In my last column, I shared that I was recently diagnosed with breast cancer. While caught early, it was considered "invasive". So while my prognosis was good, I realized that nonetheless I had to take my diagnosis seriously.
Told to avoid stories of doom and gloom, I moved on to finding doctors while figuring out how to tell my loved ones. Being open, honest, and not making more of something than necessary, I tried to be in the moment, putting anxiety on the shelf and taking control wherever I could. This coping strategy helped keep me from being overwhelmed and is one I like to teach my own patients. Feeling empowered, I was able to focus on what I needed to - my family, work, treatment or simply healing - and this felt very good.
So, over the past months, I've jokingly told my family that I am playing the "c" card when I want something I might not ordinarily ask for, and I practice saying out loud, "I have cancer," or, "I have breast cancer," or more recently, "I had cancer." It takes away the sting and the power the word can have in our cancer-phobic society, and it has enabled me to adjust. Though I still have things I need to do to make sure I remain okay, I do not have to be defined by having received a cancer diagnosis.
This is important for moving on and not staying stuck in "what was" or "what if". That said, the term "survivor" never really spoke to me. Rather, I actively try to be grateful for where I am today, every day. So, as I share my journey with you, I offer you some of the strategies and wisdom that helped me get through, move on and embrace life even more fully than I did before I was diagnosed. I truly feel blessed.
Focus only on the important tasks and let everything else go for as long as you need to. Make lists of what must be done, prioritize and delegate. Find time to disconnect from people and technology. People really want to be able to help, and your energy will be limited. And practice being patient. People won't necessarily do things exactly your way, and this will be one of the many adjustments you will need to make.
Emotionally, too, embrace what is important and let go of what isn't. Let go of "what could have been" and focus on the "what is." Let go of the need to be perfect, and seize the opportunity to be human. You will be happier as a result. Put your relationships in order. While you may want to see or speak with friends, you may need to limit visits because, as mentioned above. you may be more tired or have more discomfort than you thought. Remember, too, that people don’t know what to say and may say the darnedest things, thinking they are being helpful. Tune out those who rush to tell you about someone who had it worse than you, if that upsets you, and just be appreciative of the emails, calls and people who show they care.
Take control of what you can. How you see and think about yourself and your situation will determine how you feel and respond. In other words, your attitude and approach will determine your path more than your cancer will. As such, even your choice of words will influence how you see your world. Is your cancer a huge obstacle that takes over your life, or a challenge to work through one step at a time?
Only worry about those things that you can change. Learn to let go of irrelevant and worrisome thoughts with "thought stopping" techniques. For instance, allow yourself a set day and time to focus on your worries (say, Thursday from 5 to 5:15 p.m.), and any other time these thoughts appear, say to yourself, "Not now-I'll deal with it on Thursday." Such techniques are easy to learn and can definitely lower your anxiety. At this moment, your goal is to complete your journey as easily and painlessly as possible.
Balance your need for informed and shared decision-making with your need to keep from being overwhelmed. Don’t be afraid to ask questions and bring someone along to take notes and help you integrate what you hear. Walking into a building with signs that say "oncology," "radiation" and "chemotherapy" makes your diagnosis a reality, and you will need support systems, both professional and informal, to help you negotiate the medical process and to look after you a bit.
Be in the moment. If you are feeling okay at this moment, appreciate it and be grateful. If not, ask yourself what could make it better, and solicit help. You do not need to suffer, have unbearable pain, be stressed or feel frightened.
Face your challenges rather than being filled with dread. Your journey is a new and untraveled one, and you are the navigator. It is easy to feel overwhelmed and scared when you don't have a good map. Try instead to appreciate what you see along the way and replace fear with curiosity about the unknown. At times, you may just want to pretend that you are viewing the scene on a television and you are the one with the controls to adjust the volume and picture. This can be very calming during new procedures. For example, as I lay on the table for both my surgery and radiation, I remember looking around at everything new (and potentially scary) and playing a game with myself, trying to figure out the use of each piece of equipment that was foreign to me. This little bit of distance gave me the space I needed to breathe. Take time to breathe and achieve a sense of calm, stillness and quiet within.
