Emotions & Cancer

Here are a few questions asked by a local reporter in regards emotions and Cancer:
Are previously reticent people more open to discussing emotions and spirituality once they have been diagnosed with cancer?

I have heard that attitude is an important part of beating cancer. How can loved ones help cancer patients change their attitude if it is not positive?

Responses from Dr. Rutledge

The response to a cancer diagnosis is highly variable - but most people approach their diagnosis as they have approached their life. Sometimes the cancer diagnosis can open people right up - like Andrew (see inspiring video link for his story on our website). Cancer provides a real opportunity to realize that life is very precious whether we live for another 2 years or 52 years. When people consider that carefully, they may be able to facilitate a deep transformation in their lives.

Being a loved one is very difficult. Lots of stress and often little to do but listen and brings one's loving presence to the person with the diagnosis. I don't recommend trying to change anyone - I think if we change ourselves - do our own work, deal with our own fears, let go of our judgements, be honest and open with our own emotions, then that brings a space in the relationship which may facilitate a change in perspective - but loving the person for where they are at is the goal.

Facing emotions head on: The most obvious example is working with the fear of recurrence or death. If every time those feelings come up, you simply try to suppress it, then the issue won't go away - and often comes out in different ways. If we look at the fears, we begin to understand them, untangle them, question them. It takes the power away from the fear - and we can let go of the exaggerations and extra suffering

A Few Words From Andrew

The following blog is by Andrew who was featured in Chapter 5 in The Healing Circle. Andrew was treated for an agressive brain tumour over 3 years ago and is doing extremely well.

This is a "Meta-Meditation" he uses everyday as part of his healing practice.

May I be safe from internal and external harm

May I be happy - just as I am

May I be healthy - may my body serve me well

May I be peaceful - and at ease

Like many of life’s events, any healing journey exposes you. It can shatter or build you up depending on your attitude, intention and commitment; e.g., a cancer trek is not for the faint of heart. Character is fostered at all times but in tougher times, whether patient, caregiver or MD, it reveals itself as you are tested of life’s diverse levels simultaneously, that is, physical, intellectual emotional and spiritual.

The journey is made quite complex since it is a marathon not a sprint. For me, meditation became a vital part of a journey (dharma/Path) to health. It reduced stress and offers time to sort things in my mind. I believe it might be helpful for others for, its calming effect reduces blood pressure and helps receive a focus with fortitude that can be coupled with a healthier life-style e.g. balanced diet, exercise and sleep.

One helpful form of meditation I found was Mettā which is one of 10 pāramitās of the Theravāda school of Buddhism*. Buddhists believe that if you are at peace, you become happier in yourself – perhaps a bit like being on an idyllic warm beach in the Caribbean when you know it is winter cold at home in Canada.

While Mettā takes about 20 minutes to do, its effects last longer. Over time, it centers peace into you. It is an antidote to fear since it helps you focus to a return to ‘self’ as it trains your heart. It plants seeds of intention and like flowers, some flower soon but other seeds take a while to bloom.

After preparatory relaxed breathing, meditate on a shortened form (bold) or, a longer form (italics). Longer forms exist but their purpose is the same. They fill your heart’s reservoir with essences of loving kindness, friendliness, benevolence, amity, friendship, goodwill, love, kindness, sympathy and interest in others. The object is love without attachment which starts by expressing it toward inward. You must love ‘you’ before you can love others.

With practice, your reservoir of loving kindness fills. When full, you can direct it to others, friends and foes, known and unknown - like waves ripple out when a stone is tossed into calm waters. You can only give it away easily if you harbour no ill-will and have no personal motive; but if not full, e.g. as a caregiver, your energetic battery drains and leads to ‘burn out’.

Wonderful words craft Mettā, but can you reveal meditative concepts with limits like words? Not really. It is better to feel them; but that said, here is an attempt:

1. Safe - Everyone needs to be safe. Harmful things in a world outside can range from a corrupt political system to street hooligans to fierce weather. It can be worse if you hear harmful voices in your mind ranging from bad habits to unresolved conflicts. Whatever it is, Mettā offers a way to train your mind to get to an inner safe place free from perceptions of danger. It gets front-row-seats to see an amazing person – you!

