In my psychology practice, I am often asked by parents, “What is the best school for my child?”

The children with whom I work, by and large, are not well suited to your typical school. I could tell the parents what qualities that I think would be best for their children, but the truth is, for most families, the ideal doesn’t exist. Consequently, I respond by asking about constraints.

“What is your neighborhood school?”
(Schools should be comparable across the area, but unfortunately, that is far from the case. And I’m not just talking about limited availability of good public schools in low income areas. I’m talking about limited availability of good public schools in ANY area of my city. But there are some.)

“Is private school an option?”

“How do you feel about religious schools?”
(There are a number of religious schools in the area that do a good job of providing a nurturing but structured environment. Also, of private schools, the religious one charge less money than the secular schools.)

“How far are you willing to drive your child to school?”

In other words, before I say, “Your child’s ideal school environment would include x, y, and z”, I narrow things down to the most attainable options.

I do this for two reasons. First, it is a very practical approach. Secondly, it is far less discouraging.  We could go on endlessly about the characteristics of a “perfect” school only  to discover that it simply does not exist.

No one likes a “dead end”. We like the idea of endless possibility. However, knowing the dead ends, the improbabilities, and the impracticalities, can stop us from spinning in a life of too many options, many of which are false ones.

There are dead ends in my own life. There is no longer the option of “I will live my life as if there is an unlikely chance that something REALLY bad might happen.”

REALLY bad things have already happened.  Scary, awful things.

Knowing that this way of thinking is a dead end in my life is sad but it is also liberating. Knowing what I can’t do makes some of the choices simpler, in a way.

Today, I choose to live the best life that I can within the constraints that define me as an imperfect human being.

Today, my life is pretty darned good.

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I am not pithy. You may have noticed. I used to write poetry. It was pithy. But the truth was and still is that I have to think A LOT to write a little. Not to mention the rewriting process.

Okay, I’ve already written more than I intended. This is supposed to be an introduction to a poem I saw in the woods at the Bloedel Reserve. April is poetry month.

I like this more than a pithy amount. Maybe you will, too.

Song of the Thunders

Sometimes
I go about pitying myself
while I am carried by the wind
across the sky.

-Songs of the Chippewa
-Translated by Francis Densmore

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It’s spring.

I have wonderful family and friends.

I am thankful.

DSC04736Salmonberry blossom at Fauntleroy Creek, Seattle.

 

DSC04835Peony. Seattle Chinese Garden.

DSC04998 (1)Dogwood from the neighborhood.

 

DSC05025Bloedel Reserve, Bainbridge Island, WA

DSC05044Skunk cabbage looking glamorous.
Bloedel Reserve, Bainbridge Island, WA

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DSC04444 (1)Neighborhood cherry blossoms.

DSC05031Pileated woodpecker at the Bloedel Reserve.
She flew from this tree to her nest, located in a hollow in a nearby tree.

It is National Siblings Day so I am reposting this one from November 2012 about my younger brother and me.

I have mentioned perhaps one or six hundred times that I have five brothers. One of my older brothers’ favorite “games” was pig pile. This involved announcing a victim and then having five siblings tackle and pile atop this person. For example the exclamation, “Pig pile on Liz!” was followed by my being tackled and piled on by five brothers, the oldest of whom was nearly 10 years my senior.

Pig piles seemed to be exclaimed on a very frequent basis and as the only girl of six children and the second to youngest it seemed that I was more often than not, the vortex to which the pile was attracted. A Bermuda Triangle of porcine piling, if you will. As the “baby” of the family, my brother James also spent a fair amount of time face planted on the living room floor beneath four sets of sprawling limbs shod in Converse low tops of various sizes.

Although our older brothers would admit to the pig piling, they would disagree with the metaphorical implications. They believed James and me to be spoiled. We avoided the horrors of ruler wielding nuns, whereas they all attended St. Anthony’s School, for example. Our family also had a little more money when I was growing up, not a lot more but just enough to fuel the “you’re spoiled” flames. I maintain that whatever advantages we may have had were more than offset by their mean older brother shenanigans.

