Healthcare Decisions for Our Parents and Us

In a recent New York Times article, Dr. Mikkael A. Sekeres, a cancer specialist. told of his first meeting with a 97 year-old patient. The elderly man had recently moved into an assisted living facility in Cleveland in order to be near his son and daughter-in-law, who had come with him to the appointment.  He was being seen for abnormal blood counts requiring periodic transfusions. As of yet his condition hadn’t been diagnosed.

“I don’t know if I’m looking forward to being 98,” the man confided. When Dr. Sekeres asked him to explain, he said, “I don’t want to end up . . . you know, blotto,” simultaneously leaning to the side and opening his mouth to imitate advanced senescence. Dr. Sekeres suspected that the man’s blood abnormalities were the result of a cancer that kept the bone marrow from producing enough healthy blood cells. The diagnosis could be confirmed by a bone marrow biopsy.

Did it make sense to do the procedure, though? The condition didn’t seem to be worsening, and treatment wouldn’t cure it. Plus, the man’s fear of becoming “blotto” didn’t stem just from his illness. He thought he might end up worse off “Because of my medical condition, or whatever you’re going to recommend I treat it with.”  Medical interventions don’t always make things better. As the saying goes, “sometimes the cure is worse than the disease.” The older and more decrepit we get, the more this is likely to be the case.

Dr. Sekeres brought up the biopsy, but the man immediately rejected the idea. Dr. Sekeres indicated that it didn’t have to be done; the procedure would be painful and wouldn’t offer the man any foreseeable benefit. Hearing his father’s comment and the doctor’s reply, the man’s son quickly assented. Too often, children question their elderly parents’ decisions, often to the point of treating the parent like a child who isn’t capable of making choices. Certainly there are situations where the parent isn’t capable or hasn’t thought through the implications of a decision. However, Sederes’ patient clearly had his wits about him and had thought about what sort of medical care he wanted. Fortunately, the son knew his father well enough to take his dissent seriously.

During the past few years I’ve been in the son’s position; I’ve taken my mom to doctor’s appointments during which treatment options were discussed. Most recently, it was an appointment at a gastroenterology clinic to review her difficulties with swallowing. She has had a variety of treatments in the past, resulting in no more than slight, temporary improvement. She has to puree her food and even then isn’t getting enough calories to maintain her weight. During the appointment, the physician’s assistant reviewed treatment options, recommending against some but leaving others as possibilities. None is likely to make a significant difference. A feeding tube will probably be necessary at some point, but there are no clear indicators as to when it would be best to take that step. When the PA paused, mom turned to me and asked, “What do you think I should do?”

I could have told her what I thought was best, but, if I did and she deferred to me, it would be my decision, not hers. Since she would have to live with whatever was decided, it was important for her to think about her preferences. So rather than offering a firm opinion, I mostly just highlighted what I thought were the most important points the PA had made. I mentioned the risks of having her throat muscles stretched again. The PA had said she might have an infection in her throat that was adding to her difficulties; it would be possible to treat any possible infection without further testing. This might or might not help, but had little downside, so mom agreed to take an antibiotic for this purpose. We discussed the pros and cons of a feeding tube. Having one would be especially advisable if mom lost more weight; the PA suggested 120 pounds as the weight below which a feeding tube would definitely be needed. Mom agreed. The plan came together a little at a time. Mom didn’t want to make the decision by herself, but she did want a say in the decision, and that’s what happened.

I realize that not all elderly patients have either a logical, well-thought out position from which to make health care decisions (like Dr. Sedekes’ patient) or the ability to collaborate with family members and health care professionals to make such decisions (like my mom). Yet an awfully lot do, if given the chance. It certainly works best if sons, daughters, and other family members provide that chance rather than diminishing the elderly patient by hijacking the discussion of options. Many children don’t even know what quality of life the parent is (and is not) willing to sacrifice in order to increase longevity. Those of us with elderly parents need to listen and avoid making assumptions; parents whose adult children are helping them get health care need to communicate their wishes as clearly as they can. Everyone facing medical problems during the last few decades of life should be heard and have their wishes treated with respect and caring.

