I’m in the hospital waiting room, preparing to get a chemo port placed in my chest after a diagnosis of human papillomavirus–related anal cancer. This cancer emerged suddenly, though my doctor says it‘s probably been growing in me for many years. I feel alternately numb and despairing. It’s my third go-round with early-stage cancer, each disease found in a different area of my body. I wonder if I’m a magnet for cancer, and if so, why. While this cancer has a very good prognosis, my medical team has prepared me for the fact that the treatment will be dreadful. My anxiety swells by the day. I’m afraid of having cancer again, afraid of the treatment protocol, and like the rest of the world, afraid of getting COVID-19.
In the waiting room, a man sits across from me. He has a gang tattoo across his neck and inked teardrops leaking from his left eye. Bearded, with bulging muscles, he huddles close to a woman who’s whispering in his ear and stroking his arm. He looks as scared as I feel. I’d like my husband to be at my side right now, stroking my arm, but the hospital insisted that because of COVID precautions, only patients would be allowed inside. Idly, I wonder how they’ve dodged that rule.
Soon, a nurse ushers me into a more secured prep area, and the bearded man enters too, this time alone. I watch as he paces nervously and harangues the nurse sitting behind a desk. “I don’t want to be here by myself,” he complains. “Don’t make me go through this on my own!”
Later, I’m lying on a gurney, hooked up to an IV, thinking about the prospect of doing this alone and the difference between outward toughness and inner strength. When it comes to a host of really difficult challenges in life, we must go through them solo. How do some of us find a way to rest inside our own skin? What kinds of techniques and strategies might promote internal balance in the face of situations that are alarming, relentless, or uncontrollable? How do we develop the necessary self-comforting skills that can be our saving grace in the midst of great disruption?
Before my cancer diagnosis last fall, my life was already stressful: the year was filled with worries about our country’s political divides, racial unrest, the galloping pandemic, and a sense of imminent burnout from managing a full client caseload with few breaks in my schedule. I’d recently become the president of my local clinical social-work association, which brought still more challenges and responsibilities. I was staying in close touch with many therapists—friends, local colleagues, and those I consulted with—and I appreciated the sense that we were all in this together, trying to figure out how to bring therapy online while taking good care of ourselves and our clients. Then, in September 2020, the bomb fell. I was diagnosed with cancer. It came without warning, as the disease often does, and the ground on which I stood began to shift and crumble.
From experience, I knew a bit of what to expect, although each cancer during the past 30 years had carried distinctive challenges. I knew that cancer, like many other crises, was a powerful teacher for me. What I didn’t know was just how this current experience would test me. I didn’t yet know all I’d need to do—and be—in order to stay calm in the midst of acute pain, persevere in my daily treatment, and allow myself to hope for resilience. I wondered what skills and healing methods might help, and how I could learn them quickly.
One thing that’s been a constant for me is that when the word cancer is uttered by a medical professional, time speeds up. So when my surgeon removed a small tumor last year and said to me, with genuine sadness, “It’s cancer,” I felt like I’d been pushed onto another fast-moving train. Life as I knew it blurred into the distance. Tests and scans disrupted my weekly scheduled clients and social-work association meetings. But that was only the beginning. The actual treatment regimen would begin in 30 days and continue for at least two grueling months.
I felt overwhelmed. After three hours of Zoom calls with the chemo nurse, the radiation nurse, and the dietician, I had long lists of things to purchase and prepare for, as well as numerous steps to take immediately. I knew I needed to get organized, but I mostly wanted to collapse and pull the bedcovers over my head. How could I figure out what to do first, when everything on my cancer to-do list seemed equally pressing?
Fortunately, I remembered a prioritizing mantra that I’d long held dear: “Integrity first, needs second, wants third.” To understand the distinctions among integrity, needs, and wants, imagine that you’re driving your car on a bridge over a deep river. Your first concern should be the integrity of the bridge—knowing that the bridge is solidly made of steel that won’t bend or break. Then your attention can shift to what the car needs to run well: Do you have enough gas to get to your destination? Is the windshield clean and unobstructed? Finally, you can focus on your wants—a song on the radio that’s fun to hum to as you travel.
