Gratitude, Grief and Why You Don't Have to Choose

Dr. Diane Reidy-Lagunes:

It's the holiday season, and there's a universal truth in the idea that appreciating what you have and what is positive will bring you joy. But cancer can rob people of that joy, and for many, holidays are the hardest, most melancholy time of the year. But today we talk about gratitude because somewhat surprisingly, research shows us that gratitude often arises when we're faced with a diagnosis like cancer and or a loss. And gratitude has the power to heal, to bring hope and to energize while acknowledging that we still feel the pain in the sorrow. Gratitude doesn't make us choose between being happy or being sad. It can encompass both at once. Hello, I'm Dr. Diane Reidy-Lagunes from Memorial Sloan Kettering Cancer Center, and welcome to Cancer Straight Talk. We're bringing together national experts and patients fighting these diseases to have evidence-based conversations. Our mission is to educate and empower you and your family members to make the right decisions and live happier, healthier lives. For more information on the topics discussed here, or to send us your questions, please visit us at mskcc.org/podcast.

Dr. Diane Reidy-Lagunes:

To be clear, there's nothing about the horrific cancer disease itself that I can possibly be grateful for, but I am so very grateful for the honor to care for some of the most beloved, outstanding individuals that I've met in my lifetime. I'm so grateful to our patients, caregivers and clinician scientists that have come on this show as well to share their stories. And so today we've asked some of them to provide a follow up of where they are today, how they are, and what they're grateful for. Joining me is Dr. Wendy Lichtenthal, clinical psychologist at MSK who has dedicated her entire career to supporting patients and their families as they carry on their cancer journey, and for the family members who have had others pass on. Wendy, welcome to the show.

Dr. Wendy Lichtenthal:

Thank you so much.

Dr. Diane Reidy-Lagunes:

I want to start by hearing from Ursula, who we met earlier this year and has been treated for stage four colorectal cancer. Let's take a listen.

Ursula:

I have stage four colon cancer that metastasized to my lungs. The cancer is gone from my colon – I had a colonoscopy a couple of months ago – but there is multiple lung metastasis. And so when you don't have any definitive answers, you're just really grateful for the basic things that you do have answers for, which is the people you can count on, my family, I have really amazing friends, my whole community here in Chatham, New Jersey has rallied behind me. When you feel like you have people thinking about you – whether it be praying for you or thinking about you, or just wanting to surround you with a loving white light of thought – you're just really grateful for that. It's like really simple stuff. It really simplifies everything. And I have three kids and they're doing really, really well. They're thriving and that's kind of what it's all about.

Dr. Diane Reidy-Lagunes:

She realizes the gravity of her situation, but is grateful for what she says are the little things. Wendy, let's talk about how it is that two things like gratitude and the reality of having a stage four cancer diagnosis can be true at the same time.

Dr. Wendy Lichtenthal:

Absolutely. Diane, I think that it is, first though, really, really important to amplify something you said from the start, which is really that the situation itself – the diagnosis, the experience, the losses – are so, so hard. And so I think as we enter this conversation about gratitude, we really wanna make sure that it's clear that when we talk about it, it's not a prescription to be grateful. We're not saying people should be grateful or to have a positive attitude or anything like that, but rather really what you hear is kind of a choice in where people focus their lens. So I think that from the get-go is important. And in this case, you hear Ursula do that. She kind of just shifts her lens and talks about gratitude and is able to say, you know, there are things that I'm uncertain about, but I can also be grateful. We need to recognize that human beings have the capacity to feel more than one thing at once. That we can be sad and grateful. We can be relieved and yet scared. We can be angry and appreciative. Cancer is an "and" experience. It is complicated. It is not just one thing, and I think Ursula's comment really speaks to that. So that's around the emotion, right? The feelings that come with the experience. But I think the other thing to think about is the way we think about things, the cognitions we have, and that idea that we can really look at a single experience from multiple perspectives and remind ourselves that we have a choice in which perspective we want to kind of hone in on in a given moment. In her response here, she honed in on what she was grateful for. And her ability to do that led to thinking about how amazing her family and friends have been, how supportive her community have been, how well her kids are doing. And you hear, you can even hear in her voice, when she just zooms in on those aspects of her situation, she moves to that place of gratitude. But I think if you asked her about the hard parts, she'd be able to say all that too, right? It's this ability we have, the capacity we have to zoom in and just kind of hang out there, and that you can use that as a coping tool, right? You can say in this moment, if I just focus my lens on how well my kids are doing, good feelings come. Okay, I'm gonna hang out there for a while. But it's not to deny that in her private time, she's not experiencing a host of other feelings. So it really is about that coexistence. It's an "and".

