Back in December, I wrote an article, entitled “A Prescription For Compassionate Healthcare” that highlighted what medical professionals can offer to patients who are facing health crises. I mentioned a nurse friend named Ondreah Johnson who was anticipating hip replacement surgery. She came through the procedure with flying colors and established a support system of friends and family to aid in her recovery. She is ambulating with a cane and is still not 100% but getting there. She reflected that her body was going through changes that were sometimes disturbing as she ages, but never expected to be in this situation in her 50’s. She knows that healing is an ongoing process.
No sooner had the dust settled post-surgery, then another tidal wave hit. She was doing a routine self-exam and detected a lump in her left breast. Taking a deep breath, she took seriously, this latest development and scheduled an appointment for a professional exam. A series of tests followed and as a career nurse, as well as an intuitive person, she hoped for the best, but knew that it might not turn out as she wished.
In conversation, I suggested that in anticipation of the day she was to hear the results, she would say to the doctor, “Before you deliver the news, imagine that you are sitting before a family member who would be in my situation. How would you tell them the diagnosis?”
On the day that she met with the oncologist, she was prepared to say those words but had not gotten to that point when the doctor was about to offer the outcome. She did ask the physician to sit closer, so she could feel the human behind the mask of professionalism. She complied. The biopsy indicated that she had a rare form of breast cancer. It is so unusual that the staff needed to do more research. She is in the mode that requires decision making about treatment, but first needs to let the information settle in. Of course, it feels surrealistic. In her typical fashion, she could laugh amid her tears as she related that she doesn’t do anything small or in the realm of the norm. That will be part of her treatment regimen. Her friends will see to that.
“In a small study published in 2013, researchers interviewed 17 women receiving treatment for recurrent ovarian cancer about the ways they used and viewed humor related to their diagnosis. The researchers found that nearly all (14 out of 17, 82%) used humor to cope with their diagnosis, and 13 out of 17 (76%) reported it helped reduce their anxiety. In a separate study, 93% of people facing a terminal illness (316 out of the 340 patient participants) said maintaining a sense of humor at the end of life was “very important,” making it almost as important as the absence of pain.”
Gilda Radner was a proponent of laughter amid life challenges. Diagnosed with ovarian cancer from which she died in 1989, she was determined to make the most of the time she had. Following her passing, her husband Gene Wilder, therapist Joanna Bull and friend Joel Siegel created Gilda’s Club which is a non-residential cancer support community for those living with cancer, as well as for their family and friends. It is a come as you are kind of place where laughter and tears merge.
As a medical professional, my friend knows the power of words to harm or heal. When a patient receives a life-altering diagnosis, it will rock their world to the core. What felt normal before, no longer does. We create a new sense of normal. What we took for granted in terms of routine, must be altered to accommodate this altered reality.
One way that she is addressing her new reality is with language. She wrote this social media posting to be fully expressed on this matter.
“So Today…. Fri Jan 13th a most auspicious day in my life.. a day I NEVER imagined would be my day… Yes.. the Docs have said.. Yes, those cells in my Left Breast, My Beautiful Left Breast have gotten some mixed message and have decided to create some rather uncommon over growth.. NOTE… I reject the words (tumor, mass, cancer, metastasis. all those heavy fear based words) How do I rise again from this? I feel numb, then fearful, then quiet, then terrified, then open, then deep grief, then a spark of positivity… and so goes the train ride into the Deep Abyss… I am most def on the train.
Hold the vision with me of all those ‘cells that got a mixed message, it’s time to go, see them destroyed and removed easily… send them Love to go..”
The Five Stages of Loss and Grief come into play here as well. Although there is no straight trajectory, but rather a meandering path, the ideas of anger-denial-bargain-depression-acceptance are common when someone receives cancer diagnoses.
A caring and compassionate medical professional would benefit themselves and their patients by acknowledging this dynamic as well as these concepts:
- Imagine your life turning upside down with the words, “You have cancer.”
- Know that your patient may have an initial onslaught of emotion or remain stoic.
- Make eye contact and sit as close as the patient is comfortable with.
- Use language the patient will understand. Be prepared to repeat yourself, since it may take the time to sink in.
- Offer options for treatment, knowing that any given person will want to make his or her own choices. A combination of mainstream and mind-body medicine may be in order.
- Be a consultant and treatment team participant knowing that he or she is the most important member of the team.
- Offer resources such as cancer support groups and supportive psychotherapy with one trained in this specialty.
- Be aware of cultural and religious diversity when addressing the needs of the patient.
- Recognize that each person is unique, with their own history, that they bring to the treatment process.
- Know that some with trauma history may react more intensely. Being in a vulnerable position as a person with a new diagnosis may trigger and re-traumatize.
- Encourage creating a support network of family and friends. Bring them into the treatment process at the comfort level of the patient.
The book called Share the Care was written by Cappy Caposella and Sheila Warnock offers a multitude of suggestions for creating a net of assistance as they state, “No one should have to go it alone.”
The environment is important. When Ondreah was in the hospital for her hip surgery, the room was decorated by a friend of ours with twinkle lights and a tapestry. She brought along her bed comforter, as well as iPad and speakers from which soothing music wafted, her essential oils and prayer beads. It provided her a sense of comfort.
On the day of the appointment with the oncologist, she carried with her some of that accouterment. Per the friend who accompanied her, she “Changed the energy in the room.” She sees herself as an alchemist who can make those adaptations and says there is a “grace in ownership” of her condition. “What am I going to do with this, because this is mine? How do I navigate with this inside of me? There is a grieving that needs to take place. I know that although the treatment comes from the outside, healing is an inside journey. There is something about the embracing of it that makes it yours because it is. The things that we incorporate, in my case such as a Vision Board with uplifting words, pictures of Goddesses and images of healthy breasts, impact the people who are working with you. We have been told, to use affirmation and prayer, and being told you can do this…it is more than reframing. This is part of my soul’s journey, not just my mind and body’s journey.”
Doctor and patient communication are essential. Per Jennifer Fong Ha, MBBS (Hons) Dip Surg Anat and Nancy Longnecker, Ph.D., “Effective doctor-patient communication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart and art of medicine. This is important in the delivery of high-quality health care.”
A term for such a relationship is referred to as ‘clinical empathy’, as explained by Jodi Halpern, MD, Ph.D., “Physicians’ emotional attunement greatly serves the cognitive goal of understanding patients’ emotions,” which in turn, makes them more effective clinicians.
From the perspective of this clinician who has worked with those in medical and mental health settings, it cannot be stressed strongly enough that health care professionals explore their own relationship with loss, death, and illness. When they can face those realities in their own lives, they become more effective in their practices and those they serve benefit immensely.