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View From the Other Side of the Stethoscope

2024; Wolters Kluwer; Volume: 46; Issue: 1 Linguagem: Inglês

10.1097/01.cot.0001005112.91501.5c

1548-4688

Wendy S. Harpham,

Empathy and Medical Education

Revelers went wild when the midnight fireworks lit up Times Square. At home, my husband gently kissed me while I, anticipating another biopsy early January, silently wondered, Is the flashing year on the jumbotron a sign of my number to be inscribed after the dash? Since my first cancer diagnosis, I've found this ancient festival of surviving and embarking on new beginnings uplifting some years, problematic other years, and often a messy mix. Attention to common thoughts and feelings that arise over the New Year's holiday opens opportunities to help patients respond in healthy, hopeful ways. Reflecting My approach to life after cancer centers on letting go of my “old normal” and settling into new routines that keep me focused on the present. The New Year's holiday throws a wrench in all that with one of its cardinal tasks: reflecting on the past year. Psychological literature documents how negative experiences—such as a family vacation ruined by horrid weather—make a greater impression than positive ones. Consequently, patients' reflections on the past year may recharge grief and disappointment even if many positive things also happened, and even if things turned around and are going well now. As 2022 wound down, I was feeling much better physically and awash in relief and gratitude. My New Year's reflections dampened the high by reminding me of illness-related losses, including many I hadn't thought about in months: a missed wedding, declined invitations, and resignations from committees. For other patients, reflecting may not only worsen holiday blues, but also stir up anger, self-pity, and helplessness if dealing with resistant disease, the consequences of delayed diagnoses, financial toxicity, or abandonment by loved ones. Exacerbating patients' grief are media's Year-in-Review pieces that push comparisons of then and now and that include lists of notable deaths. Photo montages of public figures bring to mind the faces of co-survivor friends whose obituaries I added to my file this year. The clustering of memorials generates a wave of grief with an undercurrent of anxiety about something I usually repress: the lethality of cancer. Knowing what's going on in my head enables me to leverage my New Year's reflections in healing ways. Creating a list of good things that happened despite illness stirs happy, love-filled memories. Remembering how people worked around my needs to keep me included reinforces valuable life lessons: Things don't have to be perfect to be wonderful. Finding happiness takes work and flexibility. I also reflect on good outcomes realized because of cancer. Hard-won insights on healing. Long-standing relationships grown stronger for having shared trying times. New friendships that would never have been born otherwise. Seeing myself as stronger for having endured hardships. Appreciating life in ways I couldn't if I'd never been ill. Resolving Reflection gives way to anticipation as the iconic ball descends on Times Square. As a survivor, watching the televised countdown to a new beginning feeds fear of an ending. If I'm adjusting to a recent diagnosis, the roar of the revelers ratchets up my anxiety. If I'm doing well, a wisp of anxiety blows through, reminding me I'm living on borrowed time. Another potential problem for patients is how celebrants frame the New Year as an inviting blank slate. If struggling with treatments or aftereffects, patients' slate appears splotched with problems that will continue long after the Times Square crowd goes home. I've found a solution to those challenges in another cardinal New Year's task: making resolutions. This exercise shifts attention to things within my control. The momentum of this collective once-a-year activity encourages me to reboot my efforts toward healthy behaviors and recommit to the work of finding hope and happiness. Making resolutions (whether about work, exercise, relationships, or attitude) strengthens patients' belief in the possibility of a better year ahead. In tough times, to borrow a phrase from 18th Century English writer Samuel Johnson, resolutions are a triumph of hope over experience. Rejoicing The third “R” after reflecting and resolving is rejoicing in the New Year. Typical celebrations are noisy gatherings lubricated with alcohol. For patients who can't or don't feel like partying, societal expectations can lead to disappointment or loss of self-esteem. In the setting of impaired ability to enjoy intimacy or sex, festivities that climax with a midnight kiss may exacerbate patients' feelings of inadequacy or failure. Whatever a patient's condition and prognosis, if distressed by heightened uncertainty, patients may not know whether, how, or what to celebrate. Cancer taught me to see celebrating as a way to infuse meaning and joy where calendars coldly mark the passage of time. When illness prevents me from carrying out traditions, finding new ways to celebrate acknowledges all that is right in my world. On January first, whether with fireworks or a cup of tea, I rejoice. If homebound all year due to illness, I toast my trip around the sun. Whatever my condition, I honor the medical care and good luck that got me to today—and the fact that I have today. Nobody knows what tomorrow will bring, which is why celebrating today makes all the sense in the world. Supporting Patients Through the New Year's holiday Holidays present challenges and opportunities for patients. Consider leveraging the healing power of New Year's traditions by talking about the benefits of... Reflecting. You don't have to reflect. If you do look back, honor grief stirred by sad memories. Try to focus on good things that also happened. Resolving. January is a good time to recommit to measures under your control that help optimize the outcome. What you do matters. Rejoicing. Celebrate whichever way works best for you, including treating the day as ordinary. Honor your survivorship and the victories that got you to today. That you are here today and have today are reasons enough to rejoice. WENDY S. HARPHAM, MD, FACP, is an internist, cancer survivor, and author. Her books include Healing Hope—Through and Beyond Cancer, as well as Diagnosis Cancer, After Cancer, When a Parent Has Cancer, and Only 10 Seconds to Care: Help and Hope for Busy Clinicians. She lectures on “Healthy Survivorship” and “Healing Hope.” As she notes on her website (wendyharpham.com) and her blog (wendyharpham.com/blog/), her mission is to help others through the synergy of science and caring.Wendy S. Harpham, MD, FACP: Wendy S. Harpham, MD, FACP