Challenging the Battle Analogy in Cancer with Courtney Alesandro

In episode 6 of Carrie's Always Talking, Carrie has Courtney Alesandro join again to follow up on their episode from last week. The idea that dying is a moral failure and the cancer battle analogy are discussed in this mini episode. Courtney is a breast cancer survivor as well, and she shares some of her insights around how the idea of losing a battle to an illness is a way for us to separate ourselves from the painful realization that we are all going to face death at some point. The episode topic sounds heavy, but there are lots of laughs and connection taking place while sharing a similar philosophy post cancer diagnosis and treatment. 

If you have a question for next week's Who Asked Me segment, or if you have a story you'd like to tell, send me an email at carrie.always.talking@gmail.com. I'd love to hear from you.

Facebook group- www.facebook.com/groups/carriesalwaystalking/

Articles about the Cancer Battle Analogy:
https://www.npr.org/sections/health-shots/2023/02/28/1158867580/why-lost-their-battle-with-cancer-dementia-wrong-thing-to-say

https://healthydebate.ca/2013/04/about-healthy-debate/opinions-about-healthy-debate/when-dealing-with-cancer-lost-battle-language-is-inappropriate/

Transcript

Carrie McNulty (00:14)

Hello and welcome. This is episode six of Carrie's Always Talking. I'm your host Carrie McNulty. This is a mini episode today. And I decided that I would have my friend Courtney Alessandro come back and follow up on something that she had said in our last episode that kind of stuck with me. And we've had a chance to talk about it a little bit more through the week. She had mentioned

death is not a moral failing. And I sort of emphatically said yes. And then I got to thinking more about that. And especially in the context of cancer and the battle analogy that is so often used with cancer and if somebody won or lost their battle with that illness. So yeah, I think it's a interesting little brief conversation that we're having about it. Courtney is also a breast cancer survivor. She also had

cancer as well, so she can speak to it intimately as I can. And again, this is just our perspective on it. Other people may feel differently, but as we share the same perspective, I thought it would be an interesting conversation. that's what's on deck for the mini episode. To anybody who is listening and following and sharing and liking and giving positive ratings for the podcast, I really appreciate that.

Please continue to do so. I love doing it. It's super fun. yeah, at the end of the episode in the show notes, I'm gonna have a way to contact me. So if you have any questions, if you wanna be on the podcast with me, or if you want to share any comments, you can send me an email, you can send me a text through the show, and there's also a Facebook group. So I'll add the links to all of those things at the end. So without waiting anymore, let's get into my second part of the interview with Courtney.

And yeah, hope you enjoy.

Carrie McNulty (02:12)

Well, welcome back Courtney.

Courtney L Alesandro (02:15)

Thanks for having me back so soon.

Carrie McNulty (02:16)

Yeah, I know, right? Long time no see. But same. So I figured let's give people more of it, more, more. But the whole reason, like this is going to be a mini episode. And I wanted to have you back because there were things that we didn't touch on initially when we were talking because there's so much to cover. when you had said dying isn't a moral failure, I was like, yes.

Courtney L Alesandro (02:20)

You're my favorite person to talk to,

Carrie McNulty (02:46)

Yes. And so I want to talk about that a little bit more in our mini episode here and probably more as it relates to cancer, other illnesses, of course, but that is the message that people get a lot in pretty much every obituary you see. They lost their battle up. They lost their battle with cancer. It was a long, hard battle and they lost it. And you and I, know, just especially over this week of talking about how, you know, not a fan of that turn of phrase at all.

Courtney L Alesandro (03:05)

Mm -hmm.

Not a fan. Not a fan.

Carrie McNulty (03:16)

So tell me, nurse practitioner of palliative care, board certified woman, what do you think about that phrase of they lost their battle?

Courtney L Alesandro (03:29)

When I hear it from families bedside, I have a great deal of compassion. It is the way I think as a society, we have been conceptualized to see illness as a larger, you know, certainly cancer, but illness in general, right? It's a battle to fight. It's a war.

Carrie McNulty (03:50)

Mm -hmm.

Mm -hmm.

Courtney L Alesandro (03:59)

good versus evil. It's the if you do everything and bend over backwards, it's kind of the onus is on the individual. So it's a very sort of just, you know, cowboy centric, like the individual can persevere and overcome anything.

Carrie McNulty (04:12)

Mm -hmm. Mm -hmm.

