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The Art of Medicine

They bend but do not break

Sweeney, Cameron Young MMS, PA-C

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Journal of the American Academy of Physician Assistants: June 2019 - Volume 32 - Issue 6 - p 58
doi: 10.1097/01.JAA.0000558243.91627.9e
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“CRAAACCK!” The sound startled me from my slumber, and I opened my eyes in the predawn gloom just as the top of a large tree hurtled past my bedroom window as it crashed to the ground. My house was undamaged, but the dull “THUD!” from the impact shook it just the same. It was too dark to venture outside, so I hunkered down under the comforter and listened to the creaking trees groan under the uncomfortable weight of the ice that coated their branches.

My street was named for the decades-old trees that lined the road and shaded the tidy houses. The majestic hardwoods had massive trunks, some with low crooks and broad boughs good for climbing or hanging a tire swing. The evergreens, impossibly tall, shielded the homes from curious eyes.

When the sky brightened, the frozen wonderland was revealed. Most of the hardwoods stood tall with sparkling icy branches. The pines flexed unnaturally downward, in a stretch that deepened as the ice accumulated, like a novice yogi who uncomfortably attempts to fold chest toward knee in a forward bend. I saw what had awakened me: two tall cedars now terminated abruptly in jagged spikes. On the ground lay a huge treetop and long branches with feathery green needles robed in ice.

Why could some trees bear the frosty weight better than others? Some were simply sturdier and shrugged off the frozen rain. The more pliable pines would spring back once the ice began to melt and released them from its unyielding grip. But the stiff cedars splintered under the pressure.

Like my cedars, some cancer patients seem to crack under the burden of their diagnoses. For them, cancer lurks in the shadows of every dark corner like a cat poised to pounce on an unsuspecting mouse. They track every adverse reaction to therapy in minute detail and focus on the fact that they don't feel as well as they did before treatment began. They worry that every headache means brain metastases, or every momentarily painful hip or back signifies a lytic skeletal lesion.

But other people with cancer are very different. They do not define themselves by their disease. One of my patients had three different primary cancer diagnoses over the past 20 years. She underwent resection and multiple revisions for positive margins. She completed chemotherapy. She endured radiation therapy. She had a recurrence that required second-line chemo and suffered toxicities that included persistent neuropathy. Nothing about her course of treatment was easy. Yet in spite of this, when she returned to discuss the results of her frequent surveillance scans, she always wore a smile while she told us of her latest adventure. She had driven across the country with her dog, learned to swim and completed a triathlon, written a column about her cancer journey for a local publication, and started a mentorship program for those with newly diagnosed cancer, all while working full-time. She also cared for an aging parent with dementia, lost one marriage to infidelity, and another to her husband's cancer diagnosis. But she never played the victim.

When I asked about her unshakeable optimism, she told me, “I went through chemo and came crawling out that Shawshank pipe of crap,” referring to the eponymous movie in which the protagonist escapes prison by tunneling out of his cell and slinking through a sewer pipe to freedom. “Everything after that was cake.”

“Besides,” she continued, “None of us is promised tomorrow. Not you. Not me. But I survived yesterday, and I have today, and I am going to appreciate it. I enjoy both the sunlight and the rain. I savor every single sunrise.”

She paused and looked at me. “What did you do for fun over the weekend?”

I had recently moved into this house, and I sheepishly admitted that I had spent the time unpacking, cleaning, painting, nothing fun. She frowned. “Don't forget, this is a wonderful life. Ride a bicycle. Climb a mountain. Go to the movies. Volunteer. Kiss a dog. Call an old friend. Make joyful memories.”

After my patient left, I reflected on advice a swim coach once gave me. When I complained that I wasn't getting faster in spite of windmilling my arms to exhaustion, she advised me to stop fighting against the water, but to dance with it. Eventually, I learned to soften my hips and flow with the water. My stroke actually slowed but became more efficient, and my times improved.

I pictured the supple pines that bowed but did not break under the ice.

My patient didn't view her cancer experience through rose-colored glasses. But she chose to focus on her triumphs and on the possibilities that lay before her. I marveled at her lesson on resilience.

Copyright © 2019 American Academy of Physician Assistants