Cancer is a unique disease. There are five factors that make it
different from any other known illness. First, cancer cells grow
geometrically without limitation. That means 2 becomes 4, then 8, 16,
32, 64, etc. If they grew 1, then 2, 3, 4, 5, we probably would never
have heard of it. Because of this geometric growth, we must treat it
promptly and properly or it can soon grow to a point where it may be
untreatable. If we break our arm and it is not set properly, we can
have it reset again whenever we want. It is not irreversible and
Growth and Detection of Cancer Cells
One million cancer cells are smaller than the head of a pin. One billion cancer cells are the size of a pea and weigh about the same as a paper clip.
The importance of early detection and prompt treatment. Time is of the essence!
To further illustrate the way cancer grows, picture algae covering a lake. This algae doubles in area each day until, after one month's time, it completely covers the lake. When should it be noticed? When it covers one half the lake? That is the day before the end of the month. When it only covers one fourth of the lake? That is two days before the end of the month. If you caught yours three or four or five days before the end of the month, you must feel very greatful!
The second unique factor is the property of cancer cells to spontaneously travel to distant sites. One million cancer cells are smaller than the head of a pin. One billion cancer cells are the size of a pea. This means that they have the ability to float freely through the blood stream or the lymph system. They could be in your stomach today and in your head, your lungs or your toes tomorrow. If you break your arm, it cannot metastasize (spread) to your hip.
Third is that cancer is actually over 100 different diseases. There is no similarity between brain cancer and breast cancer other than the word cancer and the fact that they are both rapidly dividing cells. Different types of cancer should be treated by different types of medical specialists with totally different methods after being diagnosed through different means. Furthermore, the advances being made continuously in the many different types of treatments make it absolutely impossible for any one individual to know the very latest and best therapy for every type of cancer. In contrast, if you break your arm, many physicians would know the state-of-the-art way to set it.
Fourth is the unique fact that while many cancers can be treated successfully the first time, if they are not, often there is no second chance. For example, with my lung cancer, I had all the radiation my lung could take; so, if I had not been cured completely and had suffered a recurrence, I could not again have successfully had radiation therapy. I had my limit on Adriamycin, a particularly effective cancer drug but one which can do harm if given in excess of certain amounts, so it would not have been available to me if needed a second time. After you have one lung removed, there is no point in talking about surgery because you cannot live without both lungs. These are just examples in my case, but the same principles apply in many cases. This is why we not only preach prompt and proper treatment but also thorough treatment so you know you have the best chance of being through with it forever. If you break your arm a second time, generally it is not more critical than the first time.
Fifth and last is the major factor mental attitude plays in the recovery from cancer. Most oncologists agree that if a patient believes they will die from their cancer, they are right and cannot be saved. That is not to state that if they believe they will recover, they necessarily will, but at least they have a chance. If you break your arm, whether you think it will mend or not does not matter, it will generally heal in so many days.
Some people feel that because they don't have sufficient funds they won't receive the best treatments. In fact, these people are defeatists. They are making up their minds in advance that they are going to take the easy road out and give in to their disease. I have never seen the individual who, even though absolutely destitute, could not get the proper treatments if they applied themselves and really tried. There are resources in every major community. Remember, no one owes you anything. You have to work to get it like everything else in life. It can be done! An example of some of the resources that could be investigated are VA hospitals, state cancer hospitals, university hospitals or teaching institutions, and county or city hospitals. Treatment for patients participating in National Cancer Institute clinical research protocols at the Clinical Center of the National Institutes of Health is provided free of charge. Generally, a local, qualified physician can give you suggestions on where to look.
Some people have said I recovered because of my financial position and that I must have gotten preferential treatment. I would like to dispel this myth. First of all, I am unaware that cancer shows partiality because of financial or any other position. I believe rich or poor people have an equal chance of surviving. I also believe that tall or short people have a relatively equal chance as well as fat or thin or black or white people.
