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ne evening at a cancer survivors’ conference in which I gave a talk, a woman came up to me and told me a story I’ll never forget. She said that she had been diagnosed with breast cancer a year earlier.

“new normal.” I frequently tell people, however, not to accept a new normal too early – instead try and heal optimally first. When I interviewed cancer survivors for my new book with the American

physically well throughout my surgery, chemotherapy, and radiation.” Mary worried about how she was going to manage her “busy and complicated life” during treatment, and it turned out that it wasn’t nearly as bad as she thought. Of course, this is often more the exception than the rule. Mary credits “taking everything off my plate so that I could completely devote my energy toward recovery” as the reason that she felt much better than she expected. David, a journeyman sheet metal worker (also a breast cancer survivor), had the opposite experience. “I wish I had known that chemo treatments were cumulative in the body and that recovery from each successive treatment would be more difficult,” he responded. Another answer survivors gave quite often is that they wish they had known by Julie K. Silver, md they were going to be around many years after their cancer diagnosis. They wrote about how they would have worried less and enjoyed the intervening years more. Janet, an elementary school teacher who was diagnosed in 1993 with colon cancer, shared, “I learned not to All during treatment she counted the Cancer Society, What Helped Get Me listen to survival statistics.” Danielle, days until she was finished. Excited Through: Cancer Survivors Share Wis- a melanoma survivor wrote, “I wish I about the end of treatment, she made dom and Hope, I asked them what they had known that I would be a survivor herself a pink graduation cap and gown know now that they wish they had and had not wasted so much time in for her last chemotherapy appointment. known from the start. self-pity.” As she handed me the picture of her Pam, also a breast cancer survivor, Of course, knowing what the future “chemo graduation,” she told me that explained, “My doctor told me that it holds is impossible, and it’s hard not the happiness she felt when the photo would be a minimum of two years beworry. Still, it was heartening to hear was taken had dimmed over time before my life would start to turn around. from so many survivors how well they cause she still didn’t feel very well. Then I just didn’t believe her.” However, are doing many she asked me a question I hear a lot: Pam’s oncologist was right. Though years after the “Why do I feel so bad so many months Pam’s doctor told her from the start initial diagnosis. later? I thought I was done and would what to expect, she didn’t really believe One strong heal right away!” it until she experienced it for herself. message that As a doctor of physical medicine and Sometimes it’s hard to accept what your people who had rehabilitation, my work is focused on doctor may be telling you, and other been through cancer wanted those who were newly diagDespite an intense desire to “get back nosed to know Dr. Julie Silver to normal,” people often end up having to is that there is hope. Pearl, a young breast cancer suraccept a “new normal.” vivor in Glasgow, Scotland, summed it up this way, “It would have helped helping cancer survivors heal as well as times there is just so much information me to know that there was a good, but possible from the side effects of treatthat it’s hard to take it all in. different, life after all the treatment – ment. I tell my patients that it might Doctors can’t always predict how that I would probably never feel so take many months or even several years well someone will tolerate treatment. much heartbreak as I did, but that it to heal optimally. It is true that despite Mary, an attorney who went through would ease in time.” an intense desire to “get back to normal,” breast cancer treatment, wrote, “I wish Certainly, survivors may feel more or people often end up having to accept a I had known that I was going to be less hopeful at different times. There’s

If I Knew Then What I Know Now …

6 COPING q March/April 2009

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plenty of bad news that comes with the initial diagnosis and beyond. However, one woman who had a very poor prognosis when she was diagnosed with colon cancer in 1998 wrote, “There is always hope, and that hope is sometimes changing. It means something different for each person in any given situation. When one doctor tells you there is nothing more that can be done, he is merely saying that he has exhausted his expertise. The next oncologist may have more up his sleeve. Hope may come in the second, third, or fourth opinion, or totally evolve in a different form.” My friend and colleague, Dr. David Johnson, who is the director of the division of Hematology and Oncology at Vanderbilt-Ingram Cancer Center in Nashville, TN, put it this way, “Hope is what you feel when you know your doctors and other care partners are

“There is always hope ... It means something different for each person.”

doing everything that is possible and reasonable to help you get well. Hope stems from that support you get from your family and friends.” What many survivors said they learned on their journeys and felt they would have been better off understanding from the start is this: It may take a long time to heal after treatment. Don’t be surprised if you are alive many years from now. And there is always hope in one form or another. Editor’s Note: Dr. Julie Silver, a physiatrist, is an assistant professor at Harvard Medical School in Boston, MA. She has authored over a dozen books, including her guidebook to recovery from cancer treatment, After Cancer Treatment: Heal Faster, Better, Stronger. Her new book, published by the American Cancer Society, What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope, marks her fifth year of survivorship. n

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If I Knew Then What I Know Now