Many another, once, you schooled,
giving strength to feeble hands;
your words set right whoever wavered,
and strengthened every failing knee.
And now your turn has come, and you
lose patience too;
now it touches you, and you are
Job 4:3

Fear is something that we are all familiar with. It can be produced by a sudden noise in the middle of the night, or by a situation that is truly life-threatening. I remember one evening, about ten years ago, I was sitting and studying. I was pretty tired and, as I often do when I'm tired, started to rub the back of my neck. I felt a lump! I felt the other side and there was no such lump. I had been working with mouse Hodgkin's disease for over five years at that time, and often the first symptom of this disease is a lump in the neck. I shall never forget the terror. I went through the whole frightening process in my mind: the biopsy, the microscopic examination, the doctor saying that it was Hodgkin's disease, my getting other opinions to see if they could confirm it, deciding who to go to for treatment, what treatment to get? Nor shall I forget the relief, several days later, when a surgeon opened up my neck and told me that the tumor was shiny bright yellow colored; a lipoma (a fatty tumor that can usually be diagnosed by looking at it, and is almost always benign. When he removed the tumor and sewed up the incision, I danced out of the operating room; the weight of the world lifted from my shoulders. It was one of the happiest moments of my life.

The frequency of the occurrence of cancer is so high (about one person in four) that it is very hard to find a family in which at least one member has not been affected. The same is true of heart disease and stroke but, for some reason, cancer seems to be more terrifying to people than either heart disease or stroke. George Crile believes that this disproportionate fear has been induced by those responsible for telling the public about cancer, and I agree with him. People who daily take their lives into their hands on the nation's highways shudder at the mention of even the possibility that they might be harboring the seed of a cancer in their own body. I believe that an important element in the fear of cancer is a fear of the unknown. We are all more or less aware of the magnitude of the risk of accidental death on the highway, and can cope with it. Most people are able to accept the risk. They try to minimize it by being as careful as possible, and put it in the back of their minds along with such thoughts as the inevitability of death. Not so with cancer. A common attitude is that "If I have cancer, I don't want to know about it." It is, perhaps, the emotional equivalent of the young man who is so terrified of accidental death that he courts it by driving his car in excess of 100 miles an hour --see, you can't hurt me! As with automobile accidents, much can be done to reduce the risk; while nothing can be done to eliminate the risk. Most tumors, but not all, grow slowly for a period of time before they spread. If they can be removed surgically at this time, the patient is cured.

The most careful driver can have a tire blowout on a highway and be killed, but the probability of being killed on the highway is less with the careful driver than the careless one. The same is true of the risk of dying of cancer. You may know someone who died of lung cancer and never smoked; by the same token, you might also know someone who won the Irish Sweepstakes. In other words, it is possible to reduce the risk of getting lung cancer. I hope that reducing the objective risk might also reduce the subjective fear. I used to worry about getting lung cancer. Instead of trying to reduce the worry, I reduced the risk by giving up the weed Since I quit smoking fifteen years ago, lung cancer no longer worries me.

While there have been changes in the treatment of disease, the ways that physician and patient approach one an other has not changed. People still come to their physician frightened and hope that he can alleviate their fears. The woman whose parents both succumbed to heart attacks wants to be told that her heart is in good shape, while the man who has lost a parent to cancer wants to be told that he does not have cancer. This need for consolation is intensified by people being bombarded with advertising that tells them how fearful cancer and heart disease are. While patients are becoming more fearful, physicians are becoming less personal and less able to deal with the fears. Anyone who has gone to a busy physician recently has probably found that the doctor has little time for feelings because he is too busy with seriously ill people who require that he minister to their physical needs. The physician who was the family friend, father confessor, and general purveyor of comfort has all but disappeared. Most people have a need to have someone to tell their troubles to. If this is a problem with relatively healthy people, think of how terrible it must be to someone who might be facing death.

