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Emotional Rollercoaster

Cancer Survivors Wonder “What or Who Do I Get Angry At”?

Dr. Josie’s Attempt to Look “Angry” – How Did I Do? 😊

Recently, a survivor asked me “who or what to get angry at” when we are diagnosed with cancer? And I think there is a lot encompassed in this fascinating question. It caught me off guard for a minute. I have had a few days to think about it and here is my first attempt. I welcome your views!

Is the question “who/what do we get angry with” the same question as “who/what to blame”? Blame to me refers to causality and responsbility. In general, I think no blame is to be had as there is still a lot unknown about our body, “the black box”. With the exception of some exposures that are known to increase cancer risk (e.g. asbestos, nicotine, HPV), I do not believe that blame can be assigned at current time and age.

But back to the question – “who/what do we get angry with”? To me this question refers to “where do we target our anger at”? The question implies that anger is like a “hot potato” that has to be gotten rid of as soon as possible before we “burn our fingers”. It may be acted out and projected onto targets with whom we feel safe (e.g. our loved ones) or anonymous (e.g. strangers or objects). We may spend a lot of time and energy on suppressing or numbing our anger (with exercise, alcohol etc). Many of these approaches are unhealthy, not safe, or even destructive: they may make us angry that we are angry, perpetuating our anger only more.

But what if we look at anger differently? What if we view anger as a sign that nudges us to pause and reflect on what we are dissatisfied with or what is bothering us? Anger is a normal emotion to have and represents a validated stage of the grieving process, which many cancer survivors may go through as they “try to find the new normal” in the aftermath of cancer diagnosis and therapies. 

It starts by recognizing that you are angry – this acknowledgment itself may already be cathartic, validating, and healing. Sometimes the “working through” your anger is quick and easy – but sometimes it may be more painful and challenging, requiring honest self-reflection and support from our loved ones and perhaps even a professional. All we can do is our best. 

If we think and feel our way through our anger, then our anger may become less intense or even disappear. The freed up energy can instead be redirected to unstuck ourselves and proceed to the 6th grief stage: finding meaning and purpose. Pursuing new adventures and making new memories. You are more than a (permanent) reaction to your cancer diagnosis – it does not need to define you – you can rise above it and transcend it – in your own unique way – at your time and pace. My wish is that you treat yourself the same way as you treat others…..with more compassion, kindness, respect, and forgiveness. 

Cancer – Saying Goodbye

Cancer – Saying Goodbye

Everyone who knows me knows that I have a really hard time saying goodbye. I am not sure why. Maybe it’s just a quirk of mine. Or maybe it’s because I have lost friends and family members due to moves (this was before the internet!) and illness. I guess that’s what makes me me.  

You may miss a person, a pet or even the ‘old’ you before cancer hit. It may last for one day or one week or one month or one year or indefinitely. The cause may be that someone is moving to a different part of the country or the world — or leaving our world. 

The loss of someone (or something) who was near and dear to you leads to grief. Grief never goes away, as you may have experienced. Over time, as you pass through the grieving stages in your own unique way and order, things may become a bit more bearable and maybe even give new meaning to your life. 

Connecting with others who have also gone through a loss may help (such as this Facebook group by David Kessler). Sharing the pain. Feeling less alone. Learning how to put words to your feelings to allow you to create your narrative. 

We all tell ourselves stories that sooth us. Our stories are defined by our personal perspective, driven by our culture and religion and upbringing. Only you can write your story, which you may refine or even rewrite as you get older and gain new insights. 

No one knows for sure what happens to our loved ones after they pass and so no one can refute your version. 

I believe that we will see each other again — in the afterlife, but even in our current lifetime, which might be evidenced by, if you are open to them, certain signs that hint that your loved one is signaling you. There are more concrete ways to see our departed loved ones again, by replaying audio or video clips, or even leaving a voicemail for them to feel like you are connecting as before. 

Saying goodbye to someone is so final. It puts a lot of pressure on the moment, making sure the last impression is the one you would like to leave them with. Have you said and done all you can or would like to? It’s almost paralyzing. Maybe that’s why I prefer to not say goodbye, but “Until we meet again!”