Hehehehehe

Right? They won their battle, they lost their battle. They won their battle. Mm -hmm. Right.

Courtney L Alesandro (04:29)

They won the battle, they lost the battle, they are in a battle and we know that if we just pull ourselves up by the bootstraps, we can win anything. That is a very comfortable narrative we have in this country and elsewhere. I just can't speak to it because as we previously talked about, I don't really like to travel. I get too anxious. we can only assume.

Carrie McNulty (04:41)

Right.

Hmm.

I can only assume they think similar things. I've never been there.

Courtney L Alesandro (04:57)

We'll just talk about it for the country. So it's a very comfortable narrative and it is an inherent narrative that creates distance.

Carrie McNulty (04:59)

Right.

Mm -hmm. Yeah. Yeah. We talked about that. Well, so let me go back just a little to say, and I did briefly mention this in the intro, but you also have had breast cancer. So we're speaking about it, each of us, from a personal place of people were in that world to varying degrees, and still to varying degrees in that world. You're seeing people, I'm sure that you were.

Courtney L Alesandro (05:14)

Mm -hmm.

I

Carrie McNulty (05:34)

take care of his patients. I still stay connected to the boards that I was a part of when I first got diagnosed when I was 29. And so we're still connected to that world. And it's still our own body. So you still have people say to you all the time, well, how are you? Are you healthy? Are you OK? Are you in on my answers? As far as I know, I'm all right. I don't know. I guess so. But the idea that cancer is a battle.

Yeah, there's a lot that you have to go through to treat cancer and it is hard, you know, and you go through the chemo and the radiation and the surgeries and all the stuff that you have to do because you have to do that. It's not as though you have multiple other choices. Now people do make other choices and unfortunately a lot of the time that doesn't go so well for people, but if you're gonna go the route of standard of care, medically, you're gonna go through a lot, your body's gonna go through a lot and it is gonna feel like a battle. However,

Courtney L Alesandro (06:21)

Right.

Carrie McNulty (06:26)

It isn't something that you could do more of. If you just did one more round of chemo, that person would have lived. It doesn't work like that. So saying that somebody lost a battle implies that they had all of these other choices and they could have done more, but they didn't quite do everything they needed to do to be here. And to your point of it creates distance. We were talking about that. It's another thing like

somebody gets diagnosed with cancer and somebody asks them a question about it, like, does that run in your family? Or why did you end up with cancer? I want to know because I want to make sure that isn't my reality. And it's not coming from a place of people being rude or inconsiderate. It comes back to that fear of death and wanting to stay as far away from that as people possibly can. So to me, the battle analogy falls along the same line in my mind.

Courtney L Alesandro (07:13)

Sure, sure.

Carrie McNulty (07:20)

I don't know if that's your thought too.

Courtney L Alesandro (07:22)

Yeah, I mean, like I said, I think it definitely creates distance, right? Because if somebody is in a battle, they ultimately are unique individual isolated, right? That is what a, you know, when you conjure up the image of battle.

Carrie McNulty (07:37)

Mm -hmm. Mm -hmm.

Mm

Courtney L Alesandro (07:48)

So it creates distance and it also creates a sense of comfort that to the distance part that I could have won that battle. had something within me. So it's a way of providing.

Carrie McNulty (08:00)

Yeah, right, right. If it were me.

Courtney L Alesandro (08:09)

a balm to our own anxiety, right? Like this is, these are the narratives that we tell ourselves so we don't have to deal with the inherent anxiety that sitting in a presence of you are going to die naturally brings up. So.

Carrie McNulty (08:11)

Mm -hmm. Mm -hmm.

Courtney L Alesandro (08:36)

It's just a very common battle. Yeah, the analogy of a battle is very, very common. And as certainly as somebody who went through just the full McGill of treatment, I certainly internalized that message when I got cancer. also internalized

Carrie McNulty (08:42)

Right, right, right.

Mm -hmm.

Courtney L Alesandro (09:05)

the or I had already internalized I should say. So I became aware of my own feelings around needing of being the weak one in the herd of knowing that I couldn't realistically do this without support and that is not a comfortable place to be. There's you know

Carrie McNulty (09:28)

Yes, same.

Courtney L Alesandro (09:31)

shame component and lack of skill component to saying, I need help. you when you have no idea how to even begin that conversation, when you're, you know, throwing up and losing clumps of hair, it's a little hard to, you know, find your best sense. Yes.

