Many of my clinic memories are coloured by the unclouded summer light of southern Texas. Its oppressive heat was never fully suppressed by the double-paned glass of the exam room, so we cranked up the air conditioning, telling ourselves this equilibrium could be maintained indefinitely, that the burning intensity of that far-off star could be denied by will alone.
I think about that amorphous, undifferentiated energy when I remember the first time I met Warren and his wife in my suburban oncology clinic. I recall how light entered the room that afternoon, just after lunch. He was 48 at the time, a South African transplanted to the suburbs of Houston, Texas. He sat limply, drawn in on himself, the novel gravity of the cancer pulling his cheeks tight, hunching his back, forcing his arms together in front of him, elbows resting on knees. His foot jiggled with nervous energy.
By the time they meet me, a medical oncologist, most patients already have their diagnosis, but we still take time on those first visits to recall the details of the odyssey that brought them to my clinic – the premonitions, the subsequent blooming of pain, the decline that seems simultaneously inexorable and flabbergasting. Warren told me the story in his broad accent. He’d begun having pain about 10 weeks prior, a sharp stab every time he tried to have a bowel movement. He’d tried home remedies, but the pain had only worsened. His primary care doctor had thought the issue was an anal fissure, but the treatments hadn’t helped. Eventually, he’d gone to see a gastroenterologist for a Botox injection to relieve the pain, but on evaluation there, the specialist had found a mass in the terminal portion of his rectum. A biopsy had shown invasive adenocarcinoma.
Warren’s pain had become its own reality, blotting out memories of life before it and the possibility of any life without it. His primary care doctor had prescribed an opioid called Norco to tide him over until he met me, but it didn’t touch the knife-like agony. He tried sitz baths, soaking in warm water to help with bowel movements. His decline continued relentlessly. He hadn’t gone to work in nearly two months. He could hardly walk. He’d started to eat less in the unconscious belief that perhaps needing the bathroom less frequently could give him relief. Now he’d lost nearly 30 pounds.
Warren was a serious amateur tennis player, maintaining an intensive training regimen and what he described as a fairly healthy diet. Before his illness, he travelled around the country playing in tournaments. Now those scorching afternoons spent trading backhands seemed barely real.
I went through the expected ritual of a physical exam to calm him and convince myself I was being thorough. A stethoscope to the back, a command to take several deep breaths. Then around to the front of his chest, listening to the sounds of valves opening and closing. I asked him to lie down on the exam table, where I pressed on his abdomen, probing for the liver and the spleen’s football tip. Fingertips to his ankles, I felt for a pulse and any sign of oedema. I deferred the rectal exam – the CT scan had told me what I needed to know.
I had him take a seat next to me at the computer monitor. We examined the scans, which shone abnormally in the liver and the sacral bone adjacent to the rectum. We hadn’t biopsied those areas, but I couldn’t gloss over their significance. This was Stage 4 cancer.
I imagined the force of that revelation, how I would react to it. Despite my medical training, I wouldn’t know what to say if the tables were turned. Words couldn’t bridge the yawning chasm, but they still tumbled forth anxiously. What next? How long have I got?
I can’t clearly remember the discussion I had with Warren that day about the prognosis of his illness. I am uncomfortable with the certainty implied by hard numbers, and instinctively shy away from them. Patients and doctors alike struggle to interpret those figures with any clarity – if the five-year overall survival of Stage 4 rectal cancer is approximately 17 per cent, the reality of what that means for the husband and wife sitting nervously in the exam room is nearly impossible to fully accept. Probability can’t give certainty when it comes to a particular life. The percentages are often replaced – if not in my patients’ minds, then surely in my own – with the fervent hope that the particular case in front of us could be the exception to the numbers, which are all we really know, imperfect and incomplete as they are. In the face of this, hope remained the only way we could remain standing.
Warren’s recollection of our first meeting is also hazy. ‘I was in my own little bubble of not processing it yet … I remember you saying it’s Stage 4. I remember looking at my wife, asking my wife if it was bad, and she said it’s not great.’