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Cancer and the Meaning of Life

Cancer and the Meaning of Life

The meaning of life. Such a loaded term. It means different things to different people at different times and phases of their lives.

You can look at it from many angles — psychological, spiritual, religious, existential.

Do you take it, find it, give it, create it, pay it forward? Is it the same or different from having a purpose in life or leaving a legacy?

Such an important yet indefinable concept, a moving target

You may not think about the meaning of life until you  are confronted with your own mortality. Most people don’t. Then you may not have enough time, energy, stamina, or resources to accomplish and realize your hopes and expectations. You may need to modify your expectations which can lead to frustration or even despair.

Should the meaning of life be about making yourself or someone else happy? Helping yourself or helping another? Making change on a small scale or a large scale?

Unless you live on a deserted island the ripple effect makes it hard to not have an effect on the world. Your small actions and gestures touch other people who touch other people, and so on. We are all connected.

Finding meaning helps you to stay on a path, but don’t let the pursuit of meaning become your purpose in life. You’ll be doomed to fail. Humans like to try to understand everything, but the more you think about life’s meaning, the more lost you may become.

Show up. Be yourself. Do what you can. That’s good enough! Sometimes there are no answers as to why we got sick and there is no guidance for finding life’s deeper meaning and purpose. All we can do is be kind, go with the flow, and focus on the small and simple things.  

Cancer: Survivor’s Guilt

Cancer: Survivor’s Guilt

Cancer survivors may be troubled by survivor’s guilt. Some may experience it more deeply than others and it may linger longer for some. People may experience guilt for different reasons. There are many different ways to look at guilt. 

Who do you feel guilty towards? Sometimes you may know the answer. For example, you may think about a cancer patient who had your same tumor type and who you connected with when you received infusions at the treatment center. Or someone you met waiting for doctor’s visit appointments. Or a loved one who put their own life on hold to support you. Sometimes you may not feel guilty towards anyone in particular (yet).  

What do you feel guilty about? Your guilt may reflect something you did but didn’t want to do or something you didn’t do but wish you had. Sometimes you may feel guilty that you’re doing better or worse than someone else. 

Survivor’s guilt represents the notion that you survived, while your peer did not, making you perhaps feel that you could (or should) have tried harder to save the other person. This leads to wondering about your purpose. Why was I spared? Does my fate have another mission to complete?  Do I deserve more time? These thoughts may lead to feeling guilty that you aren’t using the extra time given as intensely, meaningfully, or purposefully as you could. You may also feel guilty that you were a burden for your loved ones, holding them back from living their lives. These are classic examples of survivor’s guilt. Knowing we humans, there are probably many more unique reasons than these that we can find to feel guilty. 

Guilt can manifest in many ways. Self destruction (e.g. drugs, alcohol, nicotine, underperformance at work, relationship dysfunction) and overcompensation (e.g. showering someone with presents) are two examples. It can look like or coexist with anxiety, depression, or even post-traumatic stress. Guilty thoughts and feelings are a normal part of the journey and cannot be easily eradicated, but we must try to make them manageable and tolerable to stop them becoming all-consuming and killing our joy. 

Acknowledging both the thoughts of your brain and feelings of your heart rather than repressing them will allow you to channel your energy into a force of growth rather than destruction. It will allow you to take steps towards changing your perspective into a more realistic one. 

  • Recognize that feeling guilty will not bring someone back to life or undo your (in)actions.
  • Remember that it is easy to realize after the fact what you could/should have done. 
  • Let your relationships provide the love and support you need when things are good and bad. Work with your loved ones in synergy; catch each other when you fall. 

Having honest conversations with your loved one(s) may allow you to share and take ownership in your life decisions. And of course, the passing of time can also be healing, allowing you to grieve what or who has been lost. If the guilt causes any dysfunction, there is no shame in talking with a professional, which may be necessary if talking to your loved ones about your pain perpetuates guilty feelings.

