1. Harpham, Wendy S. MD, FACP

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Considering how compulsively I keep my inbox empty, it's odd I've left an interview request unanswered for days. Even odder, the journalist's topic for my interview is right up my alley: dealing with cancer. He talks with experts about bouncing back from life challenges for his podcast, Bounce-a series on resilience.

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Wendy S. Harpham, MD... - Click to enlarge in new windowWendy S. Harpham, MD, FACP. WENDY S. HARPHAM, MD, FACP, is an internist, cancer survivor, and author. Her books include Diagnosis Cancer, After Cancer, When a Parent has Cancer, and Only 10 Seconds to Care: Help and Hope for Busy Clinicians. She lectures on "Healthy Survivorship." As she notes on her website (

What's the hang-up? Throughout the 27 years of my survivorship, I have never bounced back. All these years, I've bragged endlessly about my persistence, explaining it compensates for my lack of resilience. Resilient people don't spend hours and hours in tearful counseling sessions. They don't spend years fighting fears and feeling frustrated by post-treatment fatigue. They don't cry to friends, "I wish I were tougher." Unlike me, resilient people are tough. They bounce back.


Despite all my survivorship work, I've never really thought about resilience. Until now. The journalist's invitation intrigues me. At the very least, exploring what it means to be resilient after cancer will help me decide about the podcast, so I can empty my inbox. At best, I'll learn ways to increase my resilience, with insights and tips you might find useful in your efforts to foster patients' resilience.


Resilience is often defined as the ability to recover quickly from difficulties. The associated idiom that troubles me-bounce back -provides a useful starting point for understanding resilience after cancer. Tutorials on bouncing rubber balls show you how simple physics equations reliably predict a ball's path. No such equations exist for calculating people's resilience. How well people bounce back depends on a complex interplay of unmeasurable factors unique to each person and involving all spheres of life (physical, emotional, social, financial, and spiritual).


Aha! Bouncing back from illness is different than bouncing off asphalt. Despite the obviousness of that truth, my excitement is boundless. Such exuberance reminds me of a Eureka moment decades ago, when I realized post-treatment fatigue is different than the fatigue that healthy people experience at the end of a long day. In the context of my fatigue, recognizing that people were using one word for two different phenomena liberated me from the burden of unfair comparisons and unrealistic expectations. Regarding my resilience, it was seeing the flaw in an idiom that freed me of the burden of unfair comparisons and unrealistic expectations.


The more I think about the differences between rubber balls and people, the more resilient I feel. Consider this: The world's most resilient ball doesn't always bounce well. Picture yourself standing on the ocean's edge and dropping a SuperBall. Thud. In life, horrendous adversity can act like wet sand, preventing resilient people from bouncing back quickly. Maybe the reason I needed all those counseling sessions was not my lack of resiliency, but that I was grappling with wet-sand challenges, such as chronic pain and fatigue, hanging up my white coat and stethoscope, and repeated recurrences.


Here's another thing to consider: The apogee of a dropped rubber ball degrades with each bounce, lower and lower until the ball stops. In contrast, after cancer, people can experience post-traumatic growth and end up better, in certain ways. Yes, I've shed buckets of tears. Yes, aftereffects have slowed me down. At the same time, I've become stronger in spirit and richer in relationships than I believe I would have had I never faced cancer.


Nietzsche's aphorism suggests, "That which does not kill us makes us stronger." Not always. Adversity-such as the loss of good health, a career, or a child-shatters some people forever. After cancer, some long-term survivors withdraw from life, because they fear recurrence, feel like damaged goods, or don't see the point of trying.


That said, most survivors do get on in their life, in some form or fashion. I did. Knowing how much work and support it took, Nietzsche's aphorism makes sense only if we tack on a qualifier: What doesn't kill us makes us stronger in the long run. Now I know that when facing cancer, my resilience was expressed as feeling weaker and more vulnerable for a time, before I began to feel stronger. It meant asking for guidance and support while I learned what I needed to do and slowly adjusted to the changes. Resilience meant grieving my losses, so I could then see all the opportunities that remained. At my lowest point, resilience meant having hope of a better tomorrow, without yet knowing how to make tomorrow better or what "better" might look like.


These reflections lead me to propose my own definition of resilience after cancer: The ability to adjust to unwanted changes, live for today and hope for tomorrow. What I like about that definition is it won't lead people astray with unhelpful time frames (e.g., quickly) or idioms (e.g., get up after being knocked down). More important, it empowers patients and clinicians, because anything that helps patients adjust and feel hopeful helps them build resilience.


In your routine care of patients, you help patients build resilience when you help them:


* Obtain information about what's happening, what to expect, and what they can do to help their recovery.


* Address all medical problems that drain energy (e.g., pain, fatigue, disordered sleep, inadequate nutrition, anxiety, depression).


* Refer to resources to address all other energy-draining problems (emotional, social, financial, spiritual) and to learn coping skills.


* Inquire about their hopes, and support their efforts to fulfill realistic hopes.



If nothing else, you help patients when you explain, "People are resilient, but they are not rubber balls." Remind them it takes time to adjust to changes and grieve losses, and they may feel weaker and more vulnerable before they feel stronger. By fostering patients' resilience, you help them live as fully as possible today, tomorrow, and every day. That's what I'll tell the interviewer, too, when I do his podcast.