chemo /// coping mechanisms & mental health

"the battle is as much mental as physical". A notion that's probably as overused as it is oftentimes true.

My battle with cancer brought about many lows on both the physical and mental health front, and chemotherapy was definitely the worst of it. Looking back, a few coping mechanisms really helped me out, which I'll try to summarize here.

All of these different mechanisms combined, not necessarily one more than the others, ultimately helped me continue to keep and cultivate a positive mindset during probably the darkest period of my life. That positivity was not exactly unwavering, but as an undercurrent it was so so helpful.

EXERCISE I already bragged about my physical activity in the "Lifestyle" post, so I'll keep this one short. But getting out of the house, into the fresh air, and getting a sweat on felt amazing both physically and mentally. No, my body could not perform like it did pre-chemo, but it was never really discouraging, rather the opposite that any kind of physical activity was even possible.

MAINTAINING PURPOSE

"Those who have a 'why' to live, can bear with almost any 'how'." - Viktor E. Frankl

Dr. Frankl was an Austrian neurologist, psychiatrist, and one of my favorite philosophers. He wrote a book which was life changing for me, and that's not an exaggeration (I even have a tattoo inspired by it). Dr. Frankl survived the Nazi death camps, and while I would NEVER suggest that my little battle with testicular cancer compares in any way, shape, or form to the horrors experienced by those in the holocaust, Dr. Frankl tries to use his experience to teach practical lessons than can be used in everyday struggles and generally in "man's search for meaning" (which happens to be the title of his memoir).

Frankl's quote - the importance of purpose in one's life - helps capture one of the key coping mechanisms I employed, not necessarily intentionally but more organically by accident. Continuing to work partially gave me some daily purpose, but actually the central piece of every day that gave me some semblance of a sense of purpose was cooking dinner. Cooking has always been a passion of mine (and dare I say, I am a pretty skilled home cook), and I put together 99% of the meals in our household. This continued during chemotherapy - even if Joanna offered to take up more (if not all) of the burden. No matter if I was in full zombie-mode during Week 1, I would still make dinner every night. For whatever reason, especially when I was feeling particularly low, those 30-90 minutes of cooking each day were the moments I felt the most clear headed and somehow mustered energy from seemingly nowhere. Cooking can be therapeutic - and this was definitely that. And afterwards, it definitely gave me a sense of accomplishment, that I could still churn out tasty dishes even if most of the rest of the day I had been horizontal and useless.

WEEKEND ESCAPES

With all the social contact restrictions and time in the hospital, chemotherapy made me a little stir crazy, especially as I am someone who is constantly on the go (and often in the air for travel). Obviously we couldn't go on "vacation" - a plane is not a great place for a person with an immune system on the floor, and most of the usual draws of visiting a new place (e.g. restaurants) would also be a no go. But early on we did start booking weekend getaways to secluded cabins within driving distance. The change of scenery was incredibly helpful for both Jo and I, as was being in nature and being able to easily go for nice hikes with our dog Noli. Those weekend trips away were easily some of the higher moments during a difficult period.

