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Old 06-03-2021, 03:35 PM   #1
Nguyen
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Join Date: Nov 2005
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Leaning Into Uncertainty and Discomfort With Hope

https://jamanetwork.com/journals/jam...tm_term=060321
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Old 06-04-2021, 01:22 PM   #2
Nguyen
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Join Date: Nov 2005
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Re: Leaning Into Uncertainty and Discomfort With Hope

jamanetwork.com
Leaning Into Uncertainty and Discomfort With Hope
Evelyn Anthony, MD1; Katherine Files, MBA2; Suzanne C. Danhauer, PhD3
7-9 minutes

Scrolling through the computed tomography (CT) images, I (E.A.) saw the scattered lung nodules, evidence that my husband’s cancer was back. Just 5 years earlier, in 2000, he was diagnosed with chest wall sarcoma. I was a third-year radiology resident at the time and a mother of 2 young children, with a baby on the way. We had been through his original diagnosis of a 10-cm mass, involvement of 4 ribs, negative nodes, and no distant metastases, and he had undergone en bloc surgical resection and 14 months of chemotherapy—and here we were again. The cancer was back.

Over the past 18 months, I’ve recalled this moment many times as uncertainty and anguish—with the ongoing COVID-19 pandemic, growing attention to racial injustice, and political and ideological polarization—have altered the patterns of our days and the fabric of our communities and country. While these situations certainly carry different weights, they are all characterized by living in a long-term state of stress and heightened awareness, wondering what possibly could unfold next, with much ambiguity and no end in sight.

This uncertainty is difficult for physicians, for although we are traditionally viewed as strong and confident, merely by nature of our healing profession, we are not immune to the physical and emotional toll this year has wrought. We desperately want to peer into the future for hope, but perhaps the place to look—not for answers, but for perspective, grounding, and inspiration—is the past. While we can look to history and heroes, the real starting point may be our own lives and reflecting on the strategies we use to survive, and even thrive, amid overwhelming challenge and adversity.

So, what did I do after I saw my husband’s CT scan? First, I gave myself permission to grieve the loss of health and normalcy that had marked our days until that point. Then I summed up what I did know, which admittedly was a lot. I had professional experience with the diagnosis and general management of this cancer, I knew how to navigate the local health care system, and I had numerous colleagues to turn to. I looked the worst-case scenario straight in the face and named it. Shining a light on the possibility that my husband might die, leaving me as a single mother of 3 small children while trying to master my medical specialty and school debts, somehow lessened its power over me.

Next, I developed a plan. While I could not control the outcome, I devised small, attainable goals based on the best information that I had. Our capacity is reduced in difficult times, so my first goal was to simplify what I could, such as bowing out of some projects and committee obligations, selecting limited extracurricular activities for my children, and ratcheting down my expectations for myself, whether it be scholarly publications or home-cooked meals. Amid it all, I also had to limit the information I could digest and the sources from which I received it because I could not accept endless information. I had to make a decision on who to trust for information and recommendations. I also needed to live in the present and lean on our social support system of friends and family, even if this meant simply connecting with a friend over the telephone each week. Lastly, I leaned into the plan with hope. While we may not know what the future holds, we can be certain that current circumstances will always change.

In the psychology literature, posttraumatic growth (PTG) is the experience of “positive psychological change experienced as a result of a struggle with highly challenging life circumstances,”1(p1) that is, major losses and traumas or chronic stressors—seismic types of events that occur in our lives. Not everyone will experience PTG after such events (and that is OK), but interestingly, many people do have changes, such as improvements in relationships, an increased appreciation of life, a greater sense of personal strength, enhanced spirituality, and/or an ability to envision new possibilities in life. In fact, our research with cancer survivors2,3 suggests that some women with breast cancer report a variety of positive changes during and after cancer treatment, and the combination of distress, social support, use of active coping strategies, and the level to which an experience shakes up a person’s life may contribute to PTG. In other words, experiencing greater difficulty and using effective coping may be important for promoting greater growth after—or even amid—highly stressful situations.

Returning to my (E.A.) story, my husband, our family, and I survived his cancer and 1 more recurrence. The news of lung metastases 8 years after initial treatment sucked the oxygen from the room once again. The emotions were more intense because we knew exactly what we faced with chemotherapy, surgery, potential adverse effects, and prognosis. With the first diagnosis, we moved forward into the unknown. With the second, we could already feel the pain and sheer fatigue of the coming journey. Nevertheless, we tapped into resilience through our (mental) muscle memory and moved bravely ahead.

We used what we learned in the beginning of the cancer journey, knowing that those strategies provided a reliable scaffolding when the ultimate outcome was uncertain. Interestingly, we do not look back on that time with pain or regret, but rather through a lens of gratitude for all that we learned and for the care and grace that we received. We grew in powerful and unanticipated ways. For us, our past experiences gave hope for the future.

All these years later, I still remember looking at that CT scan and feeling temporarily lost in the swirl of emotions captured in shades of gray—often the way many of us feel today. But the margin my family eventually gained, and the spark of hope that followed, colored our lives with meaning and possibility that otherwise would not be there. My hope is that this pandemic experience eventually brings us all the same.

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Article Information

Corresponding Author: Suzanne C. Danhauer, PhD, Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 (danhauer@wakehealth.edu).

Published Online: June 3, 2021. doi:10.1001/jamaoncol.2021.1496

Conflict of Interest Disclosures: Dr Danhauer reported being a member of the National Cancer Institute’s Symptom Management and Health-Related Quality of Life Steering Committee as well as serving as co–editor in chief for Global Advances in Health and Medicine, which is published in association with the Academic Consortium for Integrative Medicine & Health, all outside of the submitted work. No other disclosures were reported.

Additional Contributions: We thank the author’s husband for granting permission to publish this information.
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