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Throughout the 27 years of my survivorship, I have never bounced back. All these years, I've bragged endlessly about my persistence, explaining it compensates for my lack of resilience. Resilient people don't spend hours and hours in tearful counseling sessions. They don't spend years fighting fears and feeling frustrated by post-treatment fatigue. They don't cry to friends, "I wish I were tougher. They bounce back. Despite all my survivorship work, I've never really thought about resilience.

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Until now. The journalist's invitation intrigues me. At the very least, exploring what it means to be resilient after cancer will help me decide about the podcast, so I can empty my inbox. At best, I'll learn ways to increase my resilience, with insights and tips you might find useful in your efforts to foster patients' resilience. Resilience is often defined as the ability to recover quickly from difficulties.


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The associated idiom that troubles me- bounce back -provides a useful starting point for understanding resilience after cancer. Tutorials on bouncing rubber balls show you how simple physics equations reliably predict a ball's path.

Only 10 Seconds to Care - Help and Hope for Busy Clinicians by Wendy S | Fruugo

No such equations exist for calculating people's resilience. How well people bounce back depends on a complex interplay of unmeasurable factors unique to each person and involving all spheres of life physical, emotional, social, financial, and spiritual. Bouncing back from illness is different than bouncing off asphalt. Despite the obviousness of that truth, my excitement is boundless. Such exuberance reminds me of a Eureka moment decades ago, when I realized post-treatment fatigue is different than the fatigue that healthy people experience at the end of a long day.

In the context of my fatigue, recognizing that people were using one word for two different phenomena liberated me from the burden of unfair comparisons and unrealistic expectations. Regarding my resilience, it was seeing the flaw in an idiom that freed me of the burden of unfair comparisons and unrealistic expectations. The more I think about the differences between rubber balls and people, the more resilient I feel.

Consider this: The world's most resilient ball doesn't always bounce well. Picture yourself standing on the ocean's edge and dropping a SuperBall. In life, horrendous adversity can act like wet sand, preventing resilient people from bouncing back quickly. Maybe the reason I needed all those counseling sessions was not my lack of resiliency, but that I was grappling with wet-sand challenges, such as chronic pain and fatigue, hanging up my white coat and stethoscope, and repeated recurrences.

Here's another thing to consider: The apogee of a dropped rubber ball degrades with each bounce, lower and lower until the ball stops. In contrast, after cancer, people can experience post-traumatic growth and end up better, in certain ways. Yes, I've shed buckets of tears. Throughout her childhood, they'd turned mundane events into teachable moments, hammering home the fact that "life is a temporary gift.

For clinicians, a strength of the book is the modeling of words that facilitate discussions about goals of care. Over and over, I found myself saying, "Nice! That works. Puri countered the myth that patients always know when it's time by saying tenderly, "I can hear how hard it is to reconcile your sharp mind with how much your body is struggling…. Another strength is Puri's demonstration of how consulting the palliative care team can help you in your care of shared patients.

For one thing, a consultation can off-load some of the demands on your time. It takes time to tease out what patients mean when they say they want to "fight" or that they're hoping for "a miracle. For another, the palliative care team can support you by…. Every chapter exudes Puri's compassion for you, as much as for patients. For example, she does not criticize oncologists who unwittingly mislead a patient by talking positively about improved test results, knowing meaningful recovery is unlikely. Instead, she empathizes, "Because you care the way you do, it's natural—and beautiful—that it's difficult to say what needs to be said.

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While you're striving to do your best in difficult situations, it's healing to be reminded that you can say everything perfectly, yet patients may react badly. That you can prescribe supportive therapies optimally, yet patients may suffer at the end because "a 'good death' may not be in the cards. To ease it when you can. And to be there as they move through it…. Some of Puri's reflections may help you manage your expectations. If you see family meetings as "procedures," you'll expect them to require preparation and concentration.

If you see each meeting as part of a process, you won't be surprised or disappointed if your first conversation seems to make no difference.


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You won't blame yourself if there's still no apparent progress until after a few sessions. As Puri eloquently puts it, "There is no freeway between the mind and the heart. Ultimately, patients must decide "whether they could accept and endure the most heart-shattering information, or the greatest loss. After all is said and done, no matter how well you accept the things you cannot control, it's difficult to be "immersed in the enormity of the final experience all human beings would share.

Surely one or more will stir memories of your own patients, especially those who never experienced peaceful resolution or redeeming growth at the end. If you cry, that's a good thing.

Only 10 Seconds to Care: Help and Hope for Busy Clinicians

Just as curative chemotherapy makes patients weaker before it makes them stronger, expressing your grief in a safe place helps you hold on to the humanity that makes you a better clinician. In the care of seriously ill patients, you will see suffering. That Good Night will inspire you to recognize and respond to suffering with compassion. Whether caring for patients on your own or with the support of a palliative care team, fluency in the language of suffering will help you preserve compassion in medicine.

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