Not worried enough-stories of denial

07/17/2009 at 5:24 AM Leave a comment

A young patient came in quite worried about cancer. Not any particular cancer, such as lung ( patient smokes) or something that runs in her family. She did not have any symptoms or lumps. She acknowledged that her fear was unreasonable but she wanted “all the tests” to make sure she did not have it. 

The remarkable thing was her obliviousness to the effect her smoking had on her. She did not seem to be aware of the incongruousness between her wanting to know if she had it, versus preventing it. She could not acknowledge that the smoking was a problem. In her mind the solution was about being vigilant and catching anything before it became a problem. The actuality that by the time you catch it you are way too late ( even if you catch it early there are consequences–much better to prevent it)*. 

Furthermore, there is not such thing as “all the tests”. I think of this as the Star Trek syndrome. The doc gets some magic wand waves it all over the body and it tells you all there is to know. I used to wonder what the use of the doctor was. ( which became evident in one of the series when the doctor was actually a hologram generated by the computer).

It is one thing to realize that your behavior is potentially damaging but you are unable to alter it, quite another to ignore that fact and believe that science fiction will save you.

 

Sure, if you catch some cancers early you are ‘cured’. And this is a great thing. In some others, even if late chemo can almost ‘cure’ you: c.f. Lance Armstrong. But his does not mean there are not consequences. The consequences of chemo are obvious, of surgery to remove a tumor also obvious, but the emotional consequences are real and usually life long. Once you have had cancer you now know that you could get it again. Every time you go for a screen ( PET, CAT scan) to see if it has returned or spread  it is on  your mind ( and your loved ones minds) and for nearly all people this severely impinges on their well being. There is no “getting over it”. It is a life long concern. Much better to prevent it when possible.

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No guts No Thinking required or allowed A world of difference

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