[Y]ou can't always be sure how you or your loved ones will react....
[S]upport groups and counseling make a profound difference in one's comfort and ability to deal with cancer.
Your cancer diagnosis is very likely to seem unreal to you at first.
If you will be meeting the doctor to discuss test results and treatment choices, be prepared to have difficulty absorbing what is said.
[L]oved ones face issues that are somewhat different from those faced by the cancer survivor.
Emotions at Diagnosis
The following excerpt is taken from Chapter One of
Colon & Rectal Cancer: A Comprehensive Guide for
Patients & Families by Lorraine Johnston, copyright 2000 by
O'Reilly & Associates, Inc. For book orders/information, call
(800) 998-9938. Permission is granted to print and distribute this
excerpt for noncommercial use as long as the above source is
included. The information in this article is meant to educate and
should not be used as an alternative for professional medical care.
The events involved in diagnosis, staging, and grading, and those that will follow over the next months or years, are very likely to take an emotional toll. There are as many reactions to cancer as there are people, and you can't always be sure how you or your loved ones will react in novel, frightening circumstances.
Although professional psychologists make fine distinctions among responses, reactions, and coping mechanisms, the emotional happenings described below are discussed not in clinical terms, but rather in terms your heart and soul will recognize.
All of the reactions mentioned below, and many others, are normal, albeit painful. You may feel that these feelings are useless or counterproductive, but like all defensive behaviors, they serve to protect your mind from harm until you can assimilate this experience and begin to build a frame of reference from the facts. Don't berate yourself if you're not feeling like the poster child for mental health week.
If weeks go by and you still feel that your reactions and responses are not serving you well, if you can't eat or sleep, if you can't stop crying, if you've lost a great deal of weight in a short time, or if you feel you are jeopardizing your source of income with suboptimal performance, see your doctor for advice. The newer sleeping pills and antidepressants are very effective in restoring sleep and appetite with minimal side effects. Objective scientific studies have shown that support groups and counseling make a profound difference in one's comfort and ability to deal with cancer.
The physical aspects of fear
If you had any hint that your symptoms might be cancer-related, you probably are already familiar with tremendous, overwhelming feelings of fear and their aftereffects. The physiology of fear is such that your body prepares you very specifically either for battle or retreat. We have evolved to note and react quickly to changing stimuli during a fearful encounter. This may explain why many people, when first diagnosed with cancer, want immediately to start a treatment--any treatment--just so they're doing something to fight back.
Unfortunately, these bodily preparations for action, such as increasing your pulse rate and redirecting blood flow from your limbs to your heart, brain, and other internal organs, are not the ideal biological events to prepare you for understanding and remembering your doctor's explanations. The moment that fear hits and adrenaline pumps, senses become heightened in preparation for life-saving action. However, that sensation that you can somehow see everything around you with remarkable clarity is not necessarily going to help you remember the doctor's description of two tests that need to be done, and a third test only if the first two are inconclusive, and where your doctor said she prefers these tests be done. Instead, you may remember exactly where you were sitting, the color of the doctor's office walls, and that stray hair of the doctor's that wouldn't stay put.
Shock and numbness
Your cancer diagnosis is very likely to seem unreal to you at first. You may awake from sleep thinking you're as you were before surgery, for example, then remember, after thirty seconds or so, that you've had extensive surgery for cancer. You might not hear people who speak to you; you may have difficulty sustaining concentration for routine normal tasks; you might feel as if you're walking underwater; you might have to remind yourself to look both ways when crossing the street. Some cancer survivors report becoming paralytic for days, unable to sleep, rise, eat, or work.
If you awake from surgery to find that you have an ostomy, you may have difficulty believing this new part of you exists, no matter how carefully and thoroughly the discussions about ostomy were conducted before surgery. You might be reluctant or horrified to look at the ostomy, or to care for it.
Shelly Weiler describes how profoundly his diagnosis affected him:
Last year I was invincible. In one second the picture changed.
Randall, a survivor of stage II colorectal cancer, describes the shock upon his diagnosis:
I am a 43-year-old male from Dallas, Texas, just diagnosed yesterday. Diagnosis is so new, we don't even have staging information yet. I'm having a CT scan and more lab work this weekend to determine the extent of the cancer.
As a result of what was first presumed to be "internal hemorrhoids" and then ulcerative colitis, I had a colonoscopy on Tuesday of this week so that the doctor could confirm the latter. Instead he found a bloody five-inch-long tumor ten inches up in my colon. They did a biopsy. Results from biopsy yesterday confirmed the new diagnosis. Looking back, and knowing what I know now, I have been having symptoms of this for two years.
This is, obviously, quite a shocker in my house. Not just because cancer is always devastating, but because my life partner of twelve years was diagnosed with multiple myeloma, a hematologic cancer resembling leukemia, two years ago. We have been through his two bone marrow transplants, chemotherapy, radiation, the works, already. The shock comes from the reaction of "Haven't we already been through enough?" We have a dark humor about cancer, though, which has already kicked in: we've inquired about group discounts.
Many cancer patients and their loved ones, most being intelligent and competent people--even some doctors diagnosed with cancer--report not being able to remember anything of the doctor's explanation after hearing the word "cancer."
