When Having Cancer Means a Fresh Start

Psychologists have observed that a cancer diagnosis is for most people a major life event, mentally we tend to divide our life into before and after we had cancer. For me it’s definitely been like that, in many ways I feel as if I was given a clean slate or a new beginning. First, becoming ill with cancer has required me to both analyze and redefine the relationships I have with those closest to me. In many cases I’ve had to set new boundaries, as I will no longer tolerate toxic or unhealthy relationships. Some personal and business relationships that I had before are finished, as a rule I no longer remain in contact with people who were unable or unwilling to support me throughout my cancer journey. 

Now that I’m a cancer survivor, I’ve become more sensitive to the characteristics of toxic people and how they mistreat others. I choose to avoid them whenever possible, meanwhile I set boundaries and keep my distance when I’m in situations in which I must associate with them. I recently came across a fairly accurate description of what it’s like to be in a relationship with a toxic person, it can be a relative, a friend, your boss, or a work colleague. The harmful individual likely demonstrates all or some of the following behaviors:

  • 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 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.

Of course, evolving relationships are just one element of my new life as a cancer survivor, I’ve been forced to abandon or reassess many of my long-term professional goals. I lost numerous clients when I was unable to work for approximately a year. By the time I had undergone several major surgeries and then struggled through chemotherapy treatment, I had realized how stressful, competitive and deadline oriented my field of freelance journalism can be. I had to make the decision to step back from the relentless demands of trying to do assignments all the time.

At first it was hard to adjust to my new normal as far as work and income are concerned, but now I often relish the freedom and the time I have to relax and enjoy other things. Of course, there are still periods when I’m extremely busy, I’ve been required to learn a great deal in recent years. It’s been said that going through a cancer diagnosis and then undergoing treatment is a learning experience equivalent to a university degree. I carry an abundance of knowledge regarding the Canadian health care system, cancer, and gynecological cancer in particular, gleaned from the terrible events that I have been through. 

Finally, the way I view myself and the world has changed enormously as well. I’ve learned by necessity how to live my life day by day, and sometimes even moment by moment.  I’m always mindful of the present and what it has to offer me, I’ve also noticed that I rarely use words like “someday” because I try to avoid talking about future plans in vague or uncertain terms. Most healthy people I know take the future for granted and think of it as something that will always be there for them. In 2012 I spent over a month and a half on Unit 42 at Calgary’s Foothills Hospital. This women’s cancer ward is predominately a place of bravery, triumph, heartbreak and tears. When I looked into some of the other patients’ eyes, I could see them begging for a future, and I understood that they would do almost anything for the gift of just a few more months in this world. As a cancer survivor I’ve discovered how precarious tomorrow really is and that you can’t always depend on someday.

My Decade in Review

As we commence 2020, I perform a quick scan of traditional and online media, not surprisingly I discover an inundation of both year end and decade end reviews. Many would agree that the events of the past decade have been turbulent, sometimes even frightening. There’s some level of apprehension when we consider our planet and our civilization. In the past decade millions of people around the globe have been forced to flee from war, extreme poverty or the rise of radical factions and dictatorships. Science has presented irrefutable evidence that the world’s climate is in crisis and that fossil fuels and other human factors are mostly responsible. Meanwhile, technology, in the form of social media and smartphones, has forever altered the way we work and interact with one another. 

For me, as an ovarian cancer survivor, the decade 2010-2019 had its own special events—complete with moments of revelation. Here I’ve created a summary of what I consider to be the most significant occurrences, both for myself and for the entire ovarian cancer community.

2010: Fear and Denial

As the decade began I was experiencing vague symptoms of ovarian cancer, however I remained largely unaware of how serious my situation was. When I look back now, I wasn’t listening to my own body as much as I should have been, I tried to ignore the whisper until it became a scream. Initially, I didn’t pursue my emerging health issues aggressively or communicate openly with my doctors. I expect it was fear and denial combined with ignorance. 

2011: The Journey Begins

In 2011 an abdominal ultrasound revealed several abnormalities, including a mass on my right ovary—just as ominous was the fact that some of my symptoms (abdominal pain, lack of appetite, frequent urination) were becoming more severe. I foolishly tried to protest at first, but I ultimately consented to a complete hysterectomy as well as the removal of my right ovary. On November 3, 2011, I received the results of my surgical pathology report. As I went over the report with my gynecologist, it was the first time in my life that I had words almost literally spin before my eyes. 

