Appearing to Cope and its Dangers

I want, if I may, to use this blog for the purpose of ‘putting some meat on the bones’ of the last posting.  If you have not read it so far, it will help to do so, in order to extract the maximum benefit from this posting. I once had the pleasure of knowing a young male patient in his later teens who had been diagnosed as suffering from Ewing’s Sarcoma.  (This is a highly malignant tumour of the bone, so-called because a certain J. Ewing distinguished it from an osteosarcoma – also a malignant bone tumour- in the early 1920s.)

Robin was a very pleasant and extremely bright young man who, up to the time of the discovery and diagnosis of his serious illness, appeared “to have the world at his feet”.  For one thing he was a model ‘grade A’ pupil attending a top school.  For another, just months before, he had made it into the school’s rugby football 1st XV and was now being widely canvassed as the team’s captain-elect for the forthcoming season.  Robin was also a fine cricketing prospect with realistic hopes, it seemed, of one-day playing for an English county. He also swam for his school.  Judging from the steady stream of peer visitors, both male and female, he was, and understandably so, a very popular young man.

One might therefore think that such an illness, with all that it could portend for the frustration of so many hopes and dreams would have come upon him like a “bombshell”.  In fact, Robin continued day after day to be the essence of good nature and to consistently show warm and sincere appreciation for even the smallest service.  His ever-ready wit and pithy comments quickly endeared him as a firm favourite, especially with members of the nursing staff. Even very aggressive and highly toxic anti-cancer treatment, with its predictable noxious side-effects, did not appear to faze him. Not surprisingly, Robin was also the “apple of his parents’ eye” and I still vividly recall how surprised and at first relieved (but later as we shall see, disturbed and troubled) they were by the nature and sheer consistency of his overall coping response to this dramatic and very evident downturn to his life’s prospects overall.

We had arrived at the point of Robin’s admission to the ward for his fourth pulse of treatment.  Earlier that week I had had a long session with his parents at their request, who were now waking in the night to hear Robin sobbing but always it seemed, in his sleep.  Over the weeks and months, I had come to know him very well and had regularly witnessed his remarkable display of composure in daily coping.  However, as time progressed, behind the scenes both medical and nursing colleagues began increasingly to show increasing concern for him, with ‘knowing’ references to his (as they perceived it) “bottling it all up” and “denying like mad” etc. My opinion – expressed only when it was overtly solicited – was that we should simply “be there” for Robin but nevertheless continue to allow him to make his own running and to respect whatever coping plan he was clearly constantly evolving.

I did, of course, take every opportunity of making my interest and readiness to be a friend and confidante known to Robin, although not overtly and not in so many words. Then one day it happened – in fact at the very end of a discussion about the imminent (at that time) selection of an England cricket XV for an overseas tour.  As I got up to leave, Robin in his characteristically polite but direct manner enquired, “Dr Bindemann, everyone else who wanders in and out of this room, at some point makes thinly-veiled references to their concern for me.  Am I coping?  Do I want to talk?  Am I hiding something away? You know the sort of thing.  You never do.  Why is that?” My response to Robin’s question and what transpired beyond that point I will record in my very next blog.

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