Coming to Terms With Language

Kathleen S. Ruccione

ONF 2004, 31(5), 913-925. DOI: 10.1188/04.ONF.913-925

Over the years, I have been moved by many wonderful Flaherty lectures, and I am grateful to the Oncology Nursing Society for maintaining the tradition of this lecture as a time for us to remember the heartfelt issues that are the touchstone of oncology nursing. Twenty-two years ago, I was in the audience as Judi Johnson, PhD, RN, FAAN, gave the first "Mara lecture" (Johnson, 1982). She shared with us the vision she and Mara had of living a healthy life in spite of having cancer. I was touched and inspired by Judi's words and her memories of Mara as a vibrant, active human being who lived life to the fullest. My message is dedicated to Mara and to all those who have shown us what it means to try to maintain balance, dignity, humor, health, and sense of self when confronted with cancer. My message is about language and how we use it.

Jump to a section


    Ad Hoc Committee on Health Literacy for the Council on Scientific Affairs, American Medical Association. (1999). Health literacy: Report of the Council on Scientific Affairs. JAMA, 281, 552-557.

    Albarran, J. (2002). The language of chest pain. Nursing Times, 98(4), 38-40.

    Allen, J.E. (2000, November 6). Worlds and words apart. Los Angeles Times, pp. S1, S6.

    American Medical Association Foundation. (2003). Health literacy. Retrieved February 17, 2004, from

    Annas, G.J. (1995). Reframing the debate on health care reform by replacing our metaphors. New England Journal of Medicine, 332, 744-747.

    Arroliga, A.C., Newman, S., Longworth, D.L., & Stoller, J.K. (2002). Metaphorical medicine: Using metaphors to enhance communication with patients who have pulmonary disease. Annals of Internal Medicine, 137(5, Pt. 1), 376-379.

    Baile, W.F., Kudelka, A.P., Beale, E.A., Glober, G.A., Myers, E.G., Greisinger, A.J., et al. (1997). Communication skills training in oncology: Description and preliminary outcomes of workshops on breaking bad news and managing patient reactions to illness. Cancer, 86, 887-897.

    Betancourt, J.R., Green, A.R., & Carrillo, J.E. (2002, October). Cultural competence in health care: Emerging frameworks and practical approaches [Field report]. Boston: Commonwealth Fund.

    Bushkin, E. (1993). Signposts of survivorship. Oncology Nursing Forum, 20, 869-875.

    Campo, R. (2003). The healing art: A doctor's black bag of poetry. New York: W.W. Norton.

    Dracup, K., & Bryan-Brown, C.W. (2002). The power of words. American Journal of Critical Care, 11, 312-314.

    Duggleby, W. (2002). The language of pain at the end of life. Pain Management Nursing, 3, 154-160.

    Emmory, K. (2002). Language, cognition, and the brain. Mahwah, NJ: Lawrence Erlbaum.

    Enard, W., Przeworski, M., Fisher, S.E., Lai, C.S., Wiebe, V., Kitano, T., et al. (2002). Molecular evolution of FOXP2, a gene involved in speech and language. Nature, 418, 869-872.

    Estany, M., & Guadarrama, R.L. (2001). Focused delivery model of language and cultural services. Interpreting in the community: The complexity of the profession. Retrieved August 5, 2004, from

    Fallowfield, L., & Jenkins, V. (2004). Communicating sad, bad, and difficult news in medicine. Lancet, 363, 312-319.

    Flores, G. (2000). Culture and the patient-physician relationship: Achieving cultural competency in health care. Journal of Pediatrics, 136, 14-23.

    Flynome. (2004). A database of Drosophilia nomenclature search page. Retrieved March 13, 2004, from

    Foreman, J. (2004, February 9). Commentary: When words hurt. Los Angeles Times, p. F3.

    Frazier, L. (2001). Getting your word's worth: The spoken word as a health intervention. Advance for Nurse Practitioners, 9(5), 73-77.

    Gibbs, W.W. (2002). Saving dying languages. Scientific American, 288(8), 78-85.

    Girgis, A., & Sanson-Fisher, R.W. (1995). Breaking bad news: Consensus guidelines for medical practitioners. Journal of Clinical Oncology, 13, 2449-2456.

    Girgis, A., & Sanson-Fisher, R.W. (1998). Breaking bad news 1: Current best advice for clinicians. Behavioral Medicine, 24(2), 53-59.

