ONCOLOGY. INSIDE LOOK. VERY PERSONAL. AND NOT VERY

2024 Author: Harry Day | [email protected]. Last modified: 2023-12-17 15:43

Today I had a scheduled check-up with a doctor. Has passed the tests. The result will be in a week. And then I remembered …

Three years ago, during a preventive visit to a gynecologist, after his suspicions about my state of health, I was also sent for tests. Suspected oncology.

How was it then? It was scary and painful. Numerous analyzes. Anxious expectation of the result. A month in the regional oncological clinic. Operation. And again, anxious expectation of the result.

And happiness! Wild happiness and joy that everything worked out this time! I, restrained and outwardly balanced all these days of waiting, threw myself on the neck of the doctor, who brought me the news that "everything is within the normal range." She hugged the tired doctor in her arms and roared like a beluga with happiness. And our entire women's ward, together with me, rejoiced and roared. We are such women … we can endure the unbearable, or we can become limp at the most seemingly inopportune moment.

Oncology is something that can happen to anyone. Nobody is insured. Nothing can be a guarantee

When I first got to the regional cancer center, I was surprised at the huge number of people there. Men, women. You walk down the street and don't think that someone might be sick. And here … a huge concentration of grief. And hope.

A month in the hospital. Where not everyone gets well. What I saw. What I understood.

People react to life in different ways. Almost everyone has a similar reaction to death - it is fear. And being diagnosed with cancer means being in touch with that fear.

My friends in the ward. And unfortunately.

Nadia. They say about such "blood and milk". Forty years. She lived all her life in the village. She worked a lot. I grieved all that my sides were lying in a hospital bed. I was outraged by the fact that there were a lot of analyzes. And it takes so long. I was trying to go home: "My husband will bring another there while I'm lying here." And then she left. When I found out that the diagnosis was confirmed. I just left. Saying, "Be what will be."

Valentina Efimovna. Near eighty. Intelligent, very polite. Exhausted by the previous operation and two chemotherapy treatments that did not stop the metastases. Irradiation was prescribed. Cried softly at night. She said: “I can’t bear the pain. I would die without pain."

Galya. Fifty years. Skinny as a girl. She knew that something was happening to her for a long time - several times she was taken from work because she lost consciousness. I postponed the visit to the doctor until the last. Living in a small village, it was a whole story for her - to go to the city, leave her house, work, household for a day. A daughter who was raised alone without a husband. "Perhaps it will cost," she said, thought. She was brought in with bleeding, which was stopped for several days. Then a course of radiation was prescribed. Then there had to be an operation. She kept saying: “I have money. I earned and saved. For my daughter. But how will she be without me?"

Inna. Twenty four. Second chemistry. Sitting under a dropper (she could not lie down - she felt sick), with rage and pain: “Let me be operated on! Let them throw out the uterus and all these female organs, where this infection started! I don't want children! I do not want anything! I can't stand it anymore!"

Lyudmila Petrovna. Sixty. Very meek. In the past, the chief accountant of a large enterprise. After the operation, she quit her job a few years ago. Reoperation. Irradiation was prescribed. I went to church on the territory of the hospital. I prayed. Says: “It means that it was pleasing to God. Since he gave me such a test, it means he will give me the strength to endure it."

Sveta. My age at that time is forty-six. Fashion designer. She did not lie in our room, but she was a frequent visitor. I went to talk and support. And in a word and simply by myself: "Look, they told me that I had to die, but I live!"

I … I closed myself in my loneliness and fear. In that loneliness when you are alone with death. Not with some kind of ephemeral death, but with his own. Close people supported as best they could. But fear is like a steel cylinder. I am here, inside. And they are outside. And the more I went into myself, the stronger, more impenetrable became the walls of this cylinder. Little of what was happening outside I saw and heard.

And close people also suffered. And they didn't know what words to say to me. Very few people know the "correct" words in this case. I didn't know myself.

I just felt that talking with someone who is terminally ill is important and necessary. Talk about everything. About life and death. Listen, be near. When such conversations took place in our ward, when I listened and spoke, when I supported and reassured, when I sympathized and empathized, and saw that it was getting easier for a person, then the clutches of my own fear seemed to be unclenched. And I could take care of myself. It became easier.

In my case, helping others - I helped myself.

