"I know it will kill me," my patient Jan says calmly.
We sit in my office looking out on the river below, which glints in the fall sunshine. It is a warm day for November. Jan has just learned that her breast cancer has spread to more internal organs.
Her doctors have told her that she will not recover.
I--who have had breast cancer twice--cringe inside. Jan's blue eyes fix on mine, but she expresses no emotion at all.
In 1990 a routine mammogram showed a bright white constellation in my breast. The biopsy was positive. I heard four words: "You have breast cancer." I was forty-eight; I was certain it would kill me.
Jan is forty-five, married, with two young children. Although she's been living with metastatic breast cancer for three years, her main focus in our sessions is not her cancer. When we discuss how hard it is to lose other members in her support group, she doesn't mention herself in that context. She shows despair only when speaking about her children and how horrible it will be when they lose her.
That day of diagnosis, our drive home seemed endless; my husband and I alternated between terror and tears. Our whole happy life had changed. What was going to happen to me? How could I tell my children, who were seventeen and twenty?
Jan has been speaking rapidly. "Now I have to make 'quality of life' decisions about treatment, but I'm not sure I want any more treatment. What's the point?" Though her face is flushed, her eyes never waver. She pauses, then tells me the family is going to Florida for Christmas. There will be happy times, with lots of photos to "make memories" for her family to have after she's gone. She stares out the window.
I went through a partial mastectomy and radiation, and then it was over. Fourteen years later, however, in 2004, a new cancer showed up in my other breast. Although I hadn't dared to feel completely safe after my first experience, I hadn't expected this. Not again! I felt even more frightened than the first time. And after treatment, I felt haunted: Would I be the terminal patient in the room someday?
Even now, Jan maintains her stoic front. I so want to support her in this terrible situation--to provide a place where she can speak her fears. I've shared my own story with her; does this knowledge hold her back now? I feel upset and unhelpful; should I be doing something more? And what is it about her that tugs at me so? She's not the first cancer patient I've treated who has faced death. Perhaps it's because she's trying so hard to be brave. How familiar that feels...
During treatment, I believed that I had to hold myself together, or my fear would consume everything: my husband, our marriage, our family--everything. Afterwards, I realized that I'd learned a lot about being a breast cancer patient. In addition to enduring physical distress, I'd suffered a huge range of emotional trauma, and it was that which lingered. Eventually I sorted out my feelings of fear, anger and vulnerability. I knew that I could live with cancer--even in spite of it. But I also know that there's no script for this.
Before I can speak, Jan glances at the clock behind me. "It's time for me to go."
She walks to the door, and I stand. "I'm so very sorry to hear this news," I say.
She turns the doorknob, and I touch her shoulder.
Smiling tiredly, she looks at me: "Now we're going to get a puppy. For the kids."
Then she is gone.
I decided to focus my counseling practice on cancer support. I knew it might be complicated for me at times, but I also felt that my experience would lend me a measure of credibility with patients. I'd heard many of them say, "People just don't get it until they get it." I get how cancer can shatter your life. As a counselor, my goal is to help cancer patients to heal, to recover and to live well with cancer.
I stand there, feeling my grief and fear for Jan, my fear for myself, my helplessness for both of us. Leaning against the door, I take a deep breath to steady myself, and close my eyes. I must remember that her story is not my story. I must remind myself that I did what I could today: I supported Jan with care and respect in that space she needed, that space of no emotion, no hysterics--that space of control.
When Jan is ready, we will get to her awful reality. My job is to continue to listen with compassion and attention while she endures whatever comes next. I will put aside my cancer demons for her. During these fifty minutes, we've faced her cancer together--and we will do it again and again and again, for the duration.
I walk down the hall to meet my next patient.
About the author:
Elizabeth Tyson-Smith practices psychotherapy outside of Boston; in 2000 she founded the Virginia Thurston Healing Garden (www.healinggarden.net) to facilitate psychological healing for cancer patients. Her writings have appeared inSecond Opinion, E-The Environmental Magazine and elsewhere. She is now working on a book about the cancer journey from diagnosis to healing. "Writing has been a way for me to make sense of cancer, as well as a means to inform others how they can heal and live well with this fear-provoking disease."