What Makes Life Meaningful? (Encore)

Dr. Diane Reidy-Lagunes:

Hello, Cancer Straight Talk listeners. Today, we have a special “encore” episode: Brian Kelly, a chaplain in our Spiritual Care Service. He discussed how the holidays can bring up all sorts of conflicting feelings for those of us affected by cancer – whether it’s gratitude or grief – and it’s possible to feel both.  After that episode aired, we received so many beautiful responses from all of you. We are truly honored that it inspired conversations in your life. Whether this is your first listen or your second or even your third, we hope it brings you peace in this holiday season. Thank you for another year of caring, listening, learning and straight talk. Happy Holidays.

The holiday season is upon us and for many, it's a time that can be filled with conflicting emotions. Maybe you're grateful for treatment but angry with how cancer has upended your life. You're grateful for your health, but grieving the loss of a loved one. These emotions can feel magnified around the holidays, so how do we acknowledge them? Are there ways while still being true to your feelings, to find meaning in it all? Let's talk about it.

Hello, I'm Dr. Diane Reidy-Lagunes from Memorial Sloan Kettering Cancer Center and welcome to Cancer Straight Talk. We're bringing together national experts and patients fighting these diseases to have evidence-based conversations. Our mission is to educate and empower you and your family members to make the right decisions and live happier and healthier lives. For more information on the topics discussed here, or to send us your questions, please visit us at mskcc.org/podcasts.

Cancer, whether you're living with it or witnessing someone live with it, can bring a whole slew of emotions: fear, anger, grief, doubt. When the holidays roll around and it's time to celebrate and reflect, you may ask yourself how that's even possible. Well you're not alone. Today we're coming back to a conversation we started in last year's holiday episode where clinical psychologist, Dr. Wendy Lichtenthal, taught us that gratitude can have the power to heal, and that we're not required to choose between feeling happy or sad; we can feel both. And this year, we're getting a new perspective from someone on the Spiritual Care Service at MSK. Brian Kelly is a chaplain who has supported our patients as they go through some of the most difficult times of their lives. Brian, thank you for what you do and welcome to the show.

Brian Kelly:

Diane, thank you so much for having me. It's a great privilege.

Dr. Diane Reidy-Lagunes:

Many people don't know what chaplains actually do and how they fit in this ecosystem at a hospital like MSK. So can we start to talk a little bit about your role and what you do for us and for our patients?

Brian Kelly:

Sure. So I think one of the most wonderful things about MSK is that it has long recognized that cancer and the treatment journey is a physical experience, it's an emotional experience, and it is a spiritual experience for everyone, and that means different things to different people.

So the Spiritual Care Service is staffed by board certified chaplains, priests, rabbis, ministers, a Muslim imam and lay chaplains like myself. We're trained to understand the spiritual, religious, and really existential needs of our patients and their families. Anyone can request support from a chaplain, as we all see patients of many religious traditions and those with no affiliation at all. Our work really addresses questions of identity and hope and meaning and purpose, which may or may not be expressed in religious terms. We listen, we give support, we pray when we're asked to, we meditate, we can advocate for specific religious and spiritual needs of our patients and we do that that a lot, or we can simply be a comforting companion and a spiritual presence. We call it a ministry of presence.

I learned a long time ago that I'm not able to fix things for my patients, but I can be present for them. And so in that respect, we share with all of our MSK colleagues the privilege of witness to our patients on their journey and specifically on the spiritual part of their journey.

Dr. Diane Reidy-Lagunes:

It's beautiful. And is that what you mean by spirituality, meaning that presence and being in the “now” with patients? Or is there a specific definition when we talk about spirituality, particularly on the cancer journey?

Brian Kelly:

For me, what is spiritual to any individual is: at their core, what is it that provides meaning to them? What is it that provides purpose to them? Is there something that they see as transcendent, something greater than themselves?

For many people, that is a religious faith and one of many faith traditions. For many others, it can mean the people closest to them, or in some cases, caring for others beyond themselves. It can mean nature and the natural world. It can mean art. It can mean music. It can mean so many things.

