Tuesday 29 October 2013

5 pieces of advice on how (not) to talk about cancer

How we talk about illness can profoundly influence our experience of it.

Last week we picked up in a hospital waiting room a pamphlet called “Lost for words.”

It’s a practical and clearly written guide on “how to talk to someone with cancer.”

We wish we’d come across it earlier.

As parents of a child who has cancer, Selam and I often talk for him (Mercifully, Asa doesn’t yet understand his condition) and others talk to us as his supporters and carers.

Some misunderstandings that recur in our conversations are well addressed in the pamphlet.
In lieu of sending it to everyone we know, we’ve taken from the pamphlet five lessons that seem important -- expressed here in our own words.

(Following the format of the guide, we write about how to talk to “a friend with cancer”; but the advice applies equally for those caring for someone with cancer.)

  1. Don’t worry too much about exactly what to say.
When a friend has cancer, trust that voicing your concern / sympathy / desire to help -- and being there for them -- will be appreciated.

Too often, people obsess over getting the message just right.

This can lead to a self-imposed gag, and end up making the cancer patient feel all the more isolated.

There are, however, some things one can do to minimize the risk of clangers:

  1. Before you put your own or someone else’s cancer story on the table, reflect on the similarities and differences. 
Some stories can be very valuable -- providing insights into new treatments to pursue, or ways to make sense of experience.

Other stories can raise false hopes, or create unnecessary fears.

  1. Avoid over-confident or over-optimistic declarations.
Don’t say, “As long as you stay positive, it will all work out fine”!

Cancer doesn’t work that way.

It’s true that people who survive often attribute their survival to psychological or spiritual fortitude -- In the words of a charming young woman who had retinoblastoma as a child: “With a bit of Aunty Faith and Uncle Percy (perseverance), there’s nothing you can’t do.”  

But if a sufferer adopts this belief and then doesn’t get better, it can feel like a personal failure.

In such cases, the physical illness is compounded by feelings of guilt.

Sympathy and hopes or prayers for the best will almost always be better received than optimistic declarations.

  1. When using humour, follow the lead of the person who’s suffering.
In the right moment, laughing about one’s predicament (or any facet of it) can be a most uplifting thing.

But don’t reel off your top 10 cancer jokes impromptu!

            Instead, take cues from the person who’s living with the condition.
           
  1. Meditate on what it means to live with uncertainty.
In Birmingham last week we met a woman whose son, at nearly 4 years old, was having his 39th examination under anaesthetic.

In the course of these many exams, they had seen progress and reversals.

“People never understand,” she said, “that if things look good at one exam, it doesn’t mean you’re out of the woods -- that you’re in remission.”

“There’s no telling what you’ll find next time.” 

Good news one day can be undone the next.

What cancer teaches us is how to live with uncertainty.

Every month, every week, every day of life lived free of suffering is something to celebrate.


Update


Asa’s exam last week produced very positive results: For the first time in 18 months, there was no new tumour growth to report.

We are profoundly grateful for this, and remain hopeful that the treatment will continue to produce good results.

We go back to Birmingham for another exam in 3 weeks time.


Monday 21 October 2013

Another lesson

Since the last blog post, I've been to Ethiopia, we walked across London to raise awareness of eye cancer, and we moved house.

Things have been kind of busy.

But really the biggest news is that the treatment Asa's been receiving -- a combination of chemotherapy (using a single drug, Carboplatin) and aggressive cryotherapy -- seems to be working.

He has had two exams under anaesthetic in Birmingham since the treatment began, and the results have been more positive than we felt beforehand we could hope for.

At the Carrots Night Walk, with Cathy and Edith


The tumour load in the right eye has decreased to less than 10% of what it was before the start of this treatment.

In the doctor's words: “We're not there yet, but we're definitely headed in the right direction.”

In addition, Asa had a cataract operation at the end of September.

That went smoothly, and with the cataract out of the way it’s possible to show that there was very little new growth of the tumours in his left eye during the time that they’d been hidden from view -- more than 3 months.

No more chemo

The qualification to this catalogue of good news is that Asa had a severe allergic reaction to his last dose of chemo, two weeks ago, at Great Ormond Street Hospital.

We had just finished our lunch and were settling down for an afternoon in the out-patients' ward (the full dose takes 3 hours to infuse) when Asa suddenly became grouchy and sleepy-looking, and we lay him down on the hospital bed.

Within five minutes he was running a high fever, had vomited, and his blood pressure was plummeting -- heading into anaphylactic shock.

Thankfully the response from the medical team was almost immediate.

Within half an hour he was stable, and though he and Selam stayed in hospital for observation overnight, he was all right from there on.

The upshot, in any case, is that he'll receive no more chemo: No more Carboplatin because of his allergic reaction to that drug; and no more of the other drugs because he's already had as much of them as the doctors think he can tolerate.

Talking and reading

After this traumatic experience, Asa regressed for a few days, and stopped using his potty. (Did we mention he toilet-trained himself a few months ago?)

But that was a passing thing, and within a short while he was back to his normal routines, and chatting away happily to anyone who'd listen.


A typical conversational gambit for him is:  
“[The] 345 [bus] to South Kensington [goes by] King's College Hospital.”

Delivering a speech


Admittedly it’s not the best conversation-starter. But the enthusiasm with which he conveys this kind of information!

One of the things that strikes me about his language development is how many words he takes on board without having any notion of their real meaning.

What South means, for example, or King, or College.

Without knowing these things, phrases like this one nonetheless bind together memories -- in this case of an outing on the bus, and visiting King’s College Hospital for a flu jab.

A passion for symbols


This aspect of Asa’s language learning -- the ready use of words whose accepted meaning is obscure -- is surely common to all children.

More unusual, it seems to us, is his passion for numbers and letters.

He sees them everywhere:

  • Two manhole covers next to each other in the park are an 8
  • A piece of toast he ate at lunch yesterday became, at various points in the meal, an E, an F, an r and a 1.

Homework

The joy he takes in seeing things makes our latest piece of homework difficult.

We've been advised to patch his eyes on alternate days -- the right one, one day and the left one, the next -- to give his brain a chance to readjust to input from the left eye. (For 3 months before the recent cataract surgery the left eye provided little input at all.)

We started this on Saturday, patching the left eye -- which was no problem at all -- and yesterday we patched the right eye, leaving him with only the very impoverished vision from his left eye.

Chilling with one eye patched


Wearing glasses with a +12 lens for the left eye to compensate for liquid removed from his lens along with the cataract (and with the right eye patched), he is still very far-sighted: able to see things from across the room, but almost blind to things that are right in front of him.

We were unsure how he'd take to this -- Would he pull off the patch, and insist on using his ‘good eye’?

Remarkably, he didn’t. 

Instead, he tolerated the impaired vision all day, groping his way from room to room in the new house; occasionally bumping into a wall or a door, whereupon he’d reorient and take another tack; and generally taking it all in his stride.

Selam reported, after a short time that she spent wearing an eye patch to keep him company on Friday, that even with her 20:20 vision in the seeing-eye, she felt handicapped.

It’s yet another lesson in adaptability from our little tutor.

***

Thanks to everyone who has contributed to our fund-raising for eye cancer research.
 
http://www.justgiving.com/walkwithasa2

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