It is now two weeks since I completed my six week course of radio and chemotherapy and I want to say that I am starting to feel better or, at very least, that I have stopped feeling worse. Yet something holds me back from saying this. It sounds very irrational but it is akin to a fear of "jinxing" myself.
One of the best books on cancer I have read so far is Anticancer: a new way of life, by Dr David Servan-Schreiber. Servan-Schreiber was French physician and neuroscientist who spent much of his life working and training in the USA. He is also famous for Healing Without Freud or Prozac a profound and excellent analysis of the failures of Western medicine in dealing with anxiety and depression. Servan-Schreiber was diagnosed with a malignant brain cancer at the age of 31. He describes movingly how he was catapulted from the role of doctor to the role of patient almost overnight, going from being one of the men in white coats who breeze through waiting rooms, head held high to avoid eye contact with patients in order not to be waylaid, to being one of those who must be taken to the examination room in a wheelchair because they cannot, apparently, be trusted to walk. His book proposes a new way of confronting cancer.
But the reason I mention him here is a passing reference he makes to his fears, on breaking the news of his illness to his brother, that he would be jinxing himself by doing so. As though by starting to tell those closest to him of his illness, which was very serious, it would make it more real and condemn him in the real world too, not just the medical, abstract world of the formal test results.
I remember vividly this sensation too: one of the hardest parts of a cancer diagnosis is telling those nearest to you. Telling my children and my mother was a huge hurdle for me, though a relief when it was done. But there is another side to jinxing, apart from that initial crossing of the Rubicon when we must make our illness real by telling those around us. There is the fear, later, of bringing doom upon ourselves by being too optimistic, by "speaking too soon", counting our chickens before they are hatched and so on. It is entirely irrational of course but I think perhaps understandable. After all, cancer patients have usually been through a process whereby all their worst fears have been confirmed and their hopes of being letting off the hook have been denied. This has been followed by a course of treatment which is rarely less than harrowing. Their world has been shaken up violently, is now fundamentally different and they are struggling to find ways to live in it. They are prone to fears and superstitions (where's that damned second magpie .....?)
(As if to prove the jinxing theory, last week I sent two positive e-mails to colleagues saying that I thought I was "turning the corner". I duly spent the evening vomiting and even the bathroom joined in by deciding this was just the moment to spring a leak through the hallway ceiling!)
The question which most of us cancer patients will have, in various forms, is basically "am I going to survive this?" a question which we may later refine to "how long am I likely to survive?" And I suppose the fear is that by expressing optimistic views we will tempt fate and prove to be foolishly wrong. And yet, we are cancer patients, we need to be optimistic. Indeed, there are many rational reasons why we should be so. I suppose irrational ones could be fine too, as long as they do not deny reality, because ultimately this helps nobody.
In my particular case, the statistics indicate that I am more likely to be alive than dead in 5 years time, so optimism is not irrational. But stats, as we all know, are meaningless when it comes to individual cases. There are too many individual factors involved for any reliable predictions to be made on the basis of stats. Servan-Schreiber refers for example to the well-known case of Steven Jay Gould, a professor of Zoology at Harvard University.
At the age of 40 Gould was diagnosed with a mesothelioma of the abdomen. His oncologist being cagey about what this meant in terms of prognosis, he researched it himself. He was horrified to discover that it was incurable and that median survival was 8 months after diagnosis. But, overcoming his shock at this discovery, he saved himself from despair by using his training. Variation is the essence of nature and the median is an abstraction. He reasoned that, for the individual Gould, the question was where he was located in all the variations around the median. He brought in factors like he was young, he was in good health, didn't smoke, was diagnosed early and could count on the best available treatment. Moreover, even though the median was 8 months, many people survived for years. Equally importantly, the stats were necessarily 10 -20 years out of date and treatments had improved enormously in that time. Gould therefore concluded that his situation was significantly more optimistic than the median survival time of 8 months. He turned out to be right, and died 20 years later of another disease.
The fact that Gould died of another disease brings home another point. We are all walking through the valley of the shadow of death, whether we have cancer or not. In the last century progress has allowed us to be able to ignore this. Cancer reminds us of it, but ignoring it is unhealthy in the widest possible sense of the word.
I realise that not everybody is in circumstances which make it easier to be rationally optimistic like Gould and possibly me. I suppose what I want to say is that the fear of jinxing ourselves (anyone else suffer this?), whilst understandable, is unfounded. We can be optimistic, we can be full of love and hope even though we are all in that valley.
So yes, I am going to say it, that two weeks after treatment, I am feeling much better today. All those a bit behind me in the treatment schedule, please hang on to that! You'll get there.
