Halloween night my husband and I were taking turns answering the door to trick or treaters. In between the dinging of the doorbell, we had our noses in our laptops checking on emails and social media. My husband started laughing so hard he began to cough, and tears came to his eyes.

“What?” I asked.

He turned his monitor toward me. An airline pilot had gotten into the spirit of Halloween. Posted on social media was a picture of him walking through an airport terminal. He wore his full uniform and pilot cap, nothing unusual there, but he also wore sunglasses and walked with a white cane extended in front of him. So funny.

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A day or two later I realized the humorous image actually could be a metaphor for some of our patients. They approach their illness with the air of expertise (“I’ve read everything out there on the internet.”), walking through the cancer journey with as much authority and confidence as if they were wearing a uniform and cap. They seem to carry the tools they need to navigate their journey, yet on a fundamental level lack an understanding of the complexity of the situation.

How long does it take until some patients realize they cannot see?

There is a Netflix movie called Bird Box. In the postapocalyptic setting of this movie anyone who looks at the alien entity will be destroyed. To survive they must cover their eyes. All of the characters exist in this new world with their eyes covered. When we talk about patients or families in denial or having difficulty coping, I think of that crazy photo of the pilot on Halloween or the movie trailer with characters in Bird Box wearing bandanas covering their eyes. In both examples it is easy to see the irrationality of the coping strategy, yet patients may not. And sometimes we may not either.

These may seem like silly examples, but they point out a subtle truth. We say a patient or family is in denial or that “they just don’t get it.” We can’t understand why when we know they have been told what is going on. The pilot walking through the airport or the actors wearing bandanas over their eyes may seem absurd, but in both instances they are reacting to the world they believe they live in in that moment. There is a myth, especially here in the United States: the “you can do it, nothing is impossible” myth. Where folks think they can cheerlead themselves or their loved ones into overcoming the impossible. With just the right cane or the right bandana they can weather the storm. For the silly pilot walking through the airport with a white cane or the characters in the movie, they place their survival on believing an untruth.

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What happens if I think they do not need the cane, if I point out what is obvious but which they are not ready to consider? What if I pull their cane away?

Even more importantly, what are the white canes and bandanas that I have in my practice?