Admission of weakness; rant about lack of post-op care

I don’t like to admit my weakness; I don’t think many do.  But as I’ve been working on this “Patient’s Guide to Post-Mastectomy Advice,” which is posted below, I’ve been thinking more and more about my experience that first day I returned home from the hospital.

I had surgery on Monday; my surgery didn’t begin until nearly 1:00 p.m.  I spent nearly 3 hours in the post-op room recovering from the anesthesia, to which I had a very bad reaction.  I was hallucinating, which was the fun part—watching books and scrolls fly around the room (I tried to read them but they moved too quickly); but I was also terribly itchy, begging anyone who came near to scratch any surface of my body, as I itched everywhere.

It was after 9:00 p.m. before I was sent to a room, given something to eat, and then spent a few hours of fit-full sleep.  Thankfully, I had a very kind friend was there with me.  I should mention at this point for those who don’t know that my husband has stage-four colon cancer and has spent the last 15 months receiving very high doses of chemotherapy.  He is quite weak, and while I know he loves me, has not the strength to be a caregiver. That was my job.

By 11:00 the next morning I was discharged after having watched a video about how to strip my own surgical drains and given discharge papers that had only this advice: don’t shower for at least 24 hours and don’t lift anything over ten pounds.  Oh, they also told me which meds to take and when.  And I was out the door in a wheel chair, in the car, and home just after noon—less than 24 hours after my surgery.

If you’ve read my “Patient’s Advice for Post-Mastectomy Care,”  you will know how terribly limited I really was and how unprepared I was to take care of myself.  My husband was home, but as I explained, he is suffering from his own sickness and weakness.  And despite his undying will to “take care of things,” he simply can’t do all he wants to do because of his medical condition.

In the interest of “full-disclosure,” I did have two women friends here when I arrived home—one who drove me and another who’s just a kind loving soul and wanted to help.  I had arranged for NO help.

I had asked my surgeons the week before if I needed home care, and they told me. “No.”  Period.  So that’s what I had prepared for.

Having been home for less than an hour, still suffering from the lasting effects of anesthesia, I began to realize how completely helpless I was.  I couldn’t get up to go to the bathroom by myself.  I couldn’t pull my pants up after having done so.  I couldn’t turn on the sink faucet to brush my teeth.  I couldn’t strip the drains that I’m been instructed to do–and I had a moment of sheer panic at the helpless of my condition.

So I did what any reasonably sane person would do.  I called the number on my “release” papers from the hospital and reached my surgeon’s nurse.  I admit I was panicking.  I was scared.  I was still delusional from the anesthesia and medications—but I was not insane.  I had the presence of mind to make the call, right?

I explained to the nurse how helpless I felt.  I explained that my husband was ill and I could care for neither him nor myself.  I begged (yes, I confess, I begged) for them to re-admit me to the hospital for at least another day until I was able to better cope with my limitations or get some help.

The answer?  (It’s a really good one.)

“You’re insurance won’t cover it unless your condition is life threatening.  So if you feel you are in life-threatening danger, go to the emergency room,” (and sit for five? six? hours while in horrible pain?)  Really?

Second advice, which really pissed me off:  “Stop taking your pain medication; I think it’s making you hysterical.”  Really?  I was sent home from the hospital in a completely debilitated condition and in horrible pain and your response is that since my insurance won’t cover it, I should “just calm down (honey)?

I asked for home health care and again received the “not covered by insurance” response.

Thankfully, my friends who were here managed to arrange two days of 24-hour care from available friends and family.  And were it not for that, I have no idea how I would have managed.  But I can’t help but think how much easier it would have been if I had known in advance to PLAN for this.

And here’s my thought.  Yes, it’s a little political and little critical—forgive me.  I wonder if there is a reason doctors don’t or won’t recommend either a longer hospital stay or home health care for mastectomy patients?  I wonder if the insurance companies (who make millions in profits, right?) just don’t want to be responsible.  I wonder if the health care system just doesn’t want to recognize this incredible need.

