Archives for category: Feelings

As I mentioned in my last post, I let my home office turn into black-hole during my cancer treatment, and it stayed that way until I cleaned it a couple of weeks ago. I found that is was a bit of an archeological site. Everything my former cat, Ollie, had knocked off of the desk onto the floor and then batted way underneath, were still there. Ollie died shortly after I began cancer treatment, coincidentally from metastatic cancer. I thought of the fact that he’d touched the pen caps, binder clips, Post-it notes, and push pins. I thought fondly of him, but I didn’t have trouble getting rid of the pieces that were garbage and putting the rest of it away.

At the bottom of a pile on my desk, I found the folder in which I kept my cancer paperwork, labelled, “Cancer 2012”.

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I opened the cover and saw a set of post-surgical instructions. I also saw Explanation of Benefits forms from my insurance. A year ago I many have put it back on the top of my desk thinking I might “need” it some day. That day, however, I threw it into the recycle bin and made a plan to write about it, as I am doing right now.

Another thing I found was the tote bag I was given by the Swedish Cancer Institute with their name and logo on the side. For the first several months of treatment, I carried a binder, also provided by Swedish, containing all of my pathology and blood work reports separated with tab folders, “Initial diagnosis”, “Lumpectomy #1”, “Lumpectomy #2”, “Mastectomy”, “Oncology reports”, etc. I called it, “my big bag of cancer.”  Eventually, I stopped using the bag but continued to use the binder, which was extremely helpful in keeping my treatment organized and making some kind of sense. It was actually a very handy reference guide to take with me to my appointments.

I looked at the bag and considered getting rid of it. I have a ridiculous number of tote bags due my past as an academic researcher. I did a lot of conference travel and typically, the conference catalog and registration materials are put in a tote bag. Some of them are very nice, very sturdy, and have, as a result, never worn out. Clearly, I did not need my cancer bag in order to lug stuff around. Honestly, I don’t need most of them. They just sit around, “just in case” I need them in the future.

However, one of the first thoughts to come to mind when I saw it was a visual memory of my wonderful breast surgeon, Dr. Beatty, carrying a tote bag just like mine, holding the things he needed for that day. He was the first of my many physicians with whom I developed a doctor-patient relationship. He and his staff were wonderful. I felt so taken care of when I went to his office.

The image of being held, not as an embrace, but as being supported and cared for came to mind. I decided that “my big bag of cancer” is a holder of good things. For now, I am keeping it. Next year, who knows?

I am amazed at the significance that objects have taken on through their association with my cancer treatment. Some of the associations are comforting. Some of them are painful. All of them are part of the truth of my experience, an experience that continues to evolve over time. Experience changes; at times, it changes a lot. But the past, the future, and the present all hold their truths and are all part of me. In my mind, this is the string that holds my life together and gives me great comfort.

 

I am more comfortable giving than receiving emotional support. Nonetheless, I have found my self being “a friend in need” more than not recently. I have also been working a lot, trying to keep my head down, and keeping myself busy. It worked to a certain extent then it didn’t.

I had also planned a busy summer with lots of fun activities, spending time with friends, spending time with family, and spending time in nature. I was very much looking forward to spending three days with friends from out of town. I knew that it would be fun, they would have fun, and there would be some light and easy times.

And then it happened. I lost track of myself, my fatigue, and my anxiety. The beginning of the visit was marked by my anxiety and the bags under my eyes. I wasn’t fooling anyone. I was tired. I have slept solidly through the night once in the last two months and sometimes I am awake for a number of hours. Not sleeping well takes a major toll on me. I took on more than I could handle comfortably and then life gave me much much more. And I didn’t ask for enough help and when I didn’t do it in the way that solicits a whole lot of empathy.

Lo and behold, after a brief but intense temper tantrum, I got my shit together and focused on having a break from my daily grind, spending time with dear friends and with my husband. I had a wonderful three days. I went to mountains and islands. We talked and laughed. The tight worry in my chest and the cotton in my brain eased. I remembered what it is like to have relaxed joy.

Then I came back to my regularly scheduled program of life. I immediately picked up on the stress and anxiety in my household. Initially, I felt disappointment that I was getting wound up again so quickly. Then I remembered that I have skills. I have things to try. I started using paced breathing, a technique to strong emotions quickly. It worked. Today, I am feeling the anxiety again. And now I am writing, another strategy that helps. My heart is slowing and I am finding myself more and more in the present moment as I type these words.

I am a friend in need and I got the support I needed from both other people and from my own internal resources.

Today, I am grateful for my family.

Today, I am grateful for my friends.

