By Ann Miller Baker
When patients first see Moffitt psychiatrist Aliya Hafeez, MD, they inevitably bring a sense of anxiety along with their cancer diagnoses.
Some are dealing with existing mental health issues and need help integrating their medications into this new cancer treatment protocol. All need help managing emotional distress while on their cancer journey.
But few know how well Hafeez can relate. Originally diagnosed with stage three breast cancer in 2009, her cancer returned in August 2018. Hafeez currently splits her week between chemo recovery and her work with her patients. And she says common central issues weave throughout most patients’ experiences — including her own.
"The No. 1 thing is fear," says Hafeez. “As soon as you are diagnosed, your mind goes to the question, am I going to die? That’s a legitimate fear. One thing I say to my patients all the time is that death was a certainty even before this diagnosis.” Fear, she says, is just one of the emotions that normally comes with cancer, and it’s OK for patients to feel all of those emotions, rather than to feel pressured to be positive all the time. Helping Moffitt patients to navigate those emotions is the work that Hafeez values so strongly.
EMPOWERED THROUGH HER WORK
Hafeez is not the first Moffitt team member to also become a Moffitt patient. The fact that she can be both simultaneously is, in some ways, a credit to the support she’s received from her colleagues in Moffitt’s Department of Supportive Care Medicine, where she is one of three psychiatrists helping patients deal with the emotional aspects of a cancer diagnosis.
“I feel empowered by working, and it was really important to me to be able to continue working at this point,” says Hafeez. “I think part of it has to do with the fact that my cancer is metastatic, something I will have to live with. I was determined to learn how to live with it from the beginning.”
She says it’s important for all of us to recognize that life doesn’t stop while you deal with difficulty.
“Sure, you’re going through something you don’t want to, but you have to figure out how you’re going to live to the best of your ability. It’s not as if you can push a pause button and wait for the rest of your life to resume afterward. The days going by ARE your life.”
Hafeez strives to make the most of those days through integrative therapies like acupuncture, nutrition and massage, services also offered through Moffitt and its Supportive Care Medicine Department.
“One thing I’ve learned as a patient is that we need to be better at educating patients on the full range of options for their care. When you are diagnosed, there are protocols for treatment and those are vital. I believe supportive care should be an equally important part of our approach. We need to be better about letting patients know about options that can help with symptoms and the emotional component of a cancer diagnosis, things like acupuncture, reiki, yoga, healthy nutrition. Such measures can potentially help our clinical protocols work better or lessen their side effects.”
One more approach that sustains Hafeez is a sense of gratitude for what she views as a unique opportunity to learn and to help others. “Most people just look at cancer as this awful illness,” she says. “But I see the opportunity in this, in terms of my psychological growth, my spiritual growth, in terms of my level of compassion and empathy and my ability to really contribute to my own healing and to help others.
“If you focus on gratitude, you don’t focus as much on fear.”
COLLEAGUES ON THE GRATITUDE LIST
When Hafeez thinks of her own gratitude list, she counts fellow psychiatrists Drs. Margarita Bobonis-Babilonia and Barbara Lubrano, who help to shoulder her patient load as well as their own. “They are so gracious and don’t make me feel bad about the workload!” The same can be said of the Supportive Care psychologists who step up with patients when Hafeez can’t be there, and the rest of the staff who are always sensitive to conserving Hafeez’s energy for her patients.
“And Dr. Portman has been amazing,” adds Hafeez. The department chair of Supportive/Palliative Care Medicine, Diane Portman, MD, says it’s in keeping with her team’s mission.
"Supportive Care is a team-based specialty that focuses on providing relief from the symptoms and stress of serious illness to patients and families," says Portman. "But the care also encompasses the well-being of our own team members. As such, a core team strength is our commitment to support each other during any challenges that affect our group or individual members. We are proud that Moffitt’s commitment to the well-being of its team members has allowed our colleagues the flexibility to adjust schedules and service structures to let our cherished teammates take care of themselves and still remain engaged in this work that they find so meaningful."
Portman typically shares small year-end gifts with her team. This year’s gift was a pin shaped like a dolphin. It came with a story about how dolphins respond when a member of their pod is sick or injured. Pod members swim beneath the struggling dolphin, lifting them to the surface for needed breaths. For Hafeez, it’s a poignant reminder.
"I feel like that’s what my Moffitt colleagues have done for me," she says. "It’s awesome, and it makes me appreciate them even more."
As a psychiatrist, Hafeez is particularly attuned to the emotional side of cancer’s effects. “Healing really begins in the mind, by giving patients another option of how to think about their cancer.” She says her work with fellow cancer patients usually follows six steps:
STEPS TO ENCOURAGE HEALING
Calming emotions. It’s important to acknowledge a patient’s fear and anxiety, says Hafeez. “But if they are paralyzed by it, I’m not going to be able to help them.” Medication can help, if the patient is willing.
Connect and hear the patient’s story. You’ve been diagnosed with cancer, what do you think happens now? “Our culture has given us a certain narrative about what the cancer journey looks like. But we know better — every patient’s story is different and unique,” says Hafeez. Even two patients who share the same diagnosis will have different experiences. It’s a point reinforced by the Dr. Seuss quote stenciled on her office wall: “There is no one alive who is Youer than You.”
Challenge the central beliefs and assumptions in the patient’s story. “A lot of patients come into this thinking they have no choice but to go through chemo, but hating chemo,” she explains. “If you go into chemo treatments thinking, ‘This is a poison and it’s going to make me sick,’ then it’s not going to help as much as it can. If you go in wanting chemo to heal you, you need to look at it as your friend. The power of belief is that strong. Beliefs guide not only emotions but the choices patients will make throughout their cancer journey.”
Help patients tolerate uncertainty. That’s really hard to do, Hafeez admits. Patients naturally gravitate to two disparate ends of the belief spectrum: “Either ‘God has my back and I’m going to survive,’ or ‘I’m going to die.’ It’s really hard to hold onto the ground in between, which is that we really don’t know what’s going to happen. But psychologically, that’s the healthiest position because it’s the truth.”
Encourage a broader view of healing. While the best modern medicine is essential, it’s also important for patients to appreciate the body’s incredible power to heal itself. Hafeez encourages patients to adhere to their physician’s treatment plan, but supplement it with measures that promote healing and emotional well-being. For her, this includes everything from diet, exercise, reiki therapy and acupuncture to considering the people who surround you (are they supportive or focused on their own fear?). She even uses visualization, imagining her cells as cartoon “minions” armored up to direct the chemo to its cancerous targets and not healthy tissues.
If possible, reframe your approach to living. “I think cancer is an opportunity to make more conscious choices in life, for what you can create, do and accomplish. It can also bring an element of fearlessness, that life is short and we don’t have time to waste. None of us do.”