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A half century ago, Walter Mischel, a Stanford psychologist, led the classic “marshmallow study”, which was actually a series of studies. In one of them, young children were presented with a marshmallow and told by an adult that they could eat that marshmallow immediately but if they waited, they could have not one, but two marshmallows. Then the adult left the room for a short period of time while the young child was tested with one of the great tests of humanity, delay of gratification.

Delay of gratification is an aspect of motivation and I mean motivation from a neurological standpoint, not the popular understanding of just “wanting hard enough.” I could write an entire post on the pitfalls of thinking of motivation as “wanting” or “not wanting”; “caring or “not caring”; or the very damaging “being a good person” or “being a bad person”.

Motivation to obtain an immediate reward is easy. Motivation to avoid or escape immediate discomfort, danger, or something else we don’t like is also relatively easy. Both are forms of immediate reinforcement, the former is positive reinforcement and the latter is negative reinforcement.

I think about motivation a lot. Some of this is for professional reasons. I work with a lot of kids who have difficulties working for delayed rewards or to avoid delayed negative outcomes. They are most excellent at working for immediate reinforcement. If an activity is fun, they can do it for a long time. If an activity is mundane, boring, or frustrating, they do all they can do to avoid it or escape it.

Parents often don’t understand why it’s so hard for a kid to delay gratification. Why does he play video games all night? Why does she texts friends all of the time instead of doing homework? Don’t they know how important school is?

I empathize with the frustration. I also often give the parents an example. I say, “I have a Ph.D. and I am a generally very disciplined person. I want to be physically healthy. And yet for many years, I did not exercise regularly. I also have trouble maintaining a healthy weight. Food tastes really good.”

Most parents identify with this example. Working for the second marshmallow is really hard. The first marshmallow is right there, after all. Working to help avoid long-term negative outcomes is also hard. Those outcomes are a long way off and further, in the case of physical health, there are no guarantees of success in terms of extended life span.

This brings me to today’s topic, which is motivation to exercise. We’re all told to do it. I have struggled on and off with physical exercise. For the past several years, I’ve had a regular habit of exercise. I have recently “upped my game”. I want to hike more and the hiking in my area of the country is challenging because it is so darned hilly around here. I am also working to lose weight and be more fit in general. This has gotten me thinking about motivation.

First, here are some motivation myth-busters:
1) Motivation is not a moral characteristic. It is a neurological process.
2) Motivation does not have a switch that is turned on by wanting something hard enough.
3) Motivation is not fixed. Motivation is not the same for every life activity.  Even motivation to do the same activity can wax and wane. Making behaviors into habits can help but is not an absolute.
4) Doing things that are good for you in the long run but not satisfying right now is really hard.

Let me repeat that,  doing things that are good for you in the long run but not satisfying right now is really hard, especially if there is no immediate bad thing that happens if I skip it. However, it is possible to get better at this.

The hardest thing about exercising for a lot of us is getting started. Here are a few tips for reducing barriers. This is not an exhaustive list. Feel free to add your own tips in the comment section.

What exercise?
If you hate exercise, bundle it with something you like. Some people read or watch t.v. while using exercise equipment. I walk outside because I love being outdoors and it is also a good opportunity to take photos. If you are a social person, an exercise class may be a good idea. Once people are used to seeing you, they will ask you why you didn’t make it to a class! You can also do something pleasant or rewarding after exercise to increase motivation. (See below.)

Schedule your exercise. If you take a class that only meets particular times, this can be a major advantage. Time flexibility is not necessarily an advantage when you are trying to establish a new habit.

Seriously, when am I going to do this? I am really busy. I can’t possibly add another thing to my schedule.
Say to yourself, “Maybe I could do one more thing.” Or, “Maybe I don’t need to do all of the things I am doing now.” Then take a deep breath. Maybe it’s the thought of having another commitment, another thing “I should do” that is the burden and not so much the time. You do not have to marry exercise. You can have a fling and see how it goes.

