Criteria A: Stressor – a person is exposed to a traumatic event, such as death or the threat of death.
Joe’s first round of treatment lasted months; two weeks in the hospital, one week at home. Lather, rinse, repeat.
In the hospital, we’d watch box sets of shows we loved on my laptop. The twins and Mike would come by every day we’d have dinner together. Joe would vomit, more often than not, and we’d clean him up and then help him eat a little bit more until he pushed the food away. The sharp smell of bile cut through even the tang of disinfectant. The constant beep of his infusion pump a steady beat signaling his continued plod through life.
At home, we sanitized everything: the door, our hands, the bathrooms, our hands, food from the store, our hands. I didn’t have the sound of the infusion pump, so I kept Joe within sight as often as possible. I watched his chest expand with each breath.
In and out, week after week. Then, as quick as a summer storm, it was over. His treatment was finished. Joe was packed up in the car and we drove home from the hospital. It was 2 a.m. I sat outside while Mike helped Joe into bed. The house was dark. The street was quiet. Yet all I could hear was a steady, plodding beep. All I could smell was vomit.
Criteria B: Intrusion Symptoms – the event is persistently re-experienced in various ways.
Joe’s doctor told us to come back in three months for his first scan. I asked what we were supposed to do in the meantime. Were there precautions we should take to decrease the chance of recurrence? Should he avoid certain foods? ‘Nothing,’ he answered. ‘Just go about your life as usual.’ Mike woke me up multiple times following the end of Joe’s treatment. He would tell me I was tossing and turning. I always woke up tired. Joe would drift away, unaware, rubbing at his scars under his clothes, in the middle of conversations. He’d come back, tensing, only realizing he had gone away after the fact. Mike found himself accidentally driving towards the hospital after work, even though there was no one there for him to visit.
Criteria C: Avoidance – concerted effort of avoidance of distressing, trauma-related stimuli after the event.
Joe’s first scan was clean. When we found out, Tony immediately threw out all of the hand sanitizer in the house; he said he hated the smell. David stopped watching TV; at least, what he used to watch. Instead, he watched reality shows. Joe yelled at him once, saying it was garbage. David replied, ‘It’s all garbage.’ Joe, who used to sleep in a worn pair of boxers, slept in sweats and a shirt, his scars always tucked away. We started taking longer routes across the city, keeping a wide berth from the hospital.
Criteria D: Negative Alterations in Cognition and Mood – i.e., negative beliefs about yourself or the world, inability to experience positive emotions, sense of alienation.
I got an email from Tony and David’s school the fall after Joe’s diagnosis. They were being difficult, it said. Not so straight forward, but that’s what they meant. They sent another, saying Tony was being argumentative with his teachers; David wasn’t participating in class. I got called to the school. In the meeting I asked if their grades had suffered, knowing they hadn’t. I asked how they should be acting following the year we just had. I thought, ‘What a waste of time this is.’
My thoughts circled for ages when the tumor was discovered, and for a long time after. I thought back to before he was diagnosed and wonder how I missed it. What clues had I brushed off as inconsequential? As his mother, how could he have not told me he was in pain? How did I not notice?
Criteria E: Alterations in Reactivity – i.e., sleep disturbance, reckless behavior, hypervigilance, lack of focus, irritability.
Mike has always been a good company man, because the repetitive minutia doesn’t faze him, and he has always been naturally friendly. He has an innate skill of creating a welcoming atmosphere. Nothing throws him off-balance. That steadfastness is one of the things I love about him.
He came home one night, after Joe’s cancer recurred for the second time and he decided against further treatment. We had dinner with the boys and then they left to watch TV. We slipped out back and had a glass of wine. He told me about his day, about a staff meeting they had. He couldn’t remember what it was about but remembered it as being grating.
‘I cut the guy off in the middle of his report,’ he said. ‘I asked him if anyone was dying. He looked confused, but said no, so I told him “then why the hell does it matter?” I ended the meeting soon after.’ Mike finished his wine. ‘I just lost it. I don’t know what’s happening.’
I thought of Tony, who had always been so focused, but now was struggling to concentrate long enough to finish his math homework. He was always stopping, getting up, starting something else. I thought of David and how he was watching everyone. Cataloging our moves across the house, how many cars drove by in the afternoon. Making note of every random gesture of the hand, a twitch of the eye, as if it was all adding up to something greater. I thought about how none of them were sleeping, which I knew because neither was I. I looked at Mike and said, ‘I don’t know either.’
Criteria F: Duration – persistence of symptoms (in criteria A, B, C, D, and E) for more than one month.
In the last ten weeks of Joe’s life, he died six times. By which I mean, he thought he was and said goodbye to everyone. Then, he would cuss us all out the next morning when he woke up.
We had Thanksgiving six times that year as well. Joe kept forgetting it had already happened and would demand we celebrate it saying, ‘It’s Tony and David’s favorite.’
We didn’t have Thanksgiving the year after. Just the thought of it made me nauseous. I can’t remember what we did. We might have ordered Chinese food and watched a movie none of us had seen. We might have done nothing at all. I remember Tony being more irritable than usual; David kept getting distracted. I remember, still, that none of us were sleeping well.
Criteria G: Functional Significance – significant symptom-related distress or functional impairment (i.e. social, occupational).
We kept in touch with David mostly by email his first year at university. In one he wrote, ‘People think it’s strange that I always have a small bag packed and ready to go.’ The nibble of information was sandwiched between how windy it had been in Scotland that week and how boring his English lectures were. I didn’t know what to say in response. The idea seemed reasonable to me at the time.
Criteria H: Exclusion – disturbance is not due to medication, substance use, or other illness.
We haven’t celebrated Thanksgiving as a family since Joe died. We spend it differently. We mark the occasion by celebrating with friends and neighbors instead. Or, on one memorable occasion, at a wedding.
Most nights, one of us still has trouble sleeping. It’s not unusual for messages to ping into our family group chat at 2, 3, 4 in the morning. Mike is still steadfast, but there’s a crack there that wasn’t before. Tony is as whip-smart as he has always been, but sometimes it takes him an afternoon to slog through work that would have taken him a couple hours before. David finds it easier to be alone some days, not as much as before but every once in a while. I sometimes can’t help thinking what else I could have done when Joe was still alive. On those days, we lean a little bit harder on one another.
[Full diagnosis is not made until at least six months after the trauma, although onset of symptoms may occur immediately]
Cancer is a prolonged and protracted illness. It stretches far across both its patients and their families even well after treatment. Like a deep shadow at the height of summer threading behind your feet, we are forced to live with the memory. Of what we witnessed and what we experienced. It is a process to learn how to position those memories in a way that doesn’t consume you entirely.