Part II: Opening the Door to Hope

Constantly playing inside the mind of Ben Corn, MD, FASTRO, is a symphony of Big Ideas. And so, in conversation, after the initial pleasantries about family/weather/seen-any-good-movies-recently/last-night’s-NBA-games, he can flip a switch and riff rhythmically on science and philosophy and religion and the meaning of life. His voice is a mellifluous baritone. Crescendos, decrescendos. He speaks with the polished diction of a lexicomane. But there is an unmistakable reverb of a Brooklyn childhood in the background, which he would never want to abandon.

Ben shared his origin story as an oncologist with attendees of the 2017 ASTRO Presidential Symposium. In his elegiac eight-minute tale, “An Appointment to Keep,” an 11-year-old boy is jolted into the cruel world of malignancy and mortality after the shocking revelation of his father’s imminent demise from metastatic prostate cancer. I hope there is a recording of that talk still floating around the internet, because the narrative and the performance were sublime.

More Sublimation

I first met the young Dr. Corn, currently a Professor of Oncology at The Hebrew University, early in his meteoric rise through the academic ranks. It was my second time flubbing an interview in the City of Brotherly Love, the first a bungled try for a residency at University of Pennsylvania and the next an equally ineffectual audition for a faculty position there. Ben was already working in a grownup job as Assistant Professor and had been entrusted with leadership roles from the minute he finished his residency. Although chronologically only a few years older, he was decades ahead professionally.

Ben could have treated our 30-minute meeting as an utter waste of time with an inconsequential Southern gentile PGY-5 and listened to music through Walkman¹ headphones the whole time. He chose graciousness instead. He waxed poetic on topics ranging from ongoing RTOG studies to the psychology behind his reasons for selecting a particular color palette for the patient chart folders² at the Medical College of Pennsylvania Hospital, where he was clinical director. Unbeknownst to him, when I returned to Durham after my futile Philly foray, I anointed myself founding president of the Mid-Atlantic Chapter of the Ben Corn Fan Club, a secretive organization whose membership rolls remain confidential.

The Fan Club was completely confused a few years later when news of Ben’s move to Israel drifted our way. To me it was mind-boggling that someone on a fast track toward Chair of Radiation Oncology at [insert your favorite top five U.S. institution] would give up all of that and move a million miles away to a perennially war-torn region. Years later, with a broader lens and an awareness of Ben’s backstory, I see now that he had not only sublimated his childhood family cancer trauma into a career choice but was further channeling respect for his heritage into meaningful self-sacrifice.

Most of us would feel that that was enough to justify coasting along the rest of our lives with a clear conscience. But most of us are not Ben Corn.

Presidents and Prisoners

Dr. Corn receiving the Presidential Award for Volunteerism from Israeli President Shimon Peres in 2011.

Soon after relocating to Tel Aviv, Ben and his wife, Dvora, a family therapist, established Life’s Door, a charity organization whose primary mission is to help terminally ill patients and their families cope with angst and prepare for grief in a way that allows everyone to maximize the joy and love that can be shared when time together is limited. From humble beginnings about 25 years ago, Life’s Door has expanded internationally to involve hundreds of staff and volunteers supporting thousands of people each year through their journey. The Corns have launched programs in multiple countries (Greece, Japan, South Africa, and the UK, to name a few) and received numerous accolades for their selfless work embodied in the diverse activities of Life’s Door.

There are many praiseworthy support groups around the world that gather patients and family members in the local community center, dishing out lamb stew and hugs, lending a sympathetic ear, and maybe occasionally leading a chorus of Hallelujah.³ What sets Life’s Door apart? It is a thinking person’s movement, and its founders were quick to realize early on that they had to pivot and document rigorously their successes as well as their failures.

Ben recalls those first few years, when the emphasis was, in retrospect, too narrowly thanatological: “We did all sorts of things. We conducted retreats with patients and caregivers at a time that there was not even a Hebrew word for a retreat…The thing about that was whether we were talking to patients, caregivers or physicians, nobody really wanted to discuss death.”

At some point after hosting such an event at a beautiful resort located, with unintentional irony, near the Dead Sea, it suddenly clicked. Ben realized that Life’s Door needed a course correction. As he puts it, what people really wanted, what they really needed, “…was something else, which was the other side of that coin of life’s end, and that was hope.”