    Gonzales, I. (2002). Even though I don't speak English: A letter to every healthcare provider. Critical Care Nurse, 22(4), 47-49.

    Gordon, S. (1992, December 29). Perspectives on cancer: Patients need semantic cease-fire. Los Angeles Times, p. B7.

    Hauser, M.D., Chomsky, N., & Fitch, W.T. (2002). The faculty of language: What is it, who has it, and how did it evolve? Science, 298, 1569-1579.

    Hayakawa, S.I., & Hayakawa, A.R. (1990). Language in thought and action (5th ed.). Orlando, FL: Harcourt.

    Heiney, S. (1995). The healing power of story. Oncology Nursing Forum, 22, 899-904.

    Hickok, G., Bellugi, U., & Klima, E.S. (2002). Sign language in the brain. Scientific American, 288(6), 46-53.

    Hinds, P. (1994). Pass me the blue [Editorial]. Journal of Pediatric Oncology Nursing, 11, 43.

    Hodgkin, P. (1985). Medicine is war: And other medical metaphors. BMJ, 291, 1820-1821.

    Hoge, W. (2002, November 12). Latest word: "Klingons" in, "muggles" not quite. New York Times. Retrieved November 12, 2002, from

    Holowka, S., & Petitto, L.A. (2002). Left hemisphere cerebral specialization for babies when babbling. Science, 297, 1515.

    Hotz, R.L. (2002, August 30). Baby's "goo-goo" a building block of human speech. Los Angeles Times. Retrieved August 30, 2002, from

    Institute for Safe Medication Practices. (2001, October 31). To promote understanding, assume every patient has a literacy problem. ISMP Medication Safety Alert, 6(22). Retrieved March 28, 2002, from

    Johnson, J. (1982). Call me healthy. Oncology Nursing Forum, 9(3), 73-76.

    Kagawa-Singer, M., & Kassim-Lakha, S. (2003). A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. Academic Medicine, 78, 577-587.

    Kangas, S., Warren, N.A., & Byrne, M.M. (1998). Metaphor: The language of nursing researchers. Nursing Research, 47, 190-193.

    Keene, N. (1997). He lifted his eyes. JAMA, 277, 1502.

    Keller, H. (2003). The story of my life—The restored classic. New York: W.W. Norton.

    Kelly, S. (1997). Between the lines: Caring and studies combine to challenge cancer's taboos. Retrieved January 18, 2004, from

    Kingsley, E.P. (2003). Welcome to Holland. Retrieved August 10, 2004, from

    Klima, E.S., & Bellugi, U. (1979). The signs of language. Cambridge, MA: Harvard University Press.

    Kodish, E., Eder, M., Noll, R.M., Ruccione, K., Lange, B., Angiolillo, A., et al. (2004). Communication of randomization in childhood leukemia trials. JAMA, 291, 470-475.

    Kodish, E.D., Pentz, R.D., Noll, R.B., Ruccione, K., Buckley, J., & Lange, B.J. (1998). Informed consent in the Children's Cancer Group: Results of preliminary research. Cancer, 82, 2467-2481.

    Kovach, C.R., & Morgan, S.W. (2003). Doctor's orders: Rethinking language and intent. Journal of Nursing Administration, 33, 563-564.

    Krauss, M., Hale, K., Watahomigie, L., Yamamoto, A., Craig, C., Jeanne, L.M., et al. (1992). Endangered languages. Language, 68(1), 4-10.

    Kupst, M.J., Patenaude, A.F., Walco, G.A., & Sterling, C. (2003). Clinical trials in pediatric cancer: Parental perspectives on informed consent. Journal of Pediatric Hematology/Oncology, 25, 787-790.

    Lai, C.S., Fisher, S.E., Hurst, J.A., Vargha-Khadem, F., & Monaco, A.P. (2001). A forkhead-domain gene is mutated in a severe speech and language disorder. Nature, 413, 519-523.

    Lane, H. (1984). When the mind hears: A history of the deaf. New York: Random House.

    Lane, H., Hoffmeister, R., & Bahan, B. (1996). A journey into the deaf-world. San Diego, CA: Dawn Sign Press.

    Levi, R.B., Marsick, R., Drotar, D., & Kodish, E. (2000). Diagnosis, disclosure, and informed consent: Learning from parents of children with cancer. Journal of Pediatric Hematology/Oncology, 22, 3-12.

