What Happens When Cancer Comes to Work?

0:00 This is Beyond Confidence with your host, Divya Parikh. Do you want to live a more fulfilling life? Do you want to live your legacy and achieve your personal, professional, and financial goals? Well, coming up on Divya Parikh's Beyond Confidence, you will hear real stories of leaders, entrepreneurs, and achievers who have stepped into discomfort, shattered their status quo, and are living the life they want. You will learn how relationships are the key to achieving your aspirations and financial goals. Moving your career or business forward does not have to happen at the expense of your personal or family life, or vice versa. Learn more at www.diviapark.com, and you can connect with Divya at contact at divyapark.com. This is Beyond Confidence, and now here's your host, Divya Parikh.

0:46 Good morning, listeners. This is Divya and it's Tuesday morning and so wonderful to be here with y'all. Spring is in the air today. In the morning, I had a wonderful surprise. As I was walking, I ran into one of my best friends and it's important to let in the little surprises in life. Also, as you all know, the artificial intelligence has brought in surprise after surprise after surprise. So if you want to deal with any surprises and want to be prepared for that uncertainty and ambiguity that this AI era is bringing, then the AI agencies for you get a book and not only it will help you, it will also help entrepreneurs because we support entrepreneurs from our proceeds through Kiva.org. And Let's jump into our conversation today. Welcome, Tiffany.

1:51 Thank you. Welcome. So if I were to ask you, if you recall a moment or a person that left a remarkable imprint on you, what might that moment look like? Oh, there are so many moments. How do you pick the one? I could tell you about a patient, for example, that I write about in my book. And essentially, she came to me and she was terrified of her new diagnosis. I'm a medical oncologist. And she sat in the chair and listened to me present to her her disease, her treatment options, and all of the things that I needed to tell her about to get her started on her treatment.

2:40 And at the end of all that I said to her, she just started to well up with tears and said, but am I going to live? And I realized at that moment that all that I know and all that I teach my patients is not all that they need to hear. And they really need to know where I am with them, how I stand with them, how I hear them, how I understand them, and how I can express the information to them that are most important to And so at that moment, I realized that all the technical things that I was teaching her really didn't mean much to her. All she wanted to know is whether or not she was going to be able to go away with her family at Christmas. Is she still going to be alive for her 30th wedding anniversary? And it really changed the direction of the consultation and left an indelible mark on me to realize that patients really need to hear about themselves, about where they fit into their whole diagnosis and their treatment before they can even begin to hear the technical information about the treatment and the disease, if that makes sense.

3:56 Oh, absolutely. Because just the word, when we say see, it is so devastating because it just changes the whole trajectory of your life. And so many times what happens is that people are working and when you're working full time and have family and all of a sudden this pops in. So what has been your experience like? So, you know, for better or worse, as my job takes me, I'm the one that's often telling them that they have the cancer or that their cancer is growing or that the treatment isn't working or what have you.

4:36 And so it's a very difficult position to be in, but it's one that I am somewhat trained for, but you never can really be ready for the devastation that a patient will feel and the whole array of emotions that they're going to express once they get this diagnosis. And so a lot of it has to come from a very tight balance between being compassionate, but yet still being practical enough to help guide them through their treatments and these difficult decisions. Absolutely. So let's say there's a woman leader and she finds out. So what are some of the few things that she can put into place? If you can share that, that would be amazing.

5:26 May I just clarify? So I think what you're asking me is if she just finds out that she has the cancer diagnosis, what should she do? Right. Because then, you know, should she tell her boss or because then also it happens is that, you know, what one of my clients, she was an executive and she didn't share. She felt that she was due for a promotion that would be taken away because there is this uncertainty and she didn't want to be treated like, Oh, is she going to be there or is she not going to be there? So there's, I mean, there's this whole burden of just hearing the disease versus now. Yeah.

6:11 So, you know, it's a complicated scenario. And the first thing I usually recommend for patients is to not tell anybody at first, maybe your spouse, your, you know, one person that you can help discuss this with, because I think Until you have actually sat with the diagnosis yourself and come to terms and grips with the fact that you're going to be on this journey, some people don't like that word, but are going to be going on this pathway of fighting a cancer, you can't tell everybody right away. Because as soon as you do, everyone's going to jump in and have 15 pieces of information and scenarios and stories of somebody they knew that had cancer and what have you. And I think that's very difficult for a patient in the beginning when they're still trying to formulate how they are going to show up for this devastating news. And so my first step is to sort of sit in the moment as uncomfortable as that is.