Carrie McNulty (09:38)

Right?

Yeah,

Right, now's the time where I have all the words for this. No, it doesn't just magically happen. And I'm with you on that. I talked about it in my first episode about cancer is that that, I don't look at it as a gift whatsoever, but the journey of that taught me that I had to accept help from people. And I was not good at it before because, know, yeah. And tying in just the other episode about my mom is that when I got sick, that actually gave me street cred with her.

because it was a real like life or death thing and finally I think that kind of bumped me up a level in her mind of like okay she gets this life or death thing you know weird weird

Courtney L Alesandro (10:28)

Yeah.

Yeah, I think for like my family, it took them a second to get to the point of, my gosh, this is a big thing. I think their first inclination was to be like, this is an iteration of the battle. this is just something, a little blip. You can overcome this. You can just, you know, and again, it was a way of distancing, making people comfortable, you know.

Carrie McNulty (10:51)

Mm -hmm. Mm -hmm.

distance.

Courtney L Alesandro (11:01)

This is gonna be a sort of a side tangent, but it it sort of ties into the battle aspect that just always drove me crazy and I know when I was going through treatment we had many a good laugh over it. How much I hate the narrative of she got cancer and she climbed Mount Kilimanjaro. She grew her strength. Like those are the stories that get repeated and repeated

Carrie McNulty (11:12)

Thank

Yeah.

Courtney L Alesandro (11:31)

to take nothing away from the people who had that wherewithal and found that within themselves and needed to do it. Like all the more power to you. You will be my leader,

Carrie McNulty (11:39)

Mm -mm. Right. Very, like as we've said, risk averse, I'm not doing that. But yeah, good for you if you are, right?

Courtney L Alesandro (11:48)

Exactly.

Carrie McNulty (11:49)

And also, I just want to add to other cancer survivors, if that is how they want to compare their journey, that is 100 % okay too. This is just you and I kind of saying for us, this is not the mindset that we have around cancer or the way that we view it. There might be other people that love the battle comparison or the war comparison or whatever. I am going to link some articles that show that other people feel the same way we do, but I'm just saying there are probably other people out there that feel differently. But that's just not your experience or my experience. Yeah.

Courtney L Alesandro (12:14)

Yeah.

Right, right, and less to me important about, you know, the

maybe the concept of thinking it's a battle and if you find strength in that, what I think would, I would engage in a conversation with almost anybody about is that absorbing these narratives and internalizing these narratives and seeing repeatedly the stories again of the person going through cancer treatment, who have climbed Mount Kilimanjaro, all the more power to them. But

most people have an experience where they just want to sit on the couch under a blanket. You know, we're either, you know, just emotionally work through physically work through or just exist. So these are all stories that we tell ourselves to separate us from the pain. And that

an argument I would engage in. Not necessarily that the battle analogy is inherently bad or unhelpful, but why do we use it? And what does it mean when somebody loses that battle?

Carrie McNulty (13:41)

Mm -hmm.

Right. And I think what it means is their own body that developed the cancer within them. wasn't a foe outside of your self, right? It was your own cells that went rogue and set up shop and began creating whatever it is, you know, whether it's invasive or non -invasive, it's still a problem. And it started creating that. And that was internally something that happened within your own body. And so in essence, we're saying that you lost the battle against your own.

body, you know? And that's not, your body doesn't have any intent to harm you. That's really not where that's coming from. It's just interesting to me, I guess, that.

We have to make it something outside of ourselves, even though it's something coming from within. We have to make that narrative of it's something outside, it's an enemy that we can't see. And I will just say this, typically there are supposed to be roles of war and there aren't any with cancer. It just kind of does whatever it wants, right?

There's no you could do everything right. I have had friends who were vegan ran marathons Were treated their body the best way that they could possibly treat their body and unfortunately They are no longer living because of cancer and there was nothing they could have done any different, right?

Courtney L Alesandro (15:06)

No,

Again, you know, I know I'm sounding like a one trick pony here. But

Carrie McNulty (15:14)

Ha ha!

Courtney L Alesandro (15:19)

you know, did you do everything that you can? Did you with or without cancer? Right? Let's so even if we take cancer out of the equation and we look at somebody who who is vegan, who is running, who's doing all the things that they should be doing. They are somehow more

Carrie McNulty (15:37)

Mm -hmm.

