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On the Interior of Intimacy Under Illness “Since I got cancer, intimacy has disappeared from my relationship.” Patients have said versions of this to me many times. And there are understandable reasons why physical intimacy may change after cancer enters a relationship. Illness and treatment can bring fatigue, nausea, pain, neuropathy, and changes to the body. Time becomes organized around appointments and medications. Couples find themselves learning medical language they never imagined needing to know. Roles change, too. One partner may need to receive care while the other takes on more responsibility for providing it. Without fully realizing when it happened, two people who once knew themselves primarily as partners may begin relating to one another as patient and caregiver. There may be little energy—or room—left for being lovers. At first, I understood this to mean a loss of physical intimacy. Given everything cancer asks of the body and the relationship, that seemed explanation enough. But the more I listened, the less certain I became that physical closeness was the only thing that had gone missing. Had intimacy disappeared—or had it become harder to recognize? Physical closeness is one expression of intimacy. Intimacy is also the experience of being seen, known, and reached toward by another person. Cancer can change how we look. It can also change how we imagine we’re being looked at. A gaze that once felt loving may now be interpreted as worried. A touch that once communicated desire might become associated with tending to pain, checking an incision, or helping with something the body can no longer do alone. The body itself can begin to feel less like a place of connection and more like the place where cancer happened. Many people living with cancer tell me, “I don’t recognize myself anymore.” From an early age, we come to know something about who we are through the ways other people reflect us back to ourselves. We see ourselves in their faces, their words, their attention, and the ways they move toward us. When those familiar reflections change, it can become harder to find ourselves. A partner may say: “I still see you.” “I still love you.” “I’m still drawn to you.” The person living with cancer may know those words are sincere and still be unable to take them in. How can I believe what you see when I no longer recognize it in myself? Perhaps intimacy after cancer doesn’t begin with wanting to return to who we were before. Cancer may have changed too much for that. Nor does it require us to rediscover ourselves alone before allowing another person to come close. Sometimes we need another person’s loving recognition to help us find ourselves under the weight of cancer. Intimacy might begin by allowing two truths to exist together: I cannot yet see myself as you see me. And perhaps I can let you keep looking. The question beneath the loss of intimacy might not only be, Do you still love me? Or even, Do you still desire me? It may be: Can you still find me beneath everything cancer has changed? And perhaps the more vulnerable question: Can I let you? Reflections on the inner psychological experience of living alongside cancer. Jae L. Ross, PsyD, is a clinical psychologist who works with individuals and families whose lives have been reshaped by cancer, helping them navigate the emotional challenges of diagnosis, treatment, and beyond.

I was reading through a list of my favorite quotes the other day—an admittedly long list—and was reminded of one that once lived as a tagline in my emails. “Curiosity will conquer fear even more than bravery will.” —James Stephens I’m grateful to have become reacquainted with it because it left me pondering a question. What is it about curiosity that might be more enduring than bravery? I’ve spent much of my career sitting with people who are understandably frightened. Not always visibly so. Sometimes they’re remarkably composed or make jokes. Sometimes they’re talking about their next treatment as matter-of-factly as they might talk about an appointment for a haircut. Still, my patients tell me how frustrating it can be when people tell them how brave they are for facing cancer. “I’m not brave,” they’ll say. “What choice do I have?” I understand why they feel that way. You sit in the treatment chair, show up for scans, extend an arm for another blood draw, and live with side effects you never imagined having to tolerate while you wait for results that may change the direction of your life and the lives of those you care about. You grit your teeth and get through it, hoping for the best outcome possible. There is probably bravery in that. And I understand why it may not always feel like bravery from the inside. Sometimes just getting through something is what we do when the alternative is not available to us. Which brings me back to Stephens’s quote. Why curiosity? What could curiosity possibly offer someone who is frightened? I spend a great deal of time asking patients questions. Not that I necessarily think I know where the questions will lead. Usually, I don’t. What has this experience been like for you? What are you noticing about yourself? What has become more important? What is your body asking of you now? What is hardest about not knowing? We pause. And then we become curious together. Cancer asks for an extraordinary amount of patience. There are appointments to wait for, treatments to complete, bodies that recover at their own pace, and scan results that stubbornly refuse to arrive any faster just because we desperately want them to. We can grit our teeth through the waiting. Or we can also become curious about it. Curiosity doesn’t make any of those experiences easier. It doesn’t make the scan result arrive sooner or eliminate a treatment side effect. And it certainly doesn’t promise that what we discover will be comforting. But perhaps curiosity changes the way we stand in relation to what is happening. Fear wants certainty. It wants to know what comes next. It wants guarantees that medicine, despite everything it can do, can’t always provide. Fear can ask What if? endlessly, carrying us into futures that may never happen. Curiosity asks something different. I’m curious about what this fear is trying to protect. I’m curious what matters most to me. I’m curious about what makes the loss so difficult. I’m curious about how I want to live, even though I don’t know what the future will bring. Curiosity brings us back to the experience we’re actually having. It doesn’t ask us to predict. It asks us to notice. I see this happen with my patients. I ask a question and watch someone pause, often for quite a while, before answering. And occasionally what comes next seems to surprise both of us. Those moments stay with me. I leave the room carrying questions of my own. Over the years, my patients have taught me an enormous amount about fear and hope, love and loss, patience and uncertainty, and bravery. They’ve made me reconsider things I thought I understood. Their stories have changed the way I think about my own life. I think that’s why I write these reflections. I’m still curious. Maybe Stephens was right. Maybe curiosity can take us somewhere bravery cannot. Bravery may help us grit our teeth and keep going when we have no other choice. Curiosity invites us to notice what is happening within us along the way. And sometimes, in that noticing, we discover not only how we’re getting through our lives— but how we want to live them. Reflections on the inner psychological experience of living alongside cancer. Jae L. Ross, PsyD, is a clinical psychologist who works with individuals and families whose lives have been reshaped by cancer, helping them navigate the emotional challenges of diagnosis, treatment, and beyond.

