The elephant in the room

Ever heard this phrase used?

“Elephant in the room” is a figurative English phrase for an obvious problem that no one wants to discuss. The expression refers to a question, problem, solution, or controversial issue which is noticeable to everyone who knows about it but is deliberately ignored because to do otherwise would cause great embarrassment, sadness, or arguments, or is simply taboo. Its origin comes from a Russian fable, “The Inquisitive Man” by Ivan Krylov. In this fable a man goes to a museum where he observes many small animals but fails to notice the elephant in the room.

Grief. It is the one thing everyone close to a cancer patient is experiencing, and no one is talking about. Patients are grieving their mortality, impending disfigurement, loss of hair, a job, or potentially lost dreams or ambitions. Family and friends are grieving the potential loss of their loved one, financial burden, and significant impending life changes. Some individuals must fight cancer alone without a support network or someone to rely on or comfort them. These individuals are grieving their loneliness in what feels like an impossible situation.

Everyone in the room is experiencing complete and potentially debilitating grief, yet no one wants to talk about it. Is it because we feel guilty? humiliated? embarrassed? Grief is taboo in our society of perfect social media lifestyles. Tales of success, pursuit of dreams and beautiful perfectly groomed families plaster the walls of our social media accounts. We are embarrassed to share our moments of pain, trial and misfortune for fear of what others might think of us. We protect ourselves from being vulnerable to others and showing any signs of weakness.

So, I ask again; why do we hide our grief? Why do we protect our vulnerability? I think most people are not taught how to handle another person’s emotions. We are not trained in empathy or vulnerability. Even with those we love, we fear the repercussions of letting them know we are scared or experiencing doubts. Therefore, we suppress our grief and tell ourselves that no one wants to hear about our sadness. Meanwhile, we are left alone to process our feelings.

Even when surrounded by others, you will feel alone. The pain of your imminent situation may strike you at any time of the day. Repressing the sadness means that it can be provoked by any small trigger: an innocent comment from a stranger, a smell or lingering image, or just by the ringing silence in our ears.   

Barely Legal by Banksy held in an industrial warehouse in Los Angeles, California in 2006. Part of the exhibition was a 37-year old Indian elephant which was painted to match the wallpaper in the room it was placed. The animal refers to the metaphor of the elephant in the room.

Grief isn’t just experienced by those afflicted with cancer. Anyone who has lost a loved one, gone through a divorce or break-up, experienced failure, or received life altering news has experienced grief. How should we best process our grief? How can we be more vulnerable to those around us? I wish I had a straight forward answer for you, but the truth is, there is not a single cure for grief. Many times, grief is a life-long experience, such as the loss of a loved one. Some days are easier, while others are unbearable. As you can imagine, while advocating for cancer patients, I get to know patients and their families well. I learn their hopes and dreams, share in their wins and feel challenged by their losses. It is not unexpected that I have grieved many losses over the years. I have also grieved the loss of my own loved ones and personal failures, so here are a few tools I use to deal with my grief:

  1. I put a timer on my tears. That’s right. When I feel the pain of grief coming on, I give myself a set amount of time to cry, then I pick myself up and start again. It could be an hour, a day or a week, but I do not let the grief completely take over my life. I choose when to grieve and for how long, reminding myself that there are many other things in life to celebrate.
  2. I find something to be gracious for in the situation. For example, I recently lost a patient that fought a long two-year battle with leukemia. This patient was pure joy. She had a smile to light up the world. She loved basketball, had a brilliant mind and was full of sass. When she died, she was only a week away from graduation. Knowing her situation, the hospital and her school rallied to get her diploma printed and presented to her before it was too late. She was weak from the wearing effects of the disease, but she was all smiles at her graduation party. When she finally passed away, just two days after her graduation, I thought about how grateful I was that the school and the hospital were able to celebrate this milestone in her life. She was able to celebrate one last victory with her friends and family and we were all there to see her brilliant smile light up the room just one more time.
  3. I talk about it. A LOT. I find that talking things through always helps me organize my thoughts. I often learn more about myself, my condition or situation when I discuss how I am feeling with others. Studies have shown that women often find talking about difficult things easier than men, but I believe all people can benefit from sharing their feelings. When I am grieving, my dad is usually the first person I call. I have also relied on my husband, my sister, and many close friends to help me sort through my sad feelings. Pastors, priests, and therapists should also not be discounted here. Talking about how you feel with someone who you feel comfortable with or who can appropriately empathize with what you are going through is an excellent way to find a path through the grief.
  4. I dance and sing. When I feel the swell of grief coming on. When I know it is going to be one of those days that I just want to curl up in a ball and let the grief win, I force myself onto my feet. I turn on my favorite playlist and I just start moving. Sometimes it is just slow swaying motions that will pick up with time or a certain song. Sometimes I have tears trailing down my face while I sob out the lyrics to a pop song, but it eventually makes me feel a little better. It is hard to not be a little happier when you are dancing and singing.
  5. I take deep relaxing breaths. The kind of breaths that stretch your diaphragm. Fill your lungs to the tippy-top with air, hold it for 7 seconds (or for as long as you comfortably can), then let it out very slowly (7-10 seconds). It generates a feeling of relaxation and calm, which can help settle the overwhelming feelings of sadness. This method is particularly useful when I am in a situation where I need or want to control my emotions.

However, you process grief know that you are not alone. There are people to talk to. There are many people who care how you are feeling. Allow yourself to be vulnerable and allow others to be vulnerable with you. No one is expected to take on the world alone and no one is expected to fight cancer alone. The fight against cancer is a team effort. It’s okay to grieve. It’s okay to hurt. It’s okay to cry. Don’t let the elephant take over the room. Call it out and let the healing begin.

