Cancer passage

Three months ago, Anne finished chemotherapy.  She is tired, overweight, anxious and her feet burn.  Anne sleeps poorly, cannot concentrate at work and her relationship with her husband is distant, let alone intimate.  In my office for a “survivor’s” visit, Anne asked the glaring question. “Will I recover?  Will I ever be the same.”?  After a moment of thought I answer, “I hope not.”

OK, I was not really that cold.  What I actually said was more like, “Well, what you are going through is tough.  You are recovering from a terrible disease and even harder therapy.  But, with time, you will get stronger and feel much better. It will not be easy, but you will gain energy, appetite and sleep well.  You will be able to laugh again and enjoy your family.  There will be up and downs, but you will get back to living a full life.  But, will you be the same?  No, you are changed forever.”

There are many natural passages in life.  Starting day care or kindergarten. Your first date.  Bar Mitzvah or Catechism.  Graduations.  First job. A distant move. Marriage. Children. Retirement.

There are the bad passages, which we try hard to avoid.  Failing at school.  Being fired.  Being dumped, rejected or divorced. The sudden death of a loved one. Our house burning down or being robbed. These are crises, which tear at the lives we know, in ways we would never wish.

Each passage results in profound changes in who we are and how we see life.  Passages are not just openings to another room; they are journeys to new worlds.  Good or bad they knock us down, and force us to pull ourselves up.  Moreover, the cruel reality exists that when we see a light at the end of the tunnel, it may be an oncoming train.

Life threatening disease is an unwelcome and terrible passage.  No sane person gets up some morning and says, “Gee, I hope I get acute leukemia so that I can understand myself better, prove how tough I am, build close relationships with autocratic strangers and better appreciate the sweet moist smell of morning leaves or the brilliance of a baby’s smile.”

None-the-less, the battle against cancer or other illness is transforming.  It remakes us from the top of our head, to the bottom of our souls.

Mostly, we could do without the change.  There are gentler ways to learn about life.  However, once there, once cursed by disease, we change and not all of it is bad.  Much is confusing, requiring us to re-evaluate our world.  We have to discover who we are, and how we are different.  We learn lessons about ourselves, the people we love and life itself.  To push that idea just a little further, I would suggest that cancer patients work so hard and suffer so long, that they deserve to gain special wisdom.

So, without being callous, I do not wish that cancer patients return to the person they were.  I hope that in trade for their struggle they gain new knowledge, grace, balance and perhaps peace.  Maybe they will come to understand a purity or beauty in a particular relationship, a fulfillment in their work, honesty in thought or simply the vital ability to just say, “No.”   The dreaded disease takes so much; I hope that the passage gives something good, if just a little.


