Recently, in front of my family, friends, colleagues, and teachers, I accepted my diploma during the graduation ceremony for the UCLA psychiatry residency program.
While it wasn’t my real diploma — it’s been months since I’ve been able to work, so when I’m better I need to go back and finish some requirements — my residency program coordinator put together an awesome fake diploma so I would have something to pick up when my name was called. It looks just like the real thing but reads, in small letters, ”Elana Halks Miller has almost completed training in the UCLA Psychiatry Residency Program.”
When I start my private practice it’s getting framed and going straight up onto my wall. I wonder if some astute patient will notice the “almost” tucked away between “has” and “completed,” and think to themselves, Hey… wait a second.
The evening — marking the end of a total of twelve years of training — encouraged me to reflect on the experience of having cancer from the perspective of being a psychiatrist. Something about severe illness striking down a young, otherwise healthy woman seems to have turned me into a walking Rorschach test onto which people have projected, for better or worse, their ideas about how the world should be. I may have learned more about human nature in the last six months than I have in all my adult years prior.
(If my program director is reading this, maybe we can talk about me getting some clinic credit for having cancer? Eh?)
Some people see me and seem obviously discomforted, as if I force them to confront a reality about life they don’t want to confront. Perhaps there isn’t a greater force in the universe ensuring that bad things only happen to people who deserve them. Perhaps life isn’t fair. Perhaps if I am fragile, and mortal, then they are too.
Many people will say things, that, on some superficial level, they must believe are for my benefit, but that clearly deep down are meant to reassure themselves. They insist to me, “Everything’s going to be okay.” (Oh really? Have you been talking to my oncologist? I’d love to hear the update.) Or say cliches like, “Everything happens for a reason,” or, even worse, “God only gives us what we can carry.” (As if some greater force purposefully gave me cancer.)
I have experienced a whole spectrum of generosity — from, on one end, generosity that is actually selfish, where people offer me support because they like how it sounds rolling off their tongue, but disappear when I actually need their help.
Others offer a transactional type of generosity: they give support, emails, cards, and gifts, but in return expect me to reflect back to them what good people they are. (“Where is my thank you card?” they ask, or “Why have you not responded to my emails wishing you well?)
They think they’re being generous, but I come out of these experiences feeling uneasy and used, now obligated to return a favor I didn’t ask for and entered into an implicit contract I didn’t agree to (I wish I’d just be spared these “gifts” and the work that comes with them).
Their generosity is offered with the expectation that I do something in return, which, when you are sick and can barely peel yourself off the couch to get to chemo, is not generosity at all. I want to tell these people I’d love to spent all the time in the world reassuring them of their goodness, but I’m kind of busy with other things, like, you know, dealing with cancer.
(By the way, if you really want to send a helpful message to someone dealing with illness, say, ”I’m thinking of you. Let me know when you need anything. No need to respond.” Those last few words will be music to the person’s ears, I assure you, and will set you apart from the surprisingly high number of people who have a subtle expectation of having their ego stroked when they offer help.)
The truest kind of generosity — which is offered with no concern for the ego of the person doing the offering, and total love for the person to whom they are offering something — is touching, and beautiful, and rare. I don’t know if I would have believed it existed if my closest friends and family, and even many strangers through this blog, hadn’t so clearly demonstrated it.
Some handle their discomfort with my illness in other ways. I’ve been cornered so people can force upon me vague ”life advice,” telling me what attitude I should and shouldn’t have to deal with cancer, perhaps because they want to feel they’re smart and clever and have some important insight I need to hear.
I’ve had near-strangers divulge their personal problems to me at inopportune times. A few weeks ago a former coworker I hadn’t spoken to in years found me sitting by myself at lunch while I was waiting for a doctor’s appointment, sat down, and promptly unloaded onto me about her work, family, and interpersonal problems for the next twenty minutes.
I had just ordered a delicious sushi lunch, yet was now pressured to confront my own Sophie’s choice — eat two more pieces of sushi and be forced to hear more about the school administrator who didn’t properly appreciate her son’s contribution the classroom, four more pieces of sushi and give her a chance to start the story about her husband flirting with her sister …
Some seem to see my vulnerability — which I have no choice but to wear openly given my physical appearance — as an invitation for them to share their own vulnerability, whether my relationship with them warrants it or not.
I’ve had people I don’t know intrude on my personal space (yes, I know my fuzzy hair is awesome, but that does not mean I want strangers to randomly start rubbing my head). At a BBQ a while back I was enjoying some quiet in the garden, daydreaming and staring off into space, when a woman I had just met (but who knew I was sick), came up to me, started rubbing my back, and asked me, dramatically, “Are you okay?”
Caught off guard, I bristled back, leaned away, and promised I was fine — anything to get her to stop rubbing my back as soon as possible — but this just made her more insistent. “Are you sure?” she said, rubbing even harder.
These moments all share something in common: I am treated not as a person, but as an object. I am used, probably subconsciously, to serve another person’s emotional need without consideration as to how I might feel about it.
Others will turn my illness into their illness, as if being around cancer is anything remotely close to having it. In a text just the other day, a person I am no longer close with, while telling me how much harder my sickness has been on him than me, referred to my cancer as “cancer” — yes, with air quotes — as if I have the fake kind of cancer, and this is all just one big spa vacation for me where I get to relax on the couch while models in greek togas fan me and feed me grapes.
I did not realize before I was sick that self-awareness is a quality many people go their whole lives without developing; I did not realize age does not guarantee wisdom. (Nor does youth preclude it; in fact, almost all of the boundary violations and odd comments I have witnessed have been committed by people decades older than I. My friends and peers have generally demonstrated a compassion for my situation that is impressive given their lack of experience with it.) And the realization that naturally comes out of these points is that not everyone is equally deserving of my (currently limited) mental and emotional energy.
It is not a moral issue of some people being good and others being bad; rather, some people are highly evolved and others are not.
Those who said cruel things to me when I first wrote about my cancer diagnosis, speaking from a place that I now realize was utterly self-involved (how else could a person justify saying such harsh things to a young woman when she had so much taken away from her just days earlier?) — at the time, they devastated me. I felt their opinion mattered as much as those strangers who were so kind and supportive. But now I care much more about what I think about people at that stage of development than what they think about me.
On the other hand, there have been so many who have illustrated that true generosity and selfless love are possible. My friends and family who have visited or sent kind messages weekly, dropped off food for me, told me they will be there for me in any way I need (and when they say it I know they will); teachers and employers who have given me the gift of focusing on my health and not worrying about work; my cousin who took me in when I became homeless and treated me like her own sister.
These people hold a space in my heart. Their opinions also hold a space in my mind.
The least self-aware people don’t learn from their own experiences, repeating the same mistakes when they are older as when they are younger. Others, who are more wise, learn from their experiences and grow in self-awareness over the course of their lives. The most wise people learn not only from their own experiences, but from the experiences of others — they learn from the experiences of history.
I look forward to the day when having cancer isn’t the first thing I think of when I wake up, when it doesn’t consume me throughout the day, when the most salient thing about me isn’t the fact that I am sick. Until then — at least I’ll learn a lot.
Elana Miller is a psychiatrist who blogs at Zen Psychiatry.