A Conversation with Franklin Servan-Schreiber

18 November 2013

By Pan Macmillan

Q: Why was it important to David to write NOT THE LAST GOODBYE? What did he hope readers would take away from the book?

A: It is a book to say goodbye to his readers, and to share with them the emotional and practical issues of terminal illness. He writes of his irrational fears of werewolves at night, but also of knowing there might be a white light welcoming him when he would die. He writes of retaining his dignity, of keeping hope, as well as more practical matters such as making sure his affairs were in order.

It is a unique testimonial on facing a grave illness, coming from David who was both a doctor and a patient. He hoped it would be helpful for both patients and care givers.

Q: With Anticancer, David taught us how to live well. Would you say that NOT THE LAST GOODBYE is David’s attempt to show readers how to die well?

A: His book is not about dying well but about living well until the end.

David had helped a countless number of patients at the end of their lives, and with his own cancer diagnosis, was familiar with death as both a doctor and a patient. In the book he shares with us how to retain hope in the face of fear, how to give and feel love while impaired by disability, and how to add meaning to each day beyond lassitude.

 Q: Many people struggle with how to act or what to say to a friend or family member that is terminally ill. What words do you think David most appreciated hearing during this difficult time? And what gestures helped him the most?

A: Visits by family and friends were a tremendous support for David, and let him feel he remained “in the club of the living.” He would put the uncomfortable visitors at ease by shedding all pretenses. David writes in his chapter on appreciation, “It’s not so hard to talk to someone who’s fighting illness. You have to listen with your heart and say, quite simply, ‘I’m sorry for what you’re going through. It makes me very sad. I hope you get better soon. Tell me what I can do to help’.”

He would defuse the potentially embarrassing moment for those who sensed this may be their last goodbye by saying “we can say goodbye many times.” It became a credo among our friends, and even became the title of the book in French which was published while he was still alive. Terminally ill patients have a different sense of time and social pretense than their healthy well wishers. It’s important to allow and respect that difference.

Q: How was David able to stay optimistic through the last year of his life, despite the unsuccessful treatments and his deteriorating condition? What did David do on a daily basis to enjoy life?

A: David strove to find enjoyment in the little things of everyday life, such as friends’ visits, listening to music, watching movies, going outdoors whenever possible, and eating. He wrote that a marker on the road to recovery is the return of appetite. He would put us at ease by cracking jokes, and laughing at ours. When small mishaps happened while we cared for him he would be forgiving, even playful about them. His attitude made it pleasurable to be with him and to take care of him.

As his condition deteriorated David still held hope that some treatment might work, but he also put all his affairs in order. It is a difficult balance between reality and hope that you have to adjust on an ongoing basis. He told us meditation helped him to achieve that balance.

Q: David wrote that he failed to practice what he recommended in Anticancer in one respect: he subjected himself to an exhausting and ultimately excessive workload, especially in traveling overseas to discuss Anticancer in the US media. Did he regret his decision to work so hard the last few years of his life?

A: He never regretted that decision, not even in his very last interview a few weeks before his death. His crusade to help his fellow cancer patients with new understanding and tools to regain control of their life was immensely meaningful to him. He stated that he would rather die at fifty having achieved what he did rather than later if it meant no achievement. He deeply enjoyed meeting new people, connecting with an audience, and discovering new research. His life was fulfilled, and had given him joy. There were no regrets, except for leaving his young children behind.

Q: In NOT THE LAST GOODBYE, David wrote “Dear reader, I feel your faith in raspberries and broccoli fading…I hear you murmuring, ‘If David himself, the living incarnation of this lifestyle, the ones who thinks anticancer, eats anticancer…if even he succumbs to the disease, then what is left of Anticancer?” But he goes on to say that he absolutely stands by the methods he describes in Anticancer. Why is that? And why didn’t they protect David against a relapse?

A: David felt that his relapse might invalidate the principles of Anticancer in the eyes of some readers. It pained him to imagine that anyone would fail to claim the benefits of his research because of the specious, but instinctive, belief that his relapse nullified everything he wrote. For him it was as if you’d refuse chemotherapy because it had failed for somebody else. Thousands of cancer patients die after undergoing chemotherapy, and yet nobody would think of refusing that harsh painful treatment if they faced cancer.

David was such a symbol for Anticancer that he felt his death might have a powerful negative effect, similar to Jim Fixx’s heart attack while jogging in 1984. So he wrote the book to make it clear he stood by everything he wrote, even as he shed all pretenses in the face of his fatal illness. He wanted to reassure, help, and continue to encourage fellow cancer patients in their fight for life.

In the end, David is only a single clinical case, and not a scientific experiment. He felt it was critical to emphasize that his recommendations are, above all, based on strong scientific evidence, promising clear benefits, with virtually no negative side effects. David’s initial prognostic was a maximum of six years, but he went on to live nineteen years. It’s fair to say that his method had great benefits to him, and he wanted to share that with his readers.

Q: In NOT THE LAST GOODBYE, David called you and your brothers his “rocks in this storm” because you calmed and reassured him that his disease hadn’t changed him too much. In what other ways were you able to give David solace and comfort during this time?

A: We are lucky to be four brothers who love each other and have always been there for each other. We had been by his side for his first brain cancer operation 19 years ago, and again during his first relapse in 2000, so it was natural to be at his side this time around. When you are gravely ill you need loved ones to help you through the maze of decisions, especially important medical ones. Then there are other practical matters, such as family, finances, pain management, as well as the more mundane, but no less important on a day to day basis, eating and sleeping well.

It is emotionally critical to have a loved one by your side when affected by illness. For example, David became afraid at night of vampires and werewolves. He knew it as irrational but could not help being afraid. We slept in his hospital room to reassure him, and when we could not be present we asked a cousin or a friend to be there. We are lucky to be a large and loving family.

Q: David spends a significant amount of time in this book writing about his three children. Do you feel that this book is in part a letter to them?

A: The thought of leaving his children alone was painful to him. He had many emotional discussions with his eldest son, Sacha, who at 15 years old wanted to be by his side. But his two younger children, Charlie, 2 years old, and Anna, 7 months, will not have any memories of their father. It was important for David to share how he struggled emotionally about leaving them. He left mementos for them to remember him by.

Q: David wanted to add an innovative approach to his treatment, a made-to-measure “vaccine” concocted for his own tumor, and you discovered that a patient had benefited from a treatment like this in Leuven, Belgium, so you took David there to try the same method. Do you think it helped David emotionally to try as many of these alternative treatments as possible?

A: You have to retain hope for a cure. Brain cancer has such a dire prognosis from the start that it is vital not to feel defeated. David acknowledged the benefits of denial, but it had to be rooted in some reality of innovative treatments which show true promises. In the case of the tumor vaccine research by Professor Van Gool in Leuven, Belgium, there were some demonstrated cases of prolonged life without side effects. It was a no brainer.

The other treatment David followed, on the advice of his oncologist in Paris, was Avastin which hinders the creation of micro blood vessels feeding the tumor. Again his hope was rooted in serious medical studies showing some benefits in other patients. Unfortunately none of these treatments worked for David, from a clinical perspective. However, they helped him tremendously in feeling empowered and active against the disease.