James and I are only 18 months apart in age. Our next oldest sibling, John is 3 ½ years older than me and 3 ½ years younger than our next oldest brother, Mike. John was kind of caught between the “big boys” and the “little kids” of the family.

James and I spent a lot of time together. We played together a lot. We mostly got along very well though we could sometimes fight verbally and physically at which time my mom would yell, “I don’t care who started it. I’m finishing it. Go to your respective rooms!”

We played a combination of traditional boy and girl activities. We played with cars, trucks, and climbed trees. We designed obstacle courses in the yard and spent hours upon hours in the woods surrounding our house and neighborhood. We did not, however, play with Barbies or baby dolls. Remember, this was the late 60’s and early 70’s. My mom made us each two sets of Raggedy Ann and Andy dolls as well as a bunch of stuffed elephants. Due to her combination of genius and industry, we were able to play dramatic reenactments of family life with more socially acceptable dolls.

James was not really interested in formal music training, but he has an incredible ear and natural musical ability. He is also extremely funny. By the time I got to high school, I was pretty serious in my classical flute playing. He had a plastic slide whistle and would frequently copy whatever piece I was practicing in my room, complete with vibrato and when era appropriate, Baroque runs. When it wasn’t infuriating, it was hilarious.

These days my brother plays more music than me; he taught himself drums and plays with his 17 year-old son’s band. The only music we make together is the occasional game of Rock Band. The thread that carries over the years is that fact that my brother can always, I mean always, make me laugh.

He reminded me of this last Friday. James attended the requiem mass at St. James. I was kind of surprised to see him there since it was a pretty long drive for him and I think he hates to drive even more than I do. We got there an hour early to get a seat. During the time before the mass started, he was cracking me up and my laugh was echoing throughout the cathedral. When we were kids, due to different church rules, we were not allowed to talk before or obviously during mass. So with this as a back drop, his jokes have always been extra hilarious. I’d laugh, he’d say, “Now if any other family is coming tonight, they will be able to find us.” Then I laughed harder than before. Then he started singing family gossip in his version of Gregorian chant. I lost it again. Now here’s the thing about my brother. His antics are not particularly loud. He is actually a fairly introverted person whereas I am loud and gregarious. I believe he very much likes to set me up and watch the loud fireworks of my laughter, knowing that he is the one who lit the fuse.

James and I were successful for decades after our childhood in avoiding the bottom of the pig pile. Then I found out I had breast cancer and it wasn’t my older brothers that piled on top of me, it was the world in which I thought I had lived, that dissolved and crashed down on me. During the acute stage of my breast cancer treatment, there were many ongoing assessments and constant revisions of my treatment plan. When I was recuperating from surgery and bored, meaning prime time for worries to creep in, I called him, “James, I am bored. Tell me something funny.” And he did. And when I was anxious about waiting for the results of oncotype testing, which would determine whether my oncologist would recommend chemotherapy or not, I called my brother, “James, I have 20 minutes until I need to leave for my appointment. Can you tell me funny things and distract me?” And he did.

James does not show affection in traditional ways. I remember once, about ten years ago, his closing a telephone conversation by saying, “It was nice talking to you, Liz.” That was a major outpouring of verbal affection. But I know my brother loves me, thinks about me, and keeps the warmest wishes for my health. And he shows his love to me most consistently by making me laugh about today, laugh about cancer, and laugh about the things we did and experienced as kids.

For these things I will be ever grateful. James, you joined me at the bottom of the cancer pig pile.  I can’t thank you enough for doing that. If you didn’t realize it before, please realize it now that you have helped me tremendously. Thank you for making me laugh at some of my lowest and scariest times. I love you a lot and I know you return that even when it may come in the guise of slide whistled Mozart.

