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I recently wept as though it were the last night of my life.
I was certain that my scans the next day would confirm what my body had been telling me for the last three months: The cancer is back and you’ll soon be dead.
It was the last night of my blissful ignorance. For only a handful of hours, I still had the luxury of uncertainty. The next day’s results would end the reign of my denial. There wouldn’t be any pretending once the results came back.
A man can only stick his head so far into the sand, and denying the likely fate of metastatic recurrence more closely resembles delusion than positivity. Stage 3 kidney cancer can be survived about half the time, I know, but I also know that recurrence with aggressive metastases presents a much more dire picture.
No, instead of continuing with self-delusion, I resolved to allow the results of my upcoming scan to be the first real step toward accepting my own mortality.
I have heard from other people living with cancer about the "scanxiety" that they experience near their follow-up imaging, and was expecting it. As a psychiatrist, I understand the worry and rumination as a defense that we use to protect ourselves from the pain we fear. At some level, we think that by anticipating the worst, it won’t hurt as much.
My feeling of impending death, though, was something different altogether. It hit me without warning and took me totally by surprise. I didn’t feel any nervousness in my body, nor did I spend time worrying about "what-if" scenarios.
It felt like a kind of grief in its certainty and somberness, but still somehow anticipatory of something that hadn’t happened yet.
The experience was closer to morbid acceptance. It felt like a kind of grief in its certainty and somberness, but still somehow anticipatory of something that hadn’t happened yet.
Imaginings of my own death began to swirl in my mind. I wondered if it would still be summer at my funeral, or maybe fall. I thought about the specific photos and videos I wanted my little son to have to remember me by. I rehearsed the phone calls I would make to my parents and brother with the somber news. I thought about how I would withdraw from work projects and who would carry on the efforts without me. I wondered if I could find a little house on the beach to rent where I could spend my last days saying goodbye to loved ones.
It felt like a movie where Death shows up and the audience watches the protagonist fight and negotiate and argue only to finally accept his fate. But the protagonist was me, and the story was nearing its end.
But then something truly shocking happened: I wasn’t sentenced to death.
In fact, my scan was clean -- or at least as clean as one can expect after the major surgery I had in January. The tiny lung nodules from my first scans hadn’t progressed. In fact, the largest one shrank.
How could this be? My tumor pathology was one of the most aggressive kinds. It was large and expansive by the time we found it, with plenty of time to shoot off micrometastases around my body. Even the surgical margin was positive. The aches around my rib cage were obviously bone mets!
But the scan was clean. Suspicious of the report as I am, I can’t deny it. I have to literally learn how to live with it.
I don’t know if I should start making long-term plans again. How long is too long when every scan has the potential to wipe the slate clean? Do I dare to imagine what life may be like for me in one year or two? In five? In 10?
Perhaps I should focus only on these next three months until my next scan, and that limited scope is what life has to be now. I am not out of the woods, and I probably never will be. That’s a fact of my life that I have come to accept. But what does it mean for the life that I’m living now?
Perhaps there is value in having gone through a period of morbid acceptance only to emerge as a member of the living. I can file this experience away and recall it any time in the future that my mind goes to the worst possible outcome.
Maybe it will serve as an enduring reminder that even the most intense feeling of powerlessness cannot predict the future. Scan results will be the same no matter how you try to anticipate them. This time, the discrepancy between what I feared and what was found landed in my favor, and for that I can be nothing but thankful.
The truth is that I’m still new to all of this. I am trying to learn from listening to others. People living with cancer and chronic illness are all around, and many have been doing it for a lot longer than I have. They’ve shown me that it is possible to have a good life with an uncertain end date. Living for the moment and planning for the future are actually not mutually exclusive to those people who are able to adapt when circumstances change.
While scan dates are natural goal lines, I have to recognize that there can be joy and sorrow in a life between two scans. It would be tragic to miss out on what is happening now in order to prepare for what might come, and it would be just as bad to only live from day to day.
I have to do both. I will be trying to remember and live these lessons from now to the next scan and — I hope — beyond.
Adam Stern, MD, is a staff psychiatrist and director of psychiatric applications in the Berenson-Allen Center for Noninvasive Brain Stimulation at Beth Israel Deaconess Medical Center. He is an instructor in psychiatry at Harvard Medical School.
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