1. Happy - Everyone dreams to be happy. Imagine the exquisite nature of wanting to be happy “… just as I am …”. This is not the happiness of a new car or a hug which are great; rather, it is a deeper, profoundly simple being-ness of “who you are”. While some say happiness is a choice; others say it’s elusive often realized only by a receptive heart giving this great gift away. This is accepting things observer non judgmentally, as an observer i.e., as they are. It is not complacency. You want to make the world better - as Gandhi once said: “… be the change you want the world to be…”.

2. Healthy – Everyone wants to be healthy! Why would you not want your body(s) to be in fine shape so there is no pain? The good news is that we are human but that often comes with foibles of doing many thing(s) that are destructive to the body e.g. smoking, food excesses, etc. It is paradoxical to want good health but not work toward it. Health is aided when you are aligned with your authentic self – it’s less stress; for, it is you. At a different level, consider what is your body? Is it only physical or are there emotional, intellectual or spiritual fields?

3. Peaceful – We all wish for peacefulness, Mettā’s 4^th request. Being at one with whom you really ‘are’, i.e. your Authentic Self, is the nucleus of ease. It is the opposite of dis-ease. It starts with you and builds to home, country and world from your mind and heart. Only here can a powerful alignment transform you into being at one with yourself and the cosmos. This oneness with others or numinosity is one element in enlightenment (the 2 others are openness and curiosity). It’s in you to discover - you are the only one who can find your peace and how you are connected to others.

Over time, practicing Mettā improves my capabilities, ability to understand my mental and emotional states and deal more effectively with stressors. (Scientifically this meant changing activity in some areas of my brain i.e. temporal parietal juncture and insula - but let’s get back to Mettā.) Meditation soon became a sanctuary, as it reinforces that I must acknowledge the truth of who I am so I feel good about it. Clearly, sometimes facing my ‘self’ is not easy; but by doing it, I feel healthier at all levels. Consider: if I do not heal at all levels, then some form of dis-ease could be still in me. Hence, if I want aspects of Mettā, part of my quest must be to create peace-fullness in all levels of the physical, emotional and spiritual dimensions.

I can easily remind myself of travelling to a beautiful spot and that I can be there virtually any time in my mind’s eye. How comforting! It is similar (but different) to how I felt just before cancer surgery when I felt a surreal sense that all would be fine. A most remarkable comfort showered me. It was a “peace that passed all understanding” the likes of which I have not felt before or since; a feeling so powerful and unique it will be remembered forever.

I had heard that phrase before many times but that was when I experienced it. While that amazing moment cannot be explained scientifically, it launched me on a road to recovery with a feeling this was the place to be - my ‘dharma’ or Path, so to speak.

As my experiences evolve, I re-discover that my journey is more about finding various forms of peace and truth within me. I find the practice of Mettā meditation is one way to grow, cultivate and train my ‘self’ to find ‘me’.

The awareness triggered is that meditation channels a trust, a type of freedom as I contact my ‘self’. This encourages wholeness, (read: health) as I enjoy profound senses of my ‘self’ and my world while being connected with others. Metta is a channel to connectedness that leads to wholeness and happiness. It is the essence of gentlelovingkindness.

Looking back, why had I not done this meditation before? I guess I hadn’t had to. There was no urgency then; but now there is. So I do it regularly now to feel safe, happy, healthy and peaceful during walks in the forest, just sitting in my chair and being with others. Maybe others will enjoy it too.

Cool!

Audrey's Eulogy

Thank you all for attending my Mom’s memorial service – and joining us in honouring her and celebrating the many ways she touched people’s lives here in Qualicum and throughout her 80 years with us. I’ve only come to appreciate Mom’s true greatness through what other people have told me about her.

I’d like to reflect on Mom’s life since she was diagnosed with cancer. She fully embraced life, and found ways to express her love and caring for others despite her illness. Her great character over the last year certainly made it much easier on her family, and the fact that she had little pain or physical suffering, was a true blessing.

