John Gottmann, a psychologist at the University of Washington wrote a book called, “The Relationship Cure.” In it are strategies for strengthening marriages and other relationships. But Dr. Gottmann is a well known expert on marriage so that emphasis of the book is there. I have read a number of his books and know that one of the things he talks about quite frequently are perpetual problems. 69% of marital arguments are never resolved. And it’s not so much that happy couples need to resolve them as they need to cope with them together.

My maternal grandparents had a long marriage of 60 years. I wish I could say that it was a happy one but it was not. They had a number of perpetual conflicts but one I distinctly remember is the fight they had about a photo that my grandmother had taken with the Hawaiian entertainer, Don Ho. They took separate vacations by the time they were in their 60’s. My grandmother would frequently visit Hawaii to see their daughter, Judy and her family. My grandmother loved Don Ho’s shows. Apparently, he used to invite the grandmothers in the audience to take a photo with him. My grandmother, who was one of the most star struck people I’ve known, of course got the photo op. But she wouldn’t show the photo to my grandfather. I don’t know how many times I heard them yell at each other over some stupid photo. Like my grandmother would have an affair with Don Ho! But the argument was not about the photo. It was about some deeper issue that they were not able to manage. But because they were of a generation, a social class, and a religion that didn’t divorce, they stayed together for many unhappy years.

John and I have been together for nearly 27 years and we have our share of perpetual arguments. And conflict is part of any close relationship. It is to be expected and to be dealt with. But never in a million years would I expect to have a perpetual argument about a plant part, more specifically soursop leaves. Soursop is a fruting tree indigenous to Mexico, Central America, and the Caribbean. I first became aware of the soursop when I was visiting one of my best friends, Cheryl, for her mother’s funeral. Cheryl’s parents were both immigrants from Trinidad. Cheryl’s Uncle Norbert, a retired ichthyologist with more than a passing visual and vocal resemblance to Harry Belafonte, first told me about soursop ice cream. It is as I understand, an acquired taste.

Many years passed and I didn’t think again about soursop. Then I was diagnosed with cancer in late May of 2012. I had my first surgery scheduled for June 27th of the same year. One day, shortly after my diagnosis, John came home with a plastic bag of leaves. One of his co-workers had learned of my breast cancer and told John that tea made from soursop leaves would shrink my tumor. In fact, he thought it would help shrink my tumor even prior to surgery, which was scheduled for a couple of weeks later.

My husband is a software engineer for Disney Internet. The co-worker who gave him the leaves also had a high tech background. He was also rather eccentric, priding himself on storing his container of almond butter upside down so that the oil was easier to stir into it and it would remain creamier. I know this sounds snarky, because it is, but my mother taught me the same practical tip about peanut butter when I was a girl, with about 1/100th of the fanfare.

John brought home the leaves with instructions to make tea. I told him, “I’m not drinking that. Your co-worker is not a physician. He’s an engineer. And he’s weird.”

Okay, so that was not the best way to handle the situation but I was overwhelmed with information, trying to be the best patient that I could be, and the soursop leaf suggestion just seemed surreal to me. Go away, surreality. I need less of you. I am swimming in this cancer Hell hole as fast as I can. I don’t need any Salvador Dali in my life right now. My reality is spinning and melting enough as it is. Now, since it was so important to John I did a literature search on the use of soursop in cancer treatment. There was no evidence to support its use that I could find and some suggestion that it could be harmful. I considered his request considered, albeit in my own feisty way and ruled out for reasonable reasons.

As you might imagine, John was none too pleased with my response. He told me, “You only trust people with credentials.” Seriously? He said this as if it were a bad thing. Months later, he changed his criticism to, “You are so Western in your thinking.” I replied, “I believe that natural substances can be potentially very powerful for good or ill. I want to see an expert not just take advice from anyone. And by the way, you know I see a naturopathic oncologist and a practitioner of oriental medicine IN ADDITION to conventional oncologists, right?”

The argument comes back from time to time without resolution. I invited John to my last two psychologist visits as we work to transition from a crisis managing couple to a different sort of life together. The kind of  life that includes the possibility of cancer and has already included past cancer. We are still dealing with the aftermath.