I used this mantra to organize my massive to-do list. Integrity first meant focusing attention on everything that concerned my current health: sleep, nutrition, and exercise. Earlier in the year, I’d been diagnosed with mild sleep apnea, but I’d procrastinated about options. Now, I immediately ordered a CPAP machine to help me to sleep consistently. I consulted a nutritionist, who doubled my normal protein intake to make sure my body could respond better to what she called “the coming trauma.” I exercised daily with intensity, to get as strong as possible for as long as I could continue to work out.
Needs second meant that I had to clear the decks. I needed to stop working for the course of treatment. I told clients that I’d be out of the office for two months—which triggered a sense of guilt, since I was disrupting their lives in the midst of a pandemic. I worked overtime to make sure that each person had a plan to wait out my break or make a transition to another professional. I alerted the board of my social-work society that I was stepping back from my duties until the new year, and I got a lot of support from colleagues. But this retreat from my work, however temporary, was sad, because I wouldn’t be able to stay as engaged with the field as I’d have liked.
Wants third was easier. I began to shop online for comfort items. I enjoy British mystery series, so I ordered Acorn and BritBox TV. I reached out for personal support, making sure that everyone I loved knew my treatment schedule. I encouraged them to stay in close touch, even if I went silent. Item by item, each day I assessed my list. Going shopping to stock up on vegan ice cream? That was a want and could wait. Carving out 30 minutes between client sessions to walk? That was foundational—so I’d absolutely make time to do it.
Before treatment, each day felt precious. I was intact and healthy, and soon, for a prescribed length of time, I wouldn’t be in such good shape. My mantra simplified the start of the cancer treatment process and became a lifeline I’d cling to as I tried to use my time wisely, with structure and purpose. I remembered this lesson from previous cancers: focus on yourself, prepare your mind and body, find your seat on the cancer train, and allow it to usher you into the “new normal.”
Calling on Your Future Self
One test I’d get prior to treatment would be consequential: a PET/CT scan to determine whether the cancer had spread beyond the area of the known tumor. In a radiology center, I was prepped and dosed with isotopes. The nurse covered me with a blanket, turned the lights down, and told me that the dose would take 75 minutes to get fully absorbed into my body. “Don’t read and don’t use your cell phone,” he said. “Just recline and rest.”
Rest? Was he kidding? I was hooked up to an IV, had just consumed a big glass of barium, and was physically uncomfortable. This was going to be a long 75 minutes. My mind raced. I tried to slow my breathing and empty my mind. Not happening. Minutes crawled by. I was hating this.
And then, I felt . . . how can I put it? I felt a presence in the room, a benevolent presence. Even more remarkably, I recognized this presence, even though we’d met only once before, maybe 25 years ago. Back then, a colleague had guided me through a meditation called Your Future Self, described by Gloria Steinem in her book Revolution from Within. I recognized the presence that was now in the room as my future self, the one I’d encountered in that long-ago meditation. To say I was astonished would be an understatement. At the same time, I was deeply relieved not to feel completely alone. A sense of calm washed over me.
Steinem instructed listeners to imagine walking on a path and seeing a figure ahead, “walking where you have not walked, seeing what you have yet to see. It is your future self: wiser, more evolved, more productive, stronger, at peace—whatever you would like to be.” At the time, I came away with only a few impressions from this guided imagery exercise. The most striking to me was that my future self had stopped dyeing her hair! My future self was completely gray-haired—white-haired, really—and her hair was cut short. When I’d asked her why she’d stopped her coloring regimen, she’d said, simply, “I have better things to do.” I’d engaged in more discussion with my future self, but this is what stayed with me. I hadn’t thought about this experience, or about my future self, for decades.