How do I get started?
This is getting out of bed early to exercise before work. This is looking at the bad weather outside and going out to exercise, anyway. This is scheduling a time, the time comes, and thinking, “I can do this later.” Here are some tips that might help:

  1. Reduce the number of steps needed to get started. Lay out your exercise clothes the night before. Sleep in your exercise clothes and put your shoes next to the bed. Get fully dressed for intended morning exercise as soon as you get up, including shoes. You may be surprised at how much trouble it seems to get your shoes on after you’ve finished your breakfast and drank some coffee. If you exercise after work, change into work out gear at your work place or as soon as you get home.
  2. Build in reward for getting started. Give yourself a small square of chocolate on your drive to the gym. Treat yourself to a coffee at a drive through. When my husband and I walk together on the weekend, we stop at the local coffee shop about 15 minutes into the walk. He is highly motivated for coffee and does not like our home coffee.

How long?
You all know the answer to this. Start with what is do-able. Start small. It is easier to build up than to make your goals so high that you feel that you have failed every time you have actually done exercise.

Maybe, just maybe, you will learn to enjoy exercise. Maybe the second marshmallow will be the exercise itself. Or maybe not.

How will you know until you try?




Today, John and I went hiking on the Nisqually Delta, where the Nisqually River runs into the Puget Sound. This is a hike that my parents have taken and I recall my dad telling me about it.

It is muddy. The water is brackish. It is winter in Western Washington. The ground and the plants are dark. The sky is changeable from grays to white to peeks of blue.

This is a popular area. We see many people, mostly families with kids and gray-haired married couples. The trail is flat and wide. There are short and medium length trails. It is perfect for the young and the old. I see my past as a child learning to hike, as a mother teaching her daughter to hike, and hopefully, my future, continuing to hike with my beloved husband for many years to come.

It seems like an in-between world, between solid and liquid, earth and sky, salt and freshwater, youth and old age. I see death, in the silver tree snags that stick out from the mud. These trees will never get leaves again. I see dormancy in the live but leafless trees on the shore and in the brown bushes in and around the water.

I also, of course, notice a lot of life, when I get quiet and still. There are so many birds. Honking geese, so many kinds of ducks, gulls, waders, and those little bitty beach birds that scurry along the shore like mice when they are not flying in tight formation just over the water’s surface. Every once in awhile, I hear a frog, sounding like a cross between an animal and a one-stringed musical instrument.

Every life is in-between. It is in some moments that we are fully aware of this. Today, I see it. I hear it. I feel it. It is poignant, hopeful, sad, and sweet.

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I’m cold. I mean that literally. It is winter and I am cold.

Obvious, huh?

Not so obvious, actually. Through the miracle of insta-menopause, which was part of my cancer treatment, I was hot for a long time. I would find myself stripping down to a sports bra in February during an outdoor walk. I stopped wearing tights with my dresses and went bare-legged through many winters.

Last year, I started wearing footless leggings under my dresses. This year, I notice that my workout clothes are not warm enough. I also noticed that I have a shortage of long-sleeved dresses.

I am longing for the two sweater dresses that I gave away to charity a few years ago because I could never wear them. I always overheated.

Yes, my friends, my body continues to heal from the effects of cancer treatment and the natural hormonal changes that come with middle age. My personal thermostat is much more like it was before the years leading up to cancer when I was in peri-menopause.

Sensation continues to return to my torso, the areas of my surgeries. Although not fully restored, I no longer feel numbness when I am upright. It is odd how a lack of sensation feels very much like something, like carrying around a weight.

After nearly 7 years of survivorship, I am still healing. Perhaps, if I knew this would be the case back in 2012, I would be fearful. But today I find this to be a gentle miracle, an aging body that is better able to sense cold, pressure, and gravity.

May 2019 bring you peace and healing, dear friends.


One definition of mindfulness is awareness of the present moment. It is easy think of a mindful life as one that does not consider the past or the future. But this is not the case. Sometimes living in the moment means thinking about the past, while rooted in the present.