As I’ve said before, and I want to emphasize—I am so grateful to my doctors and their teams. I believe they have only their patients’ interest at heart.  But I also know that I never want another woman to have to suffer the way I did after surgery (or any ONE for that matter, because I’m sure this problem isn’t limited to mastectomy patients).

I hope this story helps anyone who might face this or any other surgery be more prepared.  I certainly wish I had been.

Post-Mastectomy Advice: A Patient’s Perspective

(I’m in the process of formatting this for both web and print distribution–I hope to spread it widely as I think it is needed–but while in that process, I wanted to make it available here)

Post-Mastectomy Advice

A Patient’s Perspective

ACKNOWLEDGEMENTS

First, I want to say that the care and information I received from the medical team at The University of Arizona Cancer Center (specifically Dr. Ley, Dr. Larson, and their teams) was extremely useful. But as I discussed with my doctor, most surgeons have not experienced the surgeries they perform, and therefore have limited knowledge about what it’s like to live through the experience. They are experts in surgery and medical knowledge—not in life after a mastectomy.

INTRODUCTION

I am recovering from a double mastectomy and undergoing breast reconstruction. I write this letter to give women who face this surgery some personal advice that might help make their physical recovery easier during the first few days after surgery. A woman and her caregivers have many psychological and emotional issues to deal with—I know.  And I also know it will be a long process of healing and recovery.  But I feel it important to share this information about basic physical needs that you might not hear elsewhere.  My hope is that this information will be a first step in a long journey of helping women recover from breast surgery.

I offer this information not as a medical professional or a therapist, but as a woman who learned some valuable tools to make life after surgery a bit more comfortable.

Each woman’s experience will be very different. I’ve talked to women who had a single-breast mastectomy and had very little of the difficulties I’ve faced. I’ve talked to women who have had double mastectomies and had much more difficulties than I did. Also, the options a woman chooses (if and what type) about reconstruction makes a significant difference in the challenges they face after this type of surgery. The decision to have breast surgery of any kind should be made with much consideration and input from medical professionals.  Given all that, I hope my insights prove helpful.

CLOTHING

I was told to wear a button-up shirt the day of surgery and have one to wear home after one night in the hospital. This is good advice. But what I didn’t know was that I would be unable to put on a T-shirt or another pullover top for over a week. I had one button-up shirt. Since I was unable to do laundry (reaching in a washing machine or a dryer was impossible for me the first five days after surgery), this created a wardrobe problem, and I ended up wearing my girl friend’s husband’s XL Hawaiian shirts for a week—not very attractive. I suggest you plan to have at least three or more very loose (perhaps two or three sizes larger than you normally wear) button-up short-sleeved shirts and pajama tops on hand.

You may have surgical drains and a pain pump attached to your chest and you may be very limited in how far back you can move your arms to put on even a button-up shirt. In case you do feel like getting out of the house a few days after surgery, you’ll want something that you can both put on and that will conceal these medical objects. Certainly, you will be going to post-op appointments with your doctor, and I found I felt better if I could wear something that both concealed the drains and pump and looked fairly normal.

Loose fitting elastic waist pants or skirts are also a must. Because of the pain in my chest, I found it impossible to pull up any tight fitting pants, including yoga pants. At home I wore mostly lose fitting shorts with an elastic waist, which gave me the freedom to go to the bathroom on my own without calling for assistance in pulling up my pants. Loose fitting skirts may also be an appropriate option.

Ask a friend or loved one to shop with you if possible—shopping for post-mastectomy clothes may be the first time you actually realize this is “real.” One woman told me she broke down crying in the dressing room as she tried on post-op button-up shirts.  “It just hit me,” she said, “I’m going to lose my breasts.”  These moments of realization can be very challenging.

PEOPLE

I was told that I wouldn’t need any home care after spending one night in the hospital after surgery—and while this may be true for some, it simply wasn’t true for me or the many women I’ve talk to who have had this procedure.

I needed 24-7 care for the first three days after surgery, and much help for daily tasks in the weeks that followed (see “Limitations” below).  You might not need this help, but I think it’s useful to have in place in case you do.  A spouse might provide most of this assistance, but if your spouse has to work or (silly to imagine, I know) get some sleep, an additional person can be of immense help.

