reading

“This is a great book…necessary reading for not only the victims of cancer, but for the physicians or partners or close friends of those who are afflicted. I certainly would have kept a shelf full of Amy Givler’s books and given copies to many of my patients. She has been able to put herself in the position of almost anybody who first hears the dreaded word ‘cancer’ applied to themselves.”

Internationally honored orthopedic surgeon and coauthor of Fearfully and Wonderfully Made

“While I hope you won’t need this book, I’m glad this book is here for you to read. It’s like getting a ‘house call’ from one of God’s special physicians who’s been there, done that, and knows how God can help throughout it all.”

“Dr. Amy is a double expert. Not only a knowledgeable physician, she is a cancer survivor. I highly recommend Hope in the Face of Cancer to anyone beginning their own journey.”

Professor of Pediatric Oncology Emeritus, Yale University School of Medicine, and author of Why Me? A Doctor Looks at the Book of Job

“In this book Dr. Givler has done an excellent job using her own experience to help people who are newly diagnosed with cancer—providing guidance and helpful information. I particularly like the way she tells the stories of a wide range of people who have coped with a cancer diagnosis.”

“Wow, what insight! I wish someone could have put Dr. Givler’s book into my hands when I walked out of the doctor’s office after hearing my diagnosis. Her book offers solid emotional, medical, and spiritual guidance—in a way that’s understandable and not overwhelming to someone who’s just heard such difficult news.”

“Dr. Givler has written the right book that addresses the right time with the right advice—when the diagnosis of cancer is first heard.

“I strongly recommend this singularly valuable book. It keys into the critical time point when clear thinking is so important to ensure the best outcome.”

Chair, Department of Psychiatry and Behavioral Sciences, Memorial Sloan–Kettering Cancer Center

Unless otherwise indicated, all Scripture quotations are taken from the Holy Bible: New International Version®. NIV®. Copyright© 1973, 1978, 1984 by the International Bible Society. Used by permission of Zondervan Publishing House. The “NIV” and “New International Version” trademarks are registered in the United States Patent and Trademark Office by International Bible Society.

Verses marked RSV are taken from the Revised Standard Version of the Bible, Copyright© 1946, 1952, 1971 by the Division of Christian Education of the National Council of the Churches of Christ in the U.S.A. Used by permission.

Readers are advised to consult with their physician or other medical practitioner before implementing any ideas that follow. This book is not intended to take the place of sound personal medical advice or to treat specific maladies. Neither the author nor the publisher assumes any liability for possible adverse consequences as a result of the information contained herein.

1. Cancer—Patients—Religious life. 2. Cancer—Religious aspects—Christianity. I. Title.

All rights reserved. No part of this electronic publication may be reproduced, stored in a retrieval system, distributed, or transmitted in any form or by any means—electronic, mechanical, digital, photocopy, recording, or any other—without the prior written permission of the publisher. The authorized purchaser has been granted a nontransferable, nonexclusive, and noncommercial right to access and view this electronic publication, and purchaser agrees to do so only in accordance with the terms of use under which it was purchased or transmitted. Participation in or encouragement of piracy of copyrighted materials in violation of author’s and publisher’s rights is strictly prohibited.

I deeply appreciate all the people who helped bring this book into existence. My husband, Don, and my children, Martha Grace, Pete, and John, contributed in countless ways.

Thanks also to the people who gave practical and moral support, especially Phyllis Alexander, Lesley Arnott, Renee Broyles, Eileen Horner, Madge Huff, Isabelle Middendorf, Tim Nance, Ranga and Uma Rangaraj, Debbie Wallace, Mark and Jennifer Wallace, Brent and Anne Wallace, and my Christian Writer’s Fellowship International online support group.

Thanks to Carl Freter, M.D., and Marshall Leary, M.D., for providing a model of what good oncology care looks like.

