Common Themes for Cancer Patients and Survivors

For decades now, I have worked with people going through cancer, recovering from cancer, and, sometimes, dying from cancer. Some of my time has been spent with their families, and I often continue to speak with family members after a death. Most of my time, however, has been with the individual who has the diagnosis.

All the other worries don’t vanish because cancer has happened.

For almost 40 years, I spent my days in the Oncology Unit at BIDMC. For the past two and a half years, I have had a busy private practice. This has been a major transition, but little about the work itself has changed. The biggest change has been from sitting in the same room with someone, first at the hospital and then in my home office, to sitting in front of a screen. I now have at least half a dozen patients whom I have never met in person. This has been a steep learning curve for everyone, but it works. I suspect that many people, especially those who had to drive a distance, will opt to continue with virtual therapy, while a few talk about their eagerness to return to my office.

Over the past few days, I have been especially thinking about the shared worries and common issues that I discuss with everyone. Of course, cancer happens in the course of a life. Everyone also thinks and talks about their work, their family, their personal ongoing issues. All the other worries don’t vanish because cancer has happened.

One long-term patient is a woman who has had several medical problems in her life, but never had one that forced her confront her mortality until now. Her recent experience was cardiac, but, for the first time, she is now talking about all the existential issues that cancer patients routinely confront. This shift in her and in our work together has stimulated these musings.

What has my life been about? What have I stood for? Have I made the best choices?

Looking back, we can all identify key decisions that may have seemed not too important at the time, but choices that changed the rest of our lives. One woman told me about being offered a very tempting job in New York when she graduated from college. At the time, she was in love with the man who is now her husband, and he was in school far away from there. Work or love? She chose the man and is happy with the way her life unfolded. Looking back, however, she recognizes that everything could have been different if she had taken the job. Thinking about my own life, I was offered a tempting job at another hospital at the same time that I was offered the oncology job at Beth Israel. Had I taken the other position, my whole professional life would have been different. My whole personal life would be different, too, because I met my husband at Beth Israel, and I don’t think our paths would ever have crossed otherwise.

What legacy will I leave?

An ethical will is a document, not a legal one, that you write to pass on your experiences, values, and life lessons to your descendants. A few of my patients have taken on this project, but virtually everyone thinks about it and reflects upon their lives. We tell stories to our children and grandchildren, and we will be part of others’ stories. 

What are my regrets, and can I make amends? Could I write a note of apology to someone whom I wronged in the past?

Alternately, could I write a note of thanks to someone who was more important and helpful than I recognized at the time? If the regrets are more related to life choices, can I remind myself of the benefits of the choices I did make and consciously feel grateful for what I have?

What do I want to do with the rest of my life?

I have never thought that cancer was a blessing and never have expressed gratitude for this chance to learn life’s lessons. However, I know that cancer gives us an opportunity to pause. Because the illness and treatment force us to step back from our normal busy schedules, we have a chance to think about our lives and our choices. Whether we anticipate living for many more years or fear that our time is short, we may live differently and we might even live better.