Guilt is an unavoidable part of  a cancer diagnosis. Just like everything else, you have to deal with it as it comes. This is my latest post for Cancerwise. If you enjoy it, please visit M.D. Anderson’s site and view more like it.

 Hypothetical details of exactly how the proposal would align with the evidence of my diagnosis and the uncertainty of my future consumed my thoughts. Katie and I had been dating long-distance for two and a half years while she attended graduate school in San Antonio. I’d made the trip from Dallas to San Antonio often, but never with an engagement ring in the side pocket of my travel bag. This was it.

Despite the knowledge of an upcoming clinical trial, I was excited to ask Katie to marry me. I wanted to make her the happiest girl in the world. She deserved it. On January 14^th of 2012, amidst tears of joy, I clumsily stumbled through the reading of a letter that I had written for posterity. On the final page was the question, “Will you marry me?” She said yes.

The timing wasn’t perfect, but we had long talked about the possibility of our engagement. Cancer aside, we both knew that our friendship and the sharpened communication required to make a long-distance relationship flourish was a solid foundation for a life moving forward.

Despite our excitement, however, I still struggled with feelings of guilt. Unlike most guys my age, I couldn’t promise Katie the illusion of a comfortable and secure life. I couldn’t promise the avoidance of adversity or that I’d be by her side on the day I’m scheduled to turn 90 years old. I could only promise that I’d do my best to hold her hand as we navigated through my often ambiguous reality.

I spent the first part of my diagnosis pushing those feelings aside, never acknowledging that my situation was different from those of my peers. Guilt is easy to ignore when cancer doesn’t directly affect the lives of those intimately connected to you. That’s why it’s easy to push people away, to not let anyone get close to you, to give in to the temptation to isolate yourself from the world. Guilt is always best served in isolation.

Although I knew Katie was emotionally invested into our relationship, the significance of an engagement and eventual marriage meant that every result from every piece of bone marrow taken from my body moving forward would be reflected in the every tear of sadness or joy that falls down her cheek. In an irrational way, I feel responsible for that.

When I sought the engagement blessing of Katie’s father, I did my best to acknowledge this awareness and assure him that I’d honor his little girl in a way that transcends life and all of its misfortune. Even though I’ve overcome so much adversity at such a young age, it’s sometimes difficult to not feel inadequate. It was all I could do to assure us both that I’d never give up our happiness to an illness I couldn’t control.

Soon after our engagement, I began a clinical trial at MD Anderson. I didn’t think much about the possible impact the trial could have on our new life because I had never before experienced significant medication side effects. However, I’d soon learn that I underestimated the potential consequences of physical adversity.

The trial failed. Soon after, we met with a stem cell transplant doctor to discuss the process of a bone marrow transplant. This wasn’t how I envisioned everything would turn out. Welcome to the world of cancer.

As rewarding as it was to know that I would spend the rest of my life with my best friend, I felt guilty for not knowing how long the rest of my life would be. The thought of introducing Katie to unfamiliar emotions that no young adult should be asked to experience made me feel selfish. In the same way that cancer perverts the production of cells, the mind is constantly faced with deception. It’s often difficult to discern between false feelings and reality.

Is this my fault, I’d often ask myself. When treatment after a cancer diagnosis goes well, we’re encouraged to live a normal life. When that pursuit is disrupted by a questionable blood test or scan, it’s as if the normal life you tried to live was merely the fishnet used to expose a new set of people to the harsh realities of the cancer world. It’s no wonder that some people never try to live a normal life at all.

It’s hard to define the boundaries of guilt when you have cancer. In this context,  guilt is more like a drawing than it is a coloring book. Understanding guilt means to define the correct proportions, to properly illustrate the details, and to create an end product that is recognizable to everyone, including yourself. I’m sometimes exposed as not being a great artist.

Katie and I often talk to each other about our feelings and try to process what we’re each going through – which goes a long way – but guilt is an elusive emotion that is often hard to reach. We have to stay on top of it and constantly reassure each other that negative feelings are distortions of a deeper love and security. Throughout my seven years battling leukemia, I learned that guilt is a part of the diagnosis.

Katie and I will get married in October of this year. I’ve reached a complete molecular remission, and I know, for now, that the prognosis for a normal, healthy life is somewhat good. But it’s sometimes difficult to know that landmines exist in our household. This is our new normal. Every day that I wake up, I realize I am the luckiest person in the world, first because I have my health, and second, because Katie chose to be with me when she didn’t have to.