one of our weekend escapes to a lakeside cabin in Czechia

MEDITATION / MINDFULNESS

I imagine you've already been beaten over the head enough times before about the benefits of meditation before so I'll try to spare you the lecture. But it really can be a powerful tool for mental health and happiness, both in times of calm and during a storm. That said, it's no overnight remedy. I've been practicing for nearly 6 years, not hardcore but rather "daily-ish" (with a few dry spells along the way), and I only really started to notice tangible benefits a couple of years ago. Most of the benefits I reap from meditation are tied to being more mindful and present - breaking the cycle of chatter and runaway thoughts, the endless narrative in your head - and refocusing on the here and now. You can imagine that during a time of crisis like cancer, the trains of thoughts quickly pickup steam and become runaways. For me, those thought trains often take the form of planning. Even before cancer, my inner narrative spent a disproportionate amount of bandwidth planning - the day, the weekend, the next meal, the next trip, the next presentation at work, the next ____. During cancer, there is so much uncertainty that planning is mostly folly and the name of the game is taking things day by day. So, the ability to catch my brain in the middle of an elaborate internal planning session and return to the present was really helpful. During moments of anxiety, pain, or other strong emotion - not always, but occasionally - mindfulness techniques also helped me to stop, breath, and examine the root of the discomfort rather than get completely yanked around by it. That's not to say I was totally zen or perfectly balanced and in-charge of the whipsaw of thoughts and emotions. I was definitely wound tight, and sometimes snapped especially at my wife with the added pressure. But I also had moments of awareness and calm at points where otherwise it would have been easy to get carried in a less useful direction. That word, "useful" was a tool I learned in a meditation teaching and became, well, quite useful. I tried as often as I could to invoke it when becoming aware of a runaway thought train, mini-anxiety bout etc. I would simply ask myself "is this useful?" - and investigate the internal response, which really helped.

There are tons of apps out there for guided meditations; I use the app "Happier" (formally 10% Happier) and find it keeps the "woo woo" to the right level & focuses more on practical application from some of the world's top meditation teachers. At the time of writing during chemotherapy recovery, I'm in the midst of an all time personal best # of days in a row meditating, 65! Not that mindfulness is meant to be a competition ;)

JOURNALING

When I started chemotherapy I decided to keep a handwritten journal. The waves of emotion I was feeling prior to starting were a good push to try alternative coping mechanisms and I'd been encouraged by a few people to try journaling as an outlet for what was going on inside. Although I wasn't always consistent writing every day and sometimes had to play catch-up, I did find it was helpful sometimes to put pen to paper. Sometimes forcing myself to articulate what I was feeling helped me process and put my finger on what the feelings I felt even were. It's also helpful now to be able to look back and understand where my head was at during different moments of the process. I'm don't think it's a habit I'll necessarily continue, but it was helpful for a difficult moment.

THERAPY

At some point between surgery and the start of chemotherapy, I became aware that I would probably greatly benefit from getting professional counselling to help me work through the emotions and mental health challenges I had seemingly never dealt with before. While I am lucky to have a wife, family, and close friends who I feel comfortable talking to most things about, I think it's only natural to need some additional help (with or without a crisis) and an objective, qualified person as an outlet where importantly you don't feel you are burdening them, and likewise where they are comfortable asking the tough questions.

Most of the fears brought on by cancer were not actually tied to mortality or even impacts on my long-term health, as I was very sure that the overwhelmingly positive odds that I would beat this cancer would hold. Most of the fear and anxiety I did feel was tied to how cancer would change me - would I lose myself, my ambition, my eternal optimism? What kind of long-term emotional / spiritual scar tissue would be left behind by the trauma of this ordeal, and how would my personality change? Was there a way I could make the change positive rather than negative? I've largely come to accept that change is inevitable, and I'm still working out what that change will look like for me, but I'm happy to have therapy as another tool in my toolbox to help me through it.

I tried a couple of therapists before landing on one who I felt a good chemistry and whom I felt comfortable with. I think "dating around" to find the right therapist is part of the process and I never felt that the professionals I saw would feel any rejection if I decided not to continue with them specifically. It is early in the work I am doing with my therapist now but I do intend to stick with the therapy longer-term.

CATCH-UPS & SUPPORT FROM FRIENDS & FAMILY

This one was not something I can take any credit for, but I do have to make sure to give a shout out to my family and friends for consistently being there for me. Yes, with gifts and tangible shows of support (like cooking us meals, picking me up from the hospital if needed, etc.), but the small things were important too, and by these I mostly mean the check-ins. A day never went by without a whatsapp text, instagram message, or phone call from someone checking how I was. Our friends locally also made an effort to try to meet us (outside and socially distanced) for walks or a tea when I was not in zombie mode. It was a great boost for my spirits to know people cared. A bunch of my friends from Canada and my business school in Spain even organized a regular group Zoom call. These points of social contact - even if digital and from afar - were lifelines given how physically socially isolated we were.