Medical Library

Dealing with a Difficult Diagnosis

by Steven Brown, M.D., Ph.D.
©2008

If it hasn’t happened yet, sometime soon, you or someone you love will face cancer or another serious health problem. Here are some steps to help you through the ordeal.

According to the National Cancer Institute, 40% of those born today will develop cancer at some time in their lives. If I am in that 40%, how will I deal with the diagnosis? How can I help the 40% of my friends and family who face cancer?

As a cardiologist, I see many patients who develop serious heart problems. They go through the same struggles. The process of dealing with any serious illness is similar. Let’s consider the story of one fictitious individual with cancer to illustrate some of the principles that help my patients get through this ordeal.

Judy’s Story

Judy typifies the saying that “50 is the new 40.” Since her last child went away to college, she has thrown herself into new activities. While continuing to work at an architectural firm, she participates in an aerobics class three times a week. On weekends, she and her husband travel all over the country to see their son play college basketball.

One Friday afternoon, a week after a routine mammogram, Judy received a telephone call from her doctor, asking her to come in for an appointment that afternoon. She sat for far too long in the waiting room, and then sat in the brightly lit, sterile-smelling exam room for what seemed an eternity. Finally, her doctor came in and sat down.

“There is a spot on your mammogram that is probably a cancer. We won’t know for sure until you have a biopsy. I have scheduled an appointment for you with Dr. Karen Hancock on Monday.”

The Longest Weeks of Her Life

Sometimes, waiting is worse than getting bad news. At least when we have bad news, we can begin to strategize and make plans. With uncertainty, we imagine every possible outcome from “no cancer” to “you have less than six months to live.” Our hearts run around in circles touching every possibility. It is no wonder we stay dizzy and shaken.

After she left the doctor’s office, Judy met her husband, Mark, for dinner at their favorite restaurant. Ordinarily, the smell of fresh bread and the sound of quiet conversation would make her feel warm and comfortable. Tonight, the surroundings just seemed cold and ironic, reinforcing her feelings of anger and isolation.

“Judy, what’s the worst thing that could happen?”

“I could have cancer, go through chemotherapy, and still die.”

Mark reached across the table and took both of her hands in his own.

“Judy, just remember that whatever happens, I will be there to go through it with you.”

Judy’s terror about cancer had locked her up inside her spinning emotions. Mark had just reached in and rescued her. Leaning on him, she was able to get a grasp on her situation. Now, she could look ahead to the future with a little more hope. With a gentle touch and the assurance that he would be there no matter what, he became her anchor.

Not everyone has a husband like Mark. But when faced with a crisis like a cancer diagnosis, our first step should be to find a friend to help share our burden. It may be a coworker, a family member, a clergyperson, or even a professional counselor. We should not be afraid to tell them sometimes that we do not want advice; we just need to talk things out and know they will listen and stay with us.

When a friend has a difficult diagnosis, it is tempting to avoid them, because we don’t know what to say, or because their problem reminds us of our own mortality. We need to come alongside them instead, and be that friend. Ask them what they are feeling, and how you can best encourage them. Ask about their family, also. Judy’s children need encouragement from their friends as they worry about their mother, and Mark may need to spend more time at the gym to work out his emotions there.

When Judy saw Dr. Hancock on Monday, she wanted to have surgery as soon as possible. Unfortunately, the earliest Dr. Hancock could operate was Thursday. Then, Judy had to wait another two weeks for the results of the biopsy. For Judy, the period of uncertainty lasted for 3 weeks.

Cancer

When Judy finally got the word, she did have cancer, and she did need chemotherapy. She had a good long talk with the cancer specialist. She learned that the medications we have today for treating side effects from chemotherapy are much better than they were even a few years ago, and that the chemotherapy would probably not be as unpleasant as she had feared. She was pleased to learn that she had a reasonable chance for cure, although there would always be some risk of recurrence (more uncertainty).