Today, I am grateful for nature.

Today, I am grateful for my tenacity.

 

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In my work as a psychologist, I work with children and teens who have disorders considered to be primarily genetic in cause. Environmental factors play a role as well, but according to our current understanding, they are mainly factors that maintain or exacerbate symptoms as well as the pervasiveness and persistence of the resulting impairment in carrying out life’s activities and responsibilities.

About 90% of my patients have Attention-Deficit/Hyperactivity Disorder (ADHD), the primary treatment for which are stimulant medications, which can make an enormous positive difference in an individual who is responsibly diagnosed and treated. However, even with medication, ADHD can make what we typically see as moral and responsible decisions much harder to make. Environmental supports from parents, teachers, and other professionals can help and as children grow into adolescence, individual psychotherapy can also be useful in helping an individual who has trouble internalizing rules that are good in the long run but not salient right now and to use strategies to promote life skills and success. Nonetheless, based on current longitudinal evidence, individuals with ADHD, even treated ADHD, have a much higher rate of high school drop out, only a 5% college completion rate, and a higher rate of accidental death as well as suicidality, among many scary possible outcomes.

This is why these kids, teens, and young adults are the “it takes a village” kind of people. Actually, I believe that we all belong to the village and as social animals, we rely on one another and impact one another for good, for ill, or for nil. But these individuals are particularly vulnerable. They do not tend to be resilient. They need particular parenting and educational strategies that are often inconsistently or not available. They need effective healthcare that is often in short supply.

I consider myself to have been very fortunate for many aspects of my life that just happened to me. I inherited a strong mind, a basically happy personality, grew up in a loving family, went to good schools, and had my basic needs for shelter, food, and belonging more than amply met. I take responsibility for cultivating these gifts very seriously but I don’t for a minute take responsibility for having receiving this gifts in the first place. I got very lucky and have made very good use of what I have.

Consequently, I have a great deal of love and compassion for the individuals I see, even the ones who are honestly, not very likable. Some of them are not even very nice. Sometimes they are very likeable, nice most of the time, but do really impulsive awful things. A common characteristic of many, but not all, individuals is a lack of consistent self-awareness and a very difficult time connecting their actions to negative consequences. This is a neurological issue and it results in difficulties taking responsibility. It is made worse in that when they are aware of short-comings or consequences, they often respond with very harsh judgement of themselves. This lack of self-compassion makes it harder to own up to personal responsibility. All of this is compounded with the fact that medication often makes a big positive difference because it fuels the belief that control is external.

A common way of framing this tension is by saying, “It is understandable that x, y, or z is really hard for you but it is not an excuse. You are still responsible for your decisions and behaviors. We realize it is hard and that is why we are all part of your team to support you. But you are part of the team, too.”

Yesterday, another heinous racist hate crime, an act of terrorism against African Americans was committed in our country. Many of us are angry, grief-stricken, and overwhelmed with sadness and helplessness. We are trying to make sense of this.

I think we need to stop trying to make sense of it, at least in the usual way that we do. The easiest way to explain something horrible is to put it under someone’s control and the easiest way to do that is by laying blame at a particular person. Another easy way to deal with these kind of events is to distance ourselves from them, the “I am not that” approach. Another way we can deal with this is to feel really sad, angry, and anxious for a day or two, or even a week, and then move on to the next horrible news story, further cultivating cynicism and passivity.

It is understandable to feel overwhelmed by this, to be enraged, to feel impotent, to wring our hands in perpetuity. It is even understandable to feel paralyzing and unproductive self-recriminations about the ways that we have acted unkindly to others. It is understandable to criticize the behaviors of others, to join with others in demonizing people we don’t know who have done wrong things; with social media, we join in with the professional media in shaming people in a very intense and protracted way. It has become brutal in a way that makes me fear for our culture. The stockades of the Middle Ages come to mind. Stoning. Throwing acid in a woman’s face.

These are actions that understandably fill our need for agency at times when we can think of nothing else to do. I have participated in these public shame-fests. I have participated in cynicism in the place of effective action. I have participated in judgment that is inconsistent with compassion toward myself or toward others. I have participated in racism, some of which I am aware, and likely some that I have done without self-awareness.

I believe that I am a good person in the way that most people use the term “good person”. That doesn’t mean that I haven’t done harmful things to myself or others. It doesn’t mean that I have not contributed to a hateful culture either through action or inaction, the latter because I was either “busy” or clueless.

