Diagnosis – cancer [2]

Diagnosis – cancer [2]

How do I tell someone?

How should I begin? Simply begin with the fact that you feel like something is wrong. That’s why you decided to visit a doctor and why you’ve made appointments for a variety of examinations including some that will potentially be able to find out if you’ve got cancer. Latvia has the so-called Green Corridor, which expedites any necessary tests to see whether or not you have a diagnosis of cancer. Then you can tell them that you’re already walking down the Green Corridor. Whomever you confide in will no doubt say that there’s nothing to worry about (what’s gotten into your head!). He or she will no doubt say that because they’re concerned. You should try to steel yourself. No one is immune to cancer and you’d simply like to make sure that you’re healthy. You might have to discuss other cases with other people you know – cancer patients. Naturally, this won’t be the most comfortable conversation you’ve had, but a serious one nonetheless. At this time, it will be a much more appropriate discussion than exaggerated optimism: “That’s ridiculous, you don’t have cancer! Stop fooling around!” In reality, this is the way a friend or loved one typically exhibits their shock and denial and their own anxiety about the coming test results.

Remember that the source of your despair at this point is the not knowing. This is scarier than any truth, no matter how tragic that might be. Try to focus on the thought that your anxiety is rooted in not knowing. You’ll only discover the verdict once the test results are ready. This is what you should tell your friends and loved ones. Have faith in their genuine concern for you! An open discourse is necessary for both of you.

Do I have to die?

Despite the myth, which has become ingrained in our society, that cancer is a death sentence, today that’s not at all true. In many cases, cancer can be successfully treated, even when it has become widespread. In some cases, it’s even possible to completely cure it. The illness will always be an unpleasant part of your past, but it doesn’t have to return. This is called complete remission and this is possible in many patients with stage I and II tumours. It is, however, true that tumours can be quite different from one another, so this assertion can’t be applied to all tumours. It’s also possible to significantly prolong a good quality of life for patients with stage III and IV tumours. People are often disappointed by this perspective, because everyone, without exception, is hoping for a miracle cure. Unfortunately, the pharmaceutical industry has recently placed intense pressure on society by offering so-called live-saving drugs, which will supposedly return parents to their children and children to their parents, allowing them to live long and happy lives. Sadly, this just isn’t possible, not even by paying large sums of money. In cases such as these I often tell my patients roughly the following: “Let’s hope that everything will be fine for as long as possible, but let’s be prepared for the worst scenario.” Some are disappointed with this answer. That’s understandable, because what kind of doctor can’t cure an illness? Unfortunately, cancer is one of those diseases for which we can’t give any guarantees. For these patients, the diagnosis is the part of their illness that changes the most. This is influenced by the localisation of the tumour, the spread of the process, the possibilities for therapy and the tumour’s reaction to treatment, the patient’s current state of health, concomitant illnesses and other factors, including both psychological and emotional. On the other hand, loud calls for new innovative drugs, whose costs aren’t covered by the Latvian state, are, for desperate patients, like music to their ears. People are ready to do anything and everything – sell their house, land and property – just to get their fix. Patients have told me that doctors have even recommended that they contact local charities to get money for these drugs. This is a lot of money that most Latvian citizens can’t afford. But should we be worried about it? No! I haven’t read any official report that would indicate that these new, innovative drugs have cured anyone of metastasised or widespread late-stage cancer. A small percentage of these patients have prolonged their lives by no more than a few months. In addition, many of these drugs are highly toxic and aren’t well-tolerated.

On the other hand, although treatment of painful complaints and side effects may not directly affect the illness, it can prolong life and, most importantly, improve quality of life. Today, it’s possible to decrease pain, nausea, vomiting and other agonizing symptoms by nearly 100%. The industry is more interested in profits than the fates of their patients. Think about it. What happens when the expensive drug no longer works or it’s proven altogether ineffective for that patient? Yes, the next drugs will be manufactured for an even more expensive price. Afterward, they’ll cynically explain to the patient that all modern medical opportunities have been exhausted, the way it happens here in Latvia, as well as in other countries. But help can always be found. Maybe not at a free clinic or at an urgent care centre, but family doctors are becoming more knowledgeable about the symptomatic treatment of tumours. In addition, it’s always possible to consult an oncologist or palliative care specialist.

Cancer, like any other severe chronic illness, pushes people to confront existential thoughts. Your future has suddenly become unclear and even threatened. Your life’s trajectory has diverged to a different course whose outcome is predictable. It will take time to come to terms with these thoughts. Therefore, the more you know about your illness and what you can expect, the less anxiety and discouragement you’ll experience.

Why has this happened to me?

Anger, resentment, hatred and overwhelming feelings of injustice and injury rage inside you after being diagnosed. These feelings shouldn’t be hidden from the people in your life. Your attitude toward people has changed (perhaps you don’t even realise it), because they are healthy, nothing is threatening their lives, they’re not in pain – they don’t have cancer, but you do. It’s even difficult to explain these emotions to your loved ones and this only irritates you more. In your heart of hearts, you haven’t changed yet, but the new rules of the game have left their mark on your emotions and actions. You have to understand that once you’re able to discuss these feelings with someone (a friend, doctor, psychotherapist or psychologist), the easier your life will become. That said, it could take time. Time for you to prepare yourself and perhaps also time for your loved ones, who initially may not be ready to listen. Don’t blame them for this. They’re also incredibly distraught, not only because you have cancer, but also because they’re not sure what to do or what to say. Some of my patients have told me that they have gained some relief by writing a journal and entrusting their suffering to the pages of their diaries. Some people prefer to cry or to scream by themselves. However, hugs and a proper cry in the arms of a loved one can lessen stress and encourage further verbal contact.

Remember – cancer is not a punishment for anything you’ve done in the past, for evil thoughts or some other kind of revenge. Small children are diagnosed with cancer and we can probably all agree that they’ve never done anything to deserve such an illness. Your illness is an unfortunate accident, not the result of some perceived sin and you shouldn’t feel guilty about it to anyone, especially yourself. It’s understandable to feel bad about what will happen to your parents, your children, your house or your company.  However, this illness also gives you time to discuss all kinds of things with your family, to put your affairs in order, to reconcile and to say goodbye. For some people these last phrases may seem unacceptable, but they are realistic and true. Many of my patients have told me that they’re no longer so worried about what’s to come now that they’ve put their affairs in order. I once escorted an Orthodox priest to visit a patient and I still remember his words today: “Your patients should be happy that they’ve been given the opportunity to say goodbye, because many other sick patients or those who die suddenly do not.” The 15th-century book Ars moriendi or The Art of Dying (full title: Tractatus artis bene moriendi), is a unique guide on how to die that doctors, patients and their loved ones should read.


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