Living with Cancer
(Adapted from Choices in Healing written by Michael Lerner)
Fear of Recurrence
A Personal Choice of book author, Michael Lerner
Most cancer pain - either from treatments or from the cancer itself - can be controlled, and the fear of being caught in unendurbale pain is largely unfounded. To this end, it is worth exploring both conventional and complementary systems. Here are the principle guidelines :
- Most cancer pain is not well controlled by doctors as it should be.
- Physicians associated with hospice programs are likely to know more about the effective use of pain control medication.
- Unconventional approaches to pain control can also be very useful and often have fewer side effects than drugs. These approaches include traditional Chinese medicine (acupuncture and acupressure), visualization, meditation and breathing techniques, psychological counselling and behavioural training.
- Understanding the difference between physical pain and human suffering can make a difference in the best response to both. Suffering is the psychological experience of loss that can create or enormously augment physical pain. Suffering is just as real, and just as important, as the physical basis for pain. When suffering is directly addressed, and expressed as fear or anger or grief, it tends over time to move and change, and the physical pain associated with it often diminishes or can disappear. The wound of a life-threatening cancer can cause huge suffering, and if that suffering is not addressed, then unnecessarily high levels of pain medication may be used for a pain that is deeper - not lesser - than a purely physiological pain.
- Spiritually, it is wise to remember that pain can be a great teacher. Most of us know that we have grown most during the painful times of our lives. On the other hand, too much pain can overwhelm the capacity to learn from it. Given that we cannot escape pain and suffering, which comes to all of us, the wisest course is to discover how we can learn from it, how we can accept it and make use of it.
Healing essentially involves choices in how one seeks to create the inner and outer conditions that maximize the possibilities of physical, mental, emotional, and spiritual well-being in the face of cancer. Healing can take place whether one is recovering physically or facing recurrence or even death. Healing, I believe, tends to optimize the chances for physical recovery and certainly transforms the quality of life.
The great value of healing, as Larry LeShan has put it, lies in using cancer as a turning point in one's life. For most people cancer is an extremely unwanted and unhappy development. The pain should be deeply acknowledged. The question is whether the pain can also be used to open up a space in your life to reflect on who you are, what you truly want for the rest of your life, where you are going, what matters to you now, and how you can change your life in ways that make sense to you.
People who find a way to use cancer as a turning point often seem able to expand some of the best parts of their lives at the very moment that they are facing one of the worst crises of their lives. Therefore, their lives improve even in the face of the trauma of cancer.
This inner work of healing can be done by the patient himself; with a support group; with a psychotherapist; with spiritual counsellor; with a network of supportive friends; within one's family; at work; and in a thousand uniquely personal ways. It certainly expands life to seek this kind of healing and it may possibly extend life for some people by stimulating the immune function and other resilience factors. The search for healing can also transform one's relationship with events that used to feel stressful, so that they feel less stressful. Stress, as we have seen, is known to enhance the growth of many cancers.
Fear of Recurrence
Living with the fear of recurrence is one of the most anxiety-provoking problems that a person who has had an initial successful treatment faces. The routine checkups for recurrence can be terrifying, as can the question of whether or not a new health problem signals the return of cancer. One of the best ways to deal with this fear is through a support group or with a psychotherapist who works extensively with cancer patients. If this fear is talked over with other patients living with the same problem, it often diminishes. It is also a part of the process that leads one to a deeper appreciation of life, which can diminish the fear of death and therefore the fear of recurrence.
Facing a recurrence can be as difficult - or even more difficult - than facing the initial diagnosis, primarily because recurrent cancer is generally metastatic and mainstream medicine does not have many definitive curative treatments for metastatic cancer. For people who have been actively using complementary therapies or living a consciously healthy life since the initial diagnosis, the recurrence can be doubly devastating because they often feel their efforts were in vain. Recurrence renews the whole cycle of choices about physicians and therapies. It also plunges many people deeper into choices in complementary therapies. And it raises many of the issues of pain control and dying.
We all die. Whether or not we die of cancer, we all face the prospect of death someday. The antipodes that many people experience in facing death are the wish to fight intensively for life and the wish to achieve a peaceful acceptance of death. Neither of these attitudes is "better" or "worse" than the other. Many people switch back and forth between the two.
A Personal Choice of book author, Michael Lerner
In conclusion, I will try to answer a question I am often asked: What would I do if it were me?
I do not know the answer to that question. I do not think anyone can know that unless he actually faces the experience of cancer. But here are my thoughts :
- I would be paying a great deal of attention to the inner healing process that I would hope that the diagnosis would trigger in me. I would be giving careful thought to what had meaning for me now - just what in my life I wanted to let go of and what I wanted to keep.
- I would give careful thought to choosing a mainstream physician. I would be looking less for someone with wonderful empathic skill than for someone who had a reputation for basic kindness who would also be willing to take the time I needed to answer my questions. Above all, I would be looking for someone who really stayed on top of the technical aspects of my treatment and who recognized that I was the kind of patient who wanted to share in making the decisions. I would also look for someone who was willing to stick with me if I embarked on alternative therapies. If possible, I would want someone who had a good
reputation for staying with his patients medically and emotionally if they are facing death.
- I would use mainstream therapies that offered what seemed to me a real and meaningful chance for recovery, and I would use them with gratitude and work to augment their effectiveness. But I suspect that I would be somewhat unlikely to undertake experimental therapies or therapies with a very low probability of success that were very toxic and would compromise my capacity to live and die as I chose.
- I would use complementary therapies. My first choices would include psychotherapy with a therapist experienced in work with people with cancer; a first-rate support group; and a healer with a good reputation. I would deepen and augment my regular nutritional program and I would strengthen my meditation and yoga practices. I would spend a lot of time in nature, walking in the woods, along the ocean, and in the mountains.
- I would unquestionably use traditional Chinese medicine.
- I would explore whether any of the high-tech atlernative therapies appeared to have anything to offer me.
- I would be deeply grateful for all the training I had received from friends in the Cancer Help Program in how to face cancer as best as one humanly can. I would recognize the months or years of active battle for recovery that lay ahead, followed either by living with the possibility of recurrence or facing recurrence and death as a fundamentally new part of my life. I would go for life, for recovery, with every possible tool and resource I could find. But I would also seek to face death with the same recognition of the challenge and the possibilities.
- I would spend time with people I care a lot about and with books, with writing, with music, with nature, and with God. I would do everything I could that I had not yet done and did not want to leave undone. I would not waste time with old obligations or conventions, althoutgh I would seek to extricate myself from them decently. I would be off into pure life, following its lead.
I can say none of these things with certainty. How can any of us know what he would actually do?
In cancer, there is no single right choice for all of us, but there are surely right choices for each of us. There are no certain courses of action, but there are certainly educated and wiser choices, as opposed to uneducated and more foolish ones. The skill is in the movement from ignorance toward knowledge and from knowledge toward wisdom. In wisdom, we choose what we are least likely to regret. Accepting the pain and sorrow inherent in the fate we have been given, we can seek also the beauty and the joy.