James must have been about 1 1/2 years old to my three years. It looks like we were having much fun in a rare Seattle-area snow.

James must have been about 1 1/2 years old to my three years. It looks like we were having much fun in a rare Seattle-area snow.

The yard work that I did last weekend was slightly grueling as jobs that involve lots of digging, pulling, and squatting tend to be, especially after having taken a long hiatus from this type of work. I was getting sore and I kept having the urge to quit. It would have been fine to have stopped mid job. The Earth would not have shattered. But I also knew in the back of my mind that I feel better when I accomplish something at times when my mind is swirling in ambiguity. “Look at me, World! I can do something from start to finish!”

So, at little intervals, I told myself things like, “If I got the west side of the path done, it would be a completion of something. I’ll just do that much.” Then I finished the west side of the path, which, incidentally was the harder part because it was full of small tree roots. “I’ll just do a little bit more,” I told myself. I also moved a bag of soil mix from the side of the house to where I was working. I knew that I would be too tired to do that part of the job if I left it to the end. The bag was full of wet soil and weighed a ton.

It was as if a switch had been turned. It was still hard. I was still sore. But I had something I didn’t have before. I had momentum to finish the job. The urges to stop went away and I stopped feeling overwhelmed by the task. I finished every part of it that I had wanted.

I was thrilled that day. The next day, my hamstring muscles were super tight and complaining. They were still complaining the next day. They are almost as tight today. When I was taking my walk today, I kept getting the urge to quit. My legs hurt. I had to walk slowly, which is not very energizing. I told myself to walk to the count of 10 to see if the urge would pass. That helped a little. Then I saw something down the street that I wanted to photograph. That helped a lot, for a short while. And then the sun came out, which made me feel light and energetic, for a short while. The urge was back. Then I noticed that my hamstrings had stretched out some and that I could pick up my walking pace a little. The urge switch was toggled to the off position. I met my goal.

Sometimes I have urges to stop. Other times, I have urges to act and to keep things going, even if it is not the best thing to do. I have urges to help, urges to be right, and urges to reduce my anxiety by controlling a situation or by requesting reassurance. The urges to do are stronger for me than the urges to stop. They come on quickly, so quickly, that sometimes I am acting on them before I recognize them.

These urges involve interpersonal situations. Right now in the class my family is taking, we are working on how to be more effective with other people. We talked about defining and prioritizing three goals: 1) My objectives (for example, being right, changing someone else’s behavior), 2) Maintaining the relationship with the other person, and 3) Maintaining self-respect.

These are all worthy goals, in the abstract. A person could make an inspirational poster for each of these goals. “Keep you eye on the prize!” “Would you rather be right or would you rather have friends?” “Love yourself! Respect yourself!”

A person’s priorities, however, are situation specific. And that’s why I don’t like those inspirational posters! They ignore context! But I digress. Balancing these goals is hard, especially when I act on an impulsive urge instead of thinking things through.

Right now, I am dealing with a difficult interpersonal situation, involving someone who does NOT read my blog. (it’s not you, Mom!)  I’ve been fighting off an urge to act for several days. I could even wrap my actions in high minded and reasonable sounding justifications. But I suspect that I would be lying to myself about my real goals and intentions. I am going to try to let it be.

Watch me! Ready, set, STOP!

My husband and I moved around a lot during the first several years of our marriage. We were married in 1990 and it was not until 2001 that we bought our first home in Seattle, which is the home in which we still live. This is one of the most expensive cities in the U.S. and we don’t live an ostentatious life style. Consequently, our house is not fancy or stylish. But we love our 1950’s house and have worked to inject it with our own personal style, which is colorful and eclectic.

When we moved into the house, there were flower beds in the back. I spent the first year in the house weeding and seeing what kind of plants there were. There was a grassy front yard, bordered by two huge juniper shrubs. Juniper shrubs were commonly part of the landscaping for homes built in the 1950’s and 1960’s. I imagine that they were cute back then. They get rather prickly and enormous over time. Also, they are really ugly, so ugly that the house had what my brother, a realtor, called, “No curb appeal.”  After we’d been in the house for about three years, John removed the shrubs and built a rock wall. The shrubs were weighed at the city dump for the composting program; a half ton of shrub. 1000 pounds of juniper, people!

