By Anne Crecelius, University of Dayton, Ohio, USA; Twitter: @DaytonDrC
Ask a physiologist what the most important theme or principle of physiology is and they very well may say “homeostasis” (1).
A common misconception of students is to define homeostasis as “unchanging” or “equal”, when in fact, as physiologists, we understand that homeostasis is the ability to maintain a relatively constant internal environment in the face of change, particularly in the external environment.
It is change, from some stimulus, that the body’s integrated systems respond to, often in a negative feedback manner, to correct the mismatch the initial stimulus provided.
Homeostasis is the body in balance.
Balance itself has multiple meanings. We may have made our first measurements of mass with a balance in a school laboratory. Neurophysiologists and biomechanists work to understand the mechanisms of maintaining postural balance (2). And, we’re probably all sick of hearing about work-life balance. Balance also happens to be my mother’s favourite concept and what she often has to remind me of, whether it be in my teaching, research, and service activities in academia, or in my broader life.
I primarily teach undergraduate physiology to future health professional in the United States. We talk a lot about balance (and homeostasis) and the various systems that work together to maintain homeostasis, for example, the endocrine system.
After my first year of teaching, in 2014, I was diagnosed with estrogen and progesterone-positive stage 3 breast cancer. Fortunately, after chemotherapy, surgery, and radiation, I was considered disease-free, though given the advanced stage of my cancer and high presence of positive lymph nodes, I would remain on hormonal therapy for the foreseeable future.
My body was thrown far out of balance, for many months. I continued working, and the next fall began to incorporate my own health story into my class sessions on the endocrine system (3).
As an instructor, I’ve always tried to approach my teaching with a balance of seriousness and fun, humanity and authority, basic science and clinical applicability. When faced with a major health crisis, it was important for me to remain balanced both physically and mentally as well. I felt I had learned important lessons from my diagnosis and as a cancer survivor; I was not the same person I was before my diagnosis.
I felt compelled to share that with my students.
In developing my lecture on “Patient X”, I knew that it had to be just the right mix of details to make the story vibrant, but not too many to make it awkward (even with future health professionals, I didn’t really want my students to picture me naked, or think about post-chemical menopause symptoms I might be suffering).
I wanted to show that medical advances were what allowed me to be alive, and yet there was still much research to be done.
And, knowing that it might be difficult for students to hear, I chose to balance my own story with that of my grandmother, who I would describe and a “classically stubborn Italian” and her not-so-subtle opinions about needing to take decreasing doses of oral steroids after a hospital stay where she received intravenous corticosteroid treatment (a helpful example for students of negative feedback and potential effects of exogenous pharmaceuticals).
For nearly five years, I continued to incorporate my personal story as a teaching tool that built rapport with my students, showed my own humanity, and encouraged them to connect what they were learning not just to their grade, or a future graduate school acceptance, but to their own lives, and that of their loved ones.
Then, in 2020, when the COVID-19 global pandemic had just caused us to send students home from our residential university campus, I received the news that my cancer had metastasized to my lungs and sternum and I was now dealing with stage 4 metastatic breast cancer, for which there is no cure.
How could I be balanced in sharing this news with my students? Especially students that I maybe had not even seen in person, and only knew through a Zoom video conference?
It hasn’t been easy, but I’ve tried to do so the past two semesters. In the first semester I went through the mechanisms of a new hormonal therapy that showed great promise, but unfortunately didn’t work in my case.
In the second semester we discussed systemic chemotherapy, both in oral and intravenous forms, with the good news that infusion therapy was effective at shrinking size and number of metastases.
But the universe tends to balance out good with bad as well. And more recently, the infusion-based chemotherapy has ceased to be effective anymore, so I am onto the next line of treatment options.
I will admit that I’ve lost some balance in my approach as of late. I spend a bit more time in “soapbox” mode, informing students of the need for early detection to avoid the grim survival statistics that comes with a metastatic diagnosis. I try to be optimistic and upbeat, but it is tough to smile through talking about your own terminal diagnosis. My patience can run short with hearing about my students’ own life problems, as many pale in comparison to what I’m facing.
And yet, I’m often brought back to balance by my students. My students give me hope. Hope that my spirit, of curiosity and courage lives on in therm. Hope that perhaps in the future, they will be on the front lines of discovery and clinical trials of new treatments. Hope that one day, we’ll have a real cure and no need for me or others to share this story
My cancer diagnosis has been a stimulus for change. Changes to my body of course, but changes to my teaching as well. I have been forced to be vulnerable, to accept amazing support from colleagues and students alike, and to make as much positive impact as possible in whatever time I have left.
Sharing my story, to my students and the public has been a helpful response to this change. Unlike our negative feedback mechanisms in the body, my response is not able to shut off the initial stimulus for change- the cancer that grows inside me; yet, I have accepted my new setpoint and continually work to remain in balance.
References
- Michael J and McFarland J (2011). The core principles (“big ideas”) of physiology: results of faculty surveys. Advances in Physiology Education 35(4), 336-41. https://doi.org/10.1152/advan.00004.2011
- Pollock AS et al. (2000). What is balance? Clinical Rehabilitation 14(4), 402-6. https://doi.org/10.1191/0269215500cr342oa
- Crecelius A (2021). From professor to patient X. Science 372(6542), 654. https://doi.org/10.1126/science.372.6542.654