Tag Archives: Medical Decision Making

A Doctor’s “Creed” – A Medical Review  

Creed

“I’ll fight, if you fight.”  Adonis Creed, to Rocky Balboa.

“First, do no harm.”  Hippocrates.

————————-

History of the Present Movie

The newest addition to the “Rocky” franchise, Creed, has gathered critical commendation as the best entry in years.  Like many of my generation, I was a convert to the original Rocky (1977), rooting for the workingman’s underdog from Philly against the Hollywood champ, Apollo Creed.  I delighted in the moral victory earned for completing the fight, despite the official loss on the judge’s score cards.  I absorbed all the iconic scenes: running up the courthouse stairs, chasing a chicken around the yard, and punching the slabs of beef.    Like many, I followed Rocky Balboa’s transformation over the years, holding my nose at his transformation into a cultural icon and buffoon-like superhero.  Even as future medical student, the horrific violence that was at the center of the storyline never troubled me.

It was with some trepidation, then, that I let my 12-year old son talk me into seeing this newest entry.  It was his preference over that other movie-saga of my youth, Star Wars.  But I had heard good reviews, including from a social worker colleague and an overheard locker-room comment that Stallone was a candidate for an Oscar for his role, a nomination which would be his first since Rocky.  The nuanced updating of Rocky as a mentor to Apollo’s kid promised a breath of fresh air into the storyline.  “Fine,” I thought, I’ll give it a try.”

 Review of Symptoms (No Spoilers)

The critics are right – it is the best Rocky movie since the original.  It is an inspiring story on two related fronts: the importance of pursuing your own vision while owning one’s past.  These themes play out in both main characters, Adonis and Rocky.  Over the course of the movie, each avoids owning their past, leading to difficulties in dealing with the present.  Conflicts arise, especially between the two, as the past threatens the future. As the climactic fight sequence arrives, both slowly own their past, and that emotional catharsis clears the field for moving into the future.  While predictable, the understated dialogue and tough-love demeanor make it work.  And then the overstated punches get thrown.

The director faces a similar challenge, trying to advance the new themes, while echoing the past,without descending into a cheesy reproduction.   The allusions to the private Rocky vs Apollo “third fight” that freeze-frames to end the second film is a nice touch – didn’t you really want to know who won the deciding match?   An appearance of the actual Rocky Balboa statue, with photographing tourists, is a perfect touch.  The re-ascent of the Courthouse stairs is imagined with a deft nostalgic touch.   Overall, the call-backs work, fitting smoothly into the narrative flow.rocky1

One bit of nostalgia doesn’t quite fit: I’m not sure Stallone’s performance is Oscar-worthy.  His genuine skill as an actor shakes off decades of shlock, a surprising butterfly, perhaps with crippled wings, emerging from its shell.  His understated charm works as an older man passing on the torch of fame.  One roots for the character and the actor to pull it off, and it really happens.  The buzz for awards is a consequence from the low expectations he’s set over the years.  But ultimately, this is Stallone as Rocky, a near-enough match to credit too much to acting brilliance.  It’s a ultimately a bit sad to see Stallone, the genuine actor, whose been lost over the years to the action-hero automaton.

 Medical Decision Making (Spoiler Alert)

My biggest problem with the movie was from a medical perspective.  A number of issues distracted me from the storyline, and they stemmed from the lousy doctoring, bad medicine, and questionable morality.

