This morning, I awoke at 4:15 am. As is usual for me, I typically sleep poorly the night before I have to wake up early to catch a flight. Last night was no exception. I awoke at 11:00 pm thinking that it was morning, again at Midnight, and again at 2:00 am. I don’t know if my mind doesn’t trust that my alarm will go off or if I’m just too excited about upcoming adventures, or if perhaps, I have wound myself into a tizzy getting loose ends tied up before I leave for a trip. I suppose it is likely a combination of all of these things.

Having not slept deeply, I was able to get ready quickly. I am going out to dinner with my friend, Robin when I arrive in Raleigh. Consequently, I used my friend, Cheryl’s conference travel trick of wearing comfortable traveling clothes that will also be suitable to wear at social hours and dinners out. The comfortable clothes part was fairly easy. I have a stylish professional and dress wardrobe. However, I stopped wearing clothes that need ironing or dry cleaning years ago. So all of my dresses are pretty comfortable. I also used my trick of wearing my bulkiest pair of shoes on the plane to save room in my luggage. This morning, it was a toss-up between my blue hiking boots and my black wedge sandals. The sandals are both very cute and comfortable, having been made by a savvy shoe company that caters to the middle-aged foot. Though I am not above wearing boots or sneakers with dresses in an airport, I opted for the sandals.

I typically get to the airport about 1 ½ hours before a flight. Yeah, I know that they say to get there two hours early but seriously, who does that? The cab arrived a little early and the drive to the airport was quick, and my airline was one of the first gates. So I was at the airport 1 ¾ hours early. I went through security (shoes are coming off again), found my gate, and bought a coffee at Dilettante Chocolates (they coffee is so much better than Starbucks’ plus there was no line, they are also local, and did I mention chocolate?)

By the time I sat in the gate area, I still had 1 ½ hours to kill. I sent out some silly Facebook postings, sent an “I love you” text to hubby, and watched the rain hit the tarmac with a steady strum. Time passed quickly, I boarded, and after the usual wait, the pilot’s assurance that we would be underway in a “minute or two” (airplane-speak for waits ranging between and minute or two and a several hours), we took off.

Despite the rain, the lower skies over Seattle were clear. In the early morning darkness, the city lights sparkled like fireflies. I could see the Puget Sound and islands in the distance. It was quite lovely. The effect reminded me of the beauty of my home town as well as a nostalgic reminder of the fireflies I found so enchanting when I lived in the South, which is where I am headed today, to the Raleigh/Durham/Chapel Hill area of North Carolina. I lived there for six years as a Clinical Psychology Ph.D. student at UNC-Chapel Hill. This Saturday, my Ph.D. program is having its first ever reunion, an idea prompted by the retirement of my dissertation adviser, Joe Lowman, after 40 years with the program, not counting his own years as a graduate student there. One of the faculty figured that since Joe had taught almost every living alumnus of the program, it was only fitting to have a reunion for all graduating years.

When I started graduate school in 1990, I was 24 years-old, and a newlywed of six months. I was one of the only married students in my class of 13 students. I had never lived out of the Seattle area having grown up in Renton, WA and attended college at the University of Washington in Seattle. I was only the second of my siblings and I to move more than a one hour long drive from my parents’ house. My younger brother, James and his wife, Meagan lived in South Bend, Indiana for three years while she was in law school at Notre Dame. But everyone knew that they were moving back and in fact they moved the day after her commencement.

At that time, I was planning to become a professor and knowing how few universities there are in the Pacific Northwest, I did not think I would ever again be more than a visitor to the part of the country I love so much. I remember at our first grad student orientation meeting, asking our department chair questions to clarify when the school breaks and vacations would be. She and my classmates probably thought I was a lazy student! The truth was that I was anxious and already homesick. I wanted reassurance that I would see my family again. All of these transitions, not to mention the fact that my childhood dog has passed at age 15 on my wedding day, created an abrupt take off to independence.

There were also the cultural adjustments. I had only been to the East Coast once not counting my changing planes in New York on the way to and from my honeymoon, from which I had just returned a week or so earlier. I had never been to the South and by that I mean the southeastern part of the U.S., which for cultural reasons, does not include Florida. (Having subsequently lived in north central Florida, I beg to differ.)

The first cultural adjustment was the humidity. It was August in North Carolina. I had just been in the dessert near the Egyptian/Sudanese border. This is one of the hottest places on Earth during the hottest time of the year. You know when people say, “It’s not the heat, it’s the humidity?” Word.

