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View From the Other Side of the Stethoscope

As an internist and cancer survivor, Wendy S. Harpham, MD, FACP, offers a unique perspective on oncology practices.

Monday, October 22, 2018

Beautiful Crutches

Compared to surviving cancer, needing some sort of crutch to get through the day is no big deal. Unless it is. After completing cancer treatments, some patients balk at using any aids that could make life easier, safer and, one would assume, happier. I sympathize. Early in my survivorship, I resisted using any crutches, even though what I needed was far less conspicuous than a walker or compression sleeve. Here I'll share the experiences that transformed my perception of such aids—and of myself. Maybe my story will be useful in your care of patients who refuse to take advantage of available aids or use them reluctantly and unhappily.

The first time I needed crutches—the forked-metal-struts kind with a crossbar for the armpit—was as a medical student nursing a swollen ankle. The clock ticked away as I hobbled from one tagged display to the next for my anatomy final. I hated those crutches that slowed me down.

Decades later, I needed a different kind of crutch. My injury was not a temporarily swollen joint but post-cancer fatigue and cognitive deficits. For months, I seemed to spend more time looking for my keys than driving. While running errands, my insistence on relying on my faulty memory led to mistakes that distressed me, especially when my goofs inconvenienced other people.

I didn't need a medical degree to know life would be better if I attached my keys to my pocketbook and used checklists for errands. Yet I stubbornly resisted using any aids, setting in motion a vicious cycle of feeling and functioning worse and worse until my invisible wounds wore me down and threatened my sense of self.

The reason for my resistance can be summarized in an aphorism found in my book, Healing Hope: "Illness makes smart people do foolish things." To be fair, my jokey response to a serious problem helps patients like me save face and move on without exploring the psychological and emotional terrain of our unwise decisions.

It's worth taking a moment, though, to consider possible explanations for patients' resistance to using any sort of crutch. Patients may feel daunted by the rigmarole of acquiring and learning how to properly use it. There may be a burdensome expense.

Beyond practical matters, crutches spotlight a debility—to the patient, if not to the world. Patients' resistance to using crutches may reflect their desire to…

  • Maintain control over "something"
  • Hold on to their "non-cancer" self-image
  • Not be reminded of their loss
  • Avoid accepting another loss and experiencing grief

In addition, patients may fear using anything "as a crutch," with that pejorative connotation of leaning on an aid excessively. If struggling patients are impressed by stories of mountain-climbing survivors, they may berate themselves and wonder, "Am I trying hard enough?"

For me to function more normally, I needed ordinary memory aids. That I hesitated at all highlights one of the challenges for patients whose cancer or treatments cause significant injury: Patients may have to grieve their loss as a step toward accepting it. They may have to work their way to seeing themselves as whole.

Fortunately for me, at my first survivorship event I met a middle-aged woman with a hearty laugh who had accessorized her colorful clothes with an equally colorful, matching-fabric eye patch. After barely surviving recurrent childhood retinoblastoma and suffering failed prostheses, she'd embraced her differentness with a creative flare.

Her example helped me hear—and believe—words of encouragement, such as…

  • You are not your crutch.
  • Using a crutch when you need one is different than using something as a crutch when you don't need one.
  • Choosing to use needed crutches is the same as choosing to make life the best it can be.

Prioritizing my hopes helped, too. I asked myself which I hoped for more: avoiding crutches or avoiding problems. It was a question of values: Did I care more about how I looked or how I functioned?

My hope to live my best life prompted me to go to a hardware store and buy a pink stretchy plastic spiral coil for my keys and a purple one for my wallet. Since that day, no more looking for misplaced keys. No more worrying about leaving my wallet on a store counter. When my cellphone alarm reminds me where I'm supposed to be, I simply grab my pocketbook and my cellphone with my digital checklist, and I confidently head out the door.

Looking back at my experience of hobbling through the anatomy final, I didn't hate my crutches. I hated my sprained ankle. Thanks to my crutches, I finished the semester on time and my ankle healed.

Today, every time I pick up my pocketbook I smile with relief at the sight of my plastic coils in my favorite colors. I feel grateful for—even proud of—this crutch that decreases my stress and helps me live my best life, a life made possible by my treatments.

Comprehensive cancer care includes helping patients overcome practical and emotional obstacles to using aids optimally. Acknowledging patients' losses and honoring their grief can set the stage for sharing the hopeful news: from Wal-Mart canes to high-tech orthotics, aids offer a way to take ownership of their life and function as normally as possible.