On the way out of my office, he remembers talking strategy with his wife: ‘“We’re going to take this head on. We’ve got one chance…” We made it into a really positive thing, and went: “Right, we’re gonna do this.”’
He began to think of his illness in terms of the sport he loved. He drew on his experiences being down three games in the second set of the last match of a long, hot tournament weekend. He remembered how he’d willed himself to victory so many times before. ‘We started on that way, like, being very, very positive.’ In a situation he was struggling to fully grasp, he tried to control the one thing he felt he could.
As the weeks passed, his psyche roiled with anxiety. He was one of the few patients who couldn’t stand waiting for discharge instructions after our clinic visits were done, telling my medical assistant over his shoulder on the way out to just email him the details for his next appointment.
Immediately prior to each dose of chemotherapy we administered, he vomited in the car, victim of an anxiety-driven phenomenon known as anticipatory nausea. ‘Having the chemo was horrendously bad,’ he recalled, ‘because I hate needles and still do.’ One of the drugs I gave him was continuously administered through a pump that went home with him for 48 hours. His sleep was disrupted less by the pump’s tangled tubing than by what it represented, a constant reminder of illness. After two cycles, he insisted we change to the oral form of the medication, one I’d found to be slightly more toxic.
Balance isn’t always about staying the same. Sometimes the body has to shift its internal settings
Stress isn’t always maladaptive. In fact, it can be lifesaving in the short term. When we sense danger, the body’s ‘fight or flight’ response kicks in: the sympathetic nervous system speeds up our heart rate and raises blood pressure through chemical messengers called beta-adrenergic signals. At the same time, another system – the hypothalamic-pituitary-adrenal (HPA) axis – releases the stress hormone cortisol into the blood. Together, these changes prime us to act quickly: to run from a predator, or to stand our ground. But when stress doesn’t let up – when it becomes a constant feature of life, especially in situations we can’t control – those same responses can turn against us. Over time, they strain the body and can lead to lasting health problems.
When the body faces ongoing stress – whether from daily pressures or harsh environments – it automatically works to keep its internal systems steady, a state scientists call homeostasis. But balance isn’t always about staying the same. Sometimes the body has to shift its internal settings – speeding the heart, boosting hormones or changing metabolism – to handle a challenge. That kind of stability through change is called allostasis.
The science of stress achieved new sophistication in the mid-20th century, when the Hungarian-Canadian endocrinologist Hans Selye began the scientific study of stress when he described a pattern he called the ‘general adaptation syndrome’: under relentless stress, the adrenal glands grew, immune organs like the thymus and lymph nodes shrank, and ulcers formed in the gut.
At first, Selye dismissed emotional stress as insignificant to this process. But the American physiologist John Mason pushed back, showing that psychological factors – especially uncertainty, unpredictability and novelty – were also crucial in the body’s stress response.
In 1993, the neuroscientists Eliot Stellar and Bruce McEwen built on this work, introducing the idea of allostatic load – the cumulative wear and tear the body experiences from constantly readjusting its systems under stress. Their framework shaped a new field of research into health disparities, revealing how chronic stress falls unequally across populations and contributes to unequal health outcomes.
Laboratory studies have shown several ways that constant, unrelenting stress can help cancer take hold and spread. Stress hormones such as adrenaline and cortisol can damage DNA and make it harder for cells to repair that damage. They can also switch on certain viruses linked to cancer, like human papillomavirus (HPV) and Epstein-Barr virus. On top of that, stress may make the effects of cancer-causing substances worse. But we don’t yet know if stress alone, without any exposure to those substances, can actually start a tumour. In lab experiments, these same stress signals have even been shown to help cancer cells multiply, survive longer, move through the body, and invade new tissues.
