I Am Worried...

The other day in clinic, it was a full day of routine visits and follow up after chemotherapy. While there was a variety of diagnoses, with benign hematology and oncology patients, with patients in remission and in stage 4 cancers, there was a theme in common: worried. Many patients told me that their blood pressure was high on exam because they were anxious. Or they simply told me they were stressed with different reasons. One patient told me he was worried about the work situation. Another patient said that she was worried about her son not finding work. Another patient was worried that her cancer would come back even after she received all the recommended treatments for her stage I breast cancer.

One patient in particular, is a self-claimed worrier of all time. Let us call him Bob. That day, I walked into the exam room with my usual greeting, smiling (although probably no one could tell underneath my mask), “How are you doing today?”

In the outside real world, when asked that same question, many people would answer with “good” or “fine”, or something with that effect. In the exam room, most people are truthful to their doctor. They usually share honest and often raw information. I think that is a very special bond between a physician and a patient.

Bob said that he was not feeling well because he was worried about his cancer was getting worse. After clarifying that he did not have any physical complaints, we talked. His daughter was also in the room.

I met Bob once or twice before. He is one of my partner’s patients and I happened to cover my partner that day. It turns out that Bob underwent a PET/CT 2 days prior to our office visit.

“I’m worried that the treatment is not working,” Bob said.

Bob has stage IV cancer. He has been receiving the same intravenous treatment for almost a year. He shared with me that he was worried the whole time that the treatment would not work. He then started to think of the worst case scenario, about having wide spread cancer, about having pain, about a tormented death.

After reviewing the PET/CT report, I politely interrupted Bob. We reviewed and discussed the PET/CT results. In essence, there were no new or suspicious findings compared to 6 months ago. I told Bob and his daughter that the treatment was working, and as he was tolerating the treatment well, we would continue to do the same regimen.

“What if the treatment doesn’t work (at some point)?” Bob asked.

I asked Bob, “By you worrying about this and thinking about the treatment possibly not working, are you going to change the outcome?”

“No…”

“If by worrying about how the treatment will work or not can change the result, then by all means, worry about it all day long. However, by you worrying about it is not going to change the outcome, and it just makes you feel stressed, unsettled and upset.” I answered.

I continued, “What if the treatment will continue to work and control your cancer?”

“I can’t think that way. This is who I am. I am worried about everything, and I can’t help but think of the worst that will happen to me,” Bob replied.

“How about we focus on what is going on now. The PET/CT is a good result. The treatment is working now. It is good news. If we focus on things we cannot control and worry about it, we will always feel troubled and it will be hard to appreciate what we have. We can learn to think of things a different way. Even though all your life you are anxious about almost everything, that does not mean that you cannot change your perspective. It just takes time to practice,” I said.

Someone told me (and I apologize that I forgot who she was quoting) worry is something that pretends to be essential. Different degrees of worry is so prevalent in our lives that we have coexisted with worry probably since the beginning of humanity. In modern days, we worry about our jobs, our children’s well-being, our parents’ health, and many other things.

I encouraged Bob to find other ways to think of the same situation. Even though we have many subconscious or unconscious thoughts throughout the day, if we are able to pay attention and identify what thought is causing us to worry, then we can be curious and question that particular thought. Is it true? Is there another way to see it? How will I feel if I focus on another way of thinking instead?

If you choose to feel distraught, stressed and unhappy all the time, then by all means, continue to practice and generate more thoughts which cause you to be worried. Most of us will rather not be worried all the time.

I do not think it is necessary or possible to completely rid ourselves of worry, but the volume of that worried chatter can be dialed down in our head. First by finding what we are thinking is causing us to be worried. Then come up with other ideas about the situation. Practice to think in new ways. The more you do it, the easier it is to be mindful of our own thoughts and feelings. If we are able to dial down the volume of the worried channel in our head, then we can focus on more constructive things, more positive things, be more present and can move on to doing other things.