Hope and Truth in Narrative Oncology: Dr. Brian Quaranta Abstract Session - HippSoc Conference 2026
Recorded at the 2nd Annual Hippocratic Society Conference, this talk works through the question using two texts Dr. Quaranta teaches at Duke: Stephen Jay Gould's essay "The Median Isn't the Message," written after his own diagnosis with an incurable cancer, and Akira Kurosawa's 1952 film Ikiru, in which a Tokyo bureaucrat is lied to about his stomach cancer and must decide what to do with the months he has left.
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Hi, and welcome to the Hippocratic Society Podcast. In this series of episodes, we break
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from our usual content to share presentations from the second annual Hippocratic Society
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Conference, during which physicians, trainees, and students from across our chapters came
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together to reflect on what it means to live out the virtue of hope in medicine. We hope
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you enjoy.
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So welcome to the abstract session. My name's Dr. Anthony Sorrentino. I'm also joined by
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Dr. Brian Quaranta, who's an associate professor of radiation oncology at Duke University,
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and a faculty member of the Trent Center for Bioethics, Humanities, and the History of Medicine.
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In addition to his medical interests, he is interested in literature, history, psychology,
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and philosophy, and has a master of arts in Shakespeare and theater from the Shakespeare
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Institute at the Stratford-upon-Abonne.
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He has also graduated from the theology, medicine, and culture program at Duke Divinity School.
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He is an active member of the Hippocratic Society chapter at Duke and has recently joined
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the editorial board of the HipSOC Quarterly. Dr. Quaranta today is going to talk to us about
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hope in truth and narrative oncology.
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Thank you. Thank you. So we'll try and do a session that's a little similar to what I do when I teach at Duke.
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And we're going to look at the question of, is there a tension between hope and truth
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and oncology? Because some people think that there is. Okay. So in this talk, we're going to try to
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look at, are the virtues of hope and truth in conflict? Can there be hope for patients with
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incurable cancer? What does that look like? This is my job. I take care of cancer patients.
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We cure many people, praise God, but many are not. And some of them we know from the very
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beginning are not going to be cured. And so how can we help those people to find hope?
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And then what about hope for the oncologist? And how can we help our patients to hope while
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continuing to practice truthfulness? So I want to read a few quotes from an article called,
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The Median Isn't the Message by Stephen Jay Gould, who was a world renowned paleontologist
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and evolutionary biologist and all around genius and thinker who was at Harvard in the late 20th
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century. And in 1982, he developed, he was diagnosed with an abdominal mesothelioma.
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So in July, 1982, I learned that I was suffering from abdominal mesothelioma, a rare and serious
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disorder associated with exposure to asbestos. When I revived after surgery, I asked my first
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question of my doctor and chemotherapist, what's the best technical literature about mesothelioma?
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She replied with a touch of diplomacy, the only departure she's ever made from direct frankness,
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that the medical literature contained nothing really worth reading. As soon as I could walk,
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I made a beeline for the medical library and punched mesothelioma into the computer's
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ribbon. He's looking for his own. An hour later, surrounded by the latest literature on abdominal
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mesothelioma, I realized with a gulp why my doctor had offered that humane advice. The
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literature couldn't have been more brutally clear. Mesothelioma is incurable,
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with a median mortality of only eight months after discovery. I sat stunned for about 15 minutes,
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then smiled and said to myself, so that's why they didn't give me anything to read.
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I then started to work again, thank goodness. If a little learning could ever be a dangerous
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thing, I had encountered a classic example. Attitude clearly matters in fighting cancer.
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We don't know why. From my old style materialistic perspective, I suspect that mental states feed
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back upon the immune system, but match people with the same cancer for age, class, health,
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and socioeconomic status, and in general, those with positive attitudes, with a strong will and
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with a commitment to struggle and with an active response to aiding their own treatment,
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and not just a passive acceptance of anything doctors say, tend to live longer. Hence the
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dilemma for humane doctors. Since attitude is so important, should such a somber conclusion
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be advertised? He feels the doctor was acting humanely by not giving him the whole story on
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what the outlook is for this illness. Now of course, in the rest of the article,
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Professor Gould goes on to explain how through his genius and ability to understand statistics
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better than everyone else, he was able to understand that there were things he could
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do to put him on the outlier of the curve. He obtained hope despite the prognosis and was able
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to live for 20 years after this diagnosis until he eventually died of a different malignancy.
