Her Approach to Counseling Changed After 'Knowing Cancer'

"It sounds so strange but I feel lucky that I got cancer," says Laurie-Anne Muldoon as we say goodbye. We have talked for the past 2 hours, through tears and difficult emotions, about the diagnosis that transformed the way she counsels her clients through cancer and other crises.

The concept of "lucky" hadn't come up in our discussion — and she seems surprised by her sudden declaration — but in context, it makes sense.

Now, 2 years after her diagnosis of triple positive Stage 1C, Grade 3, invasive ductal carcinoma, and feeling "mostly well," she appreciates how the ordeal deepened her understanding of the illness that first struck her mother, shaping both her childhood as well as her choice of profession, and then struck her.

Muldoon is a clinical social worker, psychotherapist, and former oncology nurse.

She now speaks with intimate knowledge from both sides of the cancer care continuum.

"Knowing what I knew behind the scenes as a cancer care provider, I felt there was a system in place to support me — but I don't think like that anymore," she admits, a hint of bitterness passing over her face.

Despite her professional experience, she was not prepared, as a patient, for "the sheer overwhelm" of the cancer care system, the feelings of being brushed off and minimized and the lack of empowerment.

Those negative experiences have reshaped her own interaction with cancer patients. "In a big way, I have walked in their shoes," she says, describing the most important lesson that she learned as a healthcare provider is to listen.

"The gift of time is so much more valuable than pulling out a prescription pad or giving some fancy advice," she says. "It's one of the most meaningful and healing interventions you can offer."

Listening almost seems "too easy" an intervention, she continues. "Like its worth is too small because it's such a simple gesture, but in fact it means the world."

"I didn't want them to fix it. I just wanted them to hear me, and to see that I was more than a partial mastectomy and a number getting chemo — to put their hand on my shoulder, to show they care," she commented. "I'm very fortunate that I have the time, space, and autonomy to be able to do that as a psychotherapist."

'Called' to Cancer Care

From an early age, long before her own diagnosis, Muldoon felt "called" to cancer care. After watching her mother being treated for breast cancer, she graduated from nursing school with special proficiency in oncology and worked for a spell in the bone marrow transplant unit at the Mayo Clinic in Phoenix, Arizona.

Returning to her home town of Ottawa, Ontario, Canada, she continued her professional journey through breast cancer screening work, and then switched to social work — "because I really enjoyed the relationships with patients" — where she focused on pediatric oncology as well as palliative care.

More recently, she opened a private practice counseling "not only people who are going through cancer themselves, but people with different connections to it: caregivers, family members, people who are experiencing a loss, or sometimes people looking for support in system navigation."

This work as a counselor has been enriched by her own cancer journey, she says.

"There's a knowing," she falters, going somewhere deep inside herself. The silence that follows is not empty or uncomfortable, as we acknowledge the subtleties of sickness. She tries, and falters again.

"There's this knowing that happens when you've been a patient in the way that I've been a patient," she finally volleys.

"It's the knowing of what it feels like to have a diagnosis. Knowing how relationships change with your spouse and your family. Knowing what it's like to be really scared and not know if it's coming back. I get that now. It doesn't matter how many times I heard it before, I understand that now. I understand living in the shadow of that."

She's talking about fear. Fear that first "unhinged" her, but that eventually propelled her "to live every day in the moment" and also infused her approach to counseling with something that only "knowing" can bring.

"In the medical system there's often this need to intervene and showcase what we know by offering a solution to a problem when really that's not what's needed," she argues.

"I feel fortunate to be in a field where I do have the time to listen, I do have the time to have a presence and to acknowledge and to witness what people are going through."

"Doctors, nurses, and other healthcare workers need to know that they don't need to provide psychotherapy. They need to listen. Period," she asserts.

"Sometimes what's more important is to hold space and to validate the impact and the emotion that this illness is having on the person, on their relationships, on their world," she elaborates.

"Some of the most memorable and beneficial interactions I had with healthcare workers were the ones who listened, who got to know me, and who weren't dismissive of my fears and my grief. Now I have more insight into some of the themes that go through your mind when you've had an illness like cancer — and it's not just cancer — I can deal with somebody who has a very close brush with death . . . and I can understand that now. I can have those conversations with clients now and people are surprised and happy to talk about it. But I don't know if I would have had the wherewithal to bring it up before."

'More in Touch With Her Dark Side'

Social worker colleague, and a friend of Muldoon's for the past 6 years, Leena Sarkar says: "She got more in touch with her dark side — but in a really good way."

"No one wants to talk about the fact that you may die, but it's a very real possibility, and Laurie-Anne got comfortable with sitting on that for herself. Now, I see a distinct shift in how she works and the way she approaches grief — she doesn't try to fix stuff as much — she's much more able to stay with the dark side. Instead of rescuing or intervening or reframing, she's just OK with letting it be."