Warren was consciously trying to manipulate his headspace in the face of crushing uncertainty
Building on this knowledge, researchers have looked beyond lab studies to large groups of people. Instead of focusing on cells or individual patients, these studies use health records and surveys to see how stress affects entire populations. In one recent paper, Cynthia Li and her colleagues found a strong link between allostatic load – the body’s cumulative wear and tear from stress – and both cancer rates and cancer deaths. Even after taking into account other factors that might skew the results, they discovered that men with high allostatic load and less than a high-school education faced more than a 50 per cent higher risk of dying from cancer, compared with men who had low allostatic load and a college education.
As Warren’s months on treatment passed, he tried his hardest to mitigate the effects of mounting stress on his body. Despite his discomfort, he walked around the infusion suite during each treatment and greeted all the nurses, asking them how they were doing. He was consciously trying to manipulate his headspace in the face of crushing uncertainty – ‘I wanted to just have that whole positive attitude.’ That carried over to his behaviour at home. After I’d told him that bland, thick foods would be easier on the lining of his mouth while on chemotherapy, he decided to subsist on ice cream and mashed potatoes, which were his favourite foods and made up most of his diet for the next nine months. ‘I made it fun.’
‘God loves me,’ Warren said. ‘I have a purpose. I mean, I literally started writing these things on the mirror. So, like, I’m strong. I will survive … Every morning brushing my teeth, I saw positivity on the mirror. Every time I brush my teeth to go to bed, I saw positivity on the mirror. It was always there, just keeping me going every day.’
The anticipation and dread created by each scan I ordered to measure his progress required me to prescribe him a short-acting benzodiazepine so he could make it through the test. And each scan showed steady improvement, the rectal mass shrinking in size, the spots in the liver too.
‘When you have a story, you write your own story. Someone never writes your story for you. It’s your life. You write your own story,’ Warren said.
The chemotherapy was working. Maybe he was right. Maybe, despite all odds, we were on our way.
The centuries-long history of positive thinking in the United States started as a reaction to the fire-and-brimstone Puritan theology dominating culture in the colonial years. Termed New Thought, this movement was popularised by Mary Baker Eddy, the founder of the Christian Science movement, who rejected the concept of predestination in favour of a world where everyone had limitless access to the divine. As Eddy wrote in her foundational text Science and Health with Key to the Scriptures (1875): ‘Hold thought steadfastly to the enduring, the good, and the true, and you will bring these into your experience proportionately to their occupancy of your thoughts.’ We were in control of the quality of our health. We just had to want it badly enough.
By the early 20th century, medical science had temporarily banished New Thought as a legitimate treatment for disease; belief in the power of positive thinking survived largely as a means to wealth and success. In the dark days of the Great Depression, Napoleon Hill’s Think and Grow Rich (1937) and Dale Carnegie’s How to Win Friends and Influence People (1936) had their first of countless print runs, reassuring us that we contained the key to all that we desired. Norman Vincent Peale, the famed pastor of the Marble Collegiate Church in New York City, further popularised these teachings through his regular sermons for radio and television as well as his own bestselling book, The Power of Positive Thinking (1952). In it, he began to revisit the idea that the mind could cure illness. He estimated that between 50 and 75 per cent of people were ill because of ‘improper mental states’ – ‘resentment, hate, grudge, ill will, jealousy, vindictiveness, are attitudes which produce ill-health’. He described his belief that heart disease, arthritis and even viral illness were largely due to emotional imbalance, and included a 12-step plan on how to regain control of one’s mind to ‘produce feelings of wellbeing’.
By the 1970s, New Age practices had come into vogue and, next to energy healing and crystal therapy, claims of curing disease through the power of thought appeared firmly back in the mainstream. Positive psychology had, by then, permeated every corner of society – corporate boardrooms, suburban megachurches, the halls of academia and, increasingly, oncology clinics such as mine. As politicians chipped away at the social safety net and wealth inequality steadily grew, Americans grasped at positive thinking as a way to regain control of lives that seemed more tenuous by the year. We hadn’t been left much else.
