03 August 2019

Book Summary: Roads to Meaning and Resilience with Cancer


Book Summary

Morhaf Al Achkar, MD, PhD

The book, “Roads to Meaning and Resilience with Cancer” tells the stories of 39 patients with incurable lung cancer. It aims to help patients, families, and healthcare providers understand the experience of living with cancer. It also invites reflections on the essential questions of meaning, resilience, and coping with adversity in life. The author is a family doctor, teacher, and researcher who is also a stage 4 lung cancer patient himself. He is patient #40.

Facing one’s mortality, patients with cancer develop an urgency to find meaning in life. They struggle with the illness, its emotional impact, and the consequences of treatments. But, with time, reflection, and support from others, they develop resilience. Cancer patients often are not passive. Instead, they choose different strategies to maintain and restore their health. They also leverage a variety of approaches to cope better with their struggle.

The first chapter, “Finding Meaning,” explores how participants search for meaning. There was no one answer to this inquiry. Some felt they had limited access to purpose and meaning as if it had all been ripped off from them or that life was nothing but chaos. Many individuals, on the other hand, find meaning in relationships and connections. Those who were fortunate enough to return to work found meaning in the spaces where they showed their talents. Those who reconstructed their identities around their experience with cancer also found meaning in serving others, especially the ones who struggle with a similar illness. For many, meaning had become about service, and service gave them a purpose.

People also developed resilience in a variety of ways, and that was the topic of the second chapter, “Building Resilience.” Some relied on themselves and took pride in being determined and strong-willed individuals. Some considered relationships in their lives to be the source of their resilience. Knowing more was how some of these people felt empowered. For others, religion arose as a source of strength, and relying on divine power was necessary. Not everyone, however, felt strong. Some participants felt broken inside.

People with advanced cancer have an existential threat. With this threat comes, for some, the desire to do all that is possible to abate the danger. Cancer also leaves many scars, and its treatment has many complications. People want to live a more tolerable life and one of better quality. In the chapter “Health Actions,” the book reviews patients’ health choices. This chapter includes a diversity of practices. It also summarizes reflections on the reasons for doing this or that practice. Furthermore, it brings insights into what has worked or did not work from the experiences of different participants. The practices spanned a variety of diet choices, exercising practices, and complementary and alternative medical approaches. Participants did not always agree on what counts as healthy and what is useful. What is common, however, between all the participants who had survived longer than what typical lung cancer patients used to is that they also take targeted chemotherapy. The book includes participants’ intimate reflections on why they choose to take medicine and battle the disease.

The chapter “Coping with The Struggle” presents reflections on what people do to cope with their struggle. These are actions that people engage in to maintain a sense of purpose and identity. Unsurprisingly, they did different things. To cope, people maintained their agency by volunteering and doing advocacy work. Also, they have shifted their frameworks around to better align with what is conducive to carrying on. For example, they attempt to redirect their attention, try to be positive, or use humor. Some have coped by learning about their cancer and how to manage it. Others have coped by living life in the here and now. Finally, some people needed extra rest and found that to be what helped them cope.

Cancer is an experience of struggle, and it shifts many aspects of a person’s life. The person’s roles in life also change, and so do the relationships they form with people around them. Further, the person’s understanding of their life’s purpose sways with the uncertainty of their prognosis. Living with cancer is uncharted territory for those experiencing the illness. This novelty is especially real for people with lung cancer with oncogenic alterations. There are positive prospects that came with targeted chemotherapies. Lung cancer patients are living longer and with a better quality of life. There is hope. Still, there are many daunting uncertainties.

The book is for cancer patients who are tarrying at the limits of time. It is also for those who live around patients with cancer: caregivers, families and friends, and health care providers. People who struggle with other illnesses will also find aspects of their story reflected here. Also, the ones who have experienced a crisis of identity will discover elements of their story here as well. By sharing the experiences of the forty authentic individuals, the book opens the space for them to teach others. They have a lot of wisdom. This book is about the essence of the human experience at its limits. It is for every reader.