Chemotherapy and the Sweat Lodge

Abstract

DOI: 10.1200/JCO.2010.34.2204 “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 shecallsherspiritualhealer.Shesaidyou’dbewelcome 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 I, 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 she 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, 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, about its incurability, and about 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 hopes 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. 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. Though 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. 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 wellknown 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 that he was honored I JOURNAL OF CLINICAL ONCOLOGY T H E A R T O F O N C O L O G Y VOLUME 29 NUMBER 13 MAY 1 2011