For helping me hone my writing skills and make my way through the editorial maze, I thank Marlene Bagnull, Elaine Wright Colvin, Paul Gossard, Nick Harrison, Carolyn McCready, Andy Scheer, John and Elizabeth Sherrill, and Monte Unger.

And I give a special word of thanks to the people with cancer whose stories I share in these pages and to their family members. Thank you for being willing to be vulnerable for the sake of others who are just starting out on their cancer journey.

On a dark January evening in 1987, I walked out of the doctor’s office. I had just heard the words, “You almost certainly have some kind of lymphatic cancer.”

If only someone could have put this book in my hands back then! I would have been better prepared for the path that suddenly lay before me.

Now, as a cancer survivor, that’s why I believe in this book. Its pages are full of hope and full of solid guidance—medical, emotional, relational, and spiritual—that will not overwhelm you. And Dr. Givler has earned the right to give this guidance. First by the profession she chose, and more important, by walking the road she did not choose—the same road on which you or a loved one may now be starting out.

THIS IS THE BOOK I WANTED when I was first diagnosed with cancer. I remember arriving at our public library within 24 hours of being diagnosed, looking for a book written by someone who had walked this path before me. I wanted to know the path was “walkable,” and I needed advice on how to avoid stumbling.

I sat in front of the computer screen, preparing to look up “cancer” in the catalog. Suddenly I looked around to make sure no one was watching me. In my small city, a friend might also be in the library. Typing in those six letters seemed so final—so incriminating—like admitting to the world that I really had this disease, when I didn’t even want to admit it to myself.

Finally I chose “Subject,” and typed “cancer.” Five pages of choices came up. I felt smothered—I felt like I was drowning.

I started over, choosing “Title,” then “cancer.” Now two books appeared, so at least I could find the right shelf. I went to the stacks and chose five books intended for people newly diagnosed with cancer, and then I rushed out of the library. I didn’t want to see anyone I knew who might ask “What’s new with you?” I wasn’t ready to be truthful.

Once home, I searched the books for an emotional anchor—a way to make sense of what was happening to me. I needed to make intelligent decisions and not just be swept along, overwhelmed.

It was as if I’d taken one step onto a rickety bridge over a gaping chasm—and now I yearned to hear a voice from the other side calling back to me, “I’ve made it, and you can too!” I wanted those books to give me that kind of encouragement.

Instead, I found too much information—information on what might have caused my cancer, information on what kind of treatments I might expect, as well as extensive information on other kinds of cancer and their treatments.

I had left the Land of Health and had to cross the rickety bridge over the chasm called Cancer. I didn’t want to be on that bridge, but the way back was blocked. I couldn’t make the cancer disappear.

In those first few months, no book I read helped me untangle my emotions. Friends did help, though, and over time I met other cancer-sufferers who became friends, and they helped too. My faith in God helped me put one foot in front of the other, and I found my faith growing stronger as I walked. I got across that rickety bridge, and in the years since my diagnosis I’ve helped others take their first step onto it.

Now I’ve written the book I was looking for back then—a book that could have helped my brain adjust to the awful truth that I had cancer, a book that could have started me walking with confidence on the path stretching out before me.

The path may be rickety, but it is walkable. And it’s possible to walk it and not stumble.

Going through cancer is a journey no one wants to make. It takes a lot of traveling to get back on the road to health. Who is prepared for this journey ahead of time? I’d say—no one.

Picture a woman sitting on her living-room couch. The doorbell rings. Ding-dong. A man stands at the door. “Congratulations,” he says. “You’ve won a trip around the world.”

“There must be some mistake,” she says. “I’ve never even entered a contest.”

“No mistake,” he says, smiling as he pulls her out of her house. “You can take a plane, a boat, or a train to get you started. More than one way will get you home again, but only one way is the absolutely best route for you. You can’t come back home until you’ve been all the way around the world. Okay? Off you go!”

“No time!” he calls out as she starts down the road. “Oh, and one more thing: If you don’t pick the right road, your life could be in danger. Have a good trip!”

