For patients with cancer especially, dealing with anxiety in a world of unknowns can be difficult.
If you are anything like me, the thing that bugs you the most is the problem yet to be solved. I’ll stay awake at night when I’m super anxious and simply worry about all the little things that need to be fixed in my house. How will I find a mason to fix my crumbling porch steps or my counter top that is wobbly? How much will that cost? Can I afford it? What if I get the wrong person? 'Chill,' I tell myself, 'there is no reason to worry about something so solvable in the middle of the night.' 'Fine,' my brain will say, 'now here is another item that I’d like to bring to your attention…' What did I worry about before I had a mortgage? I certainly found things. And I doubt I am alone in knowing this feeling.
You may not worry about home repairs, but you may worry about money, or relationships, marriage or your kids, or, well, your health. And I think the patients we care for are often in the last category on top of all the others when we are interacting with them. Under duress and intense anxiety everyone you meet will have a different coping strategy. Anxious questions, worrying, stony silence, internet research, ignoring the problem, finding a surrogate to worry for them. The list is long.
I remember one of the first patients I ever did a history and physical on as a new student, who told me quite proudly and confidently that he had no previous medical or surgical history. He was in a nursing home, and I inquired how he had found himself there. "Well, back when I was on dialysis, I got really weak and I needed physical therapy." "Oh, well you seem pretty active now," I told him. "True, but I still need help with my insulin injections every day." So I’m guessing he had diabetes and renal failure with a possible transplant?! I admit, part of me envies being able to forget your own medical history. My sage professor chuckled and said I’d meet a lot more people like that, and she was most definitely right.
For most of our patients, the very real looming cancer diagnosis hangs over their head and escapism is not usually a valid option. Maybe they cope by trying to forget or maybe they cope by planning out all the possible scenarios or somewhere in between but either way, we have a person, in our presence who has something a bit unbearable dangling over their head. Something we’ve asked them not to walk away from but rather deal with in ways they will likely find very uncomfortable and often painful.
Even stage I cancers, while they carry a sense of relief that we got it in time, require so much surveillance. It’s like we can never give our patients a break from all the looming what-ifs. And maybe we shouldn’t because after all, they really are there. Cancer recurrence is a very real subject of discussion and how we measure treatments, the 5-year and 10-year marks seemingly so important for research.
We have all these patients walking around healed, and not yet cured. A very real example of how we all live our lives -- there is always something that can hang over our heads no matter what. Yet, we all wake up in the morning and go about our day. The fragility of life always there and with us, reminding us how precious waking up in the morning actually is even on our worst day. Because, after all, there is always something to conquer and something to look forward to at the end of that battle.