By Steve Buechler

I would never recommend cancer as a way of learning life lessons. But having “been there,” I have tried to “do that.” Cancer treatment required coping strategies. Surviving it taught important lessons. Both remain surprisingly relevant in an ongoing pandemic.

 My Cancer Odyssey

 In June of 2016, I was anticipating one more year of teaching sociology before a carefree retirement. Life was good in every way. But a routine physical revealed dangerously low white blood cell counts. My doctor referred me to a hematologist who recommended a bone marrow biopsy that detected acute myeloid leukemia. Within 48 hours, I was hospitalized and began a week-long, 24/7 chemotherapy cocktail.

My hospitalization continued for the next 35 days. After chemotherapy, I became severely immunosuppressed and battled a number of predictable side-effects. By my fourth week, things improved, and a repeat biopsy revealed no evidence of leukemia. That meant I would live long enough to explore options for further treatment.

 My cancer had an “intermediate risk” of relapse so I faced a difficult decision between more chemotherapy or a stem cell transplant.  After researching my options and getting second opinions, I chose transplant. My logic was that if I had more chemotherapy and it didn’t work out, I would regret not pursing the transplant. If I had the transplant and it didn’t work out, at least I would feel as if I gave it my best shot.

In October of 2016, I received a double cord blood stem cell transplant. It was preceded by high dose chemotherapy and full body radiation to gradually destroy my compromised immune system. It was followed by two and a half weeks of recuperation before hospital discharge.

Engraftment happened surprisingly quickly. I had playfully named my baby donors “Ralph” and “Gwen.” Three weeks after transplant, yet another biopsy revealed that Ralph was 99% engrafted. We’ve been getting along ever since.

After a month of extreme fatigue, bone aches, and lingering nausea, several milestones followed. One month out, my daily clinic visits became less frequent. Three months out, I began tapering my anti-rejection medications. Six months out, I stopped those and a dozen other medications.

Nine months out, I gave the keynote address at my transplant unit’s fundraiser before 400 people. One year out, Ralph and I got our childhood vaccinations from dead viral sources to replace the originals that had been rendered inactive by the transplant. Two years out, we got additional immunizations from live viruses.

In retrospect, I hit the treatment trifecta. I got into remission on the first try.  Ralph fully engrafted in three weeks. And I’ve had no graft-vs.-host-disease. In the sweet words of my transplant oncologist, “this is as good as it gets.”

My Coping Strategies 

When I was told to expect an initial 5-week hospital stay, I was dumbfounded. I realized I needed ways to cope with how my world had suddenly become very small and quite precarious. Over the ensuing weeks, I cultivated several strategies.

I practiced mindfulness, meditation, and yoga. It helped me banish thoughts about the past and anxieties about the future, and to non-judgmentally accept and live in each moment as it unfolded.

I did as much physical exercise as my circumstances allowed, including stretching, isometric exercises, hall walking. I did it mindfully, and these routines increased my energy and lifted my spirits.

I was a pro-active patient. I made my bed, organized my hospital room, and structured my days with new routines of meditation, exercise, writing and yoga. I actively collaborated with my medical team in managing my care. Being in charge of these activities gave me agency and purpose when these were hard to come by.

I maintained my sense of humor. Sharing jokes and witty banter with my medical providers broke the ice and humanized our consults. It also gave friends and family a way to relate to me as the person I’d always been rather than the patient I’d recently become.

 I relied on a supportive belief system. For some, that’s religion. For me, it was a secular worldview based on my social science background. It encouraged me to learn about my illness and treatment, and it fostered a practical, problem-solving approach to the challenges they posed.

 Finally, I wrote my story. I sent detailed reports about my status and reflections to a large group of email correspondents. Writing for others forced me to understand my odyssey so I could articulate it for them. This writing became a psychic survival mechanism (and a memoir).

I’ll never know if these strategies contributed to my physical survival, but I always know they preserved my sanity and sustained my identity during one of the most harrowing periods of my life.

 I also benefitted from some privileged circumstances. After a year of paid sick leave, I retired with a steady income and a home that’s paid for. Within that context of material security, my coping strategies have sustained my physical, psychological and emotional health.

Coping Strategies Redux 

These strategies have also proven quite relevant during the coronavirus pandemic.

Mindfulness continues to keep me grounded in the present moment and allows me to banish anxieties if I cannot take specific actions to address the causes of my concerns. It also reminds me not to look too far ahead and rather take each day as it comes.