Okay, I know what you are thinking. Humidity is not culture; humidity is climate. Well, the humidity impacts the culture in the South, I believe, and that’s the story I am sticking to. The humidity in the South is like a character in a story. At night, walking outdoors among the outlines of live oaks and hanging Spanish moss, it feels like a seductive and exotic embrace. During the day, it is brutal, relentless, and soul-crushing. Life is lived, as much as possible, in air conditioned environments during the hot time of the year.

The second adjustment was the fact that I was only one of three students in my entire program who was from the West Coast. There was only one other student, Steve Geller, who was from Seattle but he was an advanced student who quickly left the area to complete his internship. Five years after I moved back to Seattle, I coincidentally became his office mate in our neighborhood of West Seattle, until he moved to Hawaii in the summer of 2012.

Chapel Hill is a lovely colonial college town. We don’t have colonial era architecture in Seattle. The oldest homes and buildings are from the late 1800’s and those are rare indeed. I only know of one, which is the oldest home in Seattle and the site of a small museum. In Seattle, we have totem poles that old but even Native American artifacts are not in great supply at least in western Washington due to wood being the most plentiful building material and our wet climate. Things rot. To see the old buildings in Chapel Hill, with their red brick that mirrors the color of the Georgia clay in the soil, was a lovely treat, like living in an outdoor museum.

My husband and I adjusted to living in North Carolina. In fact, we loved living there and would have considered settling there. We loved the rich history of contemporary fiction. I remember attending a short story reading in a converted 1700’s barn in Fearrington Village. These were authors who used words that painted characters with deeply saturated hues. And the music of the language was stunning. I loved it. To this day, some of my favorite authors are contemporary southern writers. Anyone who says, “Southerners are stupid” needs to pick up a damn book.

And maybe it has something to do with all of the eccentric, strong women in southern literature that allow my strong personality made waves in the South, it was not as bad as one might predict, though part of that may have been because I was in academia, an environment in which I have felt comfortable being direct and opinionated.

The last adaptation was adjusting to being in one of the most rigorous Ph.D. programs in the country. Psychology is a funny discipline. At the bachelor’s level, it is considered one of the easiest degrees to obtain. Now I took a more rigorous course of study to obtain a B.S. instead of a B.A. but even so my husband’s undergraduate program in computer science was so much harder than mine. But at the doctoral level, especially in clinical psychology, which requires both research and clinical training, psychology is a really hard course of study. Good God, the first semester kicked my ass. And it wasn’t that I performed poorly academically, it was just that I felt that I was working all of the time and running scared. For a while, I feared that I would be kicked out of the program. One of my classmates, who was an older student and therefore wiser said, “Elizabeth, you are solidly passing all of your classes (we did not get A, B, C… type grades). Why would you get kicked out?” Thank you, Craig, wherever you are. Eventually, I became a confident student. Honestly, I loved graduate school.

I have not been back North Carolina for eight years and my past trips have been brief. This is also the first time I’ve been there traveling without my husband. That makes it more of an adventure and a reminder of very exciting and important times in my early adulthood when the world opened up to a big big place.

I look forward to seeing you, my home away from home. You are the place where my husband and I built the foundation of our young marriage and shared our dreams for the future. You are the placed I learned a profession I love deeply. You taught me the importance of friendship and how friends can be like family. For awhile, you gave me a cool accent and you performed the miracle of getting me interested in spectator sports with Dean Smith and the Tarheels.

Chapel Hill, you were good to me, except for that damned humidity.

I live in the far northern reaches of the lower 48, you know the U.S. states that don’t include Hawaii or pertinent to this discussion, Alaska. During the summers in Seattle, we cannot believe our good fortune! The days that seem to last forever! The temperatures that rarely go above comfortably warm. It is true that the area in which I live is virtual Eden of during the months that are burning hot in the rest of the country. And then fall comes, in particular, “Fall back”, the adjustment from Pacific Daylight Time to Pacific Standard Time. Hello, darkness my old friend.

If I am honest with you, there has been a general trend that tells me that my adjustment to the Fall has not been good in recent years. When I was younger, Autumn was my favorite season. Summer, bleh, too hot. However, this was many years before I lived in North Carolina and learned that 75 degrees Fahrenheit is not hot. Also, 80 degrees is not so bad. When hubby and I moved to the South for graduate school, we opened the Pandora’s Box for warm weather acclimation.

For the last three Octobers, I have felt the pull toward low energy. I do not have Seasonal Affective Disorder, the depression caused by the low light conditions of winter. But I do get very tired in low light conditions. I am struggling with this, as we speak. It is ridiculously weather related. I spent last Saturday on my ass with cotton brain. The sun came out instantly and I immediately felt happier and more energetic. How predictable.

Last year, one of my doctors told me that it just might be a good idea for me to schedule fewer patients during the fall and winter, due t the fact that I had low energy during this time. Meanwhile, she gave me acupuncture treatments in hopes of raising my energy level.

