Diagnosis – cancer [1]

Diagnosis – cancer [1]

Sometimes you’re overwhelmed by a desire to run away, to disappear, to unplug or to simply forget something as if it never happened! The idea of cancer is unacceptable. It would be better if I hadn’t found out. You feel as if you have two people inside – one who stoically wants to discover everything about their disease, and the other who would prefer not knowing about it, denying it, doubting its existence altogether. The latter is your will to live – feelings that won’t listen to reason. Denial is a natural response to shocking news and it gives your mind time to process this new information.

The tests will soon be completed…

When you’re being examined you more or less anxiously await every test result and you listen intently to every comment the doctor makes, even if something is actually quite insignificant. Your imagination has run wild and that’s completely normal, because you’re essentially waiting for a verdict. Your intuition is telling you that something is wrong, but just how wrong will depend on your test results. During this period of time (and it usually takes several days to receive your diagnosis) you lack focus, it’s difficult to concentrate on work, you’re easily irritated or offended. It’s almost like living in a parallel dimension where you function in a kind of autopilot because your mind has partially shut off to solve other existential problems. You want to cry or, perhaps just the opposite, you throw yourself into your work with unusual enthusiasm, just so you can think about something else.

It’s normal to be upset. Any person would be upset under the circumstances, which is why this shouldn’t be confused with hysterics or uncontrollable nerves. You’re upset for a reason. These are not irrational, but rather very concrete fears. This is why it’s so important to share your feelings with someone close to you at this time. This doesn’t have to be a family member. However, it should be a person who is ready to listen, even if they don’t have anything significant to say.

I know from experience that patients react very differently during the examination period. There are those who already have a feeling that they are ill and are just waiting for confirmation. It’s also not uncommon for a patient to get tested for a different, supposedly unrelated health problem and their doctor’s suspicion that they might have a malignant tumour hits them like a bolt from the blue. There are also patients who, for some reason, suspected something and intentionally avoided the doctor and then feel guilty (sometimes also helpless or deeply regretful) that they let the cancer spread. However, no matter what your thoughts are or what you’re going through, you need an understanding, empathetic and soothing conversation. This could be with your doctor, a loved one, a family member or a friend. People often hide the fact that they’re undergoing tests. This is partly because you still may not believe that you could have cancer and you believe that there’s no point in worrying friends and family. On the other hand, the people who suspect that they have it are afraid or even embarrassed to tell others.

In my experience, keeping a journal is very helpful at these times. Even if you just fill an entire page over and over again with a few words – this is crazy, it can’t be, this is horrendous, etc. It’s very important at this time to release all of your fears, anxieties and despair. Crying is helpful for some, screaming for others. An older woman once told me that she went home and explained all of the bad news to her dog… Find someone who can offer a shoulder to cry on, who will listen to your fears, your pain and your despair!

I was diagnosed…

During my time as an oncologist I’ve experienced a significant paradigm shift from hiding a diagnosis during the Soviet era to complete honesty today, with some occasional backsliding into half-truths and minor deceptions. In Soviet times, it was believed that revealing a negative diagnosis would only traumatise a patient. One holdover from this era is writing a diagnosis in Latin (sometimes even a mangled version), so the patient isn’t immediately hit over the head with a hammer, so to speak, with the news. This often confuses patients and their loved ones. In the majority of countries where I’ve been the diagnosis, even in oncology, is presented in the nation’s official language. Today there is no option to tell or not to tell someone. What’s important is how you tell them. This is, however, largely dependent on the doctor’s personality, capacity for empathy and their desire to do so as carefully and sensitively as possible, but without holding back any important facts about the illness and its potential to spread.

In Latvian there are many synonyms to describe the disease – cancer, a malignant tumour, an oncological illness (not just a sickness as it is so often described in local society). On the other hand, terminology such as carcinoma, a neoplastic process, neoplasia, malignancy, suspicious growths and bad cells are just different names for the same cancer diagnoses. However, patients often perceive them differently: “The doctor said I have neoplasia. Maybe I don’t have cancer.” People are willing to grasp at any straw to keep themselves above water.

Therefore, if you’re not sure what your diagnosis means I recommend that you find the courage to ask: “Do I have cancer?” It’s possible that by asking this simple question you’ll also help to break the ice with your doctor and encourage him to speak more frankly and understandably. Today, the only excuse to hide such a diagnosis would be if the patient were in such a grievous physical or mental state that this revelation had no bearing on their decision to choose another method of therapy or model of care.

Why is it important to know your diagnosis?

No matter how unacceptable it may initially seem, it’s always better to know your diagnosis. On the one hand, being conscious of your illness can throw you off balance, but on the other hand, the more you learn about your condition, treatment possibilities and potentially beneficial lifestyle changes, the better you’ll be able to understand your treatment options and the more you’ll be able to keep track of your emotions. You’ll feel safer and more confident. Nothing causes as much anxiety in a person as uncertainty and an inability to understand oneself at crucial, life-altering moments.

A cancer diagnosis is an historic milestone that forces you to divide your life into two parts – the time before you were diagnosed, and the time after. Therefore, be brave and don’t hesitate to ask questions that interest you. For example, do I have cancer, how far has it spread, what are the treatment possibilities, what are the potential negative side effects and what would be the most appropriate solution for me? These questions are just the beginning. Over the course of your illness many more will come to light. I recommend that you write down all of your questions on a piece of paper, so you can ask your doctor the next time you see him.

Should I visit a doctor by myself or take someone with me?

This all depends on you, your attitude, your circle of friends, your relationship with your loved ones, your personality, the way you were raised, your faith in others and your ability to trust. When you discover your diagnosis, either directly or indirectly, you’ll want to be with the person (no matter how much you might want to deny it) who will be just as shocked as you are to hear the news. You’ll yearn for a person to support you, someone strong, especially if you’re both important to one another. This is why it’s so important for someone to know about you and your illness from the very beginning.

I like it when a patient brings an important person in their life to their doctor’s appointment. This isn’t necessarily a family member. This could also be a friend or a colleague. If this person is willing to take you to the doctor, this obviously means that they care about you. It’s important to be aware that you’re not alone. After all, the old Latvian proverb teaches us – “A shared sorrow is only half a sorrow.”

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