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New Year’s Promises

I don’t generally believe in the tradition of making New Year’s resolutions, but I’ve still chosen to make some promises for 2018. I’ve learned that the most important promises are the ones that I make to myself, changes I initiate in an effort to improve the quality of my life or to help nurture a sense of purpose.

I’ll begin by taking a close look at some of my relationships. Many experts argue that the most important choice you’ll ever make is the people you surround yourself with. Since my cancer diagnosis I’ve basically developed zero tolerance for having toxic people in my life. In 2018 I promise to do all that I can to eliminate the power these individuals exert over me. There are some obvious signs of a toxic person and you’ll generally recognize it when you are in such a relationship. Here are some of the common red flags:

  • Nothing you can say or do is good enough.
  • They comment on the smallest flaw or perceived imperfection.
  • They drag up your past and won’t allow you to grow or be different.
  • They act like they are fabulous and never make mistakes.
  • They leave you feeling guilty and ashamed of who you are.
  • They are critical, controlling and don’t think about your needs.
  • They leave you feeling beaten, wounded, battered bruised and torn.
  • They violate your boundaries and never respect no.
  • They don’t care about your feelings and they like to see you suffer.
  • It’s always about them and what they think and want and feel.

If you notice these signs, it’s best to cut the person out of your life completely or to at least keep them at a distance. Such individuals are capable of inflicting serious emotional and psychological harm, especially if you are in frequent contact with them over a prolonged period of time.

 

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i hear a thousand kind words about me
and it makes no difference
yet I hear one insult
and all confidence shatters

focusing on the negative

I can definitely relate to this poem which appears in the collection The Sun and Her Flowers by Rupi Kaur. I promise to be less critical of myself and to focus more on why I am a special and worthwhile human being. I promise to focus on my positive qualities and the valuable contributions that I am able to make while I’m in this world. My battle with cancer has revealed to me that people often won’t love and respect you until you choose to love and respect yourself.

Finally, I promise to be more mindful in my day to day living. I’ve discovered that one of the best ways to quiet my mind and focus my attention is a technique called mindfulness. The eminent psychologist Jon Kabat-Zinn pioneered using this method with cancer patients and other groups at the University of Massachusetts Medical School. Mindfulness is basically just a way of paying attention, a way of awakening our minds and being present in the here and now. With principles found in Buddhism, mindfulness teaches us to live the moments contained in each day rather than focusing on what might lie ahead.

Acceptance and letting go are crucial components of mindfulness. A philosophy of mindfulness encourages us to come to terms with our life, even difficult experiences such as a cancer diagnosis. Acceptance means seeing things as they actually are in the present. Mindfulness doesn’t require that you have to like your situation—you don’t necessarily have to assume a passive attitude toward suffering or life’s unfairness. However, you must come to terms with things as they are and acknowledge them, whether it’s a diagnosis of cancer or the possibility of its recurrence.

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Winter’s Wrath: What Cancer Patients Need to Cope

I’ve lived my entire life in the harsh Canadian climate and over the years the winters have become ingrained in me. It seems like I’ve endured too many winters to count and the last six of them have been as a cancer patient and cancer survivor. For the over 1 million inhabitants of Calgary, Alberta, the local winters are long, bitter and frigid. The season seems to last forever and the extended deep freeze is only interrupted by the occasional chinook. Not surprisingly, our comparatively short summers are relished and savoured. The months of July and August are like manna from heaven and offer a precious respite from the unrelenting severity of our climate.

Studies have revealed that winter is especially daunting for cancer patients—it’s a time of year that represents an assortment of physical, emotional and psychological challenges to anyone unfortunate enough to be battling cancer. For cancer patients, warmer climates and summer months can be much easier to tolerate. Given this fact, here are some of my recommendations for those of us condemned to endure another prolonged winter.