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But I think this is an interesting introduction to the concept that hope and truth might be in
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conflict. So now I want to switch and have us take a look at a film called Ikiru. Anyone seen Ikiru?
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Yeah, it's great, right? Yeah, so I recommend it. Okay, it's a bit long and it's a little
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challenging, like if you haven't seen a movie from this era and this time and place,
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but it is well worth it. It's a masterpiece from Akira Kurosawa, the great Japanese director who
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has many films on any respectable greatest 100 films list, including The Seven Samurai,
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Rashomon, other things you've heard about, The Hidden Fortress. Okay, so this is one of his
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classics, Ikiru, starring Takashi Shimura, who also starred in the first Godzilla movie. Okay,
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so the word Ikiru is translated, as I understand it, to mean to live. It was inspired by, this is
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Kurosawa's take on Tolstoy's death of Ivan Illich. Okay, it's not a adaptation of that,
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but it's a response to that story. In turn, it inspired Breaking Bad, okay, and if you look at
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the hat that our main character will be wearing soon and compare it to Walter White's hat, you'll
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see a 2022 near shot by shot remake, Living, starring Bill Nye. It's also good, but go to the
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original. All right, so the film starts out with this very intrusive narration where we have a
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scene and you have a narrator. The first thing they actually show is an X-ray of a stomach and
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said, this is a stomach that has cancer. Okay, you can already see the changes of the cancer
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on the X-ray. And then it goes to Hirsawa, protagonist. Okay, and it introduces the
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character of Mr. Watanabe. Okay, and then it shows him at work in his office and this group of women
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in immediate post-war Japan, the film came out just eight years after World War II,
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they're desperately seeking help with a raw sewage pit in their neighborhood.
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And they wanted to see it turned into a park and Mr. Watanabe works in the Tokyo bureaucracy.
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But when he's presented with this, he says, oh, it's sewage, send that to sanitation department
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and just sends them out. He works in public works. And then you see these poor women being sent from
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one department to another. Nobody cares, no one tries to help, nobody intervenes,
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and nothing gets done. It's pointless and Kafka-esque. Okay, and the narrator goes on to
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specifically tell us that Mr. Watanabe is leading a worthless life. He says the narrator actually
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can't even call this life. This is not a life worth living, okay, which is a rare technique
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to be so sort of explicit in your description of your character. So now Mr. Watanabe goes to the
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X-ray room where he's going to meet his doctor and have a discussion of his diagnosis. And there's a
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little interaction that takes place in the waiting room and then he'll meet the doctor. Okay, so we
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want to watch this for a minute. I'm not sure how the sound will be, but it's all in Japanese. So
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let's watch the titles, okay? All right, so what do we think about that scene? What kind of emotions
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does that evoke when you're watching that? It's hard to watch it. It's hard to watch someone just
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look right into someone's face from a photo away and lie to them, right? What's the doctor's
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motivation? Why is he doing that? I don't think the doctor is trying to take the easy way out.
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I don't think he's just looking to get out of it because you can see he's the first thing he does
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is have to sit and smoke a cigar to try and like de-stress, right? I think that was a hard interaction
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with him. And the nurse too, you could see how bothered she was. She can't even just sit there.
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She has to get up and move around. But it leads to this other question, which is he asks,
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what would you do if you had six months to live? And the nurse says, see the varinol? I'd take that.
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She'd kill herself, right? So the doctor is sort of denying him the chance to try to structure the
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way he lives the rest of his life. So I usually teach this in combination with a movie called
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The Farewell, which came out in I think 2019, excellent film called The Farewell that looks at
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this. It's a similar question about divulging a cancer diagnosis in a family that's partially
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American and partially from China. And they address these issues of cultural tendency of whether or
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not to disclose information. But Kurosawa really kind of has a point of view that's different than
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Merston at that time. And I'm not going to have time to show this next scene. So Mr. Watanabe,
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now he understands he has stomach cancer and he has to decide what am I going to do with my six
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months? So the first thing he does is I'm going to live a life of debauchery. So he goes out and he
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goes drinking, women hanging out with crazy characters and finds to not are surprised that
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that doesn't get him any place, right? He gets nothing out of that. So then he happens to meet
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a younger woman who worked in his office and he takes her out shopping because she doesn't have a
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lot of money and he knows he doesn't need a lot anymore. So he buys her some things and then he
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enjoys her company. So he starts taking her out and they develop this relationship. And she
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tolerates that for a while, but eventually she's like, why are we doing this? This is not a May,
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December romance. I don't know what are you getting out of this? And he looks at her. He
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says, I have cancer. I have six months to live and I enjoy being with you because you're so alive.