 

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Relocating to a Retirement Community: A New Life

I wrote recently about the first part of Richard L. Morgan’s book Settling In: My First Year in a Retirement Community. Morgan was initially enthusiastic about moving to a retirement community near his daughter, but after a month or so doubts crept in. He wrote, “The initial euphoria had worn off, and I felt suspended in a limbo between a life I loved and a life yet to come.”

I had a similar experience of having lost my old life and yearning for a new life when I moved back to my hometown in 2012 to help my parents. A move such as Morgan’s or mine is just one of many events common to older adulthood that can take us away from the life we’ve been living without supplying a new one. Retirement can have this effect, as can losing one’s mate or deteriorating health. It’s instructive to look at how Morgan responded to being in limbo.

Morgan indicates that the first step in finding his new life was a process of discernment. He explains:

“Discernment is another part of detachment. We consider our life from a critical distance and then take the next step.” (p. 91)

Morgan describes his process of discernment as taking place “through endless walks around the community and long night struggles.” What came of this?

“I discerned that God was calling me to use all the experiences and gifts of my former ministry in this place. This place? Yes, right here where people at all stages of aging need comfort and support.” (p. 92)

Morgan’s “experiences and gifts” were as a chaplain and counselor. He began volunteering to provide pastoral care. The retirement home where he resides has a variety of levels, from independent living to assisted living to nursing care to a dementia unit. He had a particular passion for working with those who had dementia. He considers ministering to them a spiritual calling:

“I am sure that today Christ can be found in the haunting, blank faces of those souls who sit behind closed doors covered with the wounds of a terrible disease of the brain…. [A]s Christians we are to go outside the camp and minister to those who are ‘outside their minds.'” (p. 143)

Morgan describes a number of interactions in which those whose memory was deeply impaired still revealed their spirituality and humanity. With time, he noticed that residents in independent living tended to avoid those from the assisted living and memory care units. One of his main goals became breaking down the dividing wall between the different categories of residents. He came to recognize that the avoidance by those in independent living stemmed from fear; higher-functioning residents were evading thoughts about their own aging and what they might become. He eventually succeeded in connecting the groups, doing so mostly through music. He started a sing-along for the dementia residents using songs from the 1930s and 1940s. He discovered that some who seemed lost to dementia were able to sing the songs of their youth. Soon, independent living residents began to attend the sing-along. Music worked magic for them as well, helping them overcome their fears. Morgan describes the scene:

“We were at last the blessed community, where all are loved and accepted. Some bent to shake the hand or hug dementia residents who had formerly lived independently. Others sat next to dementia residents and helped them follow along with the words.” (p. 154)

Through serving residents of the retirement home, helping them become a healthy, loving community, Morgan found the life for which he was looking. Service was the means by which the “life to come” that he initially longed for became his reality. All of us who have lost or will lose the life that we’ve had can benefit from his story. We, too, can enter into a process of discernment, listening for our call. As with Morgan, that call will, likely as not, entail doing something for someone else. Reaching out to that person or group will not only help them; it is the pathway to the new life that is waiting for us.

Redstone Highlands, the Retirement Community Where Richard Morgan Lives.

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Relocating to a Retirement Community: “Settling In”

I recently read Richard Morgan’s 2006 book Settling In: My First Year in a Retirement Community. At age 74, Morgan, a retired Presbyterian minister, moved from Morgantown, North Carolina to a retirement community in Western Pennsylvania. He and his wife had been in Morgantown for 50 years and had expected to stay there the rest of their lives. Two factors prompted their move to another state: affordability and proximity to their daughter. Morgan had positive expectations when he made the move, and found much to like about their new community during the first few weeks. Still, it was a shock:

“In Morganton I was known and recognized as an author, historian, and volunteer–I was ‘somebody.’ Now I was ‘nobody,’ a stranger in a strange place. There I had so many friends; here we only knew two adults and two children, our children and grandchildren.”

After a month or so, Morgan had significant second thoughts:

“I began tormenting myself with such questions as, What have I done? Was it really the best time? Why didn’t we wait a few more years until our funds would allow us to live in a retirement community nearer our home? Why was I so impulsive?

