Healthy, thriving young adults aren't supposed to get cancer. So when one does, the natural question is: Why?
It may seem like a simple inquiry. Actually, it's not. Both the question and the answer are loaded with emotions.
First: The Question. Many times I've been asked why or how I developed acute promyelocytic leukemia (APL) at the age of 31 and almost five months pregnant. People ask because they care. It's difficult to know what to say to a patient, so I always appreciate when someone tries to find the right words instead of ignoring the cancer in the room. The concern for and interest in my health spurs strong feelings of gratitude and love in me, and I know that my family's and friends' emotions are just as strong. So yes, I view the "why" query as a positive that initiates a beneficial dialogue. During these young adult years, Gen Y-ers are striving to define themselves, and a cancer diagnosis becomes part of that sense of self. Since leukemia has become part of my identity, and I'm proud of how strong I've been, I appreciate when people recognize it.
Although the question is a positive one, it can contain a subtext that makes a fighter/survivor squirm. Let me preface my point by saying: It's human nature to strive for self-preservation. The desire to live is encoded in our DNA, and is why our species has flourished. I know the subtext of the "why" inquiry because I have thought it myself. We, deep down, want to know the cause, so that we can assure ourselves that a difficult diagnosis won't happen to us, too. It's human nature, and 100 percent understandable. But the subtle shift from concern for patient to concern for self doesn't always go unnoticed by the patient, and it can trigger tough emotions for that patient.
You may be thinking that the complexity of the question supports the idea that it's difficult to find the right words to say to a fighter/survivor. You're right. Some patients may like being asked why, while the potential subtext makes others feel uncomfortable. Substituting in, "I wish you the best," or "How can I help?" is one alternative. Another is to save the loaded question until further into a conversation, once you've had a chance to assess the fighter/survivor's mindset. If you're simply curious about the risk factors, search on the Internet -- it doesn't have sensitivities.
Second: The Answer. Why did I develop APL? The risk factors for leukemia, according to Mayo Clinic's website are: 1) Increasing age -- most common after 65; 2) Your sex (more common in men); 3) Previous cancer treatments with radiation or certain chemotherapies; 4) High levels of exposure to radiation (e.g., nuclear reactor accident); 5) Dangerous chemical exposure, such as benzene; 6) Smoking; 7) Other blood disorders; 8) Genetic disorders, such as Down Syndrome.
Both having and not having any of the risk factors associated with a disease causes the answer to the "why?" question to be loaded with emotions. In my case, I don't have any of the leukemia risk factors. This is true for many young adults with survivors/fighters. Bam, out of the blue: "You have cancer."
I found out I had something wrong with my blood in the basement of an abortion clinic. Three days earlier, I'd been told at a routine ultrasound that my baby had no heartbeat. At the time, the doctors thought it was a problem with the pregnancy or baby -- not with me. The blood tests before the procedure to remove my sweet Lily Elizabeth showed that my platelet count was dangerously low -- a result of the leukemic cells crowding out the healthy cells.
When I ask myself why it happened, it's hard to answer. When someone else asks, it's even harder. I want nothing more than to assure the person that everything will be okay, not just for me, but for her, even when there's no subtext of "This can't happen to me, can it?" It shouldn't happen to anyone. Cancer survivors/fighters know how much it sucks, and thus pray and hope the disease's reach doesn't extend beyond us. We're a community that advocates and raises money for research not to benefit ourselves, but for prevention and to cure those that will be faced with "Why?" in the future.
The next time someone asks me the question, I hope she doesn't feel offended when I respond, "Don't worry. This won't happen to you. You don't have any of the risk factors. It's extremely low probability." Even if she isn't secretly wondering for her own sake, I need to say it. Because I want her to feel secure and confident, even if I can't.
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