When the going gets bad, the coping keeps you going

During chemo recently, I got a-chattin’ with Eli, my oncology nurse.

“You must see patients with many styles of coping,” I said to her.

“You have no idea,” she replied, eyes lighting up.

It was like I’d reached into the broom closet and pulled out a magic confessional wand. Years of tending to cancer patients had exposed Eli to every brand of coping mechanism of families under duress, patients deeply stressed, and lives devolving into a mess.

“People cope in so many different ways it’s crazy,” she said.

“Would you say that how people are in their regular life is how they are with cancer, only exaggerated?” I asked.

“Absolutely,” she resounded.

“Can you list ten ways – rapid fire – that you’ve seen people cope under extreme pressure?” I challenged. 

“Can I?” she retorted. And like that, Eli was off to the races.

Some coping mechanisms in Candyland:

Religion/Spirituality: Even my glib noncommittal unspiritual self has been forced to ponder ‘the beyond.’ It is not uncommon, says Eli, for patients to pray before, during or after their chemo sessions, and it is certainly not uncommon for them to embrace a renewed sense of interest in religion  or spirituality when facing the disease.

Knowledge: Seeking comfort in learning everything one can about one’s situation helps many patients gain a sense of control.

Humor: Seeing light in the dark helps eke humor out of a grim situation, making the ordeal a little more bearable.

Denial: This is not happening … this is not happening … this is not happening …. You know what? It is.

Wallowing: Glum exterior, extreme whining and epic self-pity. Sorry if you’re a wallower, but, it’s not really fun for others to be around and this coping method may not help you rally your troops most effectively.

Family crutch: Some patients’ families close around the patient and help create what becomes a passionately collective journey. This can be super helpful … and it can get very strange, says Eli, when families are cuckoo for Coco Puffs (and let’s face it – what family isn’t at least a little cuckoo?)

Friends: “We’ve had girlfriends bring in gourmet lunches with crystal and tablecloths for some women getting chemo.” I do have to say, the line between friends and family blurs in a journey such as this one and many friends become family.

Talismans/totems: Crystals, worry beads, rosaries, wood carvings, shells, stuffed animals, you name it. “One lady brought in many bears for each treatment,” notes Eli. “They just gave her great comfort.”

Displacement: Many patients become obsessed with the news, focusing their energy on bad news happening to others rather than facing their own bad news.

Anger: many people are just so mad at their diagnosis and begin to take it out on those around them, “Did you see what they did to me in this department?” Anger is a totally understandable response, but eventually, it’s not a productive response as you begin to create an emotional environment in which to heal.

Breakdown: Some patients don’t even tell anyone when they’ve been diagnosed, preferring to remain stoic and maintain the illusion that all is well. “Often, young healthy strong guys won’t admit they’re even sick until they come in here, break down and cry.”

Safe place: Many patients have their “safe place,” maybe it’s their home, maybe it’s their local bar, and often, says Eli, it becomes the oncology unit, where people are going through a similar experience and being tended to by medical professionals who have seen it all, from extreme weight loss to hair loss to body-altering surgeries to survival and to death. “On the unit,” says Eli, “many patients let their barriers down, and discuss symptoms, treatment, and a future where they may or may not be present.”

Finding trust: In the beginning, many patients are leery of the medical industry and they have to learn to trust their team. But being a team player, warns Eli, makes treatment so much more effective if the team can work as a unit toward the same goal.

Going renegade: Some believe they know better than their team – they know themselves better, they had an aunt or an uncle who died of such-and-such, and they’re not gonna fall for the same lethal advice. Along those lines, they  may think a drug is not necessary because they can’t sense its curative powers and they hate its side effects, so they play doctor and pull themselves off drugs they actually need. I’ve done this … twice. It’s very tempting, but I’ve learned not to be my own physician.

Live! When life may be a vanishing notion, today becomes more vital than ever and some patients go into bucket-list overdrive.

Projectify: Some turn their medical journey into a project (ahem). Eli says it’s not uncommon to have parents or grandparents let their children and grandchildren draw on or put temporary tattoos on their bald heads. Other projects: people knit blankets, sew quilts, write memoirs, paint, make movies – all kinds of things to help them chronicle and work through their journey.

But the saddest thing Eli said she sees is when they treat a homeless patient, or even just a patient with no family or friends, and individual coping mechanisms are a piss-poor replacement for a community of support.

“What if they have no home?” I asked her.

“They go into nursing homes sponsored by charity organizations, hospitals and Medicaid,” she said. “Nobody is not treated. But it’s very sad.”

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