A View of Cancer Care – Book Review – The Spare Room by Helen Garner

The Spare Room is a novel about caring for a friend with cancer by Australian writer Helen Garner. She is an Australian novelist, short-story writer, screenwriter and journalist who was born in Geelong, Australia on 7, November 1942. She is a graduate of the University of Melbourne. Garner’s first novel, Monkey Grip, was published in 1977, and immediately established her as an original voice on the Australian literary scene. The Spare Room is a story set over the course of three weeks while the narrator, Helen, cares for a friend dying of bowel cancer. The cancer sufferer can be very stubborn and selfish. It is a form of self-preservation. This story reflects this. The book was published in 2008.

I am a cancer survivor. I have written about my journey in https://survivingbreastcancernow.wordpress.com/. When I chose this book from the local library, I did not realise the topic it covered. I was not sure that I would be able to cope with it. However, The Spare Room is a magical gem of a book. It is gripping, moving, and unexpectedly funny. The book packs a huge punch, charting a friendship as it is tested by the threat of death.

The book made me think about how those who love had suffered when they were caring for me and watching my treatment and recovery. How much of they gave up to help me in my time of need. Likewise in this book, Helen has little idea what lies ahead and the strength she will need to muster when she offers her spare room to an old friend, Nicola. Helen arrives in plenty of time to pick Nicola up from the airport, but she wasn’t expecting to see her friend look so sick, so sick that she could hardly walk. Of course Nicola insists it was just the flight that has taken its toll on her and that she’ll be fine once she has a rest. Nicola has arrived in the city for cancer treatment. She is skeptical of the medical establishment, and placing all her faith in an alternative health center. Nicola will be attending The Theodore Institute where she she will undergo extensive alternative treatment for her cancer. She is convinced that after three weeks of this alternative treatment she will be cured of her cancer. The alternative treatment is high doses of vitamin C. Nicola is determined to find her own way to deal with her illness, regardless of the advice Helen offers.

Nicola explains to Helen how the treatment works and as far as Helen is concerned it is a load of rubbish. Helen knows that there is no miracle cure for the final stages of terminal cancer, but Nicola refuses to be convinced. However, after only a few treatments of vitamin C, Nicola starts to feel very sick and is in a lot of pain. In the weeks that follow, Nicola’s battle for survival will turn not only her own life upside down but also those of everyone around her.

She wakes during the night to sopping wet bedding from sweating and chronic pain. Each night Helen helps her change thehelen garner bedding and tries to comfort her, but her patience are wearing thin knowing this treatment will not work. As Nicola continues with the treatment, Helen becomes increasingly angry, frustrated and exhausted. She cannot seem to make Nicola see that this treatment is not only expensive, but is a waste of time. She only wants what is best for her friend:that is to make sure the time she has left is as pain free as possible.

Helen Garner’s book was a relatively quick read, but it definitely was not an easy read at times. A heartbreaking and powerful read about care, friendship and dying. The Spare Room is a book well worth reading.

This review originally appeared in Valerie Penny’s Book Reviews at: http://bookreviewstoday.info/2015/01/18/the-spare-room-by-helen-garner/.

Valerie Penny

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Post Cancer Fatigue

Cancer related fatigue (CRF) is very common.   I had just no idea how long I would suffer from fatigue after my treatment had finished.  Fatigue can often be confused with tiredness, but there are differences between the two conditions.

chronic-fatigue

Tiredness happens to everyone, especially after certain activities or chemotherapy however,  fatigue is less common and is an excessive whole-body tiredness that is not relieved with sleep.   This debilitating condition can impact your quality of life. It certainly impacts upon mine.  I am still unable to walk for the kind of distances I did previously and only do half a line dancing class instead of a full one.  My 18 weeks of chemotherapy ended almost 10 months ago.

Fatigue can be acute (lasting a month or less) or chronic (lasting from one month to six months or longer).   Mine is clearly chronic.  The precise reason for this intensive tiredness is unknown, but practitioners believe it may be related to the process of cancer itself or chemotherapies and radiation treatments.  Although  CRF is one of the most common side effects of cancer and its associated treatments, nobody told me about it or warned me I might suffer from it.  Therefore, I thought I was just being lazy and not pulling myself together properly.   I was quite wrong.

Usually  it comes on suddenly, and does not result from activity or exertion.   Although in my case exertion makes it worse.  The fatigue is often described as “paralyzing.”  It may continue for months, even after treatment is complete.

If you are a cancer survivor and feeling tired or fatigued even long after your treatment is finished, you must know you are not alone.

fatigue

About one-third of breast cancer survivors experience CRF for periods of time ranging anywhere from a year to several years post-treatment.  While there is no conventional therapy to resolve it, studies are increasingly showing yoga and other gentle exercises can help. Some patients with different cancers report relief with exercise.

Valerie Penny

The Psychological Effects of Cancer

There are other effects of cancer and its treatment that are not so widely known or discussed.  I have only discovered this recently and these are side-effects that affect not only me but also those close to me who are nearest. These are the psychological effects of cancer that make everything doubly hard: for everybody.