I planted a rock garden. A year or two later, John removed the front lawn. I covered it in layers of newspaper and cardboard followed by four inches of beautiful black compost that I had delivered to my house, which I carried around the yard by the wheelbarrow full. I didn’t plant anything in the yard for a year to make sure that all of the grass and weed seeds under the paper barrier would not get exposed to light. The following years, I started a long project of putting in flowers, summer vegetables, shrubs, garden art, soaker hoses hooked to an automatic watering timer, and slate walkways.

After the front yard was “done”, I started work on the planting strip, the piece of grass between the sidewalk and the street. This land is owned by the city but the home owner is responsible for upkeep. The city encourages people to make the strip into a garden. We had already planted two trees there, which were given to us by the city as part of their Street Trees program. I got out my garden edger and started the long process of removing sod from the strip. I did it in pieces, removing a small square and filling it with compost and new soil. I planted beans there the first summer. After a year, it was all removed and planted. Right now, it is full of blooming tulips, which I have planted in wet fall weather, my garden gloves filling with cold muddy water.

Until my cancer diagnosis, I spent a great deal of time in my yard, weeding, pruning, and planting. Then I stopped working in my yard, for the most part. I had repeated surgeries that made it hard for my to use my arms and abdomen. I started exercising regularly, which meant less time for gardening and also another way to fulfill my need to spend time outdoors. I had trouble with fatigue. I had friends that came to help. Later, I decided to get rid of the little strip of grass on the left side of the house to open up more planting area. I got about half done with that project and lost steam. It is still unfinished, a year and a half later.

But after years of working out there several times a week during the summer and frequently during the rest of the year, I found out what happens when a yard doesn’t get such regular attention. It’s not pretty. It gets weedy and full of brown stuff. Some plants get out of control and propagate wildly. The rose bushes did not get pruned. One of them got as large as a Volkswagen. It was really overwhelming. I often found myself thinking, “My yard used to be so beautiful. It was so much easier to maintain. Now it is a mess.”

Last spring, I actually hired a landscape service to weed, prune, and mulch the front yard, which is where most of the flowers are. I couldn’t afford for them to work on my back yard, too. I figured that after they did the heavy work, I would be inspired to get back into the yard because it would not be so overwhelming. The landscapers did a great job and I didn’t end up doing anything out there.

This year, I found my yard overgrown once again and myself, once again, thinking, “My yard used to be so pretty. People used to take photos of the flowers in my yard. Sometimes cars would slow down to look at my yard.” I called the landscapers out again. It was not quite as big of a job this year and it made an enormous difference. And this year, unlike last year, I did gather some momentum. I weeded my raised vegetable containers, my husband turned over the soil, and I added compost, fertilizer, and new soil. I transplanted flowers to other containers because they were getting in the way of the vegetables. I replaced broken soaker hoses for the front yard as well as for the vegetable containers. I removed three years of old bean stalks and tomato plants from my two story metal growing cages.

Today, I went back to the yard. I planted lettuce and bok choi seeds in my vegetable containers. They are fast growing and should be finished by the time for planting summer vegetables, beans and tomatoes. I cleared the hair allium that had started out as about eight bulbs and spread into several hundred plants. Waaaaay too much allium. Clearing that out took a couple of hours, working around tree roots and plants I wanted to save. The number of little allium bulbs under the soil was unbelievable. (Hair allium is cool looking and it used to be a moderately expensive plant. My guess is that they are now being giving away at Home Depot check stands. They are worse than bluebells for “naturalizing”, a.k.a. taking over like a hostile alien race from another planet.) After I dug that out, I had to use a couple of bags of soil to replace what I’d removed. When I finished, my yard looked so nice, nicer than it has looked in years.