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You're so full of life. What is it that you're doing that I'm not doing? And she says, well,
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I don't know. All I do is eat and I go to work. I take these little, make these little toys. So
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she works at a factory where she makes little hopping mechanical bunny rabbit toys and she
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shows them and she says, I make these and I feel like I'm making friends with every baby in Japan.
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Okay. And he looks at her and he's like, and she says, you should do something. You should go do
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something, make something, do something with your life. And he looks and says, it's too late. It's
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too late. And then he says, it's not too late. And he runs out and he runs downstairs and what we're
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looking at in this slide is a birthday party. And as he runs down the stairs, they start singing
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happy birthday in English, interestingly, which is the director sort of saying now he's got,
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okay. And so Mr. Watanabe then goes out and he builds that playground that was talked about in
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the beginning. Okay. A goal that is good and arduous and to be hoped for, but possible. Okay.
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So he gets the playground built. And then the last third of the movie is his funeral
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where his coworkers are sort of figuring out that that's what happened and that's why he was
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all making a commitment that from now on we're going to live just like Mr. Watanabe did. We're
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going to be like him. We're not going to wait till we hear about our coming death. We're going to go
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and live our lives. And then the final scene, someone brings a similar project to them in the
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office and I'm not going to spoil it. You have to watch and see what happens, but okay. So,
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but certainly Watanabe, okay. And this is the final moment of his life. All right. He's singing
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peacefully. He's looking on what he accomplished. The thing that he built for these children
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that's going to last beyond his life, his little touch of not quite immortality, but a legacy.
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Okay. And so he, he managed to live in those last six months. Okay. So then I want to talk
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a little bit about the work of Dr. Corn, who I did not know would be at the conference
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when I decided to do this talk, but he's here, although he's not here.
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So I'm going to talk about his work. All right. He is a tireless advocate for the consideration of
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hope in oncology patients. And he works under this framework called hope theory,
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which was invented by the psychologist, Dr. C.R. Snyder, and he applies it to oncology practice.
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So Snyder's hope theory lists three conditions for hope, goals, pathways, and agency. Thinking
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back to this morning's excellent first lecture. This is my day of slide for you. Okay. Timely is
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a passion for being drawn toward a future possible and arduous good. So what's a goal is
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a good, right? A goal is a good pathways are implied by the arduous, right? You have to have
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a solution to try and get there. And possible implies that there's agency. This is a thing that
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is potentially achievable. So the, the definition between a kindness and Snyder are not incompatible.
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Dr. Corn, one of his publications defines hope as a belief in one's personal ability
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to be in a positive direction, given the realities of a situation. Okay. So goals,
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something to hope for doesn't have to be cure. It doesn't have to be additional life.
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Some examples include reconciling with family, making certain milestones, an accomplishment
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at work, maybe some bucket list activity, or spiritual goals. Dr. Corn wrote about a patient
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who wanted to read through the Talmud. And he, you know, was able to achieve that through working
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together and felt delivered, I'm sorry, experienced tremendous growth and benefit
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from pursuing that goal in the last months of his life. Pathways are strategies for achieving goals
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and agency consists in the belief that it's possible to pursue these goals actively.
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One of the advantages of these, the hope theory is that it constructs hope in a measurable manner.