Now, as I sat hooked up to an IV, I knew that my future self was next to me. She was silent, but she radiated kindness, and I was touched to the point of tears. While I knew she was a part of me, it also felt like she was independent of me, accompanying me on her own. Having her as my companion was deeply comforting. The rest of the time passed quietly. At one point, she seemed to whisper, “It won’t be as bad as you think.”
Days later, my husband and I held hands and cried as we read the report, both of us relieved beyond words. The scan showed good news: the cancer was confined only to the area around the tumor and hadn’t metastasized beyond the initial site. My future self had been right: it wasn’t as bad as I’d feared.
Many therapists have trained to work with parts of the self. From my own earlier training in Gestalt therapy, I’m familiar with the concept. Richard Schwartz, developer of Internal Family Systems, focuses on the parts model of therapy, observing that the method is rooted in the interplay of mind and body. It seems to me that, although I hadn’t thought about my experience with Steinem’s meditation for decades, the future self was still present in my deeper layers of memory, embedded in both my mind and body. Although my future self had appeared without a conscious request, Schwartz teaches that we can intentionally bring forward various parts of self to communicate with different aspects of our being for insight and healing.
At home, after the scan, I looked in the mirror with some wonder. With my hair gray and short, I now look much like my future self had looked decades ago, when I was trying to catch up with her on the path. Curious to read the guided-imagery exercise for myself, I found a copy of Steinem’s book and saw that I’d unconsciously fulfilled another part of her instructions: “If the gifts of wisdom your future self is trying to give you are too much to absorb now, ask your unconscious to store it up and give it to you at exactly the right time.” I’m deeply grateful that my future self remembered this directive and came to help me at exactly the right time.
The Art of Self-Soothing
Once my cancer treatment had begun in earnest, I focused my attention on my own personal challenges. Essentially, I lived in two bubbles—cancer and COVID. Each day was all about getting through the prescribed regimen and, since I had to go in and out of a large medical building, staying free of the virus. The cancer protocol consisted of one chemo infusion through my port and then, Monday through Friday, six weeks of chemo pills and radiation sessions. Morning and night, I swallowed chemo tablets designed solely to break down my white blood cells and weaken my immune system. This would allow the radiation, in effect, to burn me better—killing both cancer cells and healthy ones.
In my earlier cancer treatments, I hadn’t required radiation. Now, without wanting to, I joined a sort of club. Each morning at 10:30, I arrived at the radiation clinic, donned my mask, changed into a gown, and sat in a waiting room with others, our chairs spaced at a safe distance, waiting for our turn on the machine.
The techs on the radiation team were kind and professional, and the exposure to the beam didn’t hurt as I lay on my back on the steel bed, my gown open below the waist, waiting for the arms of the radiation machine to encircle me. Through all of this—waiting for my turn, getting aligned properly (and sometimes having to get realigned), lying as still as possible as the beam moved around me—I wanted to stay calm. The radiation itself took only 15 minutes. I needed to relax, to not add any more stress to my body than it was already undergoing.
I tried many ways to comfort myself. The one that worked best was also the simplest: I sent messages of love and support to myself. I did this from the moment I arrived in the waiting room, while I lay on the radiation table, afterward as I changed and dressed, and on the drive home. I praised my body for the good job it was doing. I repeated affirmations I’d memorized from a tape by guided imagery pioneer Belleruth Naparstek to optimize radiation. “More and more, I can consider that my body is teaching me something useful. I engage my powerful will to assist my body in my intention to heal. I hold the picture of a strong, vital and healthy body. I can see it and feel it. I say these words: strong, healthy, vital, free and clear of disease.”
It’s easier to practice guided imagery in the comfort of a soft chair, or on a lovely white-sand beach, or beneath a tree in a green forest. But calming myself on a slab of metal while a radiation machine whirred around me took a particular degree of will. It took intention. Soothing myself during a treatment that would simultaneously help me and cause me pain and harm, was a lesson in self-love. Slowly, I learned how to be with myself from the inside out, with appreciation, even when fear and anxiety hovered over my shoulder. I recognized that learning to be at rest within my body regardless of circumstance was a gift, even though many days I stumbled out of the radiation chamber, cried in the changing room, and felt that it was all more than I could endure.
