Ragged Clown

It's just a shadow you're seeing that he's chasing…


Let the bells ring out!

I follow a bunch of cancer and healthcare hashtags on Twitter. This tweet caught me off-guard.

When cancer patients complete a course of radiation or chemotherapy, many clinics have a little ceremony where the patient gets to ring a bell and all the nurses and other patients clap and cheer to mark the end of one chapter in the patient’s life and the beginning of a new one.

There were a bunch of replies to that tweet suggesting that it might be unfair to publicly celebrate an event that many cancer patients will never get to enjoy. Here’s a gentle one:

A bit of googling shows that there are people campaigning to abolish the ceremony because of the distress it causes to those people who will never get to ring the bell.

On Smart Patients, folks often feel guilty about posting good news about their treatment out of fear of offending the folks who have no good news of their own. But good news posts are invariably met by an outpouring of joy and congratulations even from those folks whose own prognosis is bleak. Of course, selection bias means that the folks who do not find joy in other folks’ good news remain silent. It’s hard to get a true picture of who loves sharing joy and who finds only sadness in other folks’ triumphs. It’s easy to sympathise with Crazy Cancer Lady:

I’m terminal too but I experience incredible joy from knowing that other people have happy moments, happy lives. To everything, there is a season.

1. To every thing there is a season, and a time to every purpose under the heaven:

2 A time to be born, and a time to die; a time to plant, and a time to pluck up that which is planted;

3 A time to kill, and a time to heal; a time to break down, and a time to build up;

4 A time to weep, and a time to laugh; a time to mourn, and a time to dance;

5 A time to cast away stones, and a time to gather stones together; a time to embrace, and a time to refrain from embracing;

6 A time to get, and a time to lose; a time to keep, and a time to cast away;

7 A time to rend, and a time to sew; a time to keep silence, and a time to speak;

8 A time to love, and a time to hate; a time of war, and a time of peace.

Eclessiastes 3:1-8

I think this would be a sad world if we decided to abolish joy on the grounds that one person’s time to dance is another’s time to mourn.

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8 responses to Let the bells ring out!

Georgina June 17, 2022

I can understand both sides and believe it is important to celebrate good news.

As a comparison, I think back of the time I so wanted to have a baby. Took us five years to get pregnant. It felt like everyone around me was having babies but me. I remember being I tears every month thinking it would never happen to me. My tears had nothing to do with other mothers’ good news, and try as I could, I was still sad.

Maybe like someone suggested, instead of ringing the bell, maybe give a medal, or a box of chocolate or something to commemorate such a wonderful time.

Just my thinking….

Robin Martinez June 17, 2022

I agree about not abolishing joy, but I’d like to get rid of the bell thing.

1. It’s cheesy. It reminds me of eating at Long John Silver’s, the fried fish place where you’re asked to ring the captain’s bell on the way out if you enjoyed your fast-food meal.
2. The big gold bell is clangy and intrusive. Dinging a hotel-desk bell on your way out of the treatment area might be okay.
3. The success is often temporary. Do people feel let down when they have to come back for more?

Why not just give the person a certificate and/or greeting card signed by the staff? Maybe add a flower or two. Hugs, handshakes, a few tears perhaps, a quiet moment of relief. This accomplishment is endurance, not necessarily success.

Janet June 18, 2022

Little to add to G and R’s sterling posts–I agree with every word they said above–but can’t help myself.

It’s a well-intentioned but too easy one-size-fits-all approach to a situation that is experienced 100 percent uniquely by each person who experiences it. It rings hollow (bad pun, I know, but I couldn’t think of another way to say it!) to some and reinforces whatever unhopeful emotions they are feeling.

I don’t know if the ringing of the bell was originally literally intended to celebrate the fact that “you don’t have to come back in three weeks!” or if it was always imbued with a broader sense of having achieved treatment success or wellness, but the latter is where it’s ended up as far as I can tell. That’s mostly where the problem lies for me.