If possible, connect with people you trust and organize help in advance.  After surgery you may not feel up to the task.  I asked one very reliable friend to be a “contact” person who helped me organize help for in-home care, shopping, transportation to post-op appointments, and meals.  She checked in with me once a day and asked what I needed. She in turn had a list of contacts who had offered to help and whom I felt comfortable asking for help. If it’s feasible for you, you might even consider hiring a home-health care nurse or having that available should you need it.

A final word about people. If you’re anything like me, this will be an incredibly emotional experience. Having supportive and loving friends and/or family available to talk with—even scheduled visits—was invaluable for me in that I could express my sadness and fear. More importantly we could laugh and find joy, which I believe is immensely helpful to the healing process.

FURNITURE AND ACCESSIBILITY

I was given wonderful advice from another mastectomy patient to have a recliner chair in place before I returned from surgery. I covered the chair with a fitted sheet and surrounded it with various pillows. It was impossible for me to lay flat for the first two weeks after surgery, and the tendency to try and roll over on my side while sleeping caused great pain. So the recliner was a perfect space to both rest and sleep during the two weeks after surgery. For the first few days, it was impossible for me to reach the lever that moved the footrest (one of the many reasons having full-time assistance for the first three days was so important for me).  Had I not had help available, getting up to go to the bathroom anytime of day, especially at night, would have been impossible.

If you don’t have a recliner, make sure you have some support to prop yourself up in bed or on a couch. For the first few days, I could not have done any of that on my own. I needed someone to assist me by pressing behind my neck to help me sit up because any use of abdominal muscles involves the chest also.

Before surgery, place the things you might need on a table near your space. Mine included lip balm, medications, water, phone and charger, lotion, pen and paper, a good book, and crossword puzzles.

LIMITATIONS

Regardless of how much support you have, it’s important to think about limitations you may face during the first few days and weeks after surgery. You may experience pain; you may experience sadness and depression—eliminating the additional frustration of unexpected limitations can be very helpful.

I suggest that anyone about to undergo a double mastectomy try this exercise: have a friend tighten a belt around your arms just above your elbows, fastening them to your sides.  Imagine that you are not only physically limited in this way, but also in pain (this is exactly how I felt for about three days after surgery; both the limitation of my arms and the pain began to lesson slowly over the next few weeks)—then see what you can accomplish and what you cannot.

Here’s a list of some things that might prove difficult and some solutions:

• One activity required of post-mastectomy patients is to “strip” the surgical drains a few times each day. It was impossible for me to reach the tops of these drains and perform this seemingly simple activity without help.  However, the stripping of drains felt to me very intimate—a close friend, family member, or professional health-care assistant may make this experience feel less invasive.

 

• One potentially difficult problem that few will tell you about is that you may not be able to wipe yourself after using the bathroom.  An ironic side benefit to the constipation that many experience after anesthesia for me was that I didn’t have such concerns for the first three days after surgery—by then I was able to reach to wipe myself.  (Many people experience constipation after having been under anesthesia.  I recommend you have a bottle of magnesium sulfate on hand in case this is an issue for you.  It certainly helped me when I began to feel the discomfort of constipation after three days.)  If constipation is not an issue, and if you are in such pain that your arm reach is very limited, try using a pair of rubber-coated kitchen tongs.  Wrap either toilet paper or a wet-wipe around one side of the tongs, and this may provide you with enough reach to clean yourself.

 

• I could not get up out of or sit down into my chair without assistance for the first two days. I spent many nights in a recliner chair, and it was impossible for me to reach down and pull the lever that either pulled up or released the footrest. Again, the only solution to this for me was having someone near to help—someone willing to wake up at two o’clock in the morning to assist me so I could get to the bathroom.

 

• I was not able to cook (even microwave meals proved a challenge; if your microwave is above your oven, you may not be able to reach it), do laundry, or water plants. Plan in advance to have accessible meals and help with these activities.