There is a public outcry for a return to the days when the physician was a friend of the family and not only helped them medically, but comforted them emotionally. In this mobile society in which we live, it is unlikely that we will ever recreate the old country doctor. Besides, I don't think that we would really want to. The old country doctor was very good at comforting the sick and dying, but he was damned ineffective at actually curing disease. We need all of the help that scientific medicine can provide. There is, however, nothing in scientific medicine that is incompatible with the physician also being humane. Dr. Elisabeth Kubler-Ross would like the physician to be able to handle both the physical and the emotional aspects of patient care. Her goal is a laudable one which might be attainable with many physicians, but certainly not with all of them. This is what the thinking medical educator would build into all of his physicians if he could. The ideal physician understands scientific medicine (what medical science can and cannot do for a patient) and also can comfort his patients when he can do no more for them physically. It is also what every patient wants in a physician.

No one person can be expected to do everything. The man who performs the surgery may be temperamentally unsuited to provide the emotional support his patient may need; and by the same token the person able to provide the emotional support may be incapable of performing the surgery. Some psychiatrists and psychologists have assumed the role of helping the incurably ill, as have many ministers. There are not enough professionals available to handle the problem. Besides, psychiatrists, like surgeons, also find themselves swamped with the seriously mentally ill and do not have time to comfort the dying. It seems to me that the only solution to the problem is the education of everyone in desirable ways of dying and living.

When a doctor tells you that you have cancer, it's as if you just had your death warrant signed. There is no escaping the terror. As Elisabeth Kubler-Ross describes it, the first reaction is usually "This couldn't be happening to me." This is followed by anger, with the "victim" resenting everyone else who is healthy, and wondering what they could have done to deserve this. This stage is magnificently described in the book of Job. Following this comes a stage of acceptance in which a person is ready to deal with reality. Fortunately, in most cases, the realities are nowhere near as grim as the word "cancer" implies. Many cases can be completely cured with surgery and the patient with incurable cancer often has many pain-free years before the end.

One of the most difficult things that a person with cancer has to deal with is the fact that there can never be certainty. One is never sure whether or not the operation has actually cured the disease. Even if the operation did not cure the disease, or the disease was untreatable, one has no idea whether the end will come soon, or not for many years. The nagging problem is this uncertainty. It might be easier to live with the certainty of immediate impending death, than it is not to know how long. Yet, we all of us have to handle the fact that very few things in life are "certain." There are dangers inherent in driving a car, swimming, riding, bicycling, or even walking on the streets. The person who is aware of this uncertainty can make some adjustments to it. Most of us proceed with some illusion of certainty, because it is the only practical thing to do. To do otherwise is to live in constant terror. Most of us are able to utilize illusion when it is necessary to do so. For most of our lives, we act as if we were immortal. The diagnosis of cancer says something to you that you have been aware of for a long time: that you are going to die, but you don't know when. You have been aware of it, but have ignored it. Most reasonable people look at the grim realities for a while, and then reestablish their illusion of immortality. Even people with incurable cancer usually have a number of years in which they are feeling well and in which they can do anything that people without cancer can do. Some people with incurable cancer have managed to accept it, and have made their remaining years rich and meaningful for themselves and the people around them. Others have frozen the rest of their lives in the panic stage, and have spent their remaining time desperately searching for cures that did not exist. They have essentially managed to die emotionally at the time of the diagnosis. They were deprived of many years of effective living.

If you have been diagnosed as having cancer, you would be well advised to first get the best possible treatment that is available and to then go on living as best you can. Every year that passes without a sign of recurrence means that the chances of your having been cured by the treatment are better and, by five years for most curable cancers, you are pretty well out of the woods. In the meantime, you have not wasted what may well be one-fifth to one-twentieth of your life stewing about the possibility that you are going to die.

The same basic approach is useful should you find out that you have an incurable type of cancer for which medical science can do nothing, or at best prolong your life by a few years. People who have been able to resign themselves to a limited life have been able to make their remaining time as rich and meaningful as possible for both themselves and their loved ones. I strongly recommend that, should you find your self in this predicament, you read Elisabeth Kubler-Ross' book called On Death and Dying. You may find this hard to believe, but some people with incurable cancer have made the last few years of their life the most meaningful and beautiful ones for both themselves and the people around them.

There is another general rule for successful living that is particularly useful to people with incurable cancer: it is DON'T LOOK BACK. It does little good to stew about the things that you might have done, or should not have done.

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