I have learned to make some accommodations. I take extra vitamin D during these months. I continue to walk outside. It is particularly important for me to connect with nature and the reduced sunlight. I use light therapy for about 15 minutes in the afternoon. This summer and during the early fall, I changed the lighting in my living room. I added stronger lighting to buffer against the darkness in my beautiful part of the world. This year, I am also trying out a wake up light, an alarm clock that simulates the light of dawn at the time that I appoint rather than that dictated by Mother Nature, who is a little withholding up here during the short day light months. Since cancer treatment, my former status as a morning person has been questionable.

I may just have to accept a “new normal” that these are low energy and low mood months for me. But I enjoy being energetic and happy too much not to try a few things out.

Stay tuned.

“He’s a boy. He’s my friend. But he’s not my boyfriend!”

Since I was a girl, I have heard other girls say this time and time again. First they were my peers, then my patients, then a variation of this said by my own daughter. The last time I read the research literature on the subject (ahem, awhile ago), I learned that children will play and interact with both sexes equally until about age 3, at which time same sex preferences become the norm.

I have had close male friends since I was a teen. And since I was an adult, men have been among my very closest friends. My husband is my best friend and has been for 28 years. I’m not talking about him. I’m talking about my platonic male friends.

I suppose this is somewhat unusual. At least, most of my women friends do not have non-related close male friends. At my core, it’s felt natural to me. I grew up with five brothers and my mom has had male friends through choir for many years. I am interested in people and men are people.

I have to admit, though, that making and keeping male friends requires hard work. The easiest way to have a male friend, or any friend, really, is to work together. I don’t have any male colleagues at my office. Most of my close male friends don’t even live near by. Most of them live on the east coast.

I had a sad epiphany last week. I was talking to a close male friend and asked him a question. I don’t remember what the question was but I realized after asking it that I already knew the answer and I had been asking out of irrational anxiety and seeking reassurance about the stability of our friendship. I commented on this to him and noted that I needed to think about why I had asked the question in the first place.  Then the answer came to me. “I’ve lost every close male friend I’ve ever had.”

I didn’t mean that I’d fought with them or that I no longer considered them to be friends at all. People move. I’ve lived around the country. So have a good number of my friends. Men get married and get busy with family. They tend to work longer hours. On top of that, men are less likely to be taught how to maintain friendships across distance, how to make phone calls, emails, send Christmas cards, etc. Whenever I happen to see these friends, however, they are thrilled to see me.

Are you surprised that the reasons were not because of the man/woman thing? There is research showing that men tend to sexualize friendliness from women whereas women just think they are being friendly. And I also recall many hours as a research assistant reading essays by men and women who were asked to pretend that they had met God and to describe the encounter. As part of the research, men were told that God was female and the women were told that God was male. The women tended to describe God as an ideal friend, a great listener, kind, and someone who understood them. The men’s essays included a lot of sexual fantasies. But these studies were conducted long ago and the men and women studied were college students. People have a way of growing up.

It is true that I have had a couple of close friends try to cross friendship boundaries. But they were not crazy and I was clear about the relationship. They got an earful from me, I let my husband know what had transpired, and the relationships survived. And yes, sometimes I flirt with men to whom I am not married. It happens. I never found myself in hot water over it but maybe in luke warm water.

The main impediments I have found are logistical. And yes, I can reach out. I have, many times. There are only so many times I will call, email, or write with no reply. I don’t take this personally but I find it very sad.

Later this week, I will be in North Carolina for my graduate program reunion. I am spending a good part of the day with one of my male friends, who was one of my very closest friends for 3-4 years. We have not spoken to each other since I last visited NC eight years ago. We have texted 2-3 times since then. I know that we will have a marvelous time together. He will be thrilled to see me. But I also know him and he will feel guilty for not keeping in touch. He’s that way, plus when he disclosed recently that he missed me a lot, I did not let him off the hook. “If only there were some communication tools we could use to solve that problem”, I asked. (Yes, I know. I can be an ass kicker. But sometimes people need a light ass kicking from their good natured friend. This was one of those times.)

Friends are so very important. There are a source of love, joy, silliness, and solace. They are only a phone call, a Skype, or a text away.

As you know I am a child/adolescent psychologist with a private practice. A few years back, I got a voicemail from one of the local news stations asking me if I was interested in writing a parenting column for the health section of their website. I returned the call and listened to the description of the webpage. I also looked at it online while on the phone, at the man’s suggestion.

Then he said it. “So, we want to partner with you financially to set up your parenting column.”

I said, “Wait a minute. You’re selling advertising.”

