At the end of a gruelling chemo or radiotherapy treatment cycle, it has become customary for patients to ‘ring the bell’.
This symbolic ritual marks the end of a pretty miserable time and celebrates a super-human effort in getting through it.
Ringing of the bell is sometimes accompanied by lots of applause and shouts of well done from medical staff and other patients. It is a pivotal moment, a rite of passage and a transition into a more normal life.
The ringing of the bell can really lift spirits and offers others the hope and motivation that they too can get the job done. It also helps empower medical staff by allowing them to witness the effect of all their hard work.
For some patients, ringing the bell on their last appointment can be a very emotional and meaningful part of their journey. For some patients, the ritual provides a sense of community and fuels a sense of determination in their own cancer journey.
The whole bell ringing ceremony idea was adopted from the US Navy’s tradition of ringing the bell after completing a task that went well and was started by head and neck cancer patient Admiral Irve Charles “Chuck” Charles LeMoyne.
Being a rear admiral in the U.S. Navy he told his doctor that he planned to follow a Navy tradition of ringing a bell to signify “when the job was done.” So, he brought a brass bell to his last radiotherapy treatment, rang it several times and left it as a donation.
This bell was then mounted on a wall in the Radiation Treatment Centre with the following inscription:
Ringing Out
Ring this bell
Three times well
Its toll to clearly say,
My treatment’s done
This course is run
And I am on my way!
— Charles LeMoyne
Since then, bells have popped up and have been rung by patients in corridors all over treatment wards across the world.
The bell at the ward where I have my treatment in Nottingham is based on the above and also includes a poem by Jane Brady, a patient at The Clatterbridge Cancer Centre in Bebington, Wirral, England.
In many cases, the ringing of the bell is accompanied by patients and staff lining the corridor when the patient leaves. It’s a celebration.
When that brass bell rings those listening understand that whoever is ringing the bell has been through hell, has endured, and is broadcasting their victory with pride. The chimes stand as a testament to the endurance and persistence of patients battling cancer.
Another poem you may have seen as a patient comes from the Stanford Cancer Center:
I ring this bell for myself and every other cancer patient that has, or is, or will walk the journey that a cancer diagnosis brings.
I ring this bell for my caregivers, family, friends, and perfect strangers who have given time, talents, prayer and encouragement on my behalf.
I ring this bell for each employee that works within these walls … thank you for the compassionate care you choose to give each day.
My praise and thanksgiving is for each of you and to God, the giver of your life and mine. I ring this bell, I ring this bell, I ring this bell for you!
The ship’s bell is a special symbol and highly used in ceremonies across navies and merchant fleets of the world for all different reasons, e.g. keeping time, signalling, safety and communication, alarm calls, a warning during fog, announcing whether an important personage or officer had boarded the vessel and even for baby Christenings. The Dutch Navy of the 17th century rang the bell as an order to open fire and one of the most favoured bells was the victory bell when the ship’s crew had performed well, taken down an enemy, or completed a big goal.
Some patients ring the bell, confident the worst is behind them and others choose not to ring it, aware a greater struggle lies ahead. Some ring the bells so vigorously, they break the bell!
The bell ringing ceremony can be stressful and it isn’t something some patients want to hear especially when going through their treatment. It can be disruptive to your own treatment and watching someone walk out the doors punching the air can be demoralising. It’s not that you aren’t happy for them, you are, but you know you’ve got a long road ahead and it all just feels too much.
For some patients, there might not be an end as treatment and care will be ongoing. In my case, I’m receiving immunotherapy for incurable cancer and there is no end date to it and this sort of excludes me from ringing the bell.
In this regard, the ‘victory bell’ near those with terminal conditions has been seen as unkind and unethical. To me, the sound of the bell is what I associate with a boxing match and I’m the one fighting in it!
Some regard the bell ringing as a false hope ritual because the end of treatment doesn’t mean that’s the end of cancer. It isn’t really a time to celebrate as there is still plenty more work to be done and the side-effects can last for months and years.
From a personal perspective, I know from my first cancer that cancer isn’t over after you ring the bell as I’ve had various sequelae associated with radiotherapy such as osteoradionecrosis, trismus and huge problems eating, swallowing and speaking.
It doesn’t have to be this way.
We could just get rid of the bell ceremony as some have suggested or we can have a re-think regarding its use.
We don’t have to wait until the end of a treatment to ring the bell. Who says that we have to? There are no rules that it has to be this way.
We should ring the bell each time we go for treatment and celebrate the fact that we are still here!
I like the way the Abramson Cancer Center at Penn Medicine Cherry Hill (PMCH) has redefined the treatment bell. Staff there realised that the bell can be, and should be, used in different ways and not restricted to the completion of a cycle.
They call it the ‘Bell of Hope‘ and believe that ringing it can be done at anytime such as getting a good scan result, reaching a personal milestone, or just having a good day.
This is just like the Milestone Bell at the Clatterbridge Cancer Centre and the intention is the same: it can be rung whenever you like, either in the traditional sense when you finish treatment, or at any other point.
“Basically, the staff wanted patients to give it a ring whenever it felt necessary or the patient wanted to spark hope or joy. They also chose to ring the bell when nurses on the floor hit a personal milestone like a new certification or being recognized for helping a patient. No longer was the bell ringing only for certain people, it was for everyone.”
Today (01.04.2024) was my 50th immunotherapy treatment and I decided to ring the bell to celebrate this milestone! This isn’t the end of treatment for me but I just wanted to ring it and give it another meaning. To me this is a personal best and I’m my oncologist’s first fifty!
The ringing of the bell is not just for the patient. By ringing it we are saying thank you to the staff, our families and friends and all those that have been part of our experiences. Staff, family and friends can ring it too.
We could go much further and actually ask patients and give them a say and a choice! Defining the value of the bell depends upon why people ring it, or why they don’t.
Some thought needs to be given whether the bell should be in a private or public space for those that want it keeping. If the bell remains a feature, we need to offer other patients alternatives such as a certificate, a gift or just the option to walk out quietly with dignity and pride.
Personally, I’d like to see the introduction of ‘For He’s a Jolly Good Fellow’ being sung when the bell rings:
For he’s a jolly good fellow, for he’s a jolly good fellow
For he’s a jolly good fellow, and so say all of us!
I think it is now time to reconsider the bell ceremony and consider alternative celebrations that best meet individual patients’ needs.
The aggiornamento of the ‘cancer bell’ is long overdue. Let’s widen its remit and ring the changes!
Thanks for your usual inspiration and insight John. I’m waiting for a start date for radio therapy to attack my adenoidal cystic carcinoma and you’re blogs and daily thoughts help to keep the trepidation at bay.
Thanks Richard. I know how that waiting feels and you just want to get on with it. All my best.