There are times in our lives when looking backward feels easier than looking ahead. Something happens that changes things. Maybe by choice. Maybe not. Either way, you find yourself standing somewhere you’ve never stood before, looking toward a future you don’t recognize. It’s natural to want to go back to the way things were. The life you had was familiar. You knew its rhythms, who you were inside it, what you could manage and what was expected of you. Even the parts you think you could’ve done without begin to look different from a distance. When this happens, I wonder if it’s not that we’re longing for how good life was, but rather for how recognizable it was. Cancer can create this kind of longing. I just want my old life back. I have heard versions of that sentence many times. I’ve come to think it doesn't always mean for everything to be exactly as it once was. I think sometimes it means: I want to recognize myself again. I want confidence in my body again. I want to know what tomorrow might look like. I’m tired of having to figure everything out. There’s comfort in familiar terrain. But cancer changes the landscape. And there usually isn’t one clear map to navigate your way through it. If you’re fortunate, you find a team who has walked the terrain before and can help offer guidance. But the direction forward is different for each person walking it. After treatment ends, or if your cancer becomes a chronic condition, life begins asking for attention differently. The world expects you to step back into it. And you may discover that you aren’t entirely sure how. It can feel a little like emerging from a dense forest into an open meadow. Behind you is the terrain you’ve already traveled. Ahead of you is wide open space. There are no arrows pointing toward the life you’re supposed to live next. No clearly marked trail. Perhaps you stand there looking for one. What am I supposed to do now? Which way am I supposed to go? Who am I after all of this? The questions aren’t surprising. Cancer can change your relationship with your body, your work, your relationships, your assumptions about the future, and your sense of safety in the world. And now you’re being asked to enter uncharted terrain while you’re still discovering who you are within it. Discovery feels different when you didn’t choose to become a beginner again. Maybe that’s why we become so preoccupied with figuring out where we’re going before we begin. We wait for clarity. We wait to feel motivated. We wait until we know what matters now. We wait to feel more like ourselves. But what if those things aren’t waiting to meet us at the edge of the meadow? What if we can only discover them by walking into it? That can be difficult to do when so much of your recent experience may have reminded you of what you couldn’t control. Cancer can make you acutely aware of your body’s limits, the uncertainty of what lies ahead, and how quickly the world we know can reshape itself. Moving into unfamiliar territory asks you to trust yourself differently. In a way, you’ve done this before. There was a time in your life when you didn’t expect yourself to know exactly who you were before you began engaging with the world. You tried things, met new people, and wandered toward whatever caught your attention. Some things stayed with you. Others didn’t. You discovered what you loved and what left you cold. You found places you belonged and others where you didn’t. You learned what interested you, challenged you, brought you pleasure, and what you never wanted to do again. Through those experiences, you were discovering who you were. Somewhere along the way, we change and start assuming we know ourselves well enough to know what we want. What matters. That we should have some idea where we’re going before we start moving. Then something happens that rearranges the life we felt we knew so well. Cancer can do that. It can leave you trying to answer enormous questions from a place that’s constantly shifting: Who am I now? What truly matters to me? What do I want my life to look like now? You don’t need to have answers to those questions before you begin. Some of the answers can only be discovered by engaging with life again. Trying something. Noticing. Learning. And choosing again. Sometimes we don’t think our way into a new life. We begin living our way into one. That can be difficult when you don’t feel ready. At the edge of the meadow, you may find yourself waiting to feel motivated. We tend to believe that motivation comes first. When I feel more like myself, I’ll call my friends. When I have more energy, I’ll start going places again. When I know what I want, I’ll make some plans. It can work that way. Sometimes. But it can also work in the other direction. You accept an invitation without knowing whether you’ll enjoy yourself. You return to something you once loved—or try something you’ve never done before—without knowing what it will feel like now. And then you pay attention. Maybe dinner with friends feels wonderful for the first hour and exhausting by the second. Maybe the hobby you couldn’t wait to return to doesn’t hold your attention anymore. Maybe you sit outside with a cup of coffee and notice that, for ten minutes, you weren’t thinking about cancer. Maybe you laugh. Maybe you become interested in something new. Maybe you simply discover, No. Not this. Not yet. That matters too. Because the purpose of taking the step isn’t to prove that you’re getting better at life again after cancer or demonstrate that you’re moving on. Stepping into the experience gives you information. You begin to notice what still fits and what doesn’t. What you miss and what you don’t miss at all. What leaves you depleted and what gives something back. What feels meaningful enough that you might want to move toward it again. Perhaps that’s a gentler question than asking yourself what you want to do with the rest of your life. What matters enough to me right now that I might be willing to take one step toward it? It doesn’t have to be profound. It doesn’t have to tell you where you’re going. It only has to give you somewhere to begin. So you step into the meadow. You move toward something that catches your attention. You walk for a while and discover that it isn’t what you expected. You change direction. That's not failure. You’ve learned something you couldn’t have known while standing at the edge. Something else may catch your attention along the way. Something you hadn’t noticed before because you were so busy looking for a path. You move toward that instead. Little by little, the landscape becomes more familiar. This is how a life can begin to take shape again. One choice gives you information for the next. You’re not starting over. You’re discovering. Perhaps discovering what you’re capable of now. We often talk about finding our way forward. Maybe there isn’t a well-worn path waiting to be found. Sometimes we live our way into one by becoming willing to discover what we might find along the way. You only have to be willing to take the first step. Reflections on the inner psychological experience of living alongside cancer. Jae L. Ross, PsyD, is a clinical psychologist who works with individuals and families whose lives have been reshaped by cancer, helping them navigate the emotional challenges of diagnosis, treatment, and beyond.