Get a Flu Shot

On a physical health level, influenza and the common cold abound during the winter months. Cancer and standard cancer treatments, such as chemotherapy and radiation therapy, frequently weaken the immune system, which helps fight off these viruses. People with cancer or a history of the disease are more likely to have serious complications if they get the flu. Some other high risk groups include pregnant women, young children, people over 65, and those diagnosed with lung disease, heart disease or diabetes, They are more likely to end up in the hospital, some might even die from flu-related problems. Getting a flu shot is strongly recommended for most people with cancer as well as cancer survivors. Their family members are normally encouraged to get immunized too.

 

Winter

 

Stay Warm

I strongly suggest that you have a wardrobe of warm winter clothes on hand, including sweaters, parkas, boots and gloves. Deprived of the warmth of summer, individuals with cancer may be at above average risk for hypothermia and other dangerous medical conditions triggered by cold temperatures. When our body can’t produce enough heat to stay warm, hypothermia occurs. Certain medications and medical disorders associated with cancer or cancer treatment can interfere with our body’s natural ability to adjust its temperature. Dehydration, a common side effect of cancer treatment, and having a low amount of body fat may also increase this risk. In addition, some cancer patients who are unable to be physically active may have reduced blood flow, which can lead to hypothermia.

Don’t be SAD

Ultimately there is the emotional and psychological impact of the winter season. Weather often affects people’s moods. Sunlight breaking through clouds can lift our spirits, while a dull, rainy day may make us feel slightly gloomy. While noticeable, these shifts in mood generally don’t affect a person’s ability to cope with daily life. As cancer patients, however, we are sometimes more vulnerable to a type of depression that follows a seasonal pattern. For some people living with cancer, the shortening days of late autumn are the beginning of a type of clinical depression that can last until spring. This condition is called “Seasonal Affective Disorder,” or SAD. Luckily there are ways to cope, sitting near a window or getting outside for a short period of time each day can help. Light box therapy is a popular and often very effective way to cope with mild Seasonal Affective Disorder. The lights are effective because they mimic the sun’s rays.

Pursue a Hobby

Winter is the season to take on an indoor hobby, this is especially true if you are facing cancer. When cancer patients undertake these activities, whether individually or with the guidance of a creative art therapist, they stand to benefit psychologically and emotionally. Recently there’s been a trend toward simple or old-fashioned crafts and hobbies such as knitting. Other common winter diversions include baking, building scale models or simply getting lost in a good book. Some adults, including myself, are even using colouring books to relax and reduce daily stress. This concept started several years ago with the publication of Johanna Basford’s Secret Garden. Her colouring book for adults has since been translated into 14 languages and has sold over one million copies.

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Why You Should Read When Breath Becomes Air

I highly recommend reading Paul Kalanithi’s bestseller, When Breath Becomes Air, especially if you’re dealing with a cancer diagnosis. At the age of 36, on the verge of completing a decade’s training as a neurosurgeon, Kalanithi was diagnosed with inoperable lung cancer. One day he was a doctor treating the dying, the next he was a patient struggling to live. When Breath Becomes Air is a life-affirming reflection on facing our mortality and on the relationship between doctor and patient. I was often mesmerized by the author’s writing skills, almost a little envious that he could be both a talented physician and such an outstanding creator of non-fiction. There are passages in the book where Kalanithi perfectly captures what it’s like to suddenly be living with cancer.

“Severe illness wasn’t life-altering, it was life-shattering. It felt less like an epiphany—a piercing burst of light, illuminating What Really Matters—and more like someone had just firebombed the path forward.”

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Jocelyn P. Newark, R.N. talks with Dr. Paul Kalanithi at the Stanford Hospital and Clinics in February 2014.

I was also struck by a section in which Kalanithi expresses his desire to make the most of what time he has left. One frustrating irony for many of us with cancer is that the physical limitations of the disease don’t allow us to engage in fast paced or frenzied activity.

“Time for me is now double-edged: every day brings me further from the low of my last relapse but closer to the next recurrence—and, eventually, death. Perhaps later than I think, but certainly sooner than I desire. There are, I imagine, two responses to that realization. The most obvious might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. And even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder. Some days, I simply persist.”

As a neurosurgeon, the author is able to examine the doctor-patient relationship from both sides. His illness also helps him to assess his values, including some of the ultimate objectives of medicine and those who practice it. A dying Kalanithi writes eloquently about his profession and why he chose to dedicate himself to such a demanding field.