It was only when I was chatting to my cousin about cancer suffered by another member of our family and the outbursts of temper they displayed, that I began to understand that cancer results not only in physical, but also psychological effects.  The emotional effects of chemotherapy can be just as debilitating as the physical effects. From the initial diagnosis of cancer to the final dose of chemotherapy, patients undergo levels of emotional distress well beyond a healthy limit. The emotional effects of chemotherapy can be directly related to the medication or to external factors such as family, work and social life. The range of emotional distress felt by patients depends a lot on their particular support network and  their rate of recovery.  Emotions run high for the whole family during chemotherapy.  It made sense when I thought about it, but I never had.   

I asked my husband if I had ever displayed any outbursts of temper. I was sure I had not, until he reminded me of an uncharacteristic and ugly diatribe to which I subjected my daughter during a telephone conversation.  I felt so guilty because he was right.

The outburst to which I subjected my daughter is not the only evidence of my fragile mental state during cancer treatment, at present.  When the District Nurse arrived to clean my hickman line and take my pre-chemo bloods at a time different to that arranged I lost the plot and ended up asking her to leave. Oh dear! The problem is it all seemed so logical at the time.

Chemotherapy can have an emotional impact on patients because the treatment itself is a sign of emotional self-preservation. The choice to fight cancer does not end with the first dose of the medication and patients often feel emotionally taxed when recovery is slow. The physical side effects can contribute significantly to emotional distress. Insomnia, constant nausea, weight loss, hair loss and a diminished sex life can all make a patient feel emotionally distraught. Family and friends bear their pain too.

Chemotherapy also affects patients because of a perceived burden of loss on family, friends and work. Patients may feel isolated from participating in family activities due to fatigue and medical appointments. Social life is also dramatically affected by chemotherapy due to fatigue and often shame.  Therefore, some of the classical negative emotions during chemotherapy include anger, fear, anxiety, depression and isolation. The emotional distress from chemotherapy may come from a sense of not having any control over the matter.   Cognitive function and emotional health are strongly interconnected and chemotherapy can take a serious toll on both of them. In some cases, emotional distress can affect cognitive function, while in other cases, impaired cognition can alter judgment and emotional responses during cancer treatment.

However, I have to confess that, perhaps unsurprisingly, my worst outburst to date has been reserved for my long-suffering husband. This combination of temper and depression was my worst to date.  When I asked my cancer nurse if this was a normal side effect she replied in the affirmative. My husband just said very quietly, “But that does not make if acceptable.”  Of course he is right and none of the victims of my temper deserved it.

Depression is a persistent sadness that interferes with usual activities and ability to carry out roles at home, work, community, or school. Depression may also be known as sadness, feeling “down,” despair, or hopelessness. Depression and its side effects affect both men and women.  There are several risk factors that increase the potential for development of depression in the patient with cancer.  Medications commonly prescribed for cancer patients can be one of those risk factors.  There are many classes of medications that may have depression as their side effects.  Some examples are: analgesics, anticonvulsants, antihistamines, anti-inflammatory agents, antineoplastics, chemotherapy agents, hormones, immunosuppressive agents, and steroids.

Depression during chemotherapy, and generally can be managed, but it has to be admitted first.  You need to recognise what puts you at risk of depression.  Triggers include –

    • History of depression in yourself or your family.
    • Pessimistic view of life.
    • Living with a chronic disease like cancer.
    • Stressful events in your life.
    • Effects of some medications & chemotherapy.
    • Lack of support from family or friends.
    • Unrelieved physical symptoms (like pain).
    • Alcohol or drug abuse.
    • Unrelieved grief (not working through feelings of angry about how cancer & its treatment have affected your life).
    • Any persistent change in your mood, with the signs of depression listed above.
    • If you feel suicidal you must tell someone and get help. It is not safe to be on your own at these times.  

I am told it is not unusual to have times when you feel very low after a diagnosis of cancer, and during or after treatment. Many people feel physically and emotionally exhausted from the treatment, and this can lower their mood. However, for some people affected by cancer their low mood may continue or get worse and they may need specialist help or treatment. Some people find that their sadness gives way to a situation where their mood is low most of the time for several weeks or more, and they are depressed.

The relationship between cancer and depression is complex. Depression may be triggered by the diagnosis of cancer, other issues related to the cancer and its treatment, or the impact of the cancer on a person’s life. However, depression may occur by chance or be related to other difficult events, either in the past or in the present, which are nothing to do with cancer, such as the loss of a loved one.    Depression can develop slowly, making it very difficult for either you or your family to recognise when it started. In other cases it can seem to hit you suddenly – one day you wake up and realise that you feel hopeless and helpless and are engulfed in a ‘black cloud’ or, as Winston Churchill called it “black dog” of depression.  

Depression can affect anyone at any age. It is extremely common – one in five (20%) people are affected by depression at some time in their lives. Depression is not a sign of personal failure or inability to cope. You can’t ‘pull yourself together’ or ‘snap out of it’.  Depression can usually be successfully treated. The first step to feeling better is to admit the problem, then to get appropriate help.

Valerie Penny

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