In the Passenger Seat “I feel like I don’t have any control of my life." I hear some version of this almost every day as I sit with my patients. I hear it so often that I began wondering what we really mean when we talk about control—and what losing it costs us. Most of us spend our lives trying to create some sense of control. Perhaps that shouldn’t be surprising. The human mind is designed to help us survive, and feeling that we have some control over what happens can create a sense of safety. We plan and prepare. We make decisions and try to move our lives in one direction rather than another. Most of the time, we don’t even think of this as control. It simply feels like living our lives. Cancer can challenge that assumption very quickly. I’ve come to think that going through cancer can feel like becoming a passenger in your own car. For years you’ve been driving this car. You know the way you like to drive it. You know where you’re going—or at least you thought you did. You decide which route to take, when to leave, where to stop, when to speed up and when to slow down. You may occasionally get lost or encounter a road you didn’t expect, but your hands are still on the wheel. Then suddenly, you’re sitting in the passenger seat. Someone else is driving. Sometimes the driver is your oncologist or a surgeon. Sometimes an insurance company seems to have gotten behind the wheel, or you notice that your own body has taken over. And just when you’ve adjusted to one driver, another may take their place. You may know that these people are trying to get you where you need to go. You may trust them and be enormously grateful for their expertise. And still want your hands back on the wheel. There's something profoundly different about being driven through your own life. You may have some influence over where you’re going, and even agreed to the destination. You may even have chosen the person driving. But you’re no longer the only one behind the wheel. Sometimes the road changes. There’s traffic you couldn’t have anticipated. A street closes. The weather changes. The car develops a problem. A detour sends you somewhere you hadn’t expected to go. Occasionally the destination itself changes. No wonder the passenger can become anxious. Some of us aren’t particularly good passengers even under the best circumstances. We watch the road. We notice how fast the driver is going. Our foot reaches instinctively for a brake pedal that isn’t there. We wonder why they didn’t take the other route. We want to say, Watch out. Because sitting in the passenger seat requires us to tolerate something human beings often find extraordinarily difficult: We can have some influence over what happens, but we’re not entirely in control. Perhaps that’s part of what someone means when they tell me, “I have no control.” Maybe they aren’t saying that they literally have no control over anything. Maybe they’re saying: I don’t feel like I’m driving my own life anymore. That’s a very different kind of loss. It can touch independence, identity, dignity, and our sense that the life we’re living still belongs to us. And when you’re staring at the steering wheel in someone else’s hands, it can be easy to overlook what is still available to you from where you’re sitting. A passenger has choices. You can ask where you’re going. You can ask why you’re taking this route. You can say, “Please slow down.” You can say, “I need you to stop.” You can ask whether another road is possible. Sometimes you can choose the driver. Sometimes you can decide who else rides with you. You can ask questions before agreeing to continue. And there are smaller choices too. You can choose the music. You can ask for quiet. You can open the window. You can notice something beautiful outside it. You can decide that you’d rather not spend the entire ride talking about where you’re going. None of those choices puts your hands back on the steering wheel. That isn’t the point. Perhaps control and choice aren’t quite the same thing. When we’re driving the car, they can feel almost indistinguishable. We choose, and then we act. We decide, and then we move. The passenger seat separates them. You may not control the road, the traffic, or even the destination. And there are still choices available to you along the way. They may seem small compared with everything that has been taken out of your hands. But smaller does not necessarily mean less significant. The smaller territory can become more visible, more precious, and more consciously chosen. Viktor Frankl wrote about what he called “the last of the human freedoms” — the freedom to choose one’s attitude even when circumstances have taken almost everything else away. This is what remains available from the passenger seat. I don’t think Frankl means to imply that there is a right attitude to take. Nor that you must show appreciation or find some grand meaning that pulls everything together. You’re allowed to wish you were driving and to be angry that you aren’t. Just the small freedom to choose how you meet what is happening. You can still ask: What is available to me from where I’m sitting? Because choice doesn’t always mean having control over where the car is going. Sometimes it means remembering that even from the passenger seat, you’re still actively participating in the ride. And this is still your life. Reflections on the inner psychological experience of living alongside cancer. Jae L. Ross, PsyD, is a clinical psychologist who works with individuals and families whose lives have been reshaped by cancer, helping them navigate the emotional challenges of diagnosis, treatment, and beyond.

Some people are fixers. They’re the ones people call when something goes wrong. They listen, offer advice, make the phone call, solve the problem, smooth things over. They notice what needs to be done, often before anyone asks. And they worry. They worry about their children, their partners, their parents, their friends. They think about the conversation long after it has ended. They imagine what might happen next. They rehearse possible solutions. Sometimes the people they want to fix even tell them to stop. I’m okay. You don’t need to worry about me. I’ll figure it out. You don’t have to fix this. But the fixer has a hard time doing that. You might recognize some of these characteristics in yourself. In my work, people ask me why. Why do I always feel like I have to fix everything for everybody? Why can’t I stop worrying? Why can’t I just let people handle their own lives? There are infinite possible answers. But I begin with a simple one: Because you love them. Because you care about them. Because seeing someone you care about struggle is painful, and wanting to make that struggle easier is an expression of compassion. It speaks to something deeply human in you: when someone you care about hurts, you want to help. That’s a natural response to seeing someone you care about suffer. The difficulty comes when caring begins to feel like responsibility. If you’re hurting, I need to make you feel better. If there’s a problem, I need to solve it. If something might go wrong, I need to anticipate it. If I can help, I should. Over time, fixing can become more than something you do. It can become part of who you understand yourself to be. I’m a fixer. And honestly, sometimes focusing on fixing other people’s problems can give you somewhere to put your attention. Other than toward your own problems. There’s always something to think about. Something to organize. Someone to worry about. A problem to solve. It can become remarkably easy to fill the mind with other people’s lives. Until cancer enters your own. Cancer has a way of making itself difficult to ignore. Your body reminds you. The medication on the counter reminds you. The appointment on the calendar reminds you. The port in your chest reminds you. Even on the days when you would rather think about almost anything else, cancer finds ways of tapping you on the shoulder. And suddenly, disappearing into someone else’s problems becomes much harder. Oh, you may still worry about everyone else. You may still want to solve their problems. The instinct to take care of people doesn’t disappear because you have cancer. But now your own life is demanding your attention too. More loudly than before. And for someone who has spent a lifetime fixing things, cancer presents a particularly painful problem. You can’t fix it. You may be able to do a great deal. You can choose your doctors, learn about treatment, ask questions, make decisions, advocate for yourself, take medications, show