Chapter 1

1. A Cancer Diagnosis Is Life Changing

How We Deal with It Makes a Difference

“We must be willing to let go of the life we’ve planned, so as to have the life that is waiting for us.”

—Joseph Campbell

The Story of Bob and Gia

Gia’s Story

Gia woke one morning deciding she needed to act on the nagging feeling deep within her. For a number of months, she had not felt like herself and inside knew something was wrong. She seemed more and more tired, and the vitamins she was taking to help her energy didn’t seem to be doing anything. She had turned fifty-seven two months ago and had enjoyed lifelong good health. Her family was healthy, except for one aunt who died of lung cancer after a life of heavy cigarette smoking. As for the rest of the family, not only were they generally healthy, but they were also a positive bunch of people who rarely, if ever, complained about health issues. Gia’s last physical a year ago was “unremarkable,” and her physician seemed happy with her exam and lab tests.

Knowing she at least needed some reassurance about her fatigue, she returned to her physician. They did a brief physical exam and ordered some new labs. To her, it seemed quite normal as far as doctor’s visits go.

The next week, she had her follow-up visit with the doctor and noticed something about the doctor seemed different. She sat down across from the doctor and asked her, “So how am I?” The doctor was about Gia’s age and had been Gia’s physician for many years. She said to Gia, “We have the lab results, and I spoke with the pathologist at the lab. Gia, it looks like you have a particular form of leukemia.” After she heard the word leukemia, the rest of what her doctor said seemed fuzzy and slow. All Gia kept thinking was, “Leukemia—well, that’s cancer and I don’t have cancer.” Her thoughts were spinning.

Gia’s doctor knew what was happening. Sadly, this wasn’t the first time she had to have this conversation with a patient. She stopped explaining things and said, “Gia. Gia, it’s OK, and there is no right or wrong way to react to news like this.” At this, her eyes met Gia’s, and she saw Gia recognize what was happening. The doctor then slowed down and proceeded to give small bits of information waiting for Gia to take it in. She described the presumed diagnosis, what that could mean, and what tests were next. When she finished, the doctor shook Gia’s hand, squeezed her shoulder as she left, and said, “You’ll get through this. We will build a team for you, and make sure you bring a support person to your follow-up appointments to take notes.”

From that moment on, Gia’s life became two separate parts: one was “regular life,” which included work, family, and friends; the other was her “new life” as a cancer patient.

Her “new life,” that of a “person with cancer” (she specifically chose this terminology instead of “cancer patient”), was a very full life as well. The biopsy she had of her bone marrow (something she would later say is a procedure you should avoid unless you absolutely need it) was followed by more tests and a consultation with an oncologist. Gia kept asking herself, “Why?” Why with such a full life already did she have to add all this?

About two weeks into this new life, she chose a shift in thinking, which she did deliberately. She went from thinking, “What? No, this can’t be happening” to “Well, then, ‘F-Cancer!’ I don’t deserve this!” About a day and a half into the “F-Cancer” thinking, she smiled and thought, “Well, I remember Psychology 101 from college and the stages of grief.” She seemed to have internalized these stages and thought, “Denial/insulation, anger, bargaining, depression, and acceptance” and then thought, “How I wish those were just a test answer.”

As a positive person, her thoughts of “three stages to go” seemed automatic. Then almost immediately, her thoughts gave way to a feeling of overwhelming anger. She just didn’t deserve this. Not at all. “Why,” “Unfair,” and “F-Cancer” just spun through her mind on a continuous loop. She was a good person. She took care of herself, didn’t smoke or drink alcohol, exercised, and generally lived a healthy life. “This just isn’t fair!” her mind would scream.

As the weeks, doctor visits, rearranging of her life, and all of the other tasks seemingly attached to a cancer diagnosis progressed, she felt like she was passing through a collage of bargaining mixed with depression. This did not match her typical buoyant self, and she knew it. But then she told herself, “You have never had cancer before, have you, Gia?”

As days/weeks passed, Gia began to think a lot about acceptance. She thought, “The rational side of everybody’s mind has to accept the reality, right? OK, but to really accept cancer, what does that mean?” So many thoughts; “Do I have to accept this? Don’t people who refuse to accept it live longer (or is that a myth)?”

Then she recalled a famous author on a PBS show stating their cancer had “no part in their life.” “Wait,” she thought, “didn’t he have leukemia like me?” And, “I wonder what he died of?”

This internal conversation went on and on.

Gia’s second life as a person with cancer continued. There were many details and decisions to consider, such as what to do and what not to do. Her emotions had moved through denial, past anger, and into a mixture of bargaining and depression. She wasn’t denying her cancer. She was recognizing it as a reality of her life and admitting to herself that she has a life-altering disease, but she was also facing it with courage. She was not fighting the diagnosis as the author on PBS had. Gia had moved on into acceptance.

At this stage, she realized, “I have control over the medical process, to a degree, but what about my internal process?” And then she began to reflect, “What about my thoughts, feelings, emotions, and all that?” So Gia embarked on a journey that day—a journey that changed the course of both of her “lives.”

Bob’s Story

Bob was a powerhouse—successful, wealthy, and all that comes along with that. He was a surgeon and was known as an excellent physician by all. His life had focused on getting to the top of his profession. His family was well cared for financially but completely estranged from him. His children were now all adults and had various levels of contact with him. His ex-wife wanted nothing to do with him. He saw his life as a sacrifice to ensure his family was cared for at any cost. Sadly, the family saw the harder side of all this, something not uncommon for professionals. There was a woman in his life he did consider to be his partner. Bob wasn’t a bad guy, but Bob was who he was.

Bob saw his doctor for an annual physical and was good about that process almost every year. He had always been in good health. He exercised, did not drink, and had smoked for five years in college but stopped many years ago. He was conscientious about his diet and tried to live a healthy lifestyle. A year ago, at his physical, his physician said, “Well, Bob, from the looks of your labs, you’ll live forever. Must be because you’re so mean.” His physician said it with a smile, but the whole medical community knew Bob to be demanding, dogmatic, and often just nasty to be around.

During his recent physical, his physician said, “You seem uncomfortable when I palpate,” meaning Bob grimaced when the doctor pressed on one spot. Bob simply said, “I think I’ve been eating too much heavy food.”

“Anything else changed, Bob?” the physician asked.

“Well, maybe…” and Bob went on to describe some seemingly odd and random symptoms.

After more physical examination, a blood draw, and some discussing, Bob agreed to get some imaging done on his abdomen. “Better safe than sorry, Bob,” said the physician. Bob knew why the imaging was needed.

Bob was back in the doctor’s office the next day. (Yes, sometimes for a physician, tests and things can happen quite quickly.) The doctor came in and said, “Well, Bob, you have the ‘Big C’ based on the scan and labs” (most people knew this as cancer, but his physician thought he was helping break the ice). To be fair, this experienced physician never would have said this to anyone else, but he and Bob had known each other since medical school, and he really didn’t know how to break it to him otherwise. So, for better or worse, this is how Bob learned of his cancer diagnosis.

The diagnosis of “probable pancreatic cancer of high stage” dropped on Bob like a bag of cement. Unlike most cancer patients, Bob had lived his adult life as a physician. He knew exactly what this diagnosis meant, and it was not good. Although most people have probably never thought about how they would respond if they received a cancer diagnosis, Bob’s career as a physician had told him exactly what he was going to do, at least internally: nothing. Bob had predetermined that he wasn’t going to “process” a cancer...