    Mabeck, C.E., & Oleson, F. (1997). Metaphorically transmitted diseases. How do patients embody medical explanations? Family Practice, 14, 271-278.

    MacFarquhar, L. (2003, March 31). The devil's accountant. New Yorker, pp. 64-79.

    Marsa, L. (2000, July 31). Illiteracy can be hazardous to your health. Los Angeles Times, pp. S1, S5.

    Maugh, T.H. (2002, August 5). Playing the name game. Biology: When it's time to come up with monikers for species and genes, sedate scientists let their sharp wit show through. Los Angeles Times, p. A8.

    Mayer, M. (1998). Advanced breast cancer: A guide to living with metastatic disease (2nd ed.). Sebastopol, CA: O'Reilly and Associates.

    McIntyre, M. (2002, September 10). Promise you'll tell if it will hurt: A 7-year-old patient offers some rules for the grown-ups who work in hospitals. Washington Post. Retrieved September 17, 2002, from

    McWhorter, J. (2001). The power of babel: A natural history of language. New York: Time Books.

    Merriam-Webster (2004). Merriam-Webster's Collegiate® dictionary, 11th edition: New words sampler. Retrieved December 14, 2003, from

    Merriam-Webster Online Dictionary. (2004a). Language. Retrieved July 23, 2004, from

    Merriam-Webster Online Dictionary. (2004b). Metaphor. Retrieved July 23, 2004, from

    Meyer, C. (1992). Coming to new terms with death. American Journal of Nursing, 92(8), 19-20.

    Moore, L. (1997). People like that are the only people here. The New Yorker, 72(44), 58-68, 70-73.

    Morse, A. (2003). Language access: Helping non-English speakers navigate health and human services. Washington, DC: National Conference of State Legislatures.

    Ogden, P.W. (1996). The silent garden. Washington, DC: Gallaudet University Press.

    Olweny, C.L. (1997). Effective communication with cancer patients: The use of analogies—A suggested approach. Annals of the New York Academy of Science, 809, 179-187.

    Oncology Nursing Society. (2000). Guidelines for culturally competent nursing practice: Understanding the patient's culture. Pittsburgh, PA: Author.

    Online Writing Lab. (2004). Using metaphors in creative writing. Retrieved January 24, 2004, from

    Ostler, R. (2000). Disappearing languages. Retrieved December 29, 2003, from

    Parker, P.A., Baile, W.F., deMoor, C., Lenzi, R., Kudelka, A.P., & Cohen, L. (2001). Breaking bad news about cancer: Patients' preferences for communication. Journal of Clinical Oncology, 19, 2049-2056.

    Parsonnet, L., & Altilio, T. (1997). Choose your words carefully: The impact of language on the cancer experience. Coping, 11(4), 26.

    Pearson, H. (2002). Biology's name game. Nature, 411, 631-632.

    Pearson, H. (2003). 260 years of Linneaeus' plant names celebrated. Nature. Retrieved September 4, 2003, from

    Pembrook, L. (2003, July 25). Patients define what constitutes manageable day of pain. Oncology Times, p. 26.

    Pennebaker, J.W., & Seagal, J.D. (1999). Forming a story: The health benefits of narrative. Journal of Clinical Psychology, 55, 1243-1254.

    Percy, W. (1954). The message in the bottle. New York: Picador.

    Percy, W. (1991). Signposts in a strange land. New York: Picador.

    Perkins, J., Simon, H., Cheng, F., Olson, K., & Vera, Y. (1998). Ensuring linguistic access in health care settings: Legal rights and responsibilities. Executive summary. Los Angeles, CA: National Health Law Program.

    Petitto, L.A., Holowka, S., Sergio, L.E., & Ostry, D. (2001). Language rhythms in baby hand movements. Nature, 413, 35-36.

    Pilcher, H.R. (2003). Earliest handwriting found? Nature. Retrieved April 30, 2003, from

    Pinker, S. (1994). The language instinct: How the mind creates language. New York: William Morrow.

    Pollock, R. (1994). Signs of life: The language and meanings of DNA. New York: Houghton Mifflin.

    Ptacek, J.T., & Eberhardt, T.L. (1996). Breaking bad news: A review of the literature. JAMA, 276, 496-502.

    Rabow, M.W., & McPhee, S.J. (1999). Beyond breaking bad news: How to help patients who suffer. Western Journal of Medicine, 171, 260-263.

