If you have a job, you need to think carefully about whether you can continue to work. It may be that the decision is clear-cut and you know that you will be out of action for a period of weeks or months. In many cases though, it is impossible to predict in advance how you will react to your treatment, however well-informed you are about its side-effects. You might find that you can work part-time, perhaps a few days each week or a few hours each day. You may feel perfectly well and strong enough to work one day and exhausted the next.
It is sensible to start by asking your doctor’s opinion about whether you are fit to work. Although it is difficult in many circumstances for a doctor to give a definitive answer, their advice will be useful when you discuss the issue with your employer. You may be advised to ease yourself back to work gently and to ensure you take sick leave if you are feeling low, or to start by working part-time. Alternatively, your doctor may advise you to stop working
until your treatment is completed or until you are physically stronger.
The next step is to talk to your employer to make sure no misunderstandings arise about whether or not you will be at work (or ask somebody to talk to your employer on your behalf). You may be unable to guarantee from day to day when you can work, and it is important that this is fully understood. It is even more important that you are not in a state of worry about work commitments – you need your energy for yourself.
For those fortunate to be in some form of paid work, perhaps the most critical decision is exactly what to do with this activity which has previously, probably, dominated your waking existence. The decision will vary dramatically between individuals -employed, self-employed, attitude of employer, full-time, part-time, etc – but for me the key decision was surprisingly easy. We were running a chartered accountancy practice which I had established some seven years earlier and there was never any doubt in either of our minds that we both had to stop working and use all energies available on the cancer. I think we both knew that this would, of course, make us much poorer – although I am not certain we then realized the full extent and link between illness and poverty – but that there was absolutely no alternative.
I was so, so lucky in one key aspect. I had formed a wonderful friendship and mutual professional support with a friend who ran a similar practice in Devon. Without a second thought, he came to see us and worked flat out for a fortnight to sell the business as quickly and profitably as possible. The end result was that within a fortnight of C-day and with the truly heroic efforts of my friend (and his wife ‘holding the fort’ at home) and the goodwill and integrity of the purchaser, the business was sold and we faced a future with a dramatically reduced income! Except that we had the time to deal with the cancer.
I know that this situation will only apply precisely to a very limited number of people, and that the level of horsetrading between employee and employer and the trade-off between income and time will be much more complex for most. All I would stress is that for us it was a great liberation to be free of the tyranny of time and resources which our work ate up. All efforts had to go into facing the cancer.
If you do decide or have to give up work, even for a relatively short time, you will obviously need to consider the financial implications. Money – or a lack of it – is one of the most common sources of stress. Anxieties about how to pay the mortgage next month or where the money for the electricity bill or the children’s school uniforms is coming from are the last thing you need – but at the same time are issues which can’t be avoided. If you do not have any other source of income, you need advice at an early stage about any benefits you are entitled to claim and whether you will be able to manage. These benefits are covered in more detail in Chapter 8. You may also feel great bitterness that your cancer has forced you into this position and created yet further problems. Your family might find this hard to accept too, resenting the situation while not wanting to add to your worries. Do get advice if you need it – a social worker will be available at your hospital who has experience of these issues. He or she can guide you through the system and save you time and energy.
For many of us, work occupies a significant proportion of our waking hours and an important position in our lives. It often dominates almost to the extent of defining who we are – when we are introduced to someone, one of the first topics of conversation is frequently, ‘Do you work?’ or ‘What do you do for a living?’ Even though you will be preoccupied with your cancer and treatment, giving up work can leave a void in your life. If you are at home, you will need to find ways of staving off the inevitable boredom, and making sure you don’t miss out on the social contact which work naturally provides. If it is physically possible, you might prefer to continue working at a reduced level to preserve some sense of normality in your life. Different people have different priorities and you, in consultation with your doctors, will need to decide what is right for you.
One man in his 30s being treated for stomach cancer who was employed by a bank continued to work whenever he could throughout his chemotherapy, with prearranged time off for his hospital treatment every three weeks. He felt that this would prevent him from ‘climbing the walls’ at home. He wasn’t always well enough to go to work, but preferred to do so whenever possible. Another in similar circumstances felt he needed to give up work for the duration of his treatment and convalescence, in order to concentrate solely on fighting his cancer. The decision might be made for you by your state of health or the nature of your job, but if not, try to decide what is best for you and not what other people expect of you.
If much of your life has revolved around work, it can be hard to conceive of such a dramatic change to your routine, let alone to admit that you are not always physically able to manage your job. In telling your employer and colleagues, you may fear that their perception of your capabilities will be affected or that they may not be entirely sympathetic about your cancer. Perhaps you feel determined to continue working at all costs, simply to prove that you can, or feel that you must from a sense of insecurity about your career prospects in the future.
The best policy is honesty with your employer. If your doctors have advised you that you will need time off for treatment, either occasional days or more prolonged periods, don’t imply that you will not need any sick leave. If your case is less clear-cut and you may need odd days off, make this clear. It will be easier for you and your colleagues to plan around your likely absences if you are explicit with them about what to expect. How you and they will cope with this will depend very much on the nature of your work. Maybe a colleague can cover for you on an ad hoc basis when necessary. If your work doesn’t allow for that, some careful forward planning of your workload will be needed, which will require you to be as open with your colleagues as possible. There is usually a means of resolving this, either by using temporary staff, delegating elsewhere or reallocating some of your work. Losing touch and getting left behind might be a fear – but perhaps you can arrange with colleagues to keep you up-to-date if you are absent for any length of time.
When you are not fully fit, even a job which is not physically demanding can leave you exhausted at the end of the day. Frustrating though it may be, this is a time when you must put yourself first and not the demands (or perceived demands) of your job. If you insist on working against medical advice or your better judgement just to prove that you can, you will find it even harder to maintain your physical strength – and you need it for yourself above all else.
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