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After Cancer Diagnosis, Moving Beyond Our Fears

by John Wynn, MD

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We don’t see things as they are. We see them as we are. – Anaïs Nin

Cancer requires clear sight. But many people with cancer will tell you that their view of life is blurred by uncertainty and fear. They are uncertain of the technical details left to medical experts and fearful of a process that can feel like life at the roulette wheel. How can we learn to live with uncertainty? How can we move beyond our fears?

If you can focus on the uncertainty, the fears will get smaller.

Much of our life is certain: the sun will rise in the morning, the news will come on at 8 a.m., birds will fly, and the highways will hum with traffic. Today will be pretty much like yesterday; the assumptions from last week will carry over into this one. These truths reassure us that we live in a constant, certain, reliable world.

However, there are deeper truths we easily overlook. Change is constant. Friends come and go. We are born, we live, and we die. Our time here is limited, and even our most trusted beliefs are vulnerable. These truths connect us to deeper reality. They remind us that we have always lived with uncertainty.

A cancer diagnosis doesn’t make life uncertain; it merely reminds us of what has always been the case. The fear that cancer provokes is first the fear of having our immense certainty disproved. To put it simply, the first loss is the loss of an illusion – the illusion of certainty.

This illusion has probably served you well. Our illusions support our life and relationships. How could you put your head on the pillow at night without knowing that morning will come? But part of this illusion – that tomorrow will be just like today, that you will always be healthy – does not help you. It gets in the way when the things we take for granted are threatened and we are unprepared for the truth. The doctor says, “You have cancer.” And the illusion comes crashing down.

A cancer diagnosis doesn’t make life uncertain; it merely reminds us of what has always been the case.

Author of Article photo

Dr. John Wynn

This news is frightening if you have no plan, no techniques or strategies, for living with uncertainty.

But you do know how to live in an uncertain world – you’ve done it all your life. You have not built your life around certainty; you have built it around values, priorities, and purpose. You look both ways before crossing the street. You button up your overcoat when the weather is cold. You give advice, hoping others will learn from your mistakes. Every day is a series of choices, a series of questions that you answer by going to work, by taking out the garbage, by hugging or kissing or fighting or walking away.

Cancer is, of course, an uncertainty, a list of unanswerable questions: Can this be cured, stopped, stalled, delayed? Can I tolerate the treatment? Will my family survive this ordeal, whatever the outcome?

You cannot know for certain the answer to these questions, but you can live without those answers. Your task is to optimize, to do your best. Your responsibility is the same as it was on the day you were born: to make the most of each day. People will tell you to fight, don’t give up, hang in there; some will tell you to keep a smile on your face, always be positive, be an optimist. I won’t tell you these things, because they don’t answer or even address the most important questions.

The most important questions are Who am I? What am I doing here? What is my purpose? What meaning do I create each day? Whatever you do, you are making a statement of priorities and purpose. This is true if you are tucking in your child at bedtime. It is true if you are sitting in a chemotherapy infusion suite. It is true when you run a marathon, watch TV, listen to a friend. It is true when you reach out and ask for help. It is true if you act from fear or from love, with certainty or with confusion.

Coping with fear does not mean never being afraid. It means acting with integrity even when you are afraid. It means that your fear does not make the decision for you. You choose.

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Dr. John Wynn is medical director of the division of PsychoOncology at the Swedish Cancer Institute and clinical professor of Psychiatry at the University of Washington School of Medicine in Seattle, WA.

This article was published in Coping® with Cancer magazine, September/October 2010.