Becoming a Warrior
One of my therapy clients used a particular expression when he wanted to acknowledge a suggestion I made during a session without agreeing to carry it out. He’d say, “That sounds good on paper.” I loved the mixed sensory references. During cancer treatment, I felt the same way. The prescribed treatment sounded good on paper, but who would ever agree to it unless it was a matter of life or death? Of course, I wanted to be cured. But it’s hard to welcome a treatment that the medical team tells you will cause second-degree burns starting in the second week, knowing you must continue it for four additional weeks. The chemo would cause fatigue and probably some digestion issues, but the radiation was going to burn sensitive skin and organs that still needed to carry out their daily processes.
Both of my oncologists repeatedly expressed sympathy for me about the process. Everyone I told about the treatment felt sorry for me. I felt sorry for myself, too. I wasn’t sure how I’d find the strength to get through it all.
At this point, I needed more than empathy; I needed fortitude. I consider myself a strong person, a survivor, but I have my limits. I wanted someone in my corner that wasn’t going to collapse when I did, that would hold firm about next steps, that I could count on to provide tough love. I needed a coach that wouldn’t feel too sorry for me.
My son, Sky, stepped forward. Sky is a motorcycle customizer in Daytona Beach, who faithfully practices a body-building program and lives a clean and sober life. He often functions as a motivational coach for his YouTube fans, some of whom have asked him to help them overcome their addictions. In his rigorous model of self-discipline and daily action, no excuses are tolerated.
Sky’s tough love program worked like this: every day he phoned, emailed, or texted me with multiple reminders and instructions about mind, body, and soul practices he wanted me to follow. Regardless of the mood I might be in, he insisted that I think of myself as a warrior and this treatment like a contest. I was to best the cancer. I told him that after assessing me again, the radiation oncologist had actually shortened my treatment by a few sessions, from 30 to 25. He immediately emailed back: “Winning already!”
One morning, I was feeling weepy and extremely sorry for myself. Sky listened to my concerns and then abruptly asked, “Have you done your affirmations today?” I sighed. “I’m just not in the mood today,” I said. In typical Sky fashion, he responded briskly, “Mother, if you have the time to weep, you have the time to do your affirmations. Go do them now.” I got off the phone and put on my headphones. He was right: the affirmations helped. They helped a lot.
On another day, just a week away from the end of treatment, I began to engage in some internal bargaining. This was just too hard. Maybe I could do a little tweaking. If I took my morning chemo dose and went to radiation, maybe I’d skip my evening chemo. I hated that evening dose. What was the harm in taking a pass? Luckily, I told my husband about my plan. He wisely requested that I take it one day at a time, and for today, follow the entire protocol. He gave me a hug. I emailed Sky, telling him that I wasn’t sure I could complete the last days of the treatment as prescribed. He wrote back, “Mom, I want you to run at the finish line.”
I thought about that for the rest of the evening. In my situation, what did it mean to run at the finish line? How did a person accelerate toward something that was helpful but also hurtful? I thought about wounded athletes in the face of recovery. I thought about all the people facing much greater risk than me as they showed up to do their jobs during the pandemic. Could I find it inside myself to be more of a warrior for the final week? I wasn’t an especially brave person. I didn’t take a lot of risks. But I’d try.
What promotes inner courage? How do we face fear and move beyond ourselves in service of an important goal? This was another lesson from cancer, one I’d learned in the past but needed to rediscover. In my weakened state, it was hard to apply. So I turned to stories of other people’s bravery. During my free time, I began to spend more time reading and listening to reports of those who were displaying courage in their daily lives, in the face of the threats and ravages of COVID. I tried to imagine where they went inside themselves to find the strength to keep going forward. I revisited times in my life when I’d been frightened and had to be brave. Finally, I contacted a place deep inside me that had more strength than I knew, a place that was unbroken. It offered me the hope of resilience—if I’d just stick to the program.
