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Resilience: Reframing Experience, Redefining Goals

Network - Spring 2010

By Mary Brolley

We all know someone who has responded to seemingly unbearable hardship or loss with grace, restraint and even humor.

What is the aspect of character that allows some people to endure illness or misfortune that might send another person into a spiral of depression, bitterness or anger?

Is it resilience? Can it be taught or learned?

Lois Ramondetta, M.D., associate professor in the Department of Gynecologic Oncology at M. D. Anderson, has given a lot of thought to what makes some of her patients face difficulties so admirably.

But she thinks “resilience” may be too simplistic a term for this characteristic.

“I worry that ‘resilience’ limits you. It’s a pretty big goal. It implies a bouncing back, a willingness to fight on, no matter what,” she says. “Sometimes what we hope is that our patients can achieve peace of mind. That may mean realizing that they’re doing or they’ve done all they can do.”

Gynecologic oncologists, she says, have an unusually close relationship with their patients. “There’s an automatic intimacy with these types of cancers. We do both their surgery and their chemotherapy.”

She believes that part of her role — beyond treating their cancer — is to help her patients achieve peace, sometimes by helping them stay in the present moment and not be consumed by worry or grief.

“Sadly, a number of my patients will die of their cancers. So, instead of praying for a miracle, I might work with them to reframe their life goals.”

“It’s not my job to take away their hope,” she insists. “But it’s my job to prepare them for what is likely to happen. Sometimes I’ll say, ‘If there’s anything you’ve wanted to do or to say, now’s the time to do it.’ ”

In the ICU: faith, support systems help families cope

As a senior social work counselor assigned to the intensive care unit, Karen Newman works with families more often than with patients.

To get to know them, she often asks family members, “’What keeps you going? In the past, when you’ve dealt with difficult times, how did you get through them?’

“They nearly always credit their faith and their support system.”

Sometimes, she says, families bond with others in the waiting rooms.

Newman is impressed with the coping skills of most of these families, especially since many have traveled far from their primary support network.

“I can’t imagine coming here — miles from their support — and heading straight into the unknown,” she says.

“While patients are in ICU, it’s like a roller coaster,” Newman says. “One day the news inspires hope, while other days are full of despair.

“Families who are coping, or are resilient, can address the situation. Their coping strategies help them come back the next day and start over, hoping it will be a better day.”

Looking out for caregivers

Lakshmi Naik, assistant director of the Department of Social Work, sees the tightrope walk faced by caregivers who nurture and protect patients every day. She is concerned that they may begin to experience "compassion fatigue" or "compassion burnout."

"It's a double-edged sword," she says. "If they're feeling burned out, it's hard for them to help anyone else."

Naik distinguishes between emotional endurance and resilience.

“Yes, you can endure tough situations for a long time, but then you may burn out. Resilience means having the ability to come back.”

What distinguishes truly resilient patients, caregivers and professionals is that they are “resourceful in recognizing the best ways to get back on track. They can develop realistic goals and keep moving toward those goals,” she says.

Newman acknowledges the difficulty of dealing with cancer patients and families at such stressful, critical times for them.

“Family members sometimes ask me how I can work with seriously ill patients and their families day after day. I tell them, ‘Because I get to meet people like you,’ ” she says.

Tips for Caregivers

  • Know yourself. Recognize when you’re feeling worn down.
  • Form good habits. Have a “burnout plan” you can implement when you see that you’re under extreme stress. For example, you might call a friend and ask him or her to take over one of your duties so you can get away.
  • During your time away, do what you find relaxing and enjoyable.
  • Remind yourself of times when you’ve been able to soothe yourself out of anxious behaviors.
  • Seek professional help if you need it.

© 2015 The University of Texas MD Anderson Cancer Center