7:09 And then you need to make a plan. And that plan includes finding the specialist in the area that you need to see them in and deciding whether or not you want to be treated at a big cancer center or at a small private center. And sometimes the type of care that you get is different in those types of spaces. And then I often will recommend that you try to learn as much as you can on your own so that when you go into those consultations, it's not all completely foreign to you. That was the whole impetus behind my book is that if the more that you understand walking in what cancer is, what an estrogen receptor means, what a PET scan is, the likelihood is you'll not be quite as shocked and perhaps can understand a lot more that the doctor is talking to you.

8:00 And then the third thing that I always recommend is to try and, you know, organize yourself, which sounds, you know, a little complicated when you feel like the whole world is imploding on you. But if you can keep your own medical records organized so that you have the reports that you need when you go to see the different specialists But that also can mean organizing your friends and family. Everyone wants to help. Everyone wants to contribute and help to make you better. And sometimes by just becoming the CEO of your own cancer care and helping to tell everyone else how you want them to show up can be very helpful. I always, you know, I quip that if you don't tell your friends and family how they can help, such as assigning them jobs or you're going to end up with four lasagnas and five Afghans to wear during the chemo treatments. And that's not necessarily what everybody needs, right? Maybe you need somebody that's going to drive you to treatment, somebody that's going to take notes with you, with the doctor, somebody to pick up your kids from baseball practice. There are all sorts of jobs that you need to have organized. And so sometimes the easiest thing to do is to just sit down and write everything that you can think of that you're responsible for, And then actually help assign those to different friends and family to help alleviate some of that stress for yourself.

9:18 Yeah, no, that's really powerful advice because it is such a traumatic time. And now, let's say, you know, they've organized everything. You refer to private consultations, large hospitals, and then there's also academic institutions. Mm-hmm. Can you share what does the care look like in these three scenarios? So I come from an academic medical institution, obviously from Sloan Kettering, and I know best what that looks like versus a hospital system or a private practice, for example.

9:59 And then you're all looking at the difference between rural settings, city settings. And, you know, for the most part, doctors are good and you will, for the most part, get equivalent care. regardless of where you go. I think some of the benefits of being in an academic medical center is particularly if they have a lot of clinical trials that are potentially available to you, or if you have a very risky or high-risk cancer or a very unusual cancer. I think those types of situations definitely mandate being at an academic center, or if it's not clear what your treatment should be. So oftentimes, I will recommend that patients get more than one opinion, as long as it doesn't prolong the time substantially until you can get treatment. So in other words, I explain to a lot of patients that I do recommend getting a second opinion, particularly if you don't understand what the doctor is saying, if they can't explain it to you well, or if you think that there are other options that you would like to explore, that's a good idea to get a second opinion. But you have to realize that, especially in oncology, for example, each hospital system or doctor's office is going to want to confirm your pathology and which means that those slides from your initial biopsy have to be moved from one center to another to another. And that takes time. And sometimes if you have an advanced cancer or a very aggressive cancer, you don't have that kind of luxury to wait for your slides to be reviewed at the third institution,

11:30 if that makes sense. Yeah, no, definitely. It definitely makes sense. And So coming back to the work situation, let's say they've figured it out, what they need, what their treatment plan is. So then, first of all, what can they do about their hesitation, especially in line of getting important projects and getting promotion and all of that situation? What would you encourage the patients to do? Well, I think that when it gets to that situation where, for example, the patient has to have chemotherapy or is going to have to have surgery or radiation even, they're going to obviously have to tell their employer. And so the options there are either to go on medical leave for a period of time. But I would say that the majority of my patients like to try to continue to work because they want to keep their lives as normal as possible and to continue to contributing to the pathway that they had set out for themselves. So in that circumstance, obviously, you're going to have to go to your superior and to discuss with them what your treatment plan is going to look like and, you know, sort of negotiate to the best of your ability what time you're going to need for yourself in order to heal.

12:54 You know, oftentimes with my patients, I would recommend if they had a job that they were going to continue working in that perhaps they got chemotherapy on Thursday and they take off on Friday. They were off Saturday, Sunday, and most of the time they'll be feeling better by Monday and they can go back to work. So, you know, depending on the patient's regimen, she might be receiving treatment once every two weeks or once every three weeks, in which case that's two days off in two weeks. So, you know, if you're strategic about it and you're upfront with your team, I think that it should be very workable. But, you know, again, whether or not they're going to get overlooked for a promotion is going to be very specific to each person's job and circumstances.

