By Nanda Vrindavanam, MD
The 250-pound, 6-foot-4-inch ex-Marine walked into my office with the most defiant expression on his face. He was ready to fight. He was ready to fight anything life threw at him: the diagnosis I was going to give him, the entire medical system—which he had never before had to contend with—and me, the bearer of bad news. He had always won in life. He had emerged victorious from multiple situations in which death was just a minute or a few inches away. This was a fight he was determined to win as well, all by himself. Trying to put him at ease, I started by telling him that all tests had been completed and we needed to discuss some things. He told me not to sugarcoat anything and to give him the information straight, as he had better things to do than sit and talk to me forever. He wasn’t going to take any “poison,” as he had seen his uncle go through chemotherapy and he didn’t want to die that way. I asked him to hold his thought and give me some time to explain things and then we could move forward with what he wanted. I promised I’d be respectful of his wishes, whatever they were.
I write about this episode because it demonstrates one of the ways patients cope with a cancer diagnosis. It is, without question, one of the most difficult experiences in someone’s life. It brings terror and a sense of finality. It also kindles surprise, anger, sorrow, and depression. How can this be dealt with and adjusted to? Notice I didn’t say, “How can we can make it better?” That is because it cannot be entirely made better. It is, however, something that can be handled with the help of family and a very supportive medical team.
As human beings, we often feel that bad things happen only to others. So it is with cancer until we get the diagnosis ourselves. Then, we are in total shock and disbelief. Acceptance is difficult, and anger follows. It is akin to the stages of grief. It is important not to fight each part of the process. We are capable of dealing with immense emotional turmoil and emerge with what I like to call the “victory of the human spirit.” Cancer patients tend to be the toughest, most courageous people one will ever see. Most do survive the initial turmoil and go on to lead meaningful lives for as long as they can, developing memories and experiences that become milestones in the psyche of their families, loved ones, and their medical staff.
When confronted with a diagnosis of cancer, take the following steps.
- Allow the actual meaning of the diagnosis to sink in. If you feel helpless and totally out of control, give yourself some time to experience those emotions and then try to refocus. Don’t try to grasp every aspect of it, as that might be overwhelming.
- As much as you feel numb and in shock, realize that, as with everything in life, you will regroup and fight this as well. Our spirits are strong, and you’re fighting the good fight. The knowledge of that gives one’s spirit the ability to get over those feelings and to find the inner strength to deal with the diagnosis.
- A diagnosis of cancer makes us absorb only those words that scare us or otherwise make us see only the negative. During the first conversation, all you hear is that you have cancer, but you might not grasp the importance or the significance of the staging, possible treatment options, or prognosis. Take your time and request another meeting with your doctor should you feel you need a more detailed discussion once you have settled down and have a little more information about your condition.
- Even for the most private of people, cancer is a shared disease. The experience affects your family, your friends, and many other people whose support you can use and whom you can support in turn. Figuring out whom to involve and whom to share your diagnosis with is a very personal decision, but do not wait, as the best outcomes I have seen are in people who have had good support overall.
- Educate yourself about the disease in a way that applies to you. The best person to guide you in that endeavor is your doctor. Ask him or her what to read and what websites to visit. Please note it is very important to ask what exactly applies to you, as the information out there is vast, and the majority of that information probably isn’t relevant. Reading about all scenarios of a disease and its treatment can be daunting and can lead to expectations and concerns that might not be applicable to your situation at all. Do not jump to conclusions about any specific information. If you have doubts, do not hesitate to address them with your doctor before convincing yourself that a particular possibility is going to happen to you.
I’ll end by going back to my story. My patient listened while I told him he had lung cancer and would need chemotherapy, as it was stage IV. He asked me if it was curable. As is my practice, instead of answering him directly, I asked him if I had told him he had diabetes, how would he have reacted. He said, “That’s different; it’s not a death sentence.”
I told him today’s science has enabled us to look at cancer as something similar to that. I explained that cancer is treated as a chronic disease that you live with rather than die from immediately. As defiant as he was, I could see he was slowly processing what I was telling him. He agreed to do the initial testing. When that was completed and I gave him his treatment options, he chose to enroll in a clinical trial with a very novel immune-boosting agent along with his chemotherapy. I was impressed by his reasoning when he said, “At least it will help someone else in the future.”
I’m glad he had the wish to help others, because today, three years later, my patient is alive and well.