    Ree, J. (1999). I see a voice: Deafness, language, and the senses—A philosophical history. New York: Henry Holt.

    Ridley, M. (1999). Genome: The autobiography of a species in 23 chapters. New York: HarperCollins.

    Rosetta Project. (2003). Welcome. Retrieved December 30, 2003, from

    Roter, D.L. (1977). Patient participation in the patient-provider interaction: The effects of patient question asking on the quality of interaction, satisfaction, and compliance. Health Education Monographs, 5, 281-315.

    Ruccione, K. (2004, May 3). In beauty it is finished. Nurse Week, pp. 10-11.

    Ruccione, K., Kramer, R.F., Moore, I.K., & Perin, G. (1991). Informed consent for treatment of childhood cancer: Factors affecting parents' decision making. Journal of Pediatric Oncology Nursing, 8, 112-121.

    Ruccione, K., Waskerwitz, M., Buckley, J., Perin, G., & Hammond, G.D. (1994). What caused my child's cancer? Parents' responses to an epidemiology study of childhood cancer. Journal of Pediatric Oncology Nursing, 11, 71-84.

    Sacks, O. (1989). Seeing voices: A journey into the world of the deaf. Berkeley, CA: University of California Press.

    Scope. (2003). Right from the start template: Good practice in sharing the news. London: Department of Health.

    Searls, D.B. (2002). The language of genes. Nature, 420, 211-217.

    Searls, D.B. (2003). Linguistics: Trees of life and language. Nature, 426, 391-392.

    Shafer, A. (1995). Metaphor and anesthesia. Anesthesiology, 83, 1331-1342.

    Shilling, V., Jenkins, V., & Fallowfield, L. (2003). Factors affecting patient and clinician satisfaction with the clinical consultation: Can communication skills training for clinicians improve satisfaction? Psycho-oncology, 12, 599-611.

    Simon, C., Eder, M., Raiz, P., Zyzanski, S., Pentz, R., & Kodish, E.D. (2001). Informed consent for pediatric leukemia research: Clinician perspectives. Cancer, 92, 691-700.

    Simpson, R.L. (2003a). What's in a name? The taxonomy and nomenclature puzzle, part 1. Nursing Management, 34(6), 14, 18.

    Simpson, R.L. (2003b). What's in a name? The taxonomy and nomenclature puzzle, part 2. Nursing Management, 34(8), 12-16.

    Singer, E. (2002, August 12). Project preserves diversity of language in miniature. Los Angeles Times, p. A9.

    Skott, C. (2002). Expressive metaphors in cancer narratives. Cancer Nursing, 25, 230-235.

    Smyth, J.M., Stone, A.A., Hurewitz, A., & Kaell, A. (1999). Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: A randomized trial. JAMA, 281, 1304-1309.

    Sontag, S. (1977). Illness as metaphor. New York: Farrar, Straus, and Giroux.

    Spiegel, D. (1999). Healing words: Emotional expression and disease outcome. JAMA, 281, 1328-1329.

    Spiro, H.M. (1990). Are metaphors reshaping medicine? Drug Therapy, 20(12), 12A-12B, 12D.

    Surveillance, Epidemiology and End Results Program. (2004). Cancer facts and the war on cancer. Retrieved February 2, 2004, from

    Thomas, L. (1990). A long line of cells. New York: Book-of-the-Month Club.

    U.S. Department of Justice. (2003). ADA business brief: Communicating with people who are deaf or hard of hearing in hospital settings. Retrieved July 30, 2004, from

    Warner, S. (2003, May 25). The message? Your children sure get it. New York Times. Retrieved May 31, 2003, from

    White, J.A., Maltais, L.J., & Nebert, D.W. (2001). An increasingly urgent need for standardized gene nomenclature. Nature. Retrieved September 16, 2002, from

    Whitfield, J. (2001). Language gene found. Nature. Retrieved September 27, 2002, from

    Whitfield, J. (2003). Language tree rooted in Turkey. Nature. Retrieved December 1, 2003, from

    Wiley, F.M., Ruccione, K., Moore, I.M., McGuire-Cullen, P., Fergusson, J., Waskerwitz, M.J., et al. (1999). Parents' perceptions of randomization in pediatric clinical trials. Cancer Practice, 7, 248-256.

    Yoder-Wise, P.S., & Kowalski, K. (2003). The power of storytelling. Nursing Outlook, 51, 37-42.