Over the last couple of years, I’ve had the privilege of working with patients diagnosed with cancer who were referred to our clinic by local cancer treatment centers. I’ve seen people at all stages of the disease, very early to terminal. They are usually referred to me because they’re very depressed or anxious. Sometimes they are willing participants in treatment, eager to tell their story. Sometimes they are angry and resentful, feeling that their oncologist (cancer specialist) must believe that they are crazy if he or she referred them to a psychiatrist. Hopefully, we can get past that.
At first, I wasn’t sure how I could be helpful to them. After all, most people would be depressed, anxious, angry, and fearful when diagnosed with cancer. Those emotions are normal, though patients sometimes feel that they are being referred because of these strong feelings. Doctors don’t always handle their patient’s intense feelings well, so sometimes that is true. Often though, doctors just feel that their cancer patients could use some help in dealing with the emotional side of cancer. Usually, patients just need to ventilate for the first few sessions. They need to tell their story, how they were going along in life just fine and then this- a huge boulder hurtling down the mountainside towards them. Usually they feel blindsided, violated, enraged at the unfairness of it.
I realized that they need for me to be the person who can listen to their fears and not back away. Usually family members are cheerleaders, encouraging them to forge ahead with each new treatment, convinced that they are going to beat this. That’s what family should do. Cheerleaders are important. But often patients feel that they can’t fully let their guard down and talk about how scared they are, or how they maybe don’t want that next treatment, or how they don’t feel like going on that big family vacation that the kids planned, or put into words the thought that families can’t bear – that maybe they won’t make it. They need a place where they can be gut level honest.
Sometimes I put the brakes on those worst-case scenario thoughts or remind them that the prognosis for cancer treatment is better than ever. Sometimes we work together to find the words to ask for more information from their oncologist. Patients still feel intimidated by their very busy doctors, and they don’t want to “bother” them with questions, or they forget the questions when they see the doctor. Occasionally they need to find the words to say “I don’t want to do this anymore.” I help them find their voice. I remind them that this treatment thing is a two-way street, and they are an equal partner. They may not have the knowledge that the oncologist has, but it is their body.
It’s important to have a place where you don’t have to put on your game face.
Many of my patients won’t die of cancer. They will be survivors. But I have been impressed with the ways that people process a cancer diagnosis. One lady said to me recently that she stopped worrying so much about the future. She put more emphasis on today. She had a blood cancer that was likely to go in and out of remission. She said that she accepted that she probably would not live as long as many people, but she would be more present, more appreciative for each day. This quiet acceptance seems to benefit patients, but it takes some time to get there. It doesn’t mean that they’ve stopped fighting; it means that they are no longer angry with God and the Universe. They can battle cancer but still savor today.
Our medical profession has advanced unbelievably as far as technology. But I am afraid that we have lost some of our emotional connection with patients. We need to remember that quality of life is just as important as quantity of life.
I would highly recommend a book by Dr. Atul Gwande called Being Mortal: Medicine and What Matters in the End. Dr. Gwande addresses the issue of quality of life and how that concept may run counter to what the doctor recommends. He discusses some creative and humane ways to bring more quality of life to the end of life.