After I confirmed this to be the case, I continued, “Look, I run a business. There was no reason for you to hide the fact that you are selling advertisements. Businesses advertise. But I need to tell you something. Psychologists are ethically bound to be honest in how we represent ourselves, our education, the methods we use, how much we charge, and what are intentions are. If you want to engage with us, you need to be honest.”

We ended the conversation awkwardly and I suspect he may have even thought of my emphatic assertiveness in an extreme unfavorable light, a response with which I have become accustomed over the years.

One of my friends is a professor back east. She is a cancer researcher and does basic work on the metastatic process. She says that the power and influence of breast cancer research advocates is discussed by her colleagues. It is reassuring to hear that we have a voice and influence.

But because of this, we are ripe for exploitation. I was contacted earlier in this week by someone who was representing an organization that purportedly raised breast cancer awareness and was raising money. They asked if I would be wiling to be featured on their website. I did a little quick Google search and discovered that there was a business behind the group. The purpose was to promote a particular panel of medical tests to guide breast cancer treatment decisions. Having benefited from the information provided by oncotype testing, I understand the benefit of such tests. But why not inform me of the real purpose of the group? Consequently, I declined and further noted that I was uncomfortable with the lack of up front disclosure.

It was a bit of a surprise to me that my modest blog might be seen as a resource for free advertising of a medical test. But it’s easy to find breast cancer blogs and easy to send each person a form letter email invitation. The breast cancer blogging community, as a whole, communicates information quickly and widely.

In both of these examples, I was offered something that I may have actually given serious consideration to if I had been told the truth up front. At the very least, I wouldn’t have felt like someone was trying to take advantage of me for their own profit.

The worst of this in breast cancer, as you will read time and time again, is the use of these horrible diseases and their high profile, to make profit. Companies use pink ribbons as an icon of respectability, honesty, and compassion, even if they do very little to help eradicate breast cancer. It has become such a powerful iconic communication that  a lot of people don’t even notice anymore how incredibly tacky and tasteless a lot of this merchandising of our disease is. For example an enormous pink bra statue was installed in a busy pedestrian area of a city. It was inscribed with a healthcare company name and directions to advertise said company through texting so that a tiny bit of money, much less than was likely needed to build and install a 3/4 ton statue.

Then there are all of the sexualized images of women that are used to promote breast cancer awareness because sex sells. You know, if these companies really thought about what they were doing, I mean REALLY thought about it, do you think the marketing departments would say, “Hey, we can make money by leveraging the power associated with a physical disease by combining it with the influence of the cultural disease of sexism. The air of philanthropy legitimizes it and the misogyny will close the deal.”

The last bit, the last layer of this that bothers me so is that not only does all of the pinkwashing use the sexism that is already present in our society to propel itself but by legitimizing it by associating it with a charity, a way to supposedly help women, it makes sexism even more insidious. As a woman, I find this reprehensible. As a mother of a 16 year old girl, I am outraged. As a human being, I am livid.

I emphatically assert that we need more money for breast cancer research. To better understand it, to better treat it, to cure it, and to prevent it. One out of eight women and one out of eight hundred men in this country will develop breast cancer in their life time.  These are awful diseases, just awful.

So much about my breast cancer and the commercialization of this disease has reminded me of my youth, when I would be groped and sexualized by boys and men. When I complained I was often told that I should be glad to be desirable enough to solicit attention.

I am very happy to be alive. But I will not be exploited and told that it is a small price to pay for “increased awareness”. I have a brain and I know how to use it.

Corporate America, you may be powerful, super powerful. But even in my few short years as a breast cancer patient, I see increased outrage about Pinktober and it’s exploitative underpinnings. Things are changing and if I’ve discovered one thing about the breast cancer community is that we organize, we write, we talk, we support each other, and we grieve for eachother. We wish these diseases on no one.

Ta ta’s, my ass.

Several times a year, I observe one of my patients in the classroom as part of my assessment. This step is particularly helpful in assessing very young children. Once kids get older than 1st or 2nd grade, it’s hard to get a good observation in just an hour because the behaviors of interest just don’t occur as frequently by that time. So when I observe in a classroom, the kids are anywhere from 2 to 7 years old.

This morning, I observed a student in a classroom of 3-6 year old’s.   I haven’t seen little kids like this in some time due to changes in my work I made in order to accommodate my cancer treatments as well as to reduce my treatment load (I used to see lots of little kids and their families) so I could get home earlier for family reasons. Honestly, I miss little kids.

