Maybe there's no such thing as a "bad survivor," but I sometimes feel like cancer has brought a dichotomy to my survivorship.

Yes, I'm the grateful survivor with a new lease on life, thankful — all those things.

But I can also be the guilty survivor. Guilty because it appears my health is better than the woman who termed herself the bad survivor. Guilty because I did not succumb to the disease which has taken my father and my sister.

Sometimes I let go of my grip on being a grateful survivor, trodden down by everyday life. Then that leads me back to being a guilty survivor.

As long as my life on earth prevails I will be a cancer survivor, the facets of which are still coming to light.

Sent by Mary Vogelsong | 10:47 AM ET | 08-24-2006

After my first primary breast cancer diagnosis in 2001, well meaning people would say to me that one of the silver linings of having cancer was that often people feel redirected and discover new goals and passion for their lives. During my chemotherapy and radiation therapy and for several months after treatment, I felt guilty about not having attained this vision for my life. What kind of survivor was I that I hadn't discovered new things for myself and my life? However, after adjusting to the realities of mortality and the uncertainty of life, I did experience the realization of the transience and unpredictability of life. I learned to not put off goals and happiness and yes, I did come to the realization of the beauty and privilege of living each day. So much so, that at age 48, I enrolled in and completed an accelerated, second degree program in nursing. During the second semester of school, I was diagnosed with my second primary breast cancer, but was so driven to meet my goal, that I was able to complete the program (with a 4.0 grade point!) despite treatment of chemo and radiation. I was then a bedside nurse (for a mixed population of oncology and other patients) for almost 2 years. I started work toward a MSN degree. I loved what I was doing. In June of this year, I was diagnosed with metastatic disease. Now I face a confusing future. How do I continue to live my life and continue to work towards my goals? Currently I am getting chemo every other week, so due to neutropenia and fatigue, I can no longer do my bedside nursing. Due to ongoing chemo, I will probably not be able to take clinical coursework dealing with sick patients. I know I may live a long time- in fact, I am not perseverating over death per se- what I am trying to deal with is how, or if, to continue doing what I love, to continue to achieve my goals, while making memories and enjoying my friends and family. In a sense, this change of course is a death of itself. It is distressing to me to have my newly discovered educational and professional goals so altered. Yet I should be happy that I am responding to my treatment (I recently read a book which stated that the word should, should be removed from our vocabularies as it imposes guilt and obligation and removes choice from our lives). I feel I am missing something essential.

One other comment, even though we may have a greater appreciation for life, that doesn't mean that there still aren't bad days- in the sense of feeling down or upset about mundane things... we're still human.

Oops, one more thing... a good friend of mine died of breast cancer at the age of 40 in 1998. One day on the phone with her, I was complaining about some mundane frustration I was experiencing and she said, "Well, it beats the alternatives." For eight years now, I have heard her say that in my mind whenever I complain... it serves as a reminder to treasure each day and to see the bigger picture of life. Don't sweat the small stuff... Thank you for this blog. I think your express so many of our thoughts and give a clear picture into the world of cancer. You are providing great insight.

Sent by Elm | 11:32 AM ET | 08-24-2006

Leroy, What a wonderful commentary. So true and I'm so glad you talked about this. It's hard to appreciate everyday when you are suffering. But, like you said Leroy, you're still here, still living and have a chance that maybe tomorrow can be better. If your dead there are no more chances. Bless you and your insight.

Sent by Ruth White | 12:27 PM ET | 08-24-2006

It is easier to manage life with cancer by avoiding terms like good/bad survivors or even good/bad days. Aren't we all just trying to avoid suffering while pursuing what ever happiness we can find? By happiness I don't mean just pleasure, but moments of gratitude, love, fulfillment and joy. Sometimes medication can alleviate suffering. We can also refrain from contributing to our suffering through our own thinking. As a survivor I've found it easier to focus on avoiding suffering and experiencing happiness rather than labeling the day or myself as "good" or "bad". I hope Trisha can find a few moments of happiness amidst the suffering.

Sent by Jerome Frank | 12:53 PM ET | 08-24-2006

Leroy, your commentary today echoed the way I have often felt during my own cancer journey (diagnosed with stage II breast cancer about a year ago, had surgery, chemo and radiation, now getting Herceptin for a year). Unlike many cancer patients, I was fortunate to feel okay, or at least not so very lousy, during the course of my treatment. But I did feel some pressure, mostly from myself, to be a "good" cancer patient: good meaning not too whiney, looking for the silver lining(s) - generally being a good sport about it all. Part of that pressure I think comes from not wanting to tell people who ask how you are doing "Well actually, I feel like crap today" because you know it will make them feel sad, or bad, and they wont know what to say to you. And you're trying to save them (and you) from that moment of uncomfortableness.

