Seed hardening - sow struggle to harvest hope

The reward for doing something easy is often nothing more than ease itself. The reward for doing something hard, in contrast, is often too large and long-term to predict – like tilling a field and sowing seeds for years of future harvests. Between these two paradigms of working hard vs. hardly working – of harvesting tomorrow vs. wanting ease today – the choice for the industrious is easy: do something hard for a reward both seen and unseen. Yet sometimes life gives us no choice in the matter – when hard things come by force. Cancer is hard and even fatal, but doesn’t seem to offer a reward – or does it?

Snow began blanketing the roads and walkways. The glow of streetlamps tilted downward lit a path of shining circles. At first flake, these turned black against a backdrop of newly fallen white, like button covers contrasted against pressed starch. The lamp light beams painted the frost into watercolors, melting the snow to form clear puddles of warmth that lead like wisps – warm steppingstones of coal-colored asphalt seemingly exhumed from the depths of fallen cold. These would soon turn to ice – once the nocturnal deep freeze stole back their warmth. It was nearing midnight. Quiet rose up erect as darkness tucked many to bed in the rowed homes of crisscrossed streets, block after block. It was a bitter February night in Boston and winter had threatened to never leave.

I laced my running shoes – weather be damned – and wrapped plastic bags over them, tying and tucking the ends. Rubber running shells for traction then covered these and the bottoms of a third layer of pants – the outermost – slick and waterproof. The ensemble was capped with a pull-tie around my head, which narrowed around my face and left only lashes exposed to the elements. Even these would soon bead with small ice droplets. The Boston Marathon was 2 months away and despite a “Nor’easter” storm, training could not wait.

I had made a commitment to run the race to raise money for Ashley – a young 10-year-old girl – and I wasn’t going to let her down. She had endured sudden, uncontrollable shaking about a year prior while at a family picnic and spring baseball game. Emergency services had rushed her to care, only to later find medulloblastoma – a childhood cancer in the back of her brain. Those moment took every comfort and ease of modern life she knew – no choice. Everything became hard. She underwent multiple surgeries, then chemotherapy and I was the doctor who prepared and delivered her radiation treatments to both brain and spine. My treatment sacrificed her hair, which became patchy, affected her IQ, which slowed her cognition, permanently threatened her hearing, and possibly took away the ability for estrogen to ever make her a mother – if she survived. I had done it all for her own good – to save her life – but it seemed a journey that could not have been any harder. While radiation can have side effects in adults, these are nothing compared to what befalls an irradiated child with cancer.

Medulloblastoma – even when resected – is known to grow back either in the brain or as “drop metastases” – seeds of cancer floating in the fluid around the brain that drop into the spinal cord and appear months following surgery. Like weeds, even cancer sows. Radiation is a standard treatment in children with medulloblastoma to prevent recurrence by killing surviving cancer cells in the brain and spine before they can grow larger – but it’s hard.

I descended the stairs and opened my door near Maverick station – the cold bit me harder than I feared. The heavy glass outer door banged closed behind me – freezing temperatures aside, it was time to move. Despite a long workday at Massachusetts General Hospital, the evening was the only time I could train. My feet treaded lightly – a jog really, given how slippery it was – with distance and endurance being priorities more than speed. I ran for hours into the early morning, following the wisps but cautious of their ice. Around the east side of Boston Harbor, along swelling tides lapping against rock jetties, with flashing planes landing overhead, the twinkling lights of the Boston cityscape reflected off the icy water between colonial frigates and modern freight. I enlisted my feet to lead me, cautious not to slip, crunching with each snowy step – my brain would have raced us ahead too fast.

At the water’s edge at Piers Park, I stopped a moment to trade the numbing cold of non-motion for a moment of peace. I thought of Ashley, hoping she would live but knowing she could die. Her Facebook page “Ashley Strong”, organized by her mother, had rallied and permanently touched her small mid-Atlantic town. Its police chief was pictured there – who had organized a community parade in her honor when she was diagnosed– as was her family, her school principal, and many nurses and doctors who cared for her throughout her cancer journey. She wore a wig in those posts – I knew – since my beams had taken what hair she had left. “Her life is struggle, with no choice, but she carries on and inspires those around her,” I thought in silence, frosted anew by the gross unfairness. Tundra-worn but not yet finished on my own journey, I turned myself back into the dark cold to take my next step. I crunched onward, hardened – and still do whenever I think of her.

Despair for lost life is painted in the same sad watercolors no matter which coast makes its canvas. Nevada County portraits are splashed in strokes of equal weight to Boston in this regard – our lives of equal worth and beauty. Though the lamp-lit road traveled by those we lose in death turns dark, cold, and quiet, their light reflected – even through reminiscence – that once beamed their running silhouette to us onlookers – still warms and guides those who remember.

Ashley’s memory helped hardened me, my doctoring, and my writing with a greater capacity for hope. Like a seedling slowly exposed to harsh conditions of sunlight, wind, and heat, observed and experienced life struggles yield an added measure of human hardness – the ability to withstand elements of an often-unforgiving and -unfair life. With hardness, we can choose hard things – to better emulate courage, adopt nobility when facing catastrophe, and embrace hope despite uncertainty.

So, yes, there is a reward for fighting cancer. It is often too large and long-term to predict and is often unseen: the struggle plants, cultivates, and then yields hope and inspiration for those around us – our families, loved ones, and even seemingly unconnected bystanders. This cascades a harvest of hope and hardening in the lives of those who remember. These are empowered as they too choose or are forced in life to do something hard. And the ability to do hard things is a precious reward – a harvest worth passing on to those around us.

Cancer in Your Corner aims to advance public health, bolster community trust, and enhance reader understanding through medical storytelling. Dr. Hess is the Director of Radiation Oncology at Sierra Nevada Memorial Hospital. His views do not reflect official positions of SNMH, CommonSpirit Health, or Dignity Health. Some aspects of this article are fictionalized history but are based on a true story. Names are fictitious to protect confidentiality.