What a sweet little classroom it was. I see a lot of wonderful teachers. The teacher in this classroom was excellent in a way I don’t see a lot. The quietly compelling teacher. The gentle but engaging teacher. The patient but direct teacher. She was just lovely to watch.  I told her this as I left the classroom. She smiled, gently set her hand on my arm, and then put it over her heart. The students loved her. They trusted her. They followed her direction, which she did with encouragement and love.  I try not to attract attention when I observe but even so, when children happened to pass where I was seated, they smiled at me and I smiled back.

Sometimes visiting a little community like this is a truly beautiful experience. This was one of those times and I found myself feeling very moved, my eyes nearly welling with tears. It is not that small children learning in a nurturing environment, where they receive and give love, is not worth tears of joy. But there was something else I was feeling, wistfulness, a longing sadness for things lost.

I have had this feeling every morning since Sunday. At first I thought it was just related to my having had a wonderful two day visit with a friend, come to an end, kind of like that let down on Christmas after all of the packages have been unwrapped, the guests have left, the floor is a mess, and the dishes need to be done.  That was part of it but not all. A couple of days ago,  I also realized that the two day visit had given me a very much needed break from the stress not only from my job but from my family life. For two days, I concentrated on fun and entertaining people. We are not supposed to admit this as parents, especially mothers, but I must say also that I experienced many hours of feeling almost childless and this was enormously lightening. It was almost like I imagine not thinking of having had breast cancer for an entire day.

This morning, I understood another layer. I miss having a small child. I love my daughter; she is a force of nature and a singular sensation. It is still normal for her to say something if not very sweet, at least positive about my husband or me, each day. But there are also the other times, the hard parenting times. These are times that stress out the family a great deal. When I was a researcher at the University of Washington, we followed a treatment model for parenting teens, which included a  focus on guidelines, monitoring, and consequences (positive and negative). My husband and I are in the camp of parents who provide all three parts. Most parents provide guidelines to their teens, many provide consequences, effective, ineffective, fair, unfair, and/or harsh. A lot of parents, however, do not adequately monitor or supervise.

Consequently, our kid gets busted for stuff that other kids get away with because their parents aren’t paying good enough attention. And this makes here angry and insulted in only the way teen can get. Instead of “Oh no, you caught me doing x, y, and z” it’s “I can’t believe you violated my right to do x, y, and z, not that I am admitting to doing any of those things!”

Testing parental limits is a normal part of growing up for a teen. And she did it when she was little, too. And sometimes she even said really mean things to me, as mean as a four year old could be, “You’re not my friend!” “I’m going to punish you!” Or in the words of the young patient I used to have, “I’m going to put you in time out for a hundred fousand years!!”

When our kids are little, some of these statements can sound pretty funny, especially if your child still can’t pronounce /th/ in “thousand”. They are also, little. Little kids can make a powerful racket and they can express powerful feelings but in the end, they are small. They are not powerful. But teens have a lot more independence. They have a lot more power. And they often don’t want our help or limits even when they need them. When a little kid has a tantrum after testing limits, it’s typically over in a short amount of time. Even kids who have horrible and intense tantrums are usually done in an hour or two. Not to dismiss the stress of those kinds of tantrums because it is considerable, but an older child due to their increased cognitive development, can hold a grudge for a really long time. And they can test for a really long time. And because they are harder to supervise, there are tests you fail as a parent because you didn’t even know to show up for them.

We all want the best for our children, to be happy, to be responsible, to have healthy relationships, to be able to contribute positively to society, and to be able to care for themselves and others.  Some days it is incredibly exhausting and I know that it is for her, as well. And then empathizing with her tumult, creates inner turmoil for me.

Little children are so much simpler. Their world is so much smaller and they are typically happy to have you be in it. When my daughter was in preschool, she used to tell me how much she loved me in delightful ways. One of them was, “I love you more than the world has changed. And the world has changed A LOT!”

I miss my little girl. I miss her as much as her world has changed. I love the young woman that she is even more. But most of all, I pray for her happiness and her health, that her unique gifts will be fully appreciated out there in the world without my husband and me.

A common recommendation that I make on behalf of the students I diagnose with ADHD is to seat them in front of the teacher.

I mean, who wouldn’t think of that? A kid who has attention problems? Where else would you put him or her?

Although most teachers figure this out on their own, the number of times it doesn’t happen is surprising.

“Next to the fish tank”, “In the back”, “Next to the open door” are the seat locations that I hear about  with alarming frequency.

Today I thought to myself, “Why would a teacher do that?” I’ve had this thought before but this time I really thought about the answer.

“Hmm, if I sat a kid next to the fish tank, he might just zone out on the fist right next to him rather than repeatedly getting out of his seat to walk to the fish tank.”

“Hmm, if I sat a kid with ADHD right in front of me, I might be distracted when I am trying to teach.”