up for appointments. But you cannot personally make the cancer go away. You cannot guarantee that treatment will work. You cannot guarantee what the next scan will show. You cannot eliminate uncertainty. You cannot promise yourself—or the people who love you—that everything will be okay. The fixer has finally encountered something that can’t be fixed simply by trying harder. And meanwhile, everyone else’s lives continue. Someone you love is struggling. Someone makes a decision you disagree with. Someone is unhappy. Someone has a problem you know how to solve. Every familiar instinct might tell you to step in. But you may no longer have the energy. Maybe cancer has made your own needs too loud to keep placing them at the bottom of the list. Or perhaps, for the first time, you begin to wonder whether every problem you can help solve is actually yours to solve. A patient once told me she was learning to step back and let life be. Not stop caring about or abandon the people she loved. Let life be. There’s something very different about that. Letting life be means allowing someone you care about to have a problem without immediately making it your problem to solve. It means allowing someone to be disappointed, frightened, frustrated, or sad without believing you are responsible for changing how they feel. It means recognizing that the people you love may make choices you wouldn’t make. And you can still love them. For the fixer, that can be extraordinarily difficult. Because fixing has often been one of the ways you express love. So perhaps the task isn’t to stop being a fixer. Perhaps it’s learning that love has other ways of showing up. Sometimes love listens or sits beside. And sometimes love simply remains present while something difficult is happening, trusting that another can find their own way. That’s not the same as not caring. It may be another form of caring entirely. Cancer can ask you to practice that same kind of compassion with yourself. There will be things you can change and things you can’t. Some problems require action; others ask only to be lived through. Fear may not need to be fixed every time it appears. Sadness doesn’t always need to be talked out of the room. Uncertainty might not have an answer today. This is what this moment is. And perhaps we can let it be what it is. That’s difficult enough when you’re watching someone you love suffer. It can be even harder when the person whose problem you can’t fix is the one looking back at you in the mirror. Reflections on the inner psychological experience of living alongside cancer. Jae L. Ross, PsyD, is a clinical psychologist who works with individuals and families whose lives have been reshaped by cancer, helping them navigate the emotional challenges of diagnosis, treatment, and beyond.

I was having dinner with a dear friend recently when I told her about someone very close to me who is ill and in declining health. I wondered aloud to my friend about all the things I might do to help this person I love dearly get healthier. My friend is a geriatric physician. She listened for a while and then asked me a simple question. “Do you think it’s time to talk about hospice?” I stopped. Hospice. How had I not thought about hospice? I'm a psychologist in cancer care. I’ve spent over a decade on an integrated palliative care team. I’ve sat at the bedsides of people who were dying. I’ve held their hands and sat with families as they struggled with decisions about treatment and end-of-life care. Conversations about death and dying are not foreign to me. And yet hospice had never entered my thinking about my loved one. I was thinking about getting them stronger and healthier. I wasn’t thinking about dying. And that has stayed with me. Why? The easiest answer is that I love this person and don’t want to lose them. Of course I don’t. There’s nothing particularly revealing about that. None of us want to lose someone we love. What surprises me is what I had apparently managed not to think about. I knew this person was older and their health was deteriorating. I knew we were no longer talking about returning them to the life they had been living before all of this began. I knew all of those things. But somehow I hadn’t allowed those facts to become the question: Could my loved one be approaching the end of their life? Knowing that someone we love will eventually die and allowing ourselves to consider that they may be dying are not the same thing. I think we human beings have become remarkably good at keeping death outside the room. We know it exists. We know it will eventually come for the people we love. We know it will eventually come for us. Just not yet. And when someone tries to bring it into the conversation, we often push it right back out. When someone says, “I’m afraid I might die.” We respond with, “Don’t talk like that.” “I want to make sure you know what I want if things get worse” gets a reply of “You’re going to be fine.” “I think I need to start getting some things in order“ is halted with “Stop thinking that way. You need to stay positive.” We may think we’re offering hope. But sometimes I wonder who we’re actually trying to protect. From an Acceptance and Commitment Therapy perspective, there is a concept called experiential avoidance. It describes something remarkably human: our attempts to avoid, suppress, escape, or control internal experiences that are painful or frightening. And death gives us plenty of them. Fear. Grief. Helplessness. Uncertainty. The thought of a life continuing without someone we love. The awareness of our own mortality. The fear that talking about death means surrendering. Maybe even the irrational sense that saying the word aloud somehow summons death. So we don’t say it. And for a little while, that works. “Don’t talk like that.” The conversation stops. “Let’s stay positive.” We get to talk about something else. “Let’s focus on getting stronger.” Now we have something to do. And I’m beginning to wonder whether doing can sometimes be another way of avoiding. I wasn’t sitting somewhere consciously thinking, “I refuse to consider that my loved one might be dying.” I was trying to help. To solve the next problem. A reasonable thing to do. An expression of how much I care. And maybe, without realizing it, something that allowed me to remain focused on helping this person live rather than considering whether it might also be time to talk with them about dying. Avoidance doesn’t always look like running away. Sometimes it looks remarkably productive. I think about the people I sit with every day in cancer care. There are patients who know their cancer is serious and want to talk about what might happen if treatment stops working. There are people who want to talk about dying. They want to talk about what they’re afraid of. They want to make plans. They want to say things to the people they love while there is still time. Sometimes the people who love them aren’t ready to listen. “Don’t talk like that.” “You’re not going anywhere.” “We’re going to beat this.” Those words are spoken from a place of love. I wonder what it’s like to be the person who may be dying and discover that the people you most need to talk to cannot bear to hear you talk about it. Perhaps our silence doesn’t make death less frightening. Perhaps it makes dying more lonely. I’ve spent much of my professional life sitting on one side of this conversation. That night at dinner, I found myself sitting in the other chair. My friend didn’t suggest my loved one was dying. She didn’t tell me what decision I should make. She simply asked whether it might be time to let hospice enter the conversation. Nothing about my loved one’s condition changed when she asked the question. This person was exactly as ill after those words were spoken as they were before. What changed was what I was willing to consider. I’m thinking differently now about something I’ve witnessed for years in working with serious illness. Maybe talking about death doesn’t mean surrendering hope. Maybe talking about death is simply allowing ourselves to make space for something that has been in the room all along. And perhaps one of the most loving things we can do is allow death to enter the conversation long enough that we might hear what someone we love needs to say about it. Reflections on the inner psychological experience of living alongside cancer. Jae L. Ross, PsyD, is a clinical psychologist who works with individuals and families whose lives have been reshaped by cancer, helping them navigate the emotional challenges of diagnosis, treatment, and beyond.