  • Adenocarcinoma of the endometrium
  • The uterine cavity is completely filled with light tan neoplasm.
  • Right ovary with synchronous endometrioid adenocarcinoma

2012: The Fight of My Life

Finding out you have cancer, I can personally attest, is a unique kind of fear, but I believe this feeling is heightened even more for women who learn that they have ovarian cancer. It’s among the most feared and deadly cancers, one that tends to inhabit our worst nightmares of the disease. Someone once said that you never know how strong you are or how brave you can be until you encounter a crisis and have no choice. In terms of serious illnesses, I had inhabited a world of almost complete innocence, hospitalization, surgery and chemotherapy were all terrifying firsts for me. But eventually, Calgary’s Tom Baker Cancer Centre, being a patient on the gynecologic oncology unit and regular cycles of Carboplatin with Taxol became part of my routine—they became agonizingly familiar to me as I fight for my life. 

2013-2014: Picking Up the Pieces

My oncologists informed me that I was in remission and there was no evidence of cancer on any of my latest scans, however my journey was far from over. I would be required to have checkups twice a year at the cancer centre as they monitored my closely. If I didn’t experience a recurrence within five years, their plan was to ultimately discharge me back into the care of my family physician. Meanwhile, I tried pick up the pieces of my life as I came to terms with my new identity as a cancer survivor. In the fall of 2013, I participated in a major Canada-wide event the Ovarian Cancer Canada Walk of Hope. I felt less alone as I walked with hundreds of other advocates and mingled with other survivors.

Posing with my mom and brother Ray at the 2013 Ovarian Cancer Canada Walk of Hope.

2015-2016: The Emperor of All Maladies

This was the period when I started to think a great deal about the history of cancer, especially the many patients that had come before me and the pioneering oncologists. I developed a fascination with these topics while watching the PBS miniseries Cancer: The Emperor of All Maladies. The creators of this ground-breaking television documentary based their project on a Pulitzer Prize winning work of nonfiction by renowned oncologist Siddhartha Mukherjee. Both the PBS documentary and Mukherjee’s Pulitzer Prize winning volume have one overriding theme. They bring to light that our current generation’s experience with cancer represents only a momentary chapter in an epic battle spanning thousands of years.

2017: At Long Last

On my many visits to Calgary’s Tom Baker Cancer Centre, I was alarmed by the obviously overcrowded quarters. After my first couple of appointments, I found it impossible not to notice how filled to capacity the building is. I was subjected to the overflowing parking lot, the busy chemotherapy beds and the standing room only waiting areas. Finally, in the fall of 2017 ground was officially broken for the new Calgary Cancer Centre. The new facility is scheduled to open in 2023 and will have double the capacity to treat patients with state-of-the-art technology. As 2017 ended, I received the news that I had only dreamed of for so long. My oncologists were satisfied that after five years without a recurrence I no longer needed to see them, they told me my health could be managed once again by my family physician.

An artist’s depiction of the new Calgary Cancer Centre.

2018-2019: A Way Forward

I don’t know when or if my cancer will recur, but I’ve learned to accept that terrible uncertainty. All I can do is live in the moment and make the best of what I have now, I’ve become aware of how fortunate I am as I’ve watched so many other women struggle with incurable ovarian cancer or eventually succumb to this cruel and vicious disease. It was a major triumph for the Canadian ovarian cancer community in 2019 when the federal budget allocated 10 million dollars to ovarian cancer research.

I cheered on the efforts of Ovarian Cancer Canada as they relentlessly lobbied the federal government to invest the much needed 10 million. Numerous meetings with survivors on Parliament Hill finally helped persuade some key politicians that better funding is needed to save thousands of lives. “Today, the Government of Canada has taken steps to invest in needed research which will translate into scientific progress against this disease. This announcement makes an important commitment to women’s health and equity in health care – and it is a milestone made possible because of you,” wrote Ovarian Cancer Canada CEO, Elisabeth Baugh.

A Teal Christmas

Like every Christmas since my cancer diagnosis, this one will be unlike the ones I celebrated before I became a cancer survivor, A major cancer diagnosis often causes you to view the world differently—things that once seemed enormously important during the Christmas season lose significance and become almost trivial. Personally, I’ve discovered that having elaborate decorations, expensive gifts or wearing designer winter fashions all matter less to me now. These things frequently seem to fade into irrelevance as I confront a life-threatening illness. Meanwhile, my relationships with other people, discovering ways that I can make a difference in the world and learning more about the essence of who I am are at the forefront of my agenda and have an extremely high priority to me during the holidays.