Morgan missed his library, where he had spent countless hours reading and writing. He felt confined living in a unit much smaller than the house from which he and his wife had moved. He found other residents who regretted coming to the retirement community. One woman had stuffed animals arrayed on her windowsill, looking out. She said, “Those animals remind me how much I would love to be back in my home, and how I long to get out of here.” Not everyone had this view of their new living arrangements, though. Another resident also had stuffed animals on her window sill, but she had arranged them so they faced into the room. She said, “I love my animals. As they look at my apartment, they remind me of how fortunate I am to be here!”

Redstone Highlands, the Retirement Community Where Richard Morgan Lives.

Morgan was struck by the difference in these residents’ perspectives. He identified with the first woman, but wrote that “the peace and quiet acceptance of the other resident spoke to me.”  By the end of the book, his view of the community has become much like that of the second woman.

I’ll write in a later post about the change that Morgan underwent. For now, I want to note that, though I am younger than Morgan was when he wrote the book and I haven’t moved into a retirement community, I can identify with his sense of loss and displacement. I lived in the same city–also in North Carolina and only a little bigger than Morgantown–for over thirty years, then relocated to Michigan to help my parents. Though I returned to my home town, virtually all the friends from my youth had moved elsewhere. I missed the life I had in North Carolina–the work I did, the friends I had made, the church that had meant so much to me. I’ve made new friends, started working part-time, and gotten involved with church and community. Still, I don’t have as complete a life as I did before. Perhaps I never will, at least in this location.

I have no regrets about relocating. I was able to help my dad before his death in 2014 and still am providing assistance to my mother. Unlike Morgan, I don’t anticipate that where I’m living now is where I will stay the rest of my life. At some point, my mother will no longer need my help, and at that point I probably will move again. Though I could go back to North Carolina, I most want to live near one of my children. Thus, I’m not fully settled where I’m at though I’ve been here nearly five years. I’ve learned to live with that state of affairs. Life is a pilgrimage. That is to say, we are always on a journey to some place where blessing awaits us. That is true whether we stay in place physically or move constantly. My unsettled state has the virtue of making me more receptive to the journey. It cultivates in me a sense of wonder, an openness to possibilities, an expectation that the not-yet has something propitious in store. Though it can be a challenging way to live at times, it has its consolations, and for that I’m grateful.

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The Silver Lining While Waiting for Healing

I’ve had a difficult time of it recently. Though the surgery I had in February was successful, I was rehospitalized a couple weeks later with complications. Urine was leaking into my abdomen, causing severe pain. The doctors fitted me with medical equipment to drain the fluid and to prevent additional leaking, then sent me home, telling me I would just have to wait until my bladder and urethra healed. Because of the medical equipment I’ve been rather restricted in what I can do and am in constant discomfort.

I’ve always been encouraged to look for the silver lining when dark clouds roll in. I understand that adversity builds character. It also has spiritual benefits, causing those of us who believe in God to rely more on Him. So, have I seen any evidence of such benefits while I’ve been sidelined?

I definitely have, and the longer the waiting period goes on the more I become aware of how I’m being affected. I have noticed four benefits.

First, there’s gratitude. Whenever I’ve been tempted to feel sorry for myself, I’ve been reminded of what I still am able to do and to enjoy. I can enjoy my food, converse with friends, read, write, take short walks, and even drive short distances. And my prognosis is good. As I described in a previous post, my hospital roommate during my last stay had a terminal condition; contemplating his situation made me appreciate the relative insignificance of my problems. The relatively benign nature of my problems has been evident to me again and again over the past several weeks; almost every day, it seems, I’ve heard of someone with a more serious health condition than what I have. Plus, I have excellent medical care at a very reasonable cost. Given how good I have it, how can I complain?

Second, there’s patience. I recently read an article by Tobias Winright, who fell in a hotel bathroom in 2012, suffering a traumatic brain injury. He was confined to bed for a month, then had to take a semester off from his job as a professor. He indicates it took him three-and-a-half years–until he wrote the article–in order to heal. He was initially quite annoyed with the limitations imposed by his injury. He found, though, that patience “is essential to being a patient.” He quotes the early Christian leader Tertullian, who wrote that “patience is God’s nature,” so followers of Christ should likewise display patience. Winright suggests we need to be patient not only in response to our problems but also in our interactions with others. When complications developed, the hardships I was undergoing initially made me less patient with others. Over the course of the last few weeks, I think I’ve begun having more patient thoughts. Just as I have my limitations, so does everyone else, and I’m reminding myself of that more. I still find it hard to be patient when I’m in pain, though, so my patience, while growing, has not reached full blossom.

