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The Bogeyman in the Closet: Reducing Fears of Cancer Recurrence, Death and Dying

The Bogeyman in the Closet: Reducing Fears of Cancer Recurrence, Death and Dying

Speaker

David Kessler, co-author of Life Lessons with Elisabeth Kübler-Ross, author of The Needs of the Dying and Director of Palliative Care for Citrus Valley Health Partners

Lecture Summary

This is a summary of a lecture presented on June 12, 2003.

The reality is that none of us know how much time we have left. After the September 11, 2001 attacks many people recognized that life could come to an end in an abrupt and unexpected way.

Having a diagnosis of cancer does not mean that you will be the next to die, but it does provide an opportunity to begin to address issues of life and death. Each person’s relationship to life is shaped by his or her relationship to death. In order to live life to the fullest one must appreciate that life is limited. More often than not, we go through life with the expectation that life will last indefinitely. In fact, each of us is dying; we just do not know when that time will be. Life and death is a journey that is intertwined.

The challenge for individuals diagnosed with cancer is finding the balance between their focus on living, experiencing the appreciation for life, and tackling their fears of the cancer recurring or leading to death. If the fears are overwhelming and present all of the time, they crowd out the ability to live and enjoy the good part of life. There are no easy solutions to this, only thoughts to consider. Here are a few thoughts:

Actively coping and looking at the potential for life’s end can lead to a more fulfilling experience in life. It can also help to take away one’s fears. When children are afraid of the bogeyman in the closet, parents often turn on lights, open doors, look under beds and reassure children that they are okay. The process of looking at one’s fears in a realistic way is often the best approach for dissipating the overwhelming nature of them. Like the bogeyman in the closet, one’s fear of death from cancer, or from anything for that matter, should be examined openly so it can be addressed. This is not to make light of these fears nor to suggest that they will permanently disappear, but examining them may lead to a greater sense of mastery and management of them.

One of the issues that stop many of us from examining our fears is the deep concern, and often superstitious belief, that if you talk about something it might actually happen: the old “Evil Eye” Myth. Talking about death and dying will not increase the likelihood of the event occurring. Despite this knowledge, many families believe that these issues should not be discussed. By taking this approach everyone is left alone with their fears and is unable to find ways to manage them.

Talking about death can lead to an ability to understand one’s fears, address them and make plans for the future. It also provides the opportunity to live more in the present and to appreciate parts of life that otherwise might go unnoticed. Talking openly provides the opportunity to speak the words that come from the soul and to be authentic in relationships. These interactions can deepen and enhance relationships and make life more worthwhile.

Talking openly is an opportunity to deal with unfinished business. “Unfinished business” is a term that is used to describe relationships or situations in life that have not been resolved and usually involves some level of distress. By embracing the possibility of death, you give yourself the opportunity to identify those areas of your life that need additional attention. Once they are identified actions can be taken that bring resolution or peace.

Unfinished business should not be confused with the many things in life that one still wants to do. Most people have a long list of things that they would like to do before they die, but these things do not create distress. The things not yet done are usually more reflective of wants. Wants are different than unfinished business. Wants are good at whatever stage one is at in one’s life and are often part of our hope for the next day.

Many cancer patients have commented that they feel an enormous pressure to live life to its fullest. Appreciating life and enjoying each day as it comes can be a gift from cancer, but taken to an extreme it can be a burden. You can only be awestruck by so many sunsets and sometimes embracing each moment in life can be tiring or burdensome. It is okay to let go of that perspective some of the time. The desire to live life to its fullest should not bring a demand to find something extraordinary in everything. Living each day and surviving each day is sometimes more than enough. It is important to allow yourself some room to do the routine and mundane.

Having cancer inevitably raises fears of recurrence or metastasis. Living with “what if” can be a consuming experience. It is driven by anxiety. One approach to coping with “what if” is to use different “what ifs” to counteract them. For example, to the question, “What if the cancer comes back?” Response: “What if I have 10 more years, what if I have 20 more years, what if I live all those years worrying about what if? Do I want to look back on a life of what ifs?”

Most patients diagnosed with cancer have bouts of worry and concern about recurrence and progression of disease. Living with these concerns is sometimes the most challenging of all tasks as these worries can overwhelm and dissipate the joy of life. Many of us have a basic assumption that our bodies will give us some warning before it breaks down which allows us to do something about it before it gets serious. Most people experience a cancer diagnosis as being a betrayal by our body, and thus, this basic assumption is now no longer valid. Therefore, when physical pains and discomforts or changes occur, they often signal a fear of recurrence. If you couldn’t trust your body the first time, how can you know what is happening now? It is impossible to take away these concerns so one solution may be to decide on a strategy for dealing with the concerns when they inevitably arise. Make a deal with yourself that whenever you are concerned you will follow a certain plan with which you, individually, feel comfortable. For example, one person might decide that any aches or problems will be handled by calling the doctor immediately and making an appointment. Another person might decide that they will watch whatever difficulties arise for a week (two weeks. . .) and if they’re still present after that period of time then they will schedule an appointment. Making a deal with yourself to handle these crises according to your plan can help alleviate the accompanying stress. It will not relieve all of your stress, but it will help to know that you have a plan. It can also be helpful to remind yourself that you will be able to deal with whatever happens.

Getting a diagnosis of cancer changes you. No one wants to be changed in this way. It is not a choice, but it happens. Accepting life on these new terms often means grieving the loss of your old life—the life that didn’t include cancer. Your life will never go back to the way it was. The challenge becomes adjusting to the new life before you since it may be different and changed. But it still is your life with a whole different journey than you expected. One that still deserves your exploration and discovery.

For more information please visit www.DavidKessler.org

Note: This article is a brief summary of the lecture provided by David. It is not a substitute for the experience of being there. David brought laughter, stories and excerpts from his books. We encourage you to obtain this presentation on tape through the library and to read his books to enjoy and receive the benefits of his wisdom.

 

For reprint authorization, contact SimmsMannCenter@mednet.ucla.edu.

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