Oncology is the scourge of our century. I will not give data on the number of oncology diseases per capita in the CIS countries, you can find them yourself if you wish. It is enough, probably, to remember someone close or familiar to you people who faced a similar diagnosis. I think there are such people in your environment. If we are still shaky with medical support, then with psychological support it is very bad.

People with cancer themselves need psychological help. Relatives of sick people need psychological help and support, because they often do not know how and how to help a loved one. Doctors of oncological clinics need psychological help. Their burnout rate is, I think, the highest among doctors.

I understand that in the territory of the post-Soviet space it will not be soon in every oncological clinic there will be a psychologist. Therefore, it is important to be able to help yourself and a loved one if trouble touches.

What is important to know. Five stages of acceptance of the disease are experienced not only by the sick person himself, who has learned about the fatal diagnosis, but also by the patient's close relatives. Knowing about this, perhaps, will add understanding of what is happening.

These are the five stages identified by Kubler-Ross (1969) from observations of the reaction of patients after the announcement of a fatal diagnosis. (from the "Handbook of a Practical Psychologist" by S. L. Solovyova.)

Disease denial phase.(anosognosic). The patient refuses to accept his illness. Psychologically, the situation is being repressed. When visiting doctors, patients first of all hope for a denial of the diagnosis. The eternal course of salutary thought about a medical error, about the possibility of finding miraculous drugs or a healer gives a respite to the shot through the psyche, but at the same time, sleep disorders appear in the clinical picture with the fear of falling asleep and not waking up, fear of darkness and loneliness, phenomena in a dream of the "dead", memories of war, life-threatening situations. Everything is often permeated with one thing - the psychological experience of dying.

The actual state of affairs is hidden both from other people and from oneself. Psychologically, the reaction of denial enables the patient to see a non-existent chance, makes him blind to any signs of mortal danger. "No, not me!" Is the most common initial reaction to the announcement of a fatal diagnosis. It is probably advisable to tacitly agree with the patient. This is especially true for caregivers, as well as close relatives. Depending on how much a person can take control of events, and how strongly others support him, he overcomes this stage more difficult or easier. According to M. Hegarty (1978), this initial stage of refusal to recognize reality, isolation from it, is normal and constructive if it does not drag on and does not interfere with therapy. If there is enough time, then most patients have time to form a psychological defense.

This phase reflects the controversy of the issue of an individual approach in the need to know the truth about the forecast and the situation. Undoubtedly, humility before fate and acceptance of its will is valuable, but we must pay tribute to those who fight to the end, without hope of victory. Probably, there are both personal qualities and ideological attitudes, but one thing is indisputable: the right to choose is for the patient, and we must treat his choice with respect and support.

Protest phase (dysphoric) … It follows from the question that the patient asks himself: "Why me?" Hence the indignation and anger at others and, in general, at any healthy person. In the phase of aggression, the information received is recognized, and the person reacts by looking for reasons and guilty ones. A protest against fate, resentment of circumstances, hatred of those who may have caused the disease - all this should spill out. The position of the doctor or nurse is to accept this outburst out of mercy for the patient. We must always remember that aggression, which does not find an object outside, turns on itself, and can have destructive consequences in the form of suicide. The important thing in completing this stage is to be able to pour out these feelings outwardly. It should be understood that this state of hostility and anger is a natural, normal phenomenon, and it is very difficult for a patient to restrain it. You cannot condemn the patient for his reactions, in fact, not to others, but to his own fate. Here the patient especially needs friendly support and participation, emotional contact.

Aggression phase also has an adaptive character: the consciousness of death is shifted to other objects. Reproaches, abuse, anger are not so much aggressive as substitutionary. They help to overcome the fear of the inevitable.

The "bargaining" phase (auto-suggestive) … The patient seeks, as it were, to postpone the sentence of fate, changing his behavior, lifestyle, habits, refusing a wide variety of pleasures, etc. He enters into negotiations for the extension of his life, promising, for example, to become an obedient patient or an exemplary believer. At the same time, there is a sharp narrowing of the life horizon of a person, he begins to beg, bargain for himself certain favors. These are, first of all, requests to doctors regarding relaxation of the regimen, prescribing anesthesia, or to relatives with the requirement to fulfill various whims. This normal "bargaining process" for narrowly limited purposes helps the patient to come to terms with the reality of an ever-shrinking life. Wanting to extend his life, the patient often turns to God with promises of humility and obedience (“I need a little more time to finish the work I have begun”). A good psychological effect in this phase is given by stories about a possible spontaneous recovery.

