Mind Over Medicine

Dr. Paul Hamilton always chose his own path. Sometimes he created one out of thin air. Or sand. His son Skip recalls one such incident more than forty years ago in Egypt. Taking his family on an adventure, the Denver physician drove a station wagon into a stretch of desert where there were no roads.

"Of course we got stuck," recalls Skip with a laugh, "and before we knew it, we were stranded." Hamilton didn't panic at the notion of being trapped in the hot sand with his wife and young children. His calmness spread to those around him.

"I suppose looking back on it now, it was a risky situation," Skip says, "but we always trusted him to pull us out of harm's way."

After a few hours, a camel caravan came upon the lost Americans and led them to the safety of a nearby monastery.

"A week spent with Egyptian monks--that was my father's idea of a vacation," says Skip. "But that was the way we grew up. Life was always an adventure for my father. Every year he would take a month or two off from the hospital to go out and help some tribe in Kenya or bounce from boat to boat in Hong Kong giving checkups to the boat people, and he always brought us along with him. I can remember being out in some remote part of Africa wondering, 'What the heck is going on?' and Dad would give me some equipment and tell me to start pricking fingers for blood tests. I was fourteen years old! But it never dawned on any of us that something bad could happen. We just had an inherent trust in our leader."

By the early Nineties, Paul Hamilton was nearing seventy. The chief of medical oncology at Presbyterian Medical Center, he had spent his career trying to bring hope and peace to people coping with cancer. He had co-founded CanSurmount, which grew into an international network of cancer survivors. And he had started QuaLife, a Denver-based support group and home base for those facing cancer. By this time, he had spent most of his life looking for paths through the dreaded disease. Kathryn Perkey, who works at the Tattered Cover Book Store, remembers those efforts vividly. "Paul used to rollerblade into the store," she recalls, "and we would talk about new books that could possibly help his patients ease their fears and anxieties."

Last May, Perkey was diagnosed with cancer. "It was such a shock when the cancer became my own," she says. "All of a sudden, I was confronted by the mortality which Paul and I had always talked about." Hamilton, she says, helped her see cancer as a "bump in the road," not a death sentence.

And then, about two months later, Hamilton discovered that he had cancer. After surgery to remove a spot on his lung, he died of respiratory complications. But his life still reverberates.

Paul Hamilton's admirers like to point out that, although he was a skilled physician, his true talent was in giving people hope in seemingly hopeless situations--without being a cheerleader type. A patient's spiritual and mental approach to cancer was as important, he believed, as any actual medical treatment.

"One of the most amazing things about Paul," says a colleague, Dr. David Garfield, "was his ability to spend two minutes with a patient and leave them with the feeling that he'd just talked to them for twenty."

Time often stood still for Hamilton. M.L. Frohling of the Family Healing Network, who started working with Hamilton in 1981, says Hamilton was always searching for new ways to not only improve his patients' spiritual awareness but work on his own as well.

"Paul used to meditate quite a bit," Frohling recalls, "especially before he made his rounds. And occasionally, he would climb a tree and meditate up in the branches. Not too long ago, Paul was at the Denver Country Club when he saw a particularly attractive tree. He parked his bike underneath it, hung some prayer flags, then climbed up and started meditating. After a few minutes of meditation, he fell sound asleep up in the branches--only to be awakened by the sound of someone riding off on his bike. The guy obviously had no idea Paul was up in the tree and thought that the bike had been abandoned, so Paul had to scramble down and chase after him to explain."

Hamilton's eccentricities, though, never seemed to overshadow his work, which to him was talking with patients.

His former partner Garfield notes that "oncology by nature breeds a very personal relationship between doctor and patient." But Hamilton, he says, was even closer to his patients than the typical oncologist. His patients' response to him, says Garfield, bordered on worship.

"Even though he always had coffee stains and tobacco burns on his jackets and his shoes were never polished," Garfield recalls with a smile, "everybody knew he had class. What was more important to him than looking sharp was spending time with his patients. And even though he always had a lot of work, he was never hurried. He was a man of few words and he spoke very slowly, but what he said was pure quality."

Garfield points out that Hamilton's meditation was just one avenue he traveled in his quest to better understand the critical illnesses his patients had to cope with daily. "Unlike many of us when we start to get older, Paul never became rigid in his beliefs," says Garfield. "He was always open to new ideas and was willing to try absolutely anything."

Hamilton's belief in mind over medicine was the driving force that led him to found CanSurmount with cancer survivor Lynn Ringer in 1973. Skip Hamilton remembers that when his father started out in the field of oncology in the mid-Sixties, "cancer was like the kiss of death, and my father wanted to change that perception."

The simple idea behind CanSurmount was that people who had been living with cancer could use their firsthand experiences to counsel those who had been recently diagnosed with it. "Paul didn't know what it was like to have cancer," says Garfield, "so he wanted to use people who did."