“But…” she says, looking back, “but I like it at home, and I had plans. My life wasn’t supposed to go this way.”

What does she do next? It depends on her personality—and what else she’s already dealing with in her life.

She may be able to look ahead and start directly out on that trip around the world, thinking of all the new countries she has to pass through as exciting opportunities to experience new cultures. She may even learn a new language—or at least figure out how to say some key phrases.

She may. I know people who have taken this approach when handed the shock of a cancer diagnosis. They quickly adjust to the news, and then they’re able to search out the best medical care with confidence and vigor.

I admire such people, but I’m not one of them. I am much more like the woman who, when thrust out of her house, sits down on the sidewalk with her head in her hands. Maybe if I ignore this problem, it will go away.

I was already a doctor when I learned I had cancer, but I still needed help. Many people helped me get up off the sidewalk and start on the journey. And I appreciated my medical training. I already knew the language of medicine, and I understood its culture. Having faith in God helped, too. I knew that God loved me and that getting cancer wasn’t proof that he didn’t. I drew closer to him. But I still struggled to find—and then stay on—the path that would lead me back to health.

I’m home again. That is, my cancer has been successfully treated. Now I want to help others who are just starting out on their cancer journeys. Each person’s path will be different than mine, and I don’t want to focus on my pathway as the ultimate model. So I’ll share the stories of other people’s journeys, also. I’m both a guide and a fellow traveler.

As a guide, I can help translate the language of medicine and explain the underlying culture. I know the route through the emotional jungle of grieving over the loss of health. I don’t know the exact footpath to each person’s ideal treatment, but I know the characteristics a footpath should have, and I know the warning signs that signal danger.

As a fellow traveler, I point out the family and friends who are cheering from the sidelines. I help travelers think through how God fits into their odyssey. I can comfort and encourage, and I can point toward the future as a place of hope.

When I say, “I’m home again,” am I talking about “cure”? I wish cancer doctors would use the word “cure,” but they won’t. Unless the cancer sits entirely on some bodily surface (called cancer in situ) and is completely cut away, they talk about “survival” or “remission,” rather than “cure.”

But, you know, I can handle “survival.” I like the sound of that word. I am a survivor.

Here’s some good news about “survival.” It’s increasing. There are more than eight million Americans alive today who either have cancer or who once had it. Only 1.3 million cancers are diagnosed each year. Those numbers don’t include a million additional cases of in situ cancers that are cured by surgery.

Doctors who treat cancer often talk about statistics. Statistics are really just a way to see the big picture, to look at trends. The trend in cancer is very good news indeed. Five-year survival rates are going up. In the 1950s only 35 percent of people with cancer lived five years or longer. By 1974 that rate had jumped to 50 percent, and as of 1998 it was 62 percent. That means 62 out of 100 people will be alive five years after they are diagnosed. Many of that “62 percent” will go on to live their expected number of years afterward, their cancer never returning. Their treatment is “successful.”

And here’s an even sweeter tidbit: That five-year survival rate continues to climb. America has been pouring money into cancer research for 25 years—and it has led to results. Compared to 25 years ago, treatments for dozens of different kinds of cancer are more effective and less toxic. Also, cancers are being diagnosed earlier, when any treatment has a better chance of working.

Back in 1947, the outlook for people with cancer was bleak. Dr. Wendy Harpham quotes from a medical article published that year: “None of the basic problems of cancer has been solved. The death rate is constantly mounting. Small wonder that many doctors face cancer with a pessimism bordering on resignation.”

Cancer treatment has made great leaps forward since those words were written. Dr. Harpham writes, “New discoveries are expanding therapeutic options every year.” Medicine can do a lot to save lives, and even more to prevent suffering. Generally, far from a sense of “pessimism bordering on resignation,” doctors today feel a sense of anticipation as they decide how to treat someone newly diagnosed. I’m eager to see how this treatment will work.