The second step in coping with cancer is to learn the facts. Start with your doctor, as Judy did. Make a list of questions, such as “What are the chances I can be cured?” “How long am I likely to live?” “How likely is it that the treatment you have suggested will help me, and how will it help?” “What side effects can I expect?” “What symptoms indicate a need to go to the hospital, or to call you before my next scheduled appointment?” Ask your doctor to suggest other reliable sources of information.

If you use the internet, do not believe everything you read. If I had cancer, I would want desperately to believe all those sites that claim that they have learned the secret to “miracle cures without surgery or chemotherapy.” When you read their ads, remind yourself that if something sounds too good to be true, it is probably not true.

Gathering facts helps some people more than it helps others. It is possible to get so much information that you become overwhelmed. Know yourself, and do only the research you need to feel that you understand your illness. If it is your friend or family member with cancer, offer to go with them to the doctor’s office and take notes. It is amazing how much we forget when the doctor goes out of the room.

Emotions

The feelings Judy experienced in the next several weeks changed from one day to the next. Sometimes, she did not want to believe that she really had cancer. Other times, she was angry. She directed her anger at God, at her doctors, or even at Mark. Some days, she felt she could cope if only she knew tomorrow would be better, or if only she wouldn’t lose her hair from the chemo. After a couple of weeks, she went into a period of depression, where she saw no hope and expected the worst. Eventually, she began to accept the diagnosis, and in turn, slowly got back on her feet emotionally.

Judy was experiencing a series of emotions described by Elisabeth Kubler-Ross in her classic book, On Death and Dying. She describes five stages of dealing with an illness, specifically: denial, anger, bargaining, depression, and acceptance. Not everyone experiences all of the stages, experiences them in order, or just has a given stage once.

The third step in coping with cancer is to understand our feelings. When we understand the normal range of emotions associated with a devastating diagnosis, we can step back from our emotions and understand that emotions are not reality. Discussing normal emotions with a friend who has cancer opens the door to let them tell us what they feel. If we understand their feelings, we are giving them support.

Looking Ahead

After discussing the emotional stages, Kubler-Ross points out that a common thread runs through each stage: Hope. There is hope for a last minute cure, hope that tomorrow will be better, hope that we will leave a positive legacy for our children, hope that our suffering will help others in some way. With hope, we are no longer focused on the pain and suffering we feel now. Instead, we are looking ahead to what tomorrow may bring.

The fourth step in coping with cancer is to face the future. For Judy, the first step was planning another dinner out with Mark after she recovered from her first round of chemotherapy. Eventually, she even let herself hope that she would live to see her grandchildren after all.

We need to be realistic, and to accept that the future may not be what we want. Our responsibilities to others require us to do so. But we should still always hope for the best. If the doctor tells me that my chances of surviving are only ten percent, there is nothing wrong with planning to be in that ten percent. If ten percent survive, or even two percent, why shouldn’t I be one of them?

Facing the future is not just about me. Facing the future also means that I think about the needs of those around me. What can I do today that my children will always remember? What can I do today for someone else that I will always remember with satisfaction? What can I do today that will help others even after I am gone? Any doctor will tell you that cancer patients are often the kindest, most considerate, and selfless patients we see. Part of the reason is their perspective. Facing cancer means facing our own mortality. This does not just happen at diagnosis. Even if the cancer seems to be gone, every doctor’s appointment, every x-ray, every blood test, and every unexplained symptom is a reminder that the cancer is lurking around the corner, ready to come back at anytime. When we constantly face our own mortality, we can easily distinguish between the things that are truly important and the things that do not really matter.

These lessons are not just important for cancer patients. They are important for all of us. If, as the friend of a cancer patient, I learn to see life more clearly through their eyes, they will have helped me more than I have helped them.

Key points in the process:

  • Find a friend/be a friend.
  • Learn the facts.
  • Understand the feelings
  • Face the future.