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An Oncologist’s Prescription for Managing Fear


April 30, 2020
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By Douglas B. Flora, MD

When physicians present at medical conferences, we usually start with a slide disclosing any potential conflicts of interest to our audience. I probably need to disclose two things here. First, I’m an infuriating and inexhaustible optimist. Second, I’m a cancer doctor but also a recent cancer patient myself, and I understand intimately how it feels when your world unexpectedly spins out of control.

With the arrival of COVID-19 on our shores, and our lives suddenly looking as if they were cut from the pages of a Michael Crichton novel, we are all facing new fears and uncertainties previously unimagined. It’s only natural we now find ourselves seeking guidance on how best to survive in this new world. My prescription: Ask cancer patients.

These patients were going about their normal lives when a cruel and terrifying reality intruded. Sound familiar? They are trained in uncertainty. They have been forced by their diseases to adapt, survive, and thrive amidst their own personal chaos. These patients’ experiences can offer valuable lessons and simple, but powerful tools we can use to adapt to the current COVID-19 pandemic.

Cancer patients must adapt to nearly impossible situations each day with grace, courage, and indissoluble hope. Real, applied hope is a powerful thing to behold. These patients embrace it. Can we tackle the coronavirus with a similar approach? I watch this hope help my patients overcome otherwise insurmountable hurdles every day. These lessons have informed my perspective as I offer this prescription to help you through the next few very difficult months: Hope on.

For those of you on the front lines working in healthcare, hope will be the fuel we burn every morning when we head to the hospital. We’ve learned this from the resolve we’ve seen in our own patients over years fighting in the trenches. You can put this to work too. Keep your own hope alive, no matter how dark it gets. This too shall pass.

However, hope alone may not be enough. We must face some grim realities. Many lives are going to be lost before another (new) normal returns. I’m reminded of a dear patient and survivor. This young mom was diagnosed with breast cancer while caring for her husband as he was dying of cancer himself. I asked her how she coped so well under such incredible stress and sadness. Her response has stuck with me for over ten years, and I’ve shared this simple phrase with hundreds of patients since: “When there is no wind, we row.”

Right now, our nation has no wind to power our sails. Despite the fear of the unknown, we each need to row in order to support the normal rhythms of life. We must do our own part to preserve this critical physical distancing and move the boat a little each day as a nation. Already we see what this collective individual work and self-discipline has accomplished at the pandemic’s epicenter, as life is resuming today in Wuhan, China. If we do the hard, necessary things they did in China to isolate, test, mitigate, and separate, our own discipline will be similarly rewarded. My patients get this, and, despite all of their fear and uncertainty, I still see them rowing their own boats each day. In the coming months, the wind will return and fill the sails again … but until then, we row.

Cancer patients also learn to excel in stress management. In times of uncertainty, they strive to control only those things which they can control. Cancer patients understand that every moment matters, so they waste none. Another longtime patient and dear friend is living her best life despite an incurable stage IV melanoma. She is thriving. She works full time. She travels. She still punishes her Peloton almost daily! She reminds me that control is always within our grasp.

You can do this too. Exercise. Read a great book. Pause your scrolling online to call an old friend. You must stop to consider what you can control, then, to quote this wise patient, “double down on it.” This approach to stress management is just as applicable to pandemics as it is to cancer. You cannot control thousands of spring breakers reveling on Florida beaches. Let it go. However, you can safely socially distance your family, you can religiously wash your hands, and you can help those unable to help themselves. Let go of the things you cannot control, and double down on the things you can.

Cancer patients teach us about the importance of community. They find strength in numbers and groups, whether by wearing pink ribbons, running in Races for the Cure, or attending support group meetings. A community is greater than the sum of its parts. We are more powerful together than on our own. No matter if you are in Wuhan, Bergamo, or my hometown of Cincinnati, we all share the hope for better days ahead.

This infuriatingly optimistic cancer doctor sees glimmers of it already: the survival of the human spirit and real community. You can see it in the spontaneous celebrations of healthcare workers ringing from balconies in Madrid, or beleaguered nurses in hazmat suits dancing with signs on TikTok. Right now, even though it may feel like it is pulling us apart, our world is actually being pushed together by this virus, whether we realize it or not. To borrow from one of my new heroes, WHO Director-General Tedros Adhanom, “This amazing spirit of human solidarity must become even more infectious than the virus itself.”

During this hard pause while our lives are at their strangest — while there is no wind — we must row. All of us. But it’s not enough to just row; we must row together. Like cancer patients, we need all the hope, resolve, and community we can muster.

If the prescription above doesn’t work for you? This cancer doctor recommends you double the dose.

Douglas B. Flora, MD, is the Executive Medical Director of Oncology Services at St. Elizabeth Healthcare in Edgewood, Kentucky. This article first appeared on KevinMD.com on April 12, 2020.

For resources on COVID-19 as it applies to the oncology community, visit ACCC’s continually updated Coronavirus Response page. ACCC members can also access ACCCExchange, a forum that allows them to communicate in real time with their colleagues about how the COVID-19 virus is affecting their communities and their patients.