13:41 Yeah. And that definitely makes sense. And so what I'm hearing is that it's important to communicate your needs to your employer, that this is what is coming this way. They also know what support is needed by the employee. Now we looked at it from employees perspective, but about as an employer, Yeah. Or a boss's perspective as to how can they support. Right. So I want to tell you, I'm laughing because it brought to mind my own circumstance. I don't have cancer, but I have three children. When my third child, when I was pregnant with Gabriella, I remember that Obviously, they watched my belly grow over nine months, right? And everybody knew I was pregnant. And right before I was about to go out, because I could barely walk anymore because I was waddling around. And at any rate, I was going to go out about a week before I was due.

14:39 There was a scramble. There was a mad scramble to try and... Who's going to cover my patients? Who's going to see my patients? And who's going to treat them? And where are we going to move them to? And I just kept thinking. We should have had this already arranged, right? How come this is a surprise? This is not a surprise to anybody. Anyway, so even with a lot of notice, sometimes employers are not really focusing on the issue. So I think it's really important. Maybe the mistake there was maybe I should have been more proactive leading up to that and not assume that everybody had taken care of the problem, that I was actually going to have this baby and I wasn't going to be there for a period of time, right? So I guess in some circumstances, it's great as a patient to also make sure that you're advocating for yourself and perhaps helping your supervisor to plan properly for you and perhaps help reassign different things or to rearrange the schedule so the papers or the notes are due on Wednesday as opposed to on the Friday when you're going to be resting after your treatment. From an employer's point of view, I think that the best thing that an employer can do for a patient is to allow them the space and the time that they ask for, obviously, because they're not going on vacation. They're trying to heal so that they can come back and be their complete self again. And I think that not putting too much pressure on them to work through it, so to speak,

16:10 I think is really important. But I also think it's important for them, for the employer to ask the person, the employee, how do you want me to address this with everyone else? Because some patients are very private and they don't really want everybody to know that they have cancer because they don't want everybody to be, oh, are you okay? Or, you know, sympathizing with them or what have you. So I think it's important for the employer to discuss with the patient, how do we handle this publicly? How do you want this to be discussed? And so, you know, so that you can come up with a plan for that. Yeah, and you brought up a really good point over there.

16:51 So two things that are coming up for me is one is it's a partnership. And your story about scrambling. So not just leaving it up to the employer, but also that's one of the ways to show that you're committed and you're still fully engaged, that when you're gone, you're helping the employer take care of. Right. projects and team members and whatever it is depending on how you want to be communicating with your team members and not communicating with them and the second thing that you mentioned was very powerful is that employers creating that space and time so now as we are talking so we let's say we have created the space and time and at the same time there's such a deep emotional need to be seen, heard, and respected as they're going through such traumatic changes in life. What are some of the strategies that an employer can have around that?

18:01 So in terms of supporting the patient so that they can have the space to express their emotions and to, yeah, I mean, and I think that goes back to discussing with the patient or the employee themselves, how do you want this to be presented in public? How do you want this, you know, do you want other people to know? Do you, do you want the support that we could provide you? Can we, you know, perhaps, you know, the, the team surrounding the employee will gather together and they'll put together a food train for the patient or they will, you know, perhaps, you know, ask them, how can I help you? How are you doing? Not just like, oh, I'm so sorry. Is there anything I can do? Because that is sort of an empty response. It's the typical one.

18:53 It's what most people would say, but it's actually not helpful because patients don't don't want to necessarily ask you to do things for them. And they want to be seen as still competent and strong and available. Um, so sometimes it's better if you, you know, you, you make a suggestion. Like I was wondering if it would be okay if I helped you with that report that's due next Wednesday, I've had some experience doing this before, or, I'm great at graphics or something specific to offer somebody. But, you know, in terms of the emotionality of the diagnosis, you know, there's not much I don't think that the employer can do. The patient has to, unless they have some sort of a human resources program, for example, where they can have a safe space for a patient to, like, perhaps leave and go speak with somebody if they're feeling overwhelmed with their emotions. But that's a tough question. I don't really have a very defined answer for that.

19:54 And that's something maybe as we are talking about it and as our audience is reflecting upon it, so maybe understanding and maybe creating, even if it's a small program, Because it doesn't take a whole lot where it can be a designated person. It can be the team member or something where they have something in place to support their employees. So these are the conversations to have. And you brought up a good point that not just having those empty inquiries. And it's such a difficult situation. So now we've looked at it from a patient's perspective. What about the team members and friends? What are some of the things that they can keep in mind as to how they can support? Because a lot of people don't know what to do in such circumstances.