I know you've heard me repeat the words of my favorite French theologian, Pierre Teilhard de Chardin: "I believe that we are not human beings having a spiritual experience. I believe we are spiritual beings having a human experience." Cancer is the ultimate in human experiences. It's one that takes our patients to extraordinarily challenging places where they experience the full range of human emotions.

Dr. Diane Reidy-Lagunes:

Oh Brian, if I could tell you when you taught me that line, I bring that everyday into most of the folds of my being. When I'm in clinic, you will hear me repeatedly share with my patients that this is all part of our human experience. Because when those moments are just so overbearing, I think having that perspective can be incredibly helpful, for me as a clinician and for many of my patients. So I'm so grateful for you for teaching me that quote.

Brian Kelly:

You used the phrase "human experience" on one of the last few podcasts and I was like, "Yeah!"

Dr. Diane Reidy-Lagunes:

That's you! That's you and your teachings. Brian, the holidays can obviously be very tough on patients and families as they have this human experience. What kind of support can you provide to those who are navigating an illness during this time that's supposed to be precious, but can just bring up such a swarm of emotions?

Brian Kelly:

So first of all, let's remember how stressful the holidays are for everybody. It's a hopeful, yet anxious time for everybody. We're all looking forward to so many things, and at the same time we're stressed about doing them right. Now to go through that stress with either the anxiety of treatment or the pain of the loss of someone makes it even that much more challenging, obviously.

Our patients, even those in treatment, are feeling a sense of loss of what they felt was certain in their lives. That's now been replaced by the uncertainty of a journey that is not a short one and is very non-linear. And for the survivors of those who have died, it's just the ache of missing loved ones who are so important to the core of who they are. For each of these types of grief, if you will, there's no script and there is no correct or right way to do that. That's often something that's very hard for people to learn. It was hard for me to learn.

Nineteen years ago, I was widowed quite suddenly before the holidays. My wife passed away at only the age of 47, and we had sons who were 10 and 12 at the time. I was completely humbled by her loss, by the experience of grief and how little I understood it, and really how powerless I was to control it.

For me, some very wise and loving people taught me that the challenge is to try and coexist and adapt with these feelings of loss and of grief while trying to preserve the connection to the lost loved one or to the identity of who you were before you came into treatment. It is hard work and it takes time. Your sadness can come in waves and in unexpected moments. The challenge is to give yourself permission to feel that hard stuff, to lean into it and to recognize the need, as hard as it is, to surf those waves.

There's one message I try to give patients who are struggling with this on all levels: try to give yourself the same compassion that you're so good at showing others and recognize that there are days when you may not be able to do what you once did or what others expect of you, and that's okay.

Dr. Diane Reidy-Lagunes:

One hundred percent. Let's talk about gratitude, because I've seen this among my own patients – we've heard physicians talk about this as well – the grace that patients exhibit during this time when they are facing cancer is really just completely unparalleled.

I'd like to share a soundbite by Dr. Mark Lewis, who was able to see this from both sides as a patient as well as an oncologist. You may remember him from our September episode about hereditary cancers. Let's take a listen.

Dr. Mark Lewis:

Hi, this is Dr. Mark Lewis. I'm a medical oncologist practicing in Salt Lake City, Utah. In this holiday season, I am grateful for my patients. They come to me usually to receive chemotherapy. And not only that, but they do so with such a kind and gracious spirit. I'll give you an example:

Last week I was going in to see a patient. I knew I had some difficult results to share, and I started by saying, "Sir, I'm sorry I have to share this bad news with you." And he said, "Dr. Lewis, let me stop you right there. Whatever you're about to say, you are breaking the bad news. You did not make the bad news. So you don't have to be sorry. I'm never going to be angry at someone that's trying to help me."

I thought it was so incredibly selfless of him in that moment to try to alleviate my guilt. And then we could prepare together to move forward with a new treatment plan. Little things like that really make me realize that nothing is to be taken for granted.

Dr. Diane Reidy-Lagunes:

Brian, I know you felt this too. I certainly have had patients say similar things to me, and I can't get over that they're thinking about me during these incredibly challenging times. What extraordinary grace and gratitude. Can you talk about your own experiences and things like that that may have happened to you?