Listening to my eulogy, you may be left with the impression that my Mom’s approach to the cancer diagnosis, is the preferred way to work with a life threatening illness. And I’m about to describe the many ways she inspired me with her strength and resilience.

But I just want to add as an aside, as a cancer doctor with a passion for support groups, that there is no best way to approach cancer. Each of us is different, and we will find our own way. If I’d offer an advice, for those with an illness and the family members, I’d say to be honest with your emotions, both to others and to yourself. It’s perfectly human to be angry, anxious, scared, depressed, and frustrated. It’s best to express these emotions to others, to open up the communication in connection and support. That is the starting place to the healing journey. Enough with the advice.

We got the first impression of Mom’s strength and perhaps the magic that surrounded her when she was first diagnosed. She first developed electric sensations in her abdomen that shot up her chest during a trip in Greece a year ago. She became progressively confused, and by the time she got to the Nanaimo Emergency department, she was babbling about being on the high seas. As if on cue, while Mom listened to the doctor describe the tangerine sized tumour in her brain she seemed to awake from her reverie. Confronted with this awful news she said “Well, I’ve got it. I’ll have to accept it, and we’ll just go down that road.” After which she again digressed to her inner visions of boats and planes.

Mom was stoic right from the start. Through the surgery,and the rest of her treatments her mantra was the famous British slogan created during the war:
“Keep calm and carry on”.

And if you think about it this vivacious, active, intelligent, engaged woman’s life was shattered by this diagnosis. And it must have been painful lying in bed, and it was boring, and just so incredibly frustrating for her. After working so hard to become self-sufficient in every way, it must have been devastating to lose her independence.

And yet, I can hardly remember even an inference of complaint from her. Not that she wouldn’t ask for help from her others. It’s just that she was so busy considering how others felt – especially her family – that her focus was rarely on herself.

Even more so, her sense of humour and wit, remained unstoppable to the end.

I remember staying at her bedside after her brain surgery in January. The evening before I was travelling back to Halifax, I was feeling really sad to see my mom looking so frail, and knowing I would soon be leaving. Mom was bandaged up, on the brink of sleep, and very weak. I leaned over and gave her a kiss on the cheek, and in the most earnest voice said “Mom, I love you a lot”. Her whisper was barely audible in replya “and I love you….. a little.”

We had the major decision to make at the end of her radiotherapy as to whether she could return to her home or to go immediately to the Manor. The sad truth was it was too dangerous for her to be at home by herself (although she would contest that) – but she agreed to the nursing home because she didn’t want to be a burden to her family.

In march on the day that I would travel home again, with great trepidation, I dropped off Mom at the Manor. I was thinking she’s going to be upset, sitting in her room alone. But as soon as she got to the floor, she spotted Aldine in her wheelchair. The two held each others arms, their eyes just glowing. Aldine was saying “Oh, Audrey, it’s so good to see you, you were the very first volunteer who took me out for a walk when I first arrived here. I really appreciate that.” The two just chatted away like they were life-long friends. As it turns out, for the subsequent six months, every few nights, Aldine would give mom a reflexology session. Placing her healing hands on Mom’s feet, Aldine would help Mom relax and be energized by the treatments. I know Aldine loved these sessions and was getting as much out of them as was mom. But Mom reciprocated by arranging for a monthly manicure for Aldine. Even in sickness, in the last few months of life, Mom was deepening the bonds with her friends and family. Her light was glowing ever so brightly.

The other word that comes to mind when thinking about Mom in the last year is
fearlessness. And fearlessness does not mean having no fear. It more the willingness to follow own’s heart, with the confidence that you’ll have the strength to face whatever arises.

One of the cards that Mom received had a famous quote from Mother Theresa “I know God won't give me anything I can't handle.” She cried when she read those words, and it appeared to increase her resolve to “Keep calm and carry on.”

