Cancer 7: On dealing with bad news

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Cancer 7: On dealing with bad news

Paul Brasington 2023
Published by Paul Brasington in Good health · Monday 31 May 2021
Tags: Cancer
I hasten to add that I haven’t had bad news, yet. I’m still on the long wait to June 10th when they’ll tell me what they’ve found and what they’re going to do.

In the meantime I continue to try to get on with my life as best I can, which means that my working assumption is I’ll be alright at the end of this, even if the treatment is not going to be pleasant.

Then again, there’s another area of troublesome doubt. It’s possible that the treatment will be relatively non-invasive, that any surgery might be accomplished through keyhole techniques, and that any chemo or radiotherapy would be discomforts I could take in my stride; or they might need to open me up, entailing a much more painful recovery and I could end up with a colostomy.

Survival might be my working assumption, and it carries its own doubts and fears, but I am of course aware that it might be worse, that the cancer may have spread, and the best I could look forward to would be some form of palliative care for the remaining (relatively short) period of my life.

For the most part I remain optimistic, and indeed that’s arguably more realistic. It is only human that all these possibilities should be turning in my head: it is on some level rational to try to prepare yourself for the worst, in the hope that its impact will somehow be diminished. With these thoughts also comes the reflection that these may be the last weeks in my life in which I did not know I was dying. It’s very hard to know how to place that thought.
Given half a chance I will tell my favourite Russian joke (for which I have to thank the writer Vitaly Vitalev). A Russian pessimist will say, “things are so bad, they can’t get any worse.” To which a Russian optimist replies “Oh yes they can!”
“How are you?”
There are those who are temperamental Eeyores (and Eeyore has always been my favourite in the Pooh stories), but most of us tend to subsist on a more cheerful level. One of the more trying things about this diagnosis is when you meet people in the street and they say “hey, how are you?” There’s an old definition of a bore as someone who when you ask him how he is will tell you. But I think I can plead special circumstances, and it’s a real question for me now about how much I should say.

I’ve decided for the most part to tell people, because if I don’t and they find out from someone else they might reasonably wonder why I said nothing. It’s a bit of a conversation-stopper, which if you think about it is quite funny, suggesting the clouds of inattention on which we necessarily drift through our lives.

It is depressing to think how much an aversion to bad news distorts political decisions. Anybody who knows me will also know that I’m not a fan of Boris Johnson, and it beggars belief that he should continue to command apparently high levels of public support (are we really so desperate to think that all is for the best in this the best of all possible worlds?). He is a narcissistic monster of incompetence and a proven disaster in this public health crisis (just ask the families of those whose bodies were at least metaphorically piled up in the streets). As Dominic Cummings has reminded us (even if he’s not told us anything else) pretty much at every stage of the crisis Johnson has failed to act or has made the wrong decision, and has only been saved by the positive impact of the vaccine programme, which itself was the consequence of a delegated decision and the previously-sidelined (and systematically, ideologically under-resourced) effectiveness of our local public health infrastructure.
You have to wonder at our apparent propensity to grasp that straw of hope in the vaccines, and with it give credit to Johnson that he certainly doesn’t deserve. Now we know too that he is very specifically responsible for the failure to close the border against India at the same time it was locked against Pakistan and Bangladesh, a decision which really can only be explained by his desperate need to make a post-Brexit trade deal with the equally despicable Narendra Modi. Consequently in the two weeks of inaction that followed some 20,000 people were allowed to enter here from India without proper quarantine or testing, and the “Indian variant” is now threatening Johnson’s final step towards the lifting of social restrictions. Will he be held to account for this colossal misplacing of priorities? Probably not.
I appreciate that the evidence is not yet conclusive: that it’s possible the vaccination programme will have stopped the alarming rise in case rates translating into deaths or hospital admissions (something in which I have a vested interest right now). At the same time the precautionary principle has to apply: if the scientific world is saying it would be crazy to loosen restrictions at this point then that should certainly be decisive in the balance against Johnson’s aversion to giving bad news, an aversion that’s distorted his decisions all along and caused thousands on thousands of extra deaths. The economic cost of maintaining current restrictions would not be huge, and certainly nothing against the dangers of fuelling the current already-exponential rise in infections, which in turn will breed further recovery-threatening variants in the virus.
Data v dates?
It’s not as if it requires an indefinite postponement: just a few more weeks would yield clearer data, and also allow for a higher proportion of younger people to be vaccinated, which will be crucial in limiting the emergence of new variants. Yet the government continues to act as if it might still ignore the damage it has already done.

Perhaps Johnson will surprise me, and be led by data not dates, but there’s been little sign of that so far. Maybe he will be lucky again, and the spread of the variant will be halted, but there’s no sign of that at the moment either, and in those circumstances the national, economic and health interest is clear: there should certainly be no further easing of current restrictions.

Is Johnson capable of statesmanship, rather than near-criminal political calculation? (There would certainly be some political blowback if he fails to stick to his “provisional” timetable.) The irony is that there’s some polling evidence to suggest the broader population might even applaud the bad news of continuing restrictions, understanding the reasons why. Johnson’s fear seems to be of giving bad news to the morons in the right wing of his party, who have become the heart of his power base. That’s inexcusable.
The hope of a better world
There I go again, fretting about politics, which itself seems ironic when one of the first things I felt on getting my preliminary diagnosis was that I could sensibly stop worrying about these things. There is a truth in that feeling, and yet one of the reasons why we’re in such a bad state politically is that too many people seem to have become politically cynical. More than this I’ve always been a political animal, and to let my personal bad news overwhelm my concern for things that are genuinely concerning would seem a damaging loss of perspective.

Perspective, I suspect, is really the key to dealing with bad news, to understanding what it means and how you can best go forward. It doesn’t mean ignoring the bad, but placing it where it doesn’t do further damage.

In that light, I had a happy day on Saturday, meeting my mother, children and grandchildren for lunch in a pub garden overlooking the Weald of Kent, while the sun shone on us. My mother, pictured in the image above holding my granddaughter, is 84. She’s not in perfect health, but she’s still active, sustained by her passion for her dogs, and able to look after herself in the house where she’s lived alone for something over 15 years (I should be able to remember when my stepfather died, but those years have become blurred). I fret about the worry my illness will have brought her, though I imagine like me she’s assuming all will be well eventually. Certainly I understand it must feel somehow against nature if a child dies before you, so there’s another reason to hope it won’t come to that.

But maybe for both of us, looking at our family, my children and grandchildren, it’s a true comfort to know that my children have in their different ways come through to relatively happy places after some difficult times, or at least are getting there. Perhaps that’s the best we can wish for, as something better than survival for those we love. But that would take me back to politics again.

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