Next is humility. For decades, I’ve worked hard at taking care of my body. I’ve exercised four days a week, eaten plenty of fruits and vegetables, cut down on salt and sweets, and gotten enough sleep. I think I was somewhat proud that, for my age, I had very few health problems. I wasn’t as sympathetic as I might have been with those who hadn’t made quite the effort at self-care that I had and were having medical issues. I’ve always known that factors outside my control played a significant role in my health, but not until the past month has that message become salient. As a result, I’m becoming less likely to take credit for my health. I’m more humble, seeing physical well-being as influenced by what we do but even more as a gift from God, a blessing that we can’t earn.

Finally there’s hope. A couple weeks into my ordeal, I happened to listen to a sermon preached on January 8, 2017 by Andrew Sacks at St. Helen’s Bishopsgate in London. The passage on which the sermon was based was Romans 5:1-10, which includes the following:

We can rejoice, too, when we run into problems and trials, for we know that they help us develop endurance. And endurance develops strength of character, and character strengthens our confident hope of salvation. And this hope will not lead to disappointment. For we know how dearly God loves us, because he has given us the Holy Spirit to fill our hearts with his love. (vss. 3-5, New Living Translation)

Andy suggested that two conditions are needed to inculcate hope. First, there must be difficulty or struggle in the present. Second, there must be an expectation of a positive future. This future expectation is in turn dependent on having faith that we are loved by God. Ever since I became a Christian almost 50 years ago, I’ve met the second condition. Only from time to time, though, did I have enough hardship in my life to meet the first. The last month has been one of those times. In response to my current afflictions, I’m looking forward not only to the time when my body will be healed but to the eschaton, the time when all things will be made new.

Gratitude, patience, humility, hope. What a remarkable harvest. My sufferings have certainly not been in vain. Thanks be for the silver lining traced around even the darkest of clouds!

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Getting Ready to Retire: Finding Yourself

Next Avenue recently published an article by Bart Astor, a writer specializing in life transitions, titled “When will you be ready to call it quits?” After talking to numerous retirees, Astor concluded that the following factors played into their decisions to leave the workforce:

  • a milestone such as a significant birthday or a work anniversary
  • dissatisfaction with the direction taken by the employer or profession; unwillingness to adapt to workplace changes
  • health concerns
  • a feeling that life is short

Certainly other factors– family needs, lack of passion in the work, or desire for change–can be important as well. I was interested in one factor that Astor added to those listed above: identity. He explained: “That is, when you no longer want, or need, to identify yourself as, say, a teacher, manager, director or writer — even if the job title carries some prestige.”

This giving up our identities can be quite a barrier to retirement. It’s not just a matter of losing status by giving up titles, perks, or authority (though for some of us that factors in). It’s the prospect of losing who we are, how we’ve defined ourselves through the years. That potential loss can be frightening. I recently had a conversation with another psychologist who recently turned 70 and is thinking of not renewing his license to practice when it next expires. Being able to think of himself as a licensed psychologist has been quite important to his self-concept and it’s hard for him to give that up. Here’s the interesting thing about him: he has been disabled for twenty years and hasn’t been practicing psychology for that long. At first he had hopes he would recover from his medical problems and be able to practice again, but he gave up on that dream about ten years ago. Despite being permanently sidelined, he’s repeatedly renewed his license to practice, just because it’s been too hard for him to give up that aspect of his identity.

My work identity is like a tent stake holding my sense of self in place. I am likely to resist pulling up that stake unless there is something else attaching me to the ground. What other ways can we be grounded when we transition to retirement? The answer is probably different for each of us. I would like to suggest that we think about this question by looking about our past, present, and future identities. Here are three questions to help with that process:

  • What aspects of my past identity still can serve a stabilizing function?

Our life stories are a rich source of insight into who we have been through the decades. What beliefs have I always returned to? What life goals have been a persistent source of direction? What have been my lifelong interests and passions? Reconnecting with these aspects of ourselves can ground us during times of change.

  • What aspects of my identity in the present can I rely on going forward?