He knew he had a lot to live for, and that gave him strength. Most of all, he wanted to escape without surgery
Warren drew on every resource he could to re-establish control over his wavering mindset. He began doing a form of biofeedback therapy in which he was asked to repeat affirmations while a device sent light and sound frequencies through his hand to reinforce them in his mind. He also began seeing a local psychotherapist, talking through his whipsawing emotions in regular visits he found invaluable.
Though he continued to struggle with his anxiety, he was not lost in despair. He knew he had a lot to live for, and that gave him strength. He wanted to return to competitive tennis. He wanted to hold his daughter against his chest without the discomfort of her weight pressing on the plastic port he needed to get chemotherapy. Most of all, he wanted to escape his ordeal without surgery, which would require cutting into the anal muscle, rendering him permanently incontinent. He could not imagine an active life after a colostomy.
I couldn’t responsibly recommend that approach. This was a year before pivotal trials showed that rectal tumours with a complete response to chemotherapy, followed by radiation and more chemotherapy, could sometimes be managed without surgery through careful watch-and-wait. But none of those trials included patients with Stage 4 disease like Warren’s. Even if the rectal tumour disappeared, the cancer would still remain in his liver, sacral bone and bloodstream. And even with aggressive surgical removal of every metastatic site, most patients with Stage 4 rectal cancer relapse within five years. Without such an aggressive effort, the odds were worse still.
Yet, despite his agonising doubts about so much, Warren’s confidence in the chemotherapy was unshakeable. At each clinic visit, he spoke exclusively in expansive, upbeat terms, his words coming out rapidly, building into a crescendo of optimism. Knowing what I did about how he’d been struggling with the mental burden of therapy, I found it surprising. I was taken aback.
‘It’s working,’ he said. ‘The scans show it, and I know it’s going to keep shrinking each time we check.’
‘I’m happy about that, I really am,’ I replied. ‘But we know that even in liver tumours that completely resolve on scans, most of the time there are still a few microscopic cancer cells left behind. We’ll still need to do surgery. Or at least radiation. That goes for the tailbone as well.’
‘I have confidence in you, doc. I can feel that tumour shrinking. I can feel it going away completely. I know my body,’ was his response.
That final sentence. Whenever I heard it, I had to suppress the cynical reflex it so often triggered. I didn’t like the questions it raised: how was it then that cancer could grow unchecked for so long in the face of that professedly perfect self-knowledge? Truth was, I thought, we really knew very little.
Yet Warren’s confidence – in himself and in me – was intoxicating. Despite his debilitating anxiety, he believed so thoroughly in the efficacy of what we were doing that it was hard not to get swept along. I begrudgingly welcomed the affirmation. I was only a year or so into my practice as an independent medical oncologist, and I still struggled with self-belief. In many ways, I was still the kid who’d finished 10th from the bottom in my medical school class. I’d come a long way since then, completing more than a decade of gruelling training, but I still had a hard time speaking up at tumour board meetings. I qualified my opinions when discussing the care of tricky patients with other specialists. What the hell did I really know? Was Warren’s belief delusional? What could it really accomplish?
‘We’ll see in a few months.’ I had to suppress a smile.
‘There’s no doubt in my mind,’ he grinned.
I had seen people have early stage cancers recur when I thought it was certain they wouldn’t, and I had seen people with metastatic disease survive against all odds. I wasn’t sure what I had to do with any of it. I told someone at a party that I felt the essence of my job was watching what had to happen unfold. They didn’t know what to say. I had a growing sense of a reality beyond myself, one that I was merely a part of. But if the doctor wasn’t in control, who was?
We moved into the second phase of Warren’s treatment. I reduced the intensity of the chemotherapy and added radiation as a local treatment for the rectum. Turning our focus more exclusively on the rectum, we’d have to hope that the cancer didn’t use the opportunity to grow in the liver or anywhere else.
I re-iterated the possible side-effects of radiation therapy – pain, bleeding, diarrhoea. Warren waved them off. He had convinced himself that he would experience only the benefits of treatment – continued shrinkage, total resolution. Perhaps it was precisely his anxiety that drove him to cling so desperately to unequivocally positive belief, seeing in it a life raft in the storm.
