“It was hard to say the ‘C-word’,” recalled Barbara Bates Smith. “I’d been diagnosed with cancer, and I felt a resistance to even speaking the name of my disease. When I realized that was true for many people, not just me, I had this idea.”

Last August, Barbara had played the lead role in “Wit” at the Haywood Arts Repertory Theater in Waynesville. The Pulitzer-prize-winning drama by Margaret Edson opens with a poetry professor, Vivian Bearing, telling the audience that she has been diagnosed with ovarian cancer. “It is not my intention to give away the plot,” Professor Bearing states wryly, “but I think I die at the end.”

That coincidence — playing the role of a cancer patient, then being diagnosed with cancer herself — struck Smith as too significant to ignore. She wondered if it might be of value to offer some form of interactive discussion about cancer to community groups that deal with the subject: health care professionals, caregivers, counselors, clergy, patients and their families. The purpose would be to bring the “C-word” out of the closet, to open up communication and dissolve the stigma that cancer patients often feel.

And then her idea sprouted wings. A three-way doctor-patient-audience dialog could be the basic format. The opening monologue from “Wit,” in which Professor Bearing talks about her diagnosis, would be a good springboard for discussion, since it addresses a patient’s response to cancer. The next scene would be good, too, when Bearing’s doctor explains her medical situation.

Then Barbara had a brainstorm: Why not ask a real doctor to read those lines? Short of a miraculous return to perfect health, what most patients and caregivers would wish for is an opportunity for a relaxed, candid discussion with a doctor.

And she knew just the man for the role: her own oncologist, Eric Kuehn, MD.

•••

Barbara and her husband Russell had driven to Asheville early on Sept. 11, 2001, for a series of preoperative tests and interviews. Barbara was scheduled for surgery two days later and had a big decision to make: to have her whole breast removed, or just the lump, followed by 30-some trips to Asheville for radiation therapy. Through the day, as the Smiths went from one appointment to the next, they became aware that there had been some catastrophe. Though they didn’t grasp the full impact of the terrorist attacks, they sensed the shock and distress of the medical personnel they interacted with. Smith felt increasingly troubled. No one could find her mammogram. She began to doubt if the people administering the tests and interviews would be able to focus sufficiently on their work, under the circumstances. And she felt guilty to be worrying about herself, her “one little tumor,” when so many were suffering much greater losses.

Toward the end of the day, the Smiths were scheduled to meet with Dr. Kuehn, of Mountain Radiation Oncology, to discuss Smith’s decision about treatment. Russell Smith is familiar with the world of medical care, from two angles. A physician for 35 years before he retired, and now a deacon at St. Andrew’s Episcopal Church in Canton, he serves as a chaplain at Haywood Regional Medical Center. Struggling with the temptation to advise his wife — “I knew exactly what my decision would be,” he said — he wondered how the oncologist would approach that very delicate issue. Right away, he was impressed by Dr. Kuehn’s skill in helping his wife make her own choice. Barbara Smith’s anxiety began to dissolve. In spite of the distractions of that day, Dr. Kuehn sat down and offered her exactly what every patient wants, undivided attention. He would take responsibility for finding the mammogram, and by sundown, he said, he would call her with the information she needed to make her decision.

•••

The dialogue Smith began to envision a few months ago was an ad lib exchange on the taboo subject of cancer. She would talk from her personal experience as cancer patient, Eric Kuehn would speak to the medical issues, and the audience would be invited to participate with questions and comments. When she told Dr. Kuehn her idea and asked him to team up with her, he readily agreed.

“The C-Word: A Doctor-Patient Dialogue on Cancer” was first presented on May 23 to the Chaplains’ Association at Haywood Regional Medical Center. The 45-minute program embraced the gamut from tears to laughter, from unanswerable questions to practical information on many aspects of dealing with the disease.

Smith and Dr. Kuehn began with an impromptu exchange describing their initial meeting. In retrospect, their encounter had a comic aspect. Dr. Kuehn had found it “a challenge” to concentrate that day, and he was perplexed by the bald woman in his office. Why was she asking him about treatment if she’d already lost her hair to chemotherapy, and why wasn’t it mentioned in her file?

The small tumor in Smith’s breast was not out of the ordinary, given what he was accustomed to seeing every day in his profession. In the context of her profession, however, the circumstances surrounding the occurrence of cancer were extraordinary indeed. “Wit” had been such a success that it was held over into the first week of September. Barbara still had her final performances ahead of her when she learned she had breast cancer. Playing the role of Professor Bearing, she wore a hospital gown, was barefoot and attached to an IV — and had her head shaved.

Dr. Kuehn was relieved to know the explanation for Smith’s bald head. Because of the missing mammogram, however, he was unable to complete his evaluation while she was there. He promised that he would accept responsibility for finding the mammogram and call her before sundown with the information she would need to make her decision.

