M.S./Cancer Combo No. 13 And the Coping Mind Game

November 14, 2000

“The CT scan shows a spot on your liver.”

It was a stunning announcement from a surgeon walking me through the plan for dealing with a different situation, the colon cancer that had returned after less than a year. My heart was now sharing shoes with my feet.

“I don’t think it is related,” he went on.

I couldn’t hear him anymore. There was too much noise in my head.

The doctor had spoken reassuringly of his doubts about possible liver involvement, but he did order up a PET scan. PET stands for positron emission tomography, though it sounds like a machine the vet throws your dog into on occasion.

Days later, in the subbasement of the hospital and after an IV dose of radioactive glucose and 90 minutes in a high tech tube with Mozart in perfect stereo behind me, I was calmed. My liver was clean.

And the caravan moved on. The brief prospect of cancer of the liver had brought my second bout with colon cancer into sharp focus.

The first colon cancer had put my many years of struggle with multiple sclerosis into perspective. A coping device had been born and reborn.

Coping is a mind game. It pits perceptions of self against a highly subjective view of the problem and attendant limitations.

One’s fate can often be worse. I seem occasionally to lose sight of that. These crises come from nowhere, and they occur arbitrarily. There is frequently little warning. One moment, Cousin Bob is sweetly emotional and gets a lump in his throat and the next thing you know, the lump is malignant.

A critical element of coping for me is to acknowledge these crazy truths to myself, over and over again, as many times as it takes. The M.S. and Cancer Combo (No. 13 on the menu) proves that life is not fair. I think we know that.

Fairness cannot be seen as an issue with sickness and health. Too often, the cry that life is not fair goes up in a moment of crisis and high emotion, as if life and death are negotiable and some force in the universe will respond to reason. Get a life, as my children would say.

When shocking news about health lands on our shoulders, I believe we react viscerally and almost instinctively. Emotional responses are a product of who we are on a very basic level.

I think that without even realizing what we are doing, we quickly decide whether to be victims. Winner and loser are self-determined designations we will carry eternally. These labels become our badges to identify us to ourselves and to the world. Such powerful self-definition deserves to be well reasoned.

And so, we cope. Coping begins instantly with bad news and lasts a lifetime. That process may dominate our conscious thoughts and creep into our marvelous journeys into the night.

Awake or asleep, in my thoughts and in my dreams, I know I am working at coming to grips with my life, and I am increasingly able to keep track of my emotional baggage. Dealing with disease is about survival, not about heroes.

There are no medals or merit badges handed out for remaining upright and moving forward with grace. We all cope with life, but coping with illness is an aspiration that cannot be fulfilled with perfection.

Coping is not a precise science but an exercise in doing what can be accomplished. Coping is not glamorous and not an exciting spectator sport. Coping is prosaic, like watching grass grow. Coping is what gets you through the night.

I cope. You cope. He, she, it copes. Conjugating life seems routine, though it separates the strong from those who insist they are weak.

My wife and I cope for ourselves first, for the children after that. These steps are similar to standard airline procedure.

First, don your oxygen masks, then assist the children who cannot go it alone. Coping is difficult, even painful at times. I have managed to face who I really am, as opposed to who I might have wished I could be. Blame disappointment on the illness. Right. Blame it on the bossa nova.

People do not cope with equal skill and efficiency. For me, coping has become an essential survival mechanism, almost a way of life. It is my basis for being and doing. I recognize and acknowledge my frailties and significant limitations. I have trouble walking and using my right arm and hand. Legal blindness has stolen my driver’s license from me. I have learned to request and accept help. I could not always do that. This does not come naturally, and sometimes I fight it.

Coping is constant. I keep close watch on myself. I did not choose to develop the skills I associate with coping. I only chose not to be a victim. Coping was self-taught or, perhaps, only self-learned. Webster merely states that to cope means to struggle to overcome problems or difficulties.

My diagnosis of multiple sclerosis fell on the tender ears of a 25-year-old journalist who was too naive to know what might be down the road, too ambitious and impatient to take the time to find out. I simply decided not to react and careened into a state of steep denial.

I have become a student of denial. I instinctively ignored advice to get out of the television news business to seek less stressful work. I traveled the world, covering wars in the Middle East and Central America and politics at home because I denied the idea that I could not. Yet, I am criticized and charged with the vague crime of refusing to face my illness.

Excuse me? The lesson here seems to be that things must be bad if they seem too good. My neurologist once turned to a medical student and labeled me a denier. I wanted to throttle him. Even those who should know better seem to need to see the sick as less than they are. Are they projecting their own fears?

I view denial as a positive and productive coping device. What I am denying is not internal reality as does the child, but the external perception that I am so compromised that I no longer can do.

Denial can create wonderful self-fulfilling prophecies. I see myself as strong and offer family and friends permission to view me as such and not to become mired in my troubles. For me that perception then becomes functional truth. I argue that I do not need help and, in fact, then require less assistance.

This is a recipe that calls for a pinch of strength and healthy self-delusion. Determination and denial may seem a contradiction in terms, but they combine effectively to keep the momentum of living intact.

My wife, Meredith Vieira, frequently urges me to face my emotions, though what those emotions might be is not clear.

Self-pity is out. “Poor me” never flew in my family. My father made that clear long ago. My old man is a retired physician and also suffers from M.S. He says you just keep going, one day at a time. I think coping is two-thirds discipline. Self-indulgent emotion brings nothing to the party. The resolve to succeed does.

This morning, I will be doing business at the hospital.

When I awake from the day’s deep sleep, I will find out how much of me has been taken and try to reassure myself that plenty remains. M.S. and colon cancer, cane or colostomy, who I am is in my head. That is my identity. I will be fine.

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