Learning to Cope

By Mariana G. Briones

As a child growing up in Nicaragua, Dr. Rocha- Cadman dreamed of becoming a physician. “I am an immigrant who came to this country in 1986 following my dream to become a doctor. Not knowing how difficult it was going to be, I was driven by my passion and perseverance.” From her office at City of Hope in Duarte, California, Dr. Rocha-Cadman shares that “when people asked about my plans for the future, I used to say, ‘I am going to study medicine’ and people looked at me in disbelief. They would say, ‘Really? You don't even speak English,’ but I remained focused, and with little guidance, I learned that everything is possible.”

Today, as a leading psychiatrist specializing in psychooncology, a field of cancer care, she has to deal with another layer of stress: People with cancer, who are one of the most vulnerable groups to COVID-19. This makes her days more challenging, but also more rewarding.

How did your journey into psychiatry begin? “Well, I will admit that growing up in Nicaragua, my idea of being a doctor was to be a general physician. I wanted to be a doctor who would deliver your children, perform and assist in surgeries, visit my patients in the hospital or at home, and be present when they transitioned to death.

Later, as I got older, I was exposed to family and friends with cancer and considered the field of oncology. When cancer hit so close to home and my sister was diagnosed with breast cancer at the age of 26, everything changed. I had the opportunity to be with my sister until her last days before experiencing the biggest loss of my life. At this time, I knew oncology was a specialty I could no longer consider.

With the guidance and support of my husband and friends, I switched to the field of psychiatry after two years of working as a surgeon. I knew that I had the passion and interest to listen and offer help. Later in my psychiatry residency, I learned about the field of Psycho-oncology and I applied to this subspecialty. It offered everything I always wanted to do.

Prior to moving to California, I was working in NY, at Memorial Sloan Kettering Cancer Center, where I trained as a psycho-oncologist. My family and I wanted to return to California to be closer to our extended family and only City of Hope could bring me back to California. About a year ago, the opportunity to work at City of Hope became available. My personal ties with City of Hope go back to 1996. This was the hospital where my sister received her cancer treatment. My family and I loved this place and we were forever grateful for the treatment City of Hope offered her.”

What are your days like now that you have to add COVID-19 into the equation of your patients’ stressors? “Having to worry about COVID-19, in addition to dealing with cancer, has definitely been difficult for everyone. As a cancer patient receiving treatment, there is a heightened fear of getting infected because their health is already so compromised. With COVID-19, we all feel so isolated. For my patients, however, this isolation is even greater because, for many, it sometimes extends to weeks of isolation. And when you are isolated, there are a lot of things going through your head -- your mind races and you keep thinking about the worst-case scenario.

Just imagine for a minute that you are isolated in your room, people come in with all this gear and their masks. They can’t touch you. They can’t hug you when you are going through such a difficult time. And if they don't speak your language and you need an interpreter, this makes you feel even more disconnected. For Latinos, it is very different when you talk about treatment options and discuss the disease in Spanish. Just hearing someone that speaks your own language is soothing in and of itself. And it is not just speaking the language, but also connecting with your own background and culture, which then extends to building trust. So, as a Latina, I am extremely happy to be able to provide this support.

If you’re worried about continuing your cancer care because of the risk of COVID-19, let me reassure you. Your best way to beat cancer is to get the right treatment at the right time. In other words, your cancer care is critical. It cannot wait.

As a National Cancer Institute-designated comprehensive cancer center, City of Hope has the highest standards for infection prevention. While none of us expected this pandemic, City of Hope was prepared for it. And since cancer is our sole focus, we’ve been able to continue to provide our patients with the best cancer care available today.”

Do you feel that Latinos are more reluctant to seek psychiatric help? “Yes, and we are reluctant because there is a stigma regarding mental health in the Latino community. As Latinos, it is hard for us to ask for help, maybe because family plays a big role in supporting us when we are in need, and it is frowned upon to look for help elsewhere. Unfortunately, having a mental illness and receiving counseling is very stigmatizing in our culture.”

How do you break that barrier? “With a lot of education – We need to validate the feelings and suffering of our patients. The stress and suffering can lead to isolation, depression and anxiety. At City of Hope, we offer a safe space to process problems. We have to make sure people unterstand that seeking help is okay. Seeking help is appropriate and normal, especially here at City of Hope because going through cancer can be a roller coaster. It is a journey, so we make sure that there is less hesitation and try to ensure that cancer patients continue to seek help. One thing that really helps is having a health care provider that speaks your own language and understands your culture.”

How are the doctors and nurses at City of Hope coping? These are incredibly challenging times, but our group of psychologists, social workers and psychiatrists are doing our best to help each other, so we are very connected. When I see patients in the COVID-19 unit, I am always checking in on the nurses and the doctors. They are not only isolated and going through a rough time, they might also be grieving the loss of a patient. It is important to be there for them. A gesture of appreciation, such as bringing food or snacks to the unit, can make a big difference.”

What are some tips to do self-care at home during this crisis? “Since everyone reacts differently to trauma, loss, grief, stress and uncertainty, we need to pay attention to our level of distress and ask for help. We need to stay connected to avoid isolation and boredom. Exploring and nurturing our creativity, such as learning a different language, painting or learning a musical instrument can also help.”

What is the main lesson you have learned in these past few months? “The biggest lesson for me is that we are not alone -- we are in this together. We are more resilient, more grateful and appreciative towards the health care professionals and first responders.

My patients are my biggest mentors, and I learn from them every day, especially from those who are at the end of their cancer journeys – they remind me to live every day to its fullest. My patients inspire me to live my life day-by-day. When I come home, I appreciate my family and my kids so much more. I am present and am fully aware that we are here today but don't know what tomorrow may bring. My patients leave me with beautiful lessons and reminders that I can then use with other patients who are suffering. Books and trainings can provide facts and knowledge, but patients are the ones that teach you real life lessons.”