menu/ CANCER AS A TURNING POINT

By Lawrence LeShan

"She disliked the work intensely, but continued it in order to support her husband and daughters."

Maria was a Brazilian physician who loved her work as a pediatrician.

Her husband was an electrical engineer who wanted only to be a poet. He hated his field of work, at which he was actually quite successful professionally. Their twin daughters, aged fifteen and a half when I first saw Maria, were apparently of very high artistic caliber. Both wanted to be actresses and had already had minor parts on the stage in small theaters.

When the daughters were ten, their talent was recognized by a well-known theatrical director. It crystallized Maria's decision to leave the Rio de Janeiro she loved so much and emigrate to London, where her daughters could receive the best education in the theater and where her husband could devote himself full time to his poetry. She told me she had not been "back home" since her arrival in England.

Maria could not, however, find work in London as a pediatrician that would bring in the necessary income for the needs of her family. The position she had been promised failed to materialize at the last moment. She was offered a position with an adequate financial return in an oncology partnership, where she would deal chiefly with children and young people suffering from the childhood leukemias, Wilms' tumors, and so on.

She disliked the work intensely, but continued it in order to support her husband and daughters. She also hated London and constantly missed Rio, where she had grown up. She described with enthusiasm and gusto the lovely beaches, the gentle climate, the easygoing and tolerant attitudes of the people, the striking architecture, and the friends she had had there: "I always felt at home wherever I was in the city. Every street felt like my own living room."

She even missed speaking in her own language, she told me rather shyly.

By her actions, she was telling her body that it was always someone else's turn and never hers.

Everyone else would be taken care of except her.

At the age of forty-eight, she noticed a lump in her breast. She did nothing about this for over a year. By the time she had it examined by a professional colleague, it had grown several times larger. The diagnosis was adenocarcinoma of the breast. In her and her colleague's opinion, the metastases were too widespread for surgery to be an option. A course of chemotherapy was decided on, but everyone agreed that the prognosis was very poor.

I was speaking at her hospital in London during this period, and afterward she asked me for a professional appointment. We talked for an hour about her history and about her hopes and fears for the future. She saw no possibility of work that she would enjoy, of living where she would like to, or of a life that would make her glad and excited to get out of bed in the morning. Her husband and her children were very happy with their lives and she was successful enough to enable them to continue it.

Rather brutally, because I felt I had to shock her into taking some action on her own behalf, I asked her how she planned to continue supporting them after she was in the cemetery, as her cancer prognosis was so poor. She looked completely defeated. After a long pause she said: "I know I can't do it anymore. I had hoped that you would know a road for me."

Her sadness and despair moved me deeply, and for a few minutes we both just sat there. I then said that I could see no reason for her body to work hard to save her life, no reason for it to mobilize her immune system and bring its resources to the aid of the chemotherapy.

By her actions, she was telling her body that it was always someone else's turn and never hers.

Everyone else would be taken care of except her. Clearly she was telling herself that she was not worth fighting for. She listened, thought a bit, and said, "It's sort of as if I keep telling myself that for me it's always jam yesterday and jam tomorrow, but never jam today." We agreed about this message and sat in sad and companionable silence for a while. It was clearly an emergency situation. She was in very bad shape both physically and emotionally and clearly going downhill on both levels. There was little to lose.

That night Maria called a family conference and announced (apparently in no uncertain terms) that it was her turn now.

I would be leaving London in a few days and I have never been very good working over the telephone or by mail. The philosopher and spiritual leader Edgar Jackson has pointed out that in some situations, the careful man is only a short step away from the paltry man.

I told Maria the story of the woman who was sunbathing nude. A lovely chickadee flew down and perched on her ankle. She smiled lovingly at it. Then a great orange-and-black butterfly alighted on her knee. Again she smiled warmly. A magnificent dragonfly with its iridescent wings settled on her shoulder. It also received her welcoming smile, as did a beautiful goldfinch that came down and perched on her toes. Then a mosquito came down, settled on her breast, and bit her. She looked at it and said, "All right. Everybody off!"

At the punchline, Maria laughed much harder than the joke deserved. Then she sat apparently thinking very intently for several minutes. Finally she looked at me and an impish and devilish grin spread across her face. "Do you think I really could?" she asked.

She was as ready for action as a tomcat with its tail up.

She had only needed a direction and a trigger. I had provided that direction in my lecture, and our discussion was the trigger. It was a pleasure to watch her move. I had heard of the "fiery, tempestuous Brazilian personality," before but had never expected to see the stereotype in full bloom.

That night Maria called a family conference and announced (apparently in no uncertain terms) that it was her turn now. Changes would have to be made as she could no longer afford to support her entire family. If she died they were all on their own anyway, so they might as well all take a desperate and final chance to help her immune system come to the aid of the chemotherapy.

"In order to help this happen, there needed to be some major changes in her and their lifestyles."

She had, she told them, been an oncologist long enough to know that with a cancer like hers, this was the only chance. In order to help this happen, there needed to be some major changes in her and their lifestyles.

First, she said, her husband: quite a number of successful poets had supported themselves by working at regular jobs. If he wanted to follow the example of his particular idol, Edwin Arlington Robinson, and work as a ticket seller in the Underground, this was fine with her, but she felt he would do better as a draftsman or something like that even though he'd been away from engineering for eight years.

Then, the children: they were going to leave the special private schools they had been going to and go to regular public schools. They could continue some of their private acting lessons, but would also have to get part-time jobs if this were at all possible, and even if it weren't! Certainly they could work as salesgirls, waitresses, or whatever during summer and Christmas vacations unless they had professional employment.

The maid would go and all of them would pitch in with the housework. She herself was going to give up her job, take a residency in pediatrics in order to catch up with the latest techniques, and then take it from there. Moving back to Brazil when the twins were established an on their own was left as a possibility for the future. It must have been quite a family meeting.

By the end of it everyone had agreed to the new agenda and, Maria told me, "with a lot less upset and resistance than I expected. I found that they cared for me, loved me, even if I couldn't support them anymore. I'm surprised to find out that this surprised me!" In the next six months her husband obtained a fairly low-level job in an engineering firm. He said it demanded little of him and left him with a good deal of energy for his poetry ...

The daughters did get part-time jobs and expressed a good deal of resentment about having to do so. They complained in typically adolescent fashion and constantly had to be reminded about their household chores. Both paid for their acting lessons and also obtained a number of small jobs making television commercials and in obscure, avant-garde theaters.

Maria resigned from her oncology position and took a residency in pediatrics. After a year she began working full time in this field. She was paid far less than she had earned in oncology, but enjoyed it far more ...

I kept in touch with her. The chemotherapy program worked far beyond expectations.

2006 by Lawrence LeShan

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