At the beginning, no one knows how a person’s cancer will respond to treatment. All anyone can do is guess. However, this “guess” won’t be like someone pulling a random number out of a raffle basket. It’s more like guessing how many marbles are in a ten-inch jar—you can’t see them all, but you can make a guess—an educated guess.

True, some cancers have a better chance of being successfully treated than others do. Even though two colon cancers in two different men may look the same under the microscope, the first may be sensitive to a certain chemotherapy drug—that is, the cancer dies—but the second is resistant. And how the men themselves respond to chemotherapy may differ, also. One man may sail through chemotherapy just feeling a little tired, but the other man’s white blood cells (which fight infection) may drop so dangerously low that he can’t receive the full treatment dose of chemotherapy.

This is no longer 1947. Treatment possibilities abound—and for every kind of cancer, there are doctors dedicated to finding even better treatments.

I know this. I knew this in 1993. So why, on the day when I was diagnosed with lymphoma, did I think I was going to die?

I wasn’t responding as a doctor. I was responding as a human. “Cancer” was now a word that had been applied to me, and instantly my life had changed in a hundred ways. My mind struggled to process those changes. All of a sudden I’d become dependent and was in danger.

I was dependent, for I needed doctors to diagnose and treat me. And I was in danger, for if I didn’t get treatment I’d die. And I felt wretched, which made thinking harder. When I’m sick it’s hard for me to make decisions, yet here I was being forced to make decisions—now! I tend to panic when placed in situations like that.

And hardest of all was knowing that I wasn’t in control of my life. I knew, as everyone does, that a car could hit and kill me anytime while I was just crossing the street. Life is temporary. But never had that concept seemed so real, and—if I did nothing to get treatment—so inevitable.

I hung on to God. I remember thinking about the verse from Psalm 23: “Even though I walk through the valley of the shadow of death, I will fear no evil, for you are with me.” Knowing that God was walking alongside me on this journey calmed me and helped me figure out what to do.

People who have been on a “cancer journey” are transformed in the process. We tend to see life as sweeter and appreciate it more. Not everybody diagnosed with cancer is able to get to a place where he or she is living free of cancer, of course, but everybody can be a survivor. In fact, a person with cancer is a survivor from the moment of diagnosis.

People who have never faced illness may not realize it, but life is uncertain for everyone. Each day is a gift. That’s true for everyone, but cancer survivors are just more aware of it.

If you have cancer…

Consider asking yourself these questions:

How am I responding to my cancer diagnosis at this time?

Do I feel overwhelmed? Helpless? Or confident?

Am I feeling hopeless or hopeful?

Do I see myself as a survivor?

CHAPTER TWO

HEARING—OR NOT HEARING—THE WORD “CANCER” FOR THE FIRST TIME

Hearing the news Good communication

Being informed Looking ahead to hope

MORE THAN A HUNDRED YEARS AGO Rudyard Kipling wrote Captains Courageous, the story of Harvey Cheyne, a teenager whose life changed abruptly. An ultrarich and pampered boy, he fell from a trans-Atlantic steamer and was picked up by a fishing vessel. There was no returning to the steamer—it was miles away by then—and the captain of the fishing vessel refused to forfeit three months of fishing to return him to port. He didn’t believe Harvey could possibly be worth the millions of dollars he said he was, and besides—he needed Harvey’s help with the fishing work.

So Harvey’s life changed in a moment.

In the course of those three months of hard work, Harvey was transformed from a swaggering, unmanageable brat into a promising member of society. And it all started with that moment he accidentally slipped off the back of the ship.

I’d bet if Harvey Cheyne could speak with me he would be able to describe in detail his first few hours aboard the fishing vessel. He’d relate Captain Disko Troop’s words: “With good luck we’ll be ashore again somewheres about the first weeks of September,” and how he’d protested, “But—but it’s May now, and I can’t stay here doing nothing just because you want to fish. I can’t, I tell you!”

