A seven-year breast cancer survivor, Debbie Woodbury writes and speaks about the emotional fallout of living with cancer. Her books, You Can Thrive After Treatment and How to Build an Amazing Life After Treatment (Amazon), share simple secrets to creating inspired healing, wellness and live out loud joy beyond cancer. Debbie blogs at WhereWeGoNow.com and you can find her writing at  Positively Positive and the Huffington Post. 

Debbie Woodbury

It's easy to hate change, especially when it barges in frightening and unwanted. Usually, the first instinct is to fight it every step of the way. But if it's serenity you seek, you're only going to get there by accepting the changes you cannot change.

When I'm struggling with change (which happens much more than I like to admit) the following help me see things through different eyes:

"Without change, something sleeps inside us, and seldom awakens. The sleeper must awaken." - Frank Herbert

 - Change wakes us up and makes us re-evaluate our priorities and choices.

"You must be the change you wish to see in the world." Mahatma Gandhi

 - Change isn't only something that happens to us, we can and must be proactive if we want to make change for the better in the world.

"If you don't like something change it. If you can't change it, change your attitude." - Maya Angelou

 - If you are enduring difficulties, you always have a choice as to how you approach your situation.

"Change your life today. Don't gamble on the future, act now, without delay." - Simone de Beauvoir

 - So many of us put off making changes out of fear of the unknown. The bottom line is all we have is today. If you want to make a change, do it now.

"Life is about not knowing, having to change, taking the moment and making the best of it, without knowing what's going to happen next." - Gilda Radner

 - Gilda faced terminal cancer and came to embrace life as a "

." Her ability to face change and all the fear that it brings will always inspire me.

"If you realize that all things change, there is nothing you will try to hold on to. If you are not afraid of dying, there is nothing you cannot achieve." - Lao Tzu

 - We fear change because of the pain it can cause. Think of what you could achieve if you relinquished that fear through acceptance.

"Every great dream begins with a dreamer. Always remember, you have within you the strength, the patience, and the passion to reach for the stars to change the world." - Harriet Tubman 

The very moment cancer comes into your life, it is changed forever. The struggle is how to accept change you have no control over and still somehow move ahead. If you want to talk about accepting change in your life, I'll meet you in the 

Articles

Like in life, the only constant in cancer is change. Fighting it just adds to the misery.

Seven Thoughts on Accepting Change After Cancer

As my gynecologist’s nurse struggled to explain why my mammogram was suspicious without once using the word 'cancer,' it slowly dawned on me that she was carefully measuring her every word to fend off panic.

People expect fear to ignite when cancer enters the picture. Of course I was afraid, but it wasn't fear that motivated me to do what I did next.

I hung up the phone resolved to handle this alone. Rather than immediately calling my husband, my plan was to return to the breast center for additional testing in secret. I absolutely needed his support, but I couldn't bear the thought of causing my spouse of 21 years the worry that phone call caused me. Like it or not, I was going to stay mum until I knew more.

Best case scenario, I would go to the breast center, get good news and tell him after the fact. Worst case scenario — well, I didn't actually have a plan for that.

A few days later while my husband was at work and our children were at school, I snuck back to the breast center. I was lying by omission and didn’t feel good about it, but being both the bearer of bad news and its cause riddled me with tremendous guilt.

It didn’t go well. I was alone as the technician took what seemed like a hundred different views. I was alone when the radiologist came into the room to tell me she didn’t like what she saw and would need to schedule a stereotactic biopsy. As I drove home I was scared to death and now had to break the horrible news to my husband that I might have breast cancer.

Unfortunately, coming clean didn’t ease my guilt. Later, I called a cancer center in New York City and was cheerily told that though my insurance wasn’t accepted, an appointment could be set up right away. I couldn’t hang up the phone fast enough! It terrified me to risk making my cancer a financial burden on my family and I vowed to stay in network for all of my treatment.

The issue came up again when my plastic surgeon suggested a procedure to enhance my reconstructed breast which was considered cosmetic and not covered by insurance. I agonized over the cost until my husband had to firmly, but lovingly, tell me to knock it off and get it done.

That procedure was a small part of the entire mastectomy and reconstruction process, but it taught an important lesson. Knowing that guilt is an irrational emotion didn’t make it go away, so I had to learn to force myself to get what I needed in spite of it. When I felt guilty for needing someone to drive me to therapy after my mastectomy, I asked anyway 

because therapy was vital to my emotional healing.

