During the first week of October a cartoon strip character died. Her name was Lisa Moore. She was 36. She existed in the world of Funky Winkerbean. And her death was due to breast cancer.

Not surprisingly, controversy ensued. Some readers thought it was wrong that she died during breast cancer awareness month. Others were angry that she had stopped her chemotherapy. And still others felt the whole storyline was inappropriate for a comic strip. The comics, they argued, was where you turned to laugh, not cry. Yet those who had been reading Funky Winkerbean knew that this wasn’t the first time its author, Tom Batiuk, had taken on tough topics. His previous storylines had ranged from teen pregnancy and teen suicide to violence in schools and the war in the Middle East.

The Foundation first learned about the comic strip when a grandmother wrote to tell us how angry she was about it. Her daughter, who had two children, had metastatic breast cancer, and the last thing she wanted her grandchildren to see in their family newspaper was a cartoon strip about a young mother dying of breast cancer.

I wasn’t familiar with this comic strip when I first heard about the controversy. But as a breast cancer surgeon, I have had patients die from breast cancer. So, I took a look at what the cartoon strip had to say. My first impression: It was very tastefully done. My second thought: I was glad that the cartoonist had decided to pursue this storyline.

Batiuk has done what the medical profession hasn’t yet been able to do—humanize death. As doctors, we are taught to save lives. And we have gotten good at it. In fact, because of the many medical advances we’ve had over the past 30 years, it’s quite common for doctors to feel that a patient’s death means that we have failed—not just the patient and their family members and friends, but ourselves. We just weren’t good enough. As a result, many doctors never talk about death unless it is absolutely necessary to do so. And, when we do, we often aren’t very good at it.

Having gone through the deaths of family members and very good friends, I’ve come to feel differently about this. That’s why I always tried to make “it”—The “D” Word— part of the conversation I had with patients at their first office visit. It seemed to me that not mentioning death was like not mentioning cancer—what we used to all call The “C” Word. But whom are we protecting when we ignore that women who have just been diagnosed with breast cancer are undoubtedly thinking: How long do I have to live? Will I see my children graduate, or marry? Is my will in order?

I wasn’t perfect at discussing death with my patients. I’d often tell a story about a study I had read that had found that people with AIDS who had written out their wills and designed their memorial services actually lived longer than those who hadn’t. It was my way of trying to balance hope and reality, of communicating that there was nothing wrong in talking about, or preparing for, death. No one has a crystal ball. A doctor can say, “You have six months.” And it could be six—or three or nine or even longer. Some people think it’s wrong for a doctor to even suggest how long someone might have to live. I found that most women appreciated hearing the truth. Many fought back, some resigned themselves, some denied it—but very few ever told me that they felt they should have been spared the information.

I’m not saying that you should let your fear take hold, and that, if you have breast cancer, you should spend all your time worrying about dying. But I think we do a disservice to ourselves if we don’t talk about death. Not talking about it won’t make it go away. And it’s only by talking about that you can prepare children for what might happen, and leave them the legacy you want them to have.

Lisa now has a legacy of her own, too. University Hospitals (UH) in Cleveland, Ohio, has established Lisa’s Legacy Fund, which will raise money for cancer research and education. UH established the fund because it was the cancer center where Lisa received her cancer treatment in the cartoon strip. And Batiuk has published “Lisa’s Story: The Other Shoe,” a collection of the 1999 comic strips about Lisa’s initial diagnosis and treatment for breast cancer and the final series that examined her struggle with the disease and its outcome. Batiuk and King Features, which syndicates Funky Winkerbean, will donate the royalties from sales of the book to breast cancer research and education.

If you are a parent or grandparent wondering how to talk with your children or grandchildren about cancer, there are some great organizations that can help, such as Kid’s Cope and KidsConnected. In addition, Hurricane Voices has compiled an excellent Family Reading List, which is used in family support programs at major cancer centers nationwide.

A cartoon may not be a place where we expect to have “The D Word” conversation started. But that’s no reason to not keep the conversation going. It’s okay to talk about death.

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14 Responses to Dr. Dixie Mills: Talking About The “D” Word

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