We are all much more than our careers, and it’s useful to think of aspects of our present lives that transcend work. What relationships matter to me? What gives direction to the time I am away from the workplace? What or who do I put my faith in? What sustains me; what gives me the energy to go on in the face of difficulties? In all likelihood, all these things will still be with us after we retire.

  • What aspects of my future identity can ground me as I go through this transition?

We each have a future self–a person we imagine we will be one day. Some of us can picture that person clearly, while for others the image is quite blurred. It is useful to give some thought about who we envision being once the retirement transition is behind us. What will our days be like? Where will we spend our time, and with whom? What will give us satisfaction, what challenges will we face, what will be our source of hope? That future self has made the transition out of the workplace and has an identity no longer dependent on earning an income. Knowing that such a person awaits us gives us the courage to go in search of him or her. Best wishes as you explore your past, current, and future selves!

Traveler–a characteristic of my past, current, and (hopefully) future selves

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Complications

I’ve been writing recently about my medical problems. After living a year and a half with prostate cancer, I had surgery a couple weeks ago to remove my prostate. Last week, I blogged about the surgery and the first week of recovery. A few days after my post, I received the pathology report. The cancer had invaded both sides of the prostate, but there was no evidence that any had spread outside that organ. Of note, the lymph nodes were free of infection.

That was good news. I expected the recovery from that point to be a course of incremental improvement–a gradual decrease in pain and increase of strength at the incision sites, a progressive expansion of the activities I was able to perform. The path ahead seemed clear.

I didn’t reckon with complications. Last Friday I started having abdominal cramps that became stronger and stronger. Even when the cramps subsided, I was bent forward with pain. I waited a day, then phoned my doctor’s weekend answering service. The doctor on call advised that I go into the emergency room at Spectrum Butterworth, and I went.

The ER staff began assessing me immediately–urine test, blood test, physical exam, CT scan. The scan revealed fluid accumulating in my abdomen. The level of creatinine in my blood was high, suggesting that my kidneys were not working properly. I was admitted to the hospital. The admitting doctor tried to be reassuring. Perhaps the kidneys would be fine tomorrow; they had been fine less than two weeks earlier, at the time of my surgery. Still, the thought of kidney disease was sobering.

I arrived at my room about 8 in the evening. In the middle of the night another patient was wheeled in to occupy the room’s other bed. He was hospitalized for pneumonia, and had been transferred from a smaller hospital because at Spectrum he could also receive kidney dialysis during his stay. So his kidneys had failed at some point; I was later to learn that they had been destroyed by overly high doses of medication prescribed for his diabetes. I was lying there concerned about the specter of some sort of kidney problem, only to be housed with someone ten years younger than me whose kidneys were already defunct! I suppose that might have increased my fear, but it had the opposite effect. I felt sympathy for someone who had it worse than I did. I realized that my problems paled in comparison to his.

The next day, my attending physician came by. He thought that urine was probably leaking into my gut from an area of the urethra that had had to be repaired during my surgery. A urine leak would explain the abdominal pain, and would also explain the elevated creatinine level. X-rays taken after dye had been injected into the bladder confirmed this hypothesis. I was then hooked up to a couple medical devices that should keep urine from the opening until it heals itself. I and my devices were sent home Tuesday night, so now I’m there recovering.

As it is with healing so it is with life; even when the path forward seems clear and without impediment, circumstances can change suddenly. Fears can then loom; some will be justified, others not. Time and chance happen to us all, says the Preacher. I am no exception to that rule. During the journey, it’s best to hold our expectations lightly, prepared for disappointments along the way, but also for blessings. We will experience plenty of each.

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A Wineskin in the Smoke

I had surgery a week ago. I had only undergone surgery under general anesthetic once before, an outpatient surgery about fifteen years ago. This time, I had a cancerous body part removed, meaning I was unconscious for longer than during the previous go-round and had to stay in the hospital overnight.

On the day of the surgery, I had to report to the hospital at 5:30 a.m. I got up at 3:30 and took a shower, read a devotional, and practiced yoga by the time I left for the hospital. I was ready to get it done with! It took over an hour to get prepped for surgery, with the activities that took place during that process not being enough to distract me from the apprehension that loitered around the edges of consciousness. I wasn’t exactly fearful, but the thought of spending three hours supine and senseless while someone was cutting on my flesh was discomforting.

