Cancer patients depend on denial. Without its protection, we would be overwhelmed by terror. Denial filters and slows bad news, so we can digest reality in the merciful morsels; thus, we cope. Without denial, we would shut down, withdraw, and lose hope; healing would not be possible. However, if we do not move beyond denial, accept the diagnosis and loss, make a plan, we die.
Allen, a 43-year-old man, came to me after an insurance physical showed anemia. He felt well. His exam was normal. However, Allen’s blood chemistry showed an abnormal protein, in addition to the mild anemia. I recommended a bone marrow biopsy.
Was I certain that anything was wrong, Allen asked? No, I was not sure; which is why I suggested the test. What if he exercised more and improved his diet? Took vitamins. Did focused meditation. What would happen? Since I did not know what was wrong, it was very hard to predict. Well, Allen announced, if I could not be definite, he would not do the marrow.
Two years later, Allen was back. He was more anemic. The abnormal protein was higher. He had back pain. After three visits over four months, to discuss the possibilities, he agreed to the bone marrow biopsy. He canceled it two times, blaming pressures at work. I called him. Allen did not return my call.
One year later, I saw Allen in the emergency room, paralyzed, a mass in his mid-spine. Surgery was advised, to get a biopsy and relieve the pressure. He declined. Allen received emergency radiation for the unknown cancer. Blood tests showed a large increase in his abnormal protein consistent with myeloma. He desperately needed further tests and treatment. He declined, refusing follow-up, planning instead an “anti-cancer vegan low sugar high vitamin C diet.”
Tragically, there are many Allens. Either, they do not trust doctors, do not understand science, or are too frightened to accept that their bodies and lives are changing. They focus on any uncertainty, inconsistency or the unknown nature of the future, and they deny what is blatantly and simply obvious. It cannot happen to them. Denial becomes pathology, a disease itself.
It is remarkable to me is how closely cancer denial parallels the near complete lack of action that we see on climate change and global warming.
Unlike Allen, the earth has allowed extensive testing regarding its health. Thousands of studies show that the world is warming, global disruption accelerating and the cause is massive burning of fossil fuels. The probability of annihilation by our own hands within a short number of years is high. However, like Allen, we deny.
We distract ourselves with details. The warmest ten years in recorded history have been since 1997, but not every year was warmer. CO2 is higher than at any point in the last million years, but the measurements around the world are not rising at the same rate. The ozone hole is actually getting better and didn’t the satellites miss it at first? Moscow was 105, New Delhi was 120 degrees last summer, but New York was cool. What about that volcano in Iceland? The hottest years were from El Nino. There have been warming cycles before.
Like a frightened, confused, overwhelmed cancer patient, we cannot face the blatant and simply obvious reality that our world is changing and that it is our fault.
Allen said, “Doctors are trying to get rich, sell drugs.” We deny global warming as a hoax perpetrated by scientists. “They are trying to publish and make a name for themselves. Control our minds.”
Allen did not understand biology, so instead of taking medical recommendations, he took vitamins. We deny global warming by pleading ignorance to science and data.
Allen would say that chemotherapy is a poison, worse than the disease. Climate deniers talk about hundreds of bats and birds killed by wind turbines, not the billions of animals dying from the obliteration of their environment or extinction rates a thousand times normal.
Allen refused care because it would disrupt his life, take him from work, and disturb his plans. We deny our role in global warming because any solution will require changes in how we work, live and the very nature of society. We focus on the threats to today’s jobs, short-term economic loss, and fail to realize that the greatest threat is to life itself.
Allen did not trust me because I could not tell him exactly what would happen. We discard the idea of warming because the complexity of the weather on a whole planet is not completely understood. An unknown tomorrow is apparently not a tomorrow worth considering at all.
Allen said, “I feel fine.” Most of the world’s people “feel fine,” so it cannot be happening to them.
Allen died. He was admitted with kidney failure from florid multiple myeloma. Last minute chemotherapy could not rebuild multiple system failures. His disease, which could have been treated with a long survival, did not respond to denial.
Allen was upset that a disease was going to change his life. Therefore, he did nothing. Every sane person is upset that climate change will radically alter human life. Nevertheless, denial is no longer a reasonable, healthy or rational response. We must move on, accept the obvious, and act. Fail and denial will be the instrument of our end.
James C. Salwitz is an oncologist who blogs at Sunrise Rounds.