The soursop leaf debacle was discussed during the last session we had together. John explained why it was so important to him. He said, “I wanted to cure Elizabeth’s cancer.” John clarified that he did not think that he was a physician or that he had more expertise than my physicians. But he, as my husband, wanted to “help” in a way that was “curing” my cancer. It was important that I understand this. I had no idea. It makes no logical sense to me. Why would John be expected to “cure” my cancer. There is no cure for breast cancer. And if there were, it would not only be known by John and another software engineer. In fact, it probably WOULDN’T be known by a couple of high tech guys.

But John is my husband who loves me dearly. I know that when he is scared, he is not always “reasonable”, in fact he can be downright romantic and sometimes nearly magical in his thinking when things gets really emotionally tough. And guess what? I am not the paragon of reason at all times. I get scared, feel out of control, and have my own little irrational dance that I do.

I don’t know what it is like to be a spouse of someone with cancer. I hope never to have this experience. But I know that it is important for me to try to understand my husband’s experience. This way we can cope with the conflict of the soursop leaves, which is really conflict about neither of us having control over the disease of cancer.

In addition to the color pink as a emblem of breast cancer, another polarizing expression is the characterization of cancer as a “gift”. I don’t think of it as a gift but I do think that it in coping with it, I have learned some important life lessons. It has been an ultimate learning experience, a growth experience, if you will.

The recent posts on the topic reminded me of something. My clinical psychology Ph.D. program was quite demanding and the first year was steep learning curve for students. When I was an advanced grad student, I watched a new crop of students struggling toward the end of the first semester. One day they got an additional unexpected task. Some of the students were trying to reframe it in a positive light. Louis, who was really funny and had a way to getting to the heart of the matter said, “Oh great! Another fucking growth experience!”

I don’t think he’d see cancer as a “gift”, either.

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I lost my shit with my kid. I have not done this is such a long time, honestly in years. I’m not sure why I did. She was treating my bedroom like it was hers and refused to leave when I politely requested that she do so. She had that look in her eyes of “make me.” I haven’t seen that look in a long time, in a couple of years, in fact.

It was like of flood of grief came over me, of fear and anger and loss. I yelled. I lost so much. It feels like I lost years of holding my breath, patience, and rebuilding trust with my family.

I messed up. I heard my daughter tell her father, “Mom is 48 years old. I am 15. She is acting like a child.”

And she was right. I had a tantrum. One I didn’t see coming in a million years. I saw the look of rebellion the look of “make me” in the eyes of my daughter.

I’ve been dealing with roils of anger lately. Anger that comes from past helplessness. And the look of “make me” was the look of cancer. Cancer entered my life without warning and without welcome. I have become more and more aware of the trauma it inflicted on me. No, it did not ruin my life but my life will never be the same. It will continue to take time to heal.

I confused my fear of having a life out of my control with the scared eyes of a 15 year old girl. I have apologized but I had already done much damage. My husband is also hurt and angry with me. I have been there. I have been at the spot of watching a spouse lose it and undo our progress as a family.

My daughter has also apologized and although that is mostly good, in a way I feel worse. Tomorrow is another day. But right now I feel very regretful and quite ashamed. I’m not a monster and neither is my child. Why did I just act like one?

I think this is the time in my grief when I need to address my anger. This has been a long time coming. I pray that I can do so without causing more damage.

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I have a Ph.D. in psychology. This is a science degree. I was a researcher for many years, following the scientific method to answer empirical questions. Before starting a study, there is also rigorous review of research involving human participants by ethics committees, which are comprised of both academic researchers and community members. I also have a number of peer reviewed research publications. The peer review process requires that other researchers in the field (and they shouldn’t be your buddies, by the way, that would be a conflict) review an article and not only weigh in on whether the article should be published but also make sometimes very extensive recommendations about changes to be made in the writing, the logic, the conclusions, or even the type and amount of statistical tests that are performed. And by the way, the authors’ names are taken off of the article by the journal editor and the authors are also not told the names of the reviewers.