Depression phase … Having accepted the inevitability of his position, the patient inevitably falls into a state of sadness and grief over time. He loses interest in the world around him, stops asking questions, but simply repeats to himself all the time: "This time it is me who will die." In this case, the patient may develop a feeling of guilt, consciousness of his mistakes and mistakes, a tendency to self-accusation and self-flagellation, associated with an attempt to answer to himself the question: "How did I deserve this?"

Each soul has its own "piggy bank of pain" and when a fresh wound is applied, all the old ones fall ill and make themselves felt. Feelings of resentment and guilt, remorse and forgiveness are mixed in the psyche, forming a mixed complex that is difficult to survive. Nevertheless, both in mourning oneself, and in drawing up a will, where they find a place for both the hope of forgiveness, and an attempt to fix something, the depressive stage becomes obsolete. The atonement takes place in suffering. This is often a closed state, a dialogue with oneself, an experience of sadness, guilt, farewell to the world.

The depressive state in patients proceeds in different ways. In some cases, the main sad mood is aggravated by reactive moments associated with the loss of body parts or functions that are important for the holistic image of the "I", which may be associated with the surgical operations suffered due to illness.

Another type of depression seen in dying patients is understood as premature mourning for the loss of family, friends, and life itself. In fact, this is a difficult experience of losing one's own future and a sign of the initial stage of the next phase - the acceptance of death. Such patients are especially difficult for all people who come into contact with them during this period. In those around them, they cause a feeling of anxiety and anxiety, mental discomfort. Any attempts to cheer or support the patient with a joke, a cheerful tone of voice are perceived by him as ridiculous in this situation. The patient withdraws into himself, he wants to cry at the thought of those whom he is forced to leave soon.

During this period, willingly or unwillingly, all those who surround the patient begin to avoid communicating with him. This applies to both relatives and medical personnel. At the same time, in particular, relatives have an inevitable feeling of guilt for their behavior and even, at times, involuntary mental wishes to the dying person for a quicker and easier death. Even the parents of sick children are no exception in this case. To others, such alienation may seem like a heartless parental indifference to a dying child. But relatives and medical personnel should understand that these feelings under the given circumstances are normal, natural, represent the action of natural mechanisms of psychological defense. The clinician and therapist should be encouraged to overcome these feelings in caregivers and be encouraged to continue providing emotional support to the dying person no matter what. It is during this period that the patient most of all needs spiritual comfort, cordiality and warmth. Even someone's tacit presence in the ward at the bedside of a dying person can be more useful than any explanations and words. A short hug, a pat on the shoulder, and a shake of hands will tell the dying person that they are worried about him, cared for, supported and understood. Here, the participation of relatives is always necessary and the fulfillment, if possible, of any requests and desires of the patient, at least somehow directed towards life and work.

Death Acceptance Phase (Apathetic) … This is reconciliation with fate, when the patient humbly awaits his end. Humility means a willingness to face death calmly. Exhausted by suffering, pain, illness, the patient wants only to rest, finally, to fall asleep forever. From a psychological point of view, this is already a real goodbye, the end of a life's journey. The meaning of being, even undefined by words, begins to unfold in the dying person and soothes him. It's like a reward for the journey you have traveled. Now a person does not curse his fate, the cruelty of life. Now he takes responsibility for all the circumstances of his illness and his existence.

It happens, however, and so that the patient, accepting the fact of his inevitable death, resigned to fate, suddenly begins to deny again the inevitability of the already accepted fatal outcome, while making bright plans for the future. This ambivalence of behavior in relation to death is logically understandable, since agony is both a struggle for life and withering away. In this phase, it is necessary to create the patient's confidence that he will not be left alone in the final with death. Depending on his spiritual potential at this stage, the doctor can afford to involve religion as needed.

The specific gravity, the ratio of individual stages in different people differ significantly.

What I want to add more. Do not treat a sick person, even someone with a fatal disease, as already deceased. Be there. As much as possible. Empathy, compassion, empathy, support are all important. In simple words and actions. As you can.

It is equally important not to rush to the other extreme when, with the best of intentions, we ourselves decide what would be best for the patient. Listen. Allow him to participate in making decisions about his life.