March 21, 2012

Damocles and my sword

I spent 28 years not thinking about cancer. Well, I thought about it in the sense that I didn't go out of my way to do things that cause cancer, like smoking and sun baking, but cancer wasn't really on my mind.

Then cancer became something I thought about every day. And to be honest, it still is.

Several decades ago cancer was equal to death, and doctors were so busy trying to stop people from dying they didn't have time to think about what happened to the lucky few that made it. As more and more people started surviving cancer, medical professionals realised that surviving cancer can result in psychological change.

A common change in people after they finish treatment is an increase in anxiety. You read that correctly, often people experience an increase in anxiety after they have finished treatment and have 'no evidence of disease'.

Uncertainty + worry = anxiety

The increase in anxiety arises because of persistent worry that the cancer will come back. Exactly if, when and how a cancer comes back is uncertain. And therefore, how long you will survive the cancer is also uncertain.

The irony is that it's the very act of surviving that creates the worry about not surviving. In the middle of treatment we just focus on treatment, cycle after cycle, surgery after surgery, day after day. Getting rid of the cancer (or the closest you can get to that state) is the only goal.

And then you reach the goal and start to wonder 'What's next?'

Surviving is what comes next. But it's different to the surviving I was doing quite happily before my cancer was found. This survival feels like it is taking place on 'borrowed time'. Exactly how much time will be borrowed depends on whether my cancer will come back. And this is the last unknown.

The uncertainty felt by cancer survivors is called Damocles Syndrome. Damocles was a courtier under the ancient Greek king Dionysius II of Syracuse in the fourth century BC. Damocles was in the habit of pointing out how fortunate the king was being surrounded by generous people heaping praise on him. The king offered Damocles the chance to swap places but the king had a sword suspended above the throne, hung by a single hair. After some time Damocles noticed the sword and this impending and constant threat was enough to make him return to his place among the court.

It's called Damocles Syndrome in cancer survivors because of the constant sense of threat that some people feel at different times during their survivorship. I guess the other parallel is that something that we thought was without worry (being king, or surviving) isn't all that it seems (because of the hanging sword).

Ways the Greek legend is not like surviving cancer

1. A better legend would be one that has a mysterious black box above the throne that possibly contained a hanging sword. Damocles could see the threat; I don't know if there is a sword suspended by a single hair above me, or in cancer terms, a rogue cell hiding out somewhere in my body. I don't know this because medical imaging isn't good enough to detect those cells.

2. Damocles could choose to return to his place away from the sword. I don't have a choice of going back, but that is an academic argument anyway because no one would choose active cancer treatment over a disease-free state.

1 comment:

  1. I'm hearing you Ben and I am certainly always wondering if anyone see actually see that sword hanging above us? Is it all predetermined by fate? Either it's going to drop, or some random stray arrow comes in the castle window and knocks us off our throne anyway? (at some point).

    The most depressing fact of this all is that we are all going to die, but like you I am not so keen on that idea being inside my brain every day. Even more so when someone who looks so strong and amazing, like poor Jimmy, dies. I'm nowhere near the person that he is, then why would I survive longer than he did, and more to the point how can I expect to?

    I think of it this way.... before cancer I didn't know how or when I was going to die, and I still don't. Sure there is a chance of my cancer coming back, but I'm currently living in my "happily ever after" world and it helps me to keep smiling.

    Keep that smile on that dial :)