Episode 433 - Resisting the Narrative: Bill Risser's Approach to Cancer

So imagine hearing a doctor say the words, it is cancer.

Yeah. That is an absolute gut punch.

Right?Now imagine exactly one week later, you are, you know, packing your bags, boarding a plane and heading to the US Open in New York City, which is just wild. It really is. You're celebrating your 25th wedding anniversary.You're sitting in the stands at Arthur Ashe Stadium, eating like, overpriced food, watching world class tennis, while this life altering medical reality just quietly waits for you back home.

And that kind of cognitive dissonance, that immediate, almost stubborn refusal to let a terrifying diagnosis just, you know, instantly erase your identity is fascinating because normally when we think of an oncology diagnosis, we think of an immediate, total surrender to the medical system.

Exactly. You become your illness. But today, we are diving into a very different kind of journey. Welcome to the Deep Dive.We've got this incredible set of notes based on some blog posts from around 2012 and 2013 by Guy named Bill Risser.

Right, the creator of the Real Estate Sessions podcast.

Yeah. He documented his entire experience with colon cancer in a series called the Real Estate of Recovery. Bill Risser's Therapy Journey.And our mission today isn't just to read off a medical chart.

No, not at all.

We're going to trace this rapid timeline and really look at how taking deliberate control of your own narrative down to the specific vocabulary you use can fundamentally alter the experience of a crisis.

And this is incredibly relevant to you, the listener. Right. Whether you are dealing with a health issue or maybe a massive career setback, or even just the overwhelming chaos of daily life.

Oh, for sure.

Because what Bill's notes provide is a practical blueprint for realistic optimism. We're going to explore how you can apply his mindset of intentional framing to reclaim your agency when you feel, you know, entirely out of control.

And to really understand how Bill reclaims his agency, we first have to look at how quickly it was taken away.

The timeline is just. It's staggering.

It really is. I want to walk you through it because we're not talking about a slow, creeping realization here. This is a whiplash timeline.So August 20th, Bill is 51 years old, and he goes in for a routine colonoscopy.

Just that standard maintenance check. You turn 50, you get it done.

Right. Exactly. But they find a lesion which instantly

changes the atmosphere of the room. A routine preventative measure suddenly becomes, well, an active investigation.

Yep. They send it to the lab. Two days later, August 22nd, the phone rings. The doctor confirms it. It is cancer.

Wow. Two days.

Two days. And then as we mentioned at the top.A week later, on August 29th, he and his wife Cindy are at the US Open, which they got the doctor's blessing to go to, by the way. And I just find that detail so striking.

It's a really early and vital indicator of Bill's psychological baseline. I think when people get a major diagnosis, the natural human instinct is to completely contract.

Right. You cancel everything.

Exactly. You shrink your world down to the size of your living room, and you just wait for the next doctor's appointment.But by choosing to go to New York, Bill and Cindy are, you know, they're drawing a line in the sand,

asserting that the cancer is happening to him, but it's not who he is.

Precisely. But the reality is the medical machinery has already started turning. And once you're in that system, it moves fast.

Oh, incredibly fast. So they get back from New York, and on September 14, Bill is in the hospital for colon resection surgery to

remove the mass and part of his colon.

Right. He. He recovers from that. But just three days later, September 17, the surgeon comes in with the pathology report, and it's stage three.Stage three colon cancer, which is a massive paradigm shift. And the surgeons say, you're going to need an oncologist.

Yeah, because when you're dealing with a localized tumor, surgery is often viewed as the definitive fix. Right. We found it. We cut it out. You are done.

But stage three changes all that.

It does. Stage three means the cancer cells have broken out of that primary location and. And spread to the nearby lymph nodes.It shifts the entire medical strategy from a localized structural fix to a systemic battle.

Right, because if it's in the lymph nodes, it basically have access to the body's highway system.

Exactly. You can't just cut it out anymore. You have to treat the whole environment, and that requires harsh systemic interventions.