It is not a perfect system. It is not totally devoid of bias. But it a systematic process, with built in checks and balances, carried out by in my experience, very smart and dedicated people. I find it extremely powerful that at the basis of statistical testing is the possibility that a hypothesis is wrong. Mathematically, each hypothesis is tested against the null hypothesis, which to make a long story short means, “Researcher, you are wrong. What you thought made a difference, made no difference.” So while an individual researcher might be arrogant, the basic assumption of statistical testing is still steeped in a kind of humility.  In sum, carrying out science involves the hard work of employing logic, making predictions, gathering evidence, and working as a scientific community to continually build a systematic understanding of the world.

I love doing science. I’m no  longer a researcher so I am not engaged in conducting it anymore. But I like to think of myself as an extremely logical person, a scientific person, a person who despite the fact that I am passionate with strong feeling and quick thoughts, tries to examine questions in the time it takes to do so, think about evidence to support my initial judgments, and make revisions as I go.

I am also a person with a strong faith in God. And again, I am not a traditionally religious person but I do have strong faith. God cannot be seen directly, anyway. God cannot really be measured. A belief in God is not scientific. The way I have thought about this is that there are some questions that are subject to faith and others that are subject to science. The existence of God is not a question, at least at this time, that is subject to scientific inquiry. But I have faith and experience God through the love people express for each other and nature’s majesty the latter of which includes Earth and the wide expanses of the universe.

Today, is the 50th anniversary of the assassination of John F. Kennedy. It was a truly tragic and horrible event during particularly turbulent and violent times in our country’s history. People die for no good reason all of the time. It is easy to get desensitized to it. But thinking about JFK, a charismatic, young, idealistic, and good looking president grounds us and reminds us of the horror of violence.

I think most people in the U.S. would agree that there is too much violence in our country. But after that agreement, things tend to fall apart. Today I was reminded of the National Rifle Association slogan, “Guns don’t kill people, people do.” I hate that slogan. And as you know, I hate very few things. But I hate it and it’s not just because I disagree, as do most Americans, with the extreme positions of the NRA.

I could go through the illogic of the slogan. It’s not an either or situation. People with guns kill people, both a person and a weapon are usually necessary. Yes, people still get beaten to death with someones bare hands and feet, but this is a minority when all violence related deaths are considered. A tool is usually used and guns are an extremely fast and effective way of killing someone.

There has been systematic research on guns in this country. I could give you all kinds of statistics about how having a gun in one’s home increases the risk of gun death. I could quote all kinds of evidence that our current gun control laws are insufficient in truly protecting people. I could also give you really obvious logic like do people really need assault weapons for duck hunting? Or do you really want to follow the logic of Ted Nugent? I mean have you listened to him? He makes no sense.

I could give you data. Because guns, their use, and their impact are observable. They are subject to scientific inquiry. And yes that inquiry can be subject to bias and given that NRA successfully lobbied to defund grant funding through the Centers for Disease Control (they have a section of injury prevention) on any studies that involve guns, we will unfortunately get less information about a problem that most all of us would agree exists. Too many people are getting killed by people with guns.

But I could not convince most of the people I’d like to convince with logic and data. Because many people have decided that this question is one of faith, not one of science. So there’s really no way to argue. And it doesn’t matter that there is supposed to be a separation of Church and state. A religious belief, by a powerful lobby, in highly unrestricted gun access and ownership is held to not be questioned and is incorporated into law.

As a general rule, I avoid discussing politics especially the politics that get intertwined with religious belief. It’s not so much that I disagree with everyone. I just find that whether I am discussing these issues with a person who agrees with me or not, there’s an incredible intolerance for people who express a different view point. And not only is there intolerance, there is name calling, “morons”, “un-American”, “not real Americans”, “Bible thumpers”, “idiots”.

And then I just come out of the conversation fighting harshly judgmental views. I try really hard not to be harshly judgmental because it is incompatible with love and respect. And I add “harshly” because we are supposed to be judgmental; we make hundreds perhaps thousands of judgments in a single day. But the best judgments are those that are fair, safe, and respectful to ourselves and to others.

You may agree with me. You may disagree with me. If you’ve gotten to this part of this post, I thank you for your kind attention. In any case, I have faith in God. I have faith in the power of  love. And I believe that violence is a problem in our society. And in my work, I help parents and children to use alternatives to aggression. In that sense, I work on the “people” part of the NRA slogan. Along with my husband, I work to teach Zoe how to live as a loving, peaceful, fair, and respectful person. I continue to try to live in this way myself. I am not always successful. Nobody is, there is conflict in life. But I hold peace as an ideal to which I continually strive. To me, that is my personal practical brand of pacifism.

