Be the Boss Over Cancer

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Like many cancer survivors, you may now think of life as B.C. and A.C. — for, of course, before and after cancer. Once you've coped with cancer, life isn't the same. Survivors talk about major and minor overhauls of their lives — from taking another look at their family life and other relationships to switching jobs, finding an entirely new career or pursuing new leisure activities. Our panel of experts: Page Tolbert, L.C.S.W., a social worker at the Memorial Sloan-Kettering Cancer Center's Post-Treatment Resource Program, New York; Elizabeth Clark, Ph.D., M.S.W., executive director of the National Association of Social Workers, Washington, D.C.; Bobbie Bernstein, the pseudonym for a cancer patient in New York whose life is changing; Debra Thaler-DeMers, a California cancer survivor turned oncology nurse; Susan Leigh, a three-time cancer survivor and oncology nurse consultant in Tucson, AZ.

How cancer changes you

While you and everyone else knows at some level that life is finite, you probably have never thought about it as concretely or as frequently as after a diagnosis of cancer. Cancer survivors are acutely aware of our limited time on earth, mental health experts say. Mortality is, quite literally, in your face. So the cancer experience affects your perception of time. You may feel suddenly impatient and become acutely aware of your frustration at spending time at things you always perceived as meaningless — only now they may seem more so. Whenever you have a more acute sense of time being finite, you start to think more and more about what matters to you and how you want to spend your time. Trite as it may sound, cancer truly is a life-changing event. Often, someone who has weathered a cancer diagnosis comes through treatment much stronger — and ready for change.

Why cancer changes you

Although many more people now survive cancer, there's always the thought that your cancer could be life-shortening. At the least, you're aware that you expected to live to 85 or beyond, and die of old age, but that your script could be different. And that's reason enough to rethink career, friends, family, travel and other leisure pursuits. Much like a global tragedy like the 9-11 attacks on New York and Washington made a whole nation rethink priorities, a cancer diagnosis shakes you up, from head to toe.

Is your reaction typical?

No one says, "I'm glad I got cancer." But most everyone says "It changed the way I look at my life, the way I handle relationships, my career, everything." Your reaction is very typical if you are talking about your need to do something more meaningful—whether on the job or off the job, such as spending more time with family or volunteering for a worthy cause. Your reaction is typical if you find yourself thinking "Life is precious and meaningful. How do I make changes in my business life that support the changes I want to make in my personal life?" Mental health experts who work with cancer survivors say it's common for people to seek out more creative, and therefore meaningful, avenues of work or leisure. It's typical to hear an investment banker say they'd like to be a poet, but much less rare to hear a poet decide to become an investment banker. For many people trying to shift to a more meaningful job or career, money becomes secondary--despite the fact that medical bills may be overwhelming. On the other hand, if you have been living "hand-to-mouth," you may decide you need to get more education or apply for better-paying jobs. If you are "under-stressed" or under-stimulated at work, you may be even more likely to think about change.

One woman's story: from law school student to oncology nurse

Debra Thaler-DeMers, now 50, was in law school, 25 years ago, when she got the diagnosis: Hodgkin's disease, a cancer of the lymph system. "It changed my career," she says now. These days, she is an oncology nurse at Stanford (California) University Hospitals and Clinics. And in 2005, she was the Oncology Certified Nurse of the Year. Her life change started when she had to drop out of law school, so debilitating was the extensive radiation required to treat her Hodgkins. When her medical problems settled down, she went back to grad school to study mind-body immune systems. And she ran support groups for cancer patients as a volunteer. Then life took another unexpected turn. "My younger sister was diagnosed with Hodgkin's three years later," she says. Debra helped care for Terri Thaler, who told her how good she was in the role. Terri died, and Debra decided to go to nursing school. These days? "I'm not as rich but very glad. The decision was pretty easy. I was very motivated. I felt one of the advantages I had was to know as much about my own disease as possible." During her days, filled with talking with cancer patients, "I don't tell them I am a survivor unless I think it is going to help them in some way. If I have a patient who is discouraged, say, and says, 'No one ever survives.'" That patient hears her story. The payoff? "To help them find meaning in this experience, to finish the things they want to finish up if they know they aren't going to survive." Among Debra's activities have been to help patients write letters to their children's future events, such as proms or weddings. Sometimes the payoff comes in the form of an email, such as a recent one from a young leukemia survivor, who attached a photo of himself backpacking.

