Weisman and Worden1 described the first 100 days after diagnosis as an “existential plight,” a time that makes one confront whether one will live or die. These authors documented that patient concerns initially focused on existential issues of life and death more than on concerns related to health, work, finances, religion, self, or relationships with family and friends. The period from time of diagnosis through initiation of treatment is characterized by sometimes fast-paced medical evaluation and treatment, the development of new relationships with unfamiliar medical personnel, and the need to integrate a barrage of information that is at best frightening and confusing. It is also a time of crisis when a person’s world as he/she knows it is turned upside down.
When I was diagnosed with breast cancer in 1990, I was stunned by the diagnosis. There had been no warning signs or symptoms. I was in the prime of my life and feeling great, and overnight the rug was pulled out from under me. Initially, I had surgery followed by radiation and chemotherapy over 8 months.2 For the most part, I experienced the usual ups and downs of daily living with treatment effects, including neutropenia, alopecia, fatigue, weight gain, fatigue, and lymphedema. It took many months after that for my energy to return, but I knew I was going to be alright. There are many advantages to having a background in cancer care, because I was knowledgeable about the terminology used, the cancer itself, the treatment options and adverse effects, and the range of pharmacological agents to prevent or reduce potential problems. And yet all the knowledge in the world does not fully prepare you for the experience until it happens to you personally. My mind kept going back to Gilda Radnor’s book, It’s Always Something, and her comment to her physician that no one can fully understand what she was going through if you haven’t had cancer yourself.3 Armed with this new life experience, I was confident my cancer would make me a better nurse.
My return to full-time work evolved gradually because my coworkers were exceptional in stepping in and assuming much of my administrative responsibilities. I fully expected to recover completely from my breast cancer. The treatment seemed like an enormous inconvenience but never did I feel my life would end prematurely. So I was surprised when I returned to my clinical responsibilities and had feelings of being overwhelmed, almost panicked. I was finding it increasingly difficult to listen to patients share their problems. I didn’t know what was happening to me. I had helped to transport men from Vietnam as a flight nurse, and as I attended to them, they described their experiences and the flashbacks that came. It seemed to me I was experiencing similar feelings and the term used to describe these feelings related to posttraumatic stress disorder (PTSD).
Posttraumatic stress disorder is an anxiety disorder that is triggered by a traumatic event.4 Historically, PTSD has been linked to warfare, but in 1994, it was recognized by the American Psychiatric Association that a malignant disease could also serve as the precipitating traumatic event. There are degrees of responses and specific diagnostic considerations in assessing whether the condition is acute or chronic. Although my symptoms of anxiety were not sufficient to warrant a PTSD diagnosis, I needed help to work through my feelings of being overwhelmed in order to return to patient care.
The insights I have learned from my own cancer experiences are profound. We now recognize that the time of a diagnosis and treatment are emotionally exhausting for patients and family members, but it not well understood that once treatment ends that people can continue to have periods of being psychologically overwhelmed. It’s not clear what triggers these feelings in patients, but nurses need to continue to assess patients for ongoing effects and help them understand that they need assistance. This assistance can take many forms, from a supportive and consistent nurse, support groups, help-line, mediation, social worker, pastoral care, to psychiatric specialist. For me, it was not easy to acknowledge that there were areas where I needed help. I believe it is particularly difficult for nurses to ask for and accept help. I have also come to believe that these experiences have made me a better nurse. Being a patient has given me insights to the personal courage that it takes to endure the despair that creeps in when overwhelmed with fatigue and the resilience of the human spirit to heal the body and mind.
I know that I look at patients differently as I listen to their stories. In most instances, I’m able to convincingly tell them they will feel better even in the presence of advancing disease. I also can help family members understand the needs of patients and the tasks of caregiving in the context of their relationships. It’s amazingly gratifying to be with patients and know you have helped them get through their cancer experience the best they can and that my own cancer has been a blessing.
1. Weisman A, Worden J. The existential plight in cancer: significance of the first 100 days. Int J Psychiatry Med. 1976; 7 (1): 1–15.
2. McCorkle R. Surviving breast cancer. In: McCorkle R, Grant M, Frank-Stromborg M, Baird S, eds. Cancer Nursing: A Comprehensive Textbook. Philadelphia, PA: WB Saunders; 1996: 893–898.
3. Radner G. It’s Always Something. New York: Simon & Schuster; 1989.
4. Andrykowski M, Kangas M. Posttraumatic stress disorder associated with cancer diagnosis and treatment. In: Holland J, Breitbart W, Jacobsen P, Lederberg M, Loscalzo M, McCorkle R, eds. Psycho-oncology. 2nd ed. New York: Oxford Press; 2010: 348–357.