The sun was bright and warm as I drove home from a client meeting in the southwest corner of New York. I deliberately avoided the interstate highways so I could explore the rural beauty of the backroads. I moved in and out of cell phone range—which was fine because I didn't want to field any work-related calls. About halfway home, my cell phone began vibrating and I hit the home button, immediately recognizing the number of my primary care physician.

My physician's receptionist asked whether I could meet with the doctor. I explained that I was driving and asked if I could call her the following day. She then asked if I could stop in that afternoon—I held my breath. I told her that I was almost an hour away, and she responded that the doctor would wait for me.

Right away, I knew it was about the results of a biopsy that had been performed 10 days ago on a lump in my left side. I also knew that the news wasn't good—good news can be given over the phone. The meeting with my physician is a blur to this day. I don't know how long I was there. I don't recall driving home.

The lump was cancerous—sarcoma, to be exact.

Working at Being More Than My Diagnosis

I am a management attorney and have been advising employers about labor and employment matters for 30 years. I'm regularly asked to give advice about how to provide reasonable accommodations to employees with serious illnesses.

That experience didn't make coping with my potentially lethal disease any easier. When critical illness is the focus of legal advice, the illness is abstract and impersonal. When it becomes the arbiter of your continued existence, it is overwhelmingly concrete and close.

I hope that sharing my personal experiences in this article will help employers, and the lawyers who guide them, make better decisions when they have an opportunity to accommodate a cancer patient. Through my personal battle with cancer, I learned that my understanding of the disease and those who must confront it was seriously lacking.

Confronting Reality

My physician tried to be encouraging, suggesting that it appeared we found the cancer early. Yet, refining the diagnosis and formulating a treatment plan was difficult. The plan I ultimately approved (of course, my only other option was to let the cancer grow unchecked) involved:

• Multiple scans looking for cancer in other parts of my body, including two thyroid biopsies.

• Adding two oncologists, a thyroid specialist, and two surgeons to my physician list.

• Surgery to remove the cancerous lump in my side followed by surgery two months later to remove my thyroid.

• Biopsies on several spots in my lungs (while I was fully conscious)—all negative.

• Twelve weeks of radiation treatment followed by 12 weeks of chemotherapy.

The good news is that I am writing this article more than two years after my last chemotherapy treatment.

Disclosure, Discussion and Denial

At the point of my diagnosis, I didn't really understand what was ahead. In fact, I only understand it slightly better now having walked the broad path of cancer with hundreds of others at the Wilmot Cancer Center. As such, I told the important people in my life that I had “cancer” and responded “sarcoma” when they asked what kind—with no one—least of all me—understanding exactly where I stood on the cancer spectrum of life and death. I said that I was going to have surgery, radiation and chemotherapy—but I had no idea what that actually would mean for me and my family.

In some ways, leaving the discussion of my diagnosis at this superficial level was better. I decided early on that I would rely on the advice and instruction of my physicians in whom I had great confidence. Others may feel differently, but I did not believe that becoming an expert in my particular cancer and its treatment was going to help me face the battles ahead any more effectively. I told my physicians that I wanted to hear everything I needed to know to fight the good fight but had no intention of becoming a cancer expert—that was their job.

This point is important in understanding how I interacted with my partners, family and friends about my cancer. About one-third of the caring people with whom I spoke would ask detailed and personal questions about my disease. I responded with basic information (sarcoma in my abdomen) but deliberately avoided the details they requested. If they pressed harder for details, they often didn't react well when I told them that I was relying on my physicians to tell me everything I needed to know and had decided not to rely on the Internet or other resources. Several asked whether I was giving up and whether I needed counseling. I appreciated their concern, but assured them this was a personal decision that I had made about getting ready for battle. In fact, until I started writing this article, I had never looked up the word “sarcoma” on Web MD or in any other resource.

Be careful about how hard you press employees with cancer about the particulars of their disease. Understand that everyone takes a different path toward preparing for the fight of, and for, their lives.

This point is important for employers. Get the medical information you need and are entitled to for evaluating leave requests, FMLA and disability applications, and other accommodations, but don't be surprised or disturbed if your employee is not completely immersed in the particulars of their disease, or is cautious about what is shared with you.