A person remembers the moments when life changes abruptly and irreversibly.

Likewise, a person who has been told, “The results of the tests show that you have cancer,” is likely to remember that conversation in vivid detail—forever afterward. That was the moment when life changed.

MY MIND WENT BLANK

Most people with cancer point to the moment they were told—the moment of diagnosis—as the beginning of a new era for them. In the conversation, they remember only one statement—the first sentence containing the word “cancer.” So much then swirls through their heads that they can’t concentrate on the rest of the conversation.

That’s what happened with Bernice B. Three days after a routine mammogram in December 2000, the technician called her and said she needed to come back in because they “had seen an abnormality.”

She drove back to the hospital alone, something she regretted doing as soon as she saw the cluster of technicians surrounding the view box where her mammogram hung. She yearned for her husband to be by her side.

She wanted him even more a few minutes later when the radiologist who was on duty asked her to come to his office. “This tiny spot here could be cancer,” he said, pointing to her X ray, and then he continued talking. But Bernice was no longer listening.

“I felt drained, weak,” she said. “I was blinking back tears and my lips were quivering.”

Before she left, a nurse made an appointment with a surgeon. “It was a week before Christmas and I remember her saying, ‘Don’t let it ruin your holidays.’ All I could do was nod. I don’t remember the doctor’s name. I didn’t ask him any questions because I didn’t know what to ask. My mind went blank. I don’t remember how I drove home.”

Even though the radiologist was saying only that cancer was a possibility (though it was later confirmed), none of the words he spoke after “cancer” reached her brain.

COMMUNICATION

Communication isn’t communication unless the person who is listening grasps what has been said. Doctors may tell people their diagnoses and what treatment choices they have. But if the people aren’t listening, then the information isn’t received—and communication hasn’t happened.

At least now doctors think it’s necessary to let people know they have cancer. It wasn’t always so. Until the 1970s, most American doctors wouldn’t tell their patients when they had cancer. Since there were few treatments, and little success with those few, doctors felt that keeping such a diagnosis secret was the only way to allow people to stay hopeful about the future.

One researcher, Dr. Donald Oken, reported in 1961 about his survey of 219 Chicago physicians. Nine out of ten favored not telling people about a cancer diagnosis, used euphemisms (“growth,” “tumor,” or “lesion”), and evaded further questions from their patients. “The general feeling,” he wrote, “was that we can do very little to save lives and not a great deal to prevent suffering.”

Even back then, Dr. Oken recognized that this situation didn’t benefit people with cancer. After undergoing treatment that wasn’t helping them feel better, people often dashed from physician to physician, looking for relief. A family member would be told about the diagnosis, though—and that person would feel the weight of “the awful burden of knowledge.” The universal fear and dread of cancer kept people from going to their doctors if they had the slightest suspicion of such a diagnosis. This was regrettable, because even in 1961 some people were able to be cured when diagnosed early.

Dr. Oken insightfully pointed out that doctors weren’t revealing the diagnoses so they wouldn’t be confronted with their own unpleasant emotions. They had become doctors to help save lives, yet here they could only watch helplessly while people suffered. He urged the doctors of 1961 who were reading his article to overcome their tendency to avoid the subject of cancer, and instead to start researching ways to treat it.

NO LONGER TABOO

Medicine has come a long way since 1961. Brilliant scientists have researched different types of cancer and how to treat them. Now life-prolonging treatments are available for nearly every type of cancer. The number of people who “have had cancer in the past” is growing.

Doctors’ attitudes have shifted, also. Nearly all are committed to telling their patients they have cancer. Does this mean they like to do it? No. Does this mean they are skilled at the telling? Not necessarily.

Why do some doctors have such a hard time telling people they have cancer? Because, even though a cancer diagnosis no longer means unavoidable death, it’s still bad news. Sometimes very bad news.

