By: Vivek Bilolikar, SKMC Class of 2021
Midway through my second year of university, my childhood friend, EE, called me around 1 AM on Sunday and woke me up from what I could only assume was a perfectly good dream.
“I hope I didn’t wake you,” she ironically stated.
“No,” I sleepily replied, “I was up anyway. What’s up?”
She told me that she was having trouble sleeping. Initially, I thought that she had broken up with her most recent boyfriend, or something along those lines, but there was something different in the sound of her voice. We made small talk for a little while and just as I was about to end the conversation and hang up she was ready to talk.
“I’m going into surgery tomorrow,” she blurted out.
Stunned, the only words I could manage were, “For what?”
She explained that she was going to have a lumpectomy for breast cancer. A week earlier, she was diagnosed when the doctor found a lump during a routine exam. The doctors were hopeful that the lumpectomy would cure her cancer. I didn’t know what to say. I just lay in bed and listened. I tried to console her and tell her that everything will work out but what did I know? I was just a college sophomore over 1000 miles away. We talked for an hour and then hung up. I didn’t sleep the rest of the night.
A week later, when I called to follow up on her surgery she picked up the phone sniffling.
“The doc said that I have to start chemo because it spread to the lymph nodes,” she revealed.
That moment lasted for an eternity, my phone slowly slid out of my hand and bounced around on the floor. The only thought I had was that I might have to go to my best friend’s funeral.
“Are you still there?” she asked.
“I’m here, when is your first session?” I asked, coming back to reality.
“Tomorrow,” she replied.
“I can’t be there tomorrow, but I’ll be there for the second session and every single one after that,” I promised without hesitation.
Once I got home I accompanied her every other week to her chemotherapy sessions.
“Don’t go and shave your head and eyebrows. You’ll look like an alien, and there don’t need to be two of them!” She exclaimed out of the blue during her third session.
In the moment, I laughed. I realized that I would look ridiculous with no hair or eyebrows. Reflecting back on the moment, however, I realize she was looking for stability, not trying to make fun of the shape of my head, even if it was just my appearance. I think that she was acutely aware that a lot was going to change and wanted some things to stay the same. She insisted that we do things that we had done before her diagnosis, even as kids. We played P-I-G in the hospital parking lot before her chemo sessions to get rid of her anxious energy. We played cards during her sessions to pass the time. We enjoyed each other’s company without letting the circumstances define it
Unfortunately, the first combination of chemo did not work. I was frustrated and heart broken. I can only imagine EE felt the same, but she did not even seem phased by the news.
“The first round did not work, so I’ll be expecting you next week! I need to beat you at cards so that I can take your money and pay for this next round of chemo,” she declared with a smile on her face.
I could not believe her courage in the face of such devastating news. I’m sure that cancer changed her outlook on life but you wouldn’t know it by looking at her; she was still the same sharp, witty, funny girl she had always been.
Before she was diagnosed with breast cancer, EE was studying to go to law school. She tried to keep up with school but it proved harder than she expected. She took a leave of absence but she did not stop studying when we weren’t playing cards or complaining about the terrible hospital TV. She refused to become a slave to her situation. To me, it appeared as if her diagnosis had increased her zeal to thrive. After six months of chemotherapy, EE's cancer went into remission and she immediately went back to law school; she did not skip a beat.
After watching EE and being a part of her treatment, I have come to realize and appreciate that in a time of crisis having the opportunity to continue with one’s normal life is key. EE and I did not dwell on her diagnosis. I treated her as if she was still nineteen and did not have cancer. That stability, I think, gave her the chance to process the monumental changes in her life at her own pace.
Great stories about resilience and coping center on the fact that in the face of great adversity people want to continue, even excel, with their regular lives and routines. The normalcy allows them to concentrate on something else that is not connected to their crisis situation. Their subconscious has the time to process the crisis situation and begin adjusting to the adversity. Yet, often that stability is elusive because of the monumental changes that are occurring.
As future physicians, all of us at some point will have to interact with patients who have terminal illnesses. In fact, many of us will have to give patients a life-altering diagnosis. We must consider that patients and those around them deal will deal with this crisis in different ways. Dr. Shastri Swaminathan, a psychiatrist with Advocate Illinois Masonic Medical Center in Chicago, said, “In the face of a major medical illness, everything we know shows that patients go through the same five stages: denial, anger, bargaining, depression and, eventually, acceptance. Any intervention by a medical professional should be pertinent to the stage the patient is in”. It is imperative that we are able to identify the mental states of our patients so that we can offer pertinent advice when it is most effective; discussing treatment options with patients in denial will not result in a beneficial exchange and effective decision making.
Furthermore, patients who are facing adversity need to be able to develop coping mechanisms on their own terms and we, as health care providers, need to be involved. We cannot utilize a one-size-fits-all approach when it comes helping patients with facing their diagnosis because each patient is different and will require different support. The best coping mechanism is for patients to actively face their illness head on. In that same vein, physicians should encourage their patients to become an active member of their treatment team. Active involvement will help patients to maintain a sense of control and stability as they are empowered to control the elements of their life that they can. That way they are no longer a passive recipient of their treatment course, but the agent of their own destiny.
1. A shorter version of the basketball game H-O-R-S-E
2. http://www.ahchealthenews.com/2014/09/08/coping-with-a-life-threatening-medical-diagnosis/