Israel and managed to arrange a year of sabbatical, which I divided between the United States and Israel, alternating every two weeks. I moved to Jerusalem with the family and we fell in love – me, my wife, and the kids. At the end of the year I decided, I’m leaving everything and we’re making Aliya. I did not have a place to work, no one promised me a position, and during that period there was a big gap in standards between Israel and the US, in my field (radiation oncology). But the desire to live in Israel prevailed."
Corn did not immediately land in an Israeli hospital. He accepted an offer to run a start-up company that focused on biotechnology. A significant part of the work was to maintain regular contact with the FDA, the Food and Drug Administration.
“The FDA determines the prioritization of new drugs and treatments, giving permits for trials,” he says. “So in fact, this is the organization in the world that most influences the progress of medicine.”
After six years in the business world, he received an offer to launch a radiation institute at Ichilov Hospital in Tel Aviv and returned to practicing medicine full time. Along with the day-to-day work, the return to the field reinvigorated his urge to deal with the emotional aspect of cancer, that which touches upon the quality of life of patients.
“With all the tremendous progress made in recent years in the treatment of cancerous tumors, even if we look at the situation through rose-colored glasses, at best patients have only a sixty percent chance of recovery. In actuality, it’s probably less when you consider all types of cancer in the aggregate, but even if we accept this figure, we still are left with 40% of patients for whom there is, in fact, no hope.”
Together with his wife Dvora, Corn founded an organization called Life's Door, which later also received the Hebrew name “Gisha LaChaim.” One of the organization's focal points is the “Conversation Project”, which is designed to help doctors - and also family members - speak with those going through serious illness about the end of life. The project is based on the work of Ellen Goodman, an American journalist and activist who works to promote the right of terminally ill patients to be partners in decisions regarding the medical care that they will receive.
“On the one hand, everyone knows that they will reach the end of life, on the other hand it is almost impossible to talk about it,” says Corn. “We decided to formulate a kind of kit that includes specific suggestions and questions that could be asked even at the dinner table with the family. It facilitates talking about the end of life: How do you see the end of your life? Do you want aggressive treatment right up to the end or would you prefer to stop the treatments? In very gentle language, Goodman provides very effective tools that allow us to bring up these questions and help us understand what a person's values are, what her desires may be, what motivates him. In short what makes the patient’s day."
The “Conversation Project” already has Hebrew, Arabic and Russian versions, and soon there will be one in Amharic. Professor Corn and his organization lead workshops for physicians and for any one who is interested in the subject, in Israel and overseas. The project, which has gained the support of Shaare Zedek Medical Center, teaches family members of patients and also those who are responsible for their treatment, how they really want to spend the time they have left, and gives them a certain sense of control and responsibility: they are no longer passive victims of a terrible disease that nothing can be done about.
But at some point, Corn discovered that the “Conversation Project,” with all its proven importance, still does not cover all of the patient's emotional needs.
“We started to think, what do we need to do? What’s missing? We realized that by communicating directly and openly with a patient we can find different medical solutions with him, new treatments that will make it easier for him to deal with the disease, but that is not always what he really needs. We understood that there is something else a doctor can offer a patient, and that something is hope. Here I’ve been greatly assisted by the work of Prof. Malka Margalit, an educational psychologist and dean of the School of Behavioral Sciences at the Peres Academic Center.”
Here you've completely abandoned medicine and switched to philosophy.
“You could say that, although I’m still very much an oncologist. Many people do not really understand what hope is. But it’s the most human value that exists ... Hope constitutes a greater human need than even love. People can live without love but they can’t live without hope. Animals have models of love, but they do not have a model of hope. And the reason why hope doesn’t exist in the animal kingdom is that hope relates to the future, to looking ahead. The ability to look into the future is a solely a human quality. In other words, only people can set goals that are achievable.”
What hope can be offered to a patient who has developed cancer and has six months left to live?
“Let's say you have widely metastatic prostate cancer. As an oncologist, I can’t cure you, which is of course frustrating. But I can find another goal, together with you, that is attainable. And this I can learn by getting to know you. We have what we call a ‘Hope Map’ that’s divided into sections. So I might ask, what is your medical goal? The answer is to cure the cancer. But what if we don’t succeed in curing the cancer, as happens to at least forty percent? We keep going and we look for another goal. And then the patient says, ‘It scares me that if the tumor spreads, I’ll experience shortness of breath. I want to prevent this situation.’ This is an attainable goal. We have tools that can help him. Or a woman suffering from cervical cancer might say, 'I do not want to bleed, it's a matter of dignity.' Here too we can help.”
Probably one of the most significant hopes of terminally ill patients is not to suffer pain.
“Yes. Pain is one of the main fears of patients, and in this area you can offer quite a lot. There’s a great variety of medications that will alleviate pain. Until recently many doctors were afraid of giving these drugs because we feared we might cause addiction. But today we understand that addiction to painkillers is not as consequential when it comes to people who are going to die.”
I have a dream
The issue of hope is not limited only to feasible medical goals such as reducing pain, preventing bleeding or relieving shortness of breath.
“When I talk to the patients openly, I get to know their dreams and aspirations, in the professional sphere and even the personal... Let's say a particular patient has two years to live. You talk to him and he says, 'I always wanted to do a Master’s degree' or 'I have a dream of publishing a book of poetry', and I say to him, 'So let's go and we’ll help you fulfill this.' We understand that things never go completely smoothly, there are ups and downs, bumps along the way, so in the workshop that we lead, we teach how to overcome them or circumvent them. And here we arrive at another essential component in our communication with patients: motivation. How we inspire motivation and encourage them to action.”
In working to instill hope as an integral component of communication with terminally ill patients, Corn had to overcome another obstacle: the automatic disagreement of some of his colleagues, whose education was focused on finding a solutions to specific problems rather than dealing with an amorphous concept like hope. “Doctors are a tough crowd, because a doctor presents himself as a scientist who deals with measurable phenomena, and of course there is a lot of ego involved, but we received excellent feedback from physicians who went through our workshops and we get invitations from diverse places in Israel and abroad - from Greece to Germany to South Africa. You have to remember that oncologists are the doctors who struggle the most with burnout, so our workshops give them hope as well.“
What about the fear of fostering false hope in patients?
“A lot of doctors have told me that they’re fearful of this and I agree that it’s important to avoid it. There really is a thin line that separates hope from false hope, and you have to learn to recognize it, which comes with skill and experience," he says.
"On the other hand, one study sought to investigate how often doctors use the term ‘cure’ when treating children with cancer in an experimental trial that was evaluating safety of a chemotherapy drug rather than curability of the tumor. It turned out that 70 percent still used the term cure, not because of lack of awareness or an irresponsible desire to mislead. The doctors assumed that people want to be convinced that it’s possible to find a cure.
"Our mission is to teach these doctors that even if cure is not currently attainable, we can still help patients pursue hope in the broader sense of the word.”