During the prep time, the dramatis personae of the operating room (nurse, surgeon, anesthetist) all made brief appearances. They went over what they and I already knew, then gave me time for questions. These interactions were oddly reassuring. Calm, competent professionalism was exactly what the situation called for, and they provided it!

The anesthetist’s assistant started a drip and I was wheeled out in the hallway, heading for the operating room. I remember only the first ten seconds of that journey. My next memory was of the lights in the recovery room, with my first thoughts being that I would like to sleep a little longer and that parts of my body were hurting that hadn’t been hurting before. The doctor had apparently come to my bed before I had come to. He told Paula, the friend who had stayed in the waiting room for the duration of the surgery, that he didn’t see any evidence that the cancer had spread beyond my prostate. He will know more when the pathology report comes back. For now, though, the news is good.

I remember the next gurney ride, to the room where I stayed until discharge the next day. Recovery during that 20 or so hours and in the six days since then has been a series of small steps. For example, I went from sipping water to having tea and gelatin, then watery oatmeal, then tomato soup, and gradually on towards my regular diet, having to backtrack when I went too fast. I moved little the first few hours, but by late afternoon was sitting up and during the evening shuffled down the hallway, clinging to the IV pole for support.. Now I can walk slowly up and down the street in front of where I live.

I still have a moderate amount of pain, especially at the sites in my abdomen where the incisions were made. The incisions aren’t large, but their effect on me is. I move delicately, hunching a bit when I walk so my abdominal muscles won’t be stretched and using my arms as much as possible to position myself without pulling on the stitches. If I’m not careful enough, pain quickly calls me to heel (and hopefully to heal as well). I’m not driving yet; I’ve met the criteria to do so, but my focus now is more on recovery than on going anywhere.

Surgery and its effects on my body remind me of my fragility. Tomorrow is Ash Wednesday, when we are reminded that we come from and will return to dust. Even during the interim between dust and dust–when the life force flares within us–we are not as hearty as we imagine ourselves to be. I thought of this recently when for the first time I noticed a particular verse in Psalm 119:

wineskin-300x274“Though I am like a wineskin in the smoke
I do not forget your decrees.” (v. 83)

The note in my TNIV Study Bible (Zondervan, Grand Rapids, 2006) explained: “As a wineskin hanging in the smoke and heat above a fire becomes smudged and shriveled, so the psalmist bears the marks of his affliction.” Lately I’ve been feeling smudged and shriveled by the heat. It’s nice to know this sense of myself fits with a long spiritual tradition!

The second part of the verse, about remembering God’s commandments or decrees, seems to indicate that the psalmist remembers what is important even in times of hardship. I wonder whether there’s a bit more to it than that, though. In the Hebrew scripture, the law is not just a list of commandments or rules to follow but is God’s comprehensive response to the tragedy of Eden. It is aimed at restoration, at nothing less than a new creation. When life seems flimsy and transient, the thought that God is at work making all things new is a comfort. I may be a wineskin withered by the fire, but I will eventually be restored. For now, I’m at rest.

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Thinking About Cancer: Metaphors

I’ve been blogging recently about cancer. This topic has been on my mind since I am about to have my cancerous prostate removed. One thing I have been reflecting on is culture’s dominant metaphor for dealing with life-threatening illness. I’m wondering whether this metaphor is the best way to characterize what we go through when faced with such illnesses.

What metaphor am I referring to? It’s one that comes up regularly in conversations with survivors and is often included in the life narrative portion of obituaries, e.g. “I’ve been fighting cancer,” “after a long battle with congestive heart failure,” or “she struggled with multiple medical problems.” The dominant metaphor is of a war or battle. Eugene Peterson has suggested that there are two basic types of story, fights and journeys. The stories we tend to tell about our encounters with illness are fights.

Is this the best type of story to tell, though? State writer Katy Waldman suggests that urging people to fight cancer or other serious illnesses puts an unfair burden on them. If they succumb, the implication is that they didn’t fight hard enough, and that in turn can lead to feelings of guilt or inadequacy. I will eventually die of something; I don’t particularly like the idea of being considered a loser after my last battle, the one that I had no chance of winning.

