How do you find happiness when you're dealing with cancer?

In a new book On Happiness: New Ideas for the Twenty-First Century, oncologist and writer Dr Ranjana Srivastava writes about her experience on the cancer ward and where she finds happiness

After only our fourth meeting, she relays to me that she is reconciled to death but will fight until the last to preserve quality of life. This is why she declined chemotherapy for cancer diagnosed at an advanced stage – she chose to spend her remaining days with her daughter and husband.

They have taken her to every local beach and some far away ones, and every playground they can think of, each photo of the event annotated with a special message. ‘The volunteers offered to help create memorabilia but I want my daughter to know that I did this all by myself. Although, it will never replace all the sandwiches I won’t make and the assemblies I won’t attend.’

Like Debrief Daily on Facebook. 

She says, ‘I know that I won’t be here to see her start school in a few months. I have spoken to her teachers and I just have to trust that everyone else, the whole school, will be the mother she won’t have. And of course, she has a wonderful dad. She will be in good hands with him’.

At this, I choke, surreptitiously pinching the skin of my hand to remain steadfast. I remind myself that an observer like me is not entitled to subsume her grief: it is not etiquette and moreover, it feels self-indulgent.

But of course, I too have a little girl like my patient’s who is turning five. She too starts school next year and we have been attending orientation, her eyes filled with wonder that suddenly she will possess dozens of new friends, a brand new school uniform and the same blue hat that her big brother won’t let her borrow.

Just yesterday we picked out a pink lunch box and a matching pink water bottle and made a list of foods she can take to school. ‘I guess you can’t fill the fruit section with chocolate buttons’, she observed before declaring, ‘My teacher will know, she just will’.

I managed to make it to every single orientation class, never even entertaining the possibility that anyone else in our family, including her father or grandparents, might be interested in going. In the way of the all-consuming love a mother feels for her child, I did it all and did it willingly. And what fun we had there, I think, even as I ward off the thoughts – lest they magically appear on my forehead for my patient to read.

But the truth is that I didn’t have to stop at the side of the playground to clutch my hurting side and I didn’t have to fish for the omnipresent bottle of morphine to rescue me before I could move again. And when the children played catch, I joined in, rather than sitting on the bench while my little girl explained to strangers that her mummy needed all the oxygen she could to keep her breathing. My interview with my daughter’s teacher was about purely benign, happy things. I did not need to entrust her with the heartbreaking responsibility of being my child’s surrogate mother.

‘I am sorry,’ I say, contritely. ‘I am sorry that you are so ill. It’s not fair.’

‘What can you do? It was meant to be,’ she replies.

‘How are you doing?’ I ask her husband. He has given up work to care for her.

‘I feel sad for the life that we won’t have. I had always thought we’d grow old together’. His eyes shine with tears. She holds his hand.

‘I am not afraid of dying’, she says. ‘I have a strong faith and I trust God is waiting for me. So while it’s a bit premature, heaven is a good destination’.

I find her poise enormously consoling. She smiles at her husband. I can’t help thinking that it is the kind of beautiful, wholesome, comforting smile that will see him through his worst days. It is a smile I have seen before, on the lips of patients who somehow drag themselves out of their existential suffering to think of others. Although we set up another appointment, she says goodbye, articulating what we both suspect. ‘If I don’t see you again, thank you for being part of my life. You did your best. You guys have a tough job.'

Her grace leaves me speechless. She dies in the week leading up to Christmas. Her husband calls to say that she went peace- fully, even willingly.

On days like this, the word happiness loses its meaning for me. Everything appears hollow. Uncouth, unfair, and unacceptable in the face of the loss of a young woman whose time had not yet come. I mourn for the little girl who lost her mother far too early but feel guilty when I am unable to imagine what that must be like.

Also, I feel the pangs of loss even momentarily imagining being afflicted by an illness that might pull me away from my own children. On these days, happiness is a mirage. I can’t fathom how it can be so ephemeral and possibly refuse to land in the lap of a devoted young mother.

The consideration of happiness then leads to the perennial question of who deserves to be happy. If we make our own happiness, then what did my young patient do to ‘unmake’ hers? In all the time I knew her she continued to make room for the happiness of others while watching her own being tugged away. On days like this, I feel satisfied defining happiness as merely avoiding the patient’s fate. To expect anything else would be utterly selfish.

On other days, thankfully, these searing moments recede when I see genuinely uplifting things. A patient whom no-one expected to outlive 10 months returns for a 10-year check up, his once-tender-aged children now grown up, driving him to appointments, and solicitously asking questions about their dad’s health. ‘They spoil me,’ he beams.

One woman wrenched from the throes of psychotic depression, convinced that the spectre of breast cancer would forever haunt her life one day holds a healthy baby in her arms. Cradling him as she undresses for an examination, I watch his innocent and placid face entirely unaware of his mother’s battle.

‘He is adorable’, I say, handing him back. With a spark in her eyes where before there was only the dullness of tears, she says, ‘Doctor, I never ever think of my cancer any more. It’s wonderful, how he takes up all my attention!’

On days like this, I see happiness everywhere. The smiles of my patients, their relieved sighs, their stammered thanks and tentative hugs are the very essence of happiness.

These experiences also empower me to help my other patients across the chasm of doubt and pessimism that infects their lives as they confront their own illness. They say: ‘I need you to see the bright side for me because I can’t yet. But I feel reassured to hear you say that I’ll be okay.' Happiness, then, is being someone’s crutch when they are at their most vulnerable. It feels good to give.

A few times a year, I am humbled by an invitation to attend a patient’s funeral. Usually, they were people who carried their illness for a long enough time that we came to know each other beyond the confines of a clinical consultation. The sight of my children’s wobbly artwork adorning the walls proved a natural and welcome bridge to discussing the things that mattered most in life.

