1. Harpham, Wendy S. MD, FACP

Article Content

"She saved my life after I got cancer." Strangers overhearing that snippet might assume I was referring to my oncologist. But, actually, I was explaining the benefits of counseling with an oncology social worker. As clinicians, you regularly refer patients to those experts for the non-medical aspects of illness. So did I. In retrospect, I'd have done a better job had I known more about the sessions behind the social workers' closed doors. Here's my story and what I learned.

social work. social ... - Click to enlarge in new windowsocial work. social work
Wendy S. Harpham, MD... - Click to enlarge in new windowWendy S. Harpham, MD, FACP.

Throughout my first course of chemo, counseling never crossed my mind. I had every advantage, even calling myself the "princess with cancer" because of my medical knowledge, superb doctors and nurses, and endless support from family and friends. Six months later, during an overnight hospitalization, a social worker dropped by to tell me about her support group. I became a regular and then began seeing her privately, hoping to understand why I felt so off-kilter and how to get back to normal ASAP.


Had today's survivorship resources been available in 1991, my post-treatment anxiety and sadness wouldn't have blindsided me the way they did. I'd have gobbled up the print and online materials and joined ACOR listservs. Could I have skipped the counseling? No. Cancer had fractured my life. Impersonal resources couldn't address some vital pieces unique to my puzzle of recovery. Only through face-to-face meetings with an oncology social worker could I put them back together as quickly as possible.


How did she help? Sometimes by hearing the fears breathing behind my words of confidence. For example, I'd have bet my house on my husband's devotion. After mentioning a tense moment at home, I added a familiar refrain: "I know he'd never leave me...." Eyebrows raised, the social worker said, "Repeat your last sentence." In my own voice, I heard fear of abandonment. That fear was unfounded in my case. Simply bringing it to consciousness dissolved it forever. Poof. I learned to spot other irrational fears and call them purple noses: fears as easy to dismiss as someone telling me my nose was purple.


Justified fears posed a different challenge. The social worker helped me see the dangers of pooh-poohing significant fears and giving any fear too much power. I learned to size up each fear before beginning the work of managing it, using whatever blend of distraction, positive action, and cognitive reframing worked best.


Fears were low-hanging fruit. Stresses monopolized most of our sessions, from the fleeting stress of others' insensitive comments to the relentless stress of rearing children while dealing with my cancer. She understood everything, since her expertise spanned social dynamics, mental health, and the ins-and-outs of cancer care.


I learned that the puzzle of my recovery after cancer included pieces die-cut by my pre-cancer life. Regaining wholeness included talking about issues predating my diagnosis. It meant working through painful thoughts and feelings, some of which were embarrassing, shameful, petty, or selfish. With friends and family, that degree of emotional nakedness would have been painful for them and intolerable for me, and the risk of an unhelpful response too great. Behind the social worker's closed door, I could let down my guard, knowing she'd sympathize without empathizing and would leave my world once I was well.


The social worker answered many of my questions with questions, my responses to which led me to answers for my original questions-often answers I did not like, mind you, but realistic answers I could live with. When problems had no answers, she'd nod periodically as I detailed my unfixable problem. In the telling, I didn't learn a thing. After I finished, she had nothing to offer. Driving home, nothing about my situation had changed. Yet, somehow the problem no longer bothered me the same way. Her witnessing my distress had changed me in healing ways.


So, too, did her witnessing my grief. The crying I did in her office helped more than the crying I did alone or with loved ones. Why? Even more than I felt weak and vulnerable, I felt empowered by choosing to grieve without inhibition, in all its ugly messiness. I felt in charge of actively moving beyond grief as quickly as possible, while protecting my loved ones from the brunt of my pain.


In essence, at each visit I unpacked my problems du jour. We worked on them. We made progress through witnessing and problem-solving. Then I dried my tears and repacked the remaining problems into a manageable load. Because of those sessions, I engaged fully in my family life and professional life between sessions, as much as physically possible. Because of those sessions, I embraced the life I had with hope and joy.


I eventually stopped seeing her, despite my ongoing illness. She'd given me all the tools I needed to deal with the challenges of survivorship. Now, more than two decades after my last visit, her wisdom continues to guide my responses to all life's challenges. My gratitude has no bounds.


Comprehensive cancer care is a shared mission. Oncology social workers play a crucial role in:


* counseling patients (including those who refuse a psychologist/psychiatrist), whether with a single visit to address a defined problem or long-term to develop coping skills;


* providing a safe place to express distress and grief;


* alerting physicians to patients' mental health crises;


* helping friends/family to support patients while caring for themselves; and


* referring patients to online and community resources.



Every day, we give thanks for the miracles of modern medicine that save lives. Let's also express our gratitude to oncology social workers, those professionals at the nexus of body, mind, and spirit who help patients live.