 I didn’t want to admit that I couldn’t cope with the stress of teaching my daughter to drive, but I just didn’t have the resources. I felt guilty not being 

“over cancer” as quickly as my family and friends

, but I had to stand up for myself if I was ever going to move forward.

Even now, six years after treatment, guilt still makes an occasional appearance. As a stage 0 cancer patient who “only” needed a mastectomy, I was plagued by survivor’s guilt after my diagnosis. Just the other day I fell into it again when there was nothing I could do for a cancer patient who was crying from the pain of chemotherapy-induced neuropathy in her hands.  Much worse is the horrible guilt of losing metastatic cancer patients who leave behind grieving family and friends while I’m still here.

I confess that I have no idea how to stop cancer from sending me on a guilt trip. Intellectually, I know cancer isn’t my fault, but that obviously doesn’t matter. Guilt is just one more byproduct of cancer and when it takes hold, all I can do is take a breath, remind myself that it’s neither real nor useful and try to move through it.

Do you feel guilty about cancer too? Let’s talk about it in the 

 discussion group. I answer every comment.

Cancer hit me with guilt the moment it came into my life. Even now, six years later, it's still part of my cancer experience.

The Never-Ending Cancer Guilt Trip

"[W]e need never be ashamed of our tears ..." - Charles Dickens

One of the things I've come to accept about myself is that I cry easily.

What hasn’t come easily is crying in front of other people.

During the diagnostic and treatment phases of cancer, I usually clamped down my tears. As a mother, I felt I had to be strong for my children. As a wife, I saw my husband's pain and, feeling guilty for causing it, didn't want to cause more. As a daughter, sister and friend, I didn't want to worry anyone and tried to keep things positive.

Although I felt no such obligations to my doctors, I hid tears from them too. When my breast surgeon told me I needed a mastectomy, I didn’t let myself lose it until I made it out of her office and onto the elevator. When my plastic surgeon needed before photographs, requiring me to stand there practically naked while a nurse took pictures, I bit my lip to keep from crying. Time after time during testing, I'd say as little as possible to the technician, struggling to just get through it 

Tears reveal truth and, all too often, I wasn’t able to go there. Instead, I’d quietly walk away and find somewhere safe to cry in private. Why did I hide? As much as I wanted to be strong, it wasn’t about that entirely. Mostly, I think I was overwhelmed with emotions and unable to explain them. How could I make others understand all the emotions I was feeling when I couldn’t fully understand them myself?

I cried a lot during the six and a half months from my 'suspicious' mammogram to my mastectomy, but I did my best to cover my tracks. Two days after my mastectomy, that all ended. That morning, I woke up in a hospital bed with an amputated breast, hip-to-hip incision, bandages, catheter and drains.

With the comforting fog of surgical drugs finally out of my system, there was only the cold, hard reality and I gave in to a breakdown. Nurses came from everywhere to comfort me and I let them. I was no longer hiding. Instead, I outed myself completely as someone who had hit the wall and needed whatever help I could get to put myself back together.

There was no hiding the depth of my emotions anymore and my nurse navigator encouraged me to start therapy. I met a therapist once a week for a year and I cried through at least 95 percent of our time together. In fact, when I asked her why she thought I was making progress when all I did was talk and cry, her answer surprised me.

It seems that committing to toughing it out to work through the pain and tears is what therapy is all about.

Since then, I’m better at embracing vulnerability and the tears it evokes. I now work as a patient educator with the 

Pathways Women’s Cancer Teaching Project.

 Meeting with young doctors, medical students and student nurses, I tell my story and answer questions about living with cancer as a whole person.

Now when I tear up, which happens every time I talk about cancer and my husband and children, I make no effort whatsoever to hide it.

Tears are an honest reaction to cancer. Over the years, I’ve learned that hiding them only made my struggle harder and denied others the chance to recognize my suffering and be supportive.  

Do you hide your tears from family, friends and medical professionals? If not, was it hard to open up and show vulnerability? Let’s talk about it in the discussion group.

Tears are a normal part of the cancer struggle. Is hiding them isolating you and making it harder to get the support you deserve?

