With Cancer, As With Life, Be True To Yourself
The diagnosis of cancer evokes feelings of vulnerability and powerlessness in people. It's common to feel fear, denial, disbelief, despair, distress, anxiety, insomnia, and irritability. Within a few minutes of receiving their diagnosis, an oncology patient can easily feel overwhelmed by a diminished ability for self-determination.
So one might wonder why when first diagnosed with cancer, my reaction was gratitude. I remember thinking: "I am so thankful for the brave women who risked their own survival to study the effects of mastectomy versus lumpectomy in early stage breast cancer so people like me can have a better life.” As an oncology research nurse, I knew the results of that study, which showed that survival rates were the same for lumpectomy with radiation as for a mastectomy. And I was acutely aware that these research findings were going to have a profound impact on the quality of my life. It was quite important to me at that time to maintain my body intact: I was a 32 year-old who lacked confidence in my body image, and the idea of not having breasts seemed like a big deal.
There are hundreds of definitions of quality of life, billions if you consider that all humans have their own unique definition relevant to their current circumstances. The definition which I appreciate the most is "overall satisfaction with life and a general state of personal well-being.” There are six key dimensions in this definition: cognitive, social, physical and emotional health, personal productivity, and intimacy. For me, being able to have a less-disfiguring surgical approach to cancer had profound effects on many of these dimensions in my life.
My professional interest in oncology began when I volunteered to work in the newly created oncology unit at Ball Memorial Hospital in the late 1970s. It was such a joy to be in a nursing specialty where I could influence someone’s quality of life while they journeyed with “the BIG CA” (as many of my patients called it). I was so intrigued by the cancer experience that I chose to investigate the question, "What is it like to have cancer?" while studying for my master’s degree as a nurse practitioner. As fate would have it, I received my cancer diagnosis while conducting this research. In fact, I found my own cancer, while practicing breast exams during course work. So in essence, my education saved my life!
Perhaps my clearest research takeaway is that no one really knows what it's like to have cancer until their name is on the top of a pathology report. I took my diagnosis in stride seeking to do everything I could to fight the disease, including becoming a vegetarian. Four years later, when I received my second diagnosis of breast cancer, my first thought was “Ugh! I gave up meat for four years only to get cancer again!!” (A newly-diagnosed cancer patients’ brain can think odd thoughts.
While working as a nurse practitioner was rewarding and allowed me to help others, after about eight years doing this work, I wondered if there was more I could do to make a difference in quality of life issues from a societal perspective. I had begun to sense a philosophical inquisitiveness regarding my patients’ emotional and spiritual concerns related to their cancer. So, I began my studies in philosophy.
I completed my doctorate focusing on “Philosophy as an Underpinning for Quality of Life Research,” and went back into cancer care as a nurse practitioner focused on providing psychiatric and symptom management support. I was intent on providing a practical application of philosophy to cancer patients. My goal is to assist them in creating meaning in their lives, helping them make choices in their care based on their own authentic values, without pressure from others.
As a provider of health care, I allow my patients to be partners in their own care as we choose interventions based upon their definition of what brings quality to their life at various stages of their illness. And, I include philosophical considerations of health care in all of the graduate classes I teach. I believe that quality of life-oriented care provides an understanding of a patient's choices and concerns as they live with their illness.
For many cancer patients, the ways in which the cancer experience can produce alienation from their selves, their futures, their roles in life, and from others, can be almost insurmountable. As a result of my doctoral training in philosophy, I have been able to address that alienation process in myself and others through nurturing therapeutic relationships where these life changes are addressed via existential counseling and spiritual practices.
For myself, what held authentic meaning for me when I was 32—maintaining and celebrating my own physical form—has evolved in my sixth decade. Today I find meaning in empowering others to embrace spiritual formation—to discover their “unique-communal calling” as Adrian vanKaam called it. In this relationship-oriented process, as iron sharpens iron, I too am formed.
Karen Iseminger is an oncology patient and a nurse practitioner specializing in adult medicine and family practice. She has a Ph.D. in philosophy and is a professor of nursing at the University of Indianapolis.