Sunny Thoughts

(Cedarburg, WI. 2005) My friend Mary went through four bouts of cancer over several years. Each time she had the full chemo treatment and each time she got a clean bill of health. Her doctor always told her he was “going for a cure.” And that’s what Mary was going for too.

When she was into her fifth time in treatment, I was both amazed and perplexed. Having talked to several physicians I worked with at the time, I’d been told with each recurrence, the likelihood of success was diminished. Mary’s doctor must be telling her that too, I figured. Still, Mary projected a totally positive attitude. There was no talking to her about other possibilities.

During her many treatment, recovery and remission times, she had jumped head first into the circuit of support and recovery group meetings where she was the featured speaker. She seemed to enjoy the spotlight and I sometimes wondered if her notoriety made it more difficult to admit many kind of struggle.

Around the same time, I’d had a different experience. A friend’s sister-in-law, Helen, had ovarian cancer. She did the chemo treatment and went into remission. Then it came back. After several consultations with her doctor, Helen had decided to face the inevitable and live the rest of her life as well as she could.

“My chances were so small. I had to decide,” she said. “I could live the rest of my life sick from the chemo or live the rest of my life enjoying each day the best way I could. I decided to feel good.”

Helen did several presentations at her church where she talked at length about her struggle, about her faith and her decision. Helen died peacefully at home surrounded by her family. Mary died in a hospital hooked up to IV’s, still fighting and insisting she would beat it. They both suffered and both have left a void in the lives of their families and friends.

Recently, Time magazine published an issue dedicated to health; reading a small sidebar article, “Can Sunny Thoughts Halt Cancer?” brought memories of Mary and Helen back to me. The article quoted a psychiatrist from a prestigious medical center in New York, saying there was no good evidence to support the popular belief that the best fight against cancer was a “doggedly optimistic outlook.”

The article recalled research conducted in the 70’s and 80’s that first popularized the idea that attitude might affect cancer outcomes. It was this research that led doctors to encourage patients to think happy thoughts and visualize their immune system blasting away at tumor cells. But now, the article stated, most of those studies were either flawed or inconclusive.

What a 2002 review of the literature published in the British Medical Journal found was that a positive outlook did correlate with the perception of less pain (and that’s a real benefit) but there was “little consistent evidence that coping styles play an important part in survival from or recurrence of cancer.“

The psychiatrist went on to speak of “the tyranny of positive thinking” which could become one more burden for the patient. Both Mary and Helen had been affected by this but in different ways.

I recall one day when Helen was visiting with us in Door County. Someone had brought along a box of dominos, that wonderful childhood game we all remembered so fondly. We were having difficulty remembering the rules. Helen joined us, saying how her card club occasionally dedicated a night to dominos. They found it a refreshing change. She sat as we played and guided us on the rules along with a reminder of the reality of her situation.

“In years to come, after I’m gone and you’re sitting here playing dominos, just know I’m looking over your shoulder as you play,” she quipped. “That will be my legacy to you. I reintroduced you to dominos.” Talking openly was good for Helen, And for us.

I recalled two occasions when Mary and I came close to a real discussion. Once, we were sitting, waiting for our husbands who’d gone into a hobby shop. As we talked, she threw out a signal of fear or uncertainty. As soon as I responded with a willingness to listen, she made a joke and changed the subject.

Another time, Mary and I were on a trip across Lake Michigan on the Badger, the first leg of our annual theater junket to Stratford in Ontario. Maybe it was the peace and quiet of open water that prompted her. She wanted to talk about depression. Not her depression, just depression. I tried to answer her general questions. Finally, she got closer to the real issue.

“My doctor insisted that I see a psychiatrist. I guess he thinks I’m depressed,” she laughed.

“Mary, I’d think anyone could be depressed, going through what you are,” I responded. Mary didn’t’ know her husband had confided how he’d gone, without her knowledge, to her doctor and told him about the crying and emotions she expressed privately, only to him. He was unable to carry the load himself and had reached out for help.

“We have another appointment and I’m not sure if I want to keep going,” Mary said. “She wants to see the whole family. What good will that do?”

“Mary, serious illness touches everyone in the family,” I responded. “Maybe she wants to help all of you cope and it might give your family pointers on how to be supportive to you. What could be bad about that?”

Mary didn’t answer my question but seemed very hung up on what “talking to someone” might entail and what that meant about the stability of her family. I could tell she wanted nothing to do with it. She’d gotten defensive and I didn’t feel I could say much more. That was the end of that conversation and we never had a chance for another. Mary went to the end, engulfed in the “tyranny of positive thinking.”

A couple of years after Mary’s death, her husband said he’d felt Mary’s doctor had done her a disservice. He thought the doctor had never addressed the possibility of stopping treatment and helping Mary use the time she had left in the best possible way.   Perhaps the doctor was operating under the same tyranny.

According to the Time article, the medical profession is saying that pressuring patients to be paragons of positive thinking is futile. Worse, it can cause people to hide their fears and shun support. Perhaps if Mary’s doctor had discussed reality with her things could have been different.

Oh, if only Mary and Helen could have met. They could have really helped each other. If only I’d been more brazen and hadn’t let Mary put me off. But how do you know when to honor someone’s privacy and when to follow your instincts. I wish I’d read that article before Mary was gone. Then I wouldn’t have these haunting feelings that I could have done something and didn’t.

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