 

• I also found that I could not reach the water glasses on the second shelf of my pantry, and so I asked a friend to set a few glasses on the counter that were within reach. I put things I needed access to in the fridge on the lower shelves. I pre-opened tough to open bottles like drinks and salad dressings and left the lids only slightly closed. I set out a small frying pan, olive oil, and a few standard spices as in my kitchen these would have been unreachable for me for the first few days. A sturdy kitchen stool may be useful.  The amount of preparation you need will depend on how much in-home help you have.  If you live alone, consider taking many precautions to make sure you have access to items you need.

 

• Holding a phone to my ear was painful, and lifting a laptop computer impossible. Regardless of your tendencies for communication, you will need to communicate with your doctors, refill prescriptions, and schedule appointments. Have a phone charger near your resting space and within reach (use the “belt test” to check this). Consider having your computer plugged in and in an accessible location such at the kitchen table or a desk.  Using the “speaker” function on my cell phone helped make calling easier, and, if you want privacy, consider having a phone head set.

 

• You will be able to shower soon after surgery, but make sure you can reach your soap and your towel! A shoelace or a soft belt hung around your neck can be used to hold your surgical drains while you shower.  I was provided with a very handy belt that held the drains, but it was difficult to dry after showering.  Leaving the belt off and holding the drains with a thin bathrobe belt around my neck was much easier.  Having a package of disposable face/body wipes may also prove useful in case you don’t feel up to showering for the first couple of days.

 

• Though you maybe able to shower, if you tried the “belt test,” you will realize you cannot possibly reach your head.  After three days, I was desperate to have my hair washed.  I was unable to wash or even brush my hair for nearly a week.  Friends or family can perhaps help you with this; but I found lying back in a salon hair-washing chair was fairly easy after three days post-op.  I asked a friend to let me come to her salon after hours so I didn’t have to worry about being in public so soon after surgery.

 

• I was unable to drive for one week after surgery, and even then driving was a challenge. If possible, arrange in advance to have someone drive you to your post-op appointments. Even after I was able to drive, grocery shopping was a challenge because many necessary items like milk are placed higher than shoulder level—unreachable. Carrying bags of groceries was also not possible for me. Either stock up well on groceries before surgery, or ask a friend or family member to shop for you or accompany you.

 

• One final note about the limitations you may face in terms of accessibility:  I was unable to reach either kitchen or bathroom faucets to turn on water.  This limitation made brushing my teeth or washing a dish in the sink impossible.  I cannot emphasize enough how important it was for me to have help doing even the simple things to which we normally give little thought.

SEEING YOURSELF

Seeing yourself in a mirror for the first time after a double mastectomy (or any breast surgery) can be quite difficult. For some this may be easy.  But I think it a serious disservice not to warn women who will go through a mastectomy (of any kind) of the potential psychological challenges they may face afterwards. A mastectomy is an amputation.  You are losing a part of yourself that physically defined you as a person and as a woman.  I recommend you talk to women who have been through this, research survival stories, seek out support groups, or perhaps talk to a therapist.  For me, meditation practice and therapy are invaluable tools.  The sutures and scars will look much worse to you than they do to your doctors, nurses, or loved ones. The sutures, the drain tubes, the pain pump lead—these are temporary. (The Scar Project, http://www.thescarproject.org, is a wonderful organization whose mission is to reveal the beauty of life after breast surgery.)

I say this without hesitation: you are beautiful. You may see yourself as terribly damaged, but it is only temporary. Be prepared to accept what you may look like knowing that you will heal and be whole with or without reconstruction. While physical image in no way defines who you are as a person, we cannot deny it is a part of our psychological well-being.

Remember that you went through this surgery to save your life. It was worth it.

With all the best to you,
Julia Ferganchick Hilton, Phd

Post mastectomy patient who has all hope for you and your health
Email: julia@meditationpracticeinstitute.org

 

I am very open to answering questions or helping women and their caregivers with pre- or post-op questions.  I am not a physician, nor am I a therapist.  I make no pretenses to be anything more than a woman who has survived.  I know first hand that these amazing medical professionals are your best resource for help. Use it. But living through this process can be a challenge, and sometimes what we need is just to hear a kind word from someone whose a little further down this road than we are. 