Sometimes we move problems away from “front and center” because it is more convenient, at least in the short term. In the case of these students, the short term solution may leave them better entertained and thus less disrupted. But in the long term, they are also less well educated.

A major challenge to a happy life is to know when to move challenges to front and center and to know when they are best left in the periphery.

Last Friday, I hosted a lovely dinner party for friends, most of them new. One was a new “3 D” friend, someone with whom I have been friends via cyberspace but not in close proximity. (Read about it here.) At a certain point of the evening, we noticed that one of our six month old kittens, Basie, was missing. Since our house has been “Party City” since early September, the kittens have had lots of experience with visitors to the house. And they have taken strangers in stride, not hiding away like some cats are prone to do. So I was very worried. Our kittens have never been outside but I suspected that Basie had gotten outside. We live near a busy street. We also live in a neighborhood with many raccoons, who have been known to hurt or kill cats and small dogs. Not to mention the occasional coyote that sometimes graces our urban landscape.

In the back of my mind, as the hours ticked by, I was fairly convinced that there was a very good chance that Basie was dead. And his sister and litter mate, Leeloo was acting distressed without him.  It was already dark out. How does one find a black kitten in the dark? It’s not easy, let me tell you. I could tell that during the dinner party, John was going outside with a flashlight from time to time. And when he returned, I did a couple of outside rounds of “Here, kitty kitty kitty kitty kitty!” No response.

So I returned to my dinner party and did my best to keep my worry in the background. The party came to a close and I went to bed, with only one of our awesome kittens in bed with us. But again, I knew that worrying about it wouldn’t help. I just needed to do my best to sleep.

At 1 am: “Meow meow meow meow meow” we hear on our deck. Basie had come back! What a relief! Oh Basie, please no more adventures!

But I was so glad that I did not put my worry front and center when I had a dinner party and very little I could do about a jet black kitten lost in the night.

It is so difficult to know, at times, what thoughts, feelings, or experiences need to be at the “front and center”. Sometimes it is now, sometimes it is the past, and sometimes it is the future that needs to be there. And then it can change again in a second.

It’s a wonder we don’t all have psychological whiplash.

As many of you know, breast surgery often results in a lost of sensation. I had a right side mastectomy. I would make sense that in removing all of that tissue that nerves would also be removed. Now my grasp of physiology is better than the average person, but by no means expert. What I can tell you, though is for nearly two years, I have had no sensation at all in the area where my right breast used to be.

This means feeling no pressure, no heat or cold, and although it is delicate to say, no sexual response. Actually, if I want to be really clear, there is no response at all. No affectionate response. No, ”ow, you just accidentally elbowed me in the boob” response. My husband could hold a hot coal to this breast and I would not feel it. No one warned me of this side effect but I had read about it myself. So prior to my second lumpectomy when my husband asked about whether a bilateral mastectomy was indicated, I responded by spelling out the implications for our love life. I had already completed a literature review on my risk of contra-lateral breast cancer, learned about the Gail Index and so forth. I knew that my estimated risk of cancer in my left breast was at a level low enough that I found personally acceptable.

In the last few months, I’ve noticed something. The numbness in my tissues has subsided to some point. I am starting to regain sensation, at least around the edges of my mastectomy site. But what I am feeling is the occasional itch. Sometimes it is deep down and unreachable. Most times it is on the surface of my skin. I am allergic to wheat and when I do eat it I get a flare of eczema within two days and it takes about two months to clear. If I cook all of my own food, this does not happen. But over vacation last August, I ate out, had a salad, and there must have been some wheat in the dressing because I am still waiting for my skin to clear. At one point, I could see that I had an eczema flare over my breasts. We also had family photos taken at the time. It looked like I had acne. Oh well. In any event, I could feel the itch of the eczema. However, when I scratched it, I felt no relief. As my internist told me when I described it to her, “That’s just not fair!” My rash, however, got worse.

In addition to itch, I have also had the return in a sensation that can only be called, “uncomfortable”. It is the mildest of pain, though still noticeable. And it is, again, felt around the edges of my mastectomy, which was performed in August of 2012. It would not be until March of 2013 that the major part of my breast reconstruction would be completed. I am no surgeon but in my own logic, it seems likely that more digging around and transplanting that occurs, the longer tissues take to heal or as my plastic surgeon describes it, “settle”.

I have numb parts. They are starting to awaken. To what extent they will awaken is unknown. But what I do know is that the awakening is uncomfortable and at times, a bit painful. This has called to mind the numbness that can happen to each of us emotionally and cognitively. I consider myself to be above average in self-awareness. However, I have neglected parts of myself, the parts that are numb. And numb parts get that way through damage, through loss of trust, emotional baggage, past trauma. Our mind protects us from many scary and lonely thoughts and feelings. The problem is, however, that it can do too good of a job.

