The Elephant in the Room: Practical Advice When the Diagnosis is Cancer

Reviewed by: Alysa Cummings
The Abramson Cancer Center of the University of Pennsylvania
Last Modified: November 4, 2011

The Elephant in the Room

Author: Bob Riter
Publisher: iUniverse, Inc. 2011
Information: $14.95 US
ISBN: 1462046584
OncoLink Rating:
3 Stars

The morning I was scheduled to receive my first round of chemo, one of the oncology nurses handed me a hefty folder of information, the words Chemotherapy: What to Expect printed in royal blue ink across the front.

Like a straight-A student reviewing notes before the big test, I was immediately drawn to the section describing possible side effects. Minutes passed. The nurse must have noticed a sudden deer-in-the-headlights expression on my face because she patted my arm and said in a soothing voice, "Of course, every patient's different..."

I continued to scan the list of chemo side effects and felt my anxiety building exponentially with each new bullet on the page. But then the logical part of my brain kicked in for a moment. I suddenly had questions: lots and lots of questions spinning silently in my head.

How could drugs make you so sick that you could experience both constipation and diarrhea? (Aren't those opposites? That makes no sense!)

Patients could run a fever, I read. You might feel chills and experience numbness in your extremities. (Was this an either/or situation? Or did you feel both at the same time?)

Chemotherapy could bring on feelings of fatigue, I read. Or leave a patient in a state of sleepless hyperactivity. (What the hell?) I might get nauseous and be repulsed by my favorite foods. I might have strange cravings and gain weight. (Whaaaaat?)

Maybe it was the panic talking, but I looked up at the nurse and cracked my very first Bad Cancer Joke. (It would not be the last...)

"Didn't they forget to mention some of the side effects of chemotherapy?" I asked sarcastically. "What about locusts, boils and death of the firstborn? And when exactly does my ass fall off?"

Funny, the nurse wasn't laughing. But then again, neither was I. (Isn't it interesting how sometimes humor is the coping strategy of choice, especially in those moments when the harsh reality of a situation is just too much to bear?)

All these years later, and reading Bob Riter's wonderful book triggers that vivid CancerLand moment before I headed down the hall for the first time to my designated turquoise barcalounger in the Chemo Suite. Why? Maybe because it reminds me how important it is that patients in a health crisis receive information that is clear and helpful, sensitively written and practical in nature.

Using those criteria, my chemotherapy packet circa 1999 failed miserably. But Bob Riter's book, The Elephant in the Room, earns the highest possible marks; yes, I would give it an A+. Honestly, I wish I had his book when I was being treated. How fantastic to have this much valuable information on the cancer patient experience all together in one place!

Diagnosed with breast cancer in 1996, Bob Riter's personal knowledge of the cancer patient experience informs his writing in the best possible way. In fact, The Elephant in the Room is a collection of cancer columns that Riter originally published in the Ithaca Journal (NY). (I became a fan when some of Riter's columns started being reprinted on the Oncolink website during the past year).

The book is well organized, divided into sections (just diagnosed, during treatment, after treatment) that match the linear flow of the cancer patient experience and allow for easy access to the reader's topic of interest. Additionally, each chapter is brief – no more than a page and a half each – that also matches reader needs since many cancer patients report that their attention span changes during treatment. In my mind, Bob Riter earns "extra credit" for being so sensitive to the chemobrain of his readers.

My copy of The Elephant in the Room is now dog-eared from front to back, the turned down page corners marking places where there was a CancerLand idea that was new to me. Or passages that made me smile ear-to-ear. For example, what do patients do with all of the get well cards and notes they receive from well-wishers? In the chapter titled Thoughts and Prayer Tree, the author describes a tree in Gary and Mary Ellen Stewart's living room in Ithaca, New York:

It's covered with cards, letters and drawings. At first a visitor isn't quite sure what it is. It looks somewhat like a Christmas tree, but it's the wrong time of year. A closer look reveals that everything attached to the tree is offering some form of encouragement. "We're thinking of you." "I'm with you." "I love you." Gary had the idea of creating this thoughts and prayer tree to support Mary Ellen who's nearing the end of chemotherapy. Anyone who has been through chemo-or any cancer treatment-can tell you it's a grueling experience that depletes one's spirits and energy...As I was leaving their home, Mary Ellen gazed up at the tree and said, "I never get tired of looking at it."

Such a great idea! And one I won't soon forget. I could say the same thing about The Look People Give You, a Bob Riter column that describes a gripe shared by countless cancer patients on the planet. Here's a brief excerpt:

I was walking through the chemo suite yesterday and a person called me over and said, "I wish you would write a column to tell people not to give me that look."

"What look?" I asked.

"The pity puss." (At first I thought she said "platypus" which I faintly recalled as being a weird looking animal. I wondered why on earth people were making platypus faces at her)...

"Pity puss. Once I got diagnosed with cancer, people started looking at me as though I was a completely different person."

I knew the look she was referring to. When I was diagnosed, people would look at me with solemn expressions and tilted heads as if they were looking deep into my soul. That look was always unsettling, especially when I was trying to eat lunch.

Reading this column, I laughed out loud in an empty house. Note to Bob: I have always called it the "Howwww Arrrrrrrrre Youuuuuuu" look, but whatever you call it, there should be a law making it illegal for healthy people to punish cancer survivors with it, don't you think?

The Elephant in the Room addresses a wide range of social and emotional issues related to being a cancer patient in ways that will validate patients' feelings and educate the friends and caregivers who support them at the same time. All proceeds from the sale of the book go to the Cancer Resource Center of the Finger Lakes where Bob Riter is the Executive Director.


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From the National Cancer Institute