In her book Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America (2009), Barbara Ehrenreich acerbically described the toxic positivity she found inescapable after her diagnosis of early stage breast cancer in the early 2000s – pink ribbons, teddy bears embroidered with upbeat slogans, the relentless optimism of her support groups. Seamlessly incorporated into unhelpful metaphors about battling cancer and winning, the importance of positive thinking in achieving a cure is still rarely challenged by the patients I’ve seen in my office. I can sympathise. When all seems to be beyond our control, we seek desperately for any opportunity, however small, to turn the odds in our favour.
Allopathic medicine subscribed to the notion that the mind and body are totally separate entities
Medical science has struggled to keep up with the renewed cultural certainty about the power of positive thinking in the treatment of cancer. It’s true that there are many studies demonstrating how modalities such as massage, yoga, tai chi, mindfulness and cognitive-behavioural techniques reduce anxiety and depression in cancer patients. Yet what we all want is proof that attitude helps determine outcome. And, though we’ve learned much about the putative relationship between psychosocial stressors and cancer, that certainty has remained elusive.
In 1989, the psychiatrist David Spiegel and colleagues published a small, prospective trial of 86 women with metastatic breast cancer. One group of these patients were offered weekly group therapy and self-hypnosis for pain; at the end of the follow-up period, these patients lived an average of 18 months longer than their counterparts in the control arm. Researchers since have struggled to consistently replicate these findings. In 2007, Spiegel’s own follow-up study of breast cancer patients failed to confirm a survival benefit for group therapy, though in the sub-group of patients with more aggressive triple negative disease, those who received regular psychotherapy did live longer.
In a 2021 article, Anabel Eckerling and her colleagues at Tel Aviv University summarise the inconclusive course of the research that has been done since then. Reviewing the scientific literature, they identified 22 methodologically stringent randomised controlled trials, which are the gold standard of clinical research. Each trial compared the outcomes of a group of patients treated with a verified stress-management approach to an untreated control group. Eight of the 22 studies reported a statistically significant survival advantage to the group of patients treated with the psychosocial intervention. However, the majority of the trials failed to show such a benefit.
The review’s authors contend that this disagreement stems from the heterogeneity of the trials, each of which tested a different treatment protocol, initiated treatment at different times during the course of the cancer, provided treatment for differing durations, and evaluated different patient populations with different cancers. The trials were also all small, and thus not sufficiently powered to reliably detect small effects.
We didn’t learn about this equivocal, unresolved science during my oncology training. Allopathic medicine, with its roots in Enlightenment rationalism, subscribed to the notion that the mind and body are totally separate entities – we treated the cancer, the psychiatrists treated the anxiety it caused. That our patients in the hospital where we trained had little to no access to mental health care was beside the point. We understood the unspoken assumption that anyone considering the possibility of a link between patients’ psychology and the outcome of their cancer treatment was soft-headed.
If large, well-designed, replicable randomised controlled trials ever do conclusively demonstrate the benefit of stress reduction and positive thinking on rates of cancer cure, it’ll be a small effect at best. I don’t think even the most optimistic researcher believes that a psychological intervention would outweigh the impact of properly selected chemotherapy or surgery on a particular cancer.
Yet the snarled public health discourse surrounding the COVID-19 pandemic has, I think, further complicated our willingness as physicians to engage with any practice that feels out of the mainstream of allopathic medicine. In our determination to leave misinformation no purchase, we’ve left ourselves less space to acknowledge any limitations in our current biomedical understanding of illness. There is a defensiveness in this dismissal that I think patients can sense. And it’s in these blind spots that alternative practices can thrive.
In Warren’s telling, by the time he finished his radiation, he was ‘cooked’. Though his rectal pain was long gone, his hands and feet burned with neuropathy, and he could hardly hold a racket, let alone play a full set: ‘I used to go after chemo, the night after chemo, like on the Thursday. I used to go watch the guys play tennis. They’d come and pick me up. Take me out. I’d have to sit with a blanket and I’d feel cold in the middle of the summer, and I’d have to drink cups of tea, because I couldn’t even touch anything cold.’