What had happened in the rest of the world became clear to Barbara and Russell only after they got home. By the end of the day, however, they had one piece of good news. When Russell answered the telephone in the late afternoon, the doctor asked him, “Has the sun set yet?” The caring attitude expressed in his making and keeping his promise, at a time when anybody would have been forgiven for calling a day or so later, confirmed the Smiths’ sense about Dr. Kuehn. Barbara’s treatment would be handled by a physician for whom they could feel not only admiration but affection.

•••

At the Chaplains’ Association meeting, after relating how they met, Smith and Dr. Kuehn read the opening scenes from “Wit,” in which the patient has just been told by the doctor that she has cancer. The lines disclose the patient’s thoughts while the doctor uses technical terms to explain the life-threatening diagnosis — a stressful situation many people can relate to.

Members of the audience responded with accounts of personal struggles with cancer, in friends and family members and themselves, as well as what they find helpful in their work with the sick and dying. The topics they raised are familiar to anyone who has dealt with serious illness. What do you say to someone who has just been diagnosed with cancer? What to say to a person who will not recover? We long for something better than fake cheeriness, or grave concern, or pep talks.

Asking questions can be helpful, it was pointed out, if you listen carefully to the response. As we learn at the beginning of “Wit,” to use “How are you feeling today?” to greet a dying patient, followed immediately by a hearty “Great! That’s just great!” is absurd. Expressed as a genuine question, however, the same words have a completely different effect. And in place of the clichés that we tend to fall back on, merely sitting together in silence can be comforting. Even in the worst situations, according to Rebecca Snure, an audience member representing the Stephen Ministry at First Methodist Church in Waynesville, you can always say, “This must be difficult for you. Would you like to talk?”

Of course, cancer covers a broad spectrum. In Smith’s case, it was easily treatable. In other cases, it claims lives, often after great agony. The physician’s perspective on incurable disease, according to Dr. Kuehn, is to concentrate on specific goals to relieve pain and improve the patient’s quality of life.

In yet another odd coincidence, Smith recently lost a close friend to cancer. At a supper for newcomers at St. Andrew’s Church last fall, Smith encountered another woman without hair. Looking at each other, they felt an instant rapport that quickly became a deep friendship. Cheryle Robertson lived only a few more months before succumbing to ovarian cancer — the same cancer that kills Professor Bearing in “Wit.”

At one point, Smith wrote in her journal:

Now it hits. I have cancer. I had thought I was invincible. I’m not. It’s The Big C — & it changes everything .... In fact, right now the whole world has cancer. What can I — we — do about it? I don’t know ... except to live in the present moment ... realize & accept dependence upon others .... Mainly, to have compassion. And to spread the word.

“Through the play, through my closeness with Cheryle, and through my own experience as a cancer patient, I have learned a lot,” Smith says. “I feel something like a compulsion to share all this. Maybe it’s because I’m an actress, which means I’m in the business of sharing. I just hope the sharing can be helpful to others.”

•••

Dr. Kuehn’s approach, he told the chaplains’ group, is simple: he tries to put himself in his patients’ shoes. For anyone who has been diagnosed with a serious disease, he said, that’s the main thing in life at that moment. He offered the chaplains some important advice he had received at the beginning of his medical career from an older doctor: When you enter a hospital room, even if you have only a minute, always sit down.

Throughout the audience, you could hear appreciative sighs and soft expressions of agreement. From their own experience, chaplains know that especially in situations when words may be difficult, to give a visible sign of one’s intention, one’s willingness to just be present with a person who is ill — that may be the most important thing one has to offer.

The chaplains’ perspectives shed further light on how to deal with the challenges of visiting people who are sick and dying. Among difficulties they regularly face are how to respect conflicting wishes of patients and family members and how to be attentive to the needs of all the people affected by a life-threatening disease.

“Our purpose is to uphold the dignity of the patient,” one chaplain said, “including respecting their wishes — which may include not being visited by the chaplain.” Chaplains and physicians often face the same ethical problems, as when a family wants to keep the diagnosis of cancer from a patient, or a patient wants to protect the family. In such cases, one chaplain suggested, you can ask each person, “What would you want if you were in the other person’s shoes?” Other recommendations from chaplains included checking with the attending nurse to find out a patient’s condition before going in to visit, and especially for hospice volunteers, to take time before the visit to prepare oneself.

By the end of the program, the roomful of people had shared a broad range of personal and practical information on an emotional subject that many of us tend to avoid. People said that they had found it helpful, enlightening, and refreshing to share such open discussion with a doctor, especially in an entertaining format. There was a sense of kinship in the face of suffering. To hear an actress describe her real-life experience with a disease that struck her at a most improbable moment reminds us that human life is subject, at any time, to the utterly unexpected. To learn about the personal side of a doctor’s experience reminds us that we are all in this together. To witness the caring concern that people feel for one another is to remember our connectedness and our good will. To consider such difficult issues in a free-flowing interchange that allows laughter as well as tears is a testament to hope.

Barbara Smith and Eric Kuehn are offering their dialog as a public service to other community groups. Their hope is that it will help bring the “C-word” out of the closet and into the light of candid, compassionate discussion. If the presentation on May 23 was any indication, their hopes will be borne out.

For booking or further information on this program, call Barbara Bates Smith at 627.8923.