Ask Dr. Giles: I'm doing well, but the longer I live the more terrified I get.

Sarah writes:

Dr Giles,

I will be 3 yrs post radiation treatment in November. I was told that I had a 40% chance of living 5yrs. My husband and family are thrilled that I have been doing so well but the longer it is the more terrified I get. I feel like time is running out, I don’t know why I feel this way but its getting to the point where I now dream about it and wake up scared to death in the am. My husband thinks I’m crazy why is this happening now?

I’m so happy that you are doing so well! It sounds as if the odds your doctor gave you at the end of your treatment regimen really made an impact on you. It would be interesting to ask your doctor now, nearly three years later, what are the odds of making it the full five years and beyond. I would guess they would be significantly increased from 40%.

Speaking of which, is it possible that the phrase “five years” has come to represent some sort of finish line for you? Perhaps that finish line, rather than a line painted across the road, feels more like a thick stone wall–a stone wall which you are rapidly approaching! I ask this because you mentioned feeling “like time is running out” and waking up “scared to death.” It sounds like maybe your brain latched onto the idea of “five years” initially out of hope that you would live that long. Now, with the majority of that five years behind you, the time remaining of that initial five years doesn’t seem very long. It may be time to let go of the “five years” approach to life. That’s for prisoners on death row, not for healthy people like you. Here are a couple of tips to get back to thinking like a healthy person:

• Invest in your future. Plant a few saplings and plan to seem them become full-grown trees, go back to school, develop a talent, etc.
• Drop “if I’m still alive” from your thoughts and conversations. Any of us could die tomorrow–or live to be 100.
• Begin to make plans for 2011 and beyond.
• Encourage your loved ones to take these same steps.

You have had the rare privilege to know first-hand how tenuous life and health can be. It’s time to go back to enjoying what you have. Oh, and pick up some new sunglasses. Your future looks bright to me!

It seems like you are struggling with a very common difficulty for those who are faced with life-threatening medical conditions. The medical community, in an effort to inform us and give us an accurate sense of what we’re up against, has tried to characterize our chance for survival by using statistics–namely percentages. What the doctors don’t tell us, however, is that those initial odds of survival improve the longer we live.

OK. Let’s talk statistics for a moment. Apparently, your doctor quoted research that has found that out of any 100 patients with your condition completing radiation treatment, 40 will live five more years. The other 60 will not live that long. Therefore, your odds are 40 out of 100 (or 40%) that you will be one of those who lives five more years. These statistics give you less than a 50/50 chance of living five more years. Not great odds, right? But that’s just the beginning.

The longer you live, the better your chances become of making five years and beyond! If we assume an even attrition of the 60% who won’t live five years, then if you survive one year, your chances of surviving for the full five years or more go from 40 out of 100 to 40 out of 88, or 46%. For each year you survive, your odds go up. After three years, your odds of making it to five years have increased from 40% to 63%.

It sounds like what has happened is that you have wondered, from the beginning, to what group you belong. Are you in the 40% who lives 5 years or the 60% who don’t? Now, 3-plus years later, you are still wondering, “Am I about to find out I’m in the 60% group? Have I been hoping for survival when I’m destined to discover that I was in the 60% group all along?”

The problem with the statistic that your doctor dropped on you after your radiation treatment is that it does not reflect that, statistically, your odds of survival improve for every day you live after radiation.