A New Cancer Diagnosis is… Like a Wedding?

There is nothing like a cancer diagnosis to shake up your day.

I can say that wryly now, with the privilege of first person insight into the matter. In the third person, as a physician, there wasn’t an amusing moment in the few dozen times I have had to tell a patient they had cancer. That responsibility is probably the only task in my job description that edges out “suturing a toddler’s face” as the least pleasant part of being a doctor. It’s a gut punch, every time, on seeing that CT or MRI report confirming our fears; then the deep breath, finding the patient’s phone number, rehearsing, over and over, how to start this dismal conversation. I hate it.

I’ll never feel quite the same way about sharing a new cancer diagnosis with my patients. I’ve always sought to frame the news in the most positive possible way, allowing as much hope as the situation allows that those concerning images might just be false positives. After all, maybe those are just reactive lymph nodes from a cold; and perhaps that “tumor” is just a cyst. Why panic the poor soul in the couple weeks before a biopsy can be done and pathology completed? The reason, I would now say, is that those couple weeks could be spent reckoning with mortality, seeking clarity about one’s mission in life, and preparing for a life change like no other. If good news from the pathologist is the patient’s destiny, fantastic; the news will be all the sweeter. But the time after a cancer diagnosis is a genuine life event, like the birth of a child, or the death of a parent, or, yes, a wedding. I should not have gilded these conversations out of my own paternalistic concern.

My own cancer diagnosis last month did not require any awkward conversations. I should have been more worried about the increasing difficulty I was having opening my mouth wide enough to fit in a sandwich or big swirl of pasta; but, hey, it came on with a mild cold in mid-September, so surely it’s just one of those reactive lymph nodes leaning on my masseter muscles, right? I mean, not anywhere in our whole family tree has anyone gotten cancer before age 90, and I’m the healthiest branch of that tree! But when another cold made it worse again by early November, I got around to looking in my mouth. There it was: a left tonsil that looked like an oropharyngeal cancer straight from central casting.

I’m not going to lie: the next 48 hours were rough. I was quite worried, but still thinking I would be saved by a cancer numbers game that favors non-smoking triathletes in their early 50s. I snapped a photo and sent off a consult; “highly concerning for malignancy” was the gut punch I got to read for myself, this time. That was a hard morning; a full work day to absorb the news, seeing patients, talking about follow-up plans for their diabetes or hypertension, while asking myself, “Will I be able to practice, or even be alive, to see them in three or six months?” For a brief period of time, I began to see the world as comprised of two types: those who were dying slowly (like me the day before), and those who are dying quickly (like me, now). I got over that rather unhelpful phase pretty quickly.

The next phase involved a lot of logistics, with a liberal pinch of soul-searching mixed in at all sorts of unexpected moments. Yes, it reminded me of preparing for a wedding. Seriously! Hear me out…

Pick a venue.

The first step in wedding planning and cancer treatment both is finding a geographic locale that works. Keep it convenient, near your own home? Or something that works better for family, or friends? Then you need to find just the right venue within that area, one which is affordable, yet nice; and, most importantly, meet your needs.

When my wife and I got married, we threw convenience to the wind, and picked the place with the best venue, for our purposes – which, for us and our admittedly eclectic tastes, ended up being a sun-aged private ranch on the east end of the remote island of Molokai. When it came to choosing a place to get seven weeks of chemoradiation, I received rather consistent advice that head and neck cancer radiation has a “bit of an art to it,” and I would get better results with someone who specializes in this sort of thing, which ruled out our home of rural Hawaii Island. That left multiple West Coast cities with excellent programs. Given the choice between sunny Los Angeles, beautiful San Francisco, and grungy Seattle in mid-winter, we, of course, chose the latter (have I mentioned our eclectic tastes?). Having trusted friends in the medical field there helped us make the decision; but the truth is we are “Seattle in mid-winter” types of people.

Whom to tell when?

We started with a call to our parents right away after our engagement on a romantic, green Hawaiian hillside. My cancer moment? It was the one time that I’ve been grateful my parents are both now dead, so I didn’t need to call them to break this glum news. Really, this was one of the major questions torturing me as my mind ran through a hundred possibilities that morning my cancer diagnosis began to seem likely: when do I tell my patients? My friends, our family? It’s not a fun bit of news to share.

However, I quickly decided that trying to maintain normal interactions with the people in my life, while harboring a secret like having a cancer diagnosis, would be a terrible way to spend several weeks. We crafted a message to our patients and had it out within days of the news, and I quickly started composing emails to friends and family. In retrospect, that was the perfect choice for me. I’m not a very private person, and I have less patience than ever for inauthentic communications. It also led to an outpouring of support and care which I can only liken to experiencing my own funeral service without having to die first. That is a win – win!