Pre-surgical Gardening

April 14, 2013

 

I just spent the last hour enjoying a beautiful Arizona evening; a breeze is blowing, the desert is in bloom, and the birds are performing a concert that only quail, dove, mountain cardinals, cactus wren and finches in combination are able to achieve. 

 

I pause every few moments and touch my breasts.  This is the last day I’ll have them.  The real ones.  I didn’t think I cared that much about them, but when I think of having them severed tomorrow, I cry.  It’s a weird feeling.  One I doubt I can explain—but a feeling every woman who has had a mastectomy understands it.  And now I do.

 

So I spent the last hour gardening; something I love—creating beauty with the help of nature.  Tending the plants is the last of my to-do list as I prepare for surgery tomorrow.  I’ve moved the furniture so I have a space to lay and recover.  I’ve paid the bills; I’ve washed all the clothes—thinking that for the next week or so I won’t be able to reach into the washing machine, let alone carry a load of towels. 

 

I had some insights while I watered and weeded my garden.  I wanted to share.  I know gardening and life has become such a cliché.  But I can’t help it.  It works for me.

 

I was pulling weeds.  And as I did so, I had to be careful not to harm the flowers.  There’s this deep satisfaction that comes from being able to pull not just the weed, but the root.  These, I think to myself, are my mental afflictions.  These are my fears. These are my angers.   And I want to not just pull the tops, but to pull out the very roots.  I don’t mind muddy hands and fingernails packed with dirt—it’s a part of the process.  But to feel those roots of weeds severed feels so empowering, so final.  And as I go through this very emotional process, that’s what I want to do with my mind.  Pull the roots of mental afflictions, of anger, of attachment. 

 

But in that process, grasping the offending plants and pulling roots, I accidentally pulled too a beautiful flower that I’d planted and that I’d been tending with all care.  Hunched there, bending over the flower garden, I realized I’d not just severed the life of the weed, but also the flower.  And how sad.  This too is like our mind.  Sometimes, we hurt the things we love as we try to control the mental afflictions in our own minds.  It’s sad.  It’s painful.  And while it’s sometimes necessary to clear the earth for new growth, how I want to protect those flowers, which I see as friendship, as relationship, as love. 

 

Having a double mastectomy does not make a woman less of a person; I now this.  But touching my breasts, knowing they will be cut off tomorrow changes me.  In both good and bad ways.  It makes me selfish.  It makes me cry, “why me?!”  It makes me feel as though my fears and needs are more important than others.  And it also allows me to fully understand the truth of renunciation, the truth that grasping causes my own pain.  Causes pain to those close to me. 

 

And it does one other thing for me.  It makes me understand more deeply how much suffering every human being feels.  Pain of heartache; of loneliness, of emotional and physical illness; of feeling powerless.  It makes me regret that I have not been more compassionate to others who are in pain.  It makes me feel selfish for caring more about the severing of my breasts than I do about the feelings of those I love and who love me.  For that, I’m sorry. 

 

But there is a power—it’s called wisdom.  It’s understanding the truth of this illusory life we live, this dream.  It gives me the power to go to the person who has hurt me most and ask them what they need.  It’s the power to care beyond our own selfish needs.  It’s the power to love.   Despite all else.  Call it God; call it Angels.  Call it whatever works for you.  But in your hour of need; I pray you find it.  I pray I find it. 

 

I am afraid.  But I will not be consumed by it.  I am angry.  But I will do my best to keep that anger from hurting the people I love.  And I wish this commitment to every person out there who is hurting, who is in pain, who feels alone. 

