The Art of Coping with Serious Illness or Injury

Treating mental health during a chronic medical condition improves chances of recovery

By Yadira Galindo   |   April 29, 2019

​Summer Golden has been performing improv comedy for 15 years and an actor for 20, but when it came time recently to debut a new comedy routine, she became so nervous that she considered calling in “sick.”

But she mustered the courage knowing special guests would be in the audience.

“(My doctor) was talking about having a bone marrow transplant, and however grateful I would be to the donor, I don’t know if I can handle that. I have to take my own sheets when I go to a hotel. I don’t like the idea of my blood touching someone else’s bone marrow,” professed Golden to the audience, which actually included her doctor — Tiffany Tanaka, MD, a hematologist at UC San Diego Health.

The audience at the National Comedy Theater roared with laughter, which continued throughout Golden’s 10-minute set. With humor, Golden shared her feelings and experiences about being diagnosed and treated for an incurable cancer of the bone marrow — myelofibrosis. It was an act of mental health.

“I was terrified. I’m not usually that nervous about comedy. But this one was so personal,” said Golden. “I thought the audience would feel sorry for me, but a lot of people came up to me and said they were inspired. Some people do yoga but I hate stuff like that. My way of dealing with cancer is using something I love to cope.”

 

Summer Golden does comedy about her Myelofibrosis--a rare blood cancer.

Arpi Minassian, PhD, a UC San Diego Health psychologist who helps people experiencing difficulties with chronic medical conditions or with mental, emotional and behavioral disorders, said Golden is doing precisely what she and other members of the psychiatry and behavioral health team encourage patients to do — focus on their individual interests and values.

“A lot of people with chronic medical conditions complain that their identity, their sense of self, is lost. It has been taken over by their medical condition,” said Minassian, clinical professor of psychiatry. “How do we combat that? You remind people about the way that they are individuals and the parts of their lives in which they find meaning, value and joy. It is these things that define them. Not their cancer. Not their lung disease. Not their chronic pain.”

The prevalence of mental health disorders in people with serious physical conditions depends upon the specific illness or injury. For example, up to 35 percent of people who experience a traumatic injury, such as a serious burn, will also experience post-traumatic stress disorder (PTSD); half of patients suffering from chronic pain may also suffer major depression; and two out of three persons with chronic pulmonary disease might also experience depression, said Minassian.

“When faced with a serious illness or injury — and it will happen to all of us at some point in our lives — many people will cope pretty well,” said Minassian. “There are a proportion of people who do struggle more than others and may experience more profound depression, anxiety or post-traumatic stress disorder, depending upon the circumstances of their illness or injury. These are folks who down the line may develop substance use disorders or other disorders.”

That’s why some hospital specialties embed psychologists and psychiatrists in their teams. Minassian works in a comprehensive unit within the Regional Burn Center at UC San Diego Health to see every patient who is admitted, whether or not they are experiencing or displaying psychiatric issues. The chronic pain clinic and the pulmonary rehabilitation program also offer psychological and psychiatric services.

Patients undergoing cancer treatment at Moores Cancer Center at UC San Diego Health have access to the Patient and Family Support Services, which treats people who may be experiencing depression, anxiety, insomnia or other psychiatric symptoms as a consequence of their disease. Patients can meet with social workers, psychologists or psychiatrists, such as Maria Tiamson-Kassab, MD, director of psychiatry and psychological services at Moores Cancer Center and Jacobs Medical Center at UC San Diego Health, who offer individualized care because, like cancer, no two people are alike and the news of a life-changing diagnosis affects every person differently.

“The impact of cancer in a patient’s life trajectory is really significant. The psychological distress that happens depends on many factors, including the stage of the disease, the prognosis, side effects, social support and communication,” said Tiamson-Kassab, clinical professor of psychiatry at UC San Diego School of Medicine.

“For example, younger people have fantasies of what’s going to happen in their lifetime, but now that may be cut short or they have to make difficult decisions that may affect their ability to have children in the future. Parents with young children may worry about who will care for their children. All of us cope differently and as a result patients may suffer from an adjustment disorder to mild distress right down to a major depression.”

Feeling sad is normal, said Tiamson-Kassab. Knowing the difference between normal sadness and major depression may be lifesaving. Patients with cancer are two to three times more likely to experience depression and twice as likely to commit suicide.

People undergoing major depression feel isolated, excessive guilt and hopelessness. They may lose interest in things they normally enjoy. They may have suicidal thoughts.

People experiencing normal sadness after a serious physical condition still enjoy life. They still want to connect with others and look forward to the future. They just may be too tired or ill to do normal activities, said Tiamson-Kassab.

“If someone’s psychiatric illness is not well treated, studies show recovery will be prolonged,” said Minassian. “Someone with untreated depression, or particularly untreated PTSD, and a medical condition may end their lives if that psychiatric condition is not taken care of. They may have had every opportunity in the world to have survived their medical condition, but they may not survive their psychiatric condition.”

Mental health disorders are treatable — sometimes with and sometimes without medication. The Patient and Family Support Services offers support groups to assist persons undergoing similar medical conditions to connect and share their common experiences. Family counseling and caregiver support is also available because ensuring family members are healthy will help the patient too. Mindfulness programs like yoga, Tai Chi, art therapy and writing classes are also available to help patients cope in their own creative ways.

In March, Steven Arana was diagnosed with acute myeloid leukemia and was hospitalized at Jacobs Medical Center for 50 days. When his condition became precarious, Arana worried he might not leave the hospital alive and provided his health care team with a durable power of attorney.

His treatment for leukemia led to cardiac problems. A retired critical care nurse with expertise in cardiology, Arana knew what to watch out for so he kept a close eye on the cardiac monitor. The stress led to insomnia and situational anxiety.&

“It was very distressing because I didn’t know what the outcome would be,” said Arana. “I was very much aware of my heart going through these many stages. Any time something changed, the nursing staff was by my bedside and I started feeling more comfortable. Trusting a nurse is just as good as taking a sleeping pill, but with no side effects.”

patient with painting

As Arana began to recover, he was given adult coloring books. An artist, he joked that he felt constrained by lines, but he filled each page with color. Volunteer Services then brought a cart to his room filled with art supplies including 4-inch by 4-inch canvases that he used to glue flowers for vibrant pieces. But it was when he was told that he could order art supplies to be delivered to the hospital that art therapy awoke his passion.

“It took my mind off what was happening and allowed me to tap into another part of my person, which is really satisfying to me,” said Arana.

His creativity suddenly bloomed. He used gesso, a type of white plaster used in artwork, to prepare substrates for the final piece, to create a sunburst on a 2-foot by 4-foot canvas. He laid gold leaf to give color to the sun. Arana imagined the finished piece to be the sun rising from the ocean, but when the wrong color was delivered he wasn’t sure how to finish his piece.

Then came the news. The latest bone marrow test showed no more cancer cells. Suddenly the copper leaf that was mistakenly shipped to him made sense. Instead of a blue ocean, Arana used copper to create a sea of cancer cells from which his sun would emerge radiant.

“I call it ‘My Story.’ It represents getting past a very terrible time and still being hopeful. Still seeing the sun in the daytime instead of being caught up in having cancer,” said Arana.

Arana is home now, but he left “My Story” on the sixth floor of Jacobs Medical Center for other patients with cancer to look at for inspiration. He even bought supplies to refill the art cart hoping to give others the opportunity to do something creative while receiving care and recovering.

For mental health help call the psychiatry and behavior health team at 858-534-7792 (PSYC). If it is a life-threatening emergency call 9-1-1.


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