Hard time

Coping during treatment takes different skills than coping after treatment. CURE invited breast cancer survivor Lani Horn to describe her "first unsteady forays into post-treatment survivorship."Last month, a work friend told me about a gossipy lunch conversation. Some colleagues were sizing up the real-life skills of the research professors in our department, predicting which of us could actually survive hard time in prison.Smiling, she told me, "We decided you would make it. You have the skills."She knew it was an odd compliment, and we had a good laugh about it. I know that her praise was, in part, a nod to coping skills I trucked out this past year. Cancer treatment is definitely hard time.I suffered a lot. I hated it. But I was a pretty kickass cancer patient. I knew how to stay on top of stuff, chase down information, use my resources, and persevere.But now I am entering new waters.Although diagnosis is a process, there is usually a clear moment when you hear the words, "You have cancer." There is a distinct Before and After to turn over in your mind, that moment where everything changes. You slip into an alternate reality and must make your way through.Survivorship does not have such a clear beginning. There are those who believe you are a survivor from the moment you are diagnosed. I didn't experience it that way. For me, survivorship came in phases. I first felt like a survivor when my surgeon told me my tumor had shrunk substantially from the neoadjuvant chemotherapy, and I was being down staged from 3A to 1A. Then, when the Big Treatment (chemo, surgery, radiation) was over, I had the first experience of feeling unmoored. I continued to receive Herceptin on a 3-week cycle, with my last infusion in November. Once that was over, I was no longer doing anything to fight any lingering cancer cells that may not have read my emphatic eviction notice, and that was a different phase still. Finally, two weeks ago, I had a medical apparatus--my port--removed from my body.Cancer survivors often flash each other their port scars. It's our version of a secret handshake.I have a scar now where the port used to be. I can flash it to my cancer brothers and sisters. The Survivor Ship has set sail.So now what?I am still tired. My body is different. I have signs of PTSD. Havoc has been wrecked in many parts of my life.Now that the hard time is over, am I supposed to pick up where I left off?It's not possible. Too much has changed since I first heard those words, "You have cancer."So today, I went to my cancer center's survivorship clinic. I spent half an hour this past weekend filling out a few surveys designed to assess psychological, social, and medical issues.I met with a social worker and a nurse for a total of three hours, which is a luxurious eternity in the medical world. Both were wonderful. They educated me in a way that attended to my particular situation. It has already helped alleviate my anxiety. The nurse produced this beautiful two-page summary of my diagnosis and treatment that I will have to give to all my future doctors. She discussed all the possible late effects of my treatment and how I should plan to monitor and manage them. And she said the priceless words, "You are healing very well."The social worker is the first counselor-type person I've met with since my diagnosis who I could talk to honestly. I saw two other therapists during my treatment, but neither had an oncology specialty. I felt like I was having to educate them too much, so I quit counseling as an energy preservation measure.This social worker, it turns out, is herself a survivor.I spoke with her at length. My takeaway was this: During treatment, survival took one set of coping skills that could be best described as rallying: my friends, myself, my family. Treatment is about continually picking yourself up and moving forward.After treatment, survival looks different. From what I gather, it's more about waiting and acceptance, letting things heal, letting time pass, and allowing your new self to unfold.I am a problem solver. I am happiest with something to do. I imagine that it's my capacity to rally that led my colleagues to imagine me as a successful hard time prisoner.Like my cancer treatment, most jail sentences have a beginning and an end.Being a survivor, however, is a life sentence.It seems like there's a lot of waiting. Waiting, waiting, waiting...I don't know how I'll cultivate the coping skills for that.Lani Horn blogs as Chemobabe (www.chemobabe.com). She focuses on the social and emotional issues of cancer treatment and survivorship, particularly as it affects young adults.