Kneier - Finding your way through cancer: an expert cancer psychologist helps patients and survivors face the challenges of illness: based on the authors pioneering work with more than 7,500 patients

To Caitlin and Michael

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I COULD LIST HERE THE NAMES of all the people with cancer who have confided in me over the course of my career. If you were to scan this list, your eyes might glaze over as one name blurred with the next. When I first met these people, they were just names to me as well. But soon I began to know and care about them as individuals, each with his or her own life history and each confronting the crosscurrents of suffering caused by cancer. They taught me about the challenges of living with cancer, and some taught me about dying of cancer and coming to terms with letting go. They honored me by not holding back, by telling me what it was really like for them to suffer in all the ways a person can suffer from a life-threatening illness. They also showed me what true resilience looks like, and how finding meaning can sustain a person through horrendous ordeals. They honored me by reaching out for my understanding and support and for whatever guidance I could offer. This book is my best but insufficient way of thanking them and honoring them in return.

A mental health professional who wants to work with cancer patients must be accepted and embraced by physicians who work in this field. I am indebted to the many physicians who did just that, starting with Drs. Lynn Spitler and Richard Sagebiel, both of whom have devoted their careers to helping patients with malignant melanoma. They were the first to enlist my role in the care of their patients. Others followed at the University of California, San Francisco (UCSF), Comprehensive Cancer Center, especially Drs. Mohammed Kashani, Ernest Rosenbaum, Alan Glassberg, Laura Esserman, Peter Carrol, Thierry Jahan, Robert Allen, and Debu Tripathy. The cancer team at UCSF included other health care professionals who also supported my work there, especially Deborah Hamolsky, Barbara Buckley, Karen Stronach, and Rod Seeger. When I began at UCSF, I was welcomed and encouraged by the director of the Cancer Center, Dr. Frank McCormick.

After my time at UCSF, an extraordinary team of oncologists at the Sierra Nevada Memorial Hospital Comprehensive Community Cancer Center wholeheartedly included me in their whole-person approach to patient care. I am grateful to Drs. William Newsom, David Campbell, Richard Evans, David Kraus, and Brad Miller for welcoming me in this effort. The director of the Center, Ayse Turkseven, and the Centers oncology social worker, Rebecca Parsons, provided the leadership and support to make this possible. I am also indebted to Phil Genet for his generous grant to the Cancer Center to establish my role there.

To each person just listed, I extend my gratitude and appreciation. Had they not included me in the care of their patients, I would not have learned what I learned, and this book would not exist.

I am indebted to Lydia Temoshok, PhD, who chaired my dissertation and got me started in working with people suffering from metastatic melanoma.

My work at UCSF was generously supported by the Stephen Blumenthal Memorial Fund, and I am indebted to Sheryl Blumenthal and her family for making that happen. Generous funding was also provided by Phil Genet, Dr. Ernest Rosenbaum, Alan Baer, David Herschman, Brian Guance, and Deborah Huber. The UCSF Mount Zion Auxiliary and the UCSF Foundation played a key role in supporting my work.

I received invaluable feedback and encouragement from people with cancer who read earlier drafts of the essays in this collection. I especially thank Dorothea Nudelman, Frank Durham, Michelle Wilson, Karen Wagner, Linda Lachelt, Jana Peters, and Brady Williamson. Colleagues who read these drafts and contributed insight and encouragement included Dr. Jeff Kane, Mimi Roth, Peggy Blumberg, Dr. Neil Kostick, Melissa Horton, and Dr. John Curtis. Other indispensable readers included my wife, Katy, our daughter, Caitlin, my niece, Kristen Hill, and our valued friends David and Linda Palley. Kim Sagebiel, friend, novelist, and mentor to our children, guided and encouraged me through the publishing process.

When I was growing up, I aspired to emulate my older brother Gary. He is now in his late sixties and still going strong in his work as a clinical psychologist. He was so taken by my first drafts that he said he was proud to be my brother! This sweet remark became an impetus for me to continue working on these essays. He helped me improve them by offering pages of insightful comments born from his own clinical work and spiritual substance.

It was Dr. Elmer Grossman and his wife, Pam, who read the initial manuscript from cover to cover and took it upon themselves to encourage my eventual publisher, Celestial Arts, to take a serious look at my work. Had it not been for their intervention, this book would not existat least not in its present form, a form that was shaped and nurtured by those at Celestial Arts, most of all by my talented and wise editor, Lisa Westmoreland.

It took a village to make this book, and everyone mentioned here played a key role. If these essays prove helpful to those dealing with cancer, it is because I had a village teaching me and supporting me in my calling, If you are such a person, currently suffering from cancer, and find some guidance or comfort here, please give thanks in your heart, as I do, to all those who nurtured me along the way.

A WOMAN WITH CANCER ONCE told me she found herself in a new worlda world where the sun, with its warmth and light, was eclipsed by something called cancer. The sky was gray like an overcast winter evening. She felt disoriented and lost. It was a world of cancer treatments, cancer anxiety, cancer dilemmas, and cancer challenges. Her former life was slipping away. She had embarked on a perilous new journey, she said, with no road map to guide her, no sure footing, and no confidence that she could make it through. Seeing her from the outside, you wouldnt know that she was in a new world. The sun was still in the sky, shining above her. But inside her mind and heart, a troubling preoccupation had set in. There was an in-your-face aspect to all the questions and anxieties that came with the news that she had cancer. Each morning her first thought was about cancer, about what to do and what would happen. Her dreadful thoughts would come and go like the tide of a dark ocean. This was her new journey, one defined with unrelenting uncertainty about her future existence.

The essays in this book are addressed to people in her situation. Like many people touched by cancer, perhaps you find yourself in a world like hers, launched against your will on a similar journey of unknown destination. Perhaps your suffering is similar as well: the suffering of anxiety, uncertainty, and the pressure to make the right moves on confusing terrain. You probably have taken the first steps and are now continuing to make your way as best you can as you confront one challenge after another. My aim in these essays is to help you along and help you through. Well see if I can.