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PSYCHOLOGY OF SAFETY: No longer cancer-free

November 1, 2005
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The winds of grace are always blowing, but you have to raise the sail. – Ramakrishna

This is my fourth opportunity to share my cancer experience with ISHN readers. In June 2002, I discussed the diagnosis; in October 2002, the topic was treatment of my prostate cancer; and in June 2003, I addressed recovery and included a list of strategies to remain cancer-free. These strategies were gleaned from reports of cancer survivors, and for almost three years they seemed to work for me. But in late August of this year I received distressing news. I am no longer cancer-free.

The elusive zero

Safety professionals strive for “injury-free.” Their ultimate outcome statistic is “zero.” Similarly, after treatment for prostate cancer, the desirable prostate-specific antigen (PSA) score is “zero.” A post-surgery PSA above 0.001 indicates the presence of cancer. The patient is not cancer-free.

After surgery, and for five consecutive PSA tests, my score was 0.001. I was cancer-free. After three of these ideal test results, my urologist’s office only scheduled me annually for a PSA test. In fact, my recent PSA test was self-initiated. I had not yet received a postcard to prompt a PSA check. But I realized it had been a year since my last assessment and wanted verification of “cancer-free.”

I could not have been more optimistic as I waited for my test results. The doctor was friendly and cheerful as he grabbed the computer printout from the holder on the door. Suddenly, his demeanor changed dramatically. I knew something was wrong. He put his chewing gum in a paper towel, and with a look of surprise, he delicately told me my PSA was 0.18.

While 0.18 is close to zero, I knew this was not good news. It means cancer is in my body, and can certainly grow to be debilitating and life-threatening. Prostate cancer is the second-leading cause of cancer-related deaths in the U.S. The urologist reviewed my records and noted how unusual it was to see cancer after surgery and post-operative assessments as successful as mine. Such rhetoric did not make me feel any better.

Then he surprised me with the following: “At this time, I see no need for radiation, chemo, or Lupron” (Lupron is a last-resort drug that acts like a female hormone and can have a number of undesirable side effects). Then the doc asked me to schedule a reassessment of my PSA in four months. “In the meantime, you might check the Internet for possible advantages in taking vitamin E, lycopene, selenium, and vitamin D.” This is neither new nor useful information, I thought to myself. I’ve taken these supplements for years, even before my cancer diagnosis.

Relevance to safety

Each of my prior ISHN articles about my prostate cancer connected my experience to industrial safety. Do you see any relevance here? Obviously, the score of zero is ideal in both cases. Whether targeting cancer-free or injury-free, anything higher than zero is discouraging and could have dire consequences.

Also, with this scoring system and a mission to remain at zero, it is easy to adopt a failure-avoidance mindset. Just avoiding failure becomes the focus of interpersonal conversation and self-talk. This can detract from necessary attention to upstream actions needed to maintain zero. Plus, as I’ve discussed in earlier ISHN articles (February and March 2004), we feel less distressed and more empowered when working to achieve as “success seekers” than when working to avoid failure as “failure avoiders.”

Fighting complacency

I got pretty comfortable with my post-operative PSA scores, and so did my surgeon and his staff. When I left the doctor’s office to schedule another appointment, the office administrator greeted me with, “I’m so glad you’re doing so well.” She hadn’t seen my discouraging PSA, and expected only the best.

Does this happen in safety? Can a score of zero (for injury-free) lull people into a false sense of security? Without a success-seeking mindset and mindful attention to daily activities needed to remain injury-free, we can get complacent about safety. “We’ve been injury-free for two years, so if we keep doing what we’re doing, we will maintain this ideal score.” No need to change — no need to learn more about injury prevention — no need to worry.

Fighting failure acceptance

My doc says, “Come back in four months for a reassessment. Then we’ll see how fast the cancer is growing.” Are you kidding? The PSA test says I’ve gone from cancer-free to cancer-present in less than a year, and now I’m expected to wait around for another four months? Can I afford to accept this failure, and do nothing until another assessment?

Accepting my cancer state for now until a future PSA test tells me I need radical treatment is the most convenient option, and is perhaps accompanied by the least amount of stress. Keep on doing what I’m doing, and I might not be worse off. In essence, this was the advice of my urologist.

I bet this approach sounds ridiculous to most readers. Safety pros don’t view a workplace injury with such a mindset, do they? That’s tantamount to accepting occurrences of injuries until they reach some critical number. Just keep doing what we’re doing until our injury rate exceeds the standard for our business — of course that’s not acceptable. But have you ever been at a loss for what to do in order to return to zero, to injury-free?

Success seekers need strategies

My doc offered no new strategy for returning me to cancer-free. He never asked me what I’ve done to remain cancer-free in the past, nor what I’ve done differently to elevate my PSA. And if he did, I couldn’t offer any meaningful answers. From my perspective, my behavior had not changed.

Was the return of my cancer only a matter of bad luck? Was it merely genetically determined (a common view of the urologists I’ve interviewed)? Must I accept the perspective, “Not all cancer can be prevented?” If not, then what should I do?

Are all injuries preventable? Are some injuries the result of uncontrollable factors? Should we keep on doing what we’re doing, and accept failure? Of course not; but sometimes we need to ask my cancer-related question, “What should we do?”

Raise your sail

I’m drafting this article the day after my most inspiring speaking experience. I gave the closing general-session keynote at the 21st Annual Voluntary Protection Programs Participants’ Association (VPPPA) Conference in Dallas, Texas. A crowded room of about 2,000 listened intently as I introduced the audience to “People-Based Safety” — an evolution of behavior-based safety. They reacted to my concepts, stories, and cartoons with passion and energy.

“We need to make safety personal,” I said, “face the brutal facts of injuries and their contributing factors, build trusting relationships with people, and actively care with an interdependent mindset.” Then, without any forethought, I told my cancer story — emphasizing the disheartening news I had received just five days earlier.

Receiving inspiration

This turned out to be “my most inspiring” keynote not because of anything I said, but thanks to how the audience inspired me. I was touched by the many caring emotions displayed on the faces of the attentive listeners. After a standing ovation, I was swamped by an onslaught of participants expressing encouragement, wishing me good health, and telling me I’ll be in their prayers. Many asked for my email address so they could send information relevant for my fight with cancer, including the names of cancer specialists I could contact. Two participants waited more than 30 minutes to privately pray for me.

Special people

I left the ballroom 45 minutes after my keynote feeling inspired and more ready than ever to fight for zero again. That special group of safety leaders lifted my self-esteem and optimism higher than I thought possible in my current state. In a world that seems filled with mistrust, conflict, selfish entitlement, and debilitating fear, it’s uplifting to see so much genuine caring from so many people.

What’s the safety lesson here?

First, I’m convinced safety leaders are a special breed of people gifted with emotional intelligence. They are willing and able to share with others. If only those “others” would ask. Plus, safety leaders have knowledge, practical tools, and procedures they can help others use for injury prevention. If only those “others” would ask.

Safety conferences like the VPPPA are so rewarding for safety leaders. They get to interact with like-minded people who want to share and receive strategies to achieve and sustain an injury-free workplace. They return home inspired, possessing new ways to keep people safe. I hope their workplaces are receptive. But if they are not, I’m confident safety’s leaders will not accept failure and become complacent. They will inspire those “others” to fight the good fight. That’s what they did for me.

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