Dear Mr. President,

It is perhaps presumptuous of me to write to you, but I too have had cancer, and I thought that some of my experiences and reflections might be helpful to you. Just 10 years ago this past spring I was treated at Bethesda Naval Hospital for seminoma of the chest. I am truly happy to be here to write to you today.

I want to congratulate you on the decisiveness and grittiness you have shown in handling your disease. Your no-nonsense affirmativeness has already done a great deal to dispel more traditional notions that cancer means death and resignation is the way to go.

During the course of my illness, an irreverent friend assured me that I had little to worry about. "At least cancer is curable," he observed. "It's not like baldness or acne. Those are problems that medicine really can't fix."

He was right. As you are probably aware, 50 percent of the people being diagnosed today will become survivors, a figure up from about 25 percent in the 1950s. There are, in fact, 5 million Americans -- better than 2 percent of our population -- alive today who have had cancer. Three million of them are long-term survivors who have lived more than five years since the discovery of their disease.

Figures, I realize, are only of limited solace. They don't tell us what we really want to know -- what will happen with my cancer. That, Mr. President, is what I found to be the toughest part of my ordeal. It wasn't the surgery or the radiation or the chemotherapy that really got to me. It was the fear of recurrence, the niggling doubt that was always present, pickpocketing my peace of mind, making me scrutinize and doubt my own body. "You betrayed me once, body," I used to say to myself. "How am I to be sure that you won't do it again?" And I would set off looking for lumps, bumps, swollen veins or new pains.

Don't do that. Fear and doubt are unavoidable potholes in the road that lies in front of you. Don't, if at all possible, stumble on them or tarry in that part of the road. Walk bravely and briskly, as you are doing. The anxiety that we all experience about the return of the disease is a natural but, I am firmly convinced, useless phenomenon. It punishes us for no constructive purpose. The joy of work, the warmth of family and the stimulation of friends were wonderful antidotes to my fears, and I highly recommend them to you.

There are certain problems that many cancer patients encounter that I did not experience and, I suspect, you also will escape. But they are worth remembering because they affect many people with conditions similar to yours and mine. Shunning and social ostracism are not as prevalent as they once were, but cancer calls forth irrational fear and loathing in some circles. Even I, a physician living in a sophisticated, urban area, had a few friends who disappeared when I became ill and did not show up again until I was good and well.

Your paycheck, employment security and medical coverage will continue, as did mine, for the duration of your illness, no matter how complicated or prolonged. This certainty is a tremendous privilege and relief that will allow you, as it did me, the abililty to devote your full energy to your recovery. Employers' attitudes and practices vary widely and, while federal law does prohibit discrimination against people with cancer, the reality is that the job market can be a rough place after a bout with the illness. Deferential treatment and frank discrimination are facts that defy not only basic fairness but also our tremendous national investment in cancer research and treatment. Why cure people only to lock them out of the economy?

Another enormously troublesome area for cancer survivors is insurance. An individual with a history of cancer is considered an insurance risk and often denied coverage or offered a policy with a disclaimer for conditions related in any way to the cancer. This behavior may make sense to actuaries, but it is unfathomable to people who have struggled through a disease and now want to enjoy the protection afforded to other members of our society.

People live with cancer. People live through cancer. People live beyond cancer. They can be presidents, senators, Olympic medal winners, doctors, parents, artists, workers, farmers, whatever. Many of them could use a little help in the way of improved public attitudes and public policies toward them. Your very presence in these ranks is providing a sense of visibility and strength. Perhaps when an opportunity presents itself you might consider initiating some activities that would create a forum that would address the issues of cancer survival in a formal way.

In closing, I would like to pass on to you two sayings that I have picked up along the way that have been very helpful to me. Cancer has nothing to recommend it. Survival, though, has its brighter sides. There is an appreciation of life, a brilliance of the moment that I have experienced that probably visits many people who have been forced to deal intimately with the possibility of their own deaths. Someone once described this to me as "The reds all get redder." They do.

And finally a recommendation I know that you'll appreciate: "Celebrate the journey." Don't dwell on the diagnosis. Skirt those potholes. Enjoy the breeze and the sun and the magnificence of the road still running out in front of you.


Fitzhugh Mullan