Wendy Harpham, MD

My future felt like the flip of a coin. If the cancer treatment worked — “heads” &mdash; I’d live. “Tails” &mdash; I’d die. So when my post-chemo scans documented a complete remission, I assumed I’d won the coin toss and could start putting cancer behind me.     

But before my one-year checkup, just as I was finally feeling healthy again, I was in my doctor’s office murmuring, “Please don’t give up on me.” 

Having cared for patients in my medical practice who did everything right and died, I feared my newly diagnosed recurrence marked the beginning of the end. It didn’t. 

Over the next 15 years, my lymphoma kept responding to various courses of treatment. Invariably, my cancer returned, usually within months — but most recently after a glorious seven-year respite. 

Not cured and not dead, I’d unexpectedly landed on the proverbial edge of the coin. Cancer books and resources didn’t speak to patients like me, living in a no-man’s land of survivorship. My “episodic cancer” — for lack of a better term for this repeatedly recurring cancer &mdash; posed unique challenges not faced by patients in treatment, in a first remission or at the end of life.

During my third remission, heightened fear of another recurrence spoiled otherwise good times. How could I enjoy a fine day if that night I might — again &mdash; find a new lump while showering? How could I trust my body to keep me well, knowing another recurrence was not just a possibility but a likely scenario?

My liberation from life-sucking fears hinged on a realization: “I can simultaneously accept the likelihood of an unwanted outcome and hope for the best possible outcome, no matter how improbable.” 

This notion of balancing acceptance and hope pivoted on an acceptance of uncertainty. Much to my disappointment, I believed intellectually in accepting life’s uncertainty — even embracing it &mdash; long before I figured out how to do that. 

Defying the vocal “think-positive” brigade, I stopped wasting energy trying to convince myself that this time I was surely cured. Paradoxically, accepting that I was likely to need treatment again freed me to nourish genuine hope that I wouldn’t. 

Indisputable facts helped me, too, by providing a solid foundation for hope. 

FACT ONE: Frightening statistics don’t apply to me

. Unlike all the past patients whose outcomes determined the statistics quoted by textbooks and doctors, I have access to the newest therapies, including those available in clinical trials. As for tomorrow, still better therapies may become available, should I need them.

This is not pie-in-the-sky hullabaloo. The six courses of treatment I received between 1993 and 2007 were not options when my cancer was first diagnosed in 1990. Cutting-edge therapies have enabled me to outlive my original prognosis twice over (and still counting). And by the way, don’t call my cancer “incurable.” It’s one of the types for which researchers are working on cures. You watch: The textbooks are being rewritten.

FACT TWO: Cancer didn’t make life uncertain; it simply exposed the uncertainty of life

. After losing survivor-friends whose prognoses were better than mine, I’ve stopped comparing. Prognoses are not predictions but educated guesses. Uncertainties.

Uncertainty gets a bum rap in American society. When my cancer is in remission, do I want to know if my cancer is gone for good? No! Because the only ways to know if I’m cured are if my cancer recurs (not cured) or I’m in remission when I die of something else (cured). When it comes to episodic cancer, uncertainty is grand.

FACT THREE: Worrying today about recurrence tomorrow is a total waste of my time and energy.

 Trust me: I’ve tried expecting the best, the worst and everything in between. Recurrence is lousy when it happens, whatever mind games I play beforehand. 

A mantra that helps me keep worries from sabotaging good times is this: “I don’t have a problem until I have a problem.” In other words — and this refrain works only if I always do the right things to get good care &mdash; I assume I’m fine unless an evaluation proves I have a problem. This doesn’t work for everyone, and sometimes it doesn’t work for me. That’s when I remind myself that I got through treatment before. As only people who’ve already walked the walk can know, I know I can do whatever it takes to get through cancer again.

Balancing on the edge of the coin has its advantages. Episodic cancer encourages me to know both the fragility and the hopes of life. And with this knowledge, I’m on a roll.

Wendy Harpham, MD, is a non-Hodgkin’s lymphoma survivor (who has experienced seven recurrences) and is the author of several books, including 

. Visit her website, and connect with her blog, at www.wendyharpham.com. 

Articles

This sidebar to the feature “Cancer for the long haul” written by Wendy Harpham, MD, discusses her recurring non-Hodgkin’s lymphoma. 

On a Roll

The day I completed my ninth round of cancer treatment in November 2007, I realized in a whole new way how the pain of treatments is linked to hope

You make me sick, y’know. So with giddy joy I’m about to bid you farewell. Sayonara. And hallelujah. No more IVs. No more pricks. No more nasty needlesticks.

