The Survivor

I published the following essay in the 2010 “Rhetoric at Work” issue of Harlot of the Arts, a (now defunct, as far as I can tell) online literary journal started by graduate students in the Rhetoric Program at The Ohio State University Department of English, under the title “The Misplaced Rhetoric of Medicine.” Reading it again now 15 years later, I’m struck by how much of it still resonates. The Pink Ribbon crusades seem to be a thing of the past, and there are certainly other divides at play in my relationship with the patient that I am more sensitive to in 2025, but replace the word “rhetoric” with “narrative” and it’s what I still see every day in my work. If we can’t effectively listen to and act upon the stories our patients use to create their health experience, the most advanced treatments in the world won’t make a difference.

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Early in my career, I saw a 64-year-old African American woman as a new patient. I reviewed her past medical history, which was significant for a litany of serious medical conditions: diabetes, hypertension, heart disease and stroke among others. Before moving on to my examination, I asked her if she had any other medical conditions.

She replied, “I’m a survivor.”

She said the word like an incantation, an invitation to some shared and profound understanding. But I didn’t hear her and without a second thought, made a horrible mistake.

“A survivor of what?” I asked.

The confusion and contempt with which she replied, “Breast cancer” startled me. I suddenly knew, without exactly understanding why, that our relationship was over before it had even begun.

On the surface, it seemed a fair question. After all, from a medical standpoint she had survived many threats to her health. But from a rhetorical standpoint, her breast cancer was everything to her – it was her – and I was completely oblivious to that fact.

Even conditions necessitating a hysterectomy don’t strike at the core of womanhood – sexual identity, maternity – as ruthlessly and visibly as breast cancer. The intimacy of its betrayal has led to a very profound sense of pride among its victims, a pride framed by a fierce rhetoric that has come to be epitomized by one word - Survivor.

While this has obviously led to many positive outcomes – breast cancer research and treatment is light years ahead of many other forms of cancer – it has also led to a unique relationship. For the first time in history, an illness has come to define a “lifestyle.” Breast cancer survivors and their supporters are overwhelmingly proud, strong, active, committed, and engaged fighters (in the best sense of the word).

Companies picked up on this and suddenly began racing to associate their products with the “fight” against breast cancer and the extremely powerful associations that people – people with a clearly identifiable set of consumer preferences and tantalizing pool of discretionary income – made with the disease. There has never been an illness with such corporate synergy. The pink ribbon had become the new golden arches.

One can argue whether or not it’s a good thing that we live in a society in which purchasing a certain brand of kitchen mixer or golf club has been turned into a personal statement about whether or not we support people with a specific illness. But it’s hard to argue that this artificial, meticulously manufactured rhetoric doesn’t extend beyond the walls of the mall to inflict a very real, and not necessarily positive, impact on our health.

“There has never been an illness with such corporate synergy. The pink ribbon had become the new golden arches.”

My patient was literally sold a highly polished rhetorical lens through which to refract her entire life. This lens intensified the primary colors but eliminated the finer hues that gave it its texture. She defined her entire being with one word, and when I didn’t recognize that word, I immediately lost credibility. After all, if I didn’t even understand the basic language with which she framed her core beliefs about her health how could I possibly help her to manage that health?

I never saw her again.

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We hear a lot these days about the many ways in which the health care system fails us – financially, logistically, morally – but lost in the din of reproaches and recriminations is a more thoughtful exploration of how these failures impact the rhetoric of our health. This is a dangerous oversight because the doctor-patient relationship – the point at which our health care system goes from theoretical construct to physical reality – is ultimately the culmination of a high-stakes rhetorical contest. And while the end-game is played out in the seemingly inviolate arena of the exam room, those rhetorical forces determine the outcome of the contest before it begins.

The word “contest” implies an adversarial relationship between two opponents – seemingly antithetical to the relationship between physician and patient. But in many ways, it is an apt description for clinical care: while clinician and patient share the ostensible goal of improving health, each approaches it essentially as an exercise in persuasion.

Our hard-wired cultural impulse to do something – anything – at all costs smacks into a wall of co-pays, pre-existing conditions and preferred provider lists and suddenly we are stricken with the distinct feeling that the cure for our ills is out there somewhere but we’re not getting it. We react by drawing rhetorical sabers that cut far deeper than the blunt edge of their banality would suggest.

You try to persuade your physician you need an antibiotic while she argues you need nothing more than time and rest. You try to convince him that you need an MRI for your headache while he tries to convince you that you just need to cut down on the caffeine and take some Tylenol. We may be talking about pills and scans but we are really engaged in a debate about much deeper concerns: of dying, of not being taken seriously, of having our competence questioned, of being heard.

It’s disheartening how often these rhetorical walls keep us from connecting on even the simplest problems because the stakes are just so high. As my patient taught me, a single word, spoken with the best of intentions, has the power to destroy a potentially lifelong therapeutic relationship in an instant.

A professor in medical school once told me that no matter how much the economics of health care may change, medicine will always come down to the bond between doctor and patient. While those sentiments are what drive most physicians’ passion for their work – they certainly do for me – their near-sightedness can at times do more harm than good.

When we frame the doctor-patient relationship as an exercise in rhetoric as opposed to one of simply diagnosis and treatment, we uncover forces at work that we never even considered before – forces that ultimately determine our success or failure. Armed with this knowledge, and perhaps a well-placed word, we can take the first steps towards true healing.