“The physician’s duty is not to stave off death or return patients to their old lives, but to take into our arms a patient and family whose lives have disintegrated and work until they can stand back up and face, and make sense of, their own existence.”

“Our patients’ lives and identities may be in our hands, yet death always wins. Even if you are perfect, the world isn’t. The secret is to know that the deck is stacked, that you will lose, that your hands or judgment will slip, and yet still struggle to win for your patients. You can’t ever reach perfection, but you can believe in an asymptote toward which you are ceaselessly striving.”

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Dr. Lucy Kalanithi and Dr. Paul Kalanithi with their daughter, Elizabeth Acadia.

When Breath Becomes Air is a heartbreaking and ultimately beautiful reflection on the meaning of life as well as our own mortality. What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? These are the issues that many people with cancer are confronted with and that Kalanithi writes about so passionately and eloquently.

“I began to realize that coming in such close contact with my own mortality had changed both nothing and everything. Before my cancer was diagnosed, I knew that someday I would die, but I didn’t know when. After the diagnosis, I knew that someday I would die, but I didn’t know when. But now I knew it acutely. The problem wasn’t really a scientific one. The fact of death is unsettling. Yet there is no other way to live.”

Paul Kalanithi died on March 9, 2015, surrounded by members of his large and devoted family. While mourning her husband, Kalanithi’s wife helped to see his manuscript through to publication. Thanks to When Breath Becomes Air, those of us who never met the young doctor will both lament his death and benefit from his extraordinary life.

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Poetic Discourse

National Poetry Month, which takes place each April, is a celebration of poetry introduced in 1996. The event is spearheaded by the Academy of American Poets and originated on the steps of a post office in New York City. There, the story goes, Academy staff members handed out copies of T.S. Eliot’s poem, “The Waste Land,” which begins, “April is the cruellest month…” to individuals waiting in line to mail their tax returns.

Those of you who follow The Teal Diaries are aware that I write prose, however I’ve been inspired during my cancer treatments to pen a small collection of poetry. Here I’ve chosen to share two of my short poems. My compositions Patient’s Lab Results and A Visit to the Emergency Room both explore the life altering power of a cancer diagnosis.

 

Patient’s Lab Results

The sun is preparing to set on a late autumn afternoon,
its rays hold me together as I fall asleep dreaming of
my immaculate incision. Scarcely a week since my surgery.
I almost laugh to think I was such a novice.
Such a common virgin.

I pass through sliding doors to a point of no return.
Then I enter a vacant waiting room,
a place that is sinister, foreboding.
How many women have waited in these chairs?
How many innocent lives transformed?

“The ultrasound shows a growth on your ovary.”
“You need surgery to remove your uterus and right ovary.”
“You have cancer.”

Ultimately, he arrives, seeming anxious to print the pages.
“Here, this is for you.”
His words turn to ice as he offers me the pathology report.
Warmth as he grasps my hand, lending some reassurance.

My world dissolves as I take ownership of a disease.
The rapidly dividing cells, the cancerous tumors,
the abhorrent malignancy.

“Adenocarcinoma of the endometrium”
“The uterine cavity is completely filled with light tan neoplasm.”
“Right ovary with synchronous endometroid adenocarcinoma”

 

Immunotherapy one

 

A Visit to the Emergency Room

Riding unending waves of pain and nausea,
I take a secret pride in my endurance.
The sign over the door says MINOR EMERGENCIES.
Should I draw attention to this irony?

The young nurses seem aloof, peering out from
behind their curtain. I sense that we are to be
endured until morning comes. Around me
are the homeless, the destitute the addicted.

The fluorescent lights have been turned low,
casting a pale greenish tinge across the room.
Beeping monitors and moaning
patients provide the soundtrack.

I wonder if these souls feel entirely unaided,
abandoned, alone amid the chaos.
Each of us is fighting a singular
and solitary battle.