Dr. Diane Reidy-Lagunes:

Absolutely. And again, I want to emphasize that we're not telling people you must have a positive attitude in life to get going to the next moment. But like you said, it's sort of what's in your control and what you can try to embrace in that moment. At the same time though, as you said, it's such a whirlwind and patients are thinking, but this might be my last holiday. How do you get back to that place, like you just discussed, where people are living in that moment and their gratitude is there, but can quickly move over?

Dr. Wendy Lichtenthal:

I think first a permission to feel the hard stuff. It is natural. It is normal. It is understandable. And when we try to push things out that are absolutely 10 out of 10 people would feel, that's sometimes where people can get stuck, right? That's when they're "should"-ing themselves, right? "I should be grateful." And they feel badly about feeling badly. So we want to at least take that layer of feeling badly about feeling badly out, and give yourself permission to have the entirety of the experience. So first and foremost is an acknowledgement and a validation that this is hard. That has to come first. Then you can take a breath and then, as you said before, look at what is within your control. Where do you have choice? And moving your lens, shifting your lens, to what is here before me? What matters to me? What am I grateful for? That is something that you can choose to do. So I know we're gonna say it a few times here – it's just so important because people do "should" themselves, because there is this positivity idea around the cancer experience and people who say things like, "Cancer is the best thing that ever happened to me." That makes some people feel, you know, roll their eyes and feel sick to their stomach – it's not the entirety. The experience also includes hard feelings. And often when people have arrived at gratitude, there was a journey to get there. There were a lot of hard feelings that they moved through. And I think we need to acknowledge that as well. When you focus on what you have control over, you can choose to zoom in on what's meaningful and what you're grateful for when you need it, when you need those moments.

Dr. Diane Reidy-Lagunes:

Stacey Peltz, also a stage four cancer of the appendix, was featured in our third episode on "A Cancer Survivor Guide to Chemo." She shares with us all what she's focused on this season and what gives her life meaning

Stacey:

I will turn 60 years old during this holiday season. Honestly, I never thought I would get here when I was first diagnosed in 2012. A lot has changed and nothing has changed. I still have cancer. The tumors are still growing, albeit slowly. In the meantime, I'm full of gratitude for a number of things. First and foremost, Dr. Reidy has again ordered genetic testing of my cancer to see if there are any trials or treatments that would potentially have a better rate of efficacy in helping me battle this disease, maybe even cure it. Wouldn't that be great? I am also very grateful to my husband, Mike. He's a pillar of patience and my humorous better half. Forever grateful to him and to my four crazy dogs. They snuggle really well.

Dr. Wendy Lichtenthal:

I love Stacy's humor. Can we talk about the idea of, you know, people have these bucket lists and they have a lot of the "why" we live, but instead sort of focusing on the "how" we live, and some of the examples that she so beautifully described of living in those moments with her dogs and her family and her husband.

Dr. Wendy Lichtenthal:

Yeah, her honing in on what's meaningful to her – and you kind of hear it in her voice that she sounds connected to life and that gratitude emerges – that is sustaining, right? So if you've heard the quote, the Nietzsche quote, "He who has a 'why' to live for can bear with almost any 'how'." The idea behind that is acknowledging first, again, the "how" is that cancer includes distress, it includes struggling, it includes suffering, it includes uncertainty. And how do we endure that? How does someone move through what is hard? Well, there has to be a "why". Why would you bother? What's behind it? So to coexist with the hard parts, it can be through connecting to the "why's," the things that matter – her husband, her dogs, the moments of life that make it worth it. And I think it's a hard task. Sometimes it takes intentionality to focus on "this is why." I also thought it was really interesting what she said was that in her gratitude for the genetic testing, she's grateful for continued hope, right? Kind of embedded in that is like, "I'm grateful to continue to think that maybe things can be okay." So I think that idea that what is meaningful is in the here and now. So her husband, her dogs, that is her "why". And that sometimes there's also this element of hope for a future that is somehow better or desirable or meaningful, and you hear that in her answer there too.

