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human capacity to adapt. What we first imagine to be severely limiting can prove to be less destructive to quality of life because we can find alternative sources of gratification. Baum, as a psychologist, said that adaptation is often the goal of his work with his patients. Many of us adapt to frustrating and debilitating situations to a degree that surprises us. People paralyzed by accidents or by degenerative neurological disorders, some two years after losing motor function, often consider themselves to be as happy as they were before their loss. Many patients with a colostomy, a change that is often viewed with dread and despair, eventually reclaim a sense of happiness and satisfaction close to that before their colon was removed. Richard Cohen, who developed multiple sclerosis and colon cancer at a relatively young age, described his own trajectory of adaptation in his memoir, Blindsided; he later profiled other people with muscular dystrophy, inflammatory bowel disease, and advanced lymphoma. The capacity for adaptation was stunning in Cohen’s personal story and in his profiles of others.

Research studies show that all of us initially overestimate the ultimate impact of illness and its unpleasant side effects because we tend to focus on the negative and neglect the numerous positives in our lives. Daniel Kahneman, the Nobel laureate who did seminal work in cognitive psychology and decision making, emphasizes how this “focusing illusion” distorts our perceptions and plagues efforts to accurately envision the future. We often underestimate the reservoir of our resilience, the fact that we can adapt, and regress, and then strive to adapt again. Over time, we learn to expand those parts of life that still provide gratification and seek fulfillment in venues we had previously overlooked.

After intensive treatment for prostate cancer, Dana Jennings, a New York Times editor, wrote eloquently in that newspaper: “Despite everything that has happened the last couple of years, I’m a lucky man. I love my work, I’m blessed with two fine sons, and I have my compassionate and indispensable wife to snuggle with on these winter nights. Everything else will mend in its own time.”

When we checked in with Matt Conlin again six months after his surgery, we found that he had begun to adapt to his side effects. He was focused on his parents’ longevity, calculating that with his cancer gone, he would now live a long and healthy life. He decided to cut back on some projects at work so that he and his wife could take a leisurely trip to Paris and a gastronomic tour of France. With his daughter’s upcoming wedding, he was already dreaming of grandchildren.

Neither Matt Conlin’s nor Steven Baum’s story is finished. For some men, the side effects of urinary incontinence and erectile dysfunction lessen over time. But even if these problems persist for Matt and Steven, they will likely adapt.

Six

Autonomy and Coping

On an unseasonably chilly October evening, Julie Brody pulled off her T-shirt to put on a flannel nightgown and get into bed. As she lifted the shirt, her hand grazed a tiny bump under her left arm. “It was extraordinary that I noticed it,” Julie later told us. She asked her husband if he could feel it. He thought he could.

“You should go and get it checked out tomorrow,” he said.

“It’s the kind of thing I would ignore, because I’m very doctoraverse,” Julie told us. “But in my jovial manner, I called my gynecologist and said, ‘I seem to have this bit of a lump under my arm. It’s probably nothing.’ ”

The doctor responded with clear concern. “I’m booking you for a mammogram today. Hang up the phone and clear your calendar.”

Julie Brody, a short, slim, forty-two-year-old woman with a pageboy haircut and tortoiseshell glasses, had built a small, successful art gallery on the West Coast. She had always been healthy, and her only doctor was her gynecologist. She ate organic foods whenever possible, exercised regularly, and made sure she got adequate sleep. “All the women in my family are very strong and healthy,” Julie