I thought Mom was particularly brave when she travelled to Halifax in August accompanied by her grandson. Her energy was starting to wane, she was more unsteady on her feet, and her memory was quite poor. But etched forever in my mind is a memory a sunny afternoon in the in public gardens listening to the big band sounds.

During that trip , my wife, Cara, and our boys, aged 11 and 15, and cousin James, took Mom to Peggy’s Cove. Everyone, including mom, wanted to get to the top of the huge boulders, for a look out over the ocean. This meant a little mountain climbing, so with one young man on each arm, and a third pushing up the rear (literally), they hoisted mom up top to a wonderful view. The journey back down the rock face was even more interesting, but mom never complained, and we have a wonderful picture of happy kids standing beside a glowing-faced Audrey.

I think Mom went through a spiritual transformation in her last months. She began to see beauty in the world wherever she looked. Each person she was with was just ‘beautiful’. When her 15-year-old grandson so lovingly fed her, she was brought to tears with a sense of gratitude. And my heart is forever imprinted with the way she said to me “Your such a wonderful son.”

The last week of her life was a very precious time for me. I was on the very early morning shift, and we had some intimate conversations in the middle of the night as she waned in and out of lucidity.

She told me that she didn’t want me to be sad after she was gone. I told her that it was natural for us to feel those strong emotions – that people need to grieve in their own time and in their own way. But I also told her that despite the fact that she was within days of her death, there were times I felt great joy just being in her presence. It was as if our spirits had melded somehow, and I truly felt lightened and more spacious as I’d walked away in the morning. I said that we could feel both happy and sad at the same time.

She thought about what I said carefully – and said “I want you to share this with the others” which I suspect she meant our family, but I somehow hope we can all hold those feelings when reflecting on Audrey’s life.

I was especially interested in our nightly conversations because I was worried that Mom was scared on dying. She had been having nightmares about wolves and cougars circling the cabin. And I know that as human beings we have an instinctive fear of death, that our body and psyche will continue to cling to life.

Mom was very clear with me. She was not scared of dying. She has a very strong faith, and there was just not an issue of the afterlife for her. In fact, in this church in march, a parishioner approached Mom, saying how inspired she was with mom’s faith when they had spoken weeks before. This young woman was in tears at the end of the conversation. That spiritual light was being handed over to the next generation.

The last 24 hours of mom’s life were quite remarkable. Lou Ann arrived from India just in time to have the last meaningful words. Remarkably, Mom didn’t suffer much. There was an episode of shortness of breath, that quickly settled with medication, and she slipped into coma, and then into the next realm less than 12 hours later.

Mom was surrounded by the three of us at her last breath. And is so typical for Mom, her last act in this life was to bring her loved ones together.
Mom brought us together. It was most beautiful shared moments of our lives.

Thank you again for sharing this time with us – and honouring the life of this great woman.

Cancer Care Nova Scotia Excellence in Patient Care Nomination

Cancer Care Nova Scotia

Excellence in Patient Care

Nomination for Dr. Robert Rutledge, MD, Radiation Oncologist

Dr. Robert Rutledge exudes health and life. He understands his personal power as a doctor and leader and clearly practices the reality of eating, exercising and living well. Within this ‘health’ context, Rob – as he will be quick to tell you to call him – has developed the practice of being completely present when you are with him. It’s just you and Rob (and your loved one, if appropriate). It’s as though he has nothing else in the whole world to do but be there with you, listen (and listen) to your concerns and when necessary, deal with them. No matter what state you arrive in (usually stressed and fearful), you will leave his presence calm and collected with a sense that ‘all is well’ regardless of what you are facing with cancer.

Rob is extremely professional, which is particularly crucial considering the intimate types of cancer he deals with: breast and prostrate, as well as children’s cancer. He prefers to talk to you in your real clothes and not the Johnny shirts that so strip you of your sense of dignity and identity. He is honest, frank, compassionate, thoughtful and incredibly observant. He is confident without being arrogant and he is always looking to see what kind of a patient you are – what level of care do you require? This is the critical question that separates him from most others.

