A patient came to see me recently after finishing a "rigorous" (read: brutal) series of treatments against a cancer known to be curable. She suffered of course, as all patients suffer from the side effects of combination chemotherapy, but did make it through without disaster. Her celebration of life had begun with my congratulations on achieving a complete remission. As time passed, however, I found her struggling. She related several symptoms that I found perfectly legitimate, yet inexplicable - nothing that suggested a serious problem. We discussed the normal recovery from chemotherapy from our narrow perspectives - her as a survivor who has not yet recovered and me as a physician who has experienced recovery countless times, but only as an observer. Asking myself, "What is behind the mask I see before me?", I thought I sensed that something and tried to put it into words. This is what tumbled forth:
"All of your symptoms will soon be gone, but then you'll have to ask yourself 'What do I do now?' Think of your life as a wonderful swim. You were enjoying a great afternoon at the lake when suddenly you were attacked by cancer, just as if you had been bitten by a big fish. The shock alone would scare the living daylights out of anyone, not to mention the injury. Now you've recovered and you're standing on the shore, dragging your toes in the sand, wondering, 'How do I get back in?' You know you have to enter the water sooner or later - that is where your life resides. After chemotherapy it's normal to be scared of life - of the water, and what may still be in it. Some patients take months and months just to get their knees wet. All this does is delay the inevitable, that is, the day when once again you are immersed in life - your life.
"All I'm saying is that there is nothing to be afraid of now. Even though you don't feel perfect, you have recovered. Now is the time to dive back in. Don't be scared - that's what you've hired me to do. I'm the one who is supposed to worry about you, so let me do it. You get right back in the water and let me keep an eye out for trouble.
"I'm your lifeguard."
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Wow, that is lovely. I hope my Onc feels the same way. I do tell her that I've outsourced my worry to her, but somedays it is more difficult than others.
I'm trying to swim along, and well, now I have lymphedema and may need a hysterectomy, thanks to the Tamoxifen. I'm still swimming (like Dory in 'Finding Nemo') but sometimes the water gets a little rough.
Much easier said than done.
What remains for the well-treated cancer patient is the trauma of the diagnosis and treatment, as well as the dread of recurrence and the in-our-faces awareness of mortality. After a number of years of living spooked, I've figured out that if I live my life so I'm overwhelmed with joy and beauty, the dread fades way into the background, and joy becomes the foreground and the prime mover of Life. This takes time -- eight years for me -- and much encouragement from my wonderful hematologist. I'm so glad you get this, Craig.
So wonderful and inspiring. Thank you for making my day.
What's been hardest for me is feeling as though my treatments have launched me into middle age. Last year I was a premenopausal woman in my 30s, with what I thought was a great young body, looking forward to a future with children. Now, I'm postmenopausal due to chemo and a hysterectomy, on anti-estrogen drugs that make me gain weight and feel like an old woman, and with a body compromised by mascectomy and pediculed TRAM reconstruction. Yes, everyone assumes that I'm "cured" and that my treatment is done.
At least I'm alive.
I wish it were that easy.
See, if we could trust that all lifeguards were sitting vigilantly on the shore, carefully watching, that we were always safe and protected, your analogy would be wonderful, safe, and comforting.
But what about those of us who's lifeguard was behind the tower making out. What about the lifeguard who went home for a nap while still clocked in at work?
Whether lack of committment, or mere mistake, too many doctors misdiagnose. Even the medical world realizes it's a problem.
As a misdiagnosed patient, I have a hard time trusting when things just don't make sense to me. I've got great doctors now, and still, any abnormal lab still sends my heart racing.
It will improve, it already has, but I doubt I'll ever be the naive, blindly trusting patient I was 5 years ago. I just can't let go of my responsibility for my health. Because ultimately I'm the one who will live, or die, with the consequences of someone else's actions.
I don't know whether your exhortation is realistic or not, but it just what I needed to hear today. After an 18-month battle against advanced rectal cancer, today I received very good news about my latest CT scan test results. "Go jump in the lake!" is exactly what I need to do. Thanks, lifeguard Craig!
http://rtfax.blogspot.com/2007/04/unwanted-journey-day-0497-image-for.h…
All I can say is thanks. Explaining it that way the Onco as our lifeguard. Well that puts it in a greater light. As a 10 year, three time survivor NHL stage 4. I have had three great Oncologists..and I am so glad to read what you wrote.Makes me see them in a clear light..Thanks Hope.
Just what I needed to read today. A friend just died of metastatic breast cancer, I've had bc myself so this brings my background fear back to the surface. I liked the comment by Sherry above about living overwhelmed by joy. It is sunny here and my dogs are happy and I have a few days off from work. What could be more of a blessing?
Even my compassionate and esteemed lifeguard can't tell me how many additional big fish might be in that lake. The trick for me is to balance that uncertainty -- and insta-menopause, and other daily, pesky side effects -- with the joy of the swim. E.g., keep my eye on the life preserver, not on the hole.