Sometimes I think Lance Armstrong's incredible comeback and survival from his cancer, and the fact that he has become sort of a poster boy for cancer survivors, can makes lesser mortals feel like they're not "good enough" survivors, like Trisha seems to feel. So to Trisha and all cancer patients, past and present, here is what I think I have learned from all this: There is no good, or bad, or perfect cancer survivor. Ultimately, the perfect survivor is you — simply because you have survived.

Sent by Gretchen Hoag | 5:35 PM ET | 08-24-2006

I can relate to Trisha's guilt. I've been in remission just about five years and my life is better then ever. However, when I finished treatment it took me a solid two years to overcome the emotional pain and confusion cancer brought me. Physically it took me equally as long to recover from the side effects and changes treatment did to my body. It was hard to imagine at the time but life does get better. Our bodies were made to heal, even if it's a long process. We're still here and there's no reason to stop fighting.

Sent by Melissa Owens | 6:15 PM ET | 08-25-2006

Exactly! You have expressed so many ideas in this that I would have had a hard time expressing. When one is on chemo, there are going to be many, many days when one does not feel good at all. When I was on it, I tried to enjoy each day to the extent possible. Most of the time, I felt too ill to read, and working was out of the question. If I could not fully enjoy the whole day, which usually was the case, then I would try to enjoy a few hours. If that was not possible because I was too I'll, then I would always, always enjoy a few moments - a bird song, the sunshine, a pretty flower, a butterfly, a happy thought of future health.

As a survivor now, I think I don't take as much for granted, but I still don't life every moment of every day to the fullest. I get impatient, whine about little things, get annoyed when someone cuts me off on the highway and get frustrated at work at times. Survivors are still human. But it is rare for me to have a day when I don't think at least a few times how I'm fortunate to be a survivor and don't feel gratitude for a whole host of things. As another commentator said, I will be a survivor until my last breath. We all need to try to live each day to the extent possible.

Thanks again for writing a great blog, Leroy.

Sent by Art Ritter | 6:19 PM ET | 08-25-2006

I have great strength and hope with Stage 4 lung cancer and I fight each day as you do, but I will take a day at a time. I have always loved my life so I am not going to try to get the last best moments out of life.

The pressure to be a model patient or to make the "best" of your last months or years creates an unfair load on the cancer victim. We do what we can each day.

Sent by Paula Polk | 6:22 PM ET | 08-25-2006

I hate to see good, struggling people made to feel guilty. The fact is that cancer is not always managed well. Pain is especially poorly controlled, and there is no good reason for that. Nutrition is also poorly maintained. I had a friend die just short of his 40th birthday after a 2 year battle with colon cancer. First, they treated him as if he were a much older patient with a less aggressive tumor, which is the more typical scenario but was not his case at all. Then they waited way too long to start Procrit. They also were short on ideas for maintaining his nutritional status, so he basically starved to death. There is so much more that could be done to help cancer patients on a daily basis, whether a cure is in the cards or not.

Sent by Barbara | 2:49 PM ET | 08-28-2006

I sit here tonight, a survivor of Stage 2 breast cancer, thankful for every sunrise. That doesnt mean that I go around happy all the time — totally unrealistic. But, I do believe there is a reason I was lucky enough to survive and it my job to "preach" and "teach" to those who someday may also be afflicted. We MUST somehow take the sting out of this disease! We die of fright more from The Big C than we do from any other disease.

Sent by Colleen Gavin | 2:50 PM ET | 08-28-2006

This is a society that focuses on and rewards people who are ACTIVE and feeling GREAT! (Look through any magazine, or turn your television on). Do we all feel pressure at times to conform to society's view of the busy and courageous survivor? Thank you for pointing out that for some of us there are days that are just not active or fun at all, they are just to be gotten through. Those may be the days when the "bag of tricks" needs to be pulled out like the really funny videos — all the ideas people offered up a couple weeks ago when you asked what people do to get through a day when you just don't feel so great.

Sent by Nancy Oliveri | 3:01 PM ET | 08-28-2006

Sent by Candace Rechsteiner | 3:04 PM ET | 08-28-2006

Mr. Sievers,

First thank you for your chronicle. It is both moving and illuminating.

I am 62. Eight years ago I moved to Portland, Oregon to be closer to my son. After moving here, I learned about Oregon's unique assisted suicide law. As one who has had a number of ailments (none as serious or life threatening as yours), I am conscious of the possibilities at the end of my life (whenever that is).

For that reason, I intend to remain in Oregon to insure that I do have the choice if a truly debilitating illness strikes.

Sent by Richard York | 3:05 PM ET | 08-28-2006

Hi Leroy,

My dad was just diagnosed with Stage IV adenocarcinoma. He quit smoking in 89 and turned his life around eating well and running three marathons.

He began complaining of back pain and after many tests they discovered a mass on his spine that had spread to his lungs. He had emergency surgery June 23 and has had to learn to walk again which is a slow and painful process.

The mass on his lung is about 3 cm. but we found out yesterday it appears to have grown. He is undergoing chemo for his lung.