Everyone needs to find their own way towards making peace with guilt. Hopefully this will allow a weight to be lifted off your shoulders, so you can breathe more freely, stand up straighter, and allow yourself to enjoy more. Embracing the extra time you have been given after your cancer diagnosis is the best way to honor those you may feel guilt towards. And, please remember that you are only human and you are enough! 

Thank you for visiting me. Remember, I share ‘extra treats’ if you follow me on Facebook, Instagram, Twitter, or Pinterest! Plus, you can get notified of a new posting by subscribing to our newsletter!

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Cancer: Legacy

Cancer: Legacy


 When a disease confronts you with your mortality, you may start to wonder about your legacy — how you would like to be remembered when you have passed on. Everyone’s hopes and expectations about legacy differ. We all write our own unique life stories, like chapters in our book of life. Cancer may influence the direction of the story, but it cannot control our narrative. 

We all strive to leave behind a footprint when we are gone. The question is how. People have different ideals for their legacy. On one end of the spectrum, some people may prefer to focus all their time/energy/love on a select few people, while others may choose to invest in an activity that would leave a larger footprint in the world. 

Everyone is different and preferences, hopes, and ideals may change. There is nothing wrong with that, as long as you are aware of what drove that change. A healthy self awareness is good for life in general. I found the movie The Fault is in Our Stars, which shows two teenage cancer patients exploring their own perspectives on legacy, to be a great example of this concept. 

We leave a legacy in one way or another by just going about our lives. It’s hard not to. However, all we can do is shape our legacy, realizing that how we made people feel will be remembered more distinctly than our actions. We all touch other people, make an impression on them and impact their lives in a manner that we may not even be aware of. This is the so-called ripple effect which allows us to continue to live on indefinitely. 

It’s important to strive for connection, purpose, and meaning in life. Building towards your idea of a legacy will foster this pursuit and may allow distraction, healing, and channeling of your inner energy into an external target that helps both you and others. But more than that, it may allow you to get a sense of calm and peace, knowing you are working towards building a legacy that fits with who you are and where you stand in life.

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Cancer – Embracing Our Emotions

Cancer – Embracing Our Emotions

Many of you may feel like being in the midst of this pandemic has you stuck between a rock and a hard place. What’s worse — delaying cancer testing/treatment or risking Coronavirus exposure? Having to choose between two evils, you must try to anticipate and minimize your risk. 

Medically speaking, this is unknown territory, so I strongly recommend that all of you make decisions about your personalized cancer care with your medical oncologist. Here is a resource that may help to facilitate your communications. 

There is a reason we have a spectrum of emotions that can range from fear, sadness, anger, and sorrow to happiness and joy. There is no need to put up a facade and deny any of these feelings. Doing so may make things worse and make us feel fragmented. Allowing all these feelings to coexist and being in touch with them will facilitate integration, healing and inner peace. I had previously outlined a few examples of mature coping styles, but only you know what will soothe you most. If emotions are causing you or your loved ones debilitating pain or dysfunction, please reach out for help! 

I think the trick is not trying to keep the joys and the tragedies apart but you kinda gotta let them cozy up to one another, you know, let ’em coexist. And I think if you can do that, if you can manage to forge ahead with all that joy and heartache mixed up together inside of ya — never knowing which one is going to get the upper hand — well life does have a way of shaking out to be more beautiful than tragic.

Dr. Nathan Katowski (by Gerald McRaney) in This Is Us.

When you are aware of all your feelings, you can choose how to approach and act on them.  Embracing fear without letting it paralyze you, but allowing its energy to cautiously propel you forward can help you to express the best version of who you can be so you can love and honor yourself and the world. The hope is that a new (and better) normal will be born out of the Coronavirus tragedy — at global, national, local, and personal levels! 

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Cancer and Loneliness

Cancer and Loneliness

Currently, our society is engaged in social distancing to minimize Coronavirus’ footprint. Many of us are spending more time at home which can help us to rekindle our connections with our loved ones, but some of us are lonely. Elderly people may not have or know how to use devices that would allow them access to social media, FaceTime and the like. And even if you are able to stay in touch electronically, it’s not the same as having a physical, personal interaction. 

