Episode 19 Shownotes - Why Anger Hinders Treatment and Cure

You are listening to Best Life After Cancer, Episode 19.

Hi, and welcome welcome to all the new people! I am so excited, after months of work, the podcast is starting to take off, there is increasing interaction in the survivors group on the Best Life After Cancer MD facebook page, and I feel like I am making a difference in people’s lives. It helps if you guys write reviews of the podcast which makes it show up easier when people search for it. If I get to 100 by Christmas, I will stop bugging for a bit!

The housekeeping – I am a doctor, but not your doctor, so run what I say by your team before adopting any medical advice.

It is feeling like fall here this week! Suddenly, it is chilly at night. The leaves are starting to change. The kids are back in school, 3 in a hybrid model, and one full time in person. We are getting used to the schedule, after a long time without really having one. My littlest is playing soccer on a town rec team. They are doing a great job screening everyone and it feels like they are keeping everyone safe. It is nice to see the kids running and playing, and it makes things feel a little more normal. I was chilly on the sidelines at practice last night, so I remembered that it is time to stock the car with a blanket, sweatshirt and hat so I always have them. It seems like so long since I was at a kid’s sporting event. Last week my husband was away, hiking with my younger brother. It is a busier week when he is gone, when I am working and solo parenting, and carpooling without him, so I am really happy to have him back. He and my brother go hiking every September, and it is something that really makes me appreciate him when he’s back. A friend asked what I got out of this week. In the moment, I said “a week with just me and my boys where I can spoil them the way I like” and he said, “no, I mean like a trip, or a shopping spree, or what?” I told him we don’t work like that. We both do the things that fuel our own happiness and wellbeing, and we try not to dictate to the other person what they can and can’t do, and we certainly don’t go into it with a tit for tat mentality. When we take responsibility for our own happiness, it is so much easier to be happy than when we farm out our happiness based on what someone else provides. They may not do it just right, or may not want to do what we need to be happy. So, consider taking responsibility for your own wants, needs and dreams. For me, I spend time and money on ballroom dance. He hates it. I took my oldest son to the Galapagos when two other family members were going. My husband and some of my other kids get violently sea sick, and had no interest, but it didn’t mean we couldn’t go. He and my brother hike and camp. It is 12-15 miles of hiking a day, in aggressive terrain, with no hot showers the whole week. Rehydrated food from a tin foil bag. Pooping in the woods. Not really my thing. But bring it on for him! He and his brother often meet up for a conference in Jackson Hole, where his sister happens to live, for a few days of aggressive skiing. I love to ski, and Jackson is awesome, but he loves to do it with his brother – fast runs, hardest slopes, really killing it a few hours a day, and then a few hours of lectures, and I don’t mind watching the kids so they can have that time together. I want to challenge you. If you are in a relationship where you expect something back whenever you give something, maybe you want to evaluate that. I love feeling like I can choose what I want to do and know he will support it, and he loves being able to do things that I might not be jumping up and down to do. Brook Castillo always coaches on having a spouse just to love them, and not expecting anything but love back. It may seem a foreign concept, but the more I work on it, the better our relationship is.

Enough about that for now, but if you want to hear more, tune in for the Facebook Live at Best Life After Cancer MD in the survivor’s group on Saturday at 9 am, where I will get into that a little deeper. Today, I want to talk more about how our thoughts create our realities, and more specifically, why anger is a destructive emotion to go through cancer treatment with. I have had patients over the years that were extremely angry and bitter about their cancers, and it spilled out of them and onto their families, the people there to treat them and help them, and strangers at the grocery store. Many patients are angry, but some come in and really wear it on their sleeves. It happened recently, and it was so enlightening to me to observe with the lens of a life coach. Always before, I have just looked at it as an oncologist, so this was new to me. The case I am going to describe is a pretend patient, to illustrate this to you, so as to protect the confidentiality of all patients.