So what’s the alternative? Waldman prefers journey language to fight language. She cites the press release subsequent to the death of theater actor and director Roger Rees in July, 2015, which stated that Rees had “passed away … after a brief journey with cancer.” For her, the term “journey” evoked the image of “a man walking slowly into the sunset, hand in hand with an adumbral figure.”

Holding hands with cancer doesn’t sit well with me. That seems to be friendship language, and I don’t see cancer as my friend. Plus I don’t like an image that portrays cancer as my only or primary companion during this phase of life. An alternate image that comes to mind is being handcuffed or tied to cancer, but the element of coercion in those metaphors contains too much battle, not enough journey. How about walking alongside cancer, trying to maintain some distance but realizing that the path isn’t wide enough to keep from brushing against it from time to time?

Waldman rejects the alternative metaphor of “a journey through (rather than with) cancer. I like that better–or, to be more specific, I like an elaboration of that image. Thinking of a journey through cancer reminds me of the book of Psalms, especially the best known Psalm, number 23. God is compared to a shepherd, and his followers to sheep. The psalmist emphasizes God’s protection in times of danger:

Even though I walk
through the darkest valley
I will fear no evil,
for you are with me.

Some older translations refer to the valley as “the valley of the shadow of death.” That’s cancer–the dark valley, the one where death casts its shadow. That’s where I’m walking. As I see it, the journey through this valley is not a solitary one, or one in which cancer becomes my primary companion. It’s God, not cancer, who is walking beside me. There may be a battle in store, but it is not my battle, it is God’s. Should I die, it would be in God’s presence. Such a death is nothing to fear, and is neither failure nor evil. It is the start of another journey, one of homecoming.

psalm-23v4

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When Time Flies. When It Doesn’t.

calendar

Time is measured according to physical events of a cyclical nature–the earth circling the sun or turning on its axis, the phases of the moon, or the electronic transitions of certain atoms. Time matters to us, but it isn’t these physical cycles that concern us so much as our subjective experience of time. And subjective time varies tremendously.

We are all familiar with the manner in which time seems to speed up as we age. When we were children, each season lasted forever. It seemed summer would never arrive, but when it did, it plopped down and took up residence. The seasons move faster when we become adults, and still faster when we become seniors. We older adults have learned not to be fooled by the vast expanse of time each new year promises; we know that in short order it will be December again and we’ll be wondering “Where did the year go?”

I’ve been noticing that, despite my age, I don’t always experience time as rushing past. When I am eagerly anticipating some particular date, time moves particularly slowly. I know someone looking forward to retirement who set the date a year ago; now that he is just two months out, time isn’t racing for him, it’s crawling.

I wasn’t looking forward to retirement, so for me the time leading up to my final day didn’t move slowly. If anything, the opposite was the case. After taking my leave I relocated to Michigan to help my parents, and that’s when time slowed for me. I had to rebuild my life, and it took a very long time–longer than the calendar indicated–for that construction project to be completed. Once I had made friends, established my part-time psychology practice, and got involved in a church, time stopped dawdling and picked up its pace again.

Last year, time started slowing once more for me, and it’s still lagging. In the summer, it slowed as I was eagerly anticipating a major trip. Before and after that, I was dealing with several changes in my life: the church I had joined closed, some of the relationships I formed there didn’t last, and I started cutting back on work. The year before, I had put my house in North Carolina up for sale, but at first I was ambivalent about selling it. Now I’m ready–actually, I’m at the stage beyond ready–but the house is generating no more interest than if it were located in a toxic waste dump.

So there was something I was looking forward to, some unwelcome changes, and some changes I would have welcomed that didn’t occur. All these seemed to weigh down time. There’s one more thing that has impeded time for me more than all the others. In late 2015, I was diagnosed with prostate cancer. I was put on a regimen of active monitoring, meaning I was tested every three months for a marker that would signal that the cancer was progressing. Time sauntered slowly from one test to the next. I eventually had another biopsy and learned that the cancer had worsened. Surgical removal of the prostate now seems the best option. The surgery date is set. Time may slow when we’re waiting for something we want to happen; it goes even slower when waiting for something like surgery, I’ve found.

