Parenting during cancer By Carla Paras-Sison Philippine Daily Inquirer First Posted 21:21:00 09/01/2008
MANILA, Philippines—Ang sakit ng kalingkingan ay sakit ng buong katawan” (The pain in the little finger is felt by the entire body).
This is how Dr. Honey Carandang, clinical psychologist and professor at the University of the Philippines, describes a diagnosis of serious illness in the family. “Even if only one member is ill, that illness affects the entire (family) system. More so if the illness is breast cancer because it affects the mother, often the central figure who holds most Filipino families together,” says Carandang.
How can breast cancer patients cope with treatment and still be the same parent to their children?
As a newly diagnosed patient in 2004, I had that challenge. I worried about not having the right answers to my children’s questions. I fretted about not knowing enough about my own illness and not being certain about its prognosis.
I felt guilty over not being able to do all the things I used to do for the kids, like drive them to dentist appointments or check their school work.
Carandang says truth telling is key. “If you don’t know the answer, or are not sure, just say so. It is important to tell them the truth. But first, the mother must accept she has cancer. Otherwise, the child himself will not be able to accept that his mother is sick. This will just make it more difficult for the child to cope with changes in duties, roles and activities of cancer treatment.”
Cried as they pleased
It didn’t take long for me to embrace life with breast cancer. Mine was at an advanced stage and I was vocal about preparing for the worst while hoping for the best.
My children, aged nine and five then, responded in their own way. They were open about their feelings, cried whenever they pleased, and sat with me or my husband whenever they had questions or encountered stories from outside home that bothered or puzzled them.
“Children have wisdom. Depending on their age or stage of development, they have their own ability to grasp what is going on. When parents fight and put on a brave face and smile and act as if nothing happened, they deceive themselves when they think the children do not know.
“In the case of illness, talking openly will give children the correct information to help them make sense of what is happening. Hiding things from them may lead to greater anxiety and insecurity. What they imagine or fear may even be worse than what the parents are undergoing,” explains Carandang.
Jessica Orleans, now 18, was four when her mother was first diagnosed with breast cancer. She remembers being told, with her 7-year-old brother, about a “bad bukol (lump)” in their mother’s breast. Her mom had the affected breast surgically removed (in a procedure called modified radical mastectomy or MRM), followed by six weeks of radiotherapy.
As a result of this early exposure to cancer, she was reared to live a healthy lifestyle. “Because my mom had breast cancer, I grew up knowing that my risk for breast cancer is higher than others. So while we were young, it became a challenge for us to keep a healthy lifestyle. We had to drink carrot juice, we didn’t like it but mom would say, think of it just as if it were medicine, and it did taste like medicine to us,” says Jessica.
Self-blame
When she was 15, Jessica’s mother was again diagnosed with cancer of the remaining breast. Although her mom had been open to their family about annual check-up results and her suspicion that something was wrong with the remaining breast, Jessica was affected more by the second diagnosis. Her mom was to undergo another mastectomy and was going for chemotherapy this time.
“I was older so I guess I could feel the gravity of the situation more. I felt bitter but I didn’t show my mom. I didn’t want to cry in front of her. Alone in my room that first night we confirmed that it was cancer, I cried and asked God why my mom—she’s so good and faithful to Him.”
Unlike younger children, Jessica did not fall into self-blame. According to research by Dr. Paula K. Rauch, a child psychiatrist from the Harvard Medical School faculty who has a practice at the Massachusetts General Hospital (MGH), “school-age children (7-12 years old) may feel guilty about things they have said or done to the parent.”
However, educating them about cancer will help them understand and remember that their behavior did not cause the cancer.
“Children in this age group need to be educated that the cancer is not contagious and that not all cancers are caused by cigarette smoking. School-age children and adolescents understand the permanence of death; thus, the potential of death may become part of the discussion,” writes Rauch in an article she co-authored and published in the Journal of Clinical Oncology. Rauch founded and now directs the Parenting at a Challenging Time (PACT) Program of the Massachusetts General Hospital Cancer Center.
Through research and experience over a decade, PACT has developed a set of guiding principles for how clinicians can help parents during these challenging times.
Carandang, an expert in child and family therapy, advises parents to emulate children as truth tellers.
“We think children are so fragile and we wish we never have to bother them about these unsavory things. But we are not being fair to them in this way. We must trust in their wisdom and in their resilience. In the end, you cannot hide things from them. They can feel and taste and smell when something is wrong. And if we do not trust them with the truth, we are only making them distrust us as adults.”
Learn more about “Parenting During Cancer” on Sept. 6 at Silver Linings 2008, Waterfront Hotel, Lahug, Cebu City. Listen to Carandang, Orleans, and the author (Paras-Sison) share principles and techniques that may help family members of all ages effectively cope with breast cancer.
Copyright 2008 Philippine Daily Inquirer. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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