Rule # 1: I didn’t give you your cancer so be nice to me.
And the corollary:
Rule # 2: You didn’t give you your cancer so be nice to yourself.
I believe that in dealing with cancer, it helps to play by the rules. The first rule means that as angry as you are about being diagnosed with cancer (or in fact, any other life threatening or life changing disease), try not to exhibit that anger towards your doctor. It’s counterproductive for the patient (you don’t really want the entire staff calling you names behind your back and doing quick about faces when they see you in the hall, do you? And don’t imagine for a minute that we don’t!) And it’s disheartening for the physician who has dedicated his or her life to taking care of people just like you. There will always be the occasions where the doctor and the patient just don’t “connect”. If that is the case, and there is no rapport, please try to find another doctor who better fits your needs and personality. It is absolutely your right to demand your doctor’s time and attention. It is not your right to verbally abuse the doctor. Early in my career, I had a lung cancer patient who was absolutely vicious—he answered every honest question with a snarl. One day, I had had enough (another one of those epiphanies!). I said, “Mr. M, I know you are angry that you have cancer, but I didn’t give it to you and I am only trying to help you so please be nice to me.” We got along famously after that and I have had more than one occasion to say those words since.
As for Rule # 2, I cannot say how many patients come in blaming themselves for their cancer. Trust me, I have heard it all. They say, “if only I had had a better diet….”. Or “if only I had exercised more….”. Or, “I didn’t handle stress well and it gave me cancer….”. And their friends and neighbors can be ever so unhelpful—”If only you had eaten the Andrew Weil way….”. Or, “if only you had done Tai Chi which is more spiritual than that yoga YOU do….”. Or “if only you had never lived 100 miles from a nuclear power plant…..”. (Interestingly enough, no one EVER blames it on the cigarettes or the alcohol, but that’s another whole story.) Let’s face it folks—cancer, like many other life threatening diseases, is in most cases multifactorial and not at all related to one’s personality or one’s diet if one is not obese, or one’s spirituality, or whether one even does one’s laundry and which detergent one does it in. And (sadly for most of us!) you can’t choose your parents and grandparents for the good genes. Whether it’s a virus, a bacteria, a bad gene, an environmental toxin, an evil substance you voluntarily smoke or ingest, genetic or whatever—in many to most cases we’ll never know. It’s just shitty rotten luck, most of the time. So stop blaming yourself and get with the program, which means quit smoking (smokers have a higher relapse rate for nearly all types of cancer than nonsmokers), start exercising (the Harvard Nurses Study showed that embarking on an exercise program after the diagnosis of breast cancer reduces the risk of relapse and it’s likely true for other cancers as well), and get to your ideal body weight because fat people get more cancer (and yes, trust me, I DO know how hard that is!). Got that?
And finally, Rule # 3: Unashamedly stolen from that great book of my youth, The House of God, by Samuel Shem:
The Patient is the one with the Disease!
Which means, I have to hold up my end of the bargain. Come what may, I need to walk into that consultation with a warm smile and a handshake. I can’t come to work with all the baggage I bring from home—what aggravations and grievances my dogs,cats, horses, kids and husband have caused. I can’t whine about my own problems to my patients. (I do maintain the right to whine to my friends and family, however.) And finally, I can’t blame my patients when they lash out in anger, or take it personally when they refuse treatment or don’t follow my advice. It’s their right: the patient is INDEED the one with the disease.
I think the cancer business would be a little bit more pleasant, a little bit more tolerable, if we all played by the rules. Don’t you?
Great post. I think that Rule #2 is probably the hardest one of all; because of course we will use our human foilbles to find a reason why. I imagine you are asked why so often. Rule #1 makes total sense of course although I couldn’t imagine how I would behave in the midst of terminal cancer (and so freaking hope I never have to know) – I could only hope I would behave with dignity and grace.