"Are you in remission?"
"No."
"Are you getting better?"
"No."
"How are you?"
"I'm good."
Sandra Turner has, for the past 12 years, been engaged in a range of conversations to do with cancer.
Some of the dialogue has been directed inward in an attempt to come to terms with, firstly, a diagnosis at the age of 43 that she had a disease likely to preclude her living to the ripe old age enjoyed by her grandmothers.
Hence, the "I'm good" response Sandra discloses in a book about her experiences. Titled To Rakiura & Beyond, it could have been called No Point Pretending given its bare-it-all honesty. In it, she emphasises the notion of "survivorship", the importance of "keeping on living" despite the medics' odds.
She recalls a brutal three-week period in 1999 following a visit to her GP's intern, who disclosed an enormous tumour encompassing one rib had also worked its way into her spine.
At that stage, it was feared Sandra had secondary stage melanoma (the result of a malignant mole removed five years earlier). However, further tests showed a single immense tumour, a result that prompted celebration amid family and friends.
"If it had been [secondary stage melanoma] I would have been out for the count after about six months. In fact it was another form of cancer, multiple myeloma, a cancer of the plasma cells," Sandra recalls.
"It's rather odd, really. But there was more hope at that stage of another outcome."
Fast-forward 12 years and her two children, adolescents at the time of her diagnosis, are in their early 20s; her husband remains "her best companion" and Sandra has reached the age of 54 having been through the medical mill: a stem cell transplant, a multitude of drug regimes including three rounds of chemotherapy, radiation therapy ... "a lot of intrusions and a lot of recovery".
However, Sandra has now reached a point where the treatments available to her are limited.
"The word palliative can be quite scary to people because they think you must be in hospice and dying," Sandra says. "I still live a full life and work."
A psychotherapist and psychodramatist with her own private practice, she continues to work three days a week and is still involved "in a lot of professional activities". It keeps her busy, keeps her sane.
"As long as you're doing what you're passionate about; I think that's what keeps you in good spirits."
Three decades of experience as a therapist working in mental health has also given Sandra a set of skills she is able to employ on herself. Included in her tool chest is a series of journals in which she recorded everything - from conversations with those attempting to convert her to some branch of Christian fundamentalism to the visceral details of bone-marrow biopsies.
"I kept journals as way to deal with the situation, to help my rehabilitation. Over a period of time, I found I was writing stories that came out of the journals.
"You have to be able to reflect on all your feelings, the difficulties that are coming towards you, the multiple hospital treatments. If you don't have the capacity to reflect on how you respond to them then it's really hard to know what's going on," Sandra explains, adding it was important she avoid being either stoic or helpless.
She says cancer is a disease that has, paradoxically, gifted her time to focus on all that is dear to her. And in that, she hopes there's a message for others.
"You have to able to use your time well. You have to be able to talk with one another. I'm not so much into this 'bucket list' idea of things to tick off before you die, because that can entail people racing around doing stuff.
It's more about the quality of your life - is this the way you want to be living right now?"You can actually get friendly with it, get into a relationship with the disease process and not treat it as your enemy. No one wants it - I certainly don't - but I don't have to live in fear of it.
"Many people think it's the end of the Earth if they get cancer, but there are a hell of a lot of other things I'd rather not have. I'd rather not die in a motor-vehicle accident.
"Generally, we fight like anything to not face it. We want to have the perfect body and the perfect life and the perfect house. There is not much room these days for the encompassing of vulnerability, of ordinariness," Sandra says.
"We need to learn how to face our fears."
However, she is at pains to point out her outlook has little to do with the concept of "positive thinking". To her, that's just another phrase for denial.
"It is so partial. It just attends to the cognitive part of yourself; it doesn't attend to your heart, your feelings, your spirituality. It's this idea that if you think positively you can override anything; it's a salesman's talk - 'think positively and you'll make a sale today'.
"It is also so guilt-inducing, because if you don't manage it then clearly you haven't been positive enough; you haven't tried hard enough."
Sandra also takes issue with what she calls the language of cancer, the clichés of both the media and the general public. Talk of a "heroic battle" or "fighting gallantly" and one risks promulgating a mood that goes beyond the military; worse, such words imply inevitability. No surprise, then, we crouch in terror at such a diagnosis.
