Fight, flee or freeze

It disturbs me that despite all I’ve come to believe about life and death, and the equanimity with which I’m able to approach both, I can still be struck dumb by fear of cancer and where my peculiar form of it is headed. On most days I’m master of my ship. I think rationally about where I stand vis-à-vis the melanoma, am able to talk about it dispassionately with anyone who inquires, and write about it ad nauseam.

Today I can stare down the barrel of the gun, and not flinch. But tomorrow? The lizard that lives in my brain might awaken, obliterate all deliberate thought and pose three timeless options: fight, flee or freeze. I can’t seem to tame the lizard. And I definitely can’t ignore it.

I’ve read that physiologically, this fear springs from a specific bundle of nerves buried deep in the brain that plays a commanding role in how we respond emotionally to stimuli. We're wired to know fear. Once this almond-sized region—the amygdala—is engaged, it’s in charge. Because it’s part of the primitive brain, there’s no point in trying to think our way out of feeling afraid. The amygdala can put to shame that part of the brain of which we’re proudest: the cerebral cortex—the brain I’m using right now to write these words. At other moments, I think like a lizard and am able only to strike out, run away, or melt in fear. All thoughts of beauty and freedom and justice flee. I want only to survive.

I experienced this response most recently just after my surgery 10 days ago. I had it in my head that this would be easy. The surgeon would make some small incisions, casually extract the mets growing beneath the skin, and quickly stitch me up. I’d be in and out in a jiffy, and primed for a nice dinner in downtown Portland.

It didn’t turn out that way, as I wrote in a previous post. My incisions are all bigger than expected, and one now has a festering infection. I’m on antibiotics to get it under control. I was shocked when I removed the bandage and saw for the first time the jagged wound on my throat where another of the mets came out. It reminded me that I’m in a high-stakes poker game with a serious card shark. My fear is that no matter how well I play my cards, the deck is stacked against me.

I haven’t learned to co-opt my fear. I doubt that I can. I’m no longer surprised when fear washes away my resolve and confidence, but I’ve also learned that it soon passes. The jolt of adrenaline I feel when I find a skin nodule sets my heart pounding. My thoughts harden. My breathing quickens. The same is true when I hear that a CT or PET scan has found something suspicious, or when I read an article that prognosticates what usually happens to people with stage IV melanoma. There are any number of triggers that can arouse the lizard. Stepping onto the elevator tomorrow for the ride up to the cancer center will probably do it. Waiting in a sterile exam room wearing nothing but a flimsy hospital gown will too. I have yet to flee when this panic rises within me, but I've definitely felt the impulse.

Knowing there’s a neurologic basis for this messy emotion prepares me for it. It’s possible the distress I feel is not totally a bad thing as it contrasts so vividly with those nobler emotions and thoughts that I value. Fear has been given to us—and to me—for a purpose. While we cannot evict the lizard it can be managed. When it strikes, I don't resist letting it have its ugly moment. I know from experience that poise and serenity will eventually return and my brain returned to my control.