The particular nouns, adjectives, and verbs we choose to describe ourselves and our lives can alter how we see ourselves and our circumstances. They can result in a perspective that influences how we make decisions.
The family dinner I plan if a friend were to comment to me, "You seem like a super busy mom of four kids juggling multiple extracurricular activities and dinner" would probably look very different from the family dinner I would plan if the friend instead were to comment, "You seem like a mom who role models healthy eating habits and somehow gets her children to at least try vegetables at every meal."
Labels can influence how we view ourselves, set up expectations we put on ourselves and allow others to put upon us, direct our thoughts, and drive the decisions we make. They can be defining, and one may feel like they have to live up (or down) to that label.
Positive labels can be encouraging and provide extra motivation to live up to certain perceptions of ourselves. "I am positive and cheerful. I'm the sunshine." "I am calm and steady. I'm the shoulder." As a palliative care specialist (read Post 1: What Exactly Does a Palliative Care Specialist Do?), I often hear patients describe themselves as a "fighter." After listening to their life stories and learning how they have adapted to living with life altering diagnoses and illnesses, I would agree that we have many fierce "fighters" living among us. When I hear that someone is a "fighter," I think of their having the courage, determination, and will to put in the hard work, to make the sacrifices, to struggle to achieve a great goal. I witness how the words "I am a fighter" can give people inner strength and renew a sense of purpose and resolution.
These words are powerful. I see how they can do good. I also see how they can do harm.
I see potential harm when I see patients and family members equate "fighting" with attempting to be super human. We are all human, and even the strongest of us should be allowed off days - days to cry, rage, sulk. Feeling like they always have to exude the "fighting" spirit may result in less than honest communication among family members as they may feel that they are not allowed to openly express "negative" feelings such as grief, anger, sadness, doubt, worry, loneliness. A person believing that they could only express certain ("positive") thoughts, behaviors, and emotions, while suppressing other just as authentic ("negative") thoughts, behaviors, and emotions could result in their feeling lonely or isolated, even contributing to emotional or spiritual distress (read Post 61: The "Supportive Family" - Two Perspectives on Support).
One of the most troubling analogies to me is comparing living with a serious medical illness - which is a biological part of nature - to fighting a battle with a physical enemy. “Going to war against cancer” comes to mind. The implication is that if the cancer overcomes the physical body, then the person did not have the mental will or the spiritual strength to “defeat” the cancer enemy. It is unfair to pit a person against nature because nature always wins eventually. No one has "defeated" physical death.
While working as a palliative care consultant in the hospital, I was once asked to speak with a woman living with colon cancer (whose oncologist thought she might have a prognosis of weeks to limited months regardless of any treatment path she chose to take or not take). Her family was with her at the meeting and clearly supportive. Ms. Z was 63, and she knew what she wanted. As soon as I walked in the door, she told me she wanted to go home with hospice support (read Post 27: When to Consider Hospice Support - Example #3) to spend the remainder of her days with her family. "I'm at peace with the inevitable."
As I sat and listened to Ms. Z's family members eagerly share stories about their matriarch, proudly describing her "fighting spirit" and recounting anecdotes providing proof of how "she never gives up," I saw Ms. Z become more and more withdrawn. She did not want to talk much more during that visit, and I told her that I would circle back to check in with her.
The next day I dropped by Ms. Z's hospital room, and she was alone. "How are you doing?" I asked.
"I don't know," Ms. Z shook her head, “I've been thinking a lot about what was said yesterday. I'm a fighter, and it's important for my family to see that. I don’t want my children and grandchildren to think I just quit. Maybe I shouldn’t go home now after all.”
I exclaimed, “You underwent surgery to have part of your colon removed. You overcame complications from that surgery including wound infections, requiring IV (intravenous) antibiotics and intense wound care with an open abdomen for weeks. You went through intensive rehab to walk on your own again. You made it through rounds of chemotherapy that caused tough side effects. When the cancer came back, even exhausted, you made it to your oncology appointments. How could anyone, especially yourself, ever say you ‘just quit’? At every stage, you fought for something. From what I heard you describe yesterday as most important to you, it sounds like to me that you’re now fighting to live every moment you can with the people that matter most to you.”
Ms. Z stared at me for a long moment. Then she nodded. "That's exactly right. I fight for what's important to me." Ms. Z insisted that she meet with a hospice agency as soon as possible to discuss logistics on how she could most comfortably get home and remain home with family (read Post 2: Five Major Ways Palliative Care Differs from Hospice). "If something happens to me, I don't ever want my family members to panic and call 911. No offense, but I don't want to waste a precious minute of however much time I have left in this institution. I want a protocol set in place to keep me home no matter what." She called multiple family members to determine who could drive her home the soonest. She told the nurse to page the hospitalist and "respectively" notify him that she had a small window to leave the hospital and could he prioritize her discharge paperwork? Ms. Z "fought" to return to her home to be with her family that afternoon, and she did it.
Ms. Z realized something that unfortunately, not everyone is given the opportunity nor time to realize. It is not "giving up" if you change the goal (read Post 8: I Want the Best Care Possible for ME - Part 2 of 2). You can still be a "fighter." Ms. Z realized that the label "fighter" should not restrict nor place limitations on what she wanted. SHE would decide what she wanted, and SHE would decide what to fight for.