So why does time slow for situations as diverse as waiting for retirement, anticipating a vacation, adjusting to a move out of state, having a house go unsold, and waiting for cancer tests or treatments? Adjusting to a move and rebuilding one’s life are active, while waiting on retirement, travel, sale of a house, and medical procedures are more passive. Perhaps a feature common to all of them is that coping with each requires effort. My friend has to make more of an effort to get up and go to work every day. I had to work on rebuilding my life, and now I’m having to deal not only with preparing for surgery but with concerns about my future health and thoughts of mortality. Clock time kept going at its usual pace, but each month I had quite a bit of psychic distance to cover.

It occurs to me that in each case the psychic journey associated with time’s loitering was one that developed qualities of persistence and patience. In other words, I was growing as a result of these experiences. Perhaps the lesson is that time slows when we are in seasons of growth. I’m glad for the growth, but I have to admit that I won’t mind it when I have less to deal with, even if time resumes its breakneck pace. Time, stop your dawdling! Take flight again!

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Thinking About Cancer: Other People’s Stories

Prostate cancer cells. (Image by Dr. Gopal Murti/Visuals Unlimited, Inc.)

Prostate cancer cells. (Image by Dr. Gopal Murti/Visuals Unlimited, Inc.)

I recently posted about my cancer diagnosis. I am scheduled to have a radical prostatectomy next month, that being one of the treatment options available for prostate cancer. Deciding to have the surgery made me aware of things to which I had given little attention before.

As I noted in my earlier post, I became much more attuned to people’s stories about cancer. I know a few people currently undergoing treatment for cancer, and have learned recently that there are more people in my circle of acquaintance than I realized who have stories about surviving cancer. I also seem to hear more often than I used to about people who lost their lives to cancer and are no longer here to tell their stories. It’s not as if I had always dismissed such stories; I’m petty good at listening to the troubles of others and having compassion for them. What’s different is that now these stories speak to me personally. Before, I empathized and sympathized. Now I identify.

Some of the stories I hear are of fast-moving cancers that splash through the body as quickly as a spill, soaking into every crack and crevice. One woman went in for a chronic cough and fatigue; her diagnosis was advanced lung cancer, and she was dead in two weeks. Another was diagnosed with pancreatic cancer and given six months to live, though she only lasted three. These are the cancer horror stories, the nightmares, the blitzkriegs that quickly disorient and displace the person. In comparison, my cancer is more like an unpleasant dream, or, to use a military analogy, trench warfare, in which my body’s defenses will only gradually be displaced and can retreat to several fallback positions before ultimate defeat becomes likely. Like me, most of the people I know who have been diagnosed with cancer don’t have to contend with the horror-story variant.

To die from galloping cancer seems the worst way to go; the person has time to know what’s happening, but  not time to cope. I can’t help but wonder what it’s like to be in that position. What feelings emerge–despair, anger, fear? Does the urgency of getting things in order take precedence? Is there a temptation to try to protect others by holding back information or pretending you’re more at peace than you are?  How difficult or easy is it to turn to God for comfort? I hope I’ll never have to find out the answers to these questions.

Of course I’m especially sensitive to any mention of prostate cancer, the form that I have. It seems that just about everybody knows someone who has or had this cancer. Some with prostate cancer chose to have internal radiation (brachytherapy), some had prostatectomy. Some are still having the cancer monitored via blood tests and biopsies. A cousin delayed surgery for years because he was praying for God’s guidance. He eventually decided God wasn’t going to tell him what to do and went ahead with the prostatectomy. He had a good outcome, unlike a friend who had surgery promptly after being diagnosed only to learn that the disease had already spread to surrounding tissue. He now has to endure the side effects of androgen suppression therapy.

These stories and others make it clear that there is no way of eliminating all potential for future problems. A course of action that works well for one person doesn’t work well at all for someone else. And even if initial treatment response is good, there is always the possibility cancer will return. That possibility becomes a permanent feature in the psyche. I know a woman who had a mastectomy and chemo for best cancer twenty years ago but still gets quite anxious for several weeks before her annual evaluation with her oncologist.  We never know what will happen. Of course, that’s nothing new: I’m not guaranteed the future and any day could be my last.

It may well be that something entirely different from this cancer will take my life in the end. Once a thief has entered through a particular door, though, it’s only human to pay close attention from then on to that door. I may be caught unawares by something, but I probably won’t again be caught unawares again by that intruder. Such is the psychic armor donned by a cancer survivor. I hope that I’ll wear it lightly.

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