Mental Health Matters: Cancer

We were having a perfectly lovely chat, me and my primary care physician. It had been a rough year for me, and I was glad to have managed through some very difficult situations in my work environment. It was perfectly lovely. Until….

“How long has this been here?” She’s doing a routine breast exam on me. My mind goes blank; I catch my breath and utter, “How long has what been there?” She tells me it is “probably nothing, perhaps just a cyst,” but she wants me to get a 3-D mammogram. The rest of the visit is sort of a blur, but I somehow manage to get back to my vehicle to head back home.

I think I called my sister in California, had a casual conversation, and then at the end said, “Oh, and by the way, my doc found something unusual in my left breast, but she doesn’t think there’s anything to worry about. Just to make sure I am getting a mammogram done.”

It took almost three weeks before the radiology department could get me on the schedule. I busied myself with work, family and daily life. I tried not to think about it because, after all, there was nothing I could do at that point but wait. I told my children and prefaced it with the thought that it might just be a cyst. I went about my life. 

Three weeks later, I have the 3-D mammogram. Still draped in the hospital gown, I am ushered into another exam room to wait for the radiologist to tell me what they had found. Things become a little hazy in my memory at that point, but what I can recall is the sentence, “This is no cyst.” They numb my breast and then use what I think of as a hole punch, the diameter of a 410-shotgun shell (just a bit of hyperbole there), and take a biopsy of this non-cyst. I am bandaged up, get dressed and then head out to my car, although I cannot recall the actual walk from the exam room to my vehicle.  

I do recall making a call to my daughter on the way home. I am tearful and stunned. I am feeling a bit as though my body has betrayed me in some way. Internally, I can liken it to being on the Tilt-A-Whirl ride at the county fair. I am being slung around from left to right and back again, while at the same time feeling the g-force pulling me backwards and forwards, and up and down. Once I get home, I find my reclining rocking chair and sink into it as far as I can. One of my cats, whom we believe to be a healing kitty, climbs on my lap and situates himself right across my left breast, where the biopsy was performed. He starts to purr. 

About four days later, I am in my office at work when I receive the phone call. The person on the other end identifies themselves as a nurse navigator and announces that they have the results of my biopsy. I learn that the bad news is that my tumor is estrogen-positive. The good news is that this is a type of cancer for which we have effective treatments. “There’s lots of hope,” they tell me. My mind is a blank. This call triggers a series of other calls. I am ushered into a period of my life where I am seeing more doctors and going to more medical appointments than I had in my whole life up until then. 

I hang up from the call. My mind is a blur of rushing thoughts and, at the same time, emptiness. “The Big C.” One of the most feared terms in the English language. It often evokes a visceral response, one felt through one’s entire body. Yes, we have much more effective treatments than we did in the past. It is no longer considered an automatic death sentence. None of that mattered in my head. I knew that somehow, my life had turned some sort of corner, and it would never again be like it was before. Perhaps the biggest corner I had ever turned, and that is saying something. I had turned some big corners by that point in my life. This corner was going to involve a lot of uncertainty, patience, waiting and tolerance for uncertainty. 

People can react to the diagnosis of cancer with a wide range of intense feelings. All valid emotions, including shock, numbness, disbelief, fear, anger, anxiety and sadness. Emotions often fluctuate through the aforementioned range. Personally, I couldn’t get my hands on enough information to read. I needed to read, process, think, identify my feelings and repeat that routine many times over. Wanting to make sense out of what had befallen me, I wanted to know what gave me cancer. What were my risks? I had breastfed all my children. I had eaten a relatively healthy diet. I had been a runner most of my life. What had gone wrong? These questions were normal, but I could not find quick answers.

That was seven years ago, but I can recall it as if it were yesterday. Most cancer survivors I talk with can identify life before the “Big C” and life after the “Big C.” It is such a significant event not only for the patients themselves, but for the family as well. As a mental health practitioner, I am always interested in the link between various events and experiences and mental health. My researcher brain kicked into high gear, wondering how to protect my mental health in this life-changing occurrence. I wanted to know about the details of this type of cancer. What were the suggested science-backed treatments? What were the survival rates? What kinds of personal characteristics predicted the best outcomes?

Penn Medicine reports that between 25% and 33%of cancer patients report symptoms of depression, anxiety and/or emotional distress. Also common are feelings of fear and loneliness.  While all of these are treatable, they are also important variables in the patient’s adherence to treatment protocol as well as survival rates. People often report a fear of the unknown, treatment side effects and/or a recurrence. 

Also common are feelings of overwhelm, scare and being out of control. The diagnosis and treatment can be so stunning for some that they can develop symptoms of PTSD or post-traumatic stress disorder. In addition, this does not just impact the well-being of the patient. Family members and caregivers can also develop these symptoms and conditions.

People may wonder when to reach out for help. It is suggested that we seek assistance when we experience persistent sadness or feelings of hopelessness, loss of interest in activities, significant changes in sleep or appetite, difficulty concentrating or making decisions and/or withdrawal from loved ones.  

What does that help actually look like? For those who have not gotten help for depression or anxiety in the past, this can become an emotionally complicated issue. On top of the awkward feelings that arise with seeking help at all, they also do not know what to expect once they do so. 

Some people seek out counseling, psychotherapy and/or medication. Research tells us that the very best outcomes involve both treatments. For others, finding information and education are very important. Finding the facts and understanding how your cancer grows and spreads can ease many fears and worries. Education produces knowledge, and we know that knowledge is power. 

A third support is seeking out formal or informal support groups where you can talk with other cancer patients to share experiences and give one another support and encouragement. The success of these groups, of course, depends on the group members being able to maintain and offer positivity and support for each other. And finally, being open and transparent about our feelings with our oncology team is also essential.  

Patients who already carry a mental health condition are going to need additional support and resources. We know from the research that this population of people faces higher mortality rates. It is critical to receive integrated mental health care in these situations. 

I was diagnosed in June of 2019. I had a double mastectomy on July 31. By the second week of September, I started chemotherapy which lasted until the week before Thanksgiving. I was given a month to get my strength back to the point where I could begin radiation therapy. I had 25 radiation treatments by the end of January of 2020. When you are in radiation therapy, you generally see the same patients every day, and this becomes a support group. In late February, I started hormone therapy, which for me involves taking a daily estrogen suppressant. After five years on the hormone treatment, my treatment team determined that I would benefit from an additional five years of that modality of care. 

One practice that has helped me maintain my mental health is that of gratitude. Practicing my gratitude helps keep my thinking out of trouble. Our thought life has a huge impact on our overall health and well-being. It has also made my recovery much more manageable. The object of my gratitude is often the web of support and love I experience from friends and family. I am grateful. 

My experience has also helped me see what is important in life. I have survived cancer. Anything else I encounter pales in comparison. It has helped me see and remember what the small stuff is as opposed to the big stuff in life. While I would not wish for cancer for myself or anyone else, I can say that I would not go back to change anything. My life is so much richer because of this experience. My kids and I were overwhelmed by community support. Someone organized a meal train for us. People regularly came to the house to check on me or just to spend time with me. My needs were cared for without my even having to ask. It felt nothing short of miraculous. 

In 1st Corinthians 13:12, Saint Paul speaks about how we now see in a mirror dimly, but in time we will see the vast love that God has for us. While I have not fully arrived in the terms Paul uses, I can say that having cancer has allowed me to see with far greater clarity God’s love for me, as well as how God cares for me through loving relationships on this side of eternity. I am grateful.

Have questions you’d like to ask Shirley? Message her at oasistherapyservices@gmail.com.