Telescopic Focus on Life and Death

Often, a cancer diagnosis is based on scan results or biopsies that are fairly definitive. The time between diagnosis and the formulation of a treatment plan, however, can be a prolonged period in limbo, waiting on further tests, consultations with specialists, and opting for second opinions.

With this in mind, I told my wife about the diagnosis right away, and we decided not to tell anyone else until we could also tell them about the planned course of treatment. For several weeks, only my wife and I knew about my diagnosis. We tried to attend to our work and engage in our normal routine—I honestly don't know if anyone sensed that there was something wrong.

During this limbo, I remember watching a television program with my wife and teenage daughter. The program involved a father who was battling cancer, but ultimately died of the disease. My daughter cried because of the strong emotions that the program evoked in her. My wife cried because she was uncertain how much of that program she might live during the coming months. I stared at the screen—only occasionally glancing at my wife and daughter—trying desperately not to cry and praying that my wife and daughter would not suffer much, no matter what the outcome was for me.

For about a month, I wasn't sure if I had two months to live or two decades. I wondered if I should cancel the week we had planned at the Jersey shore; I thought about whether I would live to see my first grandchild, or see my youngest daughter graduate from college or get married.

As the delay in making and implementing a treatment plan increased, I imagined that the tumor was growing at an accelerated rate and wondered why my surgery wasn't scheduled immediately—don't they know that I have cancer? These thoughts raised my anxiety level, and no doubt affected my concentration at work.

Employers need to realize that a cancer diagnosis often throws employees and their family into a serious state of uncertainty. It certainly affects their work availability and attention, but it also affects parts of their lives that previously were as solid as granite.

My treatment plan was finalized in late July. Once I knew the plan, I met with the managing partners in our office, the colleague who would absorb most of my work, our office manager and my administrative assistant (and friend of more than 30 years) to explain what was happening. They were shocked and extremely supportive. I transitioned most of my work to my colleague, but continued to take telephone calls and respond to emails while I waited for my first surgery. I asked my partners to make the appropriate communications to the firm leadership team, but also told them that I did not believe an office-wide communication about my situation was necessary.

Given the nature of my work and the ability to work from home, I was able to interact with my clients and colleagues throughout my treatment and recovery, making sure that the more demanding work was handed off to my colleagues.

Whether, how and to whom an employer communicates about an employee with cancer who will have a protracted absence or require a sporadic work schedule is an important consideration.

Of course, without the employee's permission, employers generally may not disclose information about an employee's medical condition. I don't believe that this general prohibition, however, should discourage employers from discussing with employees who have cancer what, if anything, they would like disclosed about their situation.

Financial Pressure, LTD Benefits, Health Insurance

Many employers provide critically ill employees only with statutory disability benefits, plus a limited number of paid sick or paid time-off days—frequently just enough to cover the one-week waiting period for disability benefits. In New York, disability benefits are 50 percent of an applicant's average weekly wage capped at $170 per week for a maximum of 26 weeks. An upstate New York employee working 35 hours per week in a minimum wage job earns $339.50 per week—which is twice the maximum weekly disability benefit. This example should suggest just how weak this statutory financial safety net really is.

Cancer patients or others with serious illness face an even bigger challenge 26 weeks into their battle when their short-term disability benefits end. I urge employers to carefully investigate and evaluate the costs and benefits of offering long-term disability (LTD) benefits. The odds are good that many of your best employees will need those benefits at some point in their careers. Providing LTD benefits as an option is good—providing LTD benefits as part of your standard benefit package is better.

Employers should carefully investigate and evaluate the costs and benefits of the health care options they offer, particularly as those plans relate to the treatment of cancer and other life-threatening illness.

For many cancer patients, the financial pressures, emotional pain and anxiety caused by absence from work and the cost of treatment can be as excruciating as the treatment itself. For individuals without insurance or those with insurance plans that include high co-pays or substantial deductibles, the pressure of paying for what you hope will be treatment that will save your life can be unbearable.