Courtney L Alesandro (15:49)

Just.

Carrie McNulty (15:51)

Yeah. Well, that brings us back to the moral failing, right? Like, yeah.

Courtney L Alesandro (15:55)

Right. So that person who develops cancer, if we're keeping with all this, the same narrative, that was more unfair. That was more unseen. That was more tragic than somebody who's just trying to live their life and, you know, maybe walks, you know, infrequently or

you know, tries to get a vegetable in, it's just doing the yeah, doing the best that they can.

Carrie McNulty (16:26)

just really loves Doritos.

Yeah. Well, that's like, they have lung cancer. were they a smoker? Yeah, right? Like it's, OK, well, that's why that happened to you.

Courtney L Alesandro (16:34)

You know, like, were they a smoker?

Yeah, and as soon as you say, no, they weren't a smoker, you could just feel the anxiety.

Carrie McNulty (16:47)

yeah, and that's when the, did it run in their family question comes, you know? there has to be a reason. And sometimes, a lot of the time, there is no reason. There's no reason. It's just bad shit happens. There's no reason. You know?

Courtney L Alesandro (17:04)

Yeah, mean, you know,

Carrie McNulty (17:07)

Like you did genetic testing, right? And nothing came back positive for you. You just had cancer.

Courtney L Alesandro (17:12)

I just had cancer. Yup.

Yeah, just things happen and sometimes people could also do everything horrible to themselves and live good, fruitful lives.

Carrie McNulty (17:24)

Right, right. Yes, yes, they can eat all processed food. And by the way, have no, food doesn't have a moral value to me either. As an eating disorder therapist, eat whatever you want. There is no good or bad with food. Anyway, just had to say that. But to the outside opinion, they didn't eat this certain way or they smoked their whole lives and they don't end up with anything related to cancer.

Courtney L Alesandro (17:34)

Yeah.

And sometimes you can feel an undercurrent of resentment.

Carrie McNulty (17:53)

Mm -hmm. yes. Yes, yes, yes. That's not fair. Mm -hmm. Mm -hmm. Which, you know, got a secret. Life is

Courtney L Alesandro (17:57)

No, that's not fair.

If it just wasn't fair.

Carrie McNulty (18:07)

It's not fair. Life isn't fair. Stuff like that happened. But also again, it's like that person isn't deserving of cancer because they made different life choices as somebody else. But you're right. There's the undercurrent. It's not blatantly said, but there's the feeling of like, hmm, you know? And again, it's not because, well.

Courtney L Alesandro (18:25)

Absolutely. Who would say that out loud? That's terrible.

Carrie McNulty (18:29)

I'm sure there's somebody that would say it out loud. again, I'm not trying to, and if you are a person who finds yourself having said or done any of these things, this is not to guilt or shame anybody. This is to point out the connection of the need for distance between, and it's self -preservation. It doesn't make you bad person. I have said prior to being diagnosed with cancer, I have asked questions of people like, did it run in your family or why did it happen or those kinds of things. My perspective changed once it happened to me.

Courtney L Alesandro (18:31)

It's terrible thing to say.

Carrie McNulty (18:59)

in my way of thinking, but that wasn't overnight either. So it's not to put anybody down if that is their perspective, but just to say, just to make people think a little differently about it.

Courtney L Alesandro (19:10)

God, I'd be lying if I said that upon reading, you know, so and so has this disease that I don't look for a cause within that article and feel relief if there is a cause of whatever disease that they have that provides distance to me. Like, I think this is, yeah, we're only human, right? And the

Carrie McNulty (19:19)

Mm -hmm. Yeah.

Mm -hmm.

Totally human. Yeah.

Courtney L Alesandro (19:40)

exercise of wanting to be closer, the exercise of connection. That's something you just have to do constantly. And this is one of those exercises that forces you to want to look at yourself and look at what distance you're putting in. certainly not to judge anybody, but to say like this is an opportunity when you want to start thinking these things to take a little

reflection in and got curious.

Carrie McNulty (20:11)

Yeah, yeah, get curious. I always am a fan. Get curious. wonder why I'm wondering that. Hmm. okay. Yeah, because it's uncomfortable and we don't seek out discomfort. That's not how we're programmed. yeah.

Courtney L Alesandro (20:23)

No. Why would we? No, that's terrible. Why would anybody seek out discomfort?

