“You look great,” isn’t nor­mally a compli­­ment or greet­ing that causes the re­ceiver pause. For me, how­ever, it creates mixed feelings, and those mixed feelings can change depending on the person and the situation when the greet­ing is offered.

I realize how I react to what is said to me is my issue, not the speaker's. Often, they really mean to say that I look "normal" and un­harmed by my cancer and treat­ments. They are wit­nessing no outwardly changes in my appear­ance or behavior, which they take to mean the threat of the disease is passed, even if the word "cure" never comes up. They are ex­pressing happi­ness for me.

I too am very happy that my current treat­ments are work­ing and that I’m able to work and engage in most of my daily activi­ties. I’m happy that people who see me regularly think that I “look great,” but some­times I wish they knew the reality of multiple myeloma. I wish they under­stood the sub­conscious, daily struggles we patients endure knowing this is an incurable cancer.

What these people likely don’t know is that multiple myeloma is always present, even if at a given moment lab results suggest the disease is dormant. As patients, we are always aware of the threat of relapse, and we are likely experiencing side effects of treat­ment, compromised immunity, and other life-long impacts. Some patients suffer even more sig­nif­i­cant issues, like required dialysis, disability from bone fractures, or severe neu­rop­athy.

My friends are being polite and, thankfully in my case, honest. They know I have a serious illness. They know I was away being treated for a sig­nif­i­cant time, and now I'm back and I look as well as I did before. There aren't any obvious signs that I'm dealing with cancer. I don't ex­pec­t them to with­hold their compli­ment. I also believe it is inappropriate for me to regularly update them on the actual progress of my treat­ments or the subtle chal­lenges I'm dealing with daily. (Not to mention I would be­come the person everyone would avoid since those conversations be­come tedious if that's what hap­pens every time you see me.)

Still, it feels strange to have people who are close to me believe the threat has passed, and that I must keep much of the truth to myself and politely accept the compliment.

As I was writing this column and thinking about this issue, I had the oppor­tu­ni­ty to be among several family and work colleagues who I don’t see on a regular basis. In fact, it had been many months since I had seen any of them. Many of these people told me, on multiple occasions, “You look great,” and I realized I had a dif­fer­en­t reac­tion this time.

Instead of feeling like they might be dismissing the disease as some­thing that had passed, I felt they were acknowledging how well I've recovered from the disease. Perhaps they had an ex­pec­ta­tion that I would have lost weight, or my hair, or I'd look sickly, or there would be some other objective signs of illness. In this context, I felt my friends may have been surprised, or at least relieved, that I look well in spite of the multiple myeloma.

I honestly don't know what the under­lying meaning of these speakers' state­ments was, but my own reac­tion was dif­fer­en­t than when I hear the same words from people I see every day.

The people I see infrequently have some knowledge of the seriousness of the disease. I've probably shared with them some of my treat­ment plans, especially when I left work altogether for nearly a whole summer to undergo an au­tol­o­gous stem cell trans­plant. The risks and dif­fi­culty of that type of pro­ce­dure are known, and sometimes even over­blown by people not very familiar with it.

When there are large gaps of time as I am moving through sig­nif­i­cant phases of treat­ment and later see these remote family and colleagues, there is time for them to imagine I am “stuck” at that serious phase of treat­ment and not moving for­ward.

In reality, with each chal­lenge, I suc­cess­fully move through rough points only to emerge at the end with the multiple myeloma posing a lesser immedi­ate threat, and my body and life sub­stan­tially back to where they were pre-diagnosis. Honestly, the biggest lingering effect of my multiple myeloma today is the mental chal­lenges, which ebb and flow con­stantly as I contemplate my future.

When friends and colleagues see me only after the big chal­lenges have gone by, when I’m stronger and able to function nearly as well as I did pre-diagnosis, their compliments act as huge reminders to me of what I’ve accomplished.

It’s easy, maybe natural, for patients to feel shocked at diag­nosis to hear the very general and dire prog­nosis of multiple myeloma; to be told the odds of success we might encounter with the many treat­ments avail­able to us; to learn about some of the serious side effects or non-correctable damage to our body we might suffer over time. But as soon as a first treat­ment works, and the cancer numbers start to recede, we are able to push some of the neg­a­tive thoughts to the back­ground. We can begin to enjoy feeling healthier, to believe we can move for­ward. We can begin to hope the future is a little more indefinite than it seemed during those first meetings with our doctors.

When friends and colleagues who only see me after large gaps of treat­ment say “You look great,” they’re expressing relief at seeing me healthy. However, it should also remind me that I have worked hard, my doctors have made their best recom­men­da­tions, and I weathered some tough times. While there will be more chal­lenges ahead, I’ve suc­cess­fully maneuvered those in the past, and I will again.

When the people I see every day say “You look great,” they’re actually relieving me from one of my greatest fears in sharing my diag­nosis. I didn’t want to be­come “cancer guy,” with people making special accom­mo­da­tions or worse, whispering behind my back. The fact that we don’t really talk about my cancer and on­going treat­ments and instead they say “You look great” and move to the most pressing project of the day is fantastic. I’m just Mark, “normal guy,” and we have a deadline to meet.

By the way, I do feel great.

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Mark's Photo For The Month

When the nearly 100-year-old Yoshino cherry trees on the campus of the University of Washington break out in blossoms, it's a sure sign that spring has arrived in the Pacific Northwest. I recently had the oppor­tunity to walk the quad with my camera and focus entirely on the beauty of the trees and nature. It is so im­por­tant to pause and ap­pre­ci­ate what I’ve accomplished and the life I’ve been given fol­low­ing all the hard work and treat­ments.

Photo copyright © 2018 Mark Pouley.