A torrent of frustration, then drowning I panic.
I want to scream that I’m a cancer patient
and my bowels are blocked.
I long for them to have evidence.
When will they be convinced?
I’m a bloated organ about to rupture.

The pre-dawn hours break like a fever
and I emerge from my delirium.
The kind eyes of the doctor and the
contrite look on the nurse’s face.

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Finding the Resilience to Face a New Year

This is the sixth New Year that I’ve celebrated since my cancer diagnosis, and each one brings with it a mixture of hope, fear and uncertainty. For many cancer survivors watching everyone plan for the future is difficult, it can produce mixed emotions and make the dawn of a new year extremely challenging.

That’s why I’m not going to use this blog to give a lecture about New Year’s resolutions or to suggest that you make elaborate promises to yourself. I realize that living with cancer often renders such gestures trivial and that your life is probably being planned week-by-week or month-by-month. Instead I’ve chosen to share some of my favourite quotations about resilience.

I hope the meditations that I’ve selected make the beginning of another year a little less daunting for you and provide you with strength and inspiration for your cancer journey. As someone once said, life doesn’t get easier or more forgiving, but we can choose to get stronger and more resilient.

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“Resilience is accepting your new reality, even if it’s less good than the one you had before. You can fight it, you can do nothing but scream about what you’ve lost, or you can accept that and try to put together something that’s good.”

— Elizabeth Edwards

 

You may shoot me with your words,
You may cut me with your eyes,
You may kill me with your hatefulness,
But still, like air, I’ll rise.

— Maya Angelou

 

“My scars remind me that I did indeed survive my deepest wounds. That in itself is an accomplishment. And they bring to mind something else, too. They remind me that the damage life has inflicted on me has, in many places, left me stronger and more resilient. What hurt me in the past has actually made me better equipped to face the present.”

— Steve Goodier

 

“You all know that I have been sustained throughout my life by three saving graces—my family, my friends and a faith in the power of resilience and hope. These graces have carried me through difficult times and they have brought more joy to the good times than I ever could have imagined.”

— Elizabeth Edwards

 

“Those who make us believe that anything’s possible and fire our imagination over the long haul, are often the ones who have survived the bleakest of circumstances. The men and women who have every reason to despair, but don’t, may have the most to teach us, not only about how to hold true to our beliefs, but about how such a life can bring about seemingly impossible social change.”

— Paul Rogat Loeb

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Unit 42 Haiku

National Poetry Month, which takes place each April, is a celebration of poetry introduced in 1996. Those of you who follow The Teal Diaries are aware that I don’t normally write poetry, however I’ve been inspired during my cancer treatments to pen a small collection. There are few experiences in life as distressing or traumatic as being hospitalized for cancer surgery. In December 2011, I underwent surgery and was cared for on Unit 42 at Calgary’s Foothills Hospital. Many of the events that transpired are represented in the poetry that you will read here. I’ve chosen to write haiku because of the format’s simplicity and it’s ability to convey powerful emotions or striking images.