People, let’s get to work.

I’ve had a couple of difficult days. We all have them. It’s just part of life. Something throws you on your butt, you rally, you still feel kind of bad, maybe another thing knocks you back on your butt, you rally again, and keep inching your way along until you re-right yourself.

Today, I had paperwork to do but did not have to go to the office to see patients. I had been knocked on my butt a couple of days ago and still felt knocked down this morning. I meditated for a long time and thought about my life. My past, my present, and my future. I gained some clarity. I had some really wonderful thoughts about perfectionism, which I had planned to share on my blog, but promptly forgot as soon as I got out of bed. (Darn!)

The sky was blue today. I went out for my walk. The sky was not only blue but the mountains were visible. I walked to Bird on a Wire, my neighborhood coffee shop, which is quite excellent. It was as if the universe knew that I needed to be cheered up. Maddie said, “Oh, Elizabeth I’m glad you came at this time. (It was a slower part of the day.) We hate it when people we like come at busy times and we don’t get to talk to them.” Then Adrian noticed that a gluten-filled biscuit was being prepared for me instead of a gluten-free one. She saved me from some major eczema. Adrian keeps an extra eye on this, I’ve noticed and I very much appreciate it. And finally, Angel told me that I was one of his favorite people. The people who work at the coffee shop are always friendly but this was much more than usual. I told them that they were awesome but I did not let on that I was having a hard day and they have no idea how much their kindness meant to me. I also experienced the incredible kindness of a friend in the past couple of days who knew that I was having a hard time, who has checked in on me periodically over the past couple of days.

I continued, with coffee and gluten-free biscuit in hand on my walk. It was WAY too nice not to go to the beach. I didn’t have enough time to walk there so I walked a half mile back to my house, jumped into my car, and drove to Lincoln Park, which is on the Puget Sound. There was new snow on the Olympic Mountains. The sun was bright and the sky was a brilliant blue. The wind was strong and it was cold. But it was amazing! The water, the islands, the Olympic Peninsula, and the mountains were glorious. I saw osprey flying over the water and then suddenly drop to the water to fish. I saw cormorants and a few species of duck. At one point, I saw black figures as the waves broke. They were two harbor seals about 20 yards off of the coast. They were swimming along and coming up every several yards. I was able to walk along the beach fast enough to continue to observe them for several minutes. I have seen seals at this beach, but only 2 or 3 times in the past 10 years. The Pacific Madrone, one of my favorite trees, which only grow near salt water, were beautiful. The orange trunks with their peeling bark were beautiful against the blue sky. The towering Douglas fir were majestic.

I’ve had a stressful life for the past many years. The reasons for this are many, most of which I have written about here. One of the ways I deal with the stress as well as to help prevent recurrence of depression is to get a full body massage every three weeks. I have gotten them from the same lovely person, Jann Coons, for the past 13 years. The first massage from Jann was a gift from my husband for my 35th birthday. I got the first one and have never stopped going. I’ve had massages from three or four other people and no one holds a candle to Jann!

Jann surprised me today. She told me that she had a Christmas present for me in her car and noted that she couldn’t keep it in her office. She walked me out to her car and I could see that she was getting ready to open the trunk of her car. I said, “Oh, well I am guessing that you are not giving me a puppy!” She pulled an amazing variety of home grown vegetables, artfully arranged in a basket, from the cool depths of her trunk. The basket contained red chard, two kinds of kale, delicata and other squashes, red and yellow onions, mizuna (a type of green), and beautiful red beets. I’m sure Jann could tell that I was moved by her generosity. I gave her a big hug and a kiss on the cheek. I still can’t believe it. I almost cried.

I am not a traditionally religious person but I believe my faith in the spiritual beliefs I do have is very deep. Today, I experienced an overwhelmingly beautiful display of nature’s bounty. The bounty from the sky, the water, the mountains, dirt, and from other human beings, who are also part of the natural world. And I know this is only a fraction of the bounty that I enjoy. I have so many wonderful people in my life, friends and family. There are so many wonders of the Earth.