 

 

PS

 

 

I really didn’t think I would make this so public; I did want to share my thoughts about overcoming fear, but from the messages and comments I’ve received I think it’s a little unfair not let so many beautiful kind friends know what’s going.  This will be my last post for a while (but I hope to be writing more soon!) because in about 3 hours I will have a double mastectomy.  I had three small spots of breast cancer in one breast–not a big deal, just have a lumpectomy and all will be fine.  But during the testing, I found out I have the BRCA 1 gene mutation, which means I have a very high risk of future cancers, and the only smart decision is to remove those parts of my body that are risk.  Good news is that once those parts (breasts and ovaries) are removed, the chance I will NOT have recurring cancer ups to 90%.  So, it is really good news.  And now I get this amazing opportunity to see how  far meditation practice has taken me.  Yes, I’m scared; yes, I’ve been an ass to people who love me.  I even threw a bag of cashew nuts against the wall in anger one night (Didn’t want to break anything and cashews are resilient little nuts!) .  But I’ve been able to both apologize and find the strength to go through this day with joy and appreciation for all the beauty that surrounds me, surrounds us all.  The nature of human life is suffering.  That’s the first principle of Buddhism (and most of the Holy religions).  And I get to learn that lesson (have learned am learning) it very well.  I think I should get a award a second PhD in that school–anyone want to make me one?  I want to be legit; like an honorary PHD in Suffering from Harvard (or Yale).  But the second truth is that there is an end to suffering and a path to that end.  I believe with all my heart this experience will allow me to walk closer to that path’s end.  And if I can, I will do my best to take all of you with me.  Thank you all for caring and for your kindness.  Now be happy and go do something FUN today! 

Breast Cancer and BRCA

I have to apologize to anyone who actually reads this blog.  I have been long absent.  My husband, Charlie, was diagnosed with stage 4 colon cancer over 13 months ago.  He was given 6 months to live IF he took chemo therapy.  He opted for that.  We celebrated his one-year survival in February.  While I continue to practice and teach meditation, taking care of Charlie has been my full time job.  He is a very private person so I have not posted much about that here.  But in February of this year, I was diagnosed with stage 0 breast cancer and have recently had a double mastectomy because I also tested positive for the BRCA1 gene.  I’ve dedicated myself to writing more because I myself find so much solace in the stories others who are suffering have the courage to share.  I’m particularly inspired by this woman: http://well.blogs.nytimes.com/2013/02/14/life-interrupted-crazy-unsexy-cancer-tips/. 

I have more to say . . . some things I’ve written previously but not posted, and some new things I want to share.  I’ll try to stay more in touch through this venue as it seems a very convenient way to be connected to the people I love and the people I want to share with.

Seven-Step Meditation Audio

MP3 Guided meditation of the seven-step meditation practice. Click here to listen/download: 7stepmeditation

Meditation Teacher Training–New Course

Meditation Practice Institute Presents

Understanding Your World
(Level 2 – Teacher Training)

Sundays 12:30 – 2:30
September 30 – October 28, 2012 (5 weeks)

Live in Tucson at The Bloc Climbing and Fitness, 8975 E. Tanque Verde Rd
Tucson, AZ

Online Course: Participants will have access to password protected live streaming and later viewing, and all course materials.

LEARN the true art of meditation as practiced for thousands of years and carried to us in an unbroken lineage of masters.
USE meditation to reduce stress, overcome obstacles and illness, and increase health and happiness.
TEACH meditation to others as this course will both instruct you in the art of meditation and certify you to carry on the tradition!

Everyone Welcome!

$100 for 5-week workshop
Drop-ins $25/class

Workshop Leader: Co-founder of Meditation Practice Institute, Julia Ferganchick, PhD, holds advanced degrees in language theory and philosophy. After surviving a plane crash in 1999, she began a serious study of PTSD and meditation practices to heal chronic pain and panic disorder. She completed advanced studies in Buddhist and Yogic philosophy and now teaches meditation practices to promote health and healing.

Please register in advance: http://itsmorethanyouthink.org/events/teacher-training-program-level-2-understanding-your-world/
For more information: info@meditationpracticeinstitute.org or 520-271-4171

Does it work?

April 7, 2012

Does it work . . . ?

I apologize for not keeping this blog up to date more often. I was very busy the last month teaching MPI’s first Meditation Teacher Training Course with Michael Craig . . . and it was beautiful beyond description.

