The next time I saw Susie I started the conversation by asking about her party plans. ”We are going to have pizza and ice cream and chocolate. All the things I love but haven’t been able to eat.” She made a gagging face. Though she rarely complained about nausea, we had worked hard to manage it. I knew well the foods she had been forced to avoid. I asked her, “What do you think you will do after the party?” She laughed for a moment as if it were an absurd thing to ask, then understood my question was more existential than a simple inquiry about what came after planning for her party. “I’ll get back to my life.” I pushed a bit against her rosie picture, not to upset her, but to open the window a bit. “What do you think will be different?”
This time her laugh was nervous. “I can’t go there,” she said. We didn’t have to discuss where going there was when we both knew that finishing treatment did not mean cancer was no longer part of her life.
“Yes. I can imagine it is very difficult.” Now it was me who paused before continuing. “I don’t want to go there either. But I want to let you know that this next part has some of its own challenges.”
“Nothing could be as bad as chemo.”
“I’m sure that is so. What I want is to help you prepare for what is next.”
We discussed how she might feel after her end of chemo party. She said that before her diagnosis when she planned large parties, afterwards she missed the activity and planning that went into it. From there she made the connection. Once she finished her treatment it wasn’t that she would miss getting chemo, but what would be missing was the sense of purpose she had from fighting the cancer. There is a certain security that comes from waging the battle. How would she continue when the battle was done? Was it ever done? What did she fight when the elements of her fight were changed and missing?
We have strategies for managing symptoms. First and foremost is acknowledging that they exist. To manage the transition and the feelings of vulnerability, we talked about what strategies she could employ. She thought returning to yoga would help, and we talked about finding a studio with classes for those on the mend.
I saw Susie when she came for her follow-up appointment. Her enthusiasm was intact but a little restrained. “You know, I’m glad you warned me that there can be a let-down after I finished chemo.” She agreed that finding her new normal was a process. There are many ways to face the transitions of cancer treatment. Some do it as Susie did, with humor and spirit. There is no correct way to handle it. We premedicate for chemo, we tell our patients what they might expect in physical side effects. In the same way, we need to be sure our patients know what happens when their treatment is finished.
Ann Brady is the symptom management care coordinator at the Cancer Center, Huntington Hospital, Pasadena, California.
1. Getlin J. Five years after: Anxiety lingers in New York. Los Angeles Times. September 10, 2006. http://articles.latimes.com/2006/sep/10/nation/na-newyork10. Accessed February 9, 2015.