The Long Road Back

I know the dates of my surgeries, the date my radiation therapy ended, the date of my last three-day hospital visit for chemotherapy.

What I don't know is whether or when I will be finished with cancer.

Admittedly, I wasn't a beacon of health before my cancer treatment, but my body has never felt the same since. It's difficult to explain even some of the after-effects:

• Scars and adhesions from my surgeries

• Continued impact of radiation that destroyed any lingering cancer cells (but also radiated healthy cells and unaffected organs)

• Cell-by-cell devastation caused by massive doses of chemicals that were pumped through my body for three days straight on four separate occasions

Somedays, I feel as if I'm experiencing the world through a full-body hazmat suit. Understand, I'm not complaining but trying to explain. My point is that cancer patients can return to work and be highly productive, but physically may never be the same after cancer treatment.

Everyone's cancer, treatment and recovery are different—so I will not make sweeping judgments.

The emotional road back is long as well. Describing the emotional impact of this experience is complex, but one illustration stands out: I now notice reports about cancer patients, particularly obituaries for cancer patients who lost their battles, when I rarely did so before my own diagnosis.

Perhaps, this means that I was simply oblivious to others' pain and suffering before; perhaps, this is evidence of a fear that I am walking on the same path, only hours, days—or hopefully—years behind. Charles Dickens (A Christmas Carol) described Christmas as the one day of the year when all men and women of every station in life realize that they are “fellow passengers to the grave.” Cancer has had the same effect on me—for good or bad, I'm not yet sure.

Beginning Anew

About five days after I returned home from surgery to remove the sarcoma, a client called me because she was struggling with how to deal with a long-term good employee who had recently received a cancer diagnosis. We discussed what reasonable accommodations, if any, the company was required to provide. Inwardly, I questioned whether my personal experience might color my judgment and advice (although, it didn't seem so). Nevertheless, I disclosed my cancer and treatment to the client who was extremely kind and supportive. In return, she shared that her 30-year-old son had an aggressive cancer and was being treated at the same hospital as I was.

We returned to our discussion about how to accommodate this employee's cancer. This time, however, we evaluated and discussed, not what the law required, but rather all the ways that the company could reasonably support the employee. We eventually answered the legal question, but got there using a process that truly reflected this company's high regard and respect for its employees. Making judgments and giving advice about “reasonable accommodation” is difficult and imprecise, but starting with what you can do, instead of focusing only on what you must do, can lead to better outcomes for both the employer and employee.

Sidebar

Cancer Is a Short Word With an Infinite Number of Meanings. Although my father and other family members and friends have had cancer, I never had any need or desire to press past the generic label for this disease toward a more precise definition and understanding. The National Cancer Institute provides a description of those key characteristics which classify a particular physiologic anomaly as “cancer”:

Cancer is the name given to a collection of related diseases. In all types of cancer, some of the body's cells begin to divide without stopping and spread into surrounding tissues. Cancer can start almost anywhere in the human body, which is made up of trillions of cells. Normally, human cells grow and divide to form new cells as the body needs them. When cells grow old or become damaged, they die, and new cells take their place.

When cancer develops, however, this orderly process breaks down. As cells become more and more abnormal, old or damaged cells survive when they should die, and new cells form when they are not needed. These extra cells can divide without stopping and may form growths called tumors. Many cancers form solid tumors, which are masses of tissue. Cancers of the blood, such as leukemias, generally do not form solid tumors.

More than 100 cancer types are known and most are named after the organs or tissues where the cancer forms. Cancers also may be described by the type of cell that formed them, such as an epithelial cell or a squamous cell. My cancer was “sarcoma,” which may have existed in my body for a long time growing slowly, or not growing at all. Somehow these particular cells changed and, as my surgeon described, became “hyperactive and angry” growing at a very rapid pace compared to the other cells in my body.

There are an infinite number of permutations on these 100 cancer types because they impact their inhabitants (medically, emotionally and physiologically) in different places, at different times, with different velocities and toxicity, and with different levels of resistance. Cancer is a short word, but it has infinite meaning and impact.

James Holahan is a labor and employment law attorney and member at Bond, Schoeneck & King.