As to receiving preferential treatment, that was hardly the case. At home, where I was known and possibly could have gotten superior attention, I was told it was hopeless and to get my estate in order. If that is superior treatment, I don't need it. When I went 900 miles away to a mammoth institution where I was a number, I did receive superb service and attention, not because of who I was but because that is the way they do things. My doctor, before giving me any treatments, gave me his home telephone number. He said in the next two years of treatments I would want to contact him many times in the middle of the night or over the weekend. Of course, I could reach him during weekdays at the clinic. However, he did not want me to waste my energy during a sleepless night or weekend about anything that would be bothering me. He wanted me to apply all my energy to getting well. For that reason, he gave me his home telephone number and told me to call him any time anything bothered me. He did this for his other patients also as should all good doctors.
This discussion of my doctor is only for the purpose of showing you where I got my support, ideas and knowledge and what you should look for and have a right to expect from your physician.
My doctor was the greatest! Not only did he cure me from cancer, but he taught me so much along the way. In the very first telephone conversation, he started, without my knowing it, by getting my undivided attention and ascertaining my dedication.
I was diagnosed on a Wednesday with "terminal" stage 3 squamous cell lung cancer. I talked with him Wednesday night long distance, and he wanted me to fly there Thursday so I could be examined and tested Friday. The clinic is closed on Saturday and Sunday. Because I was terminal and might never have seen my home or office again, I wanted to have four days to get my estate in order at the expense of one day of testing. I wanted to fly down Sunday to be examined and tested on Monday, one working day later. My doctor said if I did not fly down on Thursday, he would not treat me.
At the time, I may have thought he was being inconsiderate. Since then, that one little remark has taught me many things. First of all, cancer is never as treatable as it is right now! At some time in the future, it is probably not treatable. Whether that time is tomorrow, next week or next month depends on the individual case. This afternoon or first thing tomorrow morning is the best time to start trying to beat it.
Possibly even more important than that, I soon came to realize he wanted to be certain that recovering from cancer had my full attention. He wanted to be certain that I would make the commitment to do whatever was necessary to get well. There is no doubt that generally it is a long, hard road with plenty of obstructions and detours. He wanted to be sure that I wasn't going to say, "OK, Doc. I'll do anything you tell me to do as long as it is convenient with me." He wanted to know that getting well came first before anything and everything else in my life.
And possibly the most important thing I learned from those few little
words was a third factor. He wanted to know that I had the dedication
and drive to do what would be required to be victorious over cancer.
That day may not have been critical. But that day represented just one
of the many negative options that would lie in the path of my recovery
that I would have to forgo if I were going to succeed. He knew my
chances of recovery were much greater if I had a truly strong, burning
desire to live. This was his way of testing me. This was his way of
proving it. If I would give up four days I wanted so desperately to give
him his one day he asked for, my dedication to success was guaranteed.
The Act of Deciding to Fight Cancer
Until you commit yourself, there is hesitancy, the chance to draw back, ineffectiveness. Once you commit yourself to do absolutely everything in your power to fight cancer, all sorts of positive things occur. The mere act of reaching a decision causes unforseen incidents, meetings and assistance that could not have been anticipated. Goethe stated, "Whatever you can do or dream you can, begin it. Boldness has genius, power and magic in it." You make it happen.
When I talk to a cancer patient who is still smoking (including but not limited to lung or throat cancer), the answer as to why that person continues to smoke is obvious without asking the question. Way down deep this person know that smoking is bad for them. No one has to explain. No one has to plead with them to give it up. What this person is saying, no, what this person is screaming to me is that they only want to live as long as it is easy and convenient for them. They are not willing to do anything and everything to help their doctor cure them. They know they must do everything in their power if they want to have a chance of getting well. By continuing to smoke, they are saying that they are not willing to do everything in their power to be cured, and therefore their chances are dramatically reduced. Maybe that is their privilege, but they should not ask others to do everything possible if they are not willing to help themselves.
I talked with a 42 year old lady paralyzed from the waist down with cancer from an undetermined origin. She had been told she would never walk again. Asked if she smoked, she replied that she knew it was bad for her and had been meaning to give it up long before she got cancer. As soon as she could get up on crutches and walk, she was going to go to a hypnotist to quit. This told me that if she didn't change her attitude, she would defeat herself. She obviously loved smoking and was dependent on it. She had promised to quit as soon as she could walk. She might have subconsciously procrastinated in her attempt to walk in order to delay as long as possible her quitting smoking.
