Learning about human nature after a cancer diagnosis
Recently, in front of my family, friends, colleagues, and teachers, I
accepted my diploma during the graduation ceremony for the UCLA
psychiatry residency program.
While it wasn’t my real diploma — it’s been months since I’ve been
able to work, so when I’m better I need to go back and finish some
requirements — my residency program coordinator put together an awesome
fake diploma so I would have something to pick up when my name was
called. It looks just like the real thing but reads, in small
letters, ”Elana Halks Miller has almost completed training in the UCLA Psychiatry Residency Program.”
When I start my private practice it’s getting framed and going
straight up onto my wall. I wonder if some astute patient will notice
the “almost” tucked away between “has” and “completed,” and think to
themselves, Hey… wait a second.
The evening — marking the end of a total of twelve years of training —
encouraged me to reflect on the experience of having cancer from the
perspective of being a psychiatrist. Something about severe illness
striking down a young, otherwise healthy woman seems to have turned me
into a walking Rorschach test onto which people have projected, for
better or worse, their ideas about how the world should be. I may have
learned more about human nature in the last six months than I have in
all my adult years prior.
(If my program director is reading this, maybe we can talk about me getting some clinic credit for having cancer? Eh?)
Some people see me and seem obviously discomforted, as if I force
them to confront a reality about life they don’t want to confront.
Perhaps there isn’t a greater force in the universe ensuring that bad
things only happen to people who deserve them. Perhaps life isn’t fair.
Perhaps if I am fragile, and mortal, then they are too.
Many people will say things, that, on some superficial level, they
must believe are for my benefit, but that clearly deep down are meant to
reassure themselves. They insist to me, “Everything’s going to be
okay.” (Oh really? Have you been talking to my oncologist? I’d love to
hear the update.) Or say cliches like, “Everything happens for a
reason,” or, even worse, “God only gives us what we can carry.” (As if
some greater force purposefully gave me cancer.)
I have experienced a whole spectrum of generosity — from, on one end,
generosity that is actually selfish, where people offer me support
because they like how it sounds rolling off their tongue, but disappear
when I actually need their help.
Others offer a transactional type of generosity: they give support,
emails, cards, and gifts, but in return expect me to reflect back to
them what good people they are. (“Where is my thank you card?” they ask,
or “Why have you not responded to my emails wishing you well?)
They think they’re being generous, but I come out of these
experiences feeling uneasy and used, now obligated to return a favor I
didn’t ask for and entered into an implicit contract I didn’t agree to
(I wish I’d just be spared these “gifts” and the work that comes with
them).
Their generosity is offered with the expectation that I do something
in return, which, when you are sick and can barely peel yourself off the
couch to get to chemo, is not generosity at all. I want to tell these
people I’d love to spent all the time in the world reassuring them of
their goodness, but I’m kind of busy with other things, like, you know,
dealing with cancer.
(By the way, if you really want to send a helpful message to someone
dealing with illness, say, ”I’m thinking of you. Let me know when you
need anything. No need to respond.” Those last few words will be music
to the person’s ears, I assure you, and will set you apart from the
surprisingly high number of people who have a subtle expectation of
having their ego stroked when they offer help.)
The truest kind of generosity — which is offered with no concern for
the ego of the person doing the offering, and total love for the person
to whom they are offering something — is touching, and beautiful, and
rare. I don’t know if I would have believed it existed if my closest
friends and family, and even many strangers through this blog, hadn’t so
clearly demonstrated it.
Some handle their discomfort with my illness in other ways. I’ve been
cornered so people can force upon me vague ”life advice,” telling me
what attitude I should and shouldn’t have to deal with cancer, perhaps
because they want to feel they’re smart and clever and have some
important insight I need to hear.
I’ve had near-strangers divulge their personal problems to me at
inopportune times. A few weeks ago a former coworker I hadn’t spoken to
in years found me sitting by myself at lunch while I was waiting for a
doctor’s appointment, sat down, and promptly unloaded onto me about her
work, family, and interpersonal problems for the next twenty minutes.
I had just ordered a delicious sushi lunch, yet was now pressured to
confront my own Sophie’s choice — eat two more pieces of sushi and be
forced to hear more about the school administrator who didn’t properly
appreciate her son’s contribution the classroom, four more pieces of
sushi and give her a chance to start the story about her husband
flirting with her sister …
Some seem to see my vulnerability — which I have no choice but to
wear openly given my physical appearance — as an invitation for them to
share their own vulnerability, whether my relationship with them
warrants it or not.
I’ve had people I don’t know intrude on my personal space (yes, I
know my fuzzy hair is awesome, but that does not mean I want strangers
to randomly start rubbing my head). At a BBQ a while back I was enjoying
some quiet in the garden, daydreaming and staring off into space, when a
woman I had just met (but who knew I was sick), came up to me, started
rubbing my back, and asked me, dramatically, “Are you okay?”
Caught off guard, I bristled back, leaned away, and promised I was
fine — anything to get her to stop rubbing my back as soon as possible —
but this just made her more insistent. “Are you sure?” she said,
rubbing even harder.
These moments all share something in common: I am treated not as a
person, but as an object. I am used, probably subconsciously, to serve
another person’s emotional need without consideration as to how I might
feel about it.
Others will turn my illness into their illness, as if being around
cancer is anything remotely close to having it. In a text just the other
day, a person I am no longer close with, while telling me how much
harder my sickness has been on him than me, referred to my cancer as
“cancer” — yes, with air quotes — as if I have the fake kind of cancer,
and this is all just one big spa vacation for me where I get to relax on
the couch while models in greek togas fan me and feed me grapes.
I did not realize before I was sick that self-awareness is a quality
many people go their whole lives without developing; I did not realize
age does not guarantee wisdom. (Nor does youth preclude it; in fact,
almost all of the boundary violations and odd comments I have witnessed
have been committed by people decades older than I. My friends and peers
have generally demonstrated a compassion for my situation that is
impressive given their lack of experience with it.) And the realization
that naturally comes out of these points is that not everyone is equally
deserving of my (currently limited) mental and emotional energy.
It is not a moral issue of some people being good and others being
bad; rather, some people are highly evolved and others are not.
Those who said cruel things to me when I first wrote about my cancer
diagnosis, speaking from a place that I now realize was utterly
self-involved (how else could a person justify saying such harsh things
to a young woman when she had so much taken away from her just days
earlier?) — at the time, they devastated me. I felt their opinion
mattered as much as those strangers who were so kind and supportive. But
now I care much more about what I think about people at that stage of
development than what they think about me.
On the other hand, there have been so many who have illustrated that
true generosity and selfless love are possible. My friends and family
who have visited or sent kind messages weekly, dropped off food for me,
told me they will be there for me in any way I need (and when they say
it I know they will); teachers and employers who have given me the gift
of focusing on my health and not worrying about work; my cousin who took
me in when I became homeless and treated me like her own sister.
These people hold a space in my heart. Their opinions also hold a space in my mind.
The least self-aware people don’t learn from their own experiences,
repeating the same mistakes when they are older as when they are
younger. Others, who are more wise, learn from their experiences and
grow in self-awareness over the course of their lives. The most wise
people learn not only from their own experiences, but from the
experiences of others — they learn from the experiences of history.
I look forward to the day when having cancer isn’t the first thing I
think of when I wake up, when it doesn’t consume me throughout the day,
when the most salient thing about me isn’t the fact that I am sick.
Until then — at least I’ll learn a lot.
Elana Miller is a psychiatrist who blogs at Zen Psychiatry.
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