Dr. Diane Reidy-Lagunes:

Wendy, you work with bereaved families. Kendra joined us for our episode focused on caregivers. And since that episode aired, her beloved husband, Charlie – our rockstar marathon runner who was actually featured on episode two discussing exercise as his outlet – passed away. Yet Kendra still has gratitude. Let's take a listen.

Kendra:

This year, I'm learning that grief and gratitude can exist at the same time. While this year was full of happy times, it was also very challenging, as Charlie went to heaven in September. I miss him everyday and especially now during the Christmas season. Dr. Reidy and her team at Memorial Sloan Kettering gave us three and a half years that we spent getting married, traveling the world and making memories that I'll keep forever. The time we had together was the best gift of all. Charlie taught me the importance of gratitude and as I look back, there's so many things that I'm grateful for this year: the friends and family who check in to share their stories about Charlie, what he means to them and how they're keeping his spirit alive; the signs that Charlie sends me like our wedding song playing when I'm feeling down, or a visit from a cardinal, a rainbow or a single star in an otherwise dark night; and for his kids who got all of his best qualities who keep me laughing and who will move forward with me.

Dr. Diane Reidy-Lagunes:

It's hard for me to listen to that 'cause I miss him so much. How do you help family members like Kendra tap into that gratitude when you're really in the thick of that grief?

Dr. Wendy Lichtenthal:

Yeah. Oh gosh, it's so hard. It's incredible to hear her "and" there, right? That there was happiness and challenge. And I think what's powerful about this is that she tapped into it because you asked. And so she shifted her lens because the question was asked of her. But she also answered it. The other reason that tapping into gratitude was important to her is because she voiced that it's a way to continue Charlie's legacy. And there is meaning behind being grateful for her at this other level because it's what Charlie taught her. So being grateful not only brings the positive feelings that come with zoning in on those amazing aspects of life, like her appreciation for others and the signs that Charlie brings, but it also really gives her an opportunity to amplify Charlie's ripple effect because it sounds like that's who he was. And so again, it's like in this out-of-control situation, what Kendra has control over is how she chooses to face this, how she chooses to face her grief, how she chooses to face a way to step into life without Charlie physically here. And she's continuing her connection with him, which is essential, and also choosing to focus her lens in a very specific way that honors him.

Dr. Diane Reidy-Lagunes:

Absolutely. And I believe in those signs. You have to look for them, but his family always says he's in the room next door. And I think all of us, you know, have different ways of trying to, like you said, remember those who have passed and thinking of them in different ways and looking for those signs. We also heard from Jay and Joan Cohen. Their 26 year old daughter, Christine, bravely agreed to be interviewed by us for the podcast right when she was at the end of her journey, just days before she passed. They are also grateful for their daughter's legacy. Let's take a listen.

Jay:

The first thing we're grateful for as we look back is the way she lived that life in the three years from her diagnosis to her passing, it was an extraordinary life that she lived.

Joan:

Christine had time to be with family, to laugh. She had a great sense of humor, which she never lost. She never complained. She had time with friends. She got to travel, which she loved. She spent time with her bestie, her sister, and she had a chance to get back to work, which was so meaningful to her. And she had an enormous amount of courage and just great spirit, which, it's a lot for all of us to live up to.

Jay:

And that's the second thing we're grateful for: this legacy that she left, not only of the spirit and the courage, but what she did to try to help others who would find themself in the same situation. From fundraising to this extraordinary podcast that she did, we know Christine will live on.

Dr. Diane Reidy-Lagunes:

What does the evolution of that grieving look like? You take care of family members of patients who have passed on and you spend a lot of time with them, and you would imagine that there's an evolution there. That in the beginning, in the thick of that grief, like we discussed where Kendra is now versus where Mr. and Mrs. Cohen are.

