Defin­ing courage

The Jerusalem Post Magazine - - OBSERVATIONS - The writer’s book, To­taled: The Bil­lion-Dol­lar Crash of the Startup that Took on Big Auto, Big Oil and the World, is avail­able on Ama­zon and other on­line book­sellers. bri­an­ BRIAN BLUM

‘Then call it a “leap of faith” – mak­ing an im­por­tant choice with im­per­fect in­for­ma­tion. Gather data then reeval­u­ate. If it doesn’t work out, you can al­ways go back’

The Mer­riam-Web­ster dic­tionary de­scribes courage as “the abil­ity to do some­thing that fright­ens one.” I’d give it a slightly dif­fer­ent def­i­ni­tion. Courage, for me, as I’ve dis­cov­ered over the past year cop­ing with chronic can­cer, is not about choos­ing to jump out of an air­plane or bungee jump off a bridge near Kathmandu. Rather, it’s do­ing some­thing you re­ally don’t want to do but know you have to.

It was courage I needed when my next im­munother­apy ap­point­ment came close.

I fin­ished four months of chemo­ther­apy for my fol­lic­u­lar lym­phoma ear­lier this year and am of­fi­cially in re­mis­sion. Now I need to go in every other month for an IV of bi­o­logic “main­te­nance” treat­ment to keep the can­cer at bay for as long as pos­si­ble. I’m sup­posed to do this for two years. It’s not as bad as chemo, but it still comes with side ef­fects.

As the day ap­proached, I be­came acutely aware of my re­sis­tance to go­ing back un­der the nee­dle. Part of that was just not want­ing to feel un­com­fort­able – not so much the hospi­tal visit but the fa­tigue and aches and pains that come af­ter. Part was that each trip to the hema­tol­ogy day­care ward re­minds me that I have a chronic, in­cur­able can­cer that will be with me for the rest of my life.

But there’s also a lin­ger­ing uncer­tainty about whether main­te­nance treat­ment is worth it.

Ac­cord­ing to Dr. John Leonard, a lym­phoma spe­cial­ist at Weill Cor­nell Medicine in New York, only 16 out of 100 pa­tients will see an im­prove­ment in PFS (that’s “pro­gres­sion free sur­vival,” the num­ber of years be­fore the dis­ease re­turns) as a re­sult of the kind of main­te­nance im­munother­apy I’m sup­posed to be get­ting.

“More­over, it makes no dif­fer­ence in over­all sur­vival,” Leonard adds. He ad­vises most of his pa­tients these days to skip main­te­nance and sim­ply “re-treat” when nec­es­sary – even if that’s sooner than it might have been if you’re in the lucky 16% group.

Dr. Jonathan Fried­berg, chief of hema­tol­ogy-on­col­ogy at the Uni­ver­sity of Rochester Med­i­cal Cen­ter in Rochester, New York, puts it more plainly. “Main­te­nance ther­apy is prob­a­bly overtreat­ment.”

I asked my own doc­tor at Hadas­sah in Jerusalem. She ad­mit­ted that “we re­ally don’t know what main­te­nance ther­apy does or how,” but she still rec­om­mended it. “Six­teen per­cent is not in­signif­i­cant.”

AS MY ap­point­ment be­came im­mi­nent, I tried to think of other ex­am­ples of courage that fit my def­i­ni­tion, to see whether any of those might pro­vide clar­ity for the de­ci­sion in front of me.

The first thing that came to mind was per­haps the com­plete op­po­site of heal­ing: war. No sane per­son ever wants to go to war, but some­times you have to do it for the health and sur­vival of your na­tion.

Divorce also is a form of courage. Re­sis­tance to this kind of ma­jor life change can be over­whelm­ing, but if you’re in the wrong re­la­tion­ship, you know deep down that some­times the only way to get healthy again is to get out.

Mak­ing aliyah takes courage, as well. My wife, Jody, and I planned our im­mi­gra­tion to Is­rael for seven years. Mak­ing a life in the Holy Land was part of the shared val­ues we brought to our mar­riage.

But when the time fi­nally came to move, I kept de­lay­ing. My ca­reer was in full swing: I had a great job at a soft­ware com­pany, I was teach­ing at San Fran­cisco State Uni­ver­sity, I’d just fin­ished a term as pres­i­dent of an in­ter­na­tional pro­fes­sional as­so­ci­a­tion. We had friends, com­mu­nity, two cars and sav­ings.

I knew that aliyah would be the healthy thing for our re­la­tion­ship, for our chil­dren, for the Jewish peo­ple.

“Mak­ing these kinds of mon­u­men­tal de­ci­sions takes a spe­cial kind of faith,” a friend once told me.

“Faith is not some­thing I’m big on,” I joked in re­turn.

“Then call it a ‘leap of faith’ – mak­ing an im­por­tant choice with im­per­fect in­for­ma­tion. Gather data, then reeval­u­ate. If it doesn’t work out, you can al­ways go back.”

Melanie Green­berg writes in Psy­chol­ogy To­day (Au­gust 2012) about six kinds of courage: feel­ing fear yet choos­ing to act, fol­low­ing your heart, per­se­ver­ing in the face of ad­ver­sity, stand­ing up for what is right, let­ting go of the fa­mil­iar, and fac­ing suf­fer­ing with dig­nity or faith.

At least four of those six are part of my per­sonal def­i­ni­tion of courage. (You guess which four.)

IN THE end, though, it was not my cog­ni­tive de­lib­er­a­tions, an ap­peal to faith or a pithy ar­ti­cle in a pop psy­chol­ogy jour­nal that shone a light on how I should de­cide. It was an episode of the TV show This Is Us.

One of the main plot points of the pop­u­lar NBC se­ries is that the fa­ther of the fam­ily dies when his kids are teenagers. The har­row­ing ex­pe­ri­ence of los­ing their fa­ther at such a young age im­pacts much of how they live as adults.

My own kids are all in their 20s, but that’s still young enough that I wouldn’t want to be­queath to them any avoid­able trauma.

Six­teen per­cent may not sound like a lot sta­tis­ti­cally, but I owe it to my fam­ily to do what­ever I can to stick around as long as pos­si­ble.

I might feel like crap, tem­po­rar­ily at least, but I know, too, that my longterm health and the health of every­one around me de­pend on me mus­ter­ing up that courage – how­ever I de­fine it.

(Max Pixel)

‘COURAGE FOR me is not about choos­ing to jump out of an air­plane or bungee jump off a bridge near Kathmandu.’

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