As a psychologist, it is understandable for me to see yesterday’s terrorism as a mental puzzle to solve. But none of these understandable beliefs, actions, or conditions are an excuse for not taking my own portion of personal responsibility for being a part of a culture that can be hateful, cynical, passive, selfish, violent, and oppressive.

I am not responsible for the whole problem but I can take responsibility for my contributions to it. These are the steps I have decided to take:

1) I do not consider myself to be a racist person as a trait. However, I accept that as a human being, aggression and dominance are part of me and that I am not immune to the socializing impact of institutional racism. I accept that I can be a good person and person who has done racist things.

2) I accept that I have benefited from institutionalized racism due to the privilege afforded members of a dominant race

3) I will exercise self-compassion despite my moral and ethical failings.

4) I will work to be less judgmental, of people I know and of people I don’t know.  In terms of social media, this means objective criticism of ideas or behaviors but not of people and that said criticism needs to fuel a positive purpose.

5) I will work to help children and families be healthy.

6) I will work to maintain my own mental health.

7) I will work to treat cynicism as understandable, but as being incompatible with compassion and effective change, nonetheless.

8) I will work to promote unity instead of division in my culture.

9) I will work to elect individuals who promote unity and fairness instead of division.

10) I try to listen to others with different viewpoints and life experiences with an open mind.

11) I will accept that complexity is common in the very situations during which I feel the urge to simplify to make myself feel less overwhelmed.

12) I will expect myself, despite my best efforts, to fail from time to time. I will work at these times, to keep trying.

I may be wrong in my arguments, in my beliefs, and my actions. That does not make me a bad person. My imperfection and the limitations of my own mind to understand all of this is understandable. But it doesn’t take me off the hook.

It is understandable but it is not an excuse.

Stop making sense.

Start making change for the better.

I had a wonderful three day weekend with my family at the beach. That is, during the day. Saturday and Sunday nights were full of nightmares. As I mentioned yesterday, three years ago yesterday, I was diagnosed with breast cancer. I had a wonderful day yesterday, during the day. Last night I dreamed that I had a scan and that there was evidence of a recurrence. I spoke with a radiologist on my dream phone. I can’t remember quite what he said, but I recognized it immediately as a segue to bad news. I told him, “You are saying that to tell me that my cancer has come back!” He admitted that he had. Healthcare professionals, for the record, I am also a deliverer of bad news. I know your tricks, especially when it is  dream and my unconsciousness is writing the story.

In the dream, my husband looked at a written report and in a tone that communicated a lack of sufficient concern, he said, “It says here that it is an 18 meter mass.”

I grabbed the paper and saw that it said that it was a .18 meter mass. “Oh my God, John! It’s a .18 meter mass, not an 18 meter mass! That means it is a 1.8 centimeter mass NOT 18 METERS!”

(Dream mind does not always move the decimal point correctly, I admit. I also think dream mind perfectly illustrated the most stupid of the stupid marital disagreements, the one that MISSES THE POINT. I have DREAM CANCER GOD DAMMIT! Stop fighting with your husband. Neither one of you know how to treat DREAM CANCER!)

People, you get it. My brain is working crap out. Mom, if you are reading along, my brain needs to work crap out. I am doing my very best to keep the crap to a minimum. It is easier during the day time. I had a wonderful day yesterday and a wonderful today. I have less control over the worlds that my brain creates in my dreams.

This year was easier than last year. Perhaps next year will be easier than this year. Healing is a process that is approximately linear over time. But it has its fits and starts.

This morning, John and I took a walk on our own. That time together, along with the sweet historic buildings, and the beautiful farmland, did much to quell the nightmares.

I wish I did not still have them, but I do.

I am, in sum,  a pretty happy person. It has been awhile since I let the fears in my nightmares ruin my waking hours. I didn’t do that today, either.

Living with the uncertainty of life, the horrible, the traumatic, all of the things that I have experienced thus far, for me, is not about pushing it out of my mind. I can’t! My mind does not work that way. If I can’t notice both the good and the bad, I can’t help people as a psychologist. I can just spout platitudes that are not true and do not honor the hardship that many people experience.

And if I don’t notice and validate the good and bad in my own life, I can’t live with the kind of truth that gives me a sense of purpose and integrity.

I need to notice and remember in my life. But I’m living, too.

And pretty darned well if you get right down to it.

My selection of a  Boho Chic outfit thumbs its nose at nightmares!

My selection of a Boho Chic outfit thumbs its nose at nightmares!

The gentle farmland is decidedly not nightmarish.

The gentle farmland is decidedly not nightmarish.

Even pink, in its original form, is not scary to this breast cancer survivor.

Even pink, in its original form, is not scary to this breast cancer survivor.