So September 25th, Phil sits down with his new oncologist, Dr. Mendanga, and she looks at this man who has just been told his cancer has spread, and she says, you are a very lucky man.

Which sounds completely counterintuitive.

I read that and immediately thought, lucky. I mean, how does a patient even process that?If I'm sitting there, my head is spinning, I'm facing months of grueling treatment, and someone is calling me lucky.

It really highlights the extreme relativity of the medical world. To a healthy person, stage three cancer

is a nightmare, Total nightmare.

But an oncologist spends her days looking at stage four charts dealing with systemic failures, terminal prognosis. So when Dr. Mandanka says Lucky. She isn't dismissing his pain. She's looking at the biology and saying, this is treatable.We caught it in a window where my tools still work.

We have a clear protocol, right?

We have a plan.

But the protocol she's talking about is intense. By mid October, specifically October 18th and 19th, baby bill is undergoing a whole new battery of procedures.He gets a PT scan, and he has a power port surgically installed in his left chest.

That's a lot in a very short amount of time.

It is.When you look at this rapid succession of events from a routine checkup in late August to having hardware installed in your chest by mid October, it feels less like a medical journey and more like, I don't know, being shoved into an algorithmic processing plant.

You're completely stripped of your autonomy.

You really are. You're told where to stand, what to wear, when to fast, or what part of your body is being sliced open. You're basically a widget on a conveyor belt.

And that loss of autonomy is often cited by patients as the most traumatizing part of modern medicine. You are just entirely passive.But let's look at the mechanisms of what they are actually doing to him during these mid October days, because it sets the stage for what he has to endure. Next. You mentioned the PE scan, right.

Where they make him drink radioactive sugar water, which, frankly, sounds like a terrifying sports drink.

It does. But the science behind it is fascinating.

I was looking into this. Cancer cells are highly metabolic. They're basically hungry, out of control factories that consume glucose much faster than normal cells.

Exactly. The Warburg effect.

Yes. So the doctors give him this radioactive glucose. The cancer cells gorge on it.And because it's radioactive, those specific cells literally light up on the scan.

It gives the doctors a map of exactly where the enemy is hiding. It's. And the installation of the power port is equally strategic, though obviously very physically

invasive, because you don't just put an IV in someone's arm for this kind of treatment, right?

No, definitely not. The chemicals they use are highly caustic.If you tried to pump these specific oncology drugs through the small, fragile peripheral veins in your hand or arm week after week. Yeah. The veins would literally collapse or suffer severe chemical burns.So a power port is a small titanium or plastic reservoir placed completely under the skin in the chest, and it connects via a catheter directly into the superior vena cava, which is the massive vein right above the heart.

Wait, so it goes right to the heart? That means when the drugs enter the body, they Immediately hit a massive volume of fast flowing blood.

Exactly. It dilutes the caustic chemicals instantly so they don't destroy the blood vessels.

That is a brilliant engineering solution to a biological problem. But, I mean, from Bill's perspective, he now has a permanent physical modification to his chest. He has a direct input jack to his heart.

It's a constant, unavoidable reminder that he's cancer patient.

Which brings us to a really crucial moment, that reclamation of agency Dr. Mendonca unwittingly handed him when she called him lucky. Bill exercises it immediately on his very first day of treatment, October 23rd.

And he does it in such a unique way.

He does it by doing something entirely linguistic. He knows he needs 12 treatments to rid his body of the cancer. He knows the medical word is chemotherapy.And he knows that culturally, everyone, friends, movies, the nurses themselves, casually shortens it to chemo.

Right.

But Bill makes this incredibly conscious choice. He decides to drop the chemo prefix entirely. He decides to just call it therapy. In his notes, his reasoning is remarkably simple.He just says, why not?

Why not? I mean, it sounds almost too simple.

It does, but I was thinking about the cultural baggage of that word chemo.

Yeah.

It doesn't just describe a medical process. It implies sickness, vulnerability, and, you know, intense suffering. It feels like a punishment.

