uncertainty and fear. While any or all of these are understandable and common, none of them are good states of mind to be in when making important decisions.
A strong word of advice: Following a diagnosis, give time to adjust emotionally and take your time before making any major decisions. Contrary to common belief, there are very few decisions in cancer medicine where waiting to make them, waiting to act for a week or two, will affect the overall outcome. Many people think that the need to receive treatment for cancer is like when you are hemorrhaging—it needs to be done now, as soon as possible. While it is sometimes true that there can be medical emergencies involved that do demand urgent attention, in the main, a short delay of a week or two will not affect the long-term outcome. Taking your time could have you in a far better state of mind to make crucial decisions and to work well with the treatments you do accept.
This then is a time to be close to family and good friends, particularly those who have the capacity to stay present and offer their stability amid turbulent emotions. Here it is important not to be confused. Many people think the need is to be “positive,” which is true, but some think to be “positive” is to be unemotional, which is not true. I have met people who were so afraid of their emotions that they thought it was almost as if they were to cry even once, it would take a week or two off their lives. Of course if one were to cry all day, every day, that may well be a problem, but it would be perfectly natural and normal to have a few, tough emotional days as you take in a cancer diagnosis and what it means for your life and the lives of those around you.
What to Do with the Emotions
Healthy emotions are natural emotions. Unhealthy emotions are when wild emotions control you, or, as is often the case with people affected by cancer, when emotions are suppressed.
Everyone feels emotions. It is how we express them that is the issue. The observable fact is that people vary quite naturally in their range of emotional expression. Some are naturally very expressive, some quite reserved. This is influenced by a variety of factors. Some cultures are very emotionally expressive—Italians often come to mind in this regard. Some keep their emotions under pretty tight control—my culture of origin, the English, seem pretty good at this.
The point is, with emotions, as with all else, individuals do vary. Your aim is to be authentic. To allow yourself to be natural and to be comfortable with your own emotional expression.
Emotions are so important we have two specific chapters on them later, but for now, recognize that allowing your natural emotions to flow is natural, normal and healthy. While the emotions that result from a cancer diagnosis may be painful, do what you can to let them out, either on your own or in the company of those you trust. Once they have been released, it will feel like a real weight has lifted and you will be in a much better place to move on with treatment, using your own resources and taking the steps to recovery.
If you are in doubt about your emotions, if none come or if they seem to be going on forever, do be brave. This is a time to seek help, talk with a professional counselor or an experienced, trusted friend and check your situation out.
Experience says it is very difficult to think clearly, to make good decisions, to really commit to what you need to be doing, if your emotions are all over the place. Once the immediate emotional response to a diagnosis is felt, expressed, and showed, usually the intensity goes out of it. Maybe emotions will arise again in the future. Again that would be natural and normal. But be authentic. Be comfortable with your own degree of emotional expression and realize emotions are another natural part of a healthy life.
So do take time. Sit with those you are close to. Be with them. Maybe in silence. Maybe with tears. Maybe with talking and discussion. Take it in. Let it out. Allow yourself to settle. And then begin to plan. To move forward again.
Prognosis and Looking into the Crystal Ball
While diagnosis is based on fact, prognosis is based on speculation. With a prognosis comes an attempt to predict the future, to give an informed estimate of what the diagnosis, along with any treatment, is likely to lead to.
The problem with a prognosis is that it can have power in its own right.
In the ancient culture of the indigenous Australian Aborigines there is a phenomenon called the “pointing of the bone.” This culture is the oldest continuous culture on the planet and its roots stretch back in time for at least forty thousand years. Many of the Aboriginal tribes lived in small nomadic groups that thrived amid extremely harsh environments. To survive and flourish they had quite strict laws that everyone recognized and generally adhered to. One of the ultimate penalties for transgressing these laws was the pointing of the bone. Here is how it works.
If a person broke a major law, they would be very aware of it themselves. They would know something serious was wrong and they would be aware of the likely consequences. Once the transgression was recognized by the tribe, the senior people would confer, and if all agreed, the punishment of pointing the bone would be carried out by the senior law holder. This person, often referred to as a man of high degree, would dress up in ceremonial garb and the instrument of the punishment literally would be a bone—a human thigh bone.
But there was no beating or physical assault with the bone. It was “pointed.” Amidst the ritual of the process, the bone was pointed at the transgressor along with the words—the curse, if you like—the threat, the promise, that the person would die.
Interesting things would begin to happen immediately. First, the law-breaker, the person who had been pointed, would go into a rapid decline. Then, all of the tribe would withdraw and avoid contact with them. The person would become depressed, lose all interest in life, then they themselves would withdraw and become listless, apathetic.
At this point there are frequent records of Western medicine attempting to intervene. No conventional treatment has been shown to prevent the ongoing decline toward death.
As death approaches, another significant observation. The tribe members, sensing the closeness of the end, gather around again. This time they go into pre-mourning rituals and, in the process, seal the fate of the wretched victim of this extraordinary punishment.
So the pointing of the bone is invariably fatal in this Aboriginal context.
Now let us make some unnerving comparisons. A person knows they are not well, that something serious is wrong. They go for help. Senior people confer. Then comes the consultation where the key figure dresses up in ritual garb, with white coat and stethoscope, and makes a pronouncement.
When bad news is given badly, there are all the hallmarks of the pointing of the bone.
“You have only three months to live and there is nothing we can do about it.”
In days gone by the message was often given this bluntly. These days, many doctors attempt to be more subtle and compassionate, but even so, many people get the take-home message: you have cancer, you will die.
All too often what happens next is that they go home in shock, they withdraw and then so do their friends. Often friends, even family, are unsure of what to do, how to respond, how to help. Many of these people, well-meaning, kind and considerate in their nature, have told me how they were deeply concerned about doing or saying the wrong thing and so they thought it safer to