Some people never can complete a treatment cycle because of side effects (and on top of that they somehow feel that they have failed themselves and others), some labor through to the end of a cycle while observing evidence that it’s not working, some are trying again for the second or third or more time in spite of long odds and physical and emotional misery. Some of those people can embrace the celebratory vibe in the infusion center when the bell goes off, but for some who have been working mightily to keep feelings of despair and dread under control as time and progression go on, it is a difficult moment.

There are better ways to celebrate the successful conclusion of a slog like cancer treatment, no matter how it’s interpreted. And I hope we can agree that “success”(like “survival”) is a particularly squishy concept in today’s “we’ll treat it like a chronic illness” environment.

    Ragged Clown June 19, 2022

    I think your point about people who are misled by the bell ceremony is strong (the bell means my treatment is over. I am cured). I am on record as saying that I think it’s important to understand the consequences of your treatment. If your doctor is lying to you about whether your treatment “cured” you, that’s a bad doctor. But, if you chose to believe, against the evidence, that you were cured, that’s on you. You must understand the consequences of your decisions. If the doctor did not explain, or lied to you, that’s on her. If you choose not to understand, that’s on you.

    It’s different for children. Children deserve a little joy after some tough treatment. It’s sad if the treatment does not work out but they deserve that little bit of joy anyway.

    The folks who cannot take joy from other people’s triumphs…I am sympathetic but I cannot identify with their viewpoint. I take pleasure in other people’s joy, even if I won’t get to experience it for myself. I will never get to ring the bell but I am glad that other people will.

    Perhaps the nurses who organise the bell ceremony can give a heads up (WARNING: Someone else is about to celebrate an important event in their life) so that those who find it stressful can withdraw. Or perhaps the ceremony could take place where only the people who take pleasure in others’ joy will witness it.

    I definitely don’t buy into the idea that the bell could be replaced with a piece of paper or some chocolates. I think public celebration is powerful magic and private commemoration is no substitute. I don’t think we should make weddings or baby showers private because some people will not marry or cannot get pregnant. I think we should still celebrate life even when other people will not get to enjoy it. They don’t need to jolly up, but they don’t get to veto other people’s joy either.

    Ragged Clown June 19, 2022

    I’m aware that I am probably in a minority of one here.

      Janet June 20, 2022

      For now, maybe, but we could all change our minds eventually ????? The first time I heard of the bell thing, I thought “That’s so cool!” Once in the thick of it, though, I wasn’t disappointed that our local infusion center did not employ it. It was so busy in there and no privacy for anyone lined up in their chairs and rolling their IV poles to and from the bathroom, eating the snacks they’d brought, some people there for six hours, some for one or three or ?, some obviously very ill, machines beeping intermittently, always someone snoring away (often my dad, who was not there for cancer treatment but for a blood transfusion every few weeks), nurses dealing with problems of all kinds, while keeping a pleasant demeanor for everyone. But might it have been appreciated by someone who didn’t mind all those eyes on them for a minute? Maybe so! And maybe the assembled crowd would have appreciated the distraction and shared in the joy. Hard to say. Each center will make its decision based on logistics and the preferences of the managers, I am sure, whether we think it’s a good idea or not lol Some people appreciate being the center of attention among strangers and some do not. It’s the kind of public ritual that will make some feel warm and fuzzy while leaving others cold, even if cancer weren’t involved. It takes all kinds!

      Ragged Clown June 20, 2022

      I certainly agree that people who do not want to take part in the ceremony should not have to.

Janet June 18, 2022

PS If we were talking about who wins homecoming queen or who gets the big promotion at work, who won the big lottery prize, I’d be saying yeah, people need to learn to deal with things not going their way, starting as young as possible. That kind of early learning probably helps later when the stakes are high, but today we’re talking about end of life, and I say we need to give a pass to those who can’t jolly up when the celebratory bell rings.

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