It really does.

Honestly, just saying the word almost triggers a physiological stress response. It makes you tense up.

You're touching on a foundational concept in behavioral psychology. There. Words are not just passive descriptors. They are active framing mechanisms.The language we use to describe an event literally shapes our cognitive and physiological response to that event.

Okay, but I have to push back a little for the listener here. Isn't this just a classic case of toxic positivity?Like, if my house is on fire, and I call it a spontaneous thermal event, My house is still burning down.

Right. Redefining it doesn't put out the fire.

Exactly. So is dropping the word chemo just putting a smiley face sticker on a fire alarm? Does calling it therapy actually do anything?

That is a great question. And the distinction between toxic positivity and realistic optimism is critical here.Toxic positivity demands denial, like pretending everything is fine. Right. It would be Bill saying, I'm perfectly healthy. I don't need medicine. This is all fine. That is dangerous.But realistic optimism, which is what Bill is practicing, is about accepting the physical reality of the situation while taking control of the narrative surrounding it.

So how does swapping chemo for therapy actually change the narrative?

Well, think about the associations we have with the word therapy. Physical therapy, talk therapy, couples therapy. The word inherently implies healing.

Oh, that makes sense.

It implies a proactive, forward moving process where you are actively participating in your own improvement. Chemo feels like a toxic assault being inflicted upon your body. Therapy feels like necessary work you are doing for your body.

Wow, that is a huge shift.

It is.By changing that one word, Bill mentally transforms himself from a helpless victim tied to a chair into an active participant engaged in a healing project.

He totally flips the script. And what is so incredible is that we see the immediate physical manifestation of that mental shift on the very first day.

How so?

Because he has framed it as therapy. His physical entry into the hospital is entirely stripped of that clinical terror you might expect. Let me set the scene for you.It's 10am he and Cindy arrive first. They get great news. Dr. Mendonca confirms the PT scan is clear.

Okay. A huge relief.

Yeah. The surgery got the primary mass, and there are no other major hotspots lighting up.

But the systemic treatment is still required just to ensure no microscopic cells remain.

Right. So they check his surgery scars, make sure he's healing, and then they head over to what Bill calls the lounge.And I just love that he calls it a lounge. Not an infusion ward, not an oncology clinic. It's a lounge.

It sounds like an airport.

Exactly. And the environment he describes is almost shockingly mundane. It's just a room full of people. One woman is knitting, another is asleep.Some are reading magazines. It's quiet.

It totally lacks the frantic, terrifying energy we usually associate with hospitals.

Completely. So Bill looks around, takes in the scene, and realizes he is the only person who brought a laptop.He pulls it out of his backpack, checks the signal, and notes. Hey, great WI Fi. Plenty of power outlets. It'll be easy to get a lot of work done here.

This is so telling. He is treating the oncology ward like a co working space.

He just whips out his laptop to clear out his inbox. He starts observing the room, spotting the veterans.You know, the patients who come in, grab the regular seat, and just start casually chatting with the nurses about the weekends.

And he doesn't feel dread about that?

No. Instead of feeling dread about becoming one of them, Bill thinks to himself, that will be me soon. He meets his nurse, Diane, who is fantastic.She's visiting with patients, talking about their families. He literally writes in his notes, I am going to like it here.

If we look at the underlying biology of what Bill is achieving here, it is profound. We talked earlier about how stress and terror Affect the body.When you walk into a hospital feeling like a victim of a terrifying disease, your sympathetic nervous system kicks into overdrive.

That's the fight or flight response.

Exactly.Your cortisol levels spike, your heart rate increases, your blood vessels constrict, and your digestive system essentially shuts down because your body literally thinks it's being chased by a tiger.

Which is the absolute worst physical state to be in when you are trying to heal.

Precisely. Chronic high cortisol causes systemic inflammation and actually suppresses the immune system.But by normalizing the space, by opening a laptop, by focusing on the good WI fi, by viewing it as a lounge where he's just doing some therapy,

he's calming his body down.