Brian Kelly:

I've come to realize that gratitude is one of the great secrets of our world, certainly at MSK. I see it every day and in so many unexpected moments and it leaves me humbled. It's the thing that feeds me every day in my work because, in so many cases, I walk out of a room listening to a patient talk about what they're grateful for and I say to myself, "Could I be that person? Could I say that?"

You may be surprised to know that there are experts in the field of gratitude, and one of them is a psychologist and professor at UC Davis named Robert Emmons, and he has written extensively on this. He says that gratitude requires us to believe that even in a broken world there is good, and to recognize how much of that goodness comes from things outside of ourselves. He also says that unlike other emotions, gratitude is a conscious effort. To be grateful, we really need to take the time to recognize that something has been done for us to our benefit.

At the same time, our patients know well that navigating this treatment is deeply complicated and unique. They very much have these conflicting emotions like anxiety and gratitude.

The thing about gratitude is, for many religions and many faith traditions, it's almost a spiritual discipline or a spiritual practice. For many of our patients, it is exactly that. I love seeing that, but I also love witnessing what I call the surprise gratitude, which is the patient who, sitting in a chemo chair for 4 hours, wants to tell me how grateful they are for that neighbor who did something small but unexpected to them that has just lit them up.

I see it springing organically every day. It is truly the thing that I know feeds me and feeds so many of the staff that I get to work with.

Dr. Diane Reidy-Lagunes:

Me too. It's the small stuff that matters, right? There are some faith traditions at this time of year celebrating themes of finding light amongst darkness, for example, the Jewish Hanukkah, the Christian Advent. How might people use these stories and traditions to help them through their dark times?

Brian Kelly:

As a Christian, I'm more familiar with the Advent tradition, but my wife was Jewish, so I'm pretty okay on Hanukkah as well. These are very interesting periods of waiting. I love the traditions because, at a time of the year when it's getting darker and colder – there's a sense of the darkness of winter closing in on us – it's a symbol of light and hope. And hope is such a powerful sustaining force for our patients, and for us in this work. As we know, hope changes over the course of a patient's journey with us.

Dr. Diane Reidy-Lagunes:

That's right. It also just reminds us of our own traditions – who we are and what we represent.

I too was so blessed to be able to have a Jewish part of my family to celebrate Hanukkah, and a Christian part of my family to celebrate the Advent. Like you said, it's who I am, and it makes me so I can be a child in a second by just having those moments of tradition, which really defines who we are.

Brian Kelly:

I was raised in a big Irish Catholic family and when I walk into a church and I smell incense, I am transported back to those days very quickly.

Ritual, and especially ritual at this time of the holidays, is such a powerful thing. There are church rituals, there are family rituals, but the idea that we return in communities, large or small, to do those same things again is one of the things that I love about the year.

Dr. Diane Reidy-Lagunes:

Absolutely a gift. Let's hear from Anthony and some of the rituals that he has.

Anthony Robles:

Hello, my name is Anthony Robles. I am a Memorial Sloan Kettering patient. I'm currently living with stage 4 colon cancer. I want to share a moment in which I found joy most recently when I took the time to perpetuate a tradition of taking my daughter to see The Rockettes at Radio City Music Hall. When we get to the show, they dim the lights and they start preparing with the orchestra. And guess who comes out first to open the show? Santa Claus. My daughter turns to me and she says, "Dad, that is Santa Claus!" And I said, "Oh my goodness. He might have just made a special appearance just for you." And I started to cry.

I started to cry because at that moment, I realized that I still have time to live vicariously with the innocence and the joy that the small things bring to children, that we as adults take for granted. Whether you're sick or you're not sick, we can always be worse. Find your joy. Find your happiness. Don't waste time with, "Woe with me." Time is our friend.

Brian Kelly:

Amen.

Dr. Diane Reidy-Lagunes:

Amen. It's absolutely beautiful, Anthony. I could listen to him over and over again.

Brian Kelly:

I love the fact that it was this tiny moment, this tiny exchange with his daughter, that was just so powerful for him and inspired him to give a message that all of us can absolutely live by.

Dr. Diane Reidy-Lagunes:

Brian, as Anthony shared, he has stage 4 cancer, which is likely incurable. So Anthony's time is limited and he is so blessed to have what he is experiencing in the moments. But many of our patients understandably have such a fear about what's next and, quite frankly, about dying.