Dr. Wendy Lichtenthal:

Yeah. I mean, I think it's important to just keep in mind that grief is absolutely nonlinear. It's non-predictable. It is certainly ongoing. It doesn't resolve or end. And really the psychological task is to figure out how to coexist with it, how to adapt. And often the way people can is, what you hear her parents speak of, is to focus on the legacy that she left, the meaning and the inspiration. So she had courage in facing what was hard. And this idea that they are going to live up to this, and to be with grief, takes an enormous amount of courage, especially after losing a child. So the way for them to coexist with their grief is to connect to that meaning, to connect to Christine's legacy. I would say that for parents, for anyone who has such a profound loss, sometimes that grief is very much in the foreground and other times it's more in the background – other things are more in the foreground – but it's always there. And parents would say, it's always there. So this idea of being able to figure out how to coexist with it through meaning, through a continued connection to Christine, I think is a big part of the task. But I'll mention now, especially around the holiday season, that when there are moments, milestones, happy times, we expect the surge to come. We expect that there are waves of grief. And really, it becomes a matter of surfing these waves – these understandable, often very intense waves – and kind of finding yourself on the other side.

Dr. Diane Reidy-Lagunes:

Oncologists like myself and like other colleagues on the show are often surrounded by sadness. We have moments of victory and we also have moments of a lot of sadness, and it affects us all. Let's listen from Dr. Matasar on what he has to say and how he finds gratitude

Dr. Matasar:

This year I'm grateful for so many things, but one thing that I especially am grateful for is my coworkers and the teams that I work with. It's been a very hard year, made all the harder by one of my colleagues becoming very ill. And seeing how the team, my coworkers, my partners, all rallied around her, her family, her patients – and the extraordinary lengths that everyone went to to make sure that her patients were being cared for, that her family was being taken care of, and that we were showing not just professionalism, but our love – is truly inspirational. It's been a long year and that we continue to work together so diligently and so selflessly for this shared mission that we're all part of is humbling and inspirational and something for which I'm truly grateful.

Dr. Diane Reidy-Lagunes:

Clearly the world of oncology is challenging for all of us and as you articulated so beautifully, Wendy, it's all about leaning into those emotions and acknowledging them for what they are.

Dr. Wendy Lichtenthal:

And then you can take a breath and decide and choose where to focus your lens, where to focus your energy, with intentionality, to get through to the other side. But it is really hard. And there's so much beauty in the gratitude that comes out, just listening to that, to be able to zoom in in that way and look at what the unsought gifts are of an experience.

Dr. Diane Reidy-Lagunes:

Dr. Wendy Lichtenthal, thank you so much for joining us today and for all you do.

Dr. Wendy Lichtenthal:

My absolute pleasure and honor. Thank you so much for having me.

Dr. Diane Reidy-Lagunes:

Stuart Scott famously said, "You beat cancer by how you live, why you live, in a manner in which you live." In every moment, there's an opportunity and life is about those moments. To our listeners who are feeling sad, know that we are thinking of you. And for all of our listeners, I hope you can stop for a moment to look for those opportunities. They're in front of you if you stop and look for it. Lastly, we'll end with a short montage of a few quotes from my colleagues, doctors Jedd Wolchok and Neil Iyengar, and my dear patient Grace Dunn. Let's take a listen.

Dr. Wolchok:

I feel very privileged and grateful to be among a team of devoted scientists who are working tirelessly to try to develop better therapies for cancer. I'm also in this particular year, very grateful for the efforts of all of the scientists and clinicians who helped to develop the COVID-19 vaccination. Hopefully we will see better days in the year to come.

Dr. Iyengar:

I'm especially grateful for my two wonderful children, my spouse and my parents, particularly the health of my mother, who was treated for breast cancer at MSK. It's been a tough year for many of us, but I'm grateful that there are still many reasons for hope

Grace:

Since 2014, my life has been consumed by both the physical and mental effects that cancer has on someone. With a third year of good news, I am finally at a place in my life where I feel settled. I actually have hope for the future and doing all the things I feared that I wouldn't. I am thankful that I can be normal and grateful that I am breathing, and that's all anyone can be thankful for this holiday season.

Dr. Diane Reidy-Lagunes:

Thank you for listening to Cancer Straight Talk from Memorial Sloan Kettering Cancer Center. For more information, or to send us any questions you may have, please visit us at mskcc.org/podcast. Help others find this helpful resource by rating and reviewing this podcast at Apple Podcasts or wherever you listen to your podcasts. These episodes are for you, but are not intended to be a medical substitute. Please remember to consult your doctor with any questions you have regarding medical conditions. I'm Dr. Diane Reidy-Lagunes. Happy holidays to all. Godspeed. Onward and upward.