How to Show Up When You Have Cancer

In this podcast, Patricia Rockman, director of education and clinical services for the Center for Mindfulness Studies in Toronto, and Mindful columnist Elaine Smookler, both cancer survivors, talk about how mindfulness factors into the cancer experience.

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What happens when the unthinkable happens to you? My name is Elaine Smookler, and I’m here in conversation with Dr. Patricia Rockman, co-founder and director of education and clinical services for the Centre for Mindfulness Studies in Toronto. Pat and I have been friends for decades and we were both training as clowns when Pat did, as her clown piece, a show called “From Birth to Death: It’s clown burlesque.” It was a life cycle show where the clown eventually began to lose body parts, bit by bit, as it went through the life cycle. Neither Pat or I knew at the time that this was going to be prescient for future experiences. Pat is here generously willing to talk about her experience with breast cancer and some of her insights about having gone through that process.

How to Show Up When You Have Cancer

  • 40:52

Elaine Smookler: Hi Pat, thanks for coming to talk with us today.

Patricia Rockman: Hi, Elaine.

Elaine: So I would love to know, What do you recall about your first moments after hearing your diagnosis of cancer?

Patricia: Well I already had a pretty good idea that I had breast cancer because I’d had some symptoms that made me suspicious. But getting the actual diagnosis —

Elaine: Do you want to tell us what those symptoms were just since you mentioned them?

Patricia: Mostly nipple crusting, which you can get when you do long runs and I had before but this was persistent so I was suspicious. So the diagnosis came on the phone from the pathologist and I really wasn’t surprised and at first didn’t feel anything at all. It wasn’t until they called my husband and spoke to him that I got really upset about it and we were both crying on the phone. So that was really my initial reaction.

Elaine: Very powerful. And you and your husband are physicians, so was there anything different do you feel — you’ve spent a lot of time with people who’ve also gone through cancer but who are your patients. What was that like for you and your husband being on the other side of it?

Patricia: Well there are some good things about being on the other side of it from the standpoint that I understand the system and I have a pretty good idea of how to make the medical system work best for me. On the other hand —

Elaine: And you have any tips for us when you say that, I mean that’s an interesting idea. Like what?

Patricia: Make sure that you ask a lot of questions, that you understand what’s going to happen in terms of the process. I think wheninv people are more informed they tend to do better. Also investigate: If you’re able to the research associated with the treatment that you’re having and if you feel the need to get a second opinion about what’s being suggested. Those are the main things.

If you have to have surgery, try to do your best to make sure that the surgeon is a good surgeon — this is not so easy to find out. It’s a lot easier to find that out when you work in the health care profession because invariably you will know somebody who knows somebody who works in OR, in an operating room, and this is what’s needed in order to really assess a surgeon’s skill because regardless of what people say about somebody it’s only when you see what they’re doing in that situation where you can really determine how good they are at their job.

Elaine: What’s interesting about that is that none of us may or not ever know the truth about that, but at least you have the understanding that you could ask those questions and do some investigation. I appreciate you mentioning it because it’s actually something that anybody could attempt to do. Certainly any of us are in position to ask questions and potentially, depending on your scenario, even change doctors if you’re not comfortable with the emotional support you’re receiving from your doctor because it’s a long journey and it’s good to know that you’re with the person who you feel you can talk to and connect with. Would you say that’s —?

Patricia: Somewhat. I think that with respect something like breast cancer where there may be a variety of treatments that you have to go through, not all breast cancers are treated in the same way. With something like chemotherapy or radiation there’s a protocol but when you’re working with a surgeon, not all surgeons are created equal. So you may think somebody has a really good reputation as a surgeon and they could be really bad. So it’s worth trying to find that out. As far as the emotional connection goes, I think for me working with the oncologist who provided the chemotherapy and was really the person who was at the head of the treatment team, having a connection with her was really helpful, really valuable. I wouldn’t say it’s so important with the surgeon. What I really care about in a surgeon is that they’re excellent with a knife.

 Elaine: Okay fair enough! Alongside your experiences going through the physical components of cancer was the fact that you’re also a teacher, a writer, you’re the co-founder of the Centre for Mindfulness studies, so I’d like to know how did mindfulness factor in, how quickly did it come in. You talked about that first emotional experience with your husband. So what was the “and then what happened”?

Patricia: Change happens in an instant, every change happens in an instant. It tends not to be slow. Like the birth of a baby, you get married, you lose a job, you lose a spouse: These things happen quickly, it’s a psychological transition that takes time. I think mindfulness can help us with that because unless you’re incredibly evolved we’re always going to react to what life brings us. It’s really what you do next after that initial reaction — how might we respond skillfully or in a more healthy way.

Elaine: This is a really key point because I think for people who are just coming to mindfulness maybe particularly they’ve received a diagnosis of cancer their doctors said you should check out mindfulness. Perhaps they think mindfulness is going to solve all my problems and I really appreciate that you’re saying we’re still human beings. We’re going to have thoughts and feelings, they’re not always going to be peaceful.

If one expects one isn’t going to have difficult emotions, good luck with that. It’s what you do when they show up that matters: How do you treat yourself, how do you treat other people, what do you do next. Is it helpful or is it harmful?
—Patricia Rockman

Patricia: No. And in fact for me mindfulness has been most helpful in managing the difficulties of life. I often jokingly referred to myself as the queen of misery because I treat people with mental health problems who have depression and anxiety and people don’t come and see me because they’re happy. I really see my role as helping people to be able to manage difficult emotional and physical needs in healthier ways. Mindfulness can help us to be less immersed and overwhelmed by difficulty and be able to get a bit of space so that we can have choice about how we respond to what life throws at us. So for me, with the breast cancer experience, you’re immediately pitched into the role of a patient, you’re identified as sick even if you don’t feel sick. And treatment happens really fast with breast cancer. There isn’t a lot of time to contemplate, to think about, to adapt to the changing role. You’re kind of doing it all on the fly. I recognize in retrospect that there were certain decisions that I made from a reactive state, although I didn’t even necessarily know it initially so I ended up treating many decisions like they were urgent when in fact they were not. The only urgency is to start your treatment as quickly as possible. Whether that be chemo or whether that’s radiation or whether that’s surgery. All the rest can wait.

Elaine: So part of the mindfulness is the mindful awareness of our fight flight freeze response also of how quickly we want to get out of threat and how fast we might try to move away rather than giving ourselves the time and space. Is that what you’re saying to let it unfold a bit?

Patricia: Yeah. Mindfulness can help us to know when we need to do something and when we don’t. It can help us to see when we’re being driven by our emotional reactions and actually want to get away from the discomfort that comes with those versus when it’s actually necessary that we do something.

Elaine: So I’d like to investigate this a bit further. You used the word choice and there were some choice points in very kind of ordinary ways along the way that I would love to talk about. For instance some of the choices you had to make when your hair started to fall out.

Patricia: Right. It’s pretty much the norm, not everyone, but it is not uncommon that people will buy a wig when they lose their hair from chemo. Why is that? I didn’t even think about that initially. The health car