Are you looking for science to fix your cancer? He’s got that. Do you need someone to help you face your very real (and often dark) emotions? He’s not afraid to ask the tough questions with you. Is your support structure sagging? He is clear about the benefits of support groups for you and your loved one, and he is quick to tune in on yours, and your loved one’s, emotional frequency. Are you seeking spiritual answers for the sorry health prognosis you are facing? Rob can comfortably respond to that too. It’s as though he is sporting three antennae – physical, emotional, spiritual – with a sonar scan to pick up your overall state-of being. He misses nothing. Respects all. Never condescends. He can meet you where you are, no matter where you are!

What’s more, Rob offers hope regardless of the statistics and prognosis. Add bad cancer news to Rob Rutledge and the sum equals hope and possibility. He knows cancer is a head game, and he comes right alongside whatever is happening in your head to work towards the best possible outcome.

Although only in his mid-forties, Rob has spent his life’s work wanting to extend his help beyond his regular medical practice. “I realized early in my career I wanted to understand the human side of the cancer experience and apply those learnings to help others,” he said. Cancer as a disease carries an unbelievable burden of doom with it, despite how much greater survival rates are, and it is this doom that Rob enables patients to face – and reframe – into something bearable and very ‘carry-able’.

All these qualities – his personal wellness leadership, mindfulness, professionalism, commitment to respond to patient questions and concerns – merit the committee’s deep consideration for this award. However, Rob was not satisfied staying within the medical system to empower people on their journey to wellness. Early in his career, Rob and his colleague, Psychotherapist Tim Walker, PhD, decided to develop a weekend retreat workshop called “Skills for Healing Cancer”. Really. Healing Cancer. Two words you rarely find together on conventional cancer websites patients are directed to for information and support. Since 1993, they have, on their own time and dime, led over 30 weekend retreats in 15 cities in Canada and abroad, helped more than 1,000 people face, and reframe, their cancer experience. More, in 2003 they developed Skills for Wellness programs for healthcare providers to empower their colleagues to extend the reach and impact of the work they had started.

From the weekend retreats, they created the Healing and Cancer Foundation, now a registered Canadian charity; wrote a book being launched May 6, 2010; and created a website (www.HealingandCancer.org) offering all their weekend retreat wisdom and cancer patients’ true stories free of charge to anyone who wishes to view (and use) them. While this is a team effort, Rob is the heavy lifter and the energetic driver that keeps this huge and inspiring body of work moving in the right direction – endorsing conventional medicine while gently awakening and encouraging patients to see the mind-body-spirit connection.

When people are asked to describe Rob, most often the response is ‘he is a very special person’. Using Rob’s phrasing, we would say he is ‘super special’.

I hope you will seriously consider Dr. Robert Rutledge for this very deserving award. I do not think it is too bold a statement to say he has positively impacted the lives of any one he has encountered on their cancer journey.

Sincerely yours,

Kelly Hennessey

Rob Rutledge’s patient, 2008-09

What is Wholeness?

Firstly, consider what it means to heal. A woman with breast cancer told us at the start of the weekend retreat that she had either hid her diagnosis from family members / or minimized her symptoms and concerns from those she told. In essence, she was 'doing it alone'. By the end of the weekend retreat, she felt compelled to be open and honest, and to ask for help when it was appropriate. Healing in this case took place at a social level - perhaps spurred on from a healing of a psychological wound.

Another obvious example of healing occurs when someone who is angry at their diagnosis can begin to come to terms with it - to find acceptance. Somehow, we all intuitively know that holding onto anger at life creates more suffering - it poisons our relationships, and eats away (in some real way) at our body. That's not to say we shouldn't feel anger - but not to hold onto it, not let it fold up upon itself, and squeeze the life out of our heart. It's healthier to feel and express this anger - to let it flow through us, so that we can move on to experiencing the fullness of our life.

Wholeness, for me (and Tim would have a richer description) has to do with being able to hold all of ourselves - all of the anger, all of the issues we have with our family members, all of our strength - everything. Wholeness is a change in perception - not a change in reality.