We did another scan, hoping for the best. The images showed significant shrinkage of the rectal mass, resolution of the tumours in the liver, and sclerosis in the tailbone, a process of scarring that typically indicated healing.
The first colorectal surgeon who’d seen him had recommended a surgical resection of the rectum regardless of the response on scans. This was standard practice at the time, as it was felt not worth the risk of possible recurrence to leave the rectum in place.
I hated going off-book, leaving behind the safety of expert guidelines and clinical trials
I remember the conversation with Warren in my clinic after the positive news on the scan. He’d gained so much weight over the months of therapy. He was sitting up straight. His voice was strong: ‘So, I know the first surgeon you sent me to said I’d definitely need surgery after radiation. I’m going to get a second opinion downtown.’ He sounded resolute.
‘I mean, I know how you feel about surgery. I’m never against a second opinion. But I think you’re going to need the operation,’ I replied. I hated going off-book, leaving behind the safety of expert guidelines and clinical trials. But I knew even then that there’d be no convincing him.
It wasn’t just that he felt an ostomy pouch would permanently scuttle his ability to play tennis in the summer heat. He later told me that he’d been deeply affected watching his father’s painstaking recovery from a surgery for kidney cancer. He went on: ‘I had this belief that, once you have surgery on something like that, once you open it up, it’s just very, very difficult to kind of get a lead on it.’
His second surgeon called me after he saw him. I’d just arrived in Estes Park in Colorado for a weekend with some of my friends from medical residency. As I watched the sun set over the Rocky Mountains, we discussed the data from the watch-and-wait trial in rectal cancer patients, which had just been published. The surgeon told me he’d take Warren for a proctoscopy and try to biopsy his rectum to see if any cancer was left. Even if that was negative, though, we agreed his biggest risk would still be recurrence in the liver or elsewhere in the body. I still felt there had to be a few cancer cells hidden in the blood, even if the scans were negative. I knew the treatment couldn’t have worked that well, could it?
I was deeply uncomfortable with abandoning the idea of surgery, stopping Warren’s chemotherapy, as he wanted, and giving up the illusion of control. Even Warren himself had relied on chemo to get this far. Even for him, good vibes hadn’t been enough.
On a recent afternoon, I spoke with Joel Evans, who had trained as an obstetrician and gynaecologist before joining the board of directors at the Center for Mind/Body Medicine, where he had worked extensively in disseminating mind-body techniques to improve health. I asked him what he thought about the conflicting scientific evidence on the effects of the mind on cancer outcomes. We agreed that rigorous randomised controlled trials were of paramount importance, but he argued that we shouldn’t always withhold potentially helpful therapies in their absence. ‘We have to first assess their biological plausibility, then we have to assess the possibility of patient harm.’ He felt the past debate over whether massage would be beneficial to cancer patients was illustrative – did we have to wait for a randomised controlled trial to assess whether a massage could relieve stress, ease musculoskeletal pain, and increase a sense of wellbeing, before we could recommend it to a patient with metastatic cancer?
In treating each patient’s cancer, in trying to control it, we had to accept all that we couldn’t control
When it came to mind-body therapies for cancer patients, Evans liked to think of the many possible options as a buffet. ‘It’s not a one-size-fits-all approach,’ he told me. ‘Some patients will benefit most from cognitive-behavioural therapy, others from deep meditation, others from movement meditation.’ I asked whether he felt the benefit of these therapies was, like massage, primarily in relieving subjective suffering, or whether they truly could affect long-term cancer outcomes. We discussed the existing population-level research on the relationship between allostatic load and cancer incidence, and how it dovetailed with the extensive literature I’d reviewed linking stress-related signalling pathways with carcinogenesis. For Evans, this illustrated the biological plausibility of stress reduction as a means to reduce cancer-related death. But I still wondered if he thought this placed an unfair burden on our patients to be happy and stress-free even if, in the middle of chemotherapy and radiation, they were far from either.