I guess if a person was cruel and heartless, he or she could enjoy telling someone else bad news. But the vast majority of doctors are trying to reduce human suffering. Telling people bad news will increase their suffering—their emotional suffering—at least temporarily. Also, many doctors haven’t faced the fact that they themselves are finite human beings with a certain number of years to live on the earth. Having a patient with a life-threatening illness makes it harder to ignore that fact.

Some doctors are very good at communicating bad news. They are more sensitive to the emotional state of their patients than others—we call that empathy. Unfortunately, the doctor-training process can be grueling, making it hard to develop empathy. Other doctors communicate bad news so rarely that when they do it they stumble over their words. Unfortunately, too few medical schools emphasize the delicate skill of effective communication.

REJECTING THE MESSENGER

Being the bearer of bad news is tough. Back in ancient times, it was even tougher. A messenger coming to the palace from the battlefield with news of defeat might be executed on the spot. No one wanted to be the one to have to break the bad news.

Doctors aren’t afraid of execution when they tell people they have cancer, but they may be afraid of the emotions that result. People’s disappointment at such a diagnosis may turn into anger—anger directed against the bearer of the bad news.

An article in the British Medical Journal states, “The worst fear for doctors—particularly junior doctors—is that the patient will blame them personally for the bad news that they bring.” As doctors become more experienced, they learn to recognize this as a natural human reaction and understand that they are not the true target. This emotion may be natural, but it’s still unpleasant to be the object of such anger.

“We’re seldom angry about what we think we’re angry about,” wisely writes Cecil Murphey in Simply Living, a book that expands on the meaning of various biblical proverbs. The proverb he was reflecting on was “A soft answer turns away wrath, but a harsh word stirs up anger.” By answering “softly,” a wise person can help the angry person see what the root of the anger really is—a feeling of injustice, perhaps, or of life not going as expected, or of fear.

Too few doctors know how to give a “soft answer” in the face of anger. Those who do are usually more willing to give bad news when it’s needed, for their patients’ anger doesn’t “stick” when it’s directed at them.

FACING FEELINGS

Doctors are people. Just as people have different personalities, life experiences, and goals, so do doctors. Some doctors avoid the emotional aspects of their patients’ lives, seeing medicine as purely a science without emotional involvement. I think this was a more common perspective a generation ago, when science was making so many breakthroughs. Many illnesses were being understood and successfully treated for the first time in history. Medicine seemed crisp, neat, and readily explainable. Why focus on something so unpredictable as a person’s inner reaction?

In 1980 Dr. Franz Ingelfinger urged doctors to reconsider their approach. He was the well-respected editor of the New England Journal of Medicine when, three years before he died of stomach cancer, he gave a now-famous speech in which he urged doctors to change. They should avoid medical terms that “laymen either do not understand or misinterpret” and sensitize themselves to their patients’ emotions. “Distraught by anxiety, fear, and perhaps suspicion, the patient hears the sound but not the meaning of words.”

How people first hear they have cancer impacts their health—both emotional and physical. One research study found that women who thought their physicians lacked empathy when they told them they had breast cancer had a harder time coping with the necessary treatment.

When people don’t know the facts, they’re likely to use their imagination to fill in the gaps. And that tends to be far worse than the truth. “Not knowing about one’s clinical reality is often associated with uncertainty and unrealistic fears, a condition that patients describe as ‘worse than knowing the facts.’ Becoming well-informed may enable patients to maintain hope by freeing them from anxiety and fear.”

THERE’S A REAL BENEFIT IN BEING INFORMED

Doctors often view cancer from a different angle than their patients do. Cancer is conquerable. Doctors know there are many treatments “out there,” whether or not they know what they are. The average person, though, thinks cancer means inevitable, sudden, and painful death—or worse, a lingering and agony-filled death. Even though the road ahead is a challenge, what a doctor has to say today is full of hope. As one doctor wrote,