  1. First, Do No Harm — Cancer is featured as a significant part of the storyline. After a sparring session in which Rocky ends by vomiting and passing out, he is hospitalized. Following a hospitalization, he returns to the doctor’s office to find out he has non-Hodgkin’s lymphoma, a type of cancer of lymph nodes.  He is told by the doctor that he needs surgery and chemotherapy.  He refuses to consider treatment, saying that he saw his wife Adrian go through that, and “it didn’t go so well.”  He asks the flabbergasted doctor to keep this private.  She apparently agrees to do so, but gives him some pamphlets to read.  He sticks them in his pocket and heads out.  Most of the scene plays out with both parties standing up, rather than sitting for a heart-to-heart conversation.
  • So many things bothered me about this scene: the doctor’s paternalistic approach to the care, the blunt delivering of a life-threatening diagnosis, and the heavy-handed insistence on treatment without further discussion.  What about shared decision making?  What about asking about the patient’s experience?   When the patient says he had a prior “bad experience” with his wife, aren’t you going to explore this?  I was applauding internally when Rocky walked out the door, until I realized HE was supposed to the one acting inappropriately.
  • Ok, I admit that it’s a movie, that nobody wants to observe a 15 minute shared-decision-making conversation, and the plot needs to move along.  I also understand that doctor’s sometimes, perhaps often, act in this heavy-handed way, as Amy Berman has so eloquently taught us.  But I was appalled to see this portrayed so clumsily in a movie for mass consumption.  It feeds into the perception that cancer is a death-sentence, that heavy-doses of chemotherapy is the only way to cure the disease, and anyone thinking otherwise is misguided as best and foolish at worst.  This is a dangerous perception, with each element of the above containing falsehoods.
  1. The “War against Cancer” – A primary storyline for the movie is that Rocky’s legendary hardheadedness is at fault for his decision-making about cancer – that he is “giving up” by refusing to undergo chemotherapy. Adonis threatens not to fight in the championship bout unless Rocky “fights” against his cancer – i.e. he chooses to get accept chemo. Stemming back to the “War on Cancer”, we have continued to propagate the imagery of “fighting” or “battling” against an enemy, with the image of “giving up” or “quitting” on the other side of the ledger.  Given an opportunity to use Rocky’s cancer diagnosis as a metaphor for wisdom, understanding, and communication, the film falls into the same cultural trap of a war.
  1. Head trauma – Who can forget Rocky, in the midst of being pummeled by Apollo, his eyes swollen shut, telling his trainer to “cut me, Micky” – to cut his eyelids so he can see? The dramatic scene is a consequence of all the head trauma from the fight. One of the themes of Creed is that Apollo DIED from being punched in the head, which is why Adonis’s step-mother won’t let him fight.  One of the least believable parts of the movie, frankly, is that Rocky has lived long enough to get cancer, rather than suffering from Traumatic Brain Injury from repeated concussions.
  • The film doesn’t shy away from illustrating the damage occurring.  In the final dramatic scene, Adonis is knocked cold, blood flying, (with significant screaming from a woman in our theater) – only to literally spring up from the mat to finish the fight.  With his formerly anti-violence step-mother at home cheering him on, he finishes the fight, eyes swollen shut and massive bruising on his face (and presumably to his brain).  It was difficult to walk out of the theater, directly past the marquee for the movie Concussion, and not reflect on the glorification of head trauma we had just witnessed.

Thankfully, after the movie, I asked my son what he thought about boxing, and he said, “I’ll stick with gymnastics.”

Leave a comment

Filed under Decision Making, End of Life Care, Geriatric Oncology

Joshua Hemmerich, RIP

Joshua Hemmerich, PhD, was the first project manager I hired after I received my first grant as a new faculty member at the University of Chicago in 2004.  He was recommended to me by a member of the Society of Medical Decision Making, Julie Goldberg, PhD, with whom Josh had worked at the University of Illinois-Chicago.  As a cognitive psychologist with significant training in statistics, Josh was a perfect fit for my research agenda on the role of emotions in medical decision making for older cancer patients. Over the next decade, we became well-matched research colleagues as well as close friends.

Over that decade, as we co-authored 25 papers and successfully competed for several grants, we also shared innumerable conversations about life growing up in small towns in the Midwest, especially about playing sports under the demanding eye of tough-love fathers.  Over the years, we attended many SMDM conferences together, and we even managed to attract one of the Founding Fathers of the field, Arthur Elstein, PhD, to join us as a mentor and a collaborator.  We both marveled at our good-fortune to get to know such an important scholar who is also such a supportive mentor.  We each continued to build our respective careers, with Josh becoming the Research Manager for our Section of Geriatrics & Palliative Medicine, and then joining as our first PhD-only hire onto the faculty, an unusual ascension for a staff member.  When I became the Section Chief, we continued to expand our research, as Josh began building his own independent career, including as the Newsletter co-editor for SMDM.  Although we had increasing less time to share on non-work-related discussions, we were both looking forward to contributing more to the field of medical decision making.

With his untimely passing, coming as a shock to us all, I will deeply miss having Josh around, both personally and professionally.  In many ways, I am still struggling to figure out how to move our shared agenda ahead without him.  He was a uniquely gifted person, combining the insights of a psychologist with the acumen of an excellent statistician.  And for such a talented person, he we very down-to-earth and friendly, quick to tell a joke or to shoot the breeze about the latest in Cleveland versus Chicago sports.

One thing many may not know about Josh was his love of books.  I always admired, when I stopped by his office to chat, his eclectic collection of books on a wide range of topics from statistics, to cancer, to history, psychology, and (of course) decision making.  In honor of this collection, we have gathered the books he left behind and created the Joshua Hemmerich Memorial Library, which now lives in our Section Conference Room, for all to enjoy and to honor his memory.

1 Comment

Filed under Uncategorized