Yes. Bill is keeping his body in a parasympathetic state. That's the rest in digest mode. His blood pressure stays normal, his vessels are relaxed.He is biologically optimizing his body to receive the medication without fighting itself.

And he really needs that optimized state because the medical process itself is not trivial. Diane, the nurse, comes over to get the session started.And because he has that power port installed, she doesn't have to go hunting for a vein in his arm.

Right. She goes straight to the chest.

Yes. She takes a special needle and presses it straight through his chest skin, directly into the port.And Bill describes it so calmly, he just says it's a little pinch and it's in again.

His baseline is so grounded that a needle entering his chest cavity is processed as just a minor logistical step before he gets back to his emails.

Right. So Diane administers some pre medications to prevent nausea. And then it's time for part one of the cocktail.It's a combination of two drugs, Oxaliplatin and leucovorin. This part takes a couple of hours.He's just sitting in the lounge working on his laptop while these heavy duty chemicals flow through that port in the into his superior vena cava. But, you know, the laptop only solves the problem for the couple of hours he is physically sitting in the chair.The treatment doesn't stop when he packs up his backpack.

Right. Because the protocol for this type of cancer requires sustained exposure to the medication, not just a quick dose.

Exactly. And this is where Bill's practical problem solving really shines. Part two of the cocktail involves a drug called five Fu or Fluorosil.But they don't just inject it and send him home. It has to be infused incredibly slowly over 48 hours.

Wow. Two full days.

Two full days. To achieve this, the nurses hook his Chest port up to an ambulatory continuous infusion device.It's basically this portable pressurized rubber pump that dispenses exactly 5ml of medication an hour until it slowly deflates.

And what do they call this thing?

The nurses hilariously refer to this device as the party ball.

I love that even the oncology nurses are participating in this linguistic reframing. Calling it a party ball strips away so much of the clinical intimidation.

It totally does.But practically speaking, you now have a pressurized rubber ball steadily pumping chemicals into a port in your chest, and you have to go home and live your normal life for two days.

How do you even carry that around?

Right. It's the size of a large grapefruit.If you carry it in the standard issue hospital pouch, you feel like a patient dragging an IV Pole through your kitchen.

It becomes a physical tether to your illness. It dictates how you move and how people perceive you.

But Bill gets a tip from a fellow cancer survivor, a woman named Lou from Idaho. She had gone through this exact same regimen years prior and remained cancer free.

Oh, that's great.

Yeah. And her advice was brilliantly simple. She told him to go to rei, the outdoor sporting goods store, and buy a rock climber's chalk bag.

Wait, really? A chalk bag?

Yes. You know those little cylindrical pouches that rock climbers clip to their harnesses so they can dip their hands in chalk while scaling a wall?

That is an unbelievable life hack.

It's the exact perfect size for the party ball. It has a little drawstring at the top, and it clips right onto a belt loop. So Bill and Cindy head to rei, they buy one, and it works perfectly.

That is amazing.

Two days later, after the 48 hours are up, Bill walks back into Dr. Mendonca's office wearing his REI chalk bag on his hip to have the empty party ball removed from his chest.

And he has to do this how many times?

He notes he's going to have to do this 11 more times every other week.He even mentions he gets a week off for Thanksgiving because the clinic is closed, so no one will be there to unhook the party bowl on Thanksgiving day, which he's totally fine with.

Well, let's unpack the psychology of that chalk bag for a second, because it is the ultimate physical manifestation foundation of his therapy mindset. Think about the identity we associate with a rock climbing bag.

It's very rugged, active.

Right. It represents an adventurous, resilient lifestyle. It's a symbol of someone who actively chooses to scale difficult Obstacles.

It's athletic gear, not medical equipment.

Exactly. A plastic hospital pouch binds your identity to your disease. It tells your brain and everyone who looks at you, I am sick.The chalk bag feels like an active

choice, like he's gearing up for a climb.

