Principles of Medical Ethics 

Before You Donate

Think very seriously before donating to any breastcancer organization, or fundraising program until you read their Annual Report to see who their top contributors are, and if they have a product that appears frequently in the message the organization sends to the public. That would be unethical and its illegal. The same applies to a request that the public buys products, but does not receive a "donor receipt" for tax-deductible purpose. Read any and all food labels that breastcancer "non-profits" are promoting to raise money. Some organizations tell the public to help them raise money by asking you to visit their websites, but that only gives them "hits" to increase their sponsors.

Another tip, "signing" an online Petition is not acceptable, so don't fall for such antics. An ethical non-profit, or professional will not request your visit to their website, nor use "cookies" placed on your computer when you visit their site.

Purchase the Breastcancer Postage Stamp, the Post Office will always give you your charitable deduction receipt. Its a valid form of fund raising.

Your Psychological Support Team Member              

Psychiatrist (a practicing physician—M.D. or D.O. qualified specialist through Board of Medical Examiners in their specialty; or psychoanalyst—8-12 years more training and quite different from psychiatry, in general and may possess a PhD), Psychologist (a Ph.D. state licensed professional, therapist (one of many titles— social worker who has earned an MSW [Masters in Social Work], etc is not considered a psychologist without a Ph.D (Doctoral Degree).

YOU AND YOUR THERAPIST, PSYCHIATRIST, OR PSYCHOTHERAPIST

In my introduction to selecting your oncologist, I noted that s/he had better be someone you trust, and fulfills your own personal and professional requirements, as a physician, and/or as a person. S/he would be a physician you'd be seeing for the rest of your lives.  This was particularly important to me because I knew this member of my team had to be someone I could share my feelings with, openly and honestly, concerning life, death, my wishes, and my plans.  S/he had to be someone I could reveal my fears to, and would respond supportively.  And, be very honest, intellectually, and personally.

So, now I have to tell you virtually the same thing about the individual you choose to help you with the emotional/mental aspects of cancer. Yes, search; however, a lot of what you will be looking for is inward. . . is the professional you select someone you believe you are willing to put your whole heart and soul into (relatively speaking).  S/he may help you discover aspects of your reactions, responses, life, or even your existence, and it will serve you well to make a commitment to yourself that you will be totally honest with this person—and believe me, that is hard work (as you'll see below and in my journal). In fact, it is perhaps the hardest work I've ever done. In a way I feel as though I'm racing to understand myself better, in case my cancer returns! 

My own psychoanalyst is someone I definitely want on my team, and I now know will be there when he is needed. There is no doubt in my mind that I could not commit myself, for myself, to someone who was distant, non-involved, and/or appeared unfeeling. As a psychoanalyst will he or can he make mistakes? Its my mind he's working on. Certainly—he's human. And, hopefully by that time I can tell him. That is an advantage of a team approach, as well. Consideration and acceptance.

After all, I know he must have other cases like mine (he has said that the psychoanalytical association is amazed that I have endured with all that happened to me, and frankly, now, so am I). But, I do know he is dealing with other types of patients needs at the same time he's doing his level best to help me deal with the shadows of childhood.

I believe the mind very much regulates, and indeed, controls the body. This specialty would be an integral member of my team.  What gives me a chuckle is that I believe some of the other medical specialties are terrified of psychoanalysts or psychiatrists. My Oncologist lauded me for the courage to want the specialty on my team. I hope you are as fortunate.

Getting There

Their advice touched my heart.  Survivors who had radiation seemed to voice the most psychological impact.  Now I think it is because chemo patients often have their vulnerability right out in the open —and dive to take cover (the baldness, maybe a breast removed, or two, getting sick, carrying a bag to throw up in), and maybe we "stuff" our feelings. 

I was so caught up with the battle, I didn't stop much to think about myself, other than surviving the treatments, and a continued effort to be "open," realistic, and communicate with my physicians so they would know "where" I was. It was important to me that I look forward to life; however, I wanted my team to know my wishes just in case something did happen. Two very dear friends had passed away unexpectedly the past year, one during surgery from from an epidural overdose, and another, sitting waiting to leave the hospital after minor surgery.