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.

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.

During one of my recent mind adventures, my memory took me back to the old 1960’s television show, The Flying Nun. It starred Sally Field as Sister Bertrille and took place at a convent on Puerto Rico. Due to her small size, the frequent winds, and her cornette (a particular style of nun hat), she could fly, hence the title of the show. After my mind took me to this show, my fingers took me to Wikipedia.

Sister Bertrille could be relied upon to solve any problem that came her way by her ability to catch a passing breeze and fly.

That sentence gave me a good chuckle and I thought, “How could the show’s writers sustain this premise?”

Plot 1: The convent eagerly awaits a visit from the Bishop. After an albatross makes off with the his miter, Sister Bertrille hitches a ride on a gust and saves the day by retrieving it.

Plot 2: Fire breaks out in the convent campanile. After accidentally breaking the tallest ladder in town, Sister Bertrille uses her flying power to reach the fire and put out the blaze.

Plot 3: A little girl’s kitten is stuck in a tree! The fire ladder is still broken. Sister Bertrille flies to the top and saves the day!

Plot 4: Run away kite!

See, not sustainable. Nonetheless, the series lasted two seasons. How did they do it? Also, how did her cornette stay on?

A fictional life needs substance to sustain itself. It can’t be utterly ridiculous.

A real life needs so much more.

Once upon a time, my blog was often humorous. Once upon a time, my blog was mostly about cancer. My blog has changed and my needs have evolved. My husband asked me yesterday, “Do you still think about cancer every day?” I told him, “yes” and I have thought about it every day since May 25th 2012. I mean this literally. Every day.

But thinking about cancer and being actively treated for cancer are different. I think back to what I needed to do during my active treatment and I can’t believe it. The extra work I had to cram into my schedule in order to take time off for surgeries, the number of surgeries, the telling people or not telling people about my health. The changing landscape of my body. The changing energy levels. The changing brain. The major unknowns about even the near future. One of the ways I dealt with the stress and fear with laughing at the ridiculousness of it. That is a coping strategy that is useful to me, it sustains me.

I think about sustainability and capacity a great deal. I want to be a healthy person. It is too easy for an active person such as myself to work too hard and to get my life out of balance.

But sometimes we just have to work really hard. Cancer treatment is one of those times. One of the hardest thing about this time as well as during other unpredictable and serious stressors in my life is that I don’t know how long I will have to work super hard in crisis mode. In the past, I used to tell myself that I would slow down once the stressor passed, for example, once I finished my Ph.D., once I got my career settled, once my daughter was older, once we bought a house, etc.

Those stressors never stop. Life is hard and complicated. Fortunately, I appear to be in good physical health and my mental health is strong. I have a safe place to live, a loving family, lots of friends, and a wonderful job. But it is easy to get caught up in moving too fast, worrying too much, and creating needless suffering for myself even in a life that in most respects is an embarrassment of riches.

As I’ve mentioned recently, right now I am focusing on having more fun with my husband. We do something, just the two of us, at least a couple of times a week. We went on a trip. We went to grown up prom. I have also started having more fun with my daughter. I think that the fact that I am more relaxed has had some positive impact on her among other things. Just last weekend she told me, ‘Mom, have you noticed that I am out of my “I hate my mom” teen phase?’ I have learned to accept these lavish gifts with understatement. “Hmm, I guess yes, I’ve noticed. Why do you think that is?” She replied, “I don’t know. I guess I just got older.”

I take these beautiful moments for what they are, moments. And they seem to be threading together into increased maturity. But her growth is not linear; it has peaks and valleys and plateaus. All of our lives are like this, even the most stable of us because there are so many aspects of life that are out of our control.

My family life is still full of unknowns. My husband and I still deal with major stressors and challenges both within our immediate family and in our extended family. We are part of what is called “the sandwich generation“. Sometimes I feel like we are the PB&J left on the bottom of a backpack for a week that ended up getting run over by the school bus.

Nonetheless, we are making time for fun. We have trips or fun visits planned for every month from May and September. My passport is being renewed as we speak. We will see two coasts, mountains, and two states. We’ll travel by planes, trains, and automobiles. We’ll be surrounded by friends, by cities, and by nature. And yes, friends, there will be photos, lots of them.

I am discovering that  I need to make time for peace and enjoyment. One of the least sustainable premises in real life is waiting for life to get easier.

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George Lakoff

George Lakoff has retired as Distinguished Professor of Cognitive Science and Linguistics at the University of California at Berkeley. He is now Director of the Center for the Neural Mind & Society (cnms.berkeley.edu).

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