Applying Mental Lessons from Cancer Treatment to Covid-19

I’ve been taking a break from writing with so much going on, not least of which is 3 kiddos at home. But I feel compelled to write today. The number of hard conversations I’ve been having in the past week – people telling about their stark economic realities, thinking about layoffs, fear of parents getting sick etc. has been overwhelming.

What are the psychological learnings from battling cancer that can be applied to handling the Covid situation?

That’s one of the key questions I’ve been asking myself lately.

I’ve been a little surprised at my own reactions. I’m concerned about where we are and the directions this might go. But I haven’t been feeling fear or anxiety about it beyond normal baselines. This is a species of uncertainty that I’ve come to know and be familiar with, if not make friends with, over the past few years. These are lessons that I’ve only in the recent past come to somewhat internalize and practice. I’m sharing them in hopes they are helpful to you. We are all struggling with this, it’s just a matter of degree. Here’s a few bullets:

Stay cool. Step back and orient. It sounds so obvious but decouple planning from action. Step back; set a goal; develop a plan; commit & do it*. I had a few strategies that I was following during treatment. Below is literally what I drew in 5 minutes and it guided my thinking during that critical time; a simple plan beats no plan (or an overly complex/non-implemented one) any day. I credit this approach with, among other benefits, sparing me an unnecessary stem cell treatment that would have set me back even further and inflicted incredible suffering on my body and my family. Here it is, 5 well-spent minutes:

It’s not possible to make great decisions when you’re operating “inside the blizzard”. That’s the analogy I like to think about: rising above it all. Anxiety is about living in the future. And I suspect depression is the opposite – ruminating on the past. The most important thing I learned (and I still struggle with it, but at least I’m aware of it) is that being ferociously present is an antidote to either future or past orientations. And actually the levers of control reside only in the present. That doesn’t mean don’t think about the past or future. It means don’t live there.

Find a way in. When I was in treatment I asked myself a seemingly preposterous question: How could I enjoy my battle with cancer? I thought about this as moving performance (doing hard things) toward alignment with pleasure. I also thought about decoupling the outcomes of my actions from the decisions I was making. They might have turned out well, or not. The best I could do was work my plan so I shouldn’t stress about what happens on the other side of it. I didn’t choose the hand I was playing. I would play it and I would, as best I could, enjoy the playing of it. Specifically, I used two approaches: (1) write a lot to process the situation and clarify my thinking (this blog!), (2) make my chemo infusions into an event that was meaningful. I have very fond memories of my chemo infusions – each and every round – as I was surrounded by close friends, colleagues and family. It’s hard to say but I strongly suspect that had I not done it this way I might have really different feelings about the whole experience. I would certainly have spent too much time needlessly spinning in my head. Ask: is there a way I can make this personal and deeply meaningful? For now let’s ask ourselves, what could be great about shelter in place? What silver linings are staring us in the face? How might the world be better/stronger after this ends?

There’s a beautiful way of thinking about certainty in the Jewish tradition. Faith (or certainty if you prefer) isn’t binary – like you have it or you don’t. The Hebrew the word for faith is אמונה (emunah) and it’s more like a continuum, like developing a craft. It’s something to be practiced, not attained. And I don’t think it matters so much what the certainty points to, just that it’s there. So what’s certain about all this COVID? I think the way to consider this is less about faking faith for some uncertain future – none of us know how this plays out. Instead, perhaps the better way to practice it is that you’re certain that you stand here and now: I think NOW therefore I am. If nothing else, it’s an honest way in.

Stay focused within your perimeter of control. When I was in treatment there were so many times that I drifted toward fixation on the future e.g., scan results, treatment outcomes, am I going to get through this? Similarly, with COVID; when will schools open back up (will they?), what will happen with the economy? Will my parents/kids get this? Will the ripple effects result in fundamental social disarray the likes of which my generation hasn’t experienced? Etc. It never ends. A better approach is to consider what we do with this information; what bets would I make, given the situation? What difference could I made in all this?

Make data informed decisions. Some of us are more inclined in this direction than others, that’s fine. This doesn’t need to be fancy. It really helps to have a metric to stay focused on what matters. For me during treatment it was tracking my weight as I found myself not eating enough**. If it dipped I knew I had to bump my caloric intake. A sensible economic metric for these times might be something like how many months cash you have on hand (cash on hand/avg. monthly costs, of course plus any big expenses coming up e.g., property taxes). If that number dips below, say 3-6 months then some action/intervention is in order. That could inform your next steps.

We should all be VERY concerned about this situation. I am in no way trying to diminish this reality. In fact I think many folks aren’t taking this as seriously as they should. But panic adds nothing and in fact heaps needless suffering onto an already hard situation. Hope this helps. Drop me a line or a comment if you have other suggestions!

* I like to operate on weekly personal sprints. I’ve tried monthly and daily and neither hits the right balance of vision and tactical reality. I’ve found weekly to be the right cadence. Not only does it support building the habit of a weekly check-in, but it also provides 52 learning cycles/year.

** I also used a ratio of (theoretical) 1 rep maximum deadlift / weight to monitor how far I was atrophying. I ended up abandoning this as I was too weak towards the end even to get to the gym. And I was concerned about infections. Metrics are meant to be living/breathing things and should be updated when circumstances change. Have fun with it.