If you will be meeting the doctor in person to discuss test results and treatment choices, be prepared to have difficulty absorbing what is said. For example, you should be prepared to take notes, or take a friend or a tape recorder with you. Tell the doctor that you will be calling back with a list of questions after you have had time to absorb this information. If she expresses impatience or reluctance to help you, consider finding another doctor.
Many people note that upon learning of their diagnosis they were completely objective, calm and felt nothing at all, as if they were outside of their body observing this happening to someone else. This is called dissociation. Dissociation temporarily allows you to absorb information without emotional pain.
Childlike or nonsensical behavior
Some people note that they said and did things that made no sense, sometimes quite childlike things. This can be a seeking of comfort in happier times, technically called regression:
When my husband phoned to say his CT scan showed what was almost certainly cancer, I left my office immediately. Once at home I found that, although I was 40 years old, all I wanted to do was reread my old girlhood Nancy Drew books.
Some people respond to the news of their diagnosis with the belief that there is an error in the laboratory test, or that their results have been confused with someone else's. (While laboratory errors are possible, they are not common.) This reaction, called denial, is a protective reaction to allow you to absorb an onslaught of information more slowly. Denial can be used successfully to help you forget about cancer between treatments, to return to your productive life. Denial also may be a dangerous adaptive strategy, however, if you forget medical appointments, neglect ostomy care, or become convinced that your health will improve spontaneously with no treatment.
While many people develop focused feelings of anger some time after their diagnosis, others may feel a generalized anger at the time of diagnosis. They may lash out at the doctor who was the bearer of bad news about the cancer diagnosis, or at loved ones, for seemingly meaningless reasons. Sometimes anger is a form of projection, a displacement of painful feelings within the self outward onto others. As such, projection serves to reduce unbearable levels of pain. At other times, the angry person may simply feel overwhelmed by having to face all of the stresses and responsibilities of normal life, plus a cancer diagnosis. Yet others feel that being angry is more socially acceptable than feeling sad. Anger can be a useful emotion if targeted properly and harmlessly, but it can also signal the beginning of depression, and can drive away the support of others that you will almost certainly need.
Many people report that they cry or otherwise express great sadness, and that they feel better after doing so. Sadness is, of course, an entirely normal reaction to a cancer diagnosis. This change in your awareness of yourself connotes the possibilities of great losses: loss of life, loss of motility, loss of career opportunities, or loss of perceived sexual attractiveness.
This is so disheartening, considering I never took an aspirin for a headache and now I'm on a daily regimen of pills, pills, pills.
Guilt is the burden we carry for things we feel we could've handled differently. Some survivors of colorectal cancer might feel that, had they lived differently, they would not have developed cancer. This feeling haunts many survivors of many different types of cancer, but for colorectal cancer survivors, it's especially painful because the medical community in the US stresses early detection, along with prevention via dietary habits and exercise, even though some research has shown that diet and exercise are not foolproof means of avoiding colorectal cancer.
If you're feeling guilty about possibly causing your or your loved one's cancer, you need to know that no sure lifestyle-related cause of colorectal cancer has yet been found for most cases: not stress, not environmental agents, not dietary choices.
Unlike guilt, shame is the burden we carry for things we can't do anything about. Survivors of colorectal cancer may feel shame because the colon and rectum and their functions are, in some quarters, considered taboo subjects. Unlike survivors of cancers that affect an arm or the thyroid, for instance, some colorectal cancer survivors might be reluctant to discuss their condition with others, fearing their negative reaction, even if the survivor herself is comfortable with the topic.
Like anger, blame can be a form of projection. If someone has been blaming himself for his own or another's cancer, the feelings may become unbearable and he may begin looking elsewhere for an explanation. Unfortunately, some people decide that the best solution is for another person to carry this blame. Those who have been coping with stress in this way for many years sometimes skip self-blame and go directly to blaming others. If someone in your life appears to be blaming you for cancer, you might try discussing this with him. If discussion doesn't improve the relationship, it might be best to remove this person from your immediate circle of activities temporarily and deal with him only when you feel most able.
Others report that they or their loved ones initially seemed detached, withdrawn or uncaring. Those who withdraw may do so for many reasons: as a habit formed during earlier stressful experiences, as a means to avoid shameful feelings about expressing emotion, in an attempt to keep emotional levels low so that others won't become upset, as an attempt to reduce exposure to painful ideas, as an effort to hide the ostomy from loved ones, and so on.
At times it's almost impossible to know what really motivates you or others, even after serious introspection, or after others tell you what they feel. Your attempts to discuss this with the withdrawn person, or others' attempts to draw you out, may make matters temporarily worse.
Reactions of loved ones
There also seems to be some difference in reaction depending on whether it's you or your loved one who is facing a cancer diagnosis. Many cancer survivors report that, in their opinion, the experience was much harder on their loved ones than on themselves. Clearly this is a topic subject to personal interpretation, as the loving caretaker isn't undergoing treatment that can cause anything from mild discomfort to serious toxicity or even death. A cancer survivor who believes that her loved ones suffered more discomfort than she did, though, may be expressing a useful feeling of immortality, a belief of being in charge of her own fate that will serve her well during treatment.
It might be useful to keep in mind that loved ones face issues that are somewhat different from those faced by the cancer survivor. They may experience guilt that they themselves remain healthy, fear that they will be deprived of the person they love most, and helplessness in the face of cancer, an erstwhile enemy by anyone's standards.