My repertoire of physical activity now includes a cautious return to my health club for lap swimming and strength training. The physical and psychological benefits during this pandemic are inestimable.

My proactive stance toward organizing my small hospital world now plays out in a slightly larger arena at home. But there remain limits and prohibitions on things I would like to do. I draw on my acquired skills to focus on what I can control. That helps me live within these limitations, find new projects, and structure my days with activities still available to me.

My sense of humor remains intact. It reminds me not to sweat the small stuff, and that it’s almost all small stuff. And for the few things that really are big stuff, black humor works well.

The secular, problem-solving worldview that guided me through cancer treatment is especially apt for following and implementing the latest medical advice and cautions about living as safely as possible in the midst of an ever-evolving pandemic.

Finally, writing my story (including this blog post) still helps me make sense of my circumstances and find ways of acting intelligently and responding effectively to whatever life brings my way.

Further Lessons for a COVID-19 World

 There are additional lessons from my cancer odyssey that are helpful in this pandemic.

Cancer taught me that asymptomatic people who feel healthy can in fact be quite ill. That describes me upon my diagnosis, and quite a few people who are unwittingly infecting others with coronavirus now.

Cancer vanquished my sense of invulnerability. Having been in good health for my first 64 years, I still harbored a teenager’s sense of invincibility. But we can all get sick with little notice, for no particular rhyme or reason.

 Cancer taught me to be at peace with isolation. I learned to spend time alone and be resolute, whether in a hospital room or a pandemic lockdown.

Cancer taught me to await test results calmly. “Scanxiety” doesn’t change the result but can be debilitating to our energy and outlook.

 Cancer taught me to value masks.  Whether protecting me during chemotherapy-induced immunosuppression or protecting others from a contagious virus, masks are essential to caring for ourselves and others.

 Cancer taught me the value of patience during a prolonged and uncertain recovery. It was a marathon, not a sprint. Moreover, the marathon involved an obstacle course of impediments. Facing such challenges, patience is indeed a virtue.

Cancer taught me resilience. One of my favorite images is a three-legged cat who doesn’t mope and withdraw, but just continues silly cat antics despite the handicap. Facing impediments, I’ve learned to just get on with things.

Cancer fostered a deep respect for the skill, wisdom, and dedication of doctors and nurses. It taught me to be the best patient I could be for them, and now to follow their evolving pandemic guidelines for everyone’s sake.

Cancer underscored the role of chance in life.  Things sometimes happen for no apparent reason, but we still must make the best decisions we can with the incomplete, imperfect and ever-changing information we have.

 Cancer made me humble about what I can control. It’s a lot less than I would like to think but recognizing that saves a lot of energy and keeps me on an even keel.

 Cancer left me a deep well of gratitude for the life I still have and taught me to live as judiciously and mindfully as I can … and to enjoy the ride.

As I said at the beginning, cancer is a terrible way to learn life lessons. But perhaps the most important lesson of all is to make the most of the hand you’re dealt.

Steve Buechler is a retired sociologist. His memoir is titled How Steve Became Ralph: A Cancer/Stem Cell Odyssey (with Jokes). The book is “Suggested Reading” in the “Inspiration” category on the Leukemia and Lymphoma Society’s website. More information on Steve’s book, blog posts, speaking engagements, and webcasts are at www.stevebuechlerauthor.com.

Professor Murray Brookes and his daughter, Alison, in Wales, 1962, watching a Punch and Judy show.

By Alison Rosalie Brookes, MD

I have held only one person’s hands recently; and hugged and kissed only that one person, but I have been growing deeply fond of and emotionally wrapped in the arms of, lots of people whose faces I have never seen. People speaking in Spanish and sometimes in English, have been telling me their stories in the hope that I might be able to help them a little bit. They have been breathing for me into their cellphones as I Iisten for wheezes, and they have texted me photographs of their hands and feet. They have trusted me with their concerns and shared their fears. The fear of going to work, and the fear that staying home will cost them their livelihoods. The worry about finding enough food to eat, and how much they miss their loved ones, alone in the hospital. Sometimes the worst has already happened. I have been laughing with them as well, mostly because my Spanish can be quite unintentionally funny, praying with them, receiving their blessings, and to be honest I have actually cried a few times with them too.

