The Power of Denial
I mostly write about personal experiences with my family and friends, and those of patients and their loved ones. I hold all of these stories sacred though I do share them often changing names and situations to protect confidentiality. I trudged back through my functional memory banks and remembered that in my life, I have been diagnosed with cancer twice. I think I had filed those episodes under “Denial”.
The first was thyroid cancer. I was a young nurse and I knew just enough to get me into trouble. I angered the doctor when I refused to swallow radiation in order for him to definitively diagnose me. A second opinion helped me make the decision to let go of the first diagnosis.
The next one was when a doctor told me I had a salivary gland tumor. He said I needed to schedule surgery that very day or I risked the chance of the left side of my face becoming irreparably paralyzed. I actually saw two more doctors after that diagnosis, both assuring me I did not have cancer. I still have the lump and I check it from time, mostly as a reminder to listen to my intuition. I am happy to say that, forty years later, I can still wink with both eyes and sometimes if I really want to I can talk out of both sides of my mouth…just not at the same time usually!
According to Lynne Elderidge, MD, “a new study looked at denial and its relationship to physical outcomes in those with lung cancer. Moderate or increasing levels of denial were consistently related to better outcomes when contrasted with low levels of denial. The patients with the most denial functioned better physically, and were less bothered by fatigue, nausea and vomiting, loss of appetite, difficulty swallowing, and pain in the arms and shoulder.”
This brings to mind a patient I had who was sent home on hospice with a prognosis of days to live. Denial was not a possibility for her when I became her hospice nurse. Her condition had declined to the point she was bed bound. She was not eating or drinking enough to keep her alive for very long. Pain was managed with medication and other comfort measures. However, her biggest cause of discomfort was that her doctor told her that had she come in a year earlier, he would have been able to treat her lung cancer. She had been a moderate drinker and smoker most of her life. She expressed mostly feeling guilty for her life style choices over the years and for not getting a check up a year ago.
Guilt is a pain that is probably impossible to treat with medication. I asked her to tell me about the past year. She had traveled with her husband after they retired and she said they met so many wonderful people and had a blast. I described what the past year would have probably looked like had she been diagnosed a year earlier. Chemo, radiation, and surgery were discussed. Perhaps the treatments would have bought her some more time but there are no guarantees. I told her that she was a wonderful teacher for me, because she reinforced the lesson of listening to your intuition, and that in terms of time, quality is preferable to quantity.
This patient visibly relaxed. She told me that the doctors had instructed her family to not allow her have cigarettes or alcohol. Her husband and niece had dutifully denied her guilty pleasures. I told her that hospice has no such rules and she is at home and if she wants something she gets to call the shots. As I left she was having a cocktail and cigarette cheerily waving goodbye. All that I gave her was permission to not feel guilty for her life choices.
With my background, I am picky about what diagnostic procedures I will allow. I think regular blood tests give good information. Colonoscopies are amazing because they not only are a diagnostic procedure, but they also allow surgical removal of polyps at the same time. I tend to venture towards the preventative approach to staying well. When I was a nursing student I told a surgeon that I wanted to work in preventive health care. As he turned abruptly on his heel and darted away, he spurted back at me, “You’ll have a hard row to hoe, young lady!”
And you know, he was right. It is a hard row to hoe, to work at taking care of your own health. I quit smoking many years ago, because I decided it was not good for my health. I gave up alcohol mostly for the same reason though it was primarily out of solidarity with a friend who joined AA. I recently saw a documentary called Forks Over Knives. (It is available through your public library.) This is a compelling story about two doctors who studied populations and found direct correlations between the dietary intake of animal products and the occurrence of cancer. I believed their study and I have since removed all animal related foods from my diet.
There are talented, brilliant, compassionate, and ethical people in the business of medicine. I admit to not being a good patient; my family will corroborate that statement. I don’t always do what my health care professional says to do but I do consider their opinion. Hoeing that hard row has given me permission to utilize the attitude that my intuition trumps any diagnosis.
I will tell you that since I gave up tobacco, alcohol, and animal products, my joints don’t hurt like they used to and my energy levels are better than they have been in decades. If I were to ever receive a diagnosis I believed, and if my intuition told me my days were numbered, I would seriously consider having a scotch, a cigarette, and a full rack of ribs. I think that is a respectable menu for my bon voyage party. And if my loved ones were to tell me I couldn’t have what I wanted, I would insist on hospice to the rescue!
Lenora Trussell
Copyright March 2012
Lenora Trussell, RN, author of Circling the Drain, a collection of end-of-life stories and Pain Smarts, a creative strategy for symptom management, is available for workshops, presentations, and consultations on this and other topics. Her web address is www.lenoratrussell.com.