Muldoon is also fueled by the alienation that she felt as a patient — where she'd once been the professional. "It really was an eye-opener for me, being in those shoes," she flashes, her indignation cauterizing the air.

"There was this day where my oncologist explained the chemo to me. If I had been in the same room describing the protocol with him as a nurse I totally would have walked out of that session thinking it was an awesome conversation, very succinct, very clear, bravo, high-five. . . . But sitting there as a patient I totally saw it so differently. It was so robotic, you could sense he had had this conversation a million times. It was very hurtful for me. This may have been his millionth time explaining it, but it was my first time having cancer — and it was big. He's a lovely person, but he's really jokey. He was trying to lighten the mood but it just minimized things. They were talking about me losing my hair, possibly dying, stroke, blah, blah. . . . If he'd had a serious conversation it would have seemed a lot more respectful. It might have made me cry and made me upset but at least there would have been an acknowledgement that this is serious business. It really jarred me being in the patient's seat and hearing them talk like that," she said.

It made her determined to respect that with her clients: "I'm never going to sugar-coat anything if something is serious."

Indeed, her chemo was a grueling ordeal, bringing hair loss, brutal exhaustion, and life-threatening febrile neutropenia after the very first session.

She turned to the Ottawa Integrative Cancer Centre (OICC) — adding complementary therapies that brought relief, such as acupuncture, vitamins D and C, omega-3 and CoQ10 supplements, and turmeric and marigold leaves to prevent radiation burns. But the greatest torment to her traditional medical practitioners, was the mushroom extract: coriolus versicolor. It irked the nurses and antagonized the doctor. They wanted her to stop taking it — but she didn't feel their reasons were valid.

"Those treatments and the emotional support that OICC provided were huge to me. Huge, huge, and huge," she said. "But it was a constant battle. It felt territorial. There was pushback at every single turn."

History Repeats Itself

Muldoon first looked cancer in the face when she was just 13, when her mother summoned her for a look into the bathroom mirror. She stared at her mother's right breast, where a lesion, just below the surface, was pulling a dimple inward. "What do you think?" her mother had asked, and the cancer journey began. Then at age 40, now a mother herself, Muldoon saw the same thing on her own breast, in the same spot.

"I was putting up my arms in the mirror and there was this dimple on the lower, lateral aspect of my right breast. It was very slight but it was noticeable to me because I knew what it looked like. There was just a jolt of panic because this was all too similar to what my mom had experienced — what I had witnessed."

What she did not realize was this next leg of her journey would leave her former self behind. "You're forever changed in some way," she says, glancing at an old photo of herself with her husband, John.

"Looking at that picture — that's not me. It almost feels like a stranger. The me then and the me now are almost two totally different people and that effects how you perceive yourself and who you are forever. A major illness or a major surgery will do that for people — I get that now."

Her colleague Sarkar echoed this. "It's made her more aware of her vulnerability — so much more able to empathize," she says. "It's not just about doing everything right because she did everything right. She was spiritually, emotionally, and physically a healthy person — she didn't take it for granted at all — and still things can completely fall apart. The vulnerability that brought up was huge."

Appropriately, Muldoon's new identity also required a new look. Help and healing came from her hairdresser.

"I started losing my hair about 2 weeks in. I always wanted to be a redhead so I bought a long, red, thick wig, I called my hairdresser and I said, 'I need my hair shaved, I need my wig trimmed, and by the way can I drink some wine with my best friend and play some '80s music in the background?'"

Muldoon's stylist spent the afternoon cutting her long hair little by little, playing with new looks as the inches fell away.

"I was expecting to have a total meltdown by the time we got to the buzz cut, but I did really well," she laughs. "I loved that wig, it was so much fun to wear — I felt like such a Diva in it — and he took all these runway style pictures of me. It was a really good experience given all the possibilities of how it could have ended up."

Giving Feedback

Muldoon's relationship with her oncologist is smoother these days, although he's trying to convince her to take tamoxifen, and she's resisting.

"I don't really see estrogen as the problem per se," she explains. "I think most illnesses are multifactorial and I think it's one factor of many. I know it's not the most mainstream way of thinking about cancer, but I really feel like there's a lifestyle aspect to it as well. There's all these various junctures where our cells can either replicate uncontrollably or not. There are all these factors that decrease our immune system and its response to cancer. So I've had to do a bit of a reevaluation of my whole life, my stress, my childhood emotional wounds, my diet, the water I drink, the people I associate with, my work-life balance, my spirituality — everything has gotten an overhaul. I know he doesn't agree — we've had this discussion around and around many times."

But in the end, they came to a comfortable understanding that might also benefit other patients down the road. "I've asked him, do you want feedback because I don't really agree with everything you say, and I'm willing to share my perspective and observations with you. He's been open to that feedback."

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Medscape Medical News © 2019 

Cite this: Kate Johnson. Her Approach to Counseling Changed After 'Knowing Cancer' - Medscape - Nov 01, 2019.