Calm before the storm

I’ve now got 4 doctors aligned on the ‘watchful waiting‘ strategy. I’m considering that a mini triumph given that 3 doctors were in agreement to jump immediately into intense chemo just a few weeks ago before the second biopsy results came in. I should right now be in the midst of treatment.

So that leaves me in an interesting place. I’m feeling good and regaining my strength. But storm clouds loom on the horizon. There’s a feeling among the doctors that this more aggressive form of follicular lymphoma will progress, it’s just unclear when. One of the keynote talks at the lymphoma society conference last weekend was about stress and cancer. There’s a name for it, it’s called the fear of (cancer) recurrence (or fear of progression, basically it’s the same thing the difference being if one is in remission or not) – that’s a good name. The speaker talked about how much anxiety these kinds of scans can elicit and how that can impact immunity, caregivers, quality of life and etc.The stuff we all know already but worth a periodic reminder. Reading through some literature on the topic it’s not clear that stress can cause cancer; the relationship seems clearer in terms of managing cancer once you have it. For example the National Cancer Institute (NCI) says explicitly,

Evidence from experimental studies does suggest that psychological stress can affect a tumor’s ability to grow and spread.

Imagine how stressed you might have gotten over something like a job interview, big exam or the SATs. You might have even gotten sick around that time (exam time always seemed to bring that on in school). The immune system is complicated (understatement) and anyone pretending to understand the relationship between one’s mentality and immunity is probably lying, except to say that positive beats negative. My friend Geoff sent me over Stephen Jay Gould’s excellent essay, the median isn’t the message on just this topic. The essay is Here’s a particularly germane excerpt:

Attitude clearly matters in fighting cancer. We don’t know why (from my old-style materialistic perspective, I suspect that mental states feed back upon the immune system). But match people with the same cancer for age, class, health, socioeconomic status, and, in general, those with positive attitudes, with a strong will and purpose for living, with commitment to struggle, with an active response to aiding their own treatment and not just a passive acceptance of anything doctors say, tend to live longer. A few months later I asked Sir Peter Medawar, my personal scientific guru and a Nobelist in immunology, what the best prescription for success against cancer might be. “A sanguine personality,” he replied. Fortunately (since one can’t reconstruct oneself at short notice and for a definite purpose), I am, if anything, even-tempered and confident in just this manner.

I’m feeling optimistic despite all this ambiguity. I’m making it a priority to maintain this attitude as best I can. This optimism is less about blind hope, that an impending hurricane will magically shift course. No, instead it’s rooted in confidence about the house I’ve built being able to withstand the storm. I’ve been challenged with hard things in the past (I don’t have time to go into them – maybe another time). And I’ve survived. In fact I can honestly say that after just about each major challenge things in my life have improved materially. That belief is now hardwired in me. Were any of those challenges this hard? No. Not even close. But at the time some of them did feel cataclysmic (despite being mere blips on the cosmic radar).

I consider those warmups, or simulations, preparing my mind to handle all this. In this respect I’m grateful for all the challenges I’ve experienced until now. It seems to me there’s a compounding effect to handling hard situations appropriately such that each experience carries over to inform the next one. Over time this sums to strong judgment, perhaps wisdom (not that I’m there yet). But these hard experiences are serving me well. I shudder to think what getting this kind of diagnosis might have looked like for me 20 years ago.

In fact these experiences are so important that I’ve started making it a practice to explicitly run through them again to remind me that I’ve experienced hardship before. I need constant reminding that I can do this. Data points.