"There is this label that you are sick and needy and going to die and don't have much going on in your life."
Sandra uses the sometimes wild Foveaux Strait as a metaphor for the ebb and flow of her health.
"If you travel between these islands, you take whatever crossing you get. The ferry captain rarely cancels ... Some days are easy, others are as hard as they get," she writes.
It might come as no surprise to suggest there is a correlation between one's state of health and an interaction with others (even a sick baby gets grumpy). Hence the importance of a good companion, someone able to sit (and not necessarily talk), to just be there.
"Often people come towards you with their own anxieties; they want to make you better," Sandra says, adding not everybody's help is that helpful.
"When I go in for treatments, like bone-marrow biopsies and horrible things, I take with me good friends. Ask the right people to do the right jobs. Don't expect one person to do it all for you. I think people can get a bit of an idea that they will hunker down and the family will pool and do it all. It's too much on any one family to do that."
Often when someone has been diagnosed with cancer - in fact, any malady - others are overlooked, Sandra says. Yet their experiences are no less poignant; they require as much support as the central character.
An early passage in To Rakiura & Beyond illustrates that shared pain: "I wake in the night, groping across the usual warm space. The bed is cold and empty. I find him hidden in the dark of the lounge. I have known this man since I was nearly eighteen. This is new territory for us both. We reach out, hold each other, barely comprehending what is happening to our lives."
Sandra discloses her daughter proof-read her book, a revelation that suggests this is a family that has come to terms with a wife and mother's mortality.
"I think we've done very well with it," Sandra says, "but we've needed the time to do it.
"The children were 11 and 13 at the beginning. They are now in their early 20s so we can do this together. If I had died earlier, they would have suffered more. We have been very gifted with the time we've had."
However, although strong relationships with others are vitally important, the quality of relationship with oneself reigns supreme, Sandra maintains.
"At the end, that's all you've got - yourself and whatever spiritual traditions or relationships you have in that realm. People say to you, 'you'll live on in the memories of others'. Well, actually, I won't live on. They'll have me in their mind but I won't have a consciousness of that. Existentially, I'll be gone."
That said, Sandra regards herself as a spiritual person. Faith is important to her, though she admits it is an evolving process.
"You've got to work out some sort of framework in your own mind that has integrity to it both intellectually and emotionally. I think that is quite a personal process. The great religions give guidance, signposts on how to get there but, ultimately, you have to do it yourself.
"You have to be able to sit with yourself. That's all that is left in the end, I reckon.
"And we don't get much practice in that. We fill our time up with Xboxes and TVs. We don't think quietly about it."
BOOK A PLACE
A book launch for To Rakiura & Beyond (published by Southern Colour Print, on sale from the Cancer Society) will be held at The Church Restaurant, Bar and Cinema, Dundas St, Dunedin, on Friday, February 18, at 6pm.
Tickets (free, but numbers limited) are available from the Cancer Society of New Zealand's Otago Southland Division.
ABOUT CANCER
• Cancer is not one but many different diseases. What all cancers have in common is that some of the cells in the body have become abnormal.
• Many cancers can be cured if they are treated in time. It is estimated about one person in every three in New Zealand who gets cancer is cured.
Types of cancer
Cancers can be grouped into three main categories:
• carcinomas, which occur in the lining of the body's external and internal surfaces, e.g. the skin, mouth and rectum
• sarcomas, which form in connective tissues, e.g. muscles and bones
• leukaemias and lymphomas, which are cancers of the bone marrow and lymph glands.
- SOURCE: CANCER SOCIETY
For cancer information and support phone 0800 CANCER (226-237) or go to www.cancernz.org.nz
RELAY FOR LIFE
• The Cancer Society's 24-hour Relay For Life is being held at Logan Park, Dunedin, next weekend, starting at noon on Saturday, February 19. Relay For Life is a fundraising event to help support the work of the Cancer Society in our community.
• There will be a relay for life in Oamaru on March 12 and 13.
• On the net: www.relayforlife.org.nz