“It’s not just that time feels shorter. It feels more visible.” Most of us move through time without thinking much about it. Days fill. Schedules move. Life unfolds at a pace we rarely stop to question. Time sits quietly in the background. “I’ll get around to that at some point. There’s always tomorrow.” We assume time will continue, and we rarely feel the need to examine it. Until something happens that brings it into clearer view. In my work with people facing cancer, I sit with them in the spaces between. Between appointments. Between scans. Between knowing and not knowing. Waiting becomes a central part of the experience of cancer. Waiting for results. Waiting to feel better. Waiting to see if what you have endured is working. And in that waiting, time starts to feel different. It moves closer. It becomes harder to ignore. Waiting in this context isn’t neutral. It carries uncertainty, hope, fear, and a sharp awareness of how much may be at stake. Time can shift shape in this space. Some days, it seems to stretch out: a clock that seemingly won’t move, an afternoon that feels like it lasts a week, a wait for results that feels longer than the months that came before it. Other days, it compresses: a week that disappears in a blur of appointments, a month that’s gone before you have time to feel it, an entire season that ends without you ever quite arriving inside it. And the future, which you may have once assumed simply keeps unfolding, can become harder to picture. You may cautiously make plans for the near future. Or you may find you can no longer make plans at all — at least not in the way you used to. Instead, the future shows up as what could be missed. The grandchild’s birthday. The trip that was supposed to happen. The years you had assumed would be there. Time, which had been in the background for so long, is suddenly something you can’t stop being aware of. It’s not that time has suddenly changed. It’s your relationship to it that has. Time is no longer assumed. It's noticed. Felt. Measured more carefully than it ever needed to be before. And in that noticing, something inside you begins to shift. Patients often tell me that they don’t want to waste their time. You may become more aware of how you’re spending your days. Time that once passed without much thought begins to register differently. A growing awareness emerges —not just that time is passing, but that it matters. Choice begins to come into clearer view too, in small, everyday moments that used to pass without much thought. How to spend an afternoon. Whether to say yes to something, or no. Where to place your energy. Who to call back. Who not to. When time was less visible, many of these choices happened without fanfare. Now, they ask for something more. Attention. Intention. Someone once told me — “I’m being more intentional about how I spend myself.” Spend myself. Not spend my time. There’s a whole philosophy in that small grammatical shift. When time matters more, what fills time begins to matter more too. And in that recognition, things can begin to reorganize. Priorities shift. Tolerance for what feels unnecessary fades. Moments that once seemed small begin to take on greater meaning. Sitting outside, feeling the sun. The texture of a familiar voice on the phone. Watching the world move at its own pace. They begin to matter differently. But the reorganization isn’t always gentle. Often, what becomes clearer is also harder to face. A job that no longer feels worth the years it’s asking for. A relationship that’s been slowly draining you for a long time. A way of spending your energy that you had stopped questioning, and that now feels impossible to keep doing. When time becomes visible, so does what no longer fits inside it. That can be liberating. It can also be sobering. It can ask you to have conversations you’ve been avoiding, or to make choices that other people in your life may not understand. It’s not always easy to know what to do with the clarity. But the clarity itself is information. And it’s yours. Waiting, in this way, does something unexpected. It slows the outward movement of life, and it sharpens the inward experience of it. You may find yourself paying closer attention to small things. A morning. A meal. The light through a window. A face you have known for years that you suddenly find yourself looking at, really looking at, for the first time in a long time. This is what can happen when time stops being invisible. If time feels more visible to you now, you might ask yourself this question: What feels worth my time today? Not as a measure of whether you’re using time well. Just as a question to sit with, in the moments when sitting with it feels possible. Time may not feel the same as it once did. And in that shift, you may begin to choose more carefully — not only what you give your time to, but how you give yourself within it. You may not be able to control how much time you have. But you can begin to notice how you’re living inside it. Reflections on the inner psychological experience of living alongside cancer. Jae L. Ross, PsyD, is a clinical psychologist who works with individuals and families whose lives have been reshaped by cancer, helping them navigate the emotional challenges of diagnosis, treatment, and beyond.

