A short time ago, I was reading Melissa Scott’s blog on the risk of a cancer diagnosis secondary to treatment for breast cancer. As I was reading, memories of my time on the floor of a hematology-oncology unit bubbled to the surface: the incredible team there, the facility, and the patients and families with whom I worked.
One patient in particular came to mind with such force and clarity that I feel as if it were weeks or months, rather than years, since I last saw her. She was a tiny woman, sharp, angry, funny, bright, young, just 42. She had been an emergency room nurse prior to diagnosis with breast cancer at the age of 38. She described her breast cancer treatment as “...very intensive. I wanted the biggest, whopping dose of chemo they had!”
She was young, had a late stage diagnosis, and wanted "the best shot for survival." Her treatment was successful, and, after much soul-searching, she decided not to return to work, but to stay home with her two young children, with a plan to go back to her nursing career once her children were older.
Sadly, she would never get back to her career, though she was very clear that she did not, for a moment, regret her choice, since it had meant several very close years with her children. She had been diligent about follow-up care and aware of the risk of a secondary cancer. Nevertheless, when it happened, she was “twice as shocked as I was the first time around. Somehow, I just didn’t think lightning would hit twice!”
Working with Francine was a whirlwind -- she spoke fast and ended every other sentence with an exclamation! She was, from the beginning, quite sure that she would not survive the AML
(“I KNOW the statistics!”), but was determined to live as long (and as well) as she could, for her husband and her children.
We spent our time together processing the secondary cancer: working through the shock of the diagnosis, exploring her thoughts and feelings about illness, the long hospital stays, the impact on her family, reviewing her life choices and consolidating her legacy, talking about death and dying, and ultimately, her feelings of responsibility and guilt for having been “so gung-ho for the breast cancer treatment.”
Control was a powerful issue in her life -- cause-and-effect was her way of making sense of the AML, which meant that the most crucial aspect of emotional healing for her became forgiveness. Francine was very clear about where she believed the “blame” lay for the AML. She never blamed her breast team, because “they told me everything." She “knew that a secondary cancer was a real risk.”
She was able to focus on forgiving herself for her choice, without the terrible psychological complication of second-guessing the team that had cared for her, the team in whom she’d placed her trust, the team that had been her “hero,” and that she had -- needed to have -- great respect and appreciation for. Because of their clarity and honesty in communication, her emotional work at the time of the secondary diagnosis, though by no means “easy,” was far less complex or painful than it might have been.
Making peace with her choice was a tremendous challenge, but she was able to appreciate the strength and will to live, and to be there for her family. She came to appreciate that her choice may have given her those beautiful years with her children between the two cancers, and to appreciate the fact that she had not made her decision blindly, but with full disclosure and understanding.
She was able to let go of some of the feelings of responsibility and, in the end, to find comfort in thinking of her choice as rational, logical, and one that had been rooted as deeply in an understanding of “all the consequences” as it was in her love for family and life.