PERSPECTIVE: Embracing plan B
Sharron Spicer, MD, FRCPC, CCPE
It was a day that started as any other for our family, but by bedtime our world had changed. Cancer had entered our home as an unwelcome house guest.
In early September — the first week back to school — our morning routine was not yet smoothly choreographed. As we were all heading out the door with lunches and backpacks in hand, my husband gave himself a self-congratulatory pat on the belly. “Can you feel this?” he asked me. Anticipating a hernia or some other minor malady of middle age, I had him stretch out on the couch. His flanks spilled over their previous margins. Why hadn’t I noticed this girth before? I ran my hand over his abdomen. In the right upper quadrant, just below his ribcage, a grapefruit-sized mass rose up to meet my fingers. This was no hernia. We both instinctively knew that this was bad. It was a quiet drive to the family doctor’s office that morning. By afternoon, we were sitting with a radiologist in a small room, listening to his opinion. Everything on the differential diagnosis was a malignancy.
It would be another four weeks before we had a definitive diagnosis. Bloodwork, multiple scans, and a biopsy confirmed an aggressive lymphoma. The recommended treatment was chemotherapy with a stem cell transplant in first remission. With this approach, his prognosis for recovery is good. As I write, he is nearing the end of his chemo and preparing for his “Day 0” of transplant. He will be, as the doctor puts it, part of the new cohort for “rewriting the textbooks” on this cancer.
Having worked in pediatric palliative care for over a decade, the world of oncology is not totally foreign to me. I have been witness to suffering caused by cancer as well as other life-limiting conditions in childhood. Like the families of my patients, we had not signed up for this journey, yet here we were on an unexpected detour — an exit ramp from the highway, not shown on the map.
How has the experience of cancer affected me as a physician? It has been a deeply profound and personal journey. I humbly share with you some of my experience, hoping that it might encourage you in some way.
I made the decision early to take a leave of absence from my work as a physician. My husband had been the de facto at-home parent for the past few years and I knew I was needed by my family. Granted, this transition was made easier because my clinical load was small with some recent changes to my practice. I am grateful to my department head and colleagues who graciously pulled together to cover for me during my absence.
For the initial weeks after finding the tumour, my husband and I were both deeply introspective. Having cleared our work schedules, we lingered over morning coffee with conversations about life’s meaning, suffering, regrets, and hopes. As the fall mornings grew crisp, our dog happily accompanied me on many long walks. My emotions were labile, as was my outlook about the future. I kept oscillating between the positive and negative; for every good bit of perspective, there was a balancing negative and vice versa. “It’s cancer… but he’s otherwise healthy.” “It’s already spread… but he’s young.” I was overwhelmed at the thought of losing my spouse. I felt like I was in a Credit Karma commercial, waiting for the dial to land on a number that would somehow define our cancer score. I still don’t have that Credit Karma score, but with time and reflection, I have become more comfortable with uncertainty, not needing to grasp at the outcome but allowing it to unfold as I sit with palms open to what comes.
Jann Arden, the singer, songwriter, and author, wrote these words following the death of her father and while caring for her mother with advancing Alzheimer’s:
Losing people is what happens to humans. Like the constant drip of an old tap. To try to avoid that loss only leads you to avoid true happiness. When you don’t argue with grief like a drunk husband, much good can come from its stillness. Reflection is so important, time alone, reckoning. You can’t be your best self when you’re submerged in useless busy-ness. Most people choose not to stop long enough to think about how they feel… Change is taking hold of me and morphing me into a much better version of myself, and that morphing comes with some discomfort. And yes, sometimes it feels like I’m being crushed by that boulder.1
As time went by, we became more pragmatic. There were appointments to keep and medications to organize. We moved from the questions of “why” to “how.” Our philosophic questions were replaced by a more simple understanding that shit happens, let’s deal with it. We resolved to keep cancer as our “day job,” trying not to have its influence spill over into family time. We kept up with friends and hobbies. When he was feeling well, my husband hiked and played badminton. To his credit, even when he was breathless with a flight of stairs, he continued to do the family’s laundry. And I took seriously the instructions to thoroughly clean the house before his transplant. It is amazing how cathartic cleaning can be!
At times, I have wondered how I might manage if I lose my partner — not just emotionally, but with practical household things. My husband, sensing this, became a patient teacher as he narrated for me the subtleties of changing car tires and fixing furnace fans. Friends and family have walked alongside. We have had our freezer filled with food, words of encouragement sent in cards and e-mails, and offers fulfilled of dog-walking and errands to be done. We have appreciated all the thoughts and prayers made on our behalf. And I know that somehow everything will be okay.
At the centre of our thoughts, always, is our teenage daughter. More than anything, our goal is to have her continue to be a teenager without shouldering adult burdens. No doubt cancer will cast its shadow upon her, but we do everything we can to create memories of happy times. Adolescence is a developmental stage that is profoundly egocentric — necessarily so to enable the launch toward independence — and her initial questions reflected her worries of how her world might change. Frightfully honest, she would ask lots of things that began, “If Dad dies…”: “will we move? will we be poor? can we get a puppy? will you remarry?” (No, no, yes, let’s just stick with a puppy.) Over time, she has become more indifferent as she integrates this new reality into her life.
I have learned much about supporting myself and my family from Facebook COO and author Sheryl Sandberg. Known by many for her 2013 best seller, Lean In: Women Work and the Will to Lead, she went on to write Option B: Facing Adversity, Building Resilience, and Finding Joy following her husband’s sudden death in 2015. Along with some funny words of advice for responding to other’s bad news (“When life gives you lemons, I won’t tell you a story about my cousin’s friend who died of lemons”), she describes how she fostered resilience for herself and her young children. As she says,
Option A is not available. So let’s just kick the shit out of Option B. Life is never perfect. We all live some form of Option B.2
Whether you are living a Plan B, or C, or D, or walking alongside someone who is, I hope that you, too, find support along the way. Taking time away from work has been a part of my coping and resilience. It has allowed me to be fully present for my family and for my own reflection and growth. I do not know what my future holds, but I know I will be a healthy, stronger, and more compassionate medical doctor when I return to work.
References
1. Arden J. Feeding my mother: comfort and laughter in the kitchen as my mother lives with memory loss. Toronto: Random House; 2017.
2. Sandberg S, Grant A. Option B: facing adversity, building resilience, and finding joy. New York: Alfred A. Knopf; 2017.
Author
Sharron Spicer, MD, FRCPC, CCPE, is a pediatrician in Calgary. Her husband and daughter gave their permission to be referenced in this article, although Sharron did receive a scolding from her daughter for her use of profanity.
Correspondence to:
This article previously appeared in Vital Signs, a publication of Calgary and Area Medical Staff Society, in April, 2010.