How much can we afford?

I don’t think my wife and I had a hard budget for our wedding; we just tried to keep it non-extravagant, and spend on the things that were important to us. This simply might be a repressed memory, as I have no recollection of whether we spent $10,000 or $50,000 on our wedding. Spending down savings on unexpected health expenses is a bit more painful. I was warned early that a full course of chemoradiation might run well into six figures, which was daunting given that we had only recently signed up for a health sharing plan in lieu of traditional health insurance, on the basis of our outstanding health and almost never needing any health care. (Yes, irony noted.) Would they actually pay? Should we factor the possibility they might not, or cause unnecessary delays authorizing procedures, into choosing less expensive treatment options? That created some stress. It all worked out. Our health share has been fabulous. Another win.

Where should we stay?

I remember a lot of email back-and-forth to friends and family parsing through the limited accommodation options on Molokai. For some reason, there was a more extensive list of long term rentals available for the months of December and January in Seattle; I’m still scratching my head over that one. In any case, finding the right long term rental before even knowing at which facility I would be receiving treatment, with only a few weeks of lead time, was a bit stressful. Our stress was somewhat alleviated by an extremely understanding potential landlady. Then we needed to book a car, secure plane tickets, find someone to cover our practice, and seek out a house sitter; all the usual honeymoon stuff, but with a couple weeks instead of six months to prepare.

Hang on… my phone’s ringing.

I recall an awful lot of phone calls and emails from various essential vendors and wedding participants. It felt extremely important to respond to all of them immediately, as so many parts of a wedding involve branch points moving from one possible plan to the next. Same with a cancer treatment plan. If proton therapy gets recommended for radiation, we’re looking at one set of ideal locations and plane tickets; if it’s traditional gamma radiation, a different set. I might never be able to silence a phone call from the 206 area code again. It’s gotten pretty reflexive to interrupt whatever I’m doing whenever I see that pop up on my phone. (Seattle-based solicitors: please do not use this information against me.)

I now have a half-time job to go along with my full-time job!

I remember thinking that, while trying to get ready for our wedding. I’ve been thinking that now, too. The main difference is that when I was planning a wedding, I would let the stress get to me, and whine about it. Now? Life is too short to whine. I’m glad to be alive and with a good prognosis and the opportunity to deal with this logistical morass. No whining from me. Mostly.

The process is daunting, though, if not over-whelming. Like so many critical life events — marriage, the birth of children, the death of loved ones — logistics can intrude on the experience of the life event. That’s unfortunate.

So, I’ll draw one last parallel — there are more and less welcome ways to respond to the news of a cancer diagnosis, just like an engagement. I’m currently favoring something like this: “That’s huge news. How are you holding up? What can I do to help?” We might make up that a newly engaged couple is in a state of pre-marital bliss, when really they might be straining under the sudden need to make a thousand decisions together, many of which involve the relationship Bermuda Triangle of family, religion, and money.

We might also decide that someone recently diagnosed with cancer is sad, angry, or anxious, and offer sympathy. Personally, I am none of the three, and I’m not a fan of hearing people say, “I’m so sorry.” Pity makes me wonder if my good spirits and forward-thinking attitude are misplaced. Showing interest and offering assistance gives me that “still-alive-and-kicking” feeling that I am part of a community that cares about me.

At the moment I write, that good attitude is being put to the test. After arriving late into Seattle and waking up early in my new rental, I drove through a rare Seattle snow to get to a lab for some required pre-chemo labs. Two and a half hours later, I am still fasting, and still in possession of all the blood with which I walked into the lab. Truly, the level of ineptness at this LabCorp site ranges into the comedic. I’m hungry, I’d rather be running through our nearby woodland park with softly falling snowflakes, but every time I get called back to the front desk (I think I’m on call back number 8 or 9 now) I can’t help but imagine this scene in an indie movie about a new cancer patient, and it’s so funny I’m starting to laugh out loud. I’m not sure that’s helping my customer service. The poor woman behind the desk is having a meltdown with her supervisor over the phone. I’m maintaining my good attitude. Where are the damn cameras?

I’ll get this lab draw eventually. I think. My good attitude will be put to sterner tests than this circus of bureaucratic bumbling. Of that, I am certain.

Weddings are tricky, and marriage isn’t easy, either. I can say, though, that my marriage has brought me the best parts of my life.

I hope I will have similar things to say about my cancer diagnosis in seven weeks.