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And then he goes on to note that hope is correlated with many positive outcomes in
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healthcare, including smoking cessation, exercise, maintaining a healthy diet,
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tolerating pain, et cetera. Gould mentions in his essay, there's a long traditional belief that
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there's an association between negative mental states and cancer and, and through improving
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hope, we can perhaps mediate these states. All right. So he is, he, Dr. Corn reviews multiple
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studies that look at interventions designed to improve hope in oncology patients. And there are
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interventions that have been demonstrated to do that. We don't have overall survival data yet,
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but we have data that people are more hopeful. And he also designed an online intervention tool
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called hope to my eyes, which is very interesting. It helps patients to identify goals. It helps
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patients to identify strategies for how to obtain them and then measures hope before and after. It's
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tool. Okay. Hope mapping. So to go back to Ikiru, okay. I want to offer you this quote to
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philosophize is to learn to die. Who knows who said that? You maybe do. Socrates said it in the
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Fido, right? Cicero says that in Tusculum deputations, Seneca says it in How to Die,
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Montaigne says it in his essays. Okay. So this is a, a, a refrain that's echoed throughout the
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history of philosophy. And I think Kyra Salwa says it in Ikiru. And I think this makes a lot of sense
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if we understand to learn to die really means to learn how to live with a true understanding
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of your own mortality and therefore to live in such a way that we feel prepared
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when the moment of death comes. And as Dr. Corn wrote in the New England Journal, you know,
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many of the patients I work with uncover a profound appreciation of life after contemplating the
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implications of the end of life. I've seen this in my practice as well, not every time, but many
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patients grow through their confrontation with cancer, whether they're cured or not.
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People who are cured, but still are different after because few things make you contemplate
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it. So Dr. Corn writes that most people can actually be taught to turn an outright crisis
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into an occasion for growth. So my suggestion is that a willingness to ponder death can bring
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about renewed clarity and our thinking and our priorities. So I don't believe that there is a
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conflict or there has to be, okay? Every oncology patient is going to die. So is every oncologist,
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whether it's from cancer or not, acknowledging that this is true with our patients in a caring,
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frank manner can help them to live better in the time that they have and ourselves.
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I think that that can be a source of hope. And that's something that is within
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our abilities and the scope of our practice to help our patients with.
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So that's what I have to say. And I think we're pretty much on time.
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Good. All right.
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Thank you so much, Dr. Quaranta. That was a fascinating talk and really interesting to see
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those two, to really have something, a third piece to be looking at and to engage with as a group.
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One of the things that came to mind when you were talking was a great Flannery O'Connor quote,
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where she, her herself, someone who suffered greatly in life from physical illness,
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before death is one of life's great mercies. Really this idea of, to philosophize is to learn to die,
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that to deprive our patients of an understanding of their true outlook is not just presumptuous,
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this idea of seeing a possible arduous good, but to be a determinate good, one that is surely going
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to happen. I'm surely going to live. That not actually a mercy to our patients, but that truth
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of one of the joys of life. It also brings to mind Pellegrino's in thinking about the virtue
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of compassion and putting that against these other terms. I noticed come up in the room,
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this idea of pitying the patient, feeling a lot of pity and seeing what's happening,
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or this false sense of mercy or even empathy, which is definitely a laudable trait that we
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have in medicine. But instead, compassion, being to suffer with, and to suffer with,
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and I'm curious of how maybe in your practice or in doing this activity with different learners,
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you've seen at this, not only fostering hope, but fostering a means of compassion.
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Yeah. So you're not going to go in there and say, great news, you're going to die from this cancer.
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That's not the message. That's not the way to convey that. And because death is an evil,
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and even though it's inevitable and it's part of the way we're designed, it's not a good.
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Okay. So you're going to deliver this, you're going to understand,
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your patient should be understanding from you that this is not the news you want to give,
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that this is a thing that we wish we can circumvent. And in the cases where we can,
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have a chance to cure them, that that's what we're going to try to do.
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But that that's not the only good outcome that can come. So once you've established
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a therapeutic relationship, once you've established a bond and a communication,
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that's one of the things we can achieve. Sometimes it's we can relieve your pain. Okay.
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Sometimes it's we can get you more mobile. We can get you back to your family. We can improve your
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living situation. We may not be able to cure this, but we may be able to give you extra time to do
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things that you want to do there. And so it's a matter of, you know, you have to establish the
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empathetic bond. And then when the patient knows you're on their side, then you can redirect away
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from cure to goods that may be arduous, but that are possible to achieve. Yeah.
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All right. We should have more time for questions. Thank you. Thank you.
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Thank you very much for joining and reflecting with us today. Keep up with new episodes by
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