  • D Someya Reed
    Or do we rationalize the good, the "newly found appreciation" from something so horrific and unnecessary and that actually does nothing more than "teach us" things we really already knew? It's 4am...first thought that popped in my head.
    • James Salwitz, MD
      Not bad for 4:00am. Perhaps some forms of "enlightenment," are indeed just shining light into corners we have forgotten. jcs
      • D Someya Reed
        Or corners we should have been looking in all along...which brings us full circle. Who decided that such a disease was needed for us to even have this discussion? I like your "gentler ways." I've often said that life would be boring if everything went perfect all the time, no challenges. But then there are challenges and there is "browbeating" with more than just words, isn't there? And this is a challenge that, unlike "the movies" we can't volunteer to take the place of another. Well, we can but no one is capable of granting our wish. Ray is correct. The patient's partner is changed even when they don't realize or admit it. I am not the person that I was. I miss him. But, I miss her more. I always will.
  • Ray
    Its not only the patient that becomes a new person, it's also often the patient's partner
    • James Salwitz, MD
      So true. We do indeed move along together. jcs
  • meyati
    My oncologists think that I'm sweet and intelligent. They do know that I gathered all biopsies, records, did research at the medical library to get rid of an oncologist that I think is brain dead-he's transferred to many different clinics in different states. So I will fight. My PCPs generally seem scared of me-5 months of strep throat-first antibiotic didn't work. They blamed it on the radiation-and didn't do MED 101; sore throat= strep test- I told them it was strep. I just want my thyroid adequately managed-which the last 2 PCPs didn't. I don't want to be poisoned again by a modern med-statin toxicity-I have difficulty and pain in walking-fatigue-etc. My last PCP transferred from the ER-where he mostly cared for strokes and heart attacks. he thought COG-10 was a placebo-so he didn't tell me about that. At that time, the listed negative side-effects were quite different. What's wrong with expecting a PCP to manage my thyroid, prescribe Librax for my IBS-which keeps me out of the ER, etc. I pay for that myself. treat any infections that I get from people coughing on me, dogs biting me, etc. It doesn't seem like that's too much to ask. My oncologists called my PCP up and explained he should adopt the new BP and glucose standards for people in their 70s. It's really odd, but my BP dropped from 170-200+ to 135 @ check-in, and you know that it's lower at home. I wasn't charged for an ER visit, I guess because I ended up in the hospital 3 days later for the problem-dog bite. He wanted to know why I was hospitalised-mountains of pus in the bites, and clear liquid running out of 2 punctures had something to do with it. Then he asked why the system never charged me for the ER visit--I told him that I don't effing know. Go ask administration and billing--I'm not a CEO or an accountant-these things bring out the rabid rattle snake in me. Just treat a sprained ankle- treat a sinus infection or whatever-control my TSH-keep it in range and leave me the F alone. My oncologists say that my labs are perfect for them, my BP wasn't and isn't up when I see them. They ask questions that I can answer, and they don't treat me like a child. They understand that quality of life is my main motivation. How has cancer affected me-I'm a time bomb when I meet stupid--- I'm sitting there-ticking- speaking sweetly and clearly-my ENT and GYN think I'm great too.
  • An interesting and sensitive post. I'm not going to get to see what survivorship feels like, but I do know that living with cancer has definitely made me a more direct, assertive person. I have never suffered fools gladly, but now I'm learning to be direct and assertive without stomping all over the fool. That's a plus. I don't think I'll ever be in the "cancer was really a blessing" camp; I hate the disease and I hate that it's taken so much from me. At the same time, I have been able to learn and grow, and I hope that I'll continue learning and growing until I die.
  • Paula Kaplan-Reiss
    This reminds me of a quote from a song from 'Wicked.' "Who can say if I've been changed for the better, But, because I knew you, I have been changed for good." Great talking with you and your wife last night!
  • This quote on a bookmark from my son…. "I can't go back to yesterday because I was a different person then. " Lewis Carroll My family struggled with me to understand my cancer journey. They stood by me, held me up and shared the experience. Perhaps this was my lesson, my own journey in survival, to open my eyes to the love surrounding me that I previously took for granted. Physically we do recover, but emotionally the change is deeper and more permanent. While we recover these two are so intertwined it is very confusing. I did not know who I would be when I was well and I had to be patient in finding out.
  • Marie
    I enjoy most of the posts on this blog but this one made me cringe. I would be very offended if my oncologist lectured me or even presumed to know what lessons I should learn from my cancer. Well meaning but better left to those who actually have had cancer.
    • James Salwitz, MD
      I really appreciate your most interesting comment. You highlight that delicate balance between patient and doctor, which is of course different in every relationship. Both patient and doctor have different, but intense experiences and observations. I hope that my piece did not say what lessons "should" be learned, but rather that from my side of the table it is clear that patients are significantly changed and my passionate wish is that such change is not always bad. While I would never presume to lecture any patient on any subject, I would hope that oncologists would be sensitive to the reality of change, especially because patients do frequently ask what why they are still emotionally fragmented and struggling, even years later. Thanks again, jcs
  • Kris
    Am I the same? Absolutely not. I was the one who didn't think about life and death at all and who felt like I'd live forever. Now, I stopped making long term plans. Now I have scars in my body that remind me everyday what I had gone through. Now I am struggling with side effects that challenges me on a daily basis. Now I am fearful thinking that I might not be here one day for my girls. NO, I am not the same person I used to be. I am the new person now. Now I know how fragile we human beings are. Now I realize how precious my life is and feel the urgency to straighten my priorities. Now I grow empathy and generosity to reach out more people in need and community. Now my focus has changed from my own world to others. Ironically I feel more peace and calmness than ever before. Someone said God continues to challenge you until you learn the lesson. I am a two time cancer survivor and underwent 5 surgeries. Did God give me enough? I certainly hope so. And I certainly hope I learned the lesson. I believe that we, the cancer patients and survivors, have special relationships with the doctors. We build the life-long relationships with our oncologists who are watching over our health and well-being, physically and emotionally. They may not be going through the same disease as we are, but they experiencing the pain, suffering and joy through our eyes and attitudes. We are the ones who show them and others what being diagnosed with cancer is all about. That being said, are you the same person, Doc?
    • James Salwitz, MD
      Beautifully said. I am changed everyday. jcs

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