The Daily Item, Sunbury, PA

Technology

April 3, 2013

Cancer As a Non-Tragedy: How Far Can a Positive Attitude Go?

(Continued)

WASHINGTON —

She's the opposite of a hypochondriac, never missing a chance to brag about her unusually good posture and the physical strength that many women her age would envy. She informs doctors that her nickname is Tough Lady. When I asked her if I could write something about her medical situation, she said, "Make sure to include what I tell every doctor: 'I'm not old, and I'm not sick!' "

No question, she has a wonderful attitude, and her sunny disposition if distilled and bottled would be sold in every drugstore on the planet.

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But an objective account of Emily Notestein's health history, and of her attitude toward medicine, would surely note that she has not been a diligent student of her disease and that she showed no interest in seeking aggressive treatment when it first appeared. There is a fine line between optimism and denial. The power of positive thinking goes only so far.

How aggressively we deal with cancer hinges in part on age and whether the disease threatens to truncate a life dramatically or merely lop off some years in the final decade or two. And cancer in a septuagenarian can be more indolent than cancer in a young woman. Thus, an older person like my mother faces a different mental calculation than someone who is in the prime of her life. Cancer at 76 doesn't feel like a tragedy.

My mother first had breast cancer two years ago; she had a lumpectomy and no further treatment. She insisted that she didn't need chemotherapy or radiation or a combination thereof. A plausible scenario is that she was stunned by the high cost of the procedure, and lacked Medicare Part B coverage, because back when she was 65 she felt no need to sign up for something that would be useful only on the very off chance that someday she would have a medical problem. ("I was healthy!" she told me when I pressed her on it.) What's indisputable is that the cancer came back in the same breast.

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