Two years ago, after a deliciously long remission, my lymphoma recurred yet again. My best option was returning to you. Now, with calculated coolness, I’m strolling by the nurses’ station, hoping I can get my final treatment without letting it slip that today is my last day. Please, no shower of confetti for me; let’s just get this over with.

As usual, one of the nurses catches my eye and nods as if to say, “You’re in.” Mothers may have eyes in the back of their head, but that’s nothing compared to your nurses. They monitor computer screens, incoming and outgoing visitors and patients, vital signs, emotions and, most importantly, injections and drips where a misplaced decimal can decimate.  

I watch one of the younger oncologists breeze through. I’m sure I walked with the same confidence years ago in my practice, not realizing I was as close to understanding my patients’ experiences as prison guards are to their charges’ lives behind bars.

Kathy appears out of the drug room, ripping an alcohol-swab packet with her teeth as she approaches. She tells a short story to serenade me during the slow subcutaneous injection.

 Kathy’s gloves are off. My throat suddenly tightens, and my salivary glands start tingling the way they do when I’m trying not to cry. I have never felt emotional like this when I’ve finished treatment before.

In 1991 when the nurse took out my last IV, I felt dazed. And scared. Without you, how could I trust my body to keep the cancer at bay—the same body that had allowed the cancer to grow? Leaving you felt like leaping off a ship, with the shoreline far away.

Over the years, after each recurrence you served as the epicenter of my hope—ground zero for the match between science-based therapies and my cancer. At the end of each treatment course, my thoughts focused completely on my future: What could I do to hasten my recovery? How could I pursue happiness now, after cancer? Would I beat the odds and stay well?

I stand up and instinctively hug her. “Thanks for 

,” I say, while thrusting a bag filled with gifts in her hand. “Here. These are for y’all.”

I nod, feeling like a regular at a bar where everyone knows my name and “good-bye” means “until next time.”

But I’m not thinking about if or when I’ll have a “next time.” I’m just glad I’m done, and I want to get out. Yet as I head straight for the door, my legs take me on a detour toward Brook, who’s eyeing an IV and counting drops.

Brook falls in without hesitation. It’s a nurse thing: No explanation necessary. Only after I let go, does she register today’s “why.”

“Wendy,” Brook calls as I walk away. “We’ll see you ’round.”

“I hope not!” I blurt out without thinking.

….” Brook stammers, swirling her pen in the air as if mixing cake batter in a bowl, “

“Okay,” I chuckle, choke up and keep walking. 

This doesn’t make sense. I’ve learned to live well with the uncertainty. And with my youngest child now off at college, the primary fuel for my fear of dying has slowed to a trickle. I’m 

Maybe it’s because I’m realizing what you’ve done for me beyond easing my hard times and nourishing my hope of surviving: You have given me reason to believe in a future where everyone treats everyone else with kindness and patience, love and caring, and mutual respect.

You see, lately I’ve been struggling with increasing worries about the world in which my children will grow old, given the pressing weight of global troubles that have no resolution in sight. Yet I’ve never lost hope. And I believe it is partly thanks to you. Each time I’ve come here, I’ve seen people under stress working and laughing together in perfect harmony, using knowledge and technology only for good. In this space, my hoped-for possibility is a reality.

Using a voice that won’t startle Amy, who’s sitting with her back to me beside the patient by the door, I whisper, “Thanks for everything.” Then, against my better judgment, I come up from behind and wrap my right arm around Amy’s upper chest, careful not to contaminate her gloved hands. “Bye, Amy.” She reciprocates the only way possible, by putting pressure on my arm with her head.

Briskly I head down the short hall to the office exit. Hundreds of times over the years, without a second thought I’ve pressed the little red button on the wall to unlock the door. As I reach for it today, it strikes me as funny. “What? Are you trying to slow down escapees?”

As if on cue, Amy grabs me from behind—“Was today your 

 time?”—and pulls me into her arms. She doesn’t mind that I’m leaving a smudge of mascara on the shoulder of her shirt before she returns to the haven I’m leaving behind, maybe&mdash;hopefully&mdash;forever.

Moments later, I am regaining my composure as the elevator’s humming crescendos into a 

The doors open. I step in and don’t look back.

Yeah, you make me sick. That’s how you get me well. And I love you for it.

We help patients heal by reminding them that the same treatments that make them sick offer them hope of improvement.

Even if we are busy caring for sick patients, everyone benefits when we take a moment to say good-bye to patients who no longer need our care.

We comfort patients by explaining that long after we stop caring 

Wendy Harpham, MD

On a Roll

Excerpt from "Only 10 Seconds to Care"

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