Moving Through the Minefield: Fear, anxiety and the emotional toll of cancer
“Get busy living or get busy dying”
Shawshank Redemption, Tim Robbins and Morgan Freeman
It is often said that people are more afraid of public speaking than of dying. I’m calling bull**** on that one because dying remains abstract until one has experienced a serious threat to existence. Upon facing your own mortality, public speaking doesn’t seem so bad. Giving a speech never invoked the tremors that I felt when a biopsy needle was lodged in my neck or when a doctor referenced my diagnosis as an “advanced cancer.” In those moments, my psyche flatlined as my mind dissolved into white noise.
Anxiety and cancer tango in the whirlwind that uproots a life during a life-altering health crisis. I don’t know anyone who hasn’t experienced intense anxiety associated with cancer, whether at the time of diagnosis, during treatment, or in the survivorship period when we hope to remain healthy but are constantly on alert for a symptom that could signal recurrence.
If cancer is a fight, I have concluded that the biggest battle is waged in the mind. In this arena, anxiety draws its sword, poised for combat like a gladiator who expects to easily vanquish the combatant. Learning how to confront anxiety in its battle ground isn’t easy, but I’ve found it liberating. Coping skills create a durable shield welded with courage under pressure. While some perceive courage as a special attribute possessed by the fortunate few, we all have the capacity to demonstrate bravery. Courage isn’t the absence of fear but the willingness to face it in moments of adversity. The skills developed under duress are transferable to other life struggles, forging a foundation of mental resilience that is not easily overpowered. As I brawled with anxiety, a sense of confidence took root and began to bloom. Cancer would not rob me of the joy of living.
Here’s a battle strategy I learned: lean into anxiety. Lean in hard. Move toward it, look the opponent in the eye. Face-to-face combat might seem counterintuitive, but anxiety thrives on avoidance. When we run the other way, anxiety nips at our heels, expanding its reign of terror by threatening to overtake other parts of our lives. Facing anxiety may ratchet up the intensity, but feeling worse is only a temporary obstacle. Be bold and hold firm and anxiety will eventually be forced to surrender. Under our calm and wise gaze, its power dims.
Anxiety’s ultimate goal is to protect our lives, and our brains are well-trained to sound the alarm at perceived threats. When we are in immediate danger, such as being chased by a bear or experiencing a near miss on the freeway, anxiety kicks in and does its job well. But too often, anxiety misfires or magnifies the fear signal out of proportion to the threat. It acts like the smoke alarm that continually goes off when the toaster malfunctions. Instead of alerting us to a genuine threat, which would demand immediate reaction, the alarm screams “danger!” at the merest puff of smoke.
In the wake of my first cancer diagnosis, panic set in. When I asked the doctor if I would survive, she paused a little too long before answering. As long as the disease hadn’t traveled past the axillary lymph nodes, I had a good shot she said. But if it had . . . At that point, I didn’t know how far it had advanced. The week after, in the middle of the night, I woke up convinced that the cancer was spreading wildly throughout my body. So real was the anxiety that I texted my doctor at 3 am, certain that malignant cells whirled unchecked through my veins. My mind had spiraled into a dangerous place.
Cancer brought me to a reckoning. I couldn’t change that a highly aggressive malignancy had invaded my body, but I could exercise control over my response. My choices were to be swallowed up by fear or to forge a path through the minefield of my own mind. Anxiety run amok isn’t content until it has spread, like the noxious algae bloom that sucks the life out of a once clear lake. It will suffocate the joy from daily life with its endless predictions of doom and drain energy by demanding a constant state of high alert.
I decided to embrace the challenge and hone my coping skills. Over time I learned that key elements included harnessing self-talk and focusing on the present moment. I began to stand up to anxiety as it flooded my mind with panicked thoughts about my future (or lack thereof). How would I withstand pain? What if I had to declare bankruptcy? What if I couldn’t work? What if I couldn’t tolerate the next procedure? Rather than flee the fear, I stationed myself squarely within anxiety’s line of fire. The mind has the power to rev up anxiety or dial it down, and I chose to put my energy into the latter, mostly through level-headed self-talk. It required repetitive practice with varying degrees of success but, over time, I consistently gained ground.
During the agonizing wait for test results, anxiety shot off its poisoned arrows, leaving a fear swirling in my gut that sometimes morphed into an all-out revolt of my digestive system. My heart would race while my emotions melted into a messy glob. Anxiety taunted with worst-case scenarios, something cancer offers in abundance. I employed my inner dialogue to rebut anxiety’s claims which went along these lines: “Yes, this is a hard moment but as long as I keep breathing, I will make it to the other side.” “It is okay to not be okay right now.” “This is pretty awful but there are thousands of other people who have gone through this. If they did it, I can do it too.” “I am a tough girl and I will find my way, even if I come crawling to the finish line.” “Thank you for your service, anxiety (trying to protect me from threat) but I’ve got this now.” Some days, I’d have to concede territory to anxiety. It would win a battle but I wouldn’t allow it to declare victory.
Because anxiety flourishes by delivering unhappy reminders of the past or poking at future uncertainties, I’d wrangle my focus onto the present. A visible cancer bulged from my chest and continued to inflate at a fearsome clip; a ticking time bomb growing from within. The threat could only be removed after months of slowly-paced chemo, calling for patience and acceptance, attributes that are not my strengths. Cancer had deftly set its trap, and the only way out was to double-down into treatment well-known for its toxic side effects. With no guarantee that it would be effective, I redirected my thoughts to the present. I would ask myself, “Are you okay at this very moment, right here, right now?” If I continued breathing, I was good (and a bonus if it was without pain). I had options, including choices about how to live well in the moment.