I came across a random photo of my front yard from my pre-cancer days. It shocked me. My yard looked terrible! Now the fact that I’d taken a photo tells me that it was probably a “before” photo taken for spring clean up. The yard always looks bad for part of the year. My surprise at the photo got me wondering how much I had exaggerated the state of my garden in comparison to the years prior to cancer. “My yard was so beautiful before cancer.”
In truth, it was better maintained in the past and that does make an aesthetic difference. But I think nostalgia and loss has nudged my memory to increase the contrast, closer to, “Before cancer everything was wonderful.”

Truly, there are a lot of losses than come with cancer, and they are losses to grieve and honor. But sometimes I think I may be too quick to interpret “before and after” in a negative way, when I am feeling discouraged, worried, or overwhelmed. I think this is natural for people to do, to think about significant aspects of life from the past with fewer shades of gray. I learned last year with my 30th high school reunion that perhaps my recollection of high school being terrible in certain respects, was not accurate. I suspect that friends who look back at high school with very strong positive feelings and memories, may be forgetting some of the bad aspects. And then of course, there is the whole lamentation of culture and young people, “Kids today…” “Society is going to Hell in a hand basket.” It can be easy to idealize the distant past. It is not clouded with immediacy of the present or the unknown of the future.

I don’t really know how much better or worse my yard is. After all, living things grow and die, regardless of whether we work the soil or not. Things change all around us.

What I do know for sure is that today I dug in the dirt and I had a marvelous time.

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My garden

My roses in 2012. They will start blooming again soon.

My roses in 2012. They will start blooming again soon.

Several months ago, my husband and I were in Fauntleroy Park, which is the closest woods near our house. As we walked down the path, he joked, “Oh scary! Someone could jump out of the bushes at us!” The comment hit me in all of the wrong ways, though this had nothing to do with him. I said to him, only half jokingly,”You’ve ruined my sanctuary!”

I have done a lot of grieving and healing in those particular woods. I have felt my heart rate lower and my spirits lift as I walk into the entrance. I have listened to the creeks, the birds, and the sounds of the rain and wind. I found a hummingbird nest in those woods and waited for the egg to hatch into a chick, whom I discovered had not made it, when I visited the woods last Mother’s Day. As I am often the only one in the park, those woods were a safe place to sit by the trees and the running water, and have a good cry. I have felt the reassuring softness of feathery mosses, watched the emergence of new growth from the forest floor, and sampled berries from bushes that connected me to my childhood, learning about native edibles from my mother, while walking in the woods that surrounded the home in which my parents still live. I have had experiences in those woods, seeing new growth, old growth, and decay, and felt connected to the worlds of living, dying, and dead at a deep spiritual level.

I had avoided going to those woods since the loss of the hummingbird chick and my husband’s ill timed remark. I would never have predicted that I would react that way but it did. Today, as I was ambling through my neighborhood on my daily walk, I decided to get back into the woods. I was greeted with the sound of running water, birds that sounded like they were auditioning for a part in The Jungle Book, the smell of skunk cabbage, and the deep pink of salmon berry blossoms. I saw two hummingbirds. I visited the spot where the hummingbird nest had been last year. It was gone, either blown off by the wind or removed by a hiker.

This week’s stressful mammogram generated another thread of fear, sadness, and gratitude to weave into my life. I am glad to be back in the woods.

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“Wise mind” is a mindfulness concept in the class that my family has been taking. Wise mind is used when “emotion mind” or “reasonable mind” get out of balance. Wise mind is, well, wise and validates both emotion and reason.

If you look back at my last post, you can see moments where either emotion mind or reasonable mind got out of balance. There is a mindfulness skill called, “ask Wise Mind a question.” No, I kid you not. The judge-y part of my brain has thoughts like, “That sounds silly and dumb.” Fortunately, I am really trying to learn as much as I can from this class so I’ve been able to keep Judge-Y at bay, for the most part.