So how do you advise patients that are, during the holiday season in particular, saying, "This might be my last holiday. I want to live for the moment, but I can't because I have all these other emotions wrapped around me."

Brian Kelly:

For me, it's really something that patients have taught me, which is to somehow try to transform the thought of, "How is it that I want to be dying?" to "How is it that I want to live? What is it that I want and can get from these moments, as precious as they are?" It’s enormously challenging. I have lots of conversations with patients about what comes next. For many, a very deep faith gives them a sense of peace. But for so many, it's a question of the fear of uncertainty.

What patients have shown me is that they have an extraordinary capacity to find that hope in the people that love them, in the things that do give them the most meaning in their life. They lead me through it, to be honest. I wish I could tell you that I have some great wisdom to impart to them, but it's a very, very sacred time. It's one that, to be present in, is an extraordinary privilege and they teach me how to do it far more than I care for them. I wish I had a better answer for you.

Dr. Diane Reidy-Lagunes:

I think that answer's perfect and I would actually agree a hundred percent. My job is to be as transparent as I can when patients are towards the end of their journey, and from a medical perspective, explain where I think they are and what's going to happen next – recommending the best supportive care or hospice, which is always incredibly challenging.

But what I always find so remarkable are the responses, and that's where I learn. The medical establishment didn't teach me what it's like to experience dying, because I'm always trying to defy that, right? My job is to cure them. Like you said, sometimes I feel helpless, but I'm always amazed how much I learn from the patient and their caregivers when we are all honest about where we are and what's going to happen next, up to and including when they do pass. When you experience that with a patient, it's truly remarkable to the point that I truly believe that they do pass on to another side. It really is, like you said, something that the patients teach me, I don't teach them.

Brian Kelly:

Those are the moments that humble me and bring me back the next day.

Dr. Diane Reidy-Lagunes:

That's right. Brian, thank you so much for joining us today and for all you do. Happy Holidays.

Brian Kelly:

Diane, Happy Holidays to you and thank you so much again for the privilege of being with you.

Dr. Diane Reidy-Lagunes:

None of us know how much time we have, and I am so grateful to all of you listeners and our Cancer Straight Talk family for sharing this time with me. I feel like I'm the luckiest person to do my small part to help you and your loved ones, and to share this experience with all of you. I wish you a very happy and healthy holiday season.

I'll leave you with a little montage of what my fellow MSK colleagues and patients are grateful for this year. I hope it inspires you to find peace and joy this holiday season. Take it away.

Irene Dimatulac:

Hi, I’m Irene and I’m grateful in 2023 for movement. I wasn’t able to walk independently for most of 2020 and 2021, but as soon as I could, I’m grateful to have taken every step forward. From neighborhood walks with my dog, to journeys around the world – I even tried surfing this year with my knee replacement – each step has taken me on a new journey with the me I am becoming, and I’m excited to see where movement takes me in 2024.

Dr. Dana Rathkopf:

This is Dana Rathkopf. Next week, I will be celebrating my 20^th anniversary as an attending physician at Memorial Sloan Kettering. I have literally grown up here. In fact, I still have patients who remember when I was pregnant with my twin sons, and those babies just left for their first year of college this fall. I have been grateful every single day for the past 20 years to be a part of this community. It is truly a privilege to work at Memorial Sloan Kettering alongside the absolutely extraordinary staff, colleagues, patients, and their families, where we all share a common purpose, and that purpose is hope.

Dr. Diane Reidy-Lagunes:

Thank you for listening to Cancer Straight Talk from Memorial Sloan Kettering Cancer Center. For more information, or just send us any questions you may have, please visit us at mskcc.org/podcast. Help others find this helpful resource by rating and reviewing this podcast at Apple Podcasts or wherever you listen to your podcasts. Any products mentioned on this podcast are not official endorsements by Memorial Sloan Kettering Cancer Center. These episodes are for you but are not intended to be a medical substitute. Please remember to consult your doctor with any questions you have regarding medical conditions. I'm Dr. Diane Reidy-Lagunes. Onward and upward.