Every time Bill looks down at his hip, he isn't seeing a tether, he's seeing a piece of outdoor gear. It constantly signals to his brain that he is navigating a temporary physical challenge, not succumbing to a permanent state of victimhood.

And what's so vital here is that Bill isn't using the chalk bag or the word therapy to avoid reality. He is incredibly clear eyed about what this challenge actually entails.

Right. He's not in denial.

Not at all. He sits down with Dr. Mendonca and the nurses and they have a very frank discussion about the side effects of this 12 session regimen.

Because realistic optimism requires you to know exactly what the worst case scenario looks like. So you can prepare for it.

Exactly. He lists them out in his notes. He knows he probably won't lose his hair, maybe just some thinning, which he says he can handle.He knows nausea is a real threat, but he trusts the anti nausea meds they gave him in the lounge.

What about the other drugs?

Well, then there is the tough one. The oxaliplatin he's taking is notorious for causing neuropathy. Dr. Mendonca tells him it is highly likely.

Oh yeah. Oxaliplatin induced neuropathy is a very specific, very frustrating side effect.It physically alters how your nerves communicate, like tingling, tingling numbness and a very intense sensitivity to cold in the extremities.

I write about that. Cold sensitivity.Patients say that touching a cold steering wheel or just grabbing a bottle of water out of the fridge can suddenly feel like grasping shattered glass. It's a deep burning pain.

It is.And it fundamentally alters how you interact with the physical world on a daily basis, along with the overall crushing malaise that accompanies systemic chemical treatments.

But listen to how Bill processes this reality. He writes in his notes, everyone is different. I like knowing what may or may not happen. I also believe a positive attitude can make a difference.It really is a simple choice, like choosing to call my treatment therapy.

That statement right there is the core thesis of this entire deep dive.

It really is.

His acceptance of the facts. Knowing exactly how painful that neuropathy might be proves that his positive thinking isn't a delusion.He completely accepts the biological reality of the chemicals entering his chest. But he completely rejects the psychological narrative of despair that usually accompanies them.

Which brings us to the ultimate takeaway for you, the listener. Bill Risser's story isn't just a clinical timeline of a man getting a port installed and carrying around a party ball.

No, it's so much more than that.

It is a masterclass in retaining your identity when a massive impersonal system tries to turn you into a statistic.Changing a single word from chemo to therapy by consciously deciding to open a laptop and work in a medical lounge by choosing to carry a life saving chemical pump in an REI rock climbing bag, Bill found the variables he could control when the macro situation was completely out of his hands.

And that's the lesson.You might not be able to control the cellular division happening inside your body, or the macroeconomic shifts affecting your industry, or, you know, the sudden crises that pop up in your family, but you can always control the vocabulary you use at your breakfast table.

Exactly.You don't always get to choose the script you are handed, but Bill's journey proves that even if you didn't write the script, you absolutely get to choose how you play the role.

Which leaves us with a final, slightly different question for you to mull over. Today we've talked a lot about the power of naming your challenges. But what about the physical artifacts of your stress?

What do you mean by that?

Well, in psychology, there is a concept called enclosed cognition. It's the idea that the clothes we wear or the objects we carry are literally influence our psychological processes.Bill's REI chalk bag acted as a physical symbol of adventure that altered his mindset.

It reminded him he was climbing a mountain, not just lying in a hospital bed.

Right. So look around you. What are the physical artifacts of stress in your own life?Are the objects on your desk, the layout of your workspace, or even the clothes you wear while tackling a difficult project, inadvertently signaling to your brain that you are trapped, overwhelmed, or metaphorically sick. And more importantly, what is your equivalent of a rock climber's chalk bag?What physical object could you swap into your routine tomorrow to remind yourself that you are actively scaling an obstacle rather than just surviving one?

That is an incredible reframe. Hand yourself a different prop and you might just change the whole scene. Thanks for joining us on this deep dive. We'll see you next time.