I walked into the room with Mr. Smith. He had recently been diagnosed with prostate cancer (which, by the way, I don’t actually treat personally). He glanced up when I walked in, then right back down at his phone. The nurses had warned me he was angry, to the point of being belligerent and intimidating. I asked how he was holding up, and he said, “how would you be if you had surgery and the cancer was much worse than they thought and now you had to have radiation?’’ Eyes back to his phone. I did my best to engage him, and get through our discussion. He answered the questions with as few words as possible. He seemed to not really be listening as I described the treatment and side effects. When we did the consent, he grumbled about signing, saying, “I’m sure I will have ALL of these effects. So far, everything has gone wrong.” I asked if he had questions, and to be truthful, breathed a sigh of relief when he said “I just want to get done and out of here today”.

Ok. Let’s pause a moment - what did that buy him? It did not create a rapport with me or the nurses. It did not lead to him really paying attention and absorbing all that I was saying. It did not lead to him questioning what he was unsure about, and really having a good handle on his care. It did not lead to him really paying attention to the risks and benefits, and how he needed to be a participant in his treatment.

When treatment started, I told him he needed to come every day with a full bladder. This helps push the small intestines out of the pelvis and reduces side effects from treatment. He was angry that he had to come for the planning in the morning, and was not looking at me at all as I spoke. He had a newspaper, and appeared to be looking at it in between the stink eye stares he was giving. It was pretty clear he wasn’t really listening to the instructions I gave, because he was distracted with fuming about having to miss part of work that morning. We did his first treatment, and saw on the check films that the bladder was not as full as it should be. I alerted him, and he said something along the lines of “I didn’t think it was really that important”. I again asked him to work on it. He went into an angry litany of why he couldn’t have a full bladder for treatment. He had to drive here. He didn’t like water. Having a full bladder was uncomfortable. It was too early to get up and drink before he came for treatment.

What did this amount to? He didn’t hear and understand the importance of the instructions because he was so wrapped up in his anger at the cancer, the world, and everyone in it. His anger made him look for all of the reasons why he couldn’t possibly do what I asked him to do. This is something our brains do, called a negative confirmation bias. This means if we believe something negative, our brain will go to work looking for all of the data to support that belief. So, he continued to get treated with a less than full bladder.

This lead to symptoms including diarrhea and urinary complaints. This made him more angry, and he had a weekly on treatment visit where he told me in a heated way that just like he expected, all of the bad things I told him were possible were coming to pass. Not filling his bladder from the start created the reality that now it really IS challenging to fill his bladder, and he fills it even less, and the side effects get worse. It is a vicious spiral downwards.
This is obviously an exaggeration to make a point. Just so you know for sure it is not a real patient, I do not even treat prostate cancer! But there are people who come in in this state of mind. They are angry at the staff, short tempered, even rude sometimes. It is human nature to avoid someone unpleasant, so often staff will look down as the person walks by, or they say the minimum to avoid eliciting an unpleasant remark. This does not generate the rapport that we hope to have with patients, where they feel like they can talk to any of us, whenever they need, to get the support they need. When angry patients are distracted and not engaging, they miss the opportunity to really understand their care at the deepest level. They fail to join with us in creating a seamless team to fight the cancer together. I know personally, I still do my very best to care for them, but may not ask probing questions that might help me find things I can help with, when every attempt is met with a rebuttal, anger, and nastiness, or just flat stares with no answer. We might not spend time discussing what type of exercise will best support them, or how meditation can calm them, or what massage therapist really is good for helping the body feel nurtured. Not from me not wanting to, but from a natural sense of self preservation, and from a recognition that they don’t want to spend one extra minute in my presence. They are angry at the cancer. But honestly, the cancer doesn’t care. I think it even feeds on this type of negative energy. The patients are angry at god or the universe, but it comes out aimed at the people trying to help them. It is hugely counterproductive.

