What Really Matters in Life? A Cancer Surgeon's Warning After 15,000 Patients

KEYPOINTS

• 01

  The dying tend to split into two stories: 'I wish I had' and 'I'm glad I did.'

  Dr. Rahul Jandial, a neurosurgeon and neuroscientist at City of Hope who says he has treated more than 15,000 stage 4 cancer patients, noticed a pattern. Patients stuck on 'I wish I had' ('…gotten screened earlier,' '…not smoked') cope poorly, even when they're medically doing well. Those who say 'I'm glad I did' cope well, even when they're doing worse. How you tell the story mattered more than the outcome.

• 02

  The most common regret is not being bold enough at life's turning points.

  Patients whose kids have grown up tell him they wish they'd been bolder at life's pivots and trusted their hunches about changing direction. 'They never say, I'm glad I was practical and conservative.' They look back and say 'it's a short run, I should have taken a few more chances,' as long as it didn't mean hurting people or 'gambling it all away.'

• 03

  Younger parents with cancer pray for a finish line, not a cure.

  Patients in their 40s and 50s with children often aren't focused on a cure. Their prayer is to live until the kids finish high school and leave home, so the kids don't watch their mother or father die while they're teenagers. Clarity about what matters arrives fast when time is short.

• 04

  Tie your self-worth to opportunities, not outcomes.

  At 53, Jandial says he has felt lost whenever he chased an outcome instead of an opportunity. If you 'hitch your mental health or self-worth' to results, you'll either aim too low or keep judging yourself wrongly. 'There is no moment of arrival,' only preparation, strategies and coping skills.

• 05

  Sometimes you have to 'amputate' something, even when it looks bad from the outside.

  Choices in the outside world and in your own mind can each be constructive or destructive. At 19, partying too much and facing other crises as his mother was diagnosed with breast cancer, he cut out school, leaving Berkeley to go home. He says amputations like that can permanently change relationships or careers, but it was the first time he felt he was 'driving my life.'

• 06

  Mentorship rarely just lands on you. You have to put yourself where it can happen.

  While working as a security guard, he enrolled at Compton Community College, where an English professor became his mentor. That only happened because he showed up and signed up. 'You can't just wait for inspiration and mentorship to land on you.'

• 07

  In a crisis, pace your breathing so you don't panic.

  He uses this in surgery and says Navy SEALs and deep divers do too. Directing attention to your breathing trains focus, which he calls 'attentional power.' Slow, deep breaths prevent hyperventilation: 'When you blow off the carbon dioxide, you will panic,' and then you can't do what you need to. He links it to calming an over-excited limbic system.

• 08

  The brain changes by repurposing what's left, which suggests a healthy brain can change too.

  He's skeptical of loose 'rewiring' talk. After a hemispherectomy, removing nearly half the brain for uncontrollable seizures in children, the space stays hollow and fills with fluid. Nothing regrows. Yet a few years later many of those kids are walking, because the remaining neurons take on new jobs ('the dancer became the soldier'). If an injured brain can recover like that, he asks, what about a healthy one?

• 09

  Repetition literally builds the groove.

  His image: neurons are 'microscopic jellyfish' spraying electricity at each other. When you keep thinking or acting the same way, the brain saves energy by wrapping those connections in fatty insulation (myelin). Like a groove down a mountain, the path gets easier with each pass, so the first efforts take the most energy.

• 10

  Caregivers aren't alone, but they need their private moments.

  His message to family caregivers: the person next to you may not have been there yet but will be, or may already have survived it. Our struggles look similar at the brain level. Use the support available, and protect 'those private moments that you only share with yourself.'