The hours and days immediately after your cancer diagnosis has been confirmed are in some ways the most difficult because it is now that your world is turned upside-down. This is the point at which the transition into new and frightening territory begins and the time when the sense of shock is at its most raw. You may already have experienced the considerable stress of tests to establish whether or not you have cancer and the sense of being in limbo as you await the results. Receiving a cancer diagnosis, however sensitively the news is given to you, represents the confirmation, of your worst fears. You may be unwell and in pain or you may be physically able to continue your normal life. In either case, the period between diagnosis and the beginning of treatment can be a time of great upheaval, both practically and emotionally. Everybody reacts differently, but gradually you will need to find your own way of coming to terms with your cancer and working out how to live with it.
In the early days, the overwhelming emotion experienced by many people is shock. It can leave you feeling numb and dazed and can make absorbing information or taking decisions difficult. Some people start to feel that dealing with anything practical is completely superfluous, and just want someone to magic away their cancer and return their life to normal. Others are galvanized into action, and want to sort out the aspects of their life which will be affected by their cancer and treatment, such as their job or other regular commitments. Shock affects everybody differently, and there is no ‘right’ way to react to your cancer diagnosis. It will take time to accept it and the changes it will bring to your life, and this process cannot be rushed.
Neil’s diagnosis had been made during the course of a single day, and he made an immediate and conscious decision not to allow this momentous event to impose on him the passivity which is often associated with being a hospital patient.
So that was it then. I was now back at home in a physical state which was exactly the same as when I left home to visit the hospital some eight hours earlier. There was the knowledge however that I had cancer and we had better start thinking about getting a few things sorted out. I think that this is probably the moment at which it is easiest for the patient either to empower themselves by becoming totally involved in the ghastly process or to abdicate responsibility by letting events run away from you. The decision is very often in the hands of the patient and his family and friends. Do not underestimate the importance of this point!
You may feel very alone and isolated after being told you have cancer. Your doctor or GP may try to reassure you with anecdotes about the effectiveness of treatment for your type of cancer or about other patients’ experiences, but these can seem completely irrelevant to your particular situation. You might feel like the only person in the world who has ever been in such terrible circumstances. Some hospitals provide support for patients immediately after their diagnosis, such as a Macmillan nurse (who will be specially trained in helping cancer patients) or specialist counselling. You might think that talking further about your cancer cannot possibly help. After all, talking makes no difference to your diagnosis. In fact, talking to a medical professional other than the doctor who made your diagnosis can help you to start voicing your questions and fears: this in itself is a hurdle to be crossed. If the hospital has no such support system, then your GP should be happy to talk to you at short notice.
For some men, beginning to talk about a cancer diagnosis is not so easy in practice. If you are not in the habit of discussing such personal and private matters, your instinct may be that your cancer is nobody’s business but yours. A temptation to feel that you must be strong and ‘pull yourself together’ is prevalent in many men, together with a sense that the need to seek outside help is a sign of weakness. These may be entirely unconscious reactions, born of habit, and it would be unreasonable to expect any man newly diagnosed with cancer to develop new ways of coping overnight. What is important is for both men and those close to them to be aware of the support available at this stage (it may not be widely publicized), and not to feel reticent about drawing on it whenever it is needed.
After your diagnosis has been made, simply leaving the hospital and getting through the rest of the day can feel impossibly difficult. What are you to do now? It can feel as if your entire world has just collapsed around you. You know that somehow you have to go home or back to work, and that the world around you is exactly as it was before your diagnosis – but for you it has changed irrevocably.
How you react at this time will be driven less by conscious decision than by instinct and the effects of shock. Returning to your normal routine might deflect the impact of your diagnosis for a short time. It is as if the action of going back to work or to the supermarket can push your diagnosis into the background for a while. You might need to spend some time alone to absorb the news and to think quietly about it before telling anybody. If your wife or partner or a close member of your family was with you when you heard your diagnosis, you might spend time alone with them, until you feel able to start passing on the news to others. Neil found he needed time for the news to sink in, but then some issues started to become clearer:
There is a moment which seems to go on for ever on the first evening of ‘C-Day’ which is me and my partner sitting on our sofa just holding hands in absolute silence with nothing that we could possibly say. I do remember that it was that evening that we made what I am certain was the most important decision of this whole ‘voyage’: to take control in whatever ways we could. The need to attempt to regain some control over these events was the secondary emotional reaction after the trauma of the diagnosis.
The need for some sense of control is not uncommon, born of a fear that if you do not actively take control of what events you can, then events will surely take control of you. It is certainly not the only common reaction though; withdrawal into oneself can be hard to avoid too, especially if you are inclined not to talk openly about your feelings. “I really don’t want to talk about it’ may be your overriding feeling, through a combination of shock and the difficulty of seeing a way forward through the treatment and uncertainty ahead.
Getting through the day is tough. Around you, all is normal – but your world has changed. You may be capable of little but sitting at home thinking through your consultation and diagnosis. You might need to use ‘normal’ activities to prevent yourself going over the same ground again and again in your mind, taking refuge in seemingly trivial tasks – walking the dog, cutting the grass, cleaning the car. This may seem odd behaviour to an onlooker, but can feel like the only way to cope with the immediate effects of shock as you try to come to terms with your diagnosis.
It is extremely important to find and use some support at this stage and especially so if you are alone. You may feel that you can cope on your own and neither need nor want to talk to anybody. Maybe you can manage, but you are likely to cope more effectively if you feel able to ask for support, and particularly someone to talk to at this early stage. Sitting at home on your own, worrying about your cancer and treatment and the future is a natural reaction, but ultimately it will not benefit you either physically or emotionally. You need to conserve all your strength to fight your disease and deal with your treatment, so now is not the moment to assert that you don’t need any help from anybody. Even if you don’t feel like talking, just the presence of a good friend or close family member can help to dissipate the sense that you are the only person in the world facing this problem.
Even if your thoughts are not very clear at this time, talking will help you more than bottling up your questions and fears. It may take some time before you can start to think clearly. You might find your thoughts go around in circles, stuck in a loop in which you can’t get your diagnosis out of your mind, and simply don’t know what to do with yourself. Perhaps you can’t stop thinking ‘Why me? What have 1 done to deserve this?’, and want nothing more than for life to go back to normal, as it was yesterday or last week or last month. Talking will help to provide a release.
It is not always easy to find the right person to talk to, and you might feel awkward at first discussing your situation with those closest to you. Some people prefer to talk to a professional counsellor or a nurse or doctor about their disease in the first instance. If you are not offered counselling, your GP or your hospital should be able to help with this – and should also be able to advise you about other forms of practical and emotional support available to you.
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