The leading pioneer in what is now known as Hope Theory was a psychologist at the University of Kansas named Rick Snyder, PhD.⁴ Dr. Snyder was a prolific author and highly regarded academic, internationally known for work in the domain of positive psychology, which involves the cultivation of happiness and fulfillment. According to Ben, Dr. Snyder’s definition of hope boils down to three elements: (a) having a goal, (b) devising a pathway to reach that goal, and (c) marshaling the agency or motivation to set out on that pathway. A proper treatment of the topic is beyond the range of this article, but the basics and certain nuances, such as how to measure a person’s level of hopefulness and how to try to elevate it, are discussed in one of Ben’s many publications on the topic.⁵

The question emerges, though, of not only whether it is possible to enhance a person’s level of hope but also whether such enhancement leads to a desired physical and/or mental health outcome. The answer might be contextual. In Dr. Snyder’s most famous experiment, individuals with a higher level of hope demonstrated a higher level of pain tolerance.⁶ In most of Life’s Door’s ongoing collaborative initiatives with an assortment of medical research entities, the common hypothesis to be tested is whether enhancing hope in patients with a particular medical disorder (dialysis-dependent renal failure, Parkinson’s disease, fibromyalgia, early dementia, or one of an assortment of malignancies) can lead to reduced perception of symptoms, improved desire to adhere to treatment recommendations, and/or a similar quality of life benefit. Future study results will inform where meaningful gains can be made. To weave together the varied research efforts — Life’s Door has over a dozen academic partners around the globe — Ben will soon inaugurate an Institute for the Study of Hope, Dignity, and Wellbeing with the dean of his medical school.

But why stop at just the traditional boundaries of the field of medicine? Is hope enhancement a good thing outside the confines of hospitals and clinics? Ben and his team were contacted by the director of the Israeli Prison Society a while back. In Israel, approximately 7,000 incarcerated individuals are released from the jails every year, but at two years, the recidivism rate, i.e., the frequency of re-incarceration — akin to a local failure in cancer treatment — is 40%. Life’s Door is going to try to reduce that rate by coaching ex-prisoners to have more hope in order to be re-integrated into society (e.g., by finding jobs and rekindling relationships).

About a month ago, Ben received a call from another VIP, the current president of Israel, Isaac Herzog. President Herzog’s wildly ambitious idea is for Life’s Door to roll out something on a national scale for hope enhancement. Stay tuned — more to follow on how that project evolves across an ecosystem with strata ranging from the public school systems to minoritized populations. In the meantime, though, anyone anywhere in the world who thinks they could use a little hope booster shot can download the Life’s Door Hopetemize app, which will guide you along a personalized hope improvement pathway.

Simpatico

Israeli and Palestinian breast cancer patients at a Life’s Door hope enhancement workshop.

In recent years, Life’s Door’s hope-augmentation workshops have incorporated a dash of narrative medicine.⁷ A winner of the 2012 Lancet Oncology essay contest,⁸ Ben was the logical choice to be the founding editor of the Narrative Oncology section of Practical Radiation Oncology 10 years ago. Franziska Eckert, MD, used the PRO narrative canvas to paint the dark dehumanization of radiation-related experiments in Nazi Germany; Norman Coleman, MD, FASTRO, reflected on being a bone-marrow donor for a cousin with leukemia; and Ritsuko Komaki, MD, FASTRO, traced her career as a radiation scientist to her youth in Japan, where outside Hiroshima her family and friends were exposed to the nightmare of nuclear apocalypse. Many now turn to that arts-centric forum before reading the science-centric articles. Ben attributes this behavior to our common human quest for meaning. Given a vehicle to offer tales of challenges and how to overcome them, physicians and patients and caregivers alike somehow almost always find a path leading to hope.

The Life’s Door workshops have also been determined to transcend barriers. There have been events where Jewish women from Israel suffering from breast cancer spent time together with Muslim Palestinian women with the same illness. Participants shared stories across a cultural chasm of their common anxieties and fears. As Ben explains in a video about the beautiful scene in the picture, "They see in the other a reflection of themselves. And that creates the desire to help the other person."⁹

Imagine that.