It's My Cancer and I'll Cry If I Want To

	At the age of 38, Lesley Andrews found herself in a breast surgeon’s office. She wasn’t too worried about the lump in her breast, assuming it was like the one she’d found three years earlier, which was benign.

	After an examination and an ultrasound, the doctor took her into his office, sat behind the desk and said, “I don’t like the shape of this one.”

	“My stomach dropped, and I got very upset and anxious,” Andrews says. “I was looking to him for guidance, but he wouldn’t look at me. He kept checking his beeper and wouldn’t answer my questions. Finally, he told me to go to the front desk to make an appointment for a biopsy. As I left, he said, ‘Have a nice day.’”

	Ask any number of people how their doctors broke the news of a cancer diagnosis, recurrence or progression, and most will remember in striking detail. Yet, despite the numerous times the situation arises and its impact on patients, many doctors are not skilled at breaking bad news.

	Studies reveal that gender, age and education can influence how an individual prefers to receive bad news. Some patients want to know everything; others can only take in so much. Some patients prefer receiving bad news over the phone in lieu of waiting for an in-person appointment, while others prefer face-to-face discussion.

	Whatever the patient’s preference, the medical community recognizes it is the doctor’s responsibility to deliver information and support in a way that doesn’t harm the patient. More than a decade ago, an article published in 

 developed a six-step protocol, known as SPIKES, to offer guidance to clinicians breaking bad news to patients with cancer.

	The problem is that not many doctors are trained in this pivotal area, and a comforting bedside manner may not come naturally to some in the medical profession.

	A neonatologist who works with parents of high-risk newborns, Anthony J. Orsini became passionately interested in the art of breaking bad news well over 15 years ago. He believes it’s a skill that can be taught, and wants patients and their families to know they have a right to expect their doctors to be good at it.

	Recognizing that physicians and healthcare workers are “afraid to deliver bad news, and they don’t get enough guidance and training to go about it,” Orsini developed the Breaking Bad News (BBN) Model.

	1. A scenario is provided in which professional, improvisational actors portray patients or family members to whom the participant must break bad news.

	2. The role-playing sessions are filmed and watched remotely by BBN-certified instructors.

	3. Immediately after the role-playing session, the participant watches the video and reviews and reflects on his or her performance with input from the instructors.

	Specific attention is paid to body language and speech that communicates compassion and optimizes information flow. Participants learn how to prepare for the session, sit with the patient, lean in, make eye contact, and truly listen and react to the patient and family members.

	Patty Eaton, a pediatric emergency medicine fellow in Florida, completed the program three years ago and now works as an instructor. “As an intern, we’re overworked and can lose sight of why we wanted to be a doctor. This program actually taught me how to help people, help families, support people on an individual level when going through something painful, and that’s why I entered medicine.”

	Andrews never walked into her breast surgeon’s office again and had another surgeon perform the biopsy. Unfortunately, he was no better at breaking sensitive news. After the surgery, he met Andrews’ husband in the hallway and told him she had breast cancer. He then left for another surgery, leaving her stricken husband alone to break the news to Andrews.

	“We thought it was a death sentence. No one came in to talk to us, no nurse, no other doctor. They just sent us home,” Andrews says.

	Patients report that a doctor’s competence in communicating potentially distressing news is critical to establishing trust. Andrews agrees and believes the one silver lining of her experience was that it motivated her to eventually find doctors who better served her physical and emotional needs.

	If it’s important to patients, they should discuss their preferences on being told sensitive news, and by whom, with their medical team. Perhaps a patient wants to be told immediately, even if over the phone. Some may want family members present or want to record the appointment to digest the information later. Proactively approaching the situation gives patients the opportunity to identify a person who is best skilled at gathering and transmitting information, providing support and working with them to develop a treatment plan.

	In the end, the ability to break bad news well fosters a stronger doctor and patient relationship. “There is no good way to hear bad news, but you don’t want to feel like you are completely alone,” says Andrews.

Ask a number of people how they received unsettling news about their cancer and most will remember in striking detail, but a doctor-led program aims to help physicians learn how to break bad news better. Will it help?

Debbie Woodbury

Seven Thoughts on Accepting Change After Cancer

The Never-Ending Cancer Guilt Trip

It's My Cancer and I'll Cry If I Want To

The Art of Breaking Bad News

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