On Monday, while I was lying on the ultrasound table, feeling fear, scary thoughts, and starting to try to reason myself out of them with arguments that now seem kind of ridiculous, I thought, “Wise mind, what should I do?”

Within a fraction of a second, I noticed that my heart was beating fast and started using paced breathing to slow it down. My heart rate is particularly responsive to breathing techniques so that helped settle me down considerably. It also gave me something to focus on, something in the present, which was much preferable to my worrying about the future.

“Wise mind, what should I do?” was a question that got me unstuck. It helped me shift my attention and thoughts, to cope more effectively, and to make my anxiety much more manageable.

I am finding, more and more, through my practice of mindfulness and the other techniques taught in this class that I am able to limit my suffering around scans to shorter periods of time. Another skill I used is called, “Coping Ahead”. It is not a mindfulness skill. Mindfulness is powerful but it is not always useful. Coping Ahead means identifying a stressful event that you know is happening in the future, identifying skills for handling it, and visualizing yourself successfully applying these skills (mental rehearsal).

When we covered this skill, I knew that my scan was coming up so I made a plan. To be honest, the plan was not perfectly laid out but I put many elements into place. I decided that the most difficult part of my anxiety around my scans was that I am irritable and on edge and end up getting upset with my family for no good reason. I have not only coped in a way that increases my own suffering but that of the people around me. I imagined what I would be like if I was not that way and identified the skills that would help me get there.

As it turned out, the actual scan and the hour or two around it, were much more stressful than I expected it to be. But I didn’t snap at my family. In fact, we had a wonderful weekend together.

When I wrote my last post, I was trying to convey the experience that many of us have as cancer patients. Although I have not had known cancer for nearly three years, I still consider myself to be a cancer patient. I don’t know if that will ever change. I wanted people to understand that. I also wanted people to understand that meaningful and joyful life is still possible, nonetheless.

There are aspects of my life that are scary. I feel my feelings. I think my thoughts. Some of you described my last post as “harrowing”. That’s a pretty intense adjective. I was a bit shocked by the reaction and then felt sorry for having distressed people. But if I really think about it, I was describing the experience of trauma cues and fears of being sick again. That’s pretty hardcore.

My writing and my mindfulness exercises help me put my terror in a transparent box, so that I can examine it, like a specimen. It is still painful. It is still scary. But it is a way for me to move forward without hiding from myself.

“Wise mind, what should I do?”

Live my life.

Every day.

My husband and I host Thanksgiving every year and although not at Martha Stewart’s standard, I like to make the dinner tables pretty. Sometimes, John sets the table with our day to day plates and I say, “No, use the good plates.” The “good” plates consists of the full set of Franciscan dinnerware that my mother-in-law generously gave to me years ago. They match. There’s a gravy boat. There are enough for our extended family crew of 16-24 people, depending on the year. Matching, rarely used plates for fancy occasions.

Today I had a mammogram. I scheduled it many months ago. I remember telling my oncologist’s scheduler that I needed a diagnostic mammogram. She called over to the breast imaging center and told me that I didn’t need a diagnostic mammogram. I was due for a screening mammogram. I said, politely with a tinge of anxiety, “But I’ve had breast cancer.” She talked to the imaging center again and verified that a screening mammogram was what my oncologist had ordered.

I walked into the imaging center. It is in a building that adjoins my cancer institute, where I typically have my appointments. The cancer institute also does mammography. This time, I was sent to the building that is part of the same medical center but not part of the cancer center. Even though I’ve been there before, I was disoriented, even in the parking garage. I don’t have the best sense of direction on a good day but when I am nervous AND underground, it is much worse. The parking garage was packed and although I thought I was following the signs, I knew that I was anxious and distracted when I saw the sign, “Alligator” to show me that it was floor A, for the third time. I was driving in circles. I snapped out of it and worked my way down to “Camel” where I got a parking spot, wrote directions to finding my car after my appointment was finished, and went on my way.