20:50 Right, right. Which circles back to what I was talking about before. It comes, you know, often comes down to the patient sort of delineating what they need done, right? So if the patient's having trouble with her insurance company and things aren't being covered or They have to track down, you know, coverage for a medication that for some reason was denied. Those types of things are, I mean, even when you're healthy are frustrating and emotionally charged to argue with these insurance companies. You know, can you perhaps help organize the, you know, whatever it is that the patient is involved in? So if the patient has children, perhaps you're going to help organize the carpools. Perhaps you're going to help organize the food train. Who's going to deliver something for the family to eat the night that she has chemotherapy? Who is going to, you know, perhaps go to the supermarket or pick up the dry cleaning or, like I said, contribute to the next big report that she has to do? So, you know, sort of sitting down with somebody and being real and saying, tell me what's going on in your life and what we could potentially designate for other people to do. And, you know, it's hard. Women are, we're caretakers, right? In our society, we are the caretakers and we are the strong ones.

22:10 We're the linchpin, so to speak. And it's hard sometimes for women to give up control of certain things. But I think it's important from a patient perspective to realize that by giving things up, you're actually providing yourself with, like I said, the time, the space and the energy to heal. If you're running frantic, And you're worried about a million things. You're not focusing on your own health and eating well and making sure you're drinking enough water and getting a little bit of exercise every day. You're not focusing on your own self. And so when you have cancer, you need to make sure that you are the center of the universe, at least for that period of time. So the key is that it's okay to accept help.

22:56 It's okay to reach out to people. And I see it as a strength, not a weakness to ask for help, to be honest. Yeah, no, definitely. Because then you're able to focus on your recovery and you're not focused on things that could be taken care of. So that's definitely a strength to have. Now, so many times what happens is that we've talked about scenarios where people have friends and friends are available. And one definitely key thing that is appearing is that be clear as to what you want from your friends. What about those patients who may not have help?

23:42 Yeah, yeah. And there are plenty of those. I usually, you know, when a patient says that to me, I then kind of try and help them problem solve a little bit in terms of looking a little wider. Say that their children live across the country and their husband is disabled. But do you go to a church? Do you go to a synagogue? Is there a clergy that you could reach out to? And if there is really no one, your next door neighbor, Is there somebody down the block? Is there somebody that you were in a book group with? You have to sort of maybe reach out a little bit farther. But if not, if really there is nobody that they can potentially call on to help them, you have to bring in the doctor's office and support staff to help you find some support. Because there are public agencies that will provide transportation, for example, for patients, or may have volunteers that will you know, drive you back and forth to, from your treatment, um, or that could do certain errands for you and go to the supermarket or what have you. Um, and then, you know, oftentimes social workers and case managers in larger hospitals or academic institutions will be able to contribute to some, you know, some forms of suggestions. Um, but there are often some public, um, agencies that are available to help

25:13 step in, in some of the more critical cases. No, that's really, really important to know because, you know, there are so many people, especially in today's day and age, so many people are living on their own and having the, so usually like, are there any support groups out there where people meet, where they can go to? Oh, of course. You know, one scenario from what we were just talking about, I just wanted to bring up is I've had patients in the past come to me and, you know, turns out, you know, she was very nauseous from her medication, from her chemotherapy, for example. And then she ended up in the hospital because she was dehydrated. Okay.

25:54 And this all boiled back down once we pieced it all apart. Well, why was she so nauseous? Why didn't she reach out to us? How did it end up that she got so bad that she was in the hospital? And the problems are often they don't want to tell anybody because they don't want to bother anyone. Right. I've seen this before. Unfortunately, the patient had no way to get to the pharmacy to pick up their anti-nausea medicine, so didn't take it, and then ended up very nauseous, dehydrated, 911, go to the hospital. So, you know, if we can intervene and really look at these things before it becomes a critical, you know, situation, it really, it benefits them, you know, all the way down to the basics, right?

26:38 So.... I think I lost track of what you were just asking me about before. That's okay. I just thought that was an interesting scenario that people should be aware of because you never know what the real story is. And if you find out that it's really a very basic necessity, such as getting to the pharmacy to pick up your medicines to help support you, that's critical. So what did I do in that situation? Okay, well... Now I know. And so now I helped work with her and found a pharmacy that would keep her credit card on file and would deliver the medicine to her. I've actually sat with patients and showed them how to use Fresh Direct or one of the other food ordering services. It'll bring the groceries to your house because you can't assume that people know how to do that. Not everyone is on the on their computer. Like I am at 11 o'clock ordering my groceries for the next month.