Evans told me that in the work he did with cancer patients, he emphasised acceptance of current reality over projecting a superficial sense of happiness. To achieve this equanimity, we had to give up our sense of control. We needed to stay true to our natures. ‘Every patient has their dharma,’ he said.
‘Dharma’ was often translated from Sanskrit as duty. But duty felt externally imposed – peeling potatoes in the kitchen, answering a draft summons. Another way to understand dharma was more akin to purpose, a sense that emerged from within. In that way, we each had our own dharma, informed by our particular energy.
For Warren, naturally attuned as he was to sports and the mentality it took to win competitive matches, predisposed as he was to a sunny outlook on life, it made sense to encourage unwavering positivity. For another, it might not. It would not.
Even if we can ever prove that attitude confers a small benefit in curing cancer, it made about as much sense to me to blame a patient for not being able to be happy enough as it did to blame them for not finishing high school or not having more money. I was tiring of that American myth that the whole range of possibility was open to every person, and that an inability to achieve one’s desires could only be a personal failing. We were all products of particular circumstances, and we had to honour that. A patient’s life did not begin at the moment of their cancer diagnosis. Their mind and psychology were not a blank slate. In treating each patient’s cancer, in trying to control it, we had to accept all that we couldn’t control.
The way down a mountain is different for every skier. Understanding the topography, seeing each rock and tree, being honest about one’s own skill, we can each find our own line. I haven’t gone skiing in nearly 20 years, mainly because I am terrible at it, but I know that, for everyone, the best way down is rarely straight.
It’s been three years since we stopped Warren’s chemotherapy, his body worn out, his scans negative for any evidence of disease. I am cautious in my language. We haven’t cured this disease. Not yet.
But Warren tells me: ‘I believe I’m all clear. I categorically believe that I’m good. I’m done.’ He may be right. Who am I to say he is wrong?
He is back on the courts. He may never be as good as he once was, but he’ll be as good as he can be.
Pain subsiding, energy returning, Warren can look back. He tells me he is ashamed of the way he once lived his life: ‘I just took everything for granted.’
‘It’s really strange, and I don’t know if any of your other patients have said, but having cancer, I’m actually grateful. Because it’s taught me to be more spiritual, to be more relaxed, to be more open, spend more time with my family, not to be working 7-til-7.’
That tension between fate and free will is one we all feel in our own lives
Warren had been able to find a meaning in his suffering, one consonant with his nature. But I am more interested in why he thinks he has been able to get to this point when so many others have not. I ask him why chemo and radiation worked for patients like him and not for others. I ask him if it comes down to mentality or if he thinks there is something else we don’t understand.
He isn’t able to answer directly. But, in his response, he tells me about another cancer patient he knows, a young kid he played tennis with.
He’d been unexpectedly diagnosed with a brain tumour. Warren, by then on the tail end of his own treatment, had invited him over one night. They talked. They shared hard-won wisdom.
‘It’s really strange. I was at peace with it. He was at peace with it. We didn’t panic.’
He tells me his friend had gotten surgery and was now recovering. Looking at the pathology report, his doctors felt the odds were he’d do OK.
Warren thinks for a moment. ‘I mean, yes, I can say it now about my case. I panicked.’ A moment of vulnerability he hadn’t shared before. ‘But I got to peace. He got to peace a lot quicker than I did, but eventually, after the second round of chemo, I was at peace with it all too. You know what I mean?’
I imagine the vast, unspoken distance between panic and peace. I see the tension between his conviction that he needed to will his cure and his acceptance of the outcome of treatment, whatever it was. That tension between fate and free will is one we all feel in our own lives. Doing my work, I face it every day.
I want to believe, as Warren does, that we write our own stories. I want to believe I am strong enough for that responsibility. I’m still trying to get to that certainty but, even if I never do, I’m hoping I can find my own peace, like he has, about where I am on the way.
