By YASMIN ASVAT
An estimated 1.8 million people in this country may face a cancer diagnosis this year, in what has already been a bleak year of isolation and loss.
While news of the COVID-19 vaccine rolling out across the U.S. offers hope in a year of 311,000 deaths, 11 million people face the financial pressure of unemployment, and, approximately 43 percent of the nation reports some symptoms of anxiety or depression.
It is understandable that a cancer diagnosis now may be too much to bear. And yet, somehow, many patients cope with the diagnosis and the associated uncertainty, fragility, and the threat of mortality with remarkable resilience.
As a clinical psychologist in the Supportive Oncology program at a major Midwestern cancer center, I witness these quiet heroics every day.
Since the beginning of the pandemic earlier this year, I have been striving to listen, empathize, support, and help cancer patients cope as their lives have been disrupted by both a cancer diagnosis and COVID-19. These are lessons these patients have taught me.
Courage is being faced with doing something that utterly terrifies you, and you do it anyway. One of my patients described that leading up to the day of chemotherapy treatment, she is highly anxious, has racing thoughts and worries, and has trouble concentrating and sleeping. The morning of treatment, she vents to her partner about how she doesn’t want to go to the clinic. During the drive, she braces herself repeating, “I don’t want to do this” over and over again.
Once in the clinic, she tells some of her nurses that she doesn’t want to be there because she worries about COVID-19 exposure, despite all the precautions the clinics have in place. She tells another set of nurses that she is scared of the side-effects of treatment – the disabling fatigue, the nausea, the suppressed immune system.
And yet, despite her fears and her protests, she stays. The nurses hook her up to the needle, attached to a tube, attached to a bag, attached to an infusion pump that delivers the toxic and cancer-fighting chemotherapy.
She stays for her children and grandchildren and the desire to see them grow, for her partner, for the hope of a cancer-free future, for her eagerness to live. She goes home relieved that one more treatment is completed and anxiously anticipates the next round. From this remarkable woman I have learned what it means to live the adage credited to Nelson Mandela, that “courage is not the absence of fear, but the triumph over it.” You may be terrified – and yet you do what needs to be done, anyway.
When you have clarity about what matters, even impossible, heart-breaking decisions are clear. Few decisions in life are more poignant, heartbreaking, and difficult than deciding how to die. Many spend most of their lives conveniently shoving the reality of mortality to the back of their minds, necessarily so, in order to continue persevering through the expected and unexpected challenges of living. Many patients make decisions about their deaths with certainty and acceptance.
One of these patients was a Latina in her early 50s, Spanish-speaking who battled a particularly aggressive form of metastatic colorectal cancer for two years, with extensive surgery and multiple rounds of chemotherapy. All the while, her priorities were beautifully simple – to spend time with her husband of three decades, enjoy the company of her three children, dance to her favorite music, play with her beloved dog, and find comfort in her faith.
For as long as her body was able to sustain itself, she did exactly that – she lived, laughed, danced and tolerated all the side-effects of treatment with dignity. And when the day came that saw herself spending her time lying in bed because moving was too painful, sleeping because without medication the pain was so unbearable it would make her scream, she knew what she had to do because she knew what mattered. She said she was living a half-life where she was a shell of herself, breathing but not really living, seeing her family but not really participating in their lives, listening to music but not being able to dance.
Her doctor suggested yet another round of chemo, with no assurances that it would help, and she declined. She resolved to speak with her family about hospice care. There was sadness, naturally, but no despair. There was wishing she had more time, and there was gratitude for the time she did have. She said there were no regrets, and there was comfort in knowing her family would lean on each other to heal. Knowing what mattered made her choice crystal clear – in the words of German philosopher Nietzsche, she chose to “die proudly when it is no longer possible to live proudly.”
Being flexible is mandatory for our survival. One of my patients said she was crushed to realize that she would likely be spending the Christmas holiday without her grandchildren. She faced a particularly grueling treatment that knocked her down for eight days, unable to eat, severely fatigued, and spending most of her days sleeping.
By the ninth day, she started feeling a little better and was able to do a few things around the house and in her beloved garden, and another two weeks later she was back in clinic for the next round of chemotherapy. She handled this ordeal with the utmost grace and willingness to sacrifice six months of her life for the hope of the rest of her life.
But faced with the prospect of sacrificing her cherished Christmas season, she almost broke. We talked about safe options to celebrate the holidays, and we philosophized about her values and what brings meaning to her life. In the midst of circumstances that are unprecedented, uncertain, and threating to her physical health and emotional wellbeing, she chose to adapt to survive.
So she rallied, creatively and flexibly, and planned a virtual baking session — she would make the dough, her husband would drop it off to the grandchildren, and they would Facetime while the grandkids baked and decorated the cookies. She also planned to have gifts and a holiday meal delivered to her daughter’s home. And her daughter adapted by planning a holiday drive-by so her mother could see her family briefly and from a safe distance.
In true Darwinian fashion, “it is not the strongest of the species that survives, nor the most intelligent; it is the one most adaptable to change.”
Cancer patients adapt so that they may yet hold on to a slice of what brings their lives joy and meaning. It is a lesson everyone can learn.
Yasmin Asvat, PhD is a licensed clinical psychologist at Rush University Medical Center with eight years of experience providing mental health services to chronically ill patients, primarily cancer patients. She is a Public Voices Fellow through The OpEd Project.