For sure here, I don’t want to tell you that you can’t be angry. You have the absolute right as a human to feel whatever you want to feel. But you should just be aware of the effects of the emotion and the actions it is driving. When we feel a strong emotion like that, often we are not aware of the underlying thought creating the emotion, but I find that often it is useful to try. Finding the thought can help you realize that you are mad, but not at the sweet therapists who run the radiation machine. Is the thought “everything bad always happens to me?” “I didn’t deserve this?” “I am terrified I am going to die, and being pissed feels better than being terrified?” Finding all of these thoughts often allows you to function a bit better. I have so much empathy for the really angry patients, and often, I am able to help them through it during their treatment, because I find for so many, they are actually terrified, but can’t feel that feeling without completely breaking down, and so they suppress terrified with furious. But not all doctors will work that hard at engaging a furious patient. Not all staff are willing to be spoken to in that way. If you are pissed, find what thought is there. Evaluate it. Tweak it, so it is not alienating your friends, family and the people there to care for you.

So – from my standpoint, let’s talk about how a discussion with an angry patient could go. Back to Mr. Smith. Mr. Smith, you seem so very angry and it is making it really difficult for me to help you. Mr. Smith – I have a right to be pissed! Me – of course you do. But I don’t want that being pissed to keep you from doing everything you can to be cured of this cancer. Are you able to find which thought is leading to feeling so pissed? Mr. Smith – while grumbling – I think it is that everyone else who get’s prostate cancer, their treatment is quick and easy. Mine, nothing is going the way we planned. It just isn’t fair! Me – I agree. Life in general isn’t fair. We don’t get to choose what hand we are dealt. But we have to play the hand we get, because folding is not an option! How can I help you get through this? Mr. Smith – you are right. I don’t want to fold.

This little conversation is a crack in the anger that allows us to start to work together. But you don’t need to have that conversation with your doctor. You can have it with yourself. Ask – why am I so angry? What is that anger driving? You may not want to see what it is driving. Once you do, you may feel sad or ashamed. It is ok. Don’t beat yourself up. Realize it, love and forgive yourself, and move forward. Make a plan to do better. Lean into the fear, don’t force it down. Suppressing the fear leads to needing other strong emotions to keep it down. Just let the fear be there, like a backpack full of school books. As you wear it, the books get dropped to different classes and the backpack gets lighter. Maybe not the first day, but with time and work. This is SO hard. Coaching helps. Support from other survivors helps. It is ok to not be able to do it on your own. A quote I love from Ekhart Tolle that helps me really understand this. “Whatever you fight, you strengthen, and what you resist, persists.”

Ultimately, our hope is that we get to a point where we can be pissed at the cancer together. Your team is there to fight for you, and work for you. But you have to play your part. You have to do your job. Whether it is keeping your bladder full for treatment, or eating right and exercising, or limiting your alcohol. You can’t let the anger keep you from doing what the right thing is to maximize your odds. If your treatment is finished, and bitterness is making it so you overeat, overdrink, don’t exercise, and binge on Real Housewives of LA, well, that bitterness is helping your cancer and hurting you. It is EXACTLY what the cancer would most like to have – stress hormones to help it grow, and none of the things you can do being done to hinder it’s growth.

At this point, so many people have an a-ha moment, and see what they are creating. Immediately, they feel awful. They start beating themselves up for creating this. They hate themselves now instead of the cancer. Let me tell you – hating yourself creates the EXACT same things as hating the cancer. You have to LOVE yourself well. You can’t hate yourself well. I am working on a coaching group for people who want to do this work together. It will include weekly live coaching with me, workbooks and self guided work. It is starting soon. I would love to have you there with us. Go to bestlifeaftercancer.com to get more information and sign up for updates for the group.

Until then, do the work to see what your emotions are creating for you. Keep the ones that are driving good things. Get rid of the ones driving bad things. Get help if you need it. Much love, talk to you soon!