As I walked into the waiting room, I had a sense of unreality bordering on derealization, a dissociative state experienced by individuals with PTSD. The waiting room felt unfamiliar but I knew I’d been there. Then I say myself there, in my mind’s eye. This is where I had the diagnostic mammogram, the ultrasound, and the core biopsy that would establish my breast cancer diagnosis and refer me to the cancer center, nearly three years ago. “Hello, trauma cue!” Once I recognized the cue for what it was, I could at least stop wondering and start coping.

The funny thing about this is that one reason I felt uncomfortable and scared was because I had been “demoted” to a screening mammogram and to add insult to injury, had to leave the safe and familiar nest of the cancer center, to do so. Mammography involves compression of the breast tissue between plates. I’ve had all kinds of mammography, screening, diagnostic, and PEM the latter being the fanciest and as it was in Phase II trials back in 2012, was not covered by insurance costing $2000 out of pocket. PEM took three hours following a 24 hour no-sugar diet and radioactive dye injection. Oh, and did I mention that each picture takes 7 minutes, all 7 of which the plates are compressed? Oh yeah, I just remembered that the PEM tech is seated right across from your eyeballs.  But I digress.

I found myself in the waiting room thinking, “I want the good plates. I want the diagnostic mammogram.” Yes, I know, the difference between mammogram machines is not the plates. But do you blame me for thinking about the plates? (Ladies who do mammograms understand.) When I checked in, the receptionist asked, “Who do you want us to send the report to?” I provided her with the names of my physicians. Then I anxiously asked, “But I am getting a verbal report from the diagnostic radiologist during my visit today, right?” She verified that I was. Deep breaths, Elizabeth.

I changed into a gown and waited for the mammography technician. She soon greeted me and led me to the exam room. She was a very small woman, under 5 feet. As she was positioning the plates, I noted that she was about the exact right height for the job. She would not have to bend over at all to get a view of breast level for most women. I thought to myself, “Why do I notice things like this?”

She was skilled and efficient. I was lead back to the waiting room near the changing room. I waited. I was distracted for awhile talking to other women, waiting for their results. I answered some email. A woman called my name, a different woman than the mammography technician. I didn’t like this. She led me into an ultrasound room and asked me to partially disrobe, lie down, and wait for the diagnostic radiologist, Dr. Bang. She said, “He will give you the results and discharge you.”

“Uh-oh, there’s something suspicious on the mammogram.” Dr. Bang soon came into the room and introduced himself. He was a young Asian American physician with a nice smile and a professional demeanor. One of the first things he said was, “I see a 2mm mass in your left breast. It is probably a non-malignant cyst.”

My thought, “Yay, he’s being straight with me. He told me what was going on as soon as he could without being cold and abrupt. Hmm, but he also told me that he thought it was likely just a cyst. I hope he’s not one of those physicians who is afraid to tell the bad news. I hope this does not affect his judgment.”

He was very thorough, I must say. I looked at the images from the mammography. Besides thoughts to myself like, “recurrence”, I busied myself by noting how much less dense my breast tissue looked in the images than they had in 2012. As many of you know, having particularly dense breasts makes most of the imaging techniques difficult to interpret because water (the source of density) shows up as white, which is also the color that tumors look on the images. Density is reduced with age, as breasts take on more fatty tissue. I could see this change in myself, likely accelerated by my cancer treatment induced menopause through Lupron and over two years of taking Tamoxifen, which I will likely continue to take for nearly a decade.

I am a geek and a healthcare provider. I am very happy for this when I am getting a stressful medical examination. I can distract myself with wonder and fascination. I also joke with healthcare providers. This lot were pleasant but business like. Joking would not be a comfortable option. So I continued to practice paced breathing to keep myself calmer and to geek out on medical technology and to reflect on the the marvel that is the human body, post-mastectomy and all.