This made me think about cancer survivors (and their caregivers), many of whom may be alone at some point in their journey. This solitude may serve a purpose for many, but there’s a thin line between solitude and loneliness, which reflects a state of suffering and sadness due to lack of company. 

As a cancer survivor or caregiver, you may withdraw into yourself for a number of reasons. For instance, it may help you to process your thoughts and feelings and get ready for the overwhelming new situation that you have on your hands. Another reason could be self preservation; you may not want others to see you at your most vulnerable. Keeping up a facade to protect others from your feelings and thoughts or the severity of your situation may be another reason. Also, it can be distracting to have to navigate the reactions of others around you if you barely have enough reserve to keep yourself going.

However, it takes two to tango! People around you may give you more emotional or physical space than you need. They may want to avoid ‘bothering’ you. They may not know how to be of any help or what to say. They may not want to cause hurt by saying the wrong thing or introducing infectious organisms. But it can also be due to the fact that those not affected don’t want to physically contract cancer or have their perfect life stained by the perceived misery.

The reason for my outlining the different reasons for loneliness is that it may help you to gain insight into the potential drivers behind your behavior, which can prevent misunderstandings and allow you and your loved ones to communicate more openly and respectfully with each other and health care providers, and therefore act with more intent and purpose.

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Cancer and Intimacy

Cancer and Intimacy

Sexuality plays an important role in society, facilitates reproduction, and helps us to feel connected to our partner as well as to ourselves. When you are told that you have cancer, it can affect the desire of either or both partners. For some people, desire decreases (as they are distracted and not in the mood), while for others physical intimacy may sooth or provide welcome distraction.

Cancer therapies can affect sexuality in many ways. Qualitatively, your routine sexual act may need to be adapted due to anatomical changes (e.g. pelvic or breast surgeries) or functional changes (e.g. erectile dysfunction, vaginal dryness or scarring). Quantitatively, the frequency and duration of sexual acts may change, usually lessening. Reasons for the latter can be due to the experience of pain, discomfort, shame, or guilt, but also because one’s desire may be decreased when going through premature menopause/andropause, anxiety, or depression.

Oftentimes, I see couples, whether in brand-new or long-lasting relationships, in which I sense that both partners are longing for a connection but are not communicating about this out of concern for disrespecting or hurting the other. Finding a safe environment for this communication may help healing to begin. Also, it may encourage a cancer survivor to feel confident enough to talk with a health care provider to find if there is anything that can be done to improve matters.

There are medications and devices that can improve, if not resolve, anatomic/functional deficits. (As a gentle reminder, hormone replacement therapy is not an option for those who are survivors of tumors that are fueled by hormones.) Talk- and/or pill-therapy can emotionally support partners.

However, at the end of the day some things may not be fully restored to the pre-diagnostic state. Some emotional and physical scarring may be permanent. In these situations, partners may have to work harder and be more creative in finding ways to connect with each other in ways that are enjoyable, pleasurable, and satisfying for both. In addition to intimacy, identity and security can also be altered by cancer. Therefore, even couples who have been together for a long time may need to reset and rekindle their relationships. Keep in mind that sexuality is one form of physical intimacy. You may want to explore other forms of physical intimacy, such as sensuality and eroticism.

There are many other ways of being intimate that can enhance or compensate for the impaired ability to connect physically. Examples of these alternative forms of intimacy are emotional (connecting with someone else in spoken or unspoken ways that express your love), intellectual (participating in communication about a topic that both parties are passionate about), and experiential (sharing activities and making memories together).

Enjoy connecting!

Thank you for visiting me. Remember, I share ‘extra treats’ if you follow me on Facebook, Instagram, Twitter, or Pinterest! Plus, you can get notified of a new posting by subscribing to our newsletter!