One woman's story: from work-work-work to a more balanced life

Bobbie Bernstein (not her real name) was a go-go-go ad sales rep. Single, loving it, the Manhattanite would typically work 60 or 70 hours weeks without a thought. She was an executive at major magazines. Then came the diagnosis of a very rare cancer affecting the appendix that had spread to the ovary. "It was very bad," she says. At 50, she thought she had plenty of productive work years left. After surgery, chemo and a long recovery, one day at her job she said to herself: "I survived cancer to do this?" She thought of what else she might do, but came up empty. Finally, she decided it wasn't the career, but the place she worked, which wasn't well-managed, she says. She found another publication, better managed, and has remained in her original career—for now. "What I am finding is, I enjoy being back in the workforce. But I look at work differently. It is not my whole life. Before I was much more of a workaholic. My work is not who I am and I think it used to be, although not totally." "I worked much longer hours, like 60 or 70. It's down to about 50 hours now. And I know the job isn't life and death. I like what I do. I get satisfaction out of it. And I'm a pro." Still, she thinks about other possibilities, including writing. "I'm not so sure this is what I want to do for the rest of my life." And, like many cancer survivors, she is a realist. "The rest of my life may not be so long. The cancer might come back, but right now I am cancer-free." Even financial woes don't get her down like they might have before. "Financially, I'm a mess," she says. "The Internal Revenue Service is after me. I got very bad accounting information from my accountant. On the other hand, it's only money. I have my life. And I have energy."

One woman's story: from Vietnam to part-time work

Susan Leigh was just 24 years old when she returned to Tucson, AZ, from her stint as an Army nurse in Vietnam and learned she had Hodgkin's disease. "It was an isolating time," she said, "There were no support groups. This was 1972, the "ice ages" in psychosocial support of cancer patients. Then came breast cancer when she was age 43 and, in 1995, she learned she had early stage cancer in situ of the bladder, technically a pre-cancer. Today, she's stronger, more settled, and a sought-after speaker. She became an oncology nurse after more schooling and accepted an offer to work for a time with her oncologist at the University of Arizona at Tucson. Now, she mixes speaking engagements with writing and editing—most recently an oncology textbook chapter. Like many, she says, she asked, "Why me?" "Why was my life saved?" Because it was, she says, "it was so important for me to make meaning of it." One adjustment she's made that she's proud of. She tries to work part-time, sometimes going to three-quarter time. Avoiding a fulltime job gives her a sense of freedom, and she finds that invaluable.

Typical career strategies

Sometimes, finances get in the way of your search for more meaningful work. For instance, you may say you want to leave your low-paying, un-stimulating job and go work with underprivileged kids—but that may be even more low-paying. Typically, as a cancer survivor, you may be forced to create short-term and long-term plans to realize your goal of getting to more meaningful work. In the short-term, you may need to stay at a less-than-satisfying job to pay down debt, including medical bills, before you can enjoy your plans for long-term job change.

Gearing up for change

While it's normal to want to charge into change, mental health experts give trite but valuable advice: look before you leap. Use the same methods for decision making as you made about your cancer treatment--research your options, look around, get a lot of opinions. Don't impulsively switch jobs--see if you can "shadow" someone in your coveted career, at least for a day or so. Research the chances for advancement, or the chance to live in other parts of the country--whichever is more important to you. Change at a pace you're comfortable with, but know that the urge is to go too quickly.

How to ease into change

It's typical for cancer patients to want to do volunteer work, especially at hospitals or with support groups. Some mental health experts advise you to put off that experience. At Memorial Sloan-Kettering Cancer Center, for instance, you can't become a volunteer until at least a year or more post-treatment. The thinking is this: you need some time to process and digest your own experience before you can help others as much as possible. Know that your family may want to coddle you, protect you from doing too much too soon. You may need to reassure them you're capable of, even need, new challenges.

Getting help with change

Your company may offer career counseling or you can take advantage of workshops specifically designed for cancer survivors. One such workshop is offered yearly by Memorial Sloan-Kettering Cancer Center for a very minimal fee of about $15. (For information, call the Post-Treatment Resource Program, 212-717-3527.)

In balance

If you're a typical cancer survivor, you have a sense of "forward propulsion" that comes out of the experience, a sense that the sickness, now in the past, was perhaps one of your greatest motivators. And, with some patience and planning, the end of your cancer story is often a happy one, complete with more meaningful relationships on and off the job.