Helping cancer patients overcome fear
I found the best way to help patients and families was to reduce anxiety and help those confronted with this disease to marshal their internal resources to conquer their natural fears and ultimately learn to become cancer survivors.
Cancer is an intensely personal experience. Yet it routinely involves a variety of social interactions with family, friends, coworkers, and employers. The diagnosis of cancer brings up serious concerns of death, pain, suffering, and loss of control and dignity. It's an interesting observation that while overall survival following a diagnosis of malignancy is at least equal, if not superior, to that of a diagnosis of heart failure, few people told they have heart disease will declare, "Oh no, I am going to die." However, such a response is not uncommon when the diagnosis is cancer. No group of diseases generates more fear and anxiety. There are so many questions, with answers desperately sought—some very complex and not answerable, others very direct and simple, such as "Will I lose my hair?" All of these thoughts rush into one consciousness over a remarkably short period. Over my professional career, I saw a drastic need to guide patients and their families through this experience. I found the best way to help patients and families was to reduce anxiety and help those confronted with this disease to marshal their internal resources to conquer their natural fears and ultimately learn to become cancer survivors.
A Leprechaun's Laser Light of Life Excerpted from "When Tumor is the Rumor and Cancer is the Answer"
As I made rounds, lilting laughter punctuated a ragtag vocal ensemble's singing of "Danny Boy." It ebbed and flowed from the oncology ward lounge, warmly filling a sterile hallway, but not my heart. It was the twentieth St. Patrick's Day since small-cell lung cancer had riddled and devoured my tough, son-of–Hell's Kitchen, World War II–veteran Irish dad. Although he died during the dreary, wet, frozen rains of a New England fall, he was etched into my heart's memory owing to one very magical St. Patrick's Day.
As I have done on every St Patrick's Day since his death, I was reminiscing about a time when I, a newly minted, wet-behind-everything medical student and a second lieutenant in the US Air Force in the Health Professions Scholarship Program, visited my dad at work as General Electric's chief labor relations negotiator in Manhattan. The day ended at a midtown Irish bar with me accompanying him on the tavern's beer soaked upright piano as he crooned "Danny Boy." You could feel the century old pub wood weep as a sonorous tenor voice I had never before known he had lifted hearts, minds, and glasses. Mutually uninhibited, but not inebriated, father and son were in tune.
So here I was, decades later, on another St Patrick's Day, rounding on the oncology ward, tired and tied to a bittersweet memory. Regaining focus for the duties of the day, I began to thumb through the chart rack. Suddenly, intruding through the funk was the unmistakable sound of a Buck Rogers ray gun. It was right behind my left ear, magically mixing with leprechaun-like chortling and giggles.
I spun on my heels and was bowled over by the impish grin and theatrical posturing of my toy-toting assailant. Hopping and toe-dancing as lightly as a shamrock blown by faerie breath, and half naked in hospital regalia with toy cosmic carbine in hand, retired USAF Chief Master Sergeant O'Reilly squealed, "Ah-eee! Gotcha, doc"!
O'Reilly had whistled and skipped to an easy truce with his sleepy follicular non-Hodgkin's lymphoma for sixteen years prior to this admission. His blarney charmed the beast called anxiety. His acceptance of the capriciousness of a life filled with the Damocles sword of a strong probability of an aggressive transformation of his disease was like a therapeutic balm of Gilead for not only himself but also the many patients he befriended and bolstered.
His checkups were always happy routines rife with fabulous tale spinning, unabashed limerick singing, and other sound medical practices. Clinic visits from the sage retired chief leprechaun of the USAF always ended with a pat on my head, a wink at the nurses, and his trademark squeezing off of a couple laser beams of magic from the now infamous toy gun at whomever he thought needed it most. It never hurt, it often helped, and, more than once, it seemed more powerful than my prescription pad. An emeritus professor of mirth and mentorship, O'Reilly was one of the wisest men I knew.
Shortly before this final admission, the limber leprechaun interrupted plans to visit family in Ireland because, as he said, "Me shillelagh's telling me something ain't right." A thorough history and physical revealed nothing. The complete blood count showed a slight drop in his usually robust hemoglobin, and his platelet count had fallen considerably. So did my heart when review of the peripheral blood smear suggested what an immediate bone marrow examination confirmed—myelopthisis. His lymphoma had transformed aggressively and was exploding in bansheelike furor. It was replacing his bone marrow. Further staging showed broad lymph node, boney, spleen, and meningeal dissemination. An incredibly bright man, he fully understood the limits of therapy and the grave prognosis. Typically unafraid and more concerned for his family, he was annoyed at the change in travel plans. He sprightly assured me, "I have a few things yet to do, so let's have a go at it."