Learn & Think, Live & Feel:

My family decided to go all in. For years we have held ourselves back due to various issues including active or anticipated medical issues. Recently, we decided to get some more love in our house. A month ago, we expanded our family to include our beloved cat, Melky. In another month, we will be expanding again with a dog, Cookie. We are fully aware that having a pet may bring more responsibilities, worries, and expenses, so we have backup plans in place, but we do not want to miss out anymore on the therapeutic joy pets can bring. Stay tuned for our adventures!

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Focus on the Journey

Focus on the Journey

Recently, I heard a speaker discuss the concept of “horse racing” in context of an academic setting where one’s career progress depends on one’s ability to compete at the national and institutional levels for recognition of one’s worth and legacy (grants, papers). It struck me that the same concept happens to some degree in our society as a whole. We often find ourselves in an exhausting rat race where luck comes into play. We all strive for a delicate balance between fitting into society’s mold and standing out from the crowd. A certain degree of peer pressure is healthy, but no matter how hard we try, success is not a guarantee. Many factors are outside of our control.

A cancer diagnosis may impede one’s ability to perform and compete due to lack of time, energy, or motivation. Plus, cancer survivors may find themselves in an additional race with life that may lessen their sensitivity to judgment and societal pressures. This may have its own anxiety-inducing aspects, initially. At the end of the day though, the race is never completed. Sometimes we change our definition of success. At other times, we realize our goals are unrealistic or that there are bigger and better goals to achieve. Realizing it’s about the journey rather than the destination may provide comfort by allowing you to enjoy the here and now, rather than focusing on the past or future. In some strange way this may allow you to be less restless and conflicted and more able to listen to your inner voice which can guide you to find the peace and courage to serve a unique purpose in this world. Don’t be afraid to ask for support from loved ones or professionals while on this journey. 

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Learn & Think, Live & Feel:

Breast Cancer Conversations‘ podcast: “Making Sense of What Just Happened“.

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“Sibling” Rivalry Amongst Cancer Survivors

“Sibling” Rivalry Amongst Cancer Survivors

Working with cancer survivors, I have noticed a trend in which we support each other as peers, but sometimes hurt and isolate each other. Cancer survivors may feel a sense of commonality and connection to each other that they may not find with the general population — validation, a sense of physical vulnerability. This sense of comradery is crucial for guidance, role modeling, fitting in, and feeling hope that others made it through and survived, and hopefully, thrived. 

However, at the same time, a cancer survivor may desire recognition, approval, or praise. They may seek to stand out by comparing themselves in terms of cancer types, stages, or intensity of and types of cancer therapies. Inherent to this pursuit is often unconscious competition. (My cancer was worse. My therapies were worse or lasted longer or had more post-treatment effects. I had less support or finances.) This competition amongst cancer survivors may lead to hurt one or both parties and is very similar to a kind of sibling rivalry. The perpetrator may do this to redefine their identity, stand out, get attention and support, or be recognized for their unique victory. The victim may feel bullied and isolated, but should not take it personally. 

However, at the end of the day it’s important to accept the reality that none of our journeys are lighter or heavier, they are just different. Smaller tumors may require intense therapies when their behavior is aggressive. Simpler treatment regimens can still cause a great deal of bodily damage depending on their location and the patient’s ability to tolerate them. We all try to go about our travels the best we can. 

Comparing and hearing others’ stories can help but also hurt. When you tell your stories, please think about why you are sharing — to scare the other person by showing off your hardships or to help the other person by providing support, insight, and (realistic) hope. And if someone tells you a story that makes you feel upset, you should feel comfortable letting that person know in a calm and respectful manner. If communication does not help end this unhealthy dynamic, you may want to ask a neutral third party to intercede. If you still find yourself at odds, a (hopefully temporary) distancing may be needed. In tough times, it’s crucial to remember that all cancer survivors may have been scarred emotionally and try to focus on what keeps us united rather than divided. 

Thank you for visiting me. Remember, I share ‘extra treats’ if you follow me on Facebook, Instagram, Twitter, or Pinterest! Plus, you can get notified of a new posting by subscribing to our newsletter!

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