Work with someone, if need be, to help you work through your anxiety and manage your concerns, one at a time. You can learn to take in the outside world as you choose, rather than feel bombarded by it. I used a mindfulness relaxation technique that I have taught my patients, that helps you tune into your body and feel much less anxious. Replacing fear with a calm awareness allows you to understand where your anxiety comes from, deal with it and move on. Your diagnosis, procedures, surgery, radiation, chemotherapy, and their aftermath-- which can initially feel physically and psychologically burdensome-- are very real, but you can and will get through them. Having cancer can give you courage, strength and an understanding that you may never have expected, and this in itself can be quite empowering.
Find the positives - they are there. My "support team" and I saw each other as having a single goal, and I was so appreciative of what people did for me. Whether it was a daily email from my "bosom buddy"-- a woman who herself had breast cancer a few years ago-- or a surprise four-course meal, people were incredible. People offered to pray for me (for those who have written to ask, my name is Batya Leah bat Kayla Malka). In general. I focus not on why I was given this challenge now, but on what I can do with it.
Step back and try and see the humor in the situation. Lighten up and laugh over the small things in life. Trust me, you will have many opportunities. The second day of radiation, for instance, I had perfected my relaxation skills so much that I actually fell asleep on the table.
Try not to be consumed by what you are dealing with, but reach out to others instead. Ask what you can do to help people. Volunteer. You are a different person now in many ways, and you have much to offer.
Embrace your new life as a partner in your own healthcare. This is the time to eat well, rest, exercise, decrease stress and learn to relax. Get a foot massage, have your nails done, plan a mini-vacation (even just an overnight one) for when you can finally get away, and create a plan of well-being as part of a post-treatment reward. Remember, the more stressed you are, the less energy you'll have to take care of yourself.
Keep to your routine as much as possible. Work and exercise kept me sane, even if I had to listen to my body and take things a bit easier. Yes, sometimes I felt drained or tired, limited in certain ways, but I was always appreciative and grateful for what I could do.
Be kind to yourself. For a while, you may not be able to carry on with your entire old routine, but there is a lot that you can do, so use the time to catch up on things; carry a book for downtime, and appreciate a quieter pace. It is only temporary. There will be a time when you feel better.
Learn how to pass time during unpleasant events. Our nightly rush-hour trips for treatment were just not fun. I loved having the opportunity of a nightly date with my husband, but I would have much preferred not risking my life on the roads. So at the end of each week, we did something fun. Every night when I came home, I enjoyed a treat a friend provided, and put a sticker on the calendar to mark another day done. Silly and childish? Maybe, but it helped make it all bearable.
There are times when you may feel that your body does not belong to you. In addition to the wires and bandages, stitches and scars, lotions and potions, the number of people who have now seen my breasts is quite impressive. I've learned to depersonalize myself from the poking and prodding and see people as just doing their job. The patient's job may be to relax and make it easy for them, but your body image may be in for a shock, at least in the short term. Be aware that this may come after you think you are all done; you will have some adjustments to make.
Your entire family has cancer. These can be turbulent times, and everyone feels the impact of a cancer diagnosis in their own way. There is a lot to deal with, for everyone. Your relationship with your partner and your children will change in many ways. If you are the patient, you can't necessarily be there for others and juggle everything that you now personally have to deal with. The key to success is to "focus" on your needs and look after yourself before looking after others. Still, others do need to be taken care of, and if you can designate someone to help deal with that concern, you will breathe easier. Don't be afraid to seek some psychological support at any point along the way.
Early detection and treatment can be very important. Follow the recommended guidelines. Breast health awareness is an important part of early detection. For me, it was important to choose a health care team that was patient-centered and believed in shared decision-making.
Cancer is a chronic condition. It can take months to feel well after treatment ends (I actually felt worse in the weeks after my treatment ended), and there are further adjustments to make along the way. One of my saddest moments, for example, was when I learned that after 41 years of doing so, I could no longer donate blood. In addition, I had to acknowledge that I might be on medication for the next ten years. Each person has their own "stuff" that they have to learn to live with. As someone with cancer, you will now always be getting check-ups.
Enjoy every minute and be grateful to be alive. Throughout your struggles, challenges, and painful moments, life does go on, and this cancer can't be the "focus" of your life forever. Your priorities show in how you live your life. Cancer is a challenge that offers you the opportunity to learn and grow. It is up to you to make the best of it.