This is a major challenge in the grief process. The intense feelings that come with loss cannot be suppressed without negative consequences. But living in the past, living in the loss, without appreciation for the full reality of the present, is also a way to suffer and get stuck in grief.

I may have mentioned that I’ve recently started seeing a mindfulness psychologist, Bonnie. I sought out a clinical psychologist who specializes in this area and this one used to be a researcher at Fred Hutchinson’s Cancer Center at the University of Washington, doing research on mindfulness based stress reduction programs with cancer patients.

I’ve been seeing her every few weeks to keep my mindfulness practice going as well as to work on the grief of losing my dad last summer. Thanksgiving was the first major holiday we had without him. John and I hosted and I was fine until the first half of Thanksgiving Day. First I was stressed with the food preparation. When I asked John to keep an eye on the temperature of our grill for the turkey and he’d somehow let it get waaaaay too hot, I nearly cried when I looked at the burnt turkey. Then I just felt sad for a few hours.

It took me a bit by surprise. I had thought I’d been mindful of my needs. I talked to Bonnie about it and she asked, “Do you ever talk to your dad?” The suggestion caught me off guard. I hadn’t thought of doing that.

Then I was surprised that I hadn’t thought of doing that. Then I remembered that my dad was really more of a doer than a talker. I talked to Bonnie about possible conversation topics.

I visited my mom last week to help with Christmas decorations. As I was driving there, I looked at the scenery. This brought back memories of my childhood and since my dad knew these stretches of highway well, something to talk about.

“Wow, Dad. What are they building there. It looks like they are adding another highway entrance and two more lanes.”

“Remember when there used to be wetlands all along this highway? Look, there’s still a stretch over there. I see hawks in the trees over there sometimes.”It

“Hey Dad, remember that time we brought Britt [childhood dog] to the wetlands over here? She was so excited to run and swim through the water. She ignored our calling her for about 3 hours. Then she stunk to high heaven!”

“Here’s the hospital. I’m so glad you don’t have to be there any more.”

It really wasn’t as awkward as I expected it to be and it actually felt comforting. Remembering is not the same as living in the past, holding onto things and people who no longer exist. It is a way to deal with pain and a way to honor love.

Peace, friends.

I finished an 8-week-long Mindfulness-Based Stress Reduction (MBSR) class last Wednesday. I am not new to MBSR but wanted to increase my formal mindfulness practice since it had waned over the past year, with my dad’s cascade of health problems and death last July.

It was a wonderful class. I haven’t been writing much. As my meditation practice has gotten deeper, I have longer times when I am experiencing sensation more than language. This is something I knew could happen in meditation, but as a person who typically has a running monologue in my brain, it is a rather magical and new experience. It is not, however, easy to write about.

I feel some loss about the class ending. To prevent my being totally adrift, I have also started seeing a mindfulness psychologist, Bonnie, who specializes in working with cancer patients. I had actually sought her out first, her practice was full, and she recommended the class. In the mean time, space opened up and I have been seeing her. She also happens to be a friend of my dear friend, Nancy. This is not surprising since 1) Nancy seems to know almost every other psychologist in Seattle and 2) Nancy also works with cancer patients as well as being a breast cancer survivor herself. (Nancy, you may remember, is the dear friend who cleared her schedule to be with John and I for my first breast cancer appointment, back in 2012.

I feel pretty fortunate to work with Bonnie. She is very skilled and worked for many years as a researcher at the Fred Hutchinson Cancer Center. Bonnie did mindfulness classes with cancer survivors and the classes were associated with reduced recurrence.  This is why I began my mindfulness practice in 2012, by the way, after following some Canadian research on a specific mindfulness class for breast cancer survivors.