In my work as a psychologist in cancer care, I sit with moments when the mind begins to move ahead of what's actually happening — reaching toward what might come next. These moments arrive at every stage of the experience. After a diagnosis, when the body that felt familiar has suddenly become something you watch with new attention. Between treatments, when you're waiting to see if it's working. After scans, after appointments, before scans, before appointments. And after treatment ends, in the long stretch where vigilance has no clear off-ramp. Have you ever noticed how the mind moves in those moments? It begins with two words: What if. What if it's back? What if this pain means something? What if the next scan shows bad news? If these thoughts sound familiar, you're not unusual. They're an understandable response to living with uncertainty. In my work with patients, I've come to notice that worry is less about what's happening medically in the moment and more about how the mind tries to manage uncertainty about the future—by predicting it. When we look closely at what follows those two words — what if — two familiar patterns appear. I give these patterns names: Protective Paula and Catastrophic Cathy. Both are trying to protect you. Protective Paula sounds like this: Let's go to follow-up appointments. Let's pay attention to new symptoms. That feels different. We should monitor it. Paula helps us stay engaged in our care. Catastrophic Cathy sounds different: What if this is recurrence? What if they missed something? What if this time it's worse? Cathy's strategy is anticipation. If she imagines the worst ahead of time, maybe you won't be blindsided. But anticipating the worst rarely reduces uncertainty. Instead, it teaches you to suffer in advance. These thoughts can become louder in the days leading up to a scan. We call this scanxiety. In those moments, Cathy may begin whispering: This is the one. You already know. Start preparing. Sleep becomes lighter. Anxiety rises. Your mind begins rehearsing worst-case scenarios. This is normal. It's your mind doing its job, trying to protect something that matters. These thoughts can also show up in the quietest moments. I once worked with a patient who told me bedtime had become the hardest part of her day. During the day, she was steady — busy with work, friends, and the ordinary rhythm of life. But when the lights went out, and the room grew quiet, Cathy would show up: What if it's back? What if that ache meant something? Soon, Protective Paula would join in, suggesting she review symptoms again or look something up online. She described feeling responsible, as if staying mentally vigilant was part of surviving. What eventually helped wasn't answering the thoughts. It was learning to pause and say: "This is bedtime, ladies. Chillax. There's no urgency to solve this right now." Not because the fear wasn't real. But because nighttime isn't the moment to decide the future. Even when a scan comes back clear, worry doesn't always disappear. It shifts into the space between appointments: What if something is happening right now… and we don't know? It helps to remember that your medical team's monitoring is designed with a specific goal: catching changes early — when they're still more like a smoldering ember, before they have the chance to become a three-alarm fire. Early detection doesn't eliminate uncertainty. But it also means you're not watching alone. Your medical team is watching with you. And sharing that responsibility matters. It means you don't have to carry the entire burden of vigilance inside your own mind. Sometimes Protective Paula begins working overtime — encouraging constant research, repeated body-checking, or endless reassurance seeking. At first, that can feel like you're being responsible. Over time, the goal shifts from staying informed to the impossible task of eliminating uncertainty altogether. Cancer teaches what most of us would rather not learn: complete certainty is rarely possible. Both catastrophe and over-control are attempts to regain certainty. And part of living alongside cancer is learning this: certainty and uncertainty exist equally in life. The work is learning how to live alongside the uncertainty. When a "what if" thought appears, it can help to ask: Who's talking right now? Is it Catastrophic Cathy, turning possibility into certainty? Is it Protective Paula, offering proportion? That small moment of awareness creates space between the thought and your response. And in that space, balance becomes possible again. Having "what if" thoughts doesn't mean you're failing at this. It means your mind is trying to protect something that matters. You don't have to silence these thoughts. And you don't have to defeat uncertainty. You can notice when fear is escalating. You can notice when control is overreaching. You can return your attention to what is actually within your influence. You're not the only one learning how to do this. Living alongside cancer isn't about eliminating "what if." It's about restoring proportion so that what matters can speak louder than uncertainty. And again and again, you can return to the life — and the people — you're fighting so hard to be here for. Reflections on the inner psychological experience of living alongside cancer. Jae L. Ross, PsyD, is a clinical psychologist who works with individuals and families whose lives have been reshaped by cancer, helping them navigate the emotional challenges of diagnosis, treatment, and beyond.

Why did this happen to me? I thought I was doing everything right. What did I do wrong? What did I do to deserve this? At first, they appear to be different questions. I’ve begun to wonder if they’re all asking Why? in different ways. When you ask, “Why did this happen to me?” your mind begins to assemble the pieces. You look backward. You look sideways. Why this body? Why now? Why not someone else? You search for the one piece that might make everything else fall into place. Because if you can understand why this happened, perhaps the world will feel a little less random. At first, I thought this question was simply asking for an explanation. If you knew enough about genetics, environmental exposures, or chance, perhaps the question would finally be resolved. But that doesn’t quite fit. I’ve sat with people who understood exactly how their cancer developed. They could explain the mutations, the risk factors, the medical reasoning. And still… “But why me?” The explanation was accurate. It just wasn’t enough. Then there’s the next question: “I thought I was doing everything right. What did I do wrong?” Here you begin reviewing the record. Meals. Exercise. Symptoms that didn’t seem important at the time. The appointment you postponed. The cigarette you smoked years ago. The sunscreen you forgot. The family history you never knew. You keep turning pages, hoping one of them will explain today. It would be easy to hear this as self-blame. I’m not sure it is. Perhaps you’re reaching for something else. If a mistake can be found…perhaps another one can be avoided. At first, I thought this was a question about guilt. But that doesn’t quite fit either. Even when people become convinced they did nothing wrong, the question remains. Then there’s this question: “What did I do to deserve this?” This one has always felt different to me. You’re no longer searching your medical history. You’re searching your moral history. Not for something you did. But for who you’ve been. You wonder whether life keeps a kind of ledger. If good lives are somehow protected. If suffering is earned, or if this diagnosis says something about you… rather than something that happened to you. At first, I wasn’t clear what this question was asking. It didn’t seem to be asking how your cancer developed or how it could have been prevented. It was asking something else. And yet… even people who come to believe they did nothing to deserve cancer… still find themselves returning to Why? I find myself coming back to these questions. Not to ask what they mean. But what each hopes an answer would accomplish. If you knew why this happened… what would that change? If you found the mistake… what would that change? If you knew whether you deserved this… what would that change? For a long time, I thought these questions were searching for different answers. Now I’m wondering if they’re all searching for an explanation that could somehow give meaning to what’s happened. People often leave their oncologist’s office with thoughtful, accurate explanations. They understand the pathology, the genetics, the treatment. The explanation was accurate. It just wasn’t enough. It was answering a different question. Perhaps that’s why none of these three questions ever seem completely satisfied. Even when one answer has been found… another version of Why? takes its place. I’m beginning to wonder if Why me? is less a question seeking an answer than it is another way of saying, “I just want this to make sense.” Reflections on the inner psychological experience of living alongside cancer. Jae L. Ross, PsyD, is a clinical psychologist who works with individuals and families whose lives have been reshaped by cancer, helping them navigate the emotional challenges of diagnosis, treatment, and beyond.