Dr. Bang was having trouble finding the 2mm mass on the ultrasound. I asked him if it was located in the part of my breast tissue that is still very dense. He said that it wasn’t and was in fact very close to the surface. Then I thought, “Oh, if the cancer is near the surface of my breast, maybe I can get a small lumpectomy. That won’t be so bad.”

I was also thinking about what the next step would be. Biopsy? Then I remembered that I had gotten a screening mammogram and that the next step is usually a diagnostic mammogram. However, in this case, I was given an ultrasound. Hmm. A memory flooded back to me. Cancer treatment is like giving birth. They tell you what is going to happen like they are invariable steps. But it’s not. There are rules of thumb that I can understand but the course of assessment and treatment can change. I’m not complaining. If I were cookie dough, the medical team could use cookie cutters to do their job.

Another part of my brain was planning who and how to inform people that I would need follow up assessment. Before, I was pretty sure that I didn’t have cancer. After all, only 20% of biopsies are malignant. Mammography has a notoriously high false positive rate. That is one reason that it is so widely criticized. Actually, the prime reason is that we keep getting the message in our culture that it is far more accurate than it really is.

After what seemed to be 500 years, Dr. Bang told me that the cyst had been present on my last mammogram but it seemed to have grown since then. “I don’t think it’s cancer.” He told me that he wanted to “watch it” and that meant having another mammogram in six months. In the past, I would have been hesitant to ask my “worry questions” but I asked away. “Will this be a diagnostic mammogram?” (“Yes”.). “Will it be a 3D mammogram?” (“Yes”.)

There is no cure for breast cancer. I have had a status of “No Evidence of Disease” since my mastectomy on 8/8/12, which was proceeded by two failed lumpectomies performed by a marvelous and kind surgeon. Three of my four invasive tumors could only be revealed after surgery. None of the imaging technologies, MRI, ultrasound, and three types of mammography that were used, found them.

I was diagnosed nearly three years ago. I have thought about cancer every single day since I was informed of the diagnosis. That is over 1000 days. I don’t want “the good plates”.  I wanted the black and white plates. I want the plates of definite “I don’t have cancer” answers.

Cancer has provided me with a daily lesson that bad things, really bad things can happen. And I have learned to live a happy and satisfying life in the last three years despite all that my family has been through, a significant amount that has nothing to do with my cancer. Something that a pathologist looks for in examining an excised tumor and the surrounding tissue is for “clear margins”. A clear margin is the amount of healthy tissue that surrounds the tumor. Larger margins are better than small ones and if they are too small, as was the case with my first two surgeries, more surgery is recommended.

The “clear margin” is not magical or 100% accurate but it is meaningful. It is more than a good sign. There is always the possibility of disaster or hurt at the center of our hearts. I try very hard to live in the present and at present my margins are clear.

When I practice mindfulness, I encounter a paradox of experiencing a greater connectedness with thoughts, feelings, and sensations but also having some kind of buffer. I don’t really know how to describe it exactly. It’s not exactly a distance but it kind of is. No doubt there are individuals far more practiced in mindfulness who have written about this much more precisely and eloquently. I know that the word, “equanimity” is often used to describe this state, a mental composure that wards against imbalance of the mind.

Yesterday morning I was walking and noticing. I do most of my mindfulness practices while I walk. I also do a great deal of contemplation about my life. I was thinking about how much more fun I am having with my family these days and the level of harmony we’ve been experiencing. The sun was out and I could feel it on my skin. The flowers and trees in the neighborhood were beautiful. I felt a great deal of joy. In these times of mindfulness I find that I encounter unexpected thoughts and feelings. The balance that I feel makes this possible, I think.

Yesterday, I felt hopeful, a feeling that is familiar to me. But yesterday it was followed other thoughts and feelings. Hope involves taking mental chances. Hope leaves the door open for good outcomes after a long time of fearing the worst and experiencing very hard times.

Hope can be frightening.

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