But wait, I was intending to write about endings, not beginnings. The other thing that ended was the U.S. Midterm elections.  I did a lot to prepare myself for dystopian outcomes and good thing the worst case scenario did not occur because I was not successful in my preparation. They were not horrible, not great, and maybe not even good. Not horrible. That is the current benchmark for success in current U.S. national leadership. Actually, some really great things did happen. Lots of women were elected, especially women of color. Some of the people elected were LGBT/Q. Eight scientists were elected. Two women of color who are also Muslim, were elected.

So the election ended but as I had anticipated, there is still a lot of work that needs to be done. Our republic is very much in peril and so many people are suffering. I am exhausted by the news but I am also mindful of the fact that experiencing exhaustion is one of the best outcomes of our current situation. As I said, many people are suffering from abhorrent treatment and some have died or are dying due to lack of access to basic human needs or violence.

One thing ends. Another thing begins. Sometimes it is tempting to jump from one thing to the next without acknowledging the ending. Today, I feel the endings and the beginnings. I had put myself, intentionally, in a protective shell of self-care practices for the last few months. I come out for periods of time and then retreat to a thinner shell, for a shorter period of time, but it is a shell, nonetheless.

Overall, I am doing well. Most of the time, I feel happy. In the last week or so, I’ve felt not so much a wave of grief, but a persistent lapping at my toes. I have reacted more strongly to situations than normal, for example, feeling shame at times, over minor incidents. It is as if grief takes me back to a much younger time of my life. Bonnie says that the energy I am using to cope with my dad’s death is leaving me with less to cope with the normal daily stresses and that I am going back to older ways. That makes sense to me.

Working on grief is helping me define the edges of the persistent lapping at my toes. It turns out that today, they are not lapping at my toes. I am standing in the middle of the ocean. I feel sad today and a bit angry.

I don’t like to be in the middle of the ocean but I am grateful that I am standing, for now.

Peace to you, friends. I hope you are well.



Some people call October, “Breast Cancer Awareness Month”. Others call is, “Pinktober”. Still others call it, “October”.

I don’t like the commercialization of breast cancer with the commercialization of pink things, nor do I like the sexualization of breast cancer. I don’t like the commercialization of suffering or sexism at all.

I don’t, however, give Pinktober the same kind of harsh judgement as I did in the past. Part of this is because the pink stuff is decreasing. I applaud those that work to decrease it further.

Another reason is that my physical and emotional recovery from breast cancer has gotten to the point where I can even entertain the possibility of taking a broader view.

And oh yeah, I had two heart attacks.

An oh yeah, my husband and I have reared a brilliant, talented LGBT/Q daughter from age 13 at the time of my breast cancer diagnosis to her recent 20th birthday. Her life has been no picnic.

I actually forgot until just now that my dad died three months ago.

The main reason is that the broader issues of sexism, racism, health disparities, xenophobia, heterosexism, etc. have taken priority. These are my priorities and I am thankful to have the emotional and physical health not to mention financial security to be able to make these decisions.

Mindfulness is awareness. I didn’t make that up. That’s what it is. Mindfulness is an approach to reducing human suffering. I didn’t make that up, either. That came from the historical Buddha. He also talked about the main causes of human suffering as fear, hatred, and delusion.

Fear, hatred, and delusion.

There’s a lot of that going around.

As a psychologist, I’m going to tell you that fear is a basic human emotion, needed to keep us safe. But I can also tell you that our central nervous system gives us many false alarms about safety and how we respond to false alarms can certainly cause human suffering. It can also underpin anger and at it strongest form, hatred. We can also respond to an off kilter nervous system with delusion, cognitive contortions of thought. (There are also mental illnesses that produce delusions on their own and those also cause suffering.)

I guess the biggest issue I have with the way that Breast Cancer Awareness month is that it’s not even really awareness. Awareness is mindfulness of all aspects of breast cancer, which to a certain respect, is different for all of us, based on medical differences in disease processes, treatment access, and personal, social-emotional and cognitive processes.

And certainly, awareness without constructive actions, is not very useful and if we are stuck there, thinking it is sufficient, I guess that may be a kind of delusion, too.

I hope you find my musings helpful today.



