An ER Doc’s Response to Barbara Ehrenreich’s “Smile! You’ve Got Cancer”

I was recently sent a link to this article entitled “Smile! You’ve Got Cancer” written by Barbara Ehrenreich.  I encourage everyone to read it. The article lives up to its striking title and more.  And I couldn’t help but respond with my perspective. So that you know where I’m coming from, my most personal encounter with cancer is that my grandmother died from cancer. I also treat people with acute complications from cancer and/or its treatment frequently in the ER.

I love this article!  Why? Because it’s so real. Barbara talks about the “dreadful cost” of denying how you really feel.  I completely agree.  What comes to mind for me is situations in the ER when a person dies and the family members that are present react in different ways. Some openly grieve.  Some scream. Others silently feel guilty in some way.  Some look to religion for solace. Others “soldier” through. And some try to prevent others from expressing their grief/anger/disbelief.  That last group always gets me. To me, when a life-altering event happens, whether it’s a dreaded diagnosis or the death of a loved one, the most healthy thing a person can do is express her/himself.  When my world gets rocked, the last thing I want is someone telling me how to feel before I get a chance to feel it. And I understand it’s scary. It’s scary to be fully available for a life-altering experience.  But it’s exquisitely important to express that fear and anger. I found that out first hand after my grandmother died.

I lived with my grandmother for a brief time in India when I was about 4 years old before returning to the U.S. with my family. The love I felt around her is inexpressible. After moving back to the U.S., I unfortunately didn’t have much contact with her except for a few short visits back to India. Then all of a sudden, when I was in seventh grade, my parents told me she had cancer. Before I could take in what really was happening, she died.  It seemed so bizarre, so sudden, and half a world away. I didn’t know how to feel, what to feel, or if I was feeling anything at all. In fact, I pretty much forgot about it, except for a vague sense of loss.

My first inkling that I was repressing how I felt is when I visited India at the age of 22. I visited the home where I had lived with my grandmother. When I saw where she had been buried, I burst into tears. I thought I had come to terms. I didn’t know that was only the tip of the iceberg. Years later, while in medical school, I was studying for exams one evening when a song triggered the memory of my grandmother. I hadn’t thought about her in years, but something about that moment unleashed everything that I hadn’t felt since middle school. I ended up on the floor sobbing uncontrollably for what seemed like forever. And every time I thought it was over, a new wave of profound sadness would surge.  Even now, as I write this, I feel the power and depth of that moment. The amazing thing is, I felt like a new person after that evening. I felt like I was meeting myself for the first time. I certainly know I would be a different physician today were it not for that evening.

Sometimes it’s sadness that we need to express. Other times, as Barbara so eloquently described, it’s anger. Or it may be raw fear.  Whatever it is, we have to give ourselves and others the space to feel it.  I’ve found that telling someone how to feel is often just an unconscious technique to avoid what I really feel myself. Which brings me back to the ER. I try to give space to loved ones to feel and express whatever they want to.  If appropriate, I may place a hand on their shoulder, take their hand, or embrace them. I may stand with them or apart from them, silently. Or I may leave the room. I try to respect what they need to express the best I can given the limitations of the ER.

So be positive. Or be negative. Or be confused. But whatever you are, be yourself. You will be an inspiration to others, just as Barbara is.