Most of us move through life inside roles we rarely stop to think about. Parent Partner Professional. Caregiver Problem-solver Planner of the future. These roles become so familiar that they fade into the background of everyday life. They quietly shape how we move through the world and how others understand us. There is one role, however, that most of us barely notice at all. The role of the healthy person. Until the day it changes. A cancer diagnosis rarely becomes real in a single moment. The news may arrive during a brief conversation in a medical office, but the meaning of that moment usually unfolds gradually in the weeks that follow. Appointments begin to multiply. Medical language enters everyday conversation. The body, once taken for granted, suddenly becomes something we pay closer attention to. In the early weeks after diagnosis, many people describe a strange psychological dislocation. On the outside, life may look much the same. Work continues. Conversations continue. Daily routines keep moving forward. Yet inside, something feels different. Many people struggle to name this shift at first. Life may still look familiar on the surface, even as a new awareness begins to take shape. Often it is the experience of treatment — fatigue, nausea, changes in energy or routine — that slowly makes the reality of illness more tangible. The body begins to speak in ways that are harder to ignore. And somewhere in that process, another shift quietly begins to take place. The role of “healthy person” — a role most of us never consciously thought about — begins to change. That shift can be surprisingly difficult to name. People often say things like: “I don’t feel like the same person I was a few months ago. “I’ve always been the strong one in my family.” “I’m not used to being the one who needs help.” These statements are not only expressions of fear or uncertainty. They often reflect something deeper: the disruption of a role that once helped organize a person’s sense of identity. Many of the things we do in life — caring for others, solving problems, being the dependable one others rely on — involve showing up for people in practical, everyday ways. Over time, those patterns become part of how we understand who we are. For most of life, health functions as an invisible foundation. It allows us to plan ahead, care for others, and move through daily responsibilities without thinking much about the limits of our bodies. When illness enters the picture, that invisible foundation suddenly becomes visible. Now there are medical decisions to make. Energy levels may change. The future may feel less predictable. Activities that once felt ordinary may require more attention and pacing. None of this adjustment happens all at once. It unfolds gradually, often in ways that are difficult to describe. Part of the psychological work of illness involves learning how to live inside this new reality without losing connection to the parts of ourselves that remain steady and intact. Over time, many people discover that identity is more flexible than it first appears. Roles may shift, but the deeper qualities that define a person — their values, relationships, and the care they bring to others — often endure. The ways those qualities are expressed may change, but the part of a person that cared enough to act in the first place is still there. Illness changes many things. It rearranges routines, priorities, and expectations. But it does not erase the person who was there before the diagnosis. Learning to live alongside cancer often begins with a quiet recognition. A role has changed. Jae Ross, PsyD, is a clinical psychologist who works with individuals and families living with cancer, helping patients navigate the emotional challenges of diagnosis, treatment, and survivorship. Click here to subscribe and receive email alerts when a new blog is posted

You probably have people in your life you’ve come to depend upon in ways you barely notice. Over time, you’ve come to expect how they’ll show up. How they’ll respond. What you can ask of them without wondering whether they’ll be there. Their dependability becomes part of the structure of your relationship. Then something changes. The person can no longer respond as they once did. Not that the relationship matters any less, but because something in their circumstances or capacity has changed. What once was assumed without much thought now requires more attention. You have to listen more intentionally. Adjust what you expect of them. Learn how to show up differently yourself. Something similar can happen in your relationship with your body. For much of life, you may trust that your body will carry you through the day. You make plans, accept responsibilities, and expect to have the energy to spend time with the people you care about and participate in the activities that give your life meaning. You don’t think about this trust because it doesn’t usually ask to be thought about. Then cancer makes it visible. “I don’t have the strength to do things like I used to.” I often hear some version of this in my work. The sentence is not only about physical strength or fatigue. It describes a change in a relationship that had once felt dependable. Your mind continues to make plans around the body it remembers. It expects to move through the day at the same pace, carry the same responsibilities, and show up for others in familiar ways. When your body is living through cancer, it may answer differently. Not all of that. Not today. Not at that pace. When your body no longer responds as expected, it can feel like a betrayal. You may become frustrated with it or frightened by its unpredictability. You may feel guilty when you can’t help around the house, keep a commitment, or join the people you love in something you once wouldn’t have thought twice about doing. You might turn that frustration toward yourself. “I should be able to do more.” “I used to be able to handle this.” “I don’t understand why I can’t keep up.” These thoughts are trying to hold your body to the terms of the relationship as it used to be. Your mind continues to make the same demands and expects the same responses as before. Your body isn’t intentionally refusing to show up. Its capacity has changed. And now the relationship asks something more from you. It asks you to notice what you may once have taken for granted. To listen before assuming. To consider what your body may need from you as you decide what you can expect from it. This doesn’t mean giving your body sole authorship of your life. Listening isn’t the same as surrendering your choices. In any relationship, paying attention to another’s needs doesn’t require abandoning your own. It means allowing what is true for both of you to become part of the conversation. Some days, showing up differently might mean resting. On another day, it might mean asking for help, changing a plan, or choosing to use the energy you have for something that matters enough to accept the cost. The answer will not be the same from one day to the next. Perhaps, before asking, “Why can’t my body do what it used to?” you might ask: “What is my body telling me about what is possible today?” And then: “How do I want to respond?” Trust changes, too. It no longer comes from expecting your body will respond predictably. It comes from knowing that you’ll pay attention to what is true between you now. Your body is showing up differently than it once did. It’s asking you to show up differently, too. Your body signals the pace. You choose how to respond. Reflections on the inner psychological experience of living alongside cancer. Jae L. Ross, PsyD, is a clinical psychologist who works with individuals and families whose lives have been reshaped by cancer, helping them navigate the emotional challenges of diagnosis, treatment, and beyond.