I am checking in after not having written in awhile. It’s been exactly three months since Dad died. I am experiencing fewer moments of diffuse sadness and unexpected negative self-talk. I do feel a pang when I come across a photo of Dad or after not thinking about him for a few hours and then remembering that he is dead. My mom is coping very well. She is making new friends at church, singing again, and approaching each day with a schedule of chores.

I began a Mindfulness Based Stress Reduction (MBSR) course two weeks ago. I have taken one before as well as attended mindfulness classes and retreats. My formal meditation practice had fallen off in the last year. The class is in the evening, something I would not have been able to do six months ago, due to fatigue from taking beta blockers. Since going off of the medicine, my energy level has improved, and taking the class has also resulted in increased energy and emotional balance. I have also started eating more healthfully again. I am being mindful of my food choices, especially quantity and quality. I also decided to change eating plans.

More energy also means more time to do pottery! I’ve been working on some new surface design techniques, which allow me to incorporate my photography into my work. John is still taking classes with me, though I notice that his enthusiasm level is less. Maybe it’s just relative, I don’t know. I do know that he is working to take better care of himself. He had a health scare over the weekend and has asked to meditate with me, which he has been doing all week. John is also exercising again. He’s not yet convinced that his food choices might be significantly improved. I am treading lightly but making my concerns known. We are both overweight and at risk for cardiac problems. John carries all of his weight in his mid-section, which is a risk factor. The fact that his dad died of sudden cardiac death at age 49 is also a risk factor as is John’s high cholesterol.

Our daughter is doing well, nearly a senior (a few credits short) at Western Washington University, about 1 3/4 hours away. She is majoring in journalism, taking vocal lessons, and vlogging. A favorite vlog entry is, “Why you shouldn’t drive like a dick.”

Ah yes, I am also reading the news. Another reason for meditation.

Peace, friends.

I have been trying to declutter my house. Yesterday, I noticed that I still had my “big book of cancer” on the shelf in my bedroom. It’s the 3-ring binder of information I received from my cancer center when I was first diagnosed with breast cancer in 2012.



I used to carry this book around with me to every appointment. As you can see, I added tabs to it to organize all of my medical records by date. Since not all of my providers were at the cancer center, this helped me keep my care coordinated. It also helped me follow my treatment and form good questions.

When I saw it on the shelf recently, I thought, “Get rid of that! Why is that in the bedroom of all places?”

Then I remembered that every pathology report, every surgery report, and my onco/dx testing results are in there, as well as my notes, and research articles.

I will move it out of my bedroom. I no longer have to have it handy. But I may still need it.

Sometimes it is easy to get rid of the clutter of my experience with breast cancer. The harder part, however, is knowing what is clutter and what is not.

I did a saliva DNA test for my ancestry through about a year ago. My husband was a bit surprised, “Now you’re DNA is out there.” I replied, “My DNA is everywhere. It has not been private for a long time.”

In 2012, I was diagnosed with breast cancer. I underwent BRCA 1 and 2 DNA testing. The test results suggested no mutation of either gene. Mutations are associated with increased risk of breast cancer, ovarian cancer, and prostate cancer.

In 2017, I had two heart attacks within 8 days, due to Spontaneous Coronary Artery Dissection (SCAD). I provided a blood sample to the Mayo Clinic, as part of their DNA registry to identify genetic contributions to SCAD. A few months later, I had some more genetic testing done through a local cardiologist. I found that I have a genetic marker for elevated cardiac risk.

In my situation and with my personality, I prefer to gather information, if there’s not physical risk associated with it. But this is not for everyone. This is why there are genetics counselors, to help us make informed decisions about whether testing is the thing to do and to help us understand the results when we do it.

There are two times that I have refused DNA testing and it has been on behalf of other people. The first was when I was pregnant with Zoey. I opted not to have amniocentesis after a blood screen indicated increased risk for Down’s Syndrome. After looking at the testing properties of the screen, talking with a genetics counselor, and meeting with a neonatal specialist, John and I agreed that the risk of Down’s Syndrome was really low (the screen had a really high false positive rate), not high enough to risk miscarriage through the amniocentesis procedure.

