'Bell-ringing' cancer celebrations

Many cancer treatment centers have a ritual that is sometimes beloved and sometimes detested: When someone completes prescribed cancer treatment, s/he is invited to ring a large bell that hangs in the Infusion Center or, sometimes, in the lobby. This is similar to radiation treatment areas that shower patients with confetti (pink for breast cancer patients) as they exit the treatment room after the final radiation blast.

Understanding that I take the risk of being viewed as cranky or worse, I hate these activities. I am sure that there are some people who feel joyful and celebratory when the final chemotherapy needle is removed or they stand up for the final time from the radiation table. There are more people, however, who feel glad to be done, yes, but hardly celebratory at the same moment. Instead, they wrestle with a complicated mixture of feelings that include exhaustion, anxiety about the future, relief, sadness to be leaving caregivers who have become close, and general uncertainty of what life is going to be post cancer. Hopefully everyone also feels some pride in what they have accomplished, but that is rarely the primary feeling.

Even more importantly, I worry about all the people who are being treated for advanced/metastatic/recurrent cancer. They are probably going to be on one or another treatment for the rest of their lives. How do you think they feel when the staff is congratulating someone with an earlier stage version of their illness while they are trying to stay alive?

I have read articles describing universal jubilation and appreciation when that bell chimes. I read one essay that described a loud ring that can be heard throughout a cancer center and people stopping for a moment to cheer and applaud.

Really? They applaud? Do they also applaud the man with Stage IV lung cancer who is struggling to walk down the hall for his next chemotherapy? Do they applaud for the parents of the child with leukemia who has just learned that a hard-earned remission has ended? Do they applaud for the woman with Stage IV breast cancer who has just lost her hair for the umpteenth time? You catch my drift.

My strong, probably cynical, suspicion is that someone who has not had cancer began this tradition. Whether it was a clinician, an administrator or someone from marketing who thought it would be a good story, it seems to me that it was suggested without careful thought and empathy. It may have come from good intentions, but it comes without understanding.

In response to my arguments, I have been told that: Well, at our Center, we encourage patients to ring the bell to mark any important celebration in their lives. They might ring it when they finish chemotherapy, but they might also ring it when their son is being married or they are marking an important birthday. That helps soften it, but I am curious about how often and when and by whom that bell is rung. And does the idea come from the patient or is it suggested by a well-meaning friend or staff person?

Here my imagination starts to flower. What do you think a sign by such a bell might say? Ring me to celebrate successfully beating cancer or surviving your bone marrow transplant or your daughter's college acceptance? I know, sometimes I need to try to frame my thoughts in a more positive direction.

There is something about cancer that seems to attract public attention. Many of my patients have talked about the amazing chutzpah that some people demonstrate toward their wigs or scarves or very short growing-in hair. Who gave them permission to touch our heads? Or even to make comments? Another life experience that often includes such public intrusion is pregnancy when strangers pat our bellies and remark on our changing bodies and lives. I, and most others, didn't like it then, and I didn't like it again during cancer.

There isn't a bell to ring or confetti to be thrown at BIDMC's Cancer Center. What we have, instead, is respect, empathy and endless hope. These sentiments seem much more valuable than an invitation to beat the gong.