A. Six months after her 30th birthday, Lilly was diagnosed with acute Leukemia. She and her husband, Jake, have no children together. She has been relatively healthy most of her life, despite suffering from minor medical mishaps. Lilly’s socioeconomic factor is that she is a middle class, Caucasian woman who was a top ranking salesperson for a cosmetic company.
While the case study has no mentioned specific issues, Lilly has hinted past confrontations with her parents. Lilly has been evasive about all aspects of her life that occurred before she came to the clinic. The social worker intern mentioned that Lilly gave up a baby in her early 20’s. Despite the closeness with the social worker intern through the physical and emotional upheavals, her defenses surrounding her past would not budge. Through the case study, the social worker realized that Lilly’s mental health deteriorated when she lost her ability to speak due to sores in her mouth. The social worker believed that because Lily was a sales representative, losing her ability to speak negatively affected her sense of self-worth. To have that taken away from her, as the intern suggested, is an attack to her ego functioning and can deplete her mental stability in fighting this illness.
However, the salient aspects that the intern failed to address is the correlation of emotional distress and the fighting spirit on the survival time for people combating life-threatening illnesses like cancer. Due to Lilly’s socioeconomic background and support of her parents, she was able to pay for her treatments and sustain economic stability despite her health deterioration.
After the reading the case, I have several questions: were different modalities of treatments other than ego psychology that could have helped her? Would exposing her parents to relaxation training or stress management have helped alleviate some of Lilly’s anxieties? Why would Lilly keep her past so hidden, and more specifically, why wouldn’t she discuss giving her baby away for adoption? Would there be different ways of conducting interviews with her in times when she was more relaxed?
The narrator of this article articulates the typical issues that any cancer patient faces: death, dying, health, family dynamics, physical changes in appearance, and resentment towards others and projection. The intern discussed common experiences from other patients to help normalize what Lilly was going through. For example, when Lilly said she felt like she was hallucinating, the intern informed her that this was common when receiving a morphine drip. The intern seems very helpless at times. She mentions in her transcript that she feels sad and even guilty for being healthy when talking to sick patient. I feel like this social worker is risking the overwhelming need to figure everything out for Lilly, such as digging up the past and figuring out ways to repair her relationships. Her health decline, Lilly’s emotional functioning is not an optimal state and I feel that Lilly just wanted focus on the future. However, I find myself intrigued at what Lilly has to say in coming to terms with what has happened to her life and what choices she could’ve done differently. I believe there might be something in her past that Lilly is afraid to confront. I don’t believe Lilly felt marginalization due to her race, class or economic background. I believe the mere fact that this social worker intern is alive, healthy and autonomous could create tension in the relationship. For example, Lilly wants to be home with Jake and her cat, but she is forced to stay in the hospital while this social worker intern has the luxury to go back home and rest in her bed, free from the medical tubes, the chemo, and loss of bodily function.
B. I am a first generation Ecuadorean-American who is also a cancer survivor. I come from a lower-middle class economic background and my parents did not even finish grade school. They do not know how to communicate in English. I hold privilege in the fact that I am 14 years in remission with the cancer that I struggled with combating for 1-½ years.
The implications of my sociocultural location in my identity as a first-generation cancer survivor with the lack of resources can help me understand the implications that it might have in my treatment with this client. Due to my class, race and economic background, I am marginalized from Lilly. On the other hand, she is from a middle class, held an influential position and had supportive parents that knew the language. These differentials can cause a clash of cultures. On one hand, I am marginalized because I didn’t have the same opportunity in my treatment and care as Lilly did. Some of which were unethical such as translating my whole treatment process to my parents from Spanish to English and telling my parents as an 8 year old, “I have cancer”.
Yet, I am still here and cancer-free. My identity as a first-generation cancer survivor with the lack of resources could have implications in my treatment with this client. I am aware as my role as a social work intern to not influence economic privileges in the assessment. My case writing would have to focus on her mental health and provide a support system in which I am familiar of as well. My hope is despite our many differences, I would have been a support system for her because the communal understanding of the initial feeling after prognosis, the physical changes, the sickness after chemotherapy, the reactions to medications, the dynamic changes in parents due to being “sick” and having the utter realization of oblivion is something that is out of your control.
C. With the dynamic of being cancer-free and dealing with a cancer patient, I am afraid of holding the privilege over Lilly because I have beaten the cancer and so far, it hasn’t come back. Although it is not a sociocultural aspect, it is part of my identity. The word “cancer survivor” will always play a role in how I interact with people as well as being Latina, born from illegal immigrants of South America. With this fact in mind, I think having someone that was 14 years in remission would’ve given Lilly a glimmer of hope in those moments when the alienation the person feels when they experience cancer and how little they have in common with their healthier loved ones.
The cultural differences such as being Hispanic and White could play a role in how we interact with one another. It is a cultural thing to become “too caring” for someone that is sick. I witnessed it with how my family has taken care of me and I have witnessed it in my time at the Domestic Violence Crisis Center.
I realized that it could’ve been something that Lilly needed but it would’ve triggered a complexity in the relationship with transference and countertransference that would’ve been something to be addressed to my supervisor. I feel that I would’ve grown attached and cared for her too much as I would’ve seen a version of myself in her in a nurturing way. However, I think having someone understand on a more intimate level of the medical terminology and the cancer treatment process would’ve made a world of a difference on the alienation she felt at times between her family and friends.
I feel at the stage of the treatment Lilly’s anxiety when she was in the ICU and facing her fears about the irrevocable reality that she might not get better. The fact that she survived those two weeks was a miracle, yet she didn’t see it as a triumph but a truth that this is going to be her reality from now on. This experience of death, dying and the inevitable decline in death is juxtaposition to my story of recovery and health. I would experience great sadness and anxiety if she were to die in my stay as a social worker intern and would have to have self-awareness with my identity as a “cancer-survivor” and not a “cancer-statistic”. Nevertheless, my cultural way to nurture the sick, care for the helpless and communication can be helpful in this situation. I believe that our social locations of class, race and economic boundaries are diminished when we are both bonded by same harsh reality.
The truth is, when it comes to cancer, it doesn’t judge of identities or race. I do believe class and economic factors place a role in treatment. However, handling my case with Lilly, I would acknowledge our differences yet manage to find similarities in our situations. We are both woman, who even though at different ages, have a self-esteem issue when it comes to losing our hair. Women identify feminity with their hair and even as an 8 year old; being bald was a harsh reality of my illness. I resonated with Lilly when she felt disgusted when she looked at the mirror and her baldness. I understand the feeling.
Although I did not have the luxury of having my parents pay for my insurance, I did have a support system at the time and it helped with the treatment process. I feel like our differences are profound: I was an 8 year old, Ecuadorean, lower-income, first-generation cancer fighter and Lilly was a 30 year old, middle-class, American, cancer fighter.
The differences are striking when we tell our stories yet the treatment process is still the same across all boards. The conversations that would have would be reassurance, instillation of hope and not just by words but by actually being “living proof” that there is a chance. Lilly talked about that 50% chance of fighting the disease with the bone marrow transplant. I had a similar prognosis after my first chemotherapy. Our conversation would have been so profound. I would have given her hope by just being there.
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