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"You Have Cancer"

"A cancer diagnosis might play out the way they often portray it on television: a dramatic scene where our protagonist has an acute attack of pain, violently coughs up blood, then passes out on their kitchen floor; the character’s doctor takes immediate action to scan and test them in a slick montage of the highest tech hospital machines and futuristic facilities imaginable; followed by a bright whitewashed scene in an austere mahogany-trimmed office, sitting across from a stony-faced, well-manicured oncologist with his hands folded on his desk who says in a cold monotone voice, “You have cancer,” everyone breaking down in hysterical tears. “Why me, why?” It all happens in three minutes of filmmaking." -- excerpt from "Round the Twist: Facing the Abdominable" ©2023 Lisa Febre

So, what does happen when you hear the words "you have cancer" for the first time? A recent episode of Grey's Anatomy made me question what people think is the proper reaction to the news. Every tv show and movie tells us that upon hearing the words "you have cancer," we all should break down and violently react to the news. But is this true? Do we really have instant tears and feel hopelessly sorry for ourselves as soon as the doctor finishes that sentence?

Cancer renders most of us completely numb and incapable of feeling the most basic emotions. When I heard the words "you have cancer," I had already been through a gazillion tests and scans, I had already fired 2 doctors, met with 2 new doctors, and had major abdominal surgery. If I couldn't put it together that I had cancer before the words were spoken, then that was on me. No one was putting me through these tests because they thought I had IBD. When things are serious, your doctors get serious, the tests get more serious, and it becomes very clear when you've passed the point where they're wondering if it's cancer, and instead working to figure out what kind of cancer you have.

So how does it feel if you're not being blindsided by a sudden diagnosis? I liken it to "tempering eggs," a gradual easing into the bad news. When my oncologist said, "It's colon cancer," I already knew I had cancer, it was just a matter of getting the confirmation as to what variety it was. I remember staring at him and just sort of nodding. It wasn't the numbness of willful ignorance or denial. It was the numbness of knowing that big stuff is about to happen, like standing on the bridge with the bungee cord around my waist, counting down, and knowing that when the count reaches "one!" I'll have to leap. And once I leap, there's no turning back.

There's no right way to feel, so we should never feel pressure to react the way we see in movies and television. Just because you don't cry the instant the news is given, doesn't mean there is something wrong with you. All news regarding your cancer will be difficult to process. Good news is as difficult to wrap your brain around as bad news. You may cry, you may laugh, you may throw up, you may shrug and say, "ok whatever." But however you feel, is the right way to feel. Your doctor has been through this all too many times and they know that your reaction is your own. As long as you seem to be understanding their news, then it's all ok.

"Is this for real?" I asked Dr. Jacobs after my anastomosis when he said there were "no visible signs of disease." He very patiently said, "Yes. This is real." And then went on to say, "It takes a while, but eventually you'll accept this." I asked him, "Why is it so hard to accept good news?" And again, a lucid answer, "You're just not used to hearing it."

There's no right way to navigate these tricky emotions. But what is not helpful is for our friends and family to put pressure on us to behave a particular way. Most people don't have enough experience with cancer to know how to react to our diagnosis or good/bad news. All they have to go on is what they see on tv. Their friend has cancer, they feel they have to react with "You got this!" Their friend has a clear PET/CT after 6 months beyond treatment and their first reaction is "Congratulations!" They don't know that how they react has a deep effect on us, and not the effect they are used to seeing on tv. My hope is that by posting blogs like this, people will read these and the next time they are in the position of having to support a friend, they will be better educated on how to interact.

So here are some ways that friends and family can support the emotional health of a new cancer patient:

  1. Measure the reaction of the newly diagnosed. Are they acting scared? Are they calm? Are they crying or raging? Acknowledge their behavior, but don't try to direct them to feel a certain way. Let them cry, let them scream, let them act like nothing is the matter. Take your cues from their reaction, not your own feelings on the matter.

  2. Offer to help out in whatever way they need. Some people need rides to and from treatments. Some people need meal prep. Some people just need a shoulder to cry on. Don't define your role yourself; let the newly diagnosed tell you in what way they need you. They may not say the exact words "I need you do [do this]," but they may be giving hints as to what they need when they say, "I don't know how my partner is going to be able to take time off from work to drive me to my appointment on Monday."

  3. Don't overload your friend with expectations. They are trying to navigate terrifying white water rapids. They don't know how each new bit of news is going to make them react. The last thing they should be doing is modifying their behavior to soothe or comfort people around them.

  4. Keep an eye on the patient's caregiver. Often they are using all their energy to hold back their reactions so as not to scare the patient. But, if you see them struggling, reach out, privately, away from the patient, and see what kind of support they need.

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