Tue, Jul 10, 2007 - Page 13 News List

How to look mortality in the face

Faced with devastating news from your doctor, taking a slow, careful look at the options is often the best policy

by JANE E. BRODY  /  NY TIMES NEWS SERVICE , NEW YORK

Everyone knows lightning is not supposed to strike in the same place twice, let alone four times. Yet it did for Jessie Gruman, 53, the founder and president of the Center for the Advancement of Health, in Washington. She knows all too well what it's like to be on the receiving end of bad health news: first at age 20 with a diagnosis of Hodgkin's disease, 10 years later with cervical cancer, then five years ago with viral pericarditis (a potentially fatal infection of the heart's lining) and just three years ago with colon cancer.

With each diagnosis, knowing her life hung in the balance, she was "stunned, then anguished" and astonished by "how much energy it takes to get from the bad news to actually starting on the return path to health."

But following all four bouts with life-threatening illness, return to health she did, and the lessons she learned prompted her to write AfterShock: What to Do When the Doctor Gives You - or Someone You Love - a Devastating Diagnosis, published this year by Walker & Co.

I consider this book so valuable I plan to keep it on my bedside table should I need it later on. Its recommendations are based not just on the author's experiences with illness, but also on interviews with more than 250 others: patients, family members, nurses, doctors, health plan administrators, managers of busy practices and nonprofit leaders.

When confronted with a life-threatening diagnosis, most people feel a need to do something fast. But Gruman, who has a doctorate in social psychology, warns patients to "slow down" - take time to confirm the diagnosis, seek a second opinion, consider the various treatment options and their potential side effects and long-term consequences. Doing a little homework before rushing into treatment can help you get the treatment that will work best for you.

Rather than mull over what you might have done to cause the condition, Gruman points out that the past is past and that the problem now is how to handle the future. Nor should you worry about being less than optimistic. It's normal to be depressed when you get terrible news about your future. As Gruman writes, "Expressing fear, sadness, anger or guilt will not make your disease worse."

Her common-sense suggestions for getting through those first two days include the following:

- Recognize that this is a crisis and treat it as one. Don't act as if nothing is happening. If you want to be with family or friends, tell them. If you don't, tell them you need to be alone. And because memory is often slippery during a crisis, write down things you need to remember.

- Protect yourself. Talk if you want to, cry if you need to. You don't have to explain to anyone what you decide to do. And if you find the information online confusing or frightening, stop searching.

- Don't rush to form a treatment plan. Your main job now is to make the next doctor appointment and write down questions for your doctor, employer and insurance company.

- Eat and rest. Emotional stress is exhausting. Try to nap, or if you're too agitated, go for a walk. Take some deep breaths and pursue your usual exercise if you feel like it. If sleep is elusive, ask your doctor for a temporary sleep aid.

Next, learn as much as you can about your condition and its potential treatments so that you can make an informed choice. How does the disease affect the body? What may cause it to get worse? How does it usually progress? What treatments are available, and how does each affect the disease? What complications and side effects are likely with each treatment?

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