Branches of the support group opened up throughout the United States and Canada, eventually reaching as far as Australia. But CanSurmount pointed up one thing that Paul Hamilton wasn't very good at.

CanSurmount's approach to cancer treatment attracted the interest of the American Cancer Society, and in 1977 the program was absorbed by the ACS. While giving CanSurmount a higher profile, the ACS brought with it the machinery of bureaucracy. And Hamilton shied away from machinery of any kind.

"My father had no mechanical talent," his son Skip says, "and he pretty much relied on his good karma and other people to help him overcome his ineptness with machines...He would drive his car without ever thinking about checking the oil, and the thing would run forever. Looking back on it, I suppose he was protected by his karma and didn't have to worry about the things that most of us do." Skip believes that his father's avoidance of things or situations that frustrated him or caused impatience was crucial in helping him maintain his thoughtful and calm approach to a stressful profession.

But one thing Hamilton's karma couldn't protect him from was the growing bureaucracy that he thought was hindering CanSurmount's original goal of personalizing cancer treatment.

"CanSurmount brought my dad's frustration out when it became a political puppet [of the ACS]," Skip says. "The direction that it was going didn't sit well with him at all."

The ACS wanted to control the organization by regulating such things as volunteer training and hospital visits, and its officials sought to eliminate paid positions in CanSurmount. One person who worked with Hamilton in the organization says eliminating paid staff positions created major problems because volunteers were often unable to properly manage programs if they were also holding down paying jobs.

One of Hamilton's close friends says that CanSurmount ultimately "got away" from him. "Paul has a classical entrepreneurial style which gets things running well," says the friend, "but as the organization got going, Paul had problems with the bureaucracy that took over. Paul's visionary talent didn't really work well with the solid mechanics of bureaucracies."

Hamilton's friends say he quietly resigned from CanSurmount as a result of the leadership struggle. One of them characterized the episode, which upset Hamilton greatly, as his "dark days of the soul." Almost immediately, Hamilton pursued his dream of setting up a haven for cancer patients by founding QuaLife. (A current CanSurmount official denies that Hamilton had concerns about creeping bureaucracy or that CanSurmount was a "political puppet" of the ACS; the official also claims that the timing of Hamilton's departure and his founding of QuaLife in 1986 was a coincidence.)

A few years later, during one of his rare interviews with the press, Hamilton talked about how he had had "a vision for a long time of a need for a house where people could drop in, have a cup of coffee, talk--a safe place, independent of the hospital. Patients don't like to go back to the hospital, even for a seminar."

QuaLife is now located on the University of Denver's Park Hill campus, in a house once inhabited by the college president. The two-story red-brick building is a sort of safe house, and the nonprofit center's flagship program is its Wellness Weekend, which is vintage Hamilton. The program emphasizes a mind-body-spirit connection by encouraging participants to express their feelings and learn to trust the group. These goals are encouraged by activities such as a blind walk, in which a person is blindfolded and led by others around or over obstacles, as well as a board-breaking exercise, in which participants write their fears and anxieties on a rectangular piece of balsa wood, then physically punch through the board to the cheers of the group.

QuaLife's executive director, Mary Jo Cleaveland, who works as a part-time nurse in pediatric oncology at Children's Hospital and has been diagnosed with cancer herself, has a long history with Hamilton. It dates back to 1969, when her stepfather was diagnosed with cancer.

"As soon as I found out about the diagnosis, I asked for someone to talk to, and I was given Paul's number," she recalls. "Paul was totally open; he gave me the information that helped me understand it in such a gentle and caring way. He was with my family the entire last week of my stepfather's life, and it was Paul who approached us with the idea of taking him off life support. His manner was so calm and compassionate that once we talked to him, we felt we could trust his wisdom in the decision completely. After you talk to Paul, you are left with a total sense of peace, and it's been that way ever since I've known him."

It is Hamilton, more than the programs he started, who sticks in people's minds and even causes some, like Cleaveland, to continue speaking of him in the present tense. Maybe that's because Hamilton always emphasized the present instead of the past or future.

Dr. Joel Miller, a close friend of Hamilton's since 1978, remembers how Hamilton's spontaneity helped him and his wife, Susan, live for the moment after she was stricken with cancer. "About three years ago, Paul and I were having breakfast," Miller recalls, "and out of the blue, he says, 'Joel, I think we ought to go to Nepal.' My initial response was to tell him that there was no way I was going to pick up amid my wife's illness and head for Nepal. But after talking to Susan, she and I realized that it would be a golden opportunity, so we decided to go. Then, three days before the trip, Paul casually says to me, 'Oh, by the way, I'm not going.'

