The cancer world is full of clichés.  We are inundated on a daily basis with expressions, such as “the long and courageous battle,” “stay positive,” “survivor,” “every day is precious,” and now of course, pink ribbons.

One of the most common cancer clichés is the idea of the “new normal.”  After a cancer diagnosis or cancer treatments, people constantly toss around the term new normal. But what does this really mean?

When I was younger, in my twenties and thirties, I was an avid runner.  It was what I did and part of how I defined and thought of myself.  I could not think of myself as anything but a runner. 

Because of arthritis in my knee from an old injury and surgery, pain began to make running very difficult, and I was forced to face the fact that I would not be able to continue doing it.  I was depressed and disheartened but I did stop. 

I was forced to find other outlets and began swimming and cycling.  In a short time, these turned out to be equally enjoyable and, in the long run, much better for me. 

Now I know that in the grand scheme of things this is trivial, but the point is that I, against my will, was forced to adapt to a new circumstance and in the long run was better off for it.  

All of us, as we go through life on a certain course, we envision a future based upon that course. We plan and project things into the future based upon that vision: meeting certain career goals, working to a certain age, seeing children graduate and get married, having grand kids, and reaching a happy, active retirement.

But as everyone knows and certainly people who are reading this column are acutely aware, things don’t always go according to plan.  Bad stuff happens, a serious accident, the death of a child or spouse, a diagnosis of cancer. 

Suddenly we are faced with a new set of circumstances.  Our ordered vision and expectations of the future are thrown into chaos.  Goals, plans, and aspirations suddenly seem meaningless. 

The first response can be anger or depression.  It wasn’t supposed to be this way, and initially it’s difficult to see things being another way. 

But it’s really about adjusting expectations.  People are much more resilient than they might think, and the human mind has an incredible ability to adapt, adjusting to the new normal.

Dr. Jerome Groopman, one of my favorite medical writers, has written a great new book called ‘Your Medical Mind’ about how patients make complex medical decisions.  In his book, he addresses the issue of how people adapt to serious medical conditions.  “What we first imagine to be severely limiting can prove to be less destructive to quality of life because we find alternative sources of gratification…Many of us adapt to frustrating and debilitating situations to a degree that surprises us,” writes Dr. Groopman. 

He goes on to note that research studies have shown over and over that, at least initially, people will overestimate the impact of their illness on their happiness.  “We often underestimate the reservoir of our resilience, the fact that we can adapt and regress and adapt again. Over time, we learn to expand those parts of our life that will provide gratification and seek fulfillment in venues we had previously overlooked,” notes Dr Groopman.

I think that there are a couple of different aspects of this to look at.   There is a gradual transition from accepting the new circumstances, the new normal, to actually adapting to them.  And there are different types of adaptation that have to occur.  There is a difference between adapting to living with the cancer diagnosis and living with the physical changes that go along with having cancer or are the results of treatment side effects. 

Living with the cancer diagnosis is an emotional change and adjustment.  You are faced with a whole new set of expectations and visions about what the future will be, new uncertainties, the constant elephant in the room. 

The cancer and treatment side effects impose new physical limitations that need to be adjusted to as well.  Working at your job may no longer be possible but there are many other avenues of being productive and finding self expression.   Exotic adventure travel may no longer be possible but one might find satisfaction with armchair travel by reviewing great travel literature.

The new normal is not static.  It’s not just a matter of all of a sudden after the diagnosis, everything changes and then we adjust to a new normal. 

This new normal is in a constant state of flux.  New results, new side effects, and medication changes are constantly changing the outlook and expectations.  Multiple times over the course of my treatments, I have had to adjust to new results presenting new circumstances, both good and bad.

At the risk of sounding like the clichés I am trying to avoid, the new normal is an opportunity, a chance to view it as a positive.  There are many avenues to feeling happy and fulfilled; they may just not be what we had originally envisioned.