Archives of The Cheerful Oncologist, Volume 2

“Courage is not the absence of despair; it is, rather, the capacity to move ahead in spite of despair.”
-Rollo May

Last week a patient of mine with breast cancer who was fortifying herself for a long course of adjuvant chemotherapy asked me a poignant question. For some reason I found it easy to answer her and it was not because I am necessarily blessed with a Lincolnesque ability to comfort the stricken. In this case I was just thinking fast. I listened to the question and then suddenly got an idea - I answered her by posing another question:

“It’s not ‘How do I get through this?’ but rather ‘How do I not get through this?’”

She looked at me with pleasant expectation just as I realized I had pulled this answer out of the old mental filing cabinet without pausing to take along the appropriate supporting documents. I could see the words beginning to form on her lips and, never one to be shy, jumped in front of her to ask myself the follow-up question that she was about to reveal:

“What on earth am I talking about?”

Perhaps I mentioned previously that we oncologists learn early on in our training to think on our feet. Given the dire straits our patients find themselves in, combined with the confusing jumble of detailed information they must assimilate, we eventually all become experts at providing accurate information (as well as hope) to the distressed. It’s a simple task, really - just say all the right things at exactly the right time without upsetting patients or their families. Oh, is that all? Not only is this a daunting task, just try doing it extemporaneously in the midst of a chaotic office visit. Oncologists therefore who spout snappy epigrams as I do must be cautious in their use, so we don’t end up awkwardly shaking pom-pons of encouragement when the team is down by twelve touchdowns, if you know what I mean. In this instance after hearing my patient’s question I suddenly discovered my own version of the answer: not the typical there-there-you’ll-be-all-right pat on the head, but a paradoxical way of addressing this issue of how one does survive the emotional trauma of receiving chemotherapy. I tried to convince her that it is more difficult to not get through treatment, and laid out my argument as follows:

“Remember, taking adjuvant chemotherapy is obviously different than taking treatment for an incurable cancer. You’re going to take chemotherapy to kill any microscopic tumor cells remaining inside you, but officially you’re in remission after your surgery. This means that you will almost assuredly recover from the physical side effects of chemotherapy, but what about the emotional side effects? When you asked me ‘How do I get through this?’ I’ll bet you mean ‘How do I get through this without becoming disillusioned, or bitter, or angry, or consumed by hopelessness?’ You’ll never fall prey to those destructive emotions because you aren’t struggling with the three things that in my opinion can poison one’s recovery from this ordeal. They are isolation, fear and hatefulness.

“Going through chemotherapy is a lonely time. No one, not even your oncologist (unless a cancer survivor also) can understand what it means to sit in that chair week after week. That is why you must send out a clarion call to your family, neighbors and friends that you need them by your side. Sharing your feelings with those who care about you makes your suffering all the less. Use them for rides when you don’t feel like driving; let them cook for you and water your garden. No one should have to go through this alone.

“Fear of the unknown - of chemotherapy side effects, the ability to continue working, whether or not you are going to live to see your children grow up - mangles hope and deadens joy as easily as if you were a condemned prisoner waiting out the night for a date with the gallows at dawn. It is my job as your doctor to fill this void with knowledge, to inform you of what to expect as your treatment goes along and assure you that you will make it through. It is unacceptable for any patient to be frightened because their oncologist did a lousy job explaining the details. My responsibility is to do everything I can to rid you of fear.

“Lastly, becoming angry or even hateful at the unhappy twist of fate that has befallen you is like choking yourself and then crying out “Somebody help me!” Giving in to hatred removes you from the rest of us and places you in a bleak, far off land where guardian angels never bother to visit. Fight with all your might against the syrupy promises that hate uses to entrap the disheartened.”

I wasn’t sure if she was particularly enlightened after listening to my pep talk, but remembering that the secret to counseling patients effectively is to counsel them constantly, I ended our conversation with this well-worn request:

“Write down your questions as you think of them, and let’s talk again soon.”