STORY BY

Drs. Blair and Rita Justice

While in This World...

What we can give to one another during painful times

The shock comes quietly. The doctor shifting in his seat with our test results in his hand. The email with the news that a friend has been attacked and is in the hospital. A child’s hot forehead in a too-heavy sleep.

Each of us has experienced—with a loved one or with ourselves—that quiet shock, whether it takes the form of an unexpected biopsy report or overnight poverty from a Ponzi scheme. The shock for our family came when our strapping 28-year-old nephew Will, a captain for SEACOR, was diagnosed with Stage 4 lymphoma. His mother’s measured voice, strained with fear, said on the phone, “We have a situation.”

The “situation” for Deborah Rose Sills, a professor of religion at California Lutheran University, was that of being diagnosed with ovarian cancer. Her treatment and her extraordinary walk on that journey which ended in her death is told in The Light Within: The Extraordinary Friendship of a Doctor and Patient Brought Together by Cancer (William Morrow, 2008). It is a poignant book co-authored by Sills and her friend and physician Lois M. Ramondetta, MD, assistant professor at The University of Texas Medical School at Houston and associate professor of gynecologic oncology at UT M. D. Anderson Cancer Center. The two met in 1998 when Sills was a patient and Ramondetta was halfway through her oncology fellowship. Over the next eight years, the women’s friendship grew deep and true. They traveled together, collaborated on projects, visited as families and shared their inner struggles of life. They supported each other in the wisdom each brought to the art of learning to live fully, knowing illness was a certainty and death would come soon.

Ramondetta reflects on the relationship: “Deb was right in saying that friendship, like marriage, was an ongoing conversation. I had never had a friendship quite like this one, and I valued it immensely. I also think it was making me a better doctor. I was able to see, firsthand, what Deb and her family were going through—was able to share the emotional toll. If I’d had any reservations, ethical or emotional, about getting too close to patients, they were gone. Deb was taking me farther inside the worries, fears, and hopes of all my patients, and that couldn’t possibly be a bad thing.”

Resilient living

Although shock may be our first response to unexpected challenge, what follows is the “getting on” with the task of coping. The first necessary act in a successful response to shock is to draw deep down into the well of “psychological resilience”—a person’s capacity to withstand stressors and find one’s own level of resilience.

Psychologist Salvatore R. Maddi, PhD, and his colleagues at the University of Chicago conducted a landmark 12-year longitudinal study that involved 26,000 employees of Illinois Bell Telephone as it was being downsized by half in one year. In the enormous restructuring and change, about two-thirds of the employees in the study suffered significant performance, leadership and health problems, from heart attacks, strokes, obesity and depression as a result of the extreme job stress. One-third, though, actually thrived during the same period of corporate upheaval. What was the difference?

Maddi found that those who thrived maintained the “three C attitudes”—commitment, control and challenge. The commitment attitude made them decide to be a part of what was going on, rather than to feel isolated. The control attitude led them to try to influence outcomes, instead of lapsing into passivity and powerlessness. The third “C” was challenge, which made stressful changes seem to be opportunities for new learning.

In the years since that study, many researchers have built on Maddi’s work on resilience. In A Different Kind of Health: Finding Well-Being Despite Illness, Blair Justice, PhD, professor emeritus at the UT School of Public Health (and co-author of this article) summarizes the essence of this abundant research and gives examples that illustrate the three Cs. He concludes, “We are more resilient if we are able to transform adversity into accomplishment, to use physical crisis as a challenge to grow an emotionally and healthy nonphysical self.” Sills wrote in her book that when she was in a terrible period of despair, her husband, Giles, said, “If fear wins when one is in the world, then cancer wins... Death will take us all, but the real drama lies between one’s terror of loss and the possibilities of the present.”

Resilience, then, plays a critical role in coping with adversity. So also does sacrifice, the efforts others make, sometimes at great cost, to give us what we need when we are ill. Nearly every patient is accompanied on the journey of illness by someone who cares and who sacredly sacrifices plenty. Time, sleep, play, work, fresh air, exercise, money, food—blood. Whatever the extent of the sacrifice, the caregiver also benefits greatly. Many studies have shown that altruism is good for your emotional well-being and can measurably enhance your peace of mind. For example, family members of dialysis and transplant patients who became support volunteers for other patients experienced increased personal growth and emotional well-being. (Brunier G., Graydon, J., Rothman, B., Sherman, C., Liadsky, R. The Psychological Well-Being of Renal Peer Support Volunteers. Journal of Advanced Nursing. April 2002.)

‘The pleasure of her company’

When the ovarian cancer was very advanced and she was quite ill, Sills made a promised trip to Houston for a joint lecture with Ramondetta to several hundred oncologists and oncology nurses. Deb was frail, pale and nauseated to the point of vomiting shortly before the talk. Of the experience and similar ones she wrote in their book, “Writing together and speaking on issues related to human spirituality and cancer care have provided me with the opportunity to enjoy what my mother would have called ‘the pleasure of her company.’ It has enabled me to reflect on the character of human friendship and the ways in which friendship shapes the present and informs the future. Dr. Lois has helped to keep me in the world, not because she has managed the diagnostic tests or the chemotherapy agents that are involved in bone marrow transplant or in the cancer care that followed when again I fell out of the ‘Remission Society.’ Rather, I am younger for her friendship, and with her I have plans that involve both desire and good work, the imaginary and the real.”

Nearly all of us will be called upon to help someone in need of care. We may give out of love, loyalty, obligation, fear or guilt. The “why” doesn’t matter all that much. We will become part of the healing journey, and we all become bound in a way that heals each of us. Our family mustered “Will’s Army,” which joyfully disbanded when he was declared cancer-free six months after the terrifying diagnosis.

The philosopher Spinoza had it right about conatus, a striving to preserve essence. Essence shines through when everything else inside and outside the body goes down the tube. Resilience and sacrifice help us to transcend shock and suffering. In describing Deborah Sill’s death, Ramondetta says, “Deborah deserved the last word: While you may not ever get over it, she used to say, you still need to get on with it. And so we began.”

Last Updated: 4-08-2009

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