When I work with clients who must stay highly functional in the face of great challenges, I believe it’s important to utilize tools beyond listening, support, and empathic validation. From my own experience, approaches that build on strengths and include some directive coaching can be powerful. Modeling grit can make a difference, too. The more opportunities I accept to work on myself, the more I hope my efforts will translate, even implicitly, to others—clients, family, friends—who need to find fortitude and finish strong.
When Feelings Rain Down
Finally, the chemo and radiation treatment ended. I believed that I limped, not ran, across the finish line, but my doctors saw it differently. One showed me that my white blood cell count had stayed remarkably high throughout the ordeal. “You’ve done better than 90 percent of my patients who go through this treatment,” he said. Another told me, “You really sailed through this process. Your burns set up slowly and healed unusually fast.” The techs shared that they were impressed by how self-contained I seemed before and during treatment, noting that most patients experienced significant distress. Said one tech: “You were a champ.”
I was surprised and cheered by these reports. I wondered to what degree my calming and strengthening strategies had helped my body prevail. In truth, I wasn’t yet done with the treatment—or rather, it wasn’t done with me. I still had side effects to deal with. More unexpectedly, pent-up emotions began to engulf me. I’m one of those people who experiences delayed reactions to loss, illness, and calamity. I wait until the crisis has passed and I’m safe; then I feel. During the month immediately after treatment, emotions began to rain down: anxiety, sadness, survivor’s guilt, distress at the ravages of my radiated area, self-blame for getting cancer again, and of course, relief. Although it was over, I didn’t rejoice. I was too flooded with feelings and aware, for the first time, of the extent and toll of the trauma I’d endured.
At that point, I no longer needed tough love and began to rely on gentle methods of working with myself. I turned to the familiar process of RAIN mindfulness meditation, most often credited to Tara Brach, author of Radical Compassion. I found it soothing and satisfying to try to recognize, allow, investigate, and then nurture all my rational and irrational responses, especially the ones that circled round and round in my mind as I tried to sleep at night. As I listened to Brach’s podcasts on the RAIN method, what spoke to me most was the nonjudgmental welcoming of all my gnarly thoughts and feelings. The practice made space, with acceptance and compassion, for everything my psyche could serve up.
One month after the end of treatment, I returned to work and resumed my volunteer efforts. It was probably too soon to rejoin the fray, but I find that each week I feel better and healthier, as I focus on reconditioning and restoring my body and mind. I know I have much more to learn in these realms. But thus far, cancer has taught me more than I could’ve imagined. I’ve learned how to prioritize my time to counter feelings of overwhelm. I’ve learned to notice the parts of self that may be waiting to offer me comfort, and to calm and appreciate myself from the inside out in the face of suffering. I’ve discovered how to borrow strength from others and find reserves of courage that enable me to run at the finish line. I’ve learned the gentle practice of mindfulness meditation, which has helped me accept the emotional fallout of cancer treatment and accept all that I feel and think.
I’ve weathered this particular crisis, but I hope to maintain these practices over time. As we all know, life at its core is uncertain. In this time of COVID, we’ve experienced firsthand that our daily lives—those ordinary, orderly, well-planned-out lives of ours—can shift and lurch on a dime. And when they do, we need to be able to make courageous choices, take thoughtful action, reliably calm ourselves, and ask for the support we need. Perhaps, more than anything, we need to love ourselves into safety.
Lynn Grodzki, LCSW, MCC, is the author of Therapy with a Coaching Edge: Partnership, Action and Possibility in Every Session and Building Your Ideal Private Practice (2nd edition.) Contact: firstname.lastname@example.org
ILLUSTRATION © ILLUSTRATION SOURCE / KATHY WARINNER