“I thought it would all be over. But it’s not.” This is what many people tell me in the months after active cancer treatment ends. And it names something important: a specific psychological experience that surprises many patients and the people around them. There’s a moment many people imagine long before it arrives. The end of treatment. The ringing of the bell. For many, that bell carries enormous weight. It’s held out as a kind of finish line. A collective exhale, proof that something enormous has been survived. Family members weep. Nurses applaud. Photographs are taken. And for good reason: it marks something real. And yet. For many of the people I sit with — patients, survivors, caregivers moving through the aftermath — the bell marks the end of treatment. It doesn’t always mark the end of the experience. And the gap between those two things can be one of the loneliest places cancer leaves behind. One of the things that surprises people most about cancer treatment is how organized it can feel from within. Not comfortable. Not safe. But organized. During active treatment, life arranges itself around what needs to be done. There are appointments. Medications taken at precise times. Side effects to manage, decisions to make, a clinical team that knows your name and your chart and what happened last Tuesday. And within all of that, within the fear and the fatigue and the indignity of it, there’s also a clear role. You’re a patient. Someone actively moving through something. Someone fighting, enduring, getting through. That role is consuming. It’s often painful. But it’s legible, to you, to your family, to the people around you who show up with casseroles and kind words and the particular tenderness people offer to someone they can see is suffering. Treatment provides a strange kind of scaffolding for identity. Even as it takes so much away, it gives you something to stand on. And then, almost all at once, that scaffolding comes down. The appointments spread out. Three months. Six months. The intensity softens. The visible markers of illness begin to recede. The casseroles slow. The texts become less frequent. The world, which had organized itself around your crisis, begins to turn its attention elsewhere. From the outside, this looks like recovery. From the inside, it often feels like something more disorienting. There’s a question that surfaces in this space at first, then with more insistence. “I thought I’d feel relief. But it doesn’t feel over. Like I don’t know what I’m supposed to be doing now.” You may recognize some version of that. Or you may have found yourself somewhere different — still adjusting, and also adrift. Not grieving, exactly, but not quite okay. Not the person you were before, and not yet sure who you are becoming. The structure of treatment gave your days a shape and your identity a center. You knew what you were doing and why. And now that structure has dissolved, and you’re standing in the open, and the question underneath everything is: Now who am I? The word survivor is offered with great tenderness, and it carries real meaning. For many people, it becomes a source of pride and community — a word that acknowledges what they’ve been through and connects them to others who know something of the same territory. But for others, the word arrives like a door that doesn’t quite fit its frame. It implies completion — a before and after, with the cancer safely on the other side of a dividing line. And many people find that their experience simply doesn’t organize itself that way. There may still be follow-up scans, each one carrying its own quiet dread. Lingering side effects that make the body feel like a different body than the one you inhabited before. Ongoing treatment (hormone therapy, maintenance, monitoring) that continues long after the bell has rung. For some, the idea of “after” doesn’t exist at all. Treatment is simply the permanent context of living. And beneath all of this, something that doesn’t dissolve when active treatment ends: an intimacy with mortality. An awareness of the body that wasn’t there before. A changed relationship with time, with the future, with the ordinary Tuesday. Others may see you as finished. You may know the experience is still unfolding. Both of those things can be true at once. And learning to hold them both, without rushing to resolve the tension between them, is part of what this period asks of you. Support tends to gather at the dramatic moments. The diagnosis. The start of treatment. The visible crisis. These are the moments that activate the people around us. The hospital visits. The meal trains. The presence. The aftermath receives comparatively little of that. It’s quieter, slower, stranger. And it’s the period when the scaffolding comes down, and a person is left to find their footing in a life that has been fundamentally rearranged. People in this space often find themselves asking: Why does this still feel so present? Shouldn’t I be back to normal by now? Why do I feel more uncertain now than I did during treatment? If any of those feel familiar, if you’ve said them to yourself, or said them out loud to someone who didn’t quite know what to do with them, then you already know something about this place. About what it asks of a person just to be in it. There’s a cultural expectation, sometimes even a medical one, that recovery follows a trajectory. Illness, treatment, recovery, wellness. The line moves in one direction. But the psychological experience of post-treatment rarely cooperates with that model. You may find good months followed by difficult ones. Feeling, eighteen months out, more raw than you felt at six. Doing seemingly fine and then encountering something. A smell. A song. A scan date approaching on the calendar. Something that brings the whole thing flooding back. This isn’t regression. It’s what it looks like to integrate a significant experience into a life. Which is always recursive, always incomplete, always ongoing. What I’ve observed, sitting with people through this, is that the measure of progress is rarely how far away cancer feels. It’s more often: how much room is there in my life for things that aren’t cancer? That room tends to grow. Slowly, unevenly. But it grows. If you’re somewhere in this unguarded middle — after treatment, before you’ve found solid ground again — there’s no map that will tell you exactly where you are. But there may be a question worth sitting with. Not as something to solve. Just as a place to rest your attention for a moment. Instead of: Am I done? Perhaps: Where am I right now? Not where others think you should be. Not where you were before, which no longer exists as a destination. But where you actually find yourself standing. And from there, a narrower question still: What still asks for my attention? Sometimes it’s the body. Sometimes it’s fear. Sometimes it’s the persistent question of who you are now. And sometimes it’s simply the need to acknowledge that this mattered. That it changed you. And that you’re still finding your way with it. The bell may ring. The world may move forward. And still, there you are — learning where you stand within a life that has changed, and is still unfolding. Reflections on the inner psychological experience of living alongside cancer. Jae L. Ross, PsyD, is a clinical psychologist who works with individuals and families whose lives have been reshaped by cancer, helping them navigate the emotional challenges of diagnosis, treatment, and beyond.