I usually work in a miraculous little gem of a medical outpatient clinic; hidden away in plain sight in the shabbiest, oldest building of Boston’s most beloved hospital. There, we provide wonderful medical care to people who come from all over the world, and also from right around the corner. When COVID-19 descended upon us, our clinic was converted overnight into Boston’s first “RIC”, (Respiratory Illnesses Clinic) and suddenly we were confronting its reality head on. That is a story for another day, but I am here to tell you about Chelsea.

As an older physician, I was deployed to work remotely; backing up the nurses taking calls from people who receive their care at the Chelsea Health Center. My day begins at about 8.30am, with a list of messages from two nurses whose faces I have never seen, but who have become beloved friends. For 8 weeks now, we have shared our days, good and bad, and we have been bearing witness to the way that this virus does, most definitely, discriminate. It discriminates most viciously against the people we speak with, all day, from the safety of our kitchens. The essential workers, and their families, have suffered greatly. We might not, in normal times even really see them or notice the work they do, but we all depend on them to supply our food, our power, our sanitation and other public services. They care for our loved ones in nursing homes, and they clean the buildings in which we live and work. They tend to be poorly paid and live in crowded conditions. They bear a burden of poor health that puts them at much greater risk of becoming infected with, and succumbing to, the worst effects of this virus. Our job is to answer their phone calls and listen to their concerns, and then we do whatever we can to help. We never cease to be humbled and inspired by the enormity of what our patients are going through, and the fortitude they need to withstand it all. 

Suddenly, ensconced in this new life, gratefully immersed in the embrace of Chelsea, where the poetic Spanish language of South America mixes surprisingly well with the grittiness of life in Massachusetts, my father, in London, known to all of us as Daddy, did not wake up. The early morning call came from my sister and two brothers, who had miraculously been allowed into Daddy’s room at the care home, in London. They had not seen each other, or Daddy, for 6 weeks, and they were all unrecognizable in full PPE. But they were there with him and I am sure he could hear them singing together and could feel them holding his elegant, long-fingered hands. I wished I could hold his hands too, and kiss him, but instead I whispered nice things into Daddy’s ears, Facetiming on my brother’s cellphone.

 It was a long day, tranquil, with some funny moments, because it was Daddy after all, who was always apt to suddenly burst out laughing at inappropriate moments. Yet we all knew what nightfall would bring. In the evening, as the sun was thinking about setting, and Venus was clearly visible in the night sky, my sister and two brothers decided to sing Etz Chayim Hi, (The Tree of Life,) and a few of Daddy’s other favorites, including a really soppy old song called Whispering Grass. A tear ran down Daddy’s left cheek and the look on his face was the same as it was in a photo we have always loved, from 63 years earlier, as he watched Mummy signing their Ketubah. Daddy’s room had gone silent, and the red vixen who had been curled up all day, at the foot of a blossoming cherry tree outside the bedroom window, had disappeared. We had had the enormous privilege of being with our father at the end of his long, eccentric and brilliantly colorful life, and he had not suffered. All of us were conscious that death in the time of COVID was not usually like this.

 I was very sad not to be standing side by side with my siblings at Daddy’s funeral. There were many people present, Zooming in from England, Israel and several states of America, and yet, according to British Orthodox rules, we didn’t count as a minyan and so were not allowed to say Kaddish. The next day we had the most wonderful Zoom-shiva, which was attended by an even wider variety of people, including my new colleagues from Chelsea MA, whose faces I still have not seen because they modestly kept their video dark. We sent Daddy off in laughter and tears the way he would have liked it. We even managed to say Kaddish, despite it being against the strict rules that Daddy followed, because honoring your father sometimes involves a little disobedience.

A week after Daddy died, I was back at work in my kitchen, virtually in Chelsea. When patients told me about their relatives, sick with COVID-19 in the hospital, I was pierced with emotions even more poignant than those of a week before. I know what it’s like to not be able to hold your father in your arms as he passes away, but I cannot imagine what it is like to suffer the pain of not being there at all, knowing he is alone in a hospital with no visitors. I feel deep concern and compassion for the people of Chelsea, whose lives I have encountered as a result of this awful pandemic. Their culture revolves around “cariño” which is the Spanish version of our Jewish “chesed”. I am inspired by my heroic colleagues working on the frontlines, and gratefully humbled by the patients for whom I am caring. And, although I never thought I would say this, I am grateful for modern technology too.

Originally published in The Jewish Journal (Salem, MA) in May, 2020

 Alison Rosalie Brookes is a practicing physician in Boston, MA.