Many people told me that despite feeling overwhelmed and frightened by cancer, they made sense of it by realising every precious moment with their loved ones. They proposed, married, reconciled, attended graduations, held their grandchild’s finger, surfed, walked, wrote letters and generally did all the things they had always known they should do. ‘Knowing I am dying makes everything look brand new,’ a man reflected.

The last funeral I attended was of a dear octogenarian who had insisted on knitting clothes for my three children and always came to see me with an impeccable-looking cake she had baked the night before. On her last visit to hospital, she was so weak that she didn’t even notice me until I came very close. Then, recognition flooded her gaunt face and lit it up.

She hugged me tightly and told me how pleased she was to see me. I held her gnarled hand and told her that I would look after her. I reassured her that she wouldn’t experience pain. That night she died, declaring that after 10 years of having cancer and then losing her husband, she had had enough.

I felt a stab of sadness at the finality of her coffin but then, listening to the accounts of her unacceptable decline I felt happy that she was no longer suffering. I felt happy that I had managed to keep her well for so long. I felt happy that she had trimmed her garden and adjusted her furniture in the weeks before dying. And I felt immeasurably relieved and happy that I had accidentally found her in the emergency room, for as it turned out, it was to be our only meeting before she died that night.

The hospital is a revolving door for many of my patients. The chance discovery that a patient has died somewhere in this labyrinthine place without seeing a familiar doctor is distressing. The observation that even when an illness is incurable, there can be comfort from a human touch and a kind presence makes me happy. And sometimes, my feelings of gratitude, humble- ness and complete awe mingle into happiness as I realise how privileged I am to be a doctor and be let into the most intimate spaces of people’s lives.

These notions of happiness, derived from my professional work, inform my personal life. I don’t think happiness is elusive. It is also not as esoteric as people make it out to be. For a start, happiness is the absence of illness and disability and the presence of good health. Not all ill people are unhappy, but wellness should surely convey an advantage to happiness. When I watch the small and big ways in which the incapacities of my patients become a thorn in their lives, I am grateful, and hence happy, to have my health intact.

Walking along a track lit by the first rays of the sun, hearing the melody of invisible birds, beholding a dewdrop poised ever so keenly on the edge of a leaf – I know all too well that these spontaneous pleasures of my life are far from universal. Many people must plan ahead and summon the required energy to experience them. ‘I would happily exchange a shorter life for the joy of walking again,' reflected a bed-bound patient.

A very large part of my happiness is derived through my children. My pregnancies were difficult and my first pregnancy ended in the loss of twins. Even my obstetrician thought that I wouldn’t dare try again but such was the pull of motherhood that I went back three times.

My children are the pure, unadulterated joy and the proudest feature of my life. They complete a life that I had actually never deemed incomplete before they came along. Their innocence is as endearing as it is moving. Their happiness is infectious because it is delightfully uncomplicated. A scooter ride on the beach with the wind carrying their squeals, ‘You are the best mama in the world!’

Their suspicion and curiosity when they ask whether I buy the toys on Santa’s behalf, forgotten in the next instant as their eyes sparkle at the countdown to his arrival. The thrill of the tooth fairy’s visit; the exhilaration of their first plane trip; their incredulity at having their own television screen on a flight! They are not just the stuff of their happiness but very much mine too.

Walking hand in hand to school with a surprise stop at the bakery, redolent with the smell of fresh bread. Helping out in the schoolroom, losing the parent-teacher relay race to the hoarse cheers of the class, watching fireworks dazzle the night sky, reading together. I can’t help thinking that precious memories seems to cascade into your life when you have children. And I greedily grab them all.

No doubt informed by the patients whose lives are tragically cut short, I have never been one to wait for happiness to come to me. I see happiness in all kinds of incidental and everyday occasions and I don’t care if it’s unfashionable but I embrace it.

I have had an itinerant childhood, growing up and being schooled in many countries. Hand in hand with this wonderful experience came the fact that I constantly had to leave old friends and make new ones. I learned resilience and also that you don’t always need other people to make you happy.

The laughter and love of family and friends are obviously important but no less vital is the capacity to be content in one’s own company. A lot of my work involves the dictum that a sorrow shared is a sorrow halved. I listen to stories of patients who feel unfairly served by life. So at day’s end, the only recipe for my happiness can be a quiet space that allows me to read, write and reflect on the responsibility of being a doctor and the privilege of being a mother.

Many of my patients are terminally ill. I see some who chase happiness and end up dissatisfied. Sometimes I can’t help thinking that it wouldn’t be so elusive if they stopped and looked. But I also meet those who let happiness come to them through simple acts – by adjusting their expectations, reconciling to fate but not being held hostage by it. They don’t treat happiness as an external entity, to be had and lost. Instead, happiness filters through their life on a daily basis, discovered in small things.

Their grandchild’s graduation, the birth of a niece, a fishing trip with their son, a family holiday squeezed in between rounds of chemotherapy. Their happiness comes from enjoying moments that they feared they might not see. These are the people who die contented; they also leave their family consoled and uplifted by their memory.

One should always be judicious with dispensing advice but if I were to give my children a piece of advice on being happy, this is what I think I would say. Work hard at finding a job that feels like a vocation. Look beyond narrow self-interest and tend to the needs of others. Cultivate a still, reflective mind. Have few friends but hold them close. Nurture your family and hold them closer. Regard life as a gift and death as inevitable. While it’s impossible to do good and be good every single day, live each day mindfully so that you may learn from your mistakes.

I’d like to think that in living by some simple rules, you don’t constantly have to beckon happiness. Happiness will come to you.