blue slippers and gown
an eternity passes
in the pre-op room

when he cuts me open
no tumour for my collection
crave smooth healthy organs

anesthesia mask
a few deep breaths are drawn
on my way to oblivion

recovery room
the bright lights overhead
I’m dropped into darkness

conscious, I arrive
the darkness welcomes me
on a winter night

the room is spinning
I long for perfect stillness
let this voyage end

van-gogh-starry-night

I have nurse Crystal
the post surgery hours pass
finally, the dawn

they manage my pain
senses are dulled with morphine
the standard dosage

compression bandage
covers my fresh incision
my surgeon’s trademark

first blood transfusion
my outstretched arm is waiting
for type O to come

my blanket is thin
comfort of warm flannel sheets
during the still night

this building is old
mid-twentieth century
these rooms are vintage

generations past
have walked slowly down these halls
now I follow them

19th Century Surgery

I have a roommate
a Dutch Lutheran woman
her prognosis is grave

new complications
nausea, fluid leaks out
doctors seem unsure

hard recovery
my progress has been so slow
a mountain each day

my carcinoma
hides under a microscope
in some nearby lab

the truth will ooze out
why conceal my pathology
daze me with a pill

he stops by my room
cancer spread to one lymph node
the truth is laid bare

too much of this place
even the walls scream go home
find the strength to heal

past empty wheelchairs
through the lobby Christmas Eve
out hospital doors

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It Takes Lady Balls

As an ovarian cancer patient I’ll admit that I often feel overwhelmed by the dismal survival statistics and apparent futility of fighting such a deadly disease. Approximately 2,800 Canadian women are diagnosed with ovarian cancer each year and five women die from the disease every day. Currently, there are more than 17,000 of us in Canada living with the disease. The relative statistics are similar in the United States where 21,000 women will be diagnosed with ovarian cancer this year, and 14,000 will die from it.

Because the symptoms are usually subtle and there is no reliable screening test, ovarian cancer is frequently misdiagnosed or not discovered until it has reached an advanced stage. This makes treatment difficult, which is a key contributor to its high mortality rate. Ovarian cancer has a five-year survival rate of around 46 per cent, compared to nearly 90 per cent for breast cancer.

Each year at the Ovarian Cancer Canada Walk of Hope I’m proud to join a small but dedicated group of teal shirted survivors. Other participants in this key fundraising event wear white shirts— many in attendance at the walk are the husbands, children or grandchildren of those who have recently passed away. Unfortunately, since so many of us diagnosed with ovarian cancer die quickly after our diagnosis, the support network that typically forms around a cancer patient moves on quickly, creating what some have called a “leaky bucket” of advocates for the disease.

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I was delighted this January when Ovarian Cancer Canada launched Ladyballs, their boldest and most successful marketing campaign to date. Their marketing team knew that to be successful they would need to create a slogan that could be heard above the din of other national campaigns. So rather than focusing on sad facts to illicit sympathy, the team at Ovarian Cancer Canada chose to focus on the tremendous strength of survivors and the power we all have to do something about women’s most fatal cancer.

Marketing executive and ovarian cancer survivor, Lauren Richards, spearheaded Ladyballs. Richards is a former Cossette Media and Starcom MediaVest Group executive who has operated her own Toronto media consultancy since 2013. She enlisted Canadian broadcasters, newspapers, magazines and online publishers to donate several million dollars worth of space and time for the campaign.

Those behind the promotion knew from the start that they were up against organizations that have become brands in and of themselves. For example, Movember is a brand for prostate cancer and Run for the Cure is an iconic brand in the fight against breast cancer. Knowing they had such low awareness and little money, it was a daunting task.

The Ladyballs campaign’s most visible component is a video spot in which women show their so-called “lady balls” by demonstrating chutzpah in the face of pressure or adversity. “Check out the lady balls on her,” one woman says to her co-worker after a female employee disagrees with a male boss’s decision during a meeting. “Look at the lady balls on her,” says a male announcer when another woman goes all-in during a televised poker tournament. In the concluding voiceover an announcer informs viewers that women have balls–their ovaries–and they’re always at risk. Viewers are then directed to donate to the cause at ladyballs.org.

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As expected, the campaign has been highly controversial. Some critics say the ad insults women by comparing a uniquely female body part–the ovaries–to men’s testicles. They say that women don’t have to stoop to that level to promote an informed discussion. However, I personally disagree with this view. I hold the same opinion as Matt Miggins, a nursing student at St. Clair College in Windsor.

“They are not mad five women a day die from this?  I find it ironic that they are mad about words. People should be mad at the fact this is happening to our mothers, sisters and wives,” said Miggins. He said he thinks people should put things into perspective. “People need to ask themselves, if the word balls saves just one life, is it then worth it?”

According to Ovarian Cancer Canada, the campaign has been instrumental in raising awareness. Ladyballs has been responsible for a significant increase in requests for By Your Side, a resource provided to women diagnosed with the disease. It’s also led to a spike in calls to offices across the country, with callers citing the campaign as their reason for reaching out. One woman who heard a Ladyballs radio commercial immediately pledged $100,000 to the organization, and the campaign has garnered approximately $60 million in earned media impressions since its January debut.

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