"To tell the truth, I don't think he ever had any intention of going in the first place. But the trip turned out to be a wonderful experience. Paul had that ability to get people moving. When my wife was feeling depressed about her illness, Paul would come over to the house and take her out rollerblading."

That was a typical response by Hamilton to cancer patients.
"One of the things that set Paul apart was simply the way in which he reacted when I told him I had cancer," says Kathryn Perkey. Instead of displaying shock, she says, Hamilton was calm and "allowed me to express my own needs, which he responded to in a gentle and non-invasive manner."

Perkey, who absentmindedly caresses her bare scalp when discussing her cancer and treatment, recalls: "It was at this point when I hit on what Paul, I think, had always known, which is that having cancer can be a communal experience, but at the same time, each case is a totally individual experience.

"Before my own surgery, I talked to Paul, and he was such a tremendous help, so supportive. He even accompanied me to my first two chemo treatments--as a friend, not a doctor. That was his real strength: his ability to relate to his patients individually, as a friend and not a professional.

"As I talked about my situation, he was totally attentive, and he led me with questions like 'How are you with this?' or 'What are you doing about it?' There was no 'rah-rah' optimism. Just very comforting words of encouragement and a desire to help me focus on not getting too far ahead of myself. He was always reminding me to not project too far into the future, to stay present, and to come to terms with my cancer one step at a time."

Hamilton was adept at not suffocating her with concern, says Perkey, keeping a respectful distance and offering help only when she requested it. "Paul would do the subtle things, which really helped," she says. "He would leave a message on my machine checking up on me or pop into my chemo treatment just to say hi. He was always so aware of the shock that I was going through, and he did little things like bring me a book or a video that he thought I might find reassuring. Even with his busy schedule, he would find the time to bring these things to me or arrange the most convenient place for me to pick them up."

Hamilton would also occasionally give Perkey a printed message with short sayings such as "To Die Is Not to Be Defeated" that would boost her spirits. "He understood how important language is to yourself and those around you in situations like mine," she says. "He made sure that I kept a positive attitude."

Hamilton kept driving at the problem of finding such humanistic approaches to life-threatening illnesses. After QuaLife was firmly established, he began to slowly divest himself of many of his professional activities. In the mid-Eighties he left his practice at Hemotology and Oncology Associates (which by then was renamed the Rocky Mountain Cancer Center), and in 1988 he retired from Presbyterian Medical Center.

He remained active in QuaLife, however, and frequently dropped by his old practice, where Garfield and others kept an office for him. "We would have Paul come in to talk to patients who were having an especially hard time coping with their diagnosis," says Garfield. Still a relentless traveler, Hamilton continued to canvass the globe searching for anything that might help him better understand how to help people cope with terminal illness.

"Now that I look back on it," muses Garfield, "it was almost as if Paul had a premonition of what was coming and started to prepare for it by slowly giving up his responsibilities."

What was coming was totally unexpected. At 74, Hamilton had remained active--rollerblading, tennis and hiking were all regular activities for him. He even managed to conquer a small part of his discomfort with things mechanical. "Dad had a passion for rollerblading," says Skip Hamilton, "and for a long time, somebody would have to change his wheels for him. Finally, I showed him how easy it was, and he couldn't believe that all it took was one little Allen wrench to do the trick."

Not everything was so rosy. During a July hike meant to prepare him for a climb celebrating a CanSurmount anniversary, Hamilton noticed he was short of breath. He had a chest X-ray the following week and discovered that he had cancer himself: a very small tumor on one of his lungs.

"In the 52 years I knew Paul, he had never been sick a day of his life," recalls his wife, Anne. "He never had a rehearsal for this illness, but he was determined to pull through."

Hamilton was immediately scheduled for surgery, and family and friends say that, true to form, he kept his equanimity.

After the relatively routine surgery, however, unexpected complications arose in the form of acute adult respiratory distress syndrome, which is difficult--if not impossible--to fight off. The syndrome didn't have anything to do with Hamilton's cancer, says Garfield. "Looking back on it now," he says, "it would have been better if he never caught the tumor, because it wasn't the cancer that killed him." Hamilton had to be placed on a ventilator. After a week he was taken off temporarily so he could talk with his friends and family.

Visitors, including Governor Roy Romer, flocked to his bedside. He died on August 28, a little more than a month after he found out he had cancer. "All of us still really expect to see him come through the door," says Garfield. "It was such a shock--here today, gone tomorrow."

As Skip Hamilton reflects on his father's life, he recalls a conversation that he had with his dad a couple of years ago: "I remember asking him how he was doing, and he sort of contemplated this simple question for a moment before responding, 'Isn't it incredible that people always ask, "How are you doing?" It's all based upon what we're doing or how successful we are. Instead, I think we should ask, "How are you being?" I think that's much more important.'


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