I know that Thanksgiving is not for another eight days but today I feel very thankful, very blessed, and so loved. My heart is bursting.20131120_121619

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Jann's Christmas present to me. A basket of health that she grew with her own hands.

Jann’s Christmas present to me. A basket of health that she grew with her own hands.

As you know, I have been working to break the brain draining choke hold that nearly a year and a half of bad sleep has wrought upon me. There have been peaks and valleys but mostly, I am sleep deprived. And now in the northern latitudes, it has gotten very cloudy and very dark. Without the long summer days to give light to my mind, I find myself being incredibly and totally fatigued during the day.

And it hasn’t been like I haven’t been doing anything to help myself sleep well. I exercise every day, I meditate, and I try to keep my stress level to a dull roar. I also started taking Chinese herbs for sleep prescribed by Dr. Wang, who does my acupuncture. They taste like a combination of dirt and mushrooms. Surprisingly, they aren’t that bad. At least they don’t taste like feet. I also take magnesium citrate and melatonin, as recommended by my naturopathic oncologist. The magnesium also helps with the leg cramps I get from tamoxifen. I have many patients as well as my daughter who take melatonin with very good impact on improving sleep onset (falling asleep). However, I’m not sure it’s doing anything for me.

I saw my psychologist last Friday and she gently suggested that I might ask my physician for Ambien to help me sleep though the night again as lately, I have been waking up 6-8 times a night, often with night sweats, which are side effects from Lupron. I have been trying to solve this problem on my own. I also started using blue light therapy since my energy level usually gets lower with our short, low on sunlight days. The blue light has helped in the past and it seems to be helping now by increasing my day time alertness. It also seemed to be knitting the fragments of my night time sleep together a bit so that I was getting longer amounts of sleep. I noticed that I remembered more dreams and felt slightly more rested when I awoke each morning.

I had an appointment with my medical oncologist last Friday. I have not previously complained about sleep. But I did this time. She was empathetic, as usual, and suggested that I start taking gabapentin to reduce the night sweats and help me sleep at night. Preliminary data would suggest that my sleep has improved significantly since starting the medication.

Stay tuned. So far so good. Sweet dreams.

But we in it shall be remembered-
We few, we happy few, we band of brothers;
For he to-day that sheds his blood with me
Shall be my brother; be he ne’er so vile,
This day shall gentle his condition;
And gentlemen in England now-a-bed
Shall think themselves accurs’d they were not here,
And hold their manhoods cheap whiles any speaks
That fought with us upon Saint Crispin’s day.

-William Shakespeare, Henry V, St. Crispin’s Day speech

Soldiers prepare for battle is different ways. Some get drunk. Some revel, party, and have sex with prostitutes. Some pray. Some cry and despair. Some are calmly resigned to whatever fate may befall them. Some do all of these things. “War is Hell” as William Tecumseh Sherman said in 1879 and most of us give soldiers at least a little latitude in the way they deal with this reality.

Preparing for a mastectomy is one kind of battle plan. Some of us cope by crying, by grieving for the loss of a culturally and personally significant body part. Grieving for the loss of being able to depend on good health. Others cope by getting angry, by cursing the barbarous  and coarse way in which breast cancer is treated, by amputating breasts, chemical warfare, and irradiating the Hell out of potentially tumorous sites.

There are many more ways to cope. I coped by writing silly posts about accidentally turning my hair orange, because I had an irrational need to be a little bit cute, to not have gray hair after my mastectomy. I wrote another post saying goodbye to my breast using all kinds of melon-related imagery. I also spent time learning about cancer and its history. Being silly actually made me feel a lot better. It took my mind off my worries and reminded me that I had the power to do something good, to make other people and myself laugh. But I never thought for a second that my mastectomy was going to be a positive experience. And I would have never predicted that I would be reading “The Emperor of All Maladies” in the pre-op area of the hospital just prior to my mastectomy. And coincidentally, I was reading the chapters on mastectomy. In a weird way it was comforting to know that the current surgeries were far less extensive than in the past. It was reassuring to see that there had been progress in breast cancer surgery. But honestly, I look back and think, “Why was I reading about cancer?” But at the time, it was the right thing to do.