When we can see ourselves fully, when we can love ourselves wholely, it creates a space which better allows the process of healing to occur - whether it be to reconnect with others, let go of unnecessary anger, or empower our immune system. Wholeness allows us to see ourselves as perfect just as we are - "I love and accept myself just as I am right now - and I honour that I am on the ongoing process of healing my life."

Lessons learned from the ‘metastatic’ cancer support group

As I walk down the hallway in the British Columbia Cancer Agency’s Vancouver Clinic, I can hear the excited Voices and chuckles from the first arrivals of my first ‘metastatic’ cancer support group. Sydney Foran, the social worker who has led the group for several years, walks beside me, her stride is smooth, and her face shines as she looks forward. Sydney will mentor me alongside this remarkable group of women. As a full-time oncologist with a passion for empowering people beyond getting physical care, I feel like I’m coming home.

There are eight women who gather this particular afternoon. They have traveled from near and far, play different roles in their outside lives, and vary outwardly in appearance and life history as much as any sample of society. But there is something very refreshing about being with them. Perhaps it’s the way they greet each other or the way they offer me a chair so readily in their group. You can see it shining in their eyes. I see little of the masks that most people wear at work and in the social circles. They care deeply about each other. As they catch up with each other before the group starts, the first lesson is dawning on me.

The support group is not something that they’ve tacked on to their lives. It’s not an extra parcel in a large bag of tasks to be performed each week. The group here is at the very core of their psychological (and sometimes practical) support. They have literally created a web of friends who deeply understand each other, who love each other, and will be there on the phone or otherwise in a heartbeat. I feel lightened by being in the midst of a truely caring community.

The group starts with a simple exercise to bring the energy of each person back into the present – to ground them in the here and now. And then people speak from their heart. People typically feel completely and utterly safe to tell their own truth. It’s refreshing. One week I heard a woman speak about the grief she is suffering thinking about all the changes in her life. I don’t remember exactly what she said but she talked about the effect of the cancer on her family, and how she would miss them, and the frustrations of it all. Her voice was wavering, and the tears were pooling in her eyes. And in the same breath she told us of the incredible peace she has been experiencing, like she was being held in these loving arms, cradled in a source bigger than herself. This was my second big lesson.

People can experience turbulence at the psychological level and still be held by a deep inner peace. Like walking on the beach during a hurricane, the waves crashing, the wind blowing and soaking you to the skin, may represent the difficult psychological times on the cancer journey. But the same storm viewed from a mile up in the sky or 40 feet under the water’s surface is a much more peaceful place. This woman taught me that we can hold both perspectives at the same time.

There are many more lessons to be learned as you sit in the circle. From the very practical ways to negotiate the medical system (a woman in this group told us how she went to medical records directly to get the results of her CAT scan instead of waiting a week for her doctor to call her) to the deeply spiritual. Perhaps the most important lesson is that the wisdom is already there in each of us. We each heave a golden heart, the wise and kind part of ourselves, which can help guide us along the journey. The beauty of the support group is it provides us the time and space to listen to our own inner voice. It was a true honour to be part of the group and to learn from these remarkable women.

Type C Personalities

Question: Are you familiar with the body of psychology research done on Type "C" personalities?

This is the mirror image of a Type "A" ... i.e. the really nice people who bottle up their emotions. Also, why they are more prone to getting cancer?

-Anonymous

A response from Rob:

This idea has been examined for a long time. ie repressed immune system. - or energetic constriction of energy causing cells to mutate.

I don't know if there is a causation of repressed character and higher chance of cancer. Perhaps for a small percentage this may be true - but from a population perspective I don't believe it. The studies also show that there is no obvious connection between a recent major stressor experience and onset of cancer.

Cancer is so complicated and multifactorial in its development that I don't like to try to create simplified theories about causation. I respect the intuition of any one individual about why they think they developed cancer - and to use cancer as a catalyst to make the changes in their life that they would want to make regardless of whether it is the cause or the cure. Working towards wholeness is justified in itself.

Sorry I can't elaborate - but the "don't know" state keeps me open to all these possibilities.

Namaste.

Rob