Additional resources for coping with grief:

American Cancer Society: Grief and Loss

National Cancer Institute: Grief, Bereavement, and Coping with Loss

Cancer Care: Grief and Loss

Dana-Farber Cancer Institute: Bereavement Support for Patients and Families

American Childhood Cancer Organization: Resources for Parents Who Have Lost a Child

My most grievous fault

It’s been a long day….

My PhD mentor has added ten additional tasks to my already full plate.

My experiment did not work the way I expected it to.

It’s 5:15 pm and I haven’t eaten since 9:30 am

I forgot that it was my day to take the dog out and my husband is mad because now he needs to go home to let her out before he can leave for his second job.

But it’s a volunteer day! My favorite day(s) of the week! It’s my day to visit with the pediatric cancer patients in the hospital. I’ll take them food, sit and chat with them, and make sure they have everything they need to make their hospital stay as easy as possible. On this particular day, one of the children I am scheduled to visit is in the ICU and has just been placed on comfort care. The child’s parents have just been informed that there is nothing left to do except keep the child comfortable. These are words no parent should ever have to hear. The parents are in a fog. They have been fighting this disease for so long, and just like that they are losing the battle?! It’s just not fair! How much longer do they have with their child? An hour? A day? A week? No one can answer for sure. All anyone can do for this family now is be there for them.

I enter the room feeling awkward and uneasy because… what do I say? How do I provide them comfort? Do I go in? Stay for a while? Drop stuff off and leave? I have done this before, but not by myself. I don’t know this family well and I’m afraid I’m not being compassionate enough. But my heart is breaking. I ask if there is anything else I can do for them and both parents shake their heads no. I give a sympathetic smile and tell them to “If you think of anything you need, please let us know. We are here for you…. Okay. Have a good day.” WHAT?!! Yes! I said have a GOOD day. The worst part… I thought I was truly being helpful and it would be months before I realized I did anything wrong…

A couple of years ago my husband was raving about the podcast “The Tim Ferriss Show.” For those who do not know, Tim Ferriss is an author, entrepreneur, and motivational speaker. He is probably most famous for his book, The Four-Hour Work Week. (It’s a fantastic book about how to improve efficiency so you can enjoy more of your own life.) After giving in and finally listening to the Tim Ferriss podcast, I discovered he is also a gifted interviewer. He can get to the heart of the person he is interviewing. He asks exceptional open-ended questions which allow you to hear directly from the expert. Needless to say, I became hooked as well. (I, personally, aspire to be more like Tim Ferriss.) Alas, this is not about Tim Ferriss. However, about four months after the experience I have described in the previous paragraphs, it was through his podcast that I “met” Dr. Brene Brown. She is a courage, vulnerability, shame and empathy researcher at University of Houston, a four-time New York Times best-selling author, and has one of the top five most listened to Ted Talks in the world. Her Ted Talk, is captivating because she presents on the topic of vulnerability by being vulnerable. She talks about her own vulnerable experiences, how she expanded her perception through a “spiritual awakening” (aka BREAKDOWN – I think we’ve all had one of these), then calls us all to more vulnerable by 1) letting ourselves be seen 2) loving with our whole heart, even though there is no guarantee 3) practicing moments of gratitude and joy in moments of terror 4) listening instead of talking. The podcast interview led me to read Dr. Brown’s book, The Gifts of Imperfection and watch her Ted Talk. This is when my realization set in. I was not being empathetic to others… AND this was true in all my relationships: the patients I was working with, my co-workers, my family, my friends, my husband, and yes even my dog. I have always been a firm believer in being open to another’s opinion because their perspective is the sum of their own experiences, but I was not SEEING the world through anyone’s perspective but my own. Additionally, I was pretending like the words I said to people did not have an impact. When they most certainly did!.. Of course, that family was not going to have a good day. It will likely be many years from now before they have another “good day.” Even though I meant well, I am certain my words hurt.

In another presentation by Dr. Brown, she made this analogy:

“Empathy is the antidote to shame. If you put shame in a petri dish, it needs three things to grow: secrecy, silence and judgement. If you put the same amount of shame in a petri dish and douse it with empathy, it cannot survive. The two most powerful words when we are in a struggle are ‘Me, too.’… If we are going to find our way back to each other vulnerability will be our path.”

In Dr. Brown’s research she discovers vulnerability to be “the core of shame and fear and our struggle for worthiness but it appears it is also the birthplace of joy, creativity, belonging and love.” She goes on to explain that we cannot selectively numb the bad part of vulnerability. By blocking the bad vulnerable feelings, we thwart the good ones too. And herein lies my problem, I was afraid to walk into that room because I did not think I was worthy enough (as a stranger) to comfort that family and I was shielding myself from reliving any of my own painful losses. My most grievous fault was not being vulnerable to what they were going through. The family received my sympathy rather than my empathy. Thereby, I lost the connection that they needed during that difficult time.

So, here is my advice:

Start by avoiding words that can hurt:

  • I know how you feel.
  • Poor you!
  • You need to think positively.
  • You look tired.
  • It’s all for a reason.
  • It’s in God’s plan.
  • This experience is a gift.
  • Any sentence that starts with “At least…”

Here’s the thing, this does not just apply to interactions with cancer patients or their family members. It applies to all people. No matter what situation you are dealing with. No matter what your relationship is to another person. We should all practice less SYMPATHY and more EMPATHY. I believe this is what will make our world a better place.