I did not feel bereft, angry, or super sad in the weeks, days, or moments leading up to my mastectomy. I had anxiety, but it was relatively manageable. When it came time for surgery, I asked the anesthesiologist to knock me out as fast as possible, which she did. I did not want to belabor things. The operating room is surreal to me and I wanted to to experience the least amount of it as possible. More importantly, I knew that the faster I was knocked out the less time it would seem that I would have to wait until the surgery was done. I knew that there would be no perceived lapse of time between losing consciousness in the operating room and waking up in the recovery room.

But that was my way of coping, which worked for me. Not everyone wants to do what I did, scheduling surgeries as fast as possible, writing silly humorous posts, reading about cancer in the pre-op area, or getting knocked out as fast as possible. Moving ahead quickly, laughing when I could and reading history that put my disease in a larger context, made sense to me.

Some women prepare for a mastectomy by dancing. One woman, an OB/Gyn, prepared for her bilateral mastectomy by dancing to Beyonce with her surgical team. When I looked at the video, I thought of how dancing in the O.R. might be empowering for a surgeon. She may have never had surgery before and would have been used to being on the other side of the operating table. By dancing in the O.R. with her colleagues, she may have felt a sense of mastery that helped her prepare for her surgery.

I thought the video was cool but I understand why others thought it trivialized breast cancer or prescribed a model by which we are all compared. We should all be happy to have breast cancer. Yay, deforming surgeries! Yay, lymphedema! Yay, lack of sensation in the removed breasts! Yay, scars!

I am sad and angry that the popular media has taken this stance when it comes to breast cancer. But I do think, apart from that, each breast cancer patient needs to cope in his or her own way. Sometimes that way is dancing. And sometimes the dancing, just like mastectomy photos, are shared on the Internet.

We all prepare for battle in a different way but we are all fighting the same battle. Let’s do it together.

Many years ago, I was working with a child with aggressive behavior problems and his parents. As I recall, he was 8 years old at the time. He was so easily angered. Some children are. By the time an 8 year-old child who has trouble regulating anger and has a great deal of trouble with impulse control, they typically have a lot of practice being aggressive and being impatient. There is an automatic reflex for disappointment and frustration.

The boy had been playing with toys, Legos I believe. It was time to clean up. There are children who kind of lose it when they are told to clean up. He was one of those children. Now, I don’t set things up so that kids will blow a fuse. I wrote out the session schedule as a check list. An example of this kind of schedule might be as follows. 1) Grown up talking time, 2) Show and tell, 3) Grown up talking time, 4) Show and tell, 5) Clean-up time, and 6) prize time.

In other words, “clean-up time” did not come out of the blue. But as soon as the words, “It’s time to clean-up” were uttered, I could see the boy’s brow knit and his fist clench. He picked up some Legos and I could tell that he was planning to throw them across the room.

A big part of my job is observing and waiting for little opportunities. Opportunities to offer a child a chance to do something different. An opportunity to be appreciated by an adult in a positive way. Once these opportunities present themselves I have to work extremely quickly.

I picked up the Lego bin, smiled, and said, “Oh you look like you are ready to put those Legos away! Thanks so much for helping!” His face relaxed and he put them in the bin. I said, “Wow, I bet you are really fast at putting things away. Oh look at that!  You put all of those away. Oh, there are some more in the corner! There you go, I knew you were fast. Thank you for taking care of the toys. That means that other children will be able to play with them. You have been very kind.”

Did that interchange solve all of the boys problems? No, it didn’t. But I do believe that it opened a window to how things could be different. For how helping can be powerful. For how seeing the positive possibilities in another human being can be powerful rather than naive. And more important than showing this possibility to the boy was the fact that the window was opened for his parents, to see their son as capable of positive growth.

It doesn’t always work when I try to take these opportunities to make a shift with my patients, with their families, with my loved ones, or with myself. But sometimes it works and works beautifully. As I become more mindful in my own life, I look for these micro-opportunities to make changes in my own life, in the way I think about things or in the way I behave.

I often tell children, “One of the best things about life is that you almost always get another chance. Every day is a new opportunity.”

Lindbergh High School Reunion '82, '83, '84, '85

Join us this summer for our reunion in Renton, WA!

George Lakoff

George Lakoff has retired as Distinguished Professor of Cognitive Science and Linguistics at the University of California at Berkeley. His newest book "The Neural Mind" is now available.

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