I just moved from Philly to New York State to open my own business right before my dad was diagnosed. The summer has been the toughest my family has ever known.

My dad has not had a chance to see my business or new home yet and it breaks my heart. I long for the day when I can sit on my front porch with him.

For the most part he has a great attitude but he has many of "those" days where pain and depression overwhelms him. But, I coach him along and tell him, people DO beat this.

Your blog is inspirational and helpful to read. I've bookmarked it.

Thank you and you are also in my thoughts.

Sent by Giulietta Racciatti | 3:11 PM ET | 08-28-2006

Five years ago I awoke one day and noticed what appeared to be a small boil on my neck. My girlfriend who is a registered nurse suggested I see my family doctor and he was not sure what it was and sent me to a specialist who did a biopsy and sent it off for evaluation. Results came back inconclusive so the specialist had me admitted to the local hospital where they put me out so he could take a closer look at my throat area. When I woke up I was informed that I had cancer in the throat and neck area and I would be sent to Princess Margret hospital in Toronto for radiation treatments followed by surgery to remove the burned tissue etc. At the time I really felt I was going to die a horrible death. It took me a few months after the treatments and surgery to look like a reasonably normal human being and now five years later I am very grateful to all the very caring people who were involved in my recovery! I have great difficulty swallowing any solid food as I have no saliva and frequently a sore throat. Water is a very poor substitute for saliva and as such I drink Ensure to keeps my weight normal (10 CANS A DAY!). Thank god for Ensure! Also I have a sore shoulder area frequently and a sore throat from time to time. One of the worst after effects is a severe loss of sense of taste. Almost nothing tastes the same. My saliva glands were destroyed by the radiation which gives me dry mouth — water helps but is a poor substitute for saliva! Thank GOD for T3 and Oxicodone — they help manage the pain that sometimes is severe.

Sent by Karl Steadman | 3:16 PM ET | 08-28-2006

I believe each of us is a survivor (in life) until the day we die for whatever reason. Likewise, once we are diagnosed with cancer, we become a survivor until the day we die. It is not a label but rather a statement of our condition. From the day we breathe our first breath in life, we are one breath closer to the day we die. In some instances, the medical profession tries to use historical data and guess how long we have to live in other instances; life is taken in one moment without notice. When my mother was in her final stages of her battle with ovarian cancer she used to ask me if her knowing death was imminent was a good thing or a bad thing. Just as the concept of "good" survivor or "bad" survivor is suggested here, I told her it was just a thing, neither good nor bad.

Sent by Ed Brown | 3:49 PM ET | 08-28-2006

In response to Trisha. It isn't your fault you feel pain. It's natural to be affected by it. My original diagnosis followed a major operation. I spent 11 days in the hospital and barely remember at of it due to the drugs. I couldn't get out of bed for a long time and then moved to a chair in the living room where I was a lump that watched the life around me. I wasn't a happy person, but slowly, the pain eased a little and I began to be able to smile again. I mean it. For a long time I couldn't even smile. When I talk about how lucky I am to be alive, it's because I'm going through a time when I have little pain. I feel fairly good. My treatment isn't making me nauseous. It's a lot easier to feel gratitude for life when life is quasi normal. My advice, just take each day at a time. Suffer through it. Look back at the last month, or months and see what progress you've made. Look for the small things. Eating more, a little more sleep, more interest in things around you, being able to move a little better. Small steps. Just hang in there. Sometimes they find the right medication to help, and sometimes it isn't as debilitating. Grandkids helped me a lot. Good luck!

Sent by Juanita Helms | 4:16 PM ET | 08-28-2006

I am not a cancer patient, but my mother was recently diagnosed with aggressive, inflammatory breast cancer. She is a physician, and well aware of the difficult road that lies ahead of her. Quite by chance, I came across an NPR article about Miriam Engelberg. I immediately went to her website, viewed some of her cartoons, laughed until I cried (literally) and ordered the book for myself and my mother. She's a little like what I imagine Seinfeld would be like if he had cancer, except more intelligent. The book is entitled Cancer Made Me a Shallower Person and anyone who feels guilty about not "enjoying and appreciating life" SHOULD read it. Newcomers to cancer should also read it, because it gives funny but actually helpful advice to the newly diagnosed. I visit her website every day and thank God that she decided to share her experience with cancer with the world. Everyone experiences cancer in a different way, and ALL of those ways are acceptable. Including the lying on the couch watching entertainment tonight reruns way.

Sent by Jennifer Reasons | 4:51 PM ET | 08-28-2006

When I first heard the phrase "Long term survival" I thought they meant natural life span. When I found out that meant 5 years, I thought "five years? Long term? Since when is five years long term? I used to assume I would live into my nineties since that's what the women on my mother's side all did. Now I'd be really happy to make it to 60. It's funny how that changes with cancer.

Sent by Patricia Buchanan | 11:40 AM ET | 08-30-2006