At first I chalked the nightmares up to the anemia, low white count, being so incredibly sick with chemo, and the baldness, and one breast then fully removed, after a brutally partial mastectomy, thinking, "This will just take time."   I decided it was taking too much time, and I wanted someone to help me with ME.  The night I looked at my bed and decided I was afraid to fall asleep, grabbed a pillow, and headed for the sofa, I realized, "I need help - I'm afraid to go to bed!"  I  knew if I called my oncologist, he would comfort me, and do something, but this wasn't a 'cancer thing' and I couldn't bring myself to page him.

Finding Someone

My insurance company book gave me hundreds of names of doctors.  I knew I had a PPO plan, and this was going to cost me, and I was running out of the savings that I was living on - the bills were beginning to flow in heavily after chemo.  Even the cost of my chest port had come to nearly $5,000.00 totally, and that had to be done again when they removed it!  Insurance covered a lot of it, but $900 here and there, was taking it's toll.

My internist gave me the name of a psychiatrist who specialized in cancer, women, rehab. and another who took no insurance.  I spoke to them both, and saw the former.  She gave me some medication to 'try,' referred me to two "therapists," neither of whom were state board licensed, but very kind on the phone.  The first and only pill that I took that she gave me I never repeated. It sent me off to another level of life! It had been used "in the Netherlands for years" and now approved by our FDA - but not for me! There still wasn't a fit.

One psychiatrist I spoke to (and many others later) said he didn't take insurance and I kind of gave up and thought I'd see him, then, received a huge hospital bill, and thought I'd better wait.  I have come to believe that everything changes, if you just wait.  So, I put my message "out" and waited.

My infusion nurse, a very perceptive, experienced professional, had become a resource for me over the months.  I trusted her especially because she was the only person in the city who could access my VAS (chest port).  And, even then, we had extremely painful tries, over and over again.  One day, I told her I was looking for a referral, and she told me one of the oncologists used a psychiatrist whom she heard was very good.  I called him.

We had a couple of telephone conversations.  I was panicked about the costs, and had talked to my insurance company to see what they would cover.  The psychiatrist had a fairly large number of cancer patients, and said he would give me an itemized statement; he did not 'take' insurance, either.  He also told me that by the time cancer patients 'find' him, they are very often without funds, have gone through really tough times, and they need his help, and we could work on the costs together.

TIMING

Discussing feelings and fears with someone I didn't know was a very difficult experience for me...control factor, again, I guess.  Whatever it was, I decided I had to utilize this physician or waste my money.  I was already into an IRA to survive, but I figured if I wasn't healthy, what was the use of trying to live to retirement!  If I was healthy, I could still work!  Opening up to him was very difficult!  In fact, I asked him if he'd just eaves drop on any discussion I had with my friends because I'm "open" with them.  I do remember putting a toss pillow in front of my face several times the first couple of weeks, so I wouldn't see him, to make it easier for me to talk to him.  He offered to turn his chair around, let me recline on the sofa, anything, but I was persistent - I wanted to invest fully in myself, and I was determined to be "open"  and confront my inner self, and fears with him. . . but I didn't seem to have that problem with  my oncologist who is a male.

Actually, let's back up a bit....I saw him originally because I wanted him on my team, and I was feeling 'awash' after chemo, and was taking other survivors advice.  So that first appointment was in mid December.

Then, 3 days later, I had to begin my diagnostic tests (after chemo), going to a different radiology group (for sure!), and the mammogram news was very upsetting.  I had a nurse colleague with me because already I did not trust radiologists.  But, this one was thorough, looked at ALL my prior films, and did another high compression film "and this may hurt you..." against my chest wall.  There it was.  I could see it, behind my breast bone, or sternum.  We called my oncodoc - but my surgeon was gone for Christmas.

I was so upset, I called my new psychiatrist because when I left the radiologist, with 4 years of mammograms, and the discovery (which I'd handled very professionally and objectively in the illumination room) I began to cry the minute I hit the car, even screamed, then I cried for hours without any feeling whatsoever!  Thank God I had him!  That scared me...and I knew I was in trouble...not just physically, but emotionally. I knew having no feelings was not a good sign.