When my dad was diagnosed with stage IV prostate cancer in March of this year, there was a referral for genetic testing. Mom and I agreed that this was not top priority at the time.  Then my dad got an emailed referral once again about a month before he died. I handled Dad’s email correspondence.

Dad had so many medical appointments. He had dementia. He was fully physically disabled, needing two staff members at the nursing home, to move him. (He would later only need one person and that’s what allowed him to be discharged and die at home, as he wished.)

Genetic testing? Really? Since when is it surprising for an 85 year-old man to have advanced prostate cancer?

However, I don’t know the answers to all questions. I am not an oncologist. I contacted the genetics clinic and asked whether it was really important that Dad have the testing done, given his advanced age and limited quality of life. I was told that the referral had been made “due to family history of certain cancers.”

It was now clear to me that it was my history of breast cancer that led to the referral. I wrote back to the PA, explained that I’d had BRCA 1 and 2 testing, was negative, but that my testing had been done in 2012. I asked if she could tell me the testing protocol so that I could get the testing done instead of my dad. She very kindly forwarded my question to one of the physicians, who told me that she agreed that testing wasn’t a great idea for Dad and suggested that I ask my oncologist for what testing to get done.

I haven’t gotten around to the testing yet. I just sent my oncologist an email, asking for her opinion.

The Information Age puts us in the position of finding the sweet spot between too much and too little.





You may have heard that the west coast of the U.S. is filled with smoke from summer wildfires. We’ve been in the latest cloud for a few days. As I watched the ash land on my car yesterday, I was reminded of the last time I saw ash in the sky.

It was last October. I was at Spirit Rock Meditation Center for a five night meditation retreat. To the north, there were fires in California, ravaging forests and homes. I was at the meditation center without my cell phone. I had given it up on the first day of the retreat so I could have the retreat experience I wanted. I had, however, told my husband that if any time while I was there, he feared for my safety, he merely needed to call and tell them there was an emergency and I would return home. That never happened. The retreat staff did a masterful job of informing us, just enough, of our safety and the progress of the fires. I was assured that they would not put us in harm’s way.

I had gone to the retreat to be alone with myself, five months after the unexpected calamity of two heart attacks caused by Spontaneous Coronary Artery Dissection, a poorly understood cause of heart attack among primarily seemingly healthy women.

I meditated. I ate. I walked. I slept. I watched the ashes fall on the days of smoke. Sometimes I felt restless. Sometimes I felt bored. Sometimes I felt awkward. Mostly I felt that I was exactly where I wanted and needed to be. I had moments of lovingkindness, peace, equanimity, and mindfulness.

We have ashes falling again. They fall from the sky and settle. The air is hot and acrid. There have been health warnings to avoid vacuuming carpets inside to prevent the ashes that have settled into the fibers from roiling back into the air.

There has been a roil of ashes in my life. Natural calamity. My father died. This happens, especially after a life of 85 years. It is natural but it is calamitous. Normal doesn’t mean good. It means, common. Death is a normal part of life that is really really hard.

Some of the ashes are settling. As I watch them, I am reminded of the mindfulness analogy of the snow globe. If you stop shaking a snow globe, the roil of snow settles. The scene is peaceful but the snow is there.

I can’t help the ashes that fall from the heavens and follow the winds, but I can keep my vacuum tucked away in the closet, at least for now. For me, this means, continuing to protect my emotional and physical energy. I am careful about how much socializing that I do. It takes a lot of energy right now. I do a lot of art. I continue to keep my patient load on the lower side. I ask for help and understanding. I keep in touch with my mom every couple of days. I am taking short vacations.

I am doing my best to let enough ashes settle so that I can see where I am.

Peace friends.

Art, Science, Heart ❥

journals of a mature student nurse

Heart Sisters

For women living with heart disease

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 (


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