Life at the intersection of health and mental health: Celebrating the end

During my radiation, I got to know a few of the women who had appointments around the same time. We sat in a comfortable waiting area after changing into our gowns and waited for our turn with the massive machines. On the last day of our treatment, I chatted briefly with one of the women as she was changing back into her street clothes. Unlike me, her radiation occurred as the final phase of her treatment. This session was it, the end of her treatment journey.

She was bewildered. She asked me, “Is this it, is this all? Shouldn't there be some kind of drum roll?  Some kind of final "ta da!" Instead, she quietly put on her hat and left. 

We all need closure and celebration to mark important moments in our lives. Breast cancer had defined this woman's life for the past six months. The illness cost this woman her job. Her retirement plans were in chaos because of the economic impact of the treatment. She faced mortality in an intimate way. It was a big deal for her to finish treatment and move forward. She needed a ceremony.

My dad had heart surgery and a long recovery last year. He was just about back to normal when I received my cancer diagnosis. (After years of robust health, 2013 was not the best year for our family, culminating with my mother’s stroke at Christmas. I stayed up on New Year’s just to make sure 2013 really was gone!). One of the very best things about his recovery was the daily rehab he did with others at our local hospital. A little community of support and encouragement formed in those sessions. One of the things he really liked was on Friday when everyone paused and the PA system announced the name or names of those who were graduating from the program that day. Everyone gave a heartfelt cheer and "Pomp and Circumstance” was played over the PA. My dad talked about it several times and I think it was meaningful to him for a couple of reasons:

• It gave him hope. Others were moving on with their lives; there was an end in sight that he could strive for because others he knew had achieved it.
• Others were recognizing the accomplishment; there was a feeling of community support.  People cared.
• He cared about these other individuals who he had encouraged and been encouraged by.
• There was a sense of closure. People did not just fade away, but rather, they were celebrated and moved on to the next piece of their journey in life.

This hospital program did closure and celebration really well.

I think often we are too busy to stop, pause and celebrate the success of the work being done in healthcare. This is true for both behavioral health and physical health. And it's a need that I think we all have – both consumers and clinicians alike. Lori Ashcroft has written about the work they do at Recovery Innovations to build in this celebration, to pay attention to this normal human need to close one door while we open up the rest of our life. The addiction community may do this better than anyone else. They have paid attention to this human need to celebrate our accomplishments.

I wonder why we do not do this more in mental health? Are we too busy to stop, to pause and celebrate a success? Or much more ominous, do we fear that the success is only temporary and we will see this person again? Is this lack of celebration a function of our own fears? Or simply something we are too busy to take on or assume it will be handled by others? I think back on times I have moved out of a specific mental health treatment. I recall conversations about what to do to stay healthy. I recall conversations where I expressed my appreciation for the help and hard work. But to me that's different than a celebration or clear graduation marker of some kind.

When I was one of the trainers for certified peer specialist training, I always made sure there was something, a small tangible physical something that each person received that said "well done"  “you made it through” or “you are ready for the next step on your journey.” Sometimes it was a small butterfly or a small heart. Sometimes a theme emerged in a class I paid attention to – so once smiley face cookies were the perfect end to the class. There was a moment of reflection and a call to action.  People were surrounded by hope and the clear understanding that we believed in them and we saw their future as bright and full of promise. There was a meaningful celebration.

My own last day of treatment for my breast cancer journey occurred several months after that day in the radiology waiting room. As I ended my final chemo treatment, the nurse placed a band aid over the port in my chest. The receptionist nodded as I said goodbye. The elevator door closed and I was done. Six months of my life where I overcame challenges, dealt with side effects that brought me to my knees, faced my own mortality, and struggled with deep concurring depression ended with a band aid and a nod. 

I think we can, and should do better.