Sometimes the parts of us that are most important, most in need of attention, are the parts that we just don’t think about or feel. The parts that are tired, afraid, and numb.

As you know, I have been digging deep and trying to feel what I need to feel and process it all through. It is a painful but productive process. In keeping with my mindfulness practices, I have tried to keep with my thoughts and feelings throughout. This has guided my decisions. At times, I move forward, full steam ahead. At other times, I take breaks. At these times, I catch my breath, assimilate new learning, and observe a new way of looking at my life.

There are parts of me that are coming alive. At this point, there is discomfort but I believe that in time there will be continued healing and awakening.

Many years ago, I was to meet my husband at his work and then his co-worker, Dwight would take us to the airport. I think this was actually the trip we took to the U.S. Virgin Islands. It was a big deal.

I left plenty of time to drive there and because it was before the era of electronic devices, I got detailed driving directions to John’s work. You see, I get lost really easily when I drive. GPS technology changed my life. But we didn’t have it back then. We also didn’t have cell phones.

So I drove from Chapel Hill to the Research Triangle Park in NC. I got utterly and hopelessly lost when I was very close to John’s workplace.  By the time I got there, I was really late, and it was going to take a miracle for us to get to the airport on time. I hold my breath and tried my best to keep it together until Dwight got us to the airport. He drove us up to the passenger drop off site and we ran into the airport.

It was at this time that we discovered that we were not late at all. Our flight had been delayed.

You’d think I’d say, “hooray!” Instead, I folded myself into my husband’s arms and balled my eyes out.  All of the responsibility and stress I’d felt about missing our flight, missing our chance to spend time in the tropics, flooded over me.

The memory of this event popped into my brain today. A friend from the breast cancer community was feeling incredibly anxious. She didn’t understand why. She had just gotten positive on her last MRI even though she’d expected the worst. I told her that this kind of falling apart happens. “Really?”, she asked. “Nobody talks about it.”

Hmm, she may have a point there. I actually MEANT to write about this myself. I don’t think I ever did.

I don’t think this process applies to everyone but it certainly does to me. I get most stressed in anticipation of stress, deal well with the stress itself, and then fall apart at least a little after I get to breathe again. Emergency mode doesn’t allow for reflection. It’s just decision, decision, decision, action, action, action. Then when the crisis has past, there is exhaustion and also reflection on what could have been.

I am feeling a bit of this today. I was triggered by my husband expressing a lack of happiness with my stress level. I didn’t do anything awful, I was just acting on edge along the lines of, “Are you sure you turned the stove off?” You know, the anxious questions. He told me that he didn’t like it. He wasn’t unreasonable about it except that I thought he could have given me a pass because of my anxiety about the scan. I told him this and then I also shared with him my distress that he tells people that I am “cured” and that I have “a clean bill of health”. I reminded him that the best I can be is “no evidence of disease.” This was not a conversation I have previously had with him though he reads this blog faithfully. I hadn’t talked to him about it because I thought he needed to think these things to function. But today, after being mildly rebuked and having had to remind him of the scans a couple of times, I felt the need to wake him up to my reality. Maybe it was a good idea. Maybe it was not. I don’t know.

What I do know is that cancer is damned stressful, having it, maybe having it, maybe getting it again, etc. I also know that it is stressful for my family.

As I write this, I realize that I don’t know how to end this post. But I guess that’s fitting. This process will be never ending.

If I’m lucky.

I just got a call that my MRI was clear. Yay!

Recently I met with some parents to obtain background information as part of my assessment of their son. They are highly educated people, both with advanced degrees. They have three young sons, all of whom they speak of lovingly. The father charmed me with the fact that he calls his sons, “honey”. There words were measured and they described their concerns about their oldest son, his tendency at time to not to own his own actions, his quickness to anger, and his frequent use of exemplary verbal ability to argue with adults.

Despite their calm and professional demeanor, I could see the mounting fear behind their words. Their fear for their son’s happiness and safety in the world. We had had a chance to establish some rapport and I decided to take a chance on expressing an awareness of an issue that had yet been unsaid. “I can only imagine the stress that you feel in raising a Black son who has these difficulties, in our country.”

Both parents nodded vigorously and the father said with palpable relief, “Finally, someone gets it.”

I am not African American. It was chancy for me as an outsider to make the comment that I did. It was also chancy for me to use the term “Black” instead of African American. The former is more likely to be acceptable when used by African Americans, not by an outsider and further a member of a privileged race, such as myself. But I thought “Black” was a better reflection of their own thoughts and feelings about their son. I also know that due to my personality, I tend to be able to say things like this and they are interpreted in the way I intended. But I am still very careful. I will never know what it is like to be African American.