27:37 That is very powerful, Dr. Tiffany. And it's, thank you for what you're doing for your patients. It's so important. And now from doctor's perspectives, because so many times what happens in practices and all of that, everything does end up being numbers and profitability. So how can doctors partner up with patients to, to bring the care that you are bringing? So that's hard, you know, and I speak now from, you know, up high, so to speak, because I'm in private practice now and I do concierge work. And so I have the time and the space to actually dive into these types of things. Whereas before in an academic situation, you know, we have 20 minutes per patient at best. And, you know, usually the nurse would take up 10 of those gathering information for you. And then you go in and you might uncover something else. And so it's not uncommon to wait long periods of time to see your doctor in these offices because there is so much to cover.

28:42 The problem is that it probably needs to be dealt with more on an institutional level. If the physician doesn't have the time and space to do it, we need to find other ways or other people to step in to really try to understand the actual needs of each patient. and to uncover the fact that they don't drive and don't have a way to get to CVS to pick up their medicines, or that they don't know how to use the computer to order food to come to their home. But you would only know something like that by really having conversations with the patient about how they function on a day-to-day basis. What does their normal day look like, and how can I help make it easier for you?

29:27 Yeah, so these are some of the hard conversations that That we want to leave our audience with, that if you are in that position, where you are in the board position of the hospitals, or you are a doctor, taking it one step further. So you have mentioned that you have written a book, share how our audience can reach out to you. How can they find your book? Where can they connect with you? Sure. So My book is called Calming the Cancer Chaos, and it's actually a physician's guide. It's my guide that I wrote based on over 25 years of experience of working with thousands and thousands of patients. And it's written on a patient level, and so it's based on everything I know that a patient needs to understand from the moment that they find out that there's something wrong all the way through to survivorship. And so I go through... you know, how to organize your medical records, how to communicate with your doctor, how to choose your care team, the different types of cancers, the different types of doctors you're going to meet. What, who does what, who are the rest of the care team? Um, and basically the book is, is really, it's a how to have cancer for, you know, the common normal person that's not in the medical field.

30:48 Right. And so, um, you know, it, I've made this and my goal is to have it out there for every person that could possibly help. And you can reach me on my, my website, which is drtiffanytroso.com. And the book is available everywhere that you can buy books, um, online. Amazon is primarily where people are getting it right now. Um, And I also, you know, I love to speak and I love to reach out to different advocacy groups and present to them different things that I've taught in the book. And so I would be, you know, honored to follow up with anybody that was interested in learning more about what I do.

31:30 Absolutely. Are there any other parting thoughts as we come to close? I'm just so grateful that you had me here to talk to your audience and I hope I added some value to everyone and My parting words for everyone is to make sure that you advocate for yourself and make sure that you are asking for what you need and so that you can get your best possible care. People can't read your mind. We don't know what your life looks like. And if your doctor is not asking the questions that you need to have answered, then you need to bring those to him or her. Yeah, and this is such an important topic to talk about because when people are not in medical field. And this is such a devastating news. It just changes life.

32:19 So whatever we can do to support anyone who's going through. So thank you for the work you're doing. And thank you for coming and sharing with us your wisdom. My pleasure. Thank you so much for having me. Absolutely. And wonderful family. If you're going through anything like this, please check out Dr. Tiffany's book, And remember, asking for help is okay. It is a strength. And know that our thoughts and prayers are for you. And reach out to us anytime, just like you've always done. I do have prayer circles. If you're going through and want your name to be added, please reach out and we will pray for your good health and good recovery. So if you're going through it, And for family also, it's not hard to see their loved ones. So our love is with you and know that you need to be the universe during these tough times. So take care of yourself and reach out to us if how we can support you to live the best life you deserve. Let us know and we love you and be well and take care until next time. And thank you, Juan, for the support that you give.

33:42 Thank you for being part of Beyond Confidence with your host Divya Parikh. We hope you have learned more about how to start living the life you want. Each week on Beyond Confidence, you hear stories of real people who've experienced growth by overcoming their fears and building meaningful relationships. During Beyond Confidence, Divya Park shares what happened to her when she stepped out of her comfort zone to work directly with people across the globe. She not only coaches people how to form heart connections, but also transform relationships to mutually beneficial partnerships as they strive to live the life they want. If you are ready to live the life you want and leverage your strengths, learn more at www.divyapark.com. and you can connect with Divya at contact at divyapark.com.

34:26 We look forward to you joining us next week.