Greetings from CancerLand: Magical Thinking

Author: Alysa Cummings
Content Contributor: The Abramson Cancer Center of the University of Pennsylvania
Last Reviewed: May 14, 2009

I was thinking as small children think, as if my thoughts or wishes had the power to reverse the narrative, change the outcome.
-Joan Didion
The Year of Magical Thinking (Random House, 2006)

If you're a cancer survivor like me, you just might be as guilty of it as I once was.

Guilty of magical thinking, that is.

I remember the first time it happened to me; I had been in CancerLand for a few weeks. The initial shock of the words I'm sorry, you have cancer had started wearing off, but ever so slightly. (Trust me on that one).
Slowly but surely I was taking baby steps toward my post-diagnosis "new normal." Case in point: I could actually carry on a civil conversation with someone without crying my eyes out. This was no small feat. And let the record show that I was eating and sleeping normally again, showing up for work every morning and paying my bills on time. All things considered, we're talking fairly high functional here! At least, that was my goal.

But beneath the carefully constructed "I-don't need-any-help, I've-got-everything-under-control" façade, I was such a mess. Not in my right mind at all - obsessing over details, crafting lengthy to-do lists, torturing myself with questions that had no simple answers. My most disturbing feelings, (who can possibly understand what I'm going through?) found a home in the privacy of my journal:

I have cancer?
No, that's just not possible!
Could the lab have made a terrible mistake?

Disturbing, indeed. While "Good Patient Me" was busy getting to doctors' appointments on time, taking careful notes and undergoing pre-op tests, one after another, "The Real Me" wasn't completely convinced. My thoughts were twisted and tangled around medical conspiracy theories - wondering if my biopsy slides had been misread, speculating that my file had somehow been switched with someone else's.

The reality of my medical condition was crazymaking. I couldn't conceive of the words Cancer and Me even being in the same sentence. How could I possibly make sense of some freaky new reality that involved cancer cells madly multiplying in my right breast and migrating to lymph nodes in my armpit?

The short answer is this: I couldn't. Not right away. So I found a way to cope. Call it magical thinking, because that's exactly what it was.

Along with stage two breast cancer, I was suffering from a major case of magical thinking. Denial, delusion and low trust levels blended well with anger of the "why me?" variety. And the magic lingered (could the lab have made a terrible mistake?) until I was good and ready to step up to reality, as harsh as it was.

Could it be catching? I think so. Because in CancerLand these days, there's spring in the air and lots of magical thinking too. My working theory is that it might show up anyplace where cancer survivors congregate. Last month, during a conversation with a friend undergoing treatment, magical thinking appeared, without warning or fanfare.

J. and I were chatting on the phone about chemo. We had just discovered what really good friends we were: we had ACT in common. I checked the calendar, counted the days off on my fingers and asked her if she was thinking about getting a wig anytime soon. By my best estimate, she would be losing her hair by next weekend.

"A wig? I don't know...," she began and her voice trailed off. I jumped right in, the voice of experience.

"Well, there are hats, scarves and turbans. They work pretty well, especially when the weather gets warmer," I said. "But I remember how uncomfortable my wig was during the summer, so I wore a baseball cap most of the time."

"Uh huh...," she replied.

Clearly she didn't want to talk about it, but isn't that what CancerLand friends are for? I hoped that I could share a lesson with her that I had learned the hard way.

"Lots of people decide to shave their heads once the shedding starts. You know, take control of the situation instead of losing your hair, bit by bit, day after day until you're bald," I said. "I wish someone had talked me into doing that after my first round of chemotherapy."

The silence lingered. Uncomfortably so. Finally I blurted out the obvious.

"J., forgive me for saying this, but are you thinking that you'll be the only cancer patient on ACT whose hair doesn't fall out?"

My hair will fall out?
No, that's just not possible...

Here's what I believe when it comes to magical thinking. Whether it's me not accepting that my cancer diagnosis is real, even in the face of overwhelming clinical evidence to the contrary...

Or it's my friend J. stubbornly hanging onto every hair on her head, imagining that her will is stronger than Adriamycin...

Or it's the radiation patient halfway through treatment who says, "I just don't understand why I feel so tired," even though fatigue is the first side effect the doctor described during the initial Radiation Oncology appointment...

Or it's the bladder cancer survivor six weeks post-op who offers to help a relative dig up the front lawn (!!!) to replace a bad sewer line, even though his surgeon has seriously restricted his physical activity...

Or it's me, the day I got a mastectomy and insisted on walking the hospital hallways, every hour on the hour:

She walks. Past the nurse's station, the elevator and the family TV room. She walks the fourth floor, pushing the IV pole with her left arm, a miniature pillow clutched against her bandaged right side. She walks. Past her room, past the open doorways of the other patients. Around again. Another circuit. Moving one foot in front of the other. Walking hurts less than lying down flat on the bed. Feels more productive anyway. Incredibly lifelike. Walking feels like healing. Upright. Moving. One step at a time, one foot in front of the other. She walks. Five hours out of surgery and she's upright and clocking fourth floor hospital miles. What must the other cancer patients in their beds be thinking as they glance away from their TV sets momentarily and see this lady with a denim hat on her mostly bald head moving so slowly, so tentatively, so compulsively walking the fourth floor, around and around, again and again. Hey, she's not that sick, they must be thinking. Look at her. She's okay. She's walking...

Magical thinking. Incredibly seductive given the circumstances. Quite an appealing alternative actually if your reality consists of surgery, toxic drugs and painful treatments. (Which door would you open?) Yes, during the most trying times in Cancerland, magical thinking has a lot to recommend it.

Maybe it's part of the process of hanging onto who we are when cancer threatens to take our identities away. Maybe it's a deep-seated wish for normality - that healthy time, before cancer, when we were whole, when we had all our parts, (they were disease free and all worked just fine, thank you very much). Maybe it's an attempt to control the uncontrollable. Maybe it's a short course called Coping in CancerLand 101. Maybe it's all that and more.

All this thinking about magical thinking reminds me of a toy I bought years ago at the neighborhood Dollar Store; in fact, it's sitting on the top shelf of my desk. I can see it as I type these words on my laptop. It's a magic wand, clear plastic, about twelve inches long with a shiny star at the top. The ultimate accessory for a little girl dressing up like a princess. Or relic for a middle-aged breast cancer survivor. The magic wand sits on the shelf over my desk and day after day reminds me of the power of magical thinking to get cancer survivors through crisis to a healing place. (I can't think of a better symbol; a magic wand just works for me).

But, you know what? When it comes to CancerLand, the fact of the matter is I'll take whatever kind of magic I can get my hands on.


December 29, 2023

Taking Time for the Everyday Things in 2024

by Christina Bach, MSW, LCSW, OSW-C

December 7, 2023

Happy Holidays from the OncoLink Team

by Christina Bach, MSW, LCSW, OSW-C

April 4, 2023

Bringing a Piece of Home to the Hospital

by Christina Bach, MSW, LCSW, OSW-C