But I can try to understand the best I can and to be aware of the common challenges that African American families face. And my awareness must be more than an internal event. It needs to be linked to effective action. In this example, my action was communicating my awareness of the rational sources of their fears. These parents have three boys. The number one cause of death for African American males between the ages of 15 and 34 is murder. And one might think that the risk does not apply to these boys because they live in an educated and relatively affluent family. I think realistically, it may buffer this risk to a certain extent. However, even looking at my own life, I know there is a particular danger that cannot be eliminated. I have a lot of friends. A great number of them have advanced degrees. Two of my friends, both Ph.D.’s, have had murder in their immediate families, one attempted and the second resulted in the death by shooting of a friend’s brother, who was waiting in line to get into a night club. Both of these friends are African American women from well educated families. One of them even had an uncle who ran for president of another country.

There are many people who live with the cloud of potential catastrophe. We are often unable to fully appreciate it but we can do our best to understand.

I am awaiting the results of the routine MRI I had yesterday. I am learning to deal with the anxiety of these scans but I am anxious. My husband forgot about the MRI even though I’d told him a couple of times as recently as the day prior and had asked him to accompany me. His alarm went off yesterday morning at 6:30, his normal time to get ready for work. However, he was planning to go to work after my scan and it was not until 9:45. He was getting up too early to have remembered the scan so I reminded him and he came back to bed. My husband is more forgetful than I would like. But I understand that he is not doing it on purpose and further, he would have seen the appointment on his calendar. Plus, he doesn’t live in the perpetual state of Potential Cancer so there are some things he doesn’t quite understand about my experience as a cancer patient. Similarly, a close friend apologized to me yesterday for checking in with me about my MRI. He’d had quite a stressful day of his own and again, he doesn’t live in the state of Potential Cancer. Before I lived there, I didn’t really worry so much about my friends’ scans once they’d had no evidence for disease for a couple of years. The panic subsides. I don’t want my husband or my friends to live in the Potential Cancer state with me. I don’t wish that on anyone just as my friends with metastatic disease wish it for others. But the actions that come from understanding our situation are important.

As a world, we need to find a cure for breast cancers. But as individuals, we also need people in our lives who have an awareness of the unique stresses of being a breast cancer patient who are also able to convert their awareness into emotional support. You,  friends and family, may be helpless to prevent recurrence or to cure a loved one’s active disease, but you can provide emotional support. You can make living in the Potential Cancer state or the state of Perpetual Cancer more bearable and less lonely.

Perhaps it would be helpful to explain to you what scans mean to me. A clear scan means that I can live another six months with “no evidence of disease”. A clear scan to a person with metastatic cancer means that they can live with “no evidence of progression”.  If my scan shows evidence of cancer, I will go into the fast paced chaos of not knowing and having many tests, the perpetual “hurry up and wait”. If it turns out that I’ve had a recurrence, I will likely undergo a more aggressive treatment protocol than I did in the past and to undergo previous treatments for which I now appreciate the full impact having gone through them before. By the way, a lot of cancer treatment sucked. My family will suffer. My patients will suffer. I could go on and on.

I keep telling myself that the results of a scan, assuming accuracy, don’t tell me anything about myself that wasn’t true yesterday. I often tell my patients this about the diagnoses I give them. “You are the same person you were yesterday.” On myself, this is a hard sell. I am a clinical psychologist. Nobody comes to me unless they already know something is wrong. Something is not going well. There is a problem. I didn’t know I had cancer. I felt fine. There was no lump. Right now, due to my mental and physical health practices, I feel healthier than I have in years. But cancer can hide for  a long long time without someone even knowing something is wrong.

For me as a cancer survivor, it is surreal at times to realize that I can’t trust my own sense of my body. I can’t gauge my own health. My body can lie to me.  I try to be a very truthful person with myself and with others. Honesty and clarity are extremely important to me. This is hard.

Offer your loved ones your understanding and support. You don’t need to live with us and we don’t even want you to,  but do connect with us. And when the Pink wave  tells you that awareness is action and pink is helpful, put your money and volunteer time somewhere else. Somewhere that helps.

Gray and black clouds
hide the sky.
The light shines through
There is clarity above.

The clouds will burn off
maybe today
maybe tomorrow
some day, certainly.

I will see the sky
I’ll know if I traveled
during the quiet space
between dreams
to the terrifying place
the familiar chaos,
the Cancer Place.

This morning's sky inspired the poem, my first in nearly 20 years so be kind.

This morning’s sky inspired the poem, my first in nearly 20 years so be kind.

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