For those of you who don’t know, I started Meditation Practice Institute while studying with Geshe Michael at Diamond Mountain—my six-year intensive study of advanced Buddhist philosophy. Geshe Michael always encouraged us to teach and what I found most valuable about our practice was the techniques of meditation. And so, about four years ago, I founded MPI with fellow Diamond Mountain student and dear friend Brian (Kelden) Pearson. But the idea was germinating for quite a few years. How could we organize what we’d learned about philosophy and teach it in a secular way—as the Dalai Lama himself suggested in the latest issue of Shambhala Sun—as a path of personal growth rather than religion. At the time I didn’t know.

But early this year, the ideas began to form and I wrote furiously the curriculum for MPI course one, Basics of Meditation . . . I had no idea at that time that my husband would be diagnosed with cancer just a month before we started, that my life would be turned upside down, that I would fight to find a moment in which I could write and prepare for class because I wanted and needed to care for him . . .

In the hospital, just after the doctor had given us his diagnosis and prognosis, which was terribly grim, I told Charlie that I would cancel the class. I couldn’t possibly teach a course at this time. He told me, “No. You must do this.” I have no idea why he felt so strongly about it, but I’m so grateful. Not only did he gain his strength back enough to make me feel comfortable leaving him every Sunday for hours at a time, but he gave me the most amazing gift of trust that I should be doing this—teaching this meditation course that I have longed so much to teach.

I couldn’t have done it without the amazing help and support of my MPI partner Michael Craig who seemed, literally, to materialize in a bright shinning light just when I needed him most. Michael is a master teacher and a master technician of all things digital. I am so grateful to him.

But back to my reason for writing today . . . in the fourth of five classes, a beautiful woman (you are that, Anna—beautiful in so many ways) asked a question: “Does it work? Do you (as someone who has practiced meditation) live in a world without pain and anger?”

My answer at the time was honest but also a little self-effacing. I said, “Fifty-fifty. About the half the time I live in a world of beauty and peace, in the present and in bliss. I was remembering those moments in the hospital when the doctor said the word, “Cancer.” When he said, “Stage four.” When he said, “Metastasized into liver, lungs, lymph nodes.” And it was so very painful. At the same time, I remembered how very recently Carol had written to me: “Lisa’s passed.” Beautiful Lisa who died of cancer within a week after Charlie’s diagnosis. Such poignancy in the timing.

But today my answer would be different. A little bit different. Today I would say the occasional pain and heart ache of this life (just recently Eliana’s father passed, Alyssa lost both of her parents within a year, Charlie continues to fight cancer) are just blips in the matrix of beauty that is this life.

And so what I wanted to say today . . . is YES, it works.

I had a dream last night. A nightmare. It was terrifying in a normal, domestic sort of way . . . I was living with Charlie in our house. I brought home some flowers from the nursery that I wanted to plant. He was gruff and said we didn’t have any flowerbeds. I said I would make them. He said, no. Our dog was vicious and mean and I felt such despair and unhappiness. It was exactly the same as my life now except it was all pain.

When I woke, I looked from my bed out at the beautiful flowers Charlie and I planted together recently (Thank you Chere for those!) and our dog crawled carefully up on the bed to snuggle and my husband was kind. He had made my coffee, just perfect, and set it on the stand next to me . . . and I was in paradise.

Same actors, very similar stage—totally different experience. And I attribute all of it to two things (those who took MPI Course 1 will remember): Change the way you act in the world—act with integrity and kindness, and perfect your world through meditation.

Bliss and happiness does not come from outside of you, cannot come from outside of you. It comes from within. It blooms from the stem of understanding that you are making your world—for better or for worse—and taking the responsibility for making the world a better place. Cancer, as terrible a disease as it is, can be an amazing teacher. And I am grateful for the lessons. Grateful for these moments of bliss.

PS: Charlie gets healthier and stronger every day (he says it’s the medicine, and I argue it’s the raw juices and protein drinks). He bought a Harley Trike last week and jets around town like a teenager—sometimes taking me along. We have our third round of chemo this Monday.