Annette called my doctor out of the hospital room one morning to ask him a question about me. He marched her right back and gave her quite a tongue lashing in front of me. He told her never to ask him a question about me except in front of my face. There could be no secrets from a cancer patient if there was any hope that patient could get well. That single event probably did more constructive good for my mental attitude than any other factor. Just to realize that I was told everything honestly about my condition removed all doubts.
One day in the clinic we asked my doctor if a friend of ours, who he was treating, would make it. His reply startled us. He said we could talk to him and look into his eyes and know as well as he did whether this person would recover. We tried it. This person's posture was terribly bent over; his walk was a shuffle like someone 40 years older; his yellowish, sagging skin and head and face without a hair made him look like death warmed over; yet, the accent and genuine determination in his voice and glint in his eyes made us believe he was going to make it. And this was in spite of the fact that 85% of his liver had been replaced by cancer. And you know what! For several months thereafter, we got reports on how his tumor shrank and his liver regenerated itself.
Truly a miracle.
The opposite had also been true. I talked with two volunteers at the Cancer Hot Line training program. Both of these women had had breast cancer. They had been treated by fine oncologists and had been told they were cured. One of them felt very depressed whenever she talked to anyone with cancer, and the other could not stand to even mention cancer. I came home and told my wife that I did not believe either of these people were through with their cancer in spite of what they had been told by their physicians. Today, one of those two is gallantly fighting against recurrent breast cancer and the other has passed away.
I wish there were an easy way to specifically list the points to take into account to render an accurate psychological prognosis. As each case of cancer is as unique as a fingerprint, so is each person's desire and determination. To camouflage it as a positive attitude is oversimplification.
In a visit to Pittsburg for a press conference on the opening of a new Cancer Hot Line, I was picked up at the airport by a woman with an extremely positive attitude. She knew she was going to make it. She was in her fourth recurrence of breast cancer. She had the finest oncologist, in her words, in Allegheny County. I asked what his prognosis was. She told me she had never asked him because she did not want to hear what he would say. She knew she would beat it! What did this tell me? She had a qualified oncologist in whom she had complete confidence. She was afraid to ask him about her future believing he doubted she could ever recover. Therefore, down deep, she believed she would not make it. Sure enough, a few months later she passed away.
Failure to become intimately involved with all the details of your cancer is like closing your eyes after falling into quicksand. For the moment maybe, your ignorance will give you a false sense of security. However, to have a chance of escaping, you must muster all your resources and use and exhaust every option open to you.
Hamilton Jordan, White House Chief of Staff under President Jimmy Carter, upon being diagnosed with cancer at the age of 41, stated, "One of my closest friends is a doctor, and he came to see me one day and said, `You're going to have to manage your own damn medical care.' That shocked me. It put a sense of burden and responsibility on me that I wasn't sure I could exercise properly. But as I saw things unfold, I saw he was right. Although it was tempting to stay at (the hospital) and be among all my friends, and the (hospital) doctors thought they could do as good a job as anybody, I realized there were many choices to be made, and I had to make them for myself."
One of the major problems is that the initial diagnosis, while traumatic and beyound comprehension, is often relatively innocuous. It is often discovered through a routine physical examination, surgery for another situation or a question about some minor symptom. Some people feel that maybe it isn't as bad as it is cracked up to be and maybe, if they do nothing, it will just fade away. These individuals are looking in exactly the wrong direction. They should be grateful that their cancer was discovered at such an early stage and then promptly do everything in their power to successfully treat it.
The initial diagnosis of cancer makes many feel they have totally lost control. It is vital to get some part of this control back. The patient and their entire family faces a multitude of decisions. It is helpful for the patient and the family if the strategy is openly discussed and defined so that all members understand it. Also, the more information you have, the more power you can have to deal with the situation. By gaining knowledge, you can get back some of your control.
