1. Harpham, Wendy S. MD, FACP

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"Don't tell me this is my new normal! I hate the new normal!" Reactions such as this sadden me. I've championed "the new normal" since the early 1990s, when few resources were available to guide me through the challenges of my first remission. Thereafter, the notion of a "new normal" has helped me live my best life through all the transitions and rough patches.

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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

Naturally, I was pleased "new normal" became integrated into the lexicon of survivorship. Recent online rants suggest that somewhere along the way the term became dissociated from the ideas that gave rise to it. I'm hoping that by revisiting what "new normal" still means to me and exploring what it might mean to survivors who don't like it, I find a compact way for clinicians to share the healing ideas along with the term.


First let's talk about what it means for life to feel normal. The essence of this complex idea is that, for the most part, (1) our experiences match our expectations and (2) our routines help us navigate our days. Those alignments make life feel like usual.


When our reality shifts, the tension between our usual routine and what's happening now creates an odd sensation we recognize as "not normal." If the shift is sudden and distressing, life may feel surreal, which cushions the blow as we begin to process our changed reality. That's good. Unless it persists. We need normalcy to engage effectively in our life as it is.


After cancer, feeling normal can be challenging. During my first remission, my fatigue, frequent infections, and fear of recurrence kept me from resuming my usual routines or feeling like myself. A favorite lapel button showcased my yearning: "I know this sounds strange, but all I want is a normal life."


Blindsided by the physical and emotional difficulties, I joined a support group and began counseling with a social worker. Grateful for the insights, I started writing a book about recovery, subtitled Your Guide Back to Normal.


As the manuscript developed, so too did my understanding of what "normal" means: "For most have a normal life after cancer means creating a new normal that incorporates the physical, emotional and spiritual changes catalyzed by your cancer experience." The subtitle evolved, too, to reflect that forward-looking message. (After Cancer:A Guide to Your New Life)


As I saw it, cancer had splashed ugly streaks across the canvas of my life. It was up to me to fill in the rest. What did I want my life to look like? The idea of a "new normal" motivated me to find the best ways to deal with unwanted changes, a quest dependent on sound knowledge. Information about aftereffects (including those facts that initially upset me) helped me manage my expectations. Insights about survivorship enabled me to develop more adaptive routines. Over time, my expectations matched my experiences, and my new routines helped me do the right things. My confidence rose. My anxiety lessened. My life began to feel more normal


Unexpectedly, a beautiful thing happened: The obtrusiveness of unwanted changes faded, overshadowed by the vibrancy of life lessons learned through illness. My reordered priorities and savoring of ordinary pleasures made my "new normal" better, in certain ways-even while dealing with recurrences and persistent pain.


As a physician-survivor, I'm convinced of the healing potential of "the new normal." So, why might patients react with anger, confusion, bitterness, disappointment, or fear? I suspect the crux of the problem is they mistakenly equate "the new normal" with "living with unwanted changes from now on."


If so, "the new normal" traps them in their current distress. Rejecting the term is a linguistic left hook in their ongoing fight against cancer. It's their proclamation: "I'm not giving in to cancer! I'm not giving up hope!"


A thread of fear may weave through such bravado, if patients' identity remains tethered to their pre-cancer life. Asking them to enter a "new normal" where they hardly recognize themselves or their life may stir an existential fear of getting lost or trigger a real-world fear of yet another loss. Indeed, to create a "new normal," patients must let go of their "old normal"-a daunting task that triggers grief. Patients who've cried buckets may resist any path that involves loss.


For those or other reasons, patients may perceive "the new normal" as an obstacle to being who they want to be or going in the direction they want to go. The irony is that "new normal" was intended as a tool for regaining control and moving forward with hope of a better tomorrow.


Maybe tacking on the implied qualifier can fix the glitch. Calling it "the new normal for now" highlights that "normal' is a moving target. From birth to death, with or without cancer, the human condition demands creating one "new normal" after another as circumstances change. Adding "for now" emphasizes the temporary nature of "the new normal" designed to empower patients now.


Life after cancer is an art: the art of living well. The comfort of "normal" can feel elusive while in transition due to a new diagnosis, aftereffects of successful treatment, or metastatic disease. Clinicians can help patients accept and adapt to their changed reality by introducing "the new normal for now," which includes good things that come out of unwanted illness, as well as all the unwanted changes thrust on them. It includes heightened gratitude for today and all the things under their control, such as new routines and new skills that help them make life the best it can be for now.


In your care of patients, you show compassion by validating patients' losses. You empower patients in transition by providing needed information. And you inspire patients by supporting their efforts to create a "new normal for now" that helps them today, while they're hoping for a better tomorrow. "Even in the worst of times, we can strive to make life the best it can be."1


1 Healing Hope-Through and Beyond Cancer (WS Harpham; Curant House; Dallas, TX; 2018) [Context Link]