He insisted I be with someone over that weekend (that was a Friday evening), but several friends were phoning by then from my "adult hometown (vs where I grew up)," and one called back...."ticket at the airport...we'll pick you up," so I had no time to think.  I had about six frequent sessions upon my return that Monday, then the second mastectomy.  My Oncodoc was with me until I was in the OR, and I wished I had begun this much earlier in the course of this disease. I even hoped the new psychodoc would be around when I came "out of it" with no breasts left!  Psychological support is integral to total health, and to my own team. Trust was building.

In fact, my oncologist told me he admired my bravery and willingness to tackle the psychotherapy.  I remember him saying, "I think I need a psychiatrist, and I'm not the patient (it was Christmas time, doctors had disappeared, and we were going through a diagnostic crisis, and my Oncodoc was worried for me, too).  I didn't realize it at the time but I was furious!  Furious that the stupid, inept radiology group I had used in the spring, did NOT want to see all of my prior films!  The group had missed the obvious malignant areas on my right breast (they could have jumped out and hit him were they mobile!), and their own partner, who 'caught it' when I asked him to do a 2nd reading said he didn't know how his partner had "missed this," but he did NOT need to see my prior year's films, "They won't make any difference - this is malignant!"  Had he done what I offered he may have seen the left breast tumor, too. 

THERAPY/ANALYSIS   It takes time to find the physician or therapist you can work with.  And then, more time understanding the process your therapist will be using (mine also sent me for eye movement therapy in order to calm down the post traumatic stress syndrome [EMDR] so we could work on one thing at a time...the nightmares had me going in circles.  It's a challenge then to just go in and tell someone about your feelings, so don't rush it.  And, I didn't want to go to the EMDR therapist.  Truthfully, I felt I was hopeless, and I was anxious about it.  However, my analyst sent me an email, explaining how this might be a very difficult time - that helped!   I also had a close friend who was finishing many years in analysis, and her encouragement was so comforting: "You doctor knows what to do, I can tell, and he will take care of you."  Another friend 1600 miles away (strange all three of us are from the same area!!) had been here and met him and knowing me so well, was a big help and knew when I was going down the tubes, even on Internet chatting together. 

You may not know what your feelings are, and find yourself rambling.  That's okay, your doctor knows what is going on, even if YOU don't.  I had to remember, it took me this many years to even have an inkling of what my feelings/nightmares were about, and they weren't going to  be fixed in a few months.  At times, I've had to tell him I can't just do it yet, or I didn't know what they were! Fears? It was too early. I did not understand the 'therapy process,' what to do, say, tell, etc.  Telltale sign:  I wanted to be a good patient.  A well-educated, competent, and caring doctor will understand.  He was in communication with my oncologist, which I find helpful, because that is the one person I've been very open with all along, and completely trust, and vice versa.

SEEKING, BUILDING TRUST

It's worth the "footwork," and time to look for someone you want to help you to build a trust relationship with, and you feel wants to help you.  I had a particular reason for selecting the individual that I did.  For one thing, I felt as long as I'm going through this battle, I may as well dive in and strengthen my psyche with all of my energy.  Scared?  Oh, my yes.  My feelings are as unknown to me now, at times, as this elusive cancer that has affected me.  Both are scary!  But, now maybe reality may emerge and denial will lessen.

He put it quite succinctly, it's as though I were the high speed lead car, being followed by many others, and had to slam on my brakes (the cancer!). My very active lifestyle crashed into me with an incredible force, and I was helpless to do anything about it. And, the first experience I had betrayal in a system I trusted truly shattered me, and I didn't know it. I was too busy trying to find someone to help me live. That is what I had to do as a child, too, and didn't remember it.

This physician is very much like my oncologist—he's not easy to hide anything from in that he seems to genuinely care and he is someone who can be reached. He evidences expertise and professional curiosity, as well as ability.  In advance, I was told how he practices, and if necessary, titrated medication with analysis, very carefully, but no medications until he'd had several visits with his patients. I do not take drugs. However, I amazed myself, I was determined to have a holistic commitment to my healing. And, I respect him.  My oncologist and psychoanalyst are not professional buddies. I found that out when I told my oncodoc how patient the psychodoc was being with me, and his reply was: "He'd better be. . . " Doctors like this really help patients heal!

More than a month later I asked him if he'd be on my team! Some of what next occurred is on my Journal. But, I've also given him every page of my personal journal as they were finished, in the hopes that one day my experiences will be helpful to someone else. 

Please sign my Guest Book. Others reading it helps them, too. 

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