This is your life and you are entitled to make your own decisions but only if you have adequate information to make good decisions. These are all human judgments because no one has a God-given power to make them. Information will help you feel some personal control and security during treatment. The peace of mind gained by knowledge is an important factor in healing.
There are many sources for this information. Make a list of what you would like to know to ask your doctor the next time you talk to him. He us usually more than willing to explain anything you want to know. Look up your disease and the treatments in the public library. Call 1-800-4-CANCER (U.S. Government Cancer Information Service), a Cancer Hot Line, the American Cancer Society, the Leukemia Society or other appropriate support groups. They generally have a great deal of information available that they will be happy to send to you and answer your questions. It often proves helpful to talk to someone who has had the same problem. This can be arranged through your doctor or a support group.
At a meeting of the psychiatrists and psychologists who donate their services at the R.A. Bloch Cancer Management Center, a discussion was had of the priority of the various goals they try to accomplish. It was determined that one objective stood out above all others: that of ascertaining the patient's support mechanism. Whether it be family, friends, neighbors, paid people such as a companion, nurse or doctor, the most important single controllable factor in your recovery is to establish a good support organization.
Stress and depression are integral parts of this disease. The sooner we realize that, the better and easier they are to cope with. We must have outlets to vent our emotions and support us in times of need. No matter how strong we each think we are, without a good support mechanism we will crumble.
At the initial trauma of being diagnosed, a person will mistakenly feel that they do not want to burden their loved ones with the depressing aspects of the disease. They will feel that they do not want to bore or inflict their discomfort on their friends or neighbors. Nothing could be further from reality. Your family who love you want to show their love by sharing your feelings with you. Your friends want to express their support by understanding your problems and trying to help you with them. You are not imposing on them by opening up. You are allowing them to do what they deeply and sincerely want to do by sharing your emotions and feelings with them. If you shut them out of your life, you are not doing them or yourself any favor. It may be hard to believe at first, but it makes no difference how old or how young they are or how strong or how infirm they are, everyone you know wants honestly to help you and is capable in some degree to help you. You are hurting them by saying you don't want them to. Allow them in. Make them feel wanted. Let them share and do their thing. It is one of those situations where everyone wins. Everyone is better off.
In Neil Simon's "Brighton Beach Memoirs", Eugene, 14, mentions Aunt Blanche: "You see, her husband, Uncle Dan, died six years ago from...this thing. They never say the word. They always whisper it. It was (he whispers) cancer! I think they are afraid if they said it out loud, God would say, `I heard that! You said the dread disease. Just for that, I smite you down with it.' There are some things that grown-ups just won't discuss." For many cancer patients, the reticence and awkwardness of acquaintances is an additional burden.
When talking about your problem with anyone, always include a statement to the effect, "With the help of my wonderful doctors, family and friends, we are going to do everything in our power to beat this disease." It would not be wrong to state when appropriate, "Even though the statistics for my problem are (not) terrible, I am not a statistic. I am going to do everything possible to be one of those who survive this."
Make a written list of your support mechanism. In addition to family, friends, neighbors, companions, office co-workers, tradespeople, and professionals, don't forget to include volunteers and organized support groups. Many are organized for the prime purpose of helping you. Help them by allowing them to help you. On your list, next to the name of each member of your support team, write a date on which you will contact them if you have not heard from them. When you make contact, cross this date off and put the next date to contact down. By doing this, you will be helping them and yourself.
Rabbi Hirshel Jaffe, in his book "Why Me, Why Anyone" states, "I feel more in command of things. Strangely, somehow I feel more alive. By facing death I am learning how to live. I've learned you shouldn't feel cursed if you have a disease with a foul name. Don't think of yourself as worthless because you've been stricken. Tell the people you love how you feel about them while you still have the chance. Be kind to yourself. We should be thankful for each day granted to us and treat it joyously. Every moment is special to me."
Cancer is often an eye-opener teaching us that life is too short to postpone what we really want. It starts us thinking about how much we really enjoy life. In that respect it can really be a positive experience because those who come the realize they have cancer can use it in positive ways, to grow and to change their ways for the better and to profoundly affect the lives of loved ones around them in deeply positive ways.