Giving a cancer patient a reason for being is the field in which a friend or relative can excel. You have examined the feelings of a cancer patient. You have helped them make the commitment to fight and get in charge. You have helped them get knowledge and you have reviewed the ramifications of medical treatments. You have worked through the prognosis and realize that the quality of life in its truest sense is the most important factor. Now you can focus on helping in the fight against depression.
Cancer is an extremely depressing disease. The effect of malignant cells on our body is depressing. The diagnosis is depressing. The treatments are depressing. Realistically facing our own mortality is depressing. Being treated "differently" by friends because of cancer is depressing. Everything about this disease is depressing. Expect it, face it, know it will happen. Explain to the patient that it is normal to have this feeling. The idea is not to try to eliminate it but to minimize it and replace it with pleasant events so as not to dwell on the depression.
With most cancer patients, when getting under the surface feelings, depression is a paramount problem. It is perhaps the greatest single factor in the deterioration of their quality of life for most cancer patients. If it is allowed to continue, depression will grow until it becomes all consuming. Every human being is different and responds to different stimuli. Your goal is to experiment and find out what your patient reacts favorably to.
To say to a cancer patient, "Don't be depressed" is as foolish as telling Niagara Falls to stop running. As a matter of fact, it would possibly hurt the patient because it would focus their attention even more on their depression. What you must do is not try to convince them not to be depressed but to focus their attention on something they like so they will concentrate on that and forget their depression.
First, make them feel important. Make them feel truly needed. Give them a reason for being. Make them do the things they have always done and which they are still capable of doing. Let them make their decisions and some of yours, too. Let them decide what they want for lunch or dinner, what time they should turn in and even what you should wear when you go out. If they have been handling finances, certainly see that they continue if they are capable. Have them write their own notes and make their own phone calls. If they are not capable of writing, have them dictate to you. Let it be their act.
Next, plan things for the future. Set goals and plan things that will excite them and give them anticipation and joy thinking about from now until the time comes. Maybe it is a trip to somewhere they have always wanted to go. By planning it 3 or 6 months from now, they can have time to dream, study the maps, read up on what is happening there, talk to people about various aspects of the trip, and generally have 3 to 6 months of wonderful thoughts to help replace the depression that is inevitably present.
Maybe the event to plan could be as simple as renting a movie. After my surgery, the big occasion that I anticipated for 3 weeks was my first venture out to dinner and away from hospital food. I chose to go to Victoria Station for Prime Ribs. The realization was nothing compared to the anticipation. But that doesn't make any difference at all. I now realize that for the 3 weeks of recuperation, I had the anticipation to distract me from my sorrows.
The event could be giving a party, simply being invited to a party, going on a picnic, a sleigh ride, a balloon ride, to the office, taking the kids to the zoo, playing cards with friends, a drive in the country or any action that would be pleasant to the patient. Whatever would conjure up visions of happiness will fit the bill. Provide a pedicure, manicure or hair stylist - anything to build their self-esteem. An act as simple as a massage or a foot rub can do the trick. Getting their thoughts away from depression or feeling sorry for themself to something more pleasant is the entire idea. Make an effort and you can do it.
Responsible pursuits keep life meaningful, and recreation keeps it zesty. Activities that give a sense of purpose and those that give enjoyment are necessary. Some people find that cancer is a spur to do fun, adventurous or zany things they've always wanted to do but have put off as being not quite responsible. This is good because it helps ward off two overreactions: one is giving up and the other is trying to cram a life's worth of responsible accomplishments into a very short time.
There is no scientific or medical proof for it, but cancer patients who have "places to go and things to do" seem to live longer and feel better. "I'm too busy to schedule my demise, or maybe I just don't have the sense to lie down and let it happen." Many have found that they cannot retire from living. You just go through one day at a time and give it your best.
"Doing" is not the same as overdoing. Try to recognize limitations as well as capabilities. Fatigue can bring on crushing despair and many people have found that a safeguard as simple as adequate rest fends off depression. Exhaustion weakens our physical and emotional defenses. Pain also can make a mockery of attempts to function normally. Physicians are learning much about controlling pain without drugging the patient, so pain, especially if it is prolonged, should be discussed with the physician.
"Putting one's house in order" is a desire that strikes many who learn they have cancer. This is not the same as giving up. In fact, everyone needs to review their insurance policies, update wills and clean out the closets and drawers from time to time. It gives something constructive to do and relieves the stress of knowing it is undone.
Play is not an elective for health; it is essential. Play is any activity producing emotions of joy or the experience we call "having fun." Play forces us to change our perspective, suspend our limits, make up our own rules and then change them. Play requires creativity.
Creativity is particularly important when dealing with a disease considered "incurable." To conquer such an illness we must become creative, for if we accept the "expected" course of the illness, we will not get well. Play not only increases our energy but also enhances our will to live. Play improves the quality of life and makes it richer. It knocks us out of despair and increases our wish to live. In doing this, it supplies the energy needed in mustering the will to live.
Our society lays such great stress on the puritan work ethic that we adults must re-learn how to play. Because we may unknowingly apply our work attitudes to play, honest examination may sadly disclose that we are not really enjoying our play time. Make a list of 20 playful activities for the patient. Relabel their play time as work. Schedule play time and see that they honor it as being equally important as work time. As it is possible to overwork, it is possible to overplay. Strike a balance between these two equally important aspects of a full and healthy life.
One of the major things you need to do is to listen carefully to the patient and clarify exactly what they are "really" saying. How are they "really" feeling? How can you "really" be helpful? If they are angry and annoyed about little things, is it because they had a bad day at the office, because of concern over a new symptom or because they got up on the wrong side of the bed? You must clarify the source of the irritation before deciding to sympathize, suggest seeing a doctor or ignore the mood. Do not rush in to propose a solution to a problem before being certain of what the problem "really" is. Recognize the difference between complaining that relieves stress and complaining that reinforces and festers negative stress.
It is vitally important to have good communication between the support person and the patient. Failing to do this could cause a wall to build up, increasing unwanted stress on both sides. Make it a point to open up a dialogue between family and patient to be able to talk about things in depth. Share your feelings openly. It will help both parties and will lead to meaningful discussions.
Chapter 8, Suggesting actions