Carrie McNulty (20:29)

Hmm, what uncomfortable thing can I do today? Yeah, nobody thinks that and and not everybody knows what to say in situations when somebody presents information to them like hey I have cancer not everybody knows what to say to that and so we all under and I think everybody I won't say everybody but a lot of people who've been on both sides understand that it's it's a hard thing to talk about or to know what the right thing to say is and a lot of the time the right thing to say is

I'm sorry that you're going through this. Even to admit that you don't know what to say. There isn't a lot that I can say about it, but I'm thinking about you and you know, there isn't some magical thing. And it isn't the end of the world if you do ask about somebody's family history. But I guess like Courtney said, this is an invitation to think about, why am I asking that question? Is this making me uncomfortable? And chances are it is, because it is uncomfortable.

Courtney L Alesandro (21:01)

yeah.

It is comfortable, absolutely.

Carrie McNulty (21:25)

Yeah, I've never known anybody to go through treatment and be like, this is when I have felt the best in my life. I feel the most comfortable with what's going on with me. I like this direction. Yeah, this feels great.

Courtney L Alesandro (21:34)

Yeah, this feels really good. This feels really good. Yeah. And then back to my other point, and then I have to be like, my gosh, other people are climbing Mount Kilimanjaro. And I'm wondering like.

Carrie McNulty (21:44)

Mm -hmm.

Courtney L Alesandro (21:51)

I think I ate chicken salad almost every night. Chicken salad and Taco Bell. Like I've never eaten Taco Bell a day in my life. And all of a sudden I got a hankering for bean and cheese burritos from Taco Bell when I was going through chemotherapy. Thought my mother was going to have a heart attack. She was so concerned about the Taco Bell, mostly because I'd never eaten it before in my life. And she's like, my gosh, why are you feeding your body that?

Carrie McNulty (22:01)

You're

Because when

Courtney L Alesandro (22:21)

Because people are climbing out Kilimanjaro and you're sitting on the couch now with a new junk food habit. I

Carrie McNulty (22:26)

And you literally will eat anything that sounds good to you because everything typically tastes like metal. So if something doesn't and you're like, that sounds good, then you just eat it. And that's basically what your oncologist will say, too. I don't care what you eat. Just whatever you can eat. Sounds great. Do that. Do more of that. So, yeah, it's really fun experience. Don't know why anybody would want to talk about it. Yeah.

Courtney L Alesandro (22:32)

Mm

anything different.

Carrie McNulty (22:55)

So is there any parting words you want to leave with or do you think that we've done a good job of covering this? I feel great about it. I don't know about you.

Courtney L Alesandro (23:05)

Yeah, think I liked what you said about just getting curious. I think, you know, we were certainly talking about cancer, but I think being curious about your feelings and therefore your

sort of words and actions and avoidance around death, whether or not that's a death and illness and whether or not that's something, know, gosh, unexpected, this young person, this is tragic, or, you know, somebody lived a wonderful life, but over the course of, you know, 90 years, their body slows, their body becomes more,

Carrie McNulty (23:31)

Mm.

Courtney L Alesandro (23:58)

It weakens and it needs and it needs people around and it needs people who don't want to make this person 20 years old again or wish or wish with our words that this person was behaving like a 20 year old. So death comes for us

Carrie McNulty (24:01)

Mm

Yeah. That's an uplifting last message. Is this one of your contemplative? This is your contemplative medicine chant that we're doing at the end of this episode. Well, as always, thank you for talking to me and joining us. And I am going to link just a couple. You know, I did a brief search for a couple of articles and sort of support the idea of, know, why.

Courtney L Alesandro (24:24)

Yeah, that's not enough. You see I don't get invited to many cocktail parties.

Mm -hmm. is.

Carrie McNulty (24:47)

Kind of some of the issues with referring to cancer as a battle. And if somebody wants to read those, can. And if not, well, we'll be there in the show notes anyway. Next week will be a longer episode. And I'm planning on having another guest. going to talk to them later today to solidify that. So I'm not going to say for certain. But that's the plan. And until then, I hope everybody is doing OK and that you're well. And I'll catch up with you next week.

Courtney L Alesandro (25:06)

Okay.

Carrie McNulty (25:17)

Thanks a lot. Bye.

Courtney L Alesandro (25:17)

Yes, take care of yourselves.