I enjoy working with adolescents and young adults who are in treatment for addiction because, despite their vulnerability, they are at an age where interventions have a reasonably high chance of being successful. Their genetic risk for addiction is something they cannot change, but they can modify their overall risk by changing their environment and carefully choosing their friends.
It recently occurred to me that this concept is the essence of the Serenity Prayer, which is often cited in my line of work—and also in the face of a cancer diagnosis. The first part of the prayer encourages us to “accept the things we cannot change.”
Prior to my medical training, I learned that cancer was a disease for which there was no cure. In the past, a cancer diagnosis was akin to a death sentence. Now, thanks to advances in medical knowledge, there are various forms of cancer that are curable with early intervention.
Acceptance does not mean resigning ourselves to the “inevitable.” It does mean that we can be proactive about our individual situations and do whatever is possible to mitigate our risk. For example, while a lumpectomy may be considered adequate for a benign breast lump, someone with a family history of breast cancer may decide to undergo a prophylactic double mastectomy.
The second part of the Serenity Prayer seeks the “courage to change the things I can.” My family history of colon cancer is something I can’t change, but I can modify my risk by following recommendations for prevention and early detection. Getting colonoscopies more frequently than the average person is in a sense “changing the things I can.”
The last part of the Serenity Prayer asks for the “wisdom to know the difference” (between what we can and cannot change). Unfortunately, sometimes despite our best efforts at prevention, tumors arise de novo, or they are detected too late. Aggressive interventions are sometimes appropriate; at other times, hospice and palliative care are the only options that make sense.
As health care providers, we need the Serenity Prayer just as much as our patients do. Sometimes we are the ones faced with accepting the difficult reality that we can’t always cure diseases. Our acceptance of this reality shouldn’t stop us from continually caring for our patients in the best way possible. The compassion and kindness we show our patients in their time of need may be just what makes the difference.