In order for this to work, I had to accept uncertainty and become comfortable with not-knowing. I wanted answers, but they wouldn’t be available for many months. No doctor could promise that chemo would eradicate the cancer and the grotesque, diseased breast would remain affixed to my body for a minimum of six months. What did today have to offer? I found comfort in simple pleasures too often taken for granted; a relaxing hot shower, petting the cat, watching the light shift as the sun journeyed across the sky. I became exquisitely conscious of the blessings and beauty that populate everyday life and experienced moments of profound bliss. Anxiety couldn’t compete.
Every battle needs its allies, and my fellow cancer survivors stepped forward in solidarity. “Take it one day at a time,” came the most common counsel. “Don’t plan too far ahead, it is overwhelming. Focus on what’s right in front of you.” “Don’t dwell on the past and don’t look too far into the future.” An elderly woman, also undergoing chemo, declared that, “My only job is to wake up with a great attitude. Then you can handle anything they throw at you.” Their words sustained hope even when anxiety stepped up its ruthless tactics. Fellow survivors diagnosed with a devastating metastasis or who accepted the crushing reality of entering hospice demonstrated massive courage in the face of exceptional hardship. I observed women valiantly face the end of their lives, assembling support for their families and preparing their children for loss. Although I believed myself capable of doing hard things, Stevie Nicks’ lyrics frequently echoed in my mind, “Can I handle the seasons of my life?” Some days I had my doubts but fellow survivors insisted otherwise. Step into the uncertainty, embrace it even. No one wants to join the cancer club, but within it I found plentiful support and inspiration.
Occasionally, people made innocent comments that would provoke a torrent of anxiety. In the beginning, questions about the stage of the cancer touched off a cascade of dread. Sometimes, a fellow patient’s devastating diagnosis ignited a fear that I’d be next. Rather than avoiding these triggers, which promised to narrow my life with incessant warnings of danger, I forced myself to enter anxiety’s bunker for a look around. Casting light into the dark corners of anxiety’s turf, I focused on a few key questions. Why does this bother me? What is the root fear? What tools can I employ to cope? I prefer a sturdy, interior armor to serve as a bulwark against triggers rather than being at their mercy in an unpredictable encounter. For me, this approach bestows genuine freedom because I am not living my best life if anxiety claims the driver’s seat.
These days, there are ample resources available to support anyone struggling with anxiety. Some of my favorites include visualization, mindful walking, queuing up my favorite music, exercising and deep breathing (What Is 4-7-8 Breathing? (verywellmind.com). Often, I’ll categorize my fears according to what is under my control and what isn’t. I formulate plans to alleviate the former while attempting to let go of the latter (admittedly easier said than done). With plenty of self-help books, workbooks, apps and meditations, no one should feel alone in coping with anxiety.
I chose not to take anti-anxiety medication. Most of the prescription medications are benzodiazepines, which often result in a “hangover,” carry the potential for dependence and tend to result in a difficult withdrawal syndrome. Many people find the medications helpful and wouldn’t endure treatment without them. I respect that choice.
Although I have so far managed to fight my way through the anxiety slog, I can’t become complacent or over-confident. Anxiety remains a powerful adversary. Here I offer several disclaimers because there are elements that made it easier for me. I am in my late 50s and have lived a full life, in sharp contrast to younger cancer patients whose health crises intervened before they had the opportunity to experience adulthood. I don’t have children. Some of the most painful situations involve young mothers who will not live to see their children grow up or even enter kindergarten. Being single, I wouldn’t leave behind a grieving partner if cancer claimed my life. I am not living with metastatic (Stage 4) cancer, which takes the battle to an entirely new level. I have health insurance and access to quality care. Being able to trust my treatment team removes a massive amount of stress. People are born with differing biology, and some are more prone to anxiety than others. Because I wasn’t a particularly anxious person before cancer, implementing coping strategies was probably easier for me than for those who spend a lifetime living in anxiety’s shadow.
By the time of my second diagnosis, I had begun to practice a form of radical acceptance. Life’s misfortunes, including cancer, are an inevitable part of the cycle of life, not something separate from it. Upon burying his 20-year old daughter, a close friend said that, “no one gets out of here without going through some hell.” We are not in control nor should we expect to be. If anything, cancer exposes the reality of life, removing the blinders to reveal what is true for all of us; human bodies are vulnerable and life offers no guarantees, even to the healthiest of humans.
As the years passed, I developed trust in myself and found that I could usually hold fast no matter the dread a situation invoked. Like a damaged tree that produces new layers of bark after trauma, growth has encompassed the scars. Tree rings produced in harsh years provide clues about the stressors it endured, depicting the struggle to survive even as fresh rings encircle the trunk and add heft to its core. No force has the ability to remove the rings that emerge under duress. They become a permanent part of the tree, adding bulk that withstands hardship.
Life is too precious to allow cancer and its consequences to hijack the gift of today. The power of the mind serves us better when it acts as our ally. When I need a reminder, a quote from the film Shawshank Redemption often floats into my consciousness, “Get busy living or get busy dying.” The choice is mine. And I emphatically choose life.