We did. After a rocky course consisting of intensive systemic and intrathecal brain chemotherapy, massive transfusions, considerable assistance from colony-stimulating factors to support his white blood cell count and fight infection, and the use of erythropoietin to help him make blood, this knobby-kneed leprechaun of a man was zapping my dour spirits. Bald and beaming and headed toward a major clinical response, he was working his magic on this very special St Patrick's Day.
It was his family in the lounge warming the ward with lilts of laughter. Spying my doleful drudge as I began ward rounds, he had left the comfort of family and friends to fire a laser beam of life my way. Clearly unfazed by the enormous odds of a rapid and refractory-to-treatment recurrence of his cancer, he often grandly showcased his plastic phaser, quipping something to the effect of, "If it comes back, we'll zap me cancer with this thing; it's better than those poisons, eh?"
O'Reilly was one of the gifts clinical oncologists can garner in decades of clinical practice if they are open to receive them. He was one of those wonderful "doctor-patients" put in our path to minister magical wisdoms just when we oncologists need them most. Being touched by such patients' special zest, zeal, and wisdom is one of those easy medicines to swallow. Souls such as these are precious jewels in the growing treasure chest of a clinician's experience, and the luster of the clinical pearls they impart is often both illuminating and transformative. So it was with O'Reilly.
Unbeknownst to me, he had more things than fighting his cancer on his agenda. He had taken particular notice of one of my young clinic nurses. She was a seemingly emotionally cold and somewhat intense second lieutenant nurse that was "too young to act such a tough nut and too talented not to try and crack," according to O'Reilly. She had requested transfer to the inpatient oncology service. This coincidentally put her on the ward—and in O'Reilly's service and sights—when the aggressive transformation of O'Reilly's lymphoma occurred. Both I and the senior nursing staff were concerned for her, believing her far more fragile than her implacable demeanor might suggest, but our "tough nut" showed no signs of trouble and, sadly, few signs of warmth, even when O'Reilly's improbable clinical remission occurred.
Shortly after that St Patrick's Day, the probable occurred. O'Reilly was readmitted with signs and symptoms of a rapid recurrence. He was quick to grasp his situation, calmly and confidently summarizing my lengthy delivery of sad news to a family unwilling to believe the unacceptable, saying gently to all, "It's been a great run, so now, soon, I'll be with sod and saints." In his final days of a rapidly progressing malignancy that would not be denied, he had three simple requests: some intimate uninterrupted time with the missus, a steady supply of Guinness Stout, and "one last shot at some unfinished business." Curiously, and without any explanation offered, he decreed that the "tough nut" young nurse be assigned to his care, and furthermore she was to be the only medical staff he wanted in his room—no one else, no exceptions. Somewhat bewildered, but always admiring of his wisdom, the charge nurse and I warily agreed. On hearing his request, the young lieutenant almost condescendingly agreed, seemingly fashioning it as some sort of dramatic last wish. After all, she thoughtlessly quipped, it was "probably [her] turn anyway." She would be in his service, having no idea how true that would prove.
I was shaken upon news of his passing the next morning. However, deeply appreciative of O'Reilly's gifts, I was both concerned and curious as to the impact, if any, his passing had made on the young "tough nut" nurse. No worries. I no sooner strode onto the ward than she ran up to me glowing, seemingly transformed and weightless, her eyes brimming with tears of joy. She reached into her pocket and produced our leprechaun's little laser gun. Smiling, she told me that he had called her to his room, eschewing all others. She bubbled joyously about how they had chatted for hours about secret things—special things about love and the rich life. She was bursting with the pride and surprise of one who had been picked above all others as something special and lovable. Tugging at my white coat like the impatient, exuberant child she then was, she announced triumphantly that she was the last target he aimed a final salvo of saving love at. He then bequeathed his otherworldly potion in a pistol to her, saying, "I can go now. You'll know when to use it and when it's time to pass it on."
Death is not always so kind or so graceful in its gifts. When we healers and helpers are absorbed in our sorrows, perhaps lost in the fog of sadness over the limits of our skills or other concerns, we may also be most vulnerable to the laser beams of life from those who by all rights should be sorrowful and yet are not.
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"Helping cancer patients overcome fear"
Dr. Kevin Ryan graduated magna cum laude from Georgetown University, after which he authored numerous research and clinical papers, book chapters and abstracts in hematology/oncology, and presented research at the regional and national level while wo...