From rural So. Dak. to Kathmandu by way of Iowa: Choosing Life
I know what you’re thinking from my title…..that I’m a cancer survivor. I am not. I am a family physician from Iowa. I’m still processing my experiences on the trip to Nepal with Above and Beyond Cancer. In the meantime, I’d like to share what I’ve learned so far from taking care of people with cancer, being the daughter of a man with cancer, and traveling literally half way around the world to Nepal with cancer survivors and caretakers.
I grew up in a small town of 200 people in central South Dakota, with mostly dirt roads, some gravel. My Dad was the town blacksmith and my mother was a nurse who worked in a town nearby. Against all odds for that time and place and circumstances, my four siblings and I all went to college and graduated, and I went on to medical school.
In practice, I never took for granted what an honor it was to be invited to share the lives of the people who came to me, whether I was delivering their baby, treating heart failure, helping families care for loved ones with dementia, or diagnosing their cancer and going through that journey with them.I felt particularly close to my patients with cancer, the very word “cancer” brought mortality out of the closet where most of us keep it and put it right between us. Those connections occurred at an accelerated pace and were deeper. I disliked the words “fighting cancer” as some litmus test for survival, as though only those or all those who fought hard, survived. I told my patients that we would treat their cancer, but that the real fight against cancer was to live their life every day the way they wanted to, to the best of their ability. We didn’t have the word “survivorship” at the time, but that’s what it was.
When my Dad was 59 years old, he was diagnosed with stage 4 colon cancer and I learned in a very personal way, that cancer is a disease that affects families, too. He had surgical excision of the primary orange sized tumor, as many of the positive local nodes as the surgeon could find, and a seemingly isolated 2 cm solitary liver metastasis. His physicians couldn’t initially agree on what his treatment options should be, and while they hashed it out, he decided that he wasn’t going to have any further treatment. He was going home to that rural town with dirt roads three hours away to enjoy being a blacksmith, drinking 30 cups of coffee per day, talking with friends, and hanging out with my Mom, who he met when he was one year old and she was a newborn. They grew up across the pasture from each other and shared a desk at the country school. He didn’t know how many days or weeks or months he had left, but he knew what he wanted to do with whatever that amount of time was. I was afraid that he would ask his doctors what his prognosis was, and even more terrified that he would ask me.I knew I would have to be honest with him. He didn’t ask, and I didn’t say anything. I lived in dread every time he had blood drawn or a CT scan, and I would take time off work and take my babies and toddlers out of state to be with my mom in that waiting room every time he had a colonoscopy, so that my Mom wouldn’t be alone when she heard that the cancer was back. After 10 years, I stopped doing that, and had learned from my Dad’s example to choose life and take every day as a gift. After 20 years, my Dad told me he didn’t want to do any more colonoscopies and I said that was fine with me. He died 25 years after his diagnosis of cancer of complications of Parkinson’s disease at the age of 85. Coming from a place of science, I thought I knew what my Dad’s journey was going to look like. I didn’t. I had to experience this to truly believe that nobody knows what anybody’s journey is going to be. It was a humbling experience and I was grateful for it.
When we visited the cancer hospitals in Nepal last week, I was so touched by the people we met. The Nepali people are warm and kind and closely connected to each other. The physicians and staff are intelligent, very well educated, and closely connected to the patients they care for. Their ability to care for their patients is limited by the resources available to them. At the Kanti Children’s hospital where they treat children with acute leukemia, there is no blood bank. It’s not uncommon, when a child starts bleeding and they send staff out into the streets to find a blood donation, that the child has bled to death by the time they get back. As we came to a bedside, it wasn’t unusual for the patient or family members to start crying, and even though we didn’t share a language, we understood those tears. I kept thinking these people would give anything to be back in their own homes, calling their children in from play to eat their their meal of beans and rice, work hard, share a few laughs and then do it all over again, that nirvana would be the chance to savor more ordinary moments. There were survivorship stories, too, and Nepali role models for choosing life. A humbling experience, again, and I am grateful for it.
And then there are the people I traveled to Nepal with from Above and Beyond, cancer survivors, caregivers, and staff. I would say that I can’t say enough about all of them, but I can and I will…in future blogs.It has been such an honor and a privilege to get to know all of them and their way of being in the world and I have a place in my heart for each one of them because of who they are and our shared experiences. These people choose life every day. They all do it a little bit differently, but the universal theme is that everyone is making the most of their ordinary moments and living their own life the way they want to. This is what I need to be reminded of. Don’t wait. Savor that morning coffee like it’s a religious rite. Sign up to be an Ironwoman. Dance the tango. Practice your Arabic. Call your loved one at 4:00 in the morning to chat from Nepal because you miss them and want to hear their voice. Dig even deeper. Take your kayak out and float your day away. Host a slumber party to a dozen junior high boys, tell your “best lost camera story” . Bring goofy pictures of your now grown children when they were younger in a ZipLock bag and share laughs with new friends. Wear the fanny pack. Today. No matter what anyone says.