Many cancer survivors will attest to the fact that there are times during the season when they are surrounded by people and still feel very alone. This type of emotional isolation occurs when you discover that you can no longer relate to people in the same way you did before. Things that were important to you in the past are no longer important to you, and your friends and family don’t understand why you have changed so much. I’ve noticed that the books I read, the movies or television that I watch and the activities that I like to participate in have all changed a fair amount since my cancer diagnosis, so have the topics that I prefer to discuss. This transformation has affected my personal relationships and how I feel about those closest to me.

Since my ovarian cancer diagnosis eight years ago, I’ve been required to think about my mortality. I’ve also had to tend to many practical matters that I didn’t anticipate that I’d have to deal with until I was much older. While everyone around me carries on with their lives, I’ve had to stop and reflect on some of the more profound questions that others have the luxury of ignoring. Individuals diagnosed with cancer suddenly find themselves contemplating existential questions. Why am I here? What is the purpose of my life? Who am I? These issues are brought to the forefront of your mind when facing a potentially deadly disease. During the holidays I sometimes feel frustrated because most things my friends and family care about seem fairly trivial to me now. For example, they got cut off in traffic on the way to one of their annual Christmas parties or the latest popular gadget for someone on their Christmas list is currently out of stock.

I still enjoy traditions like exchanging gifts, and most Christmases I’m able to partake in a delicious turkey dinner. However, it’s the small things that matter most as I savour each moment. Every year I make a Christmas list that I share with family members, but the items on my list are usually inexpensive things that are intended to make my daily life as a cancer survivor more pleasurable. The grand total is almost always less than two hundred dollars. It may sound trite, but I carry within my heart a list of things that can’t be bought or wrapped up in a box. If I wrote them down, my Christmas list would read like a combination of a bucket list and some of the hopes and dreams that I have for all women living with ovarian cancer. 

Of course, the best Christmas gift that every current and future ovarian cancer patient could receive is a cure. But in the meantime, we need newer and better treatments as well as ways of preventing the disease or detecting it sooner. The survival rate for ovarian cancer remains dismal compared with most other types of cancer, this is essentially because the majority of women aren’t diagnosed until the disease is advanced and has spread beyond their reproductive organs. There is no reliable screening test for ovarian cancer and the symptoms are often vague. One common misperception is that a Pap Test for cervical cancer can also detect the presence of ovarian cancer, it definitely cannot. 

I strongly urge anyone who would like to make a difference in the fight against ovarian cancer to make a donation to research this holiday season. Fortunately, women whose lives have been affected by this terrible disease have a number of non-profit advocacy groups working diligently for us. For Canadian citizens or those residing in Canada I recommend donating to Ovarian Cancer Canada OCC. For American citizens or those living in the United States I recommend donating to the Ovarian Cancer Research Alliance OCRA.

Happy Holidays!

A Unique Kind of Fear

Finding out you have cancer, I can personally attest, is a unique kind of fear, but I believe this feeling is heightened even more for women who learn that they have ovarian cancer. It’s among the most feared and deadly cancers, one that tends to inhabit our worst nightmares of the disease. That is why patients with gynecologic cancer, especially ovarian, are frequently warned not to Google their condition or research it online. Admittedly most of the information that is available on websites is general or focusses on worst case scenarios. Oncologists are eager to remind us that broad statistics don’t take into consideration an individual patient’s age or overall health. In many cases the data presented is likely to overlook a lot of specific variables. Even so, when I go online the numbers pertaining to ovarian cancer are enough to terrify me.

Devastating Statistics

Ovarian cancer is the eighth leading cause of cancer in women, according to the World Health Organization. Nearly 300,000 women worldwide will develop it this year. On a global scale their prospects are often bleak, it’s estimated that one in six will die within three months of diagnosis and fewer than half will be alive in five years.

Each year about  2,800 Canadian women are newly diagnosed with ovarian cancer and an estimated 1,800 die from it. Mortality rates for ovarian cancer have declined only slightly in the forty years since the “War on Cancer” was declared. Most other cancers have shown a much greater reduction in mortality.

Ovarian cancer survival rates remain much lower than breast cancer and other cancers that affect women. Five-year survival rates are commonly used to compare different cancers. In Canada, the five-year net survival for ovarian cancer is approximately 44 per cent. This means that, on average, only about 44 per cent of the women who are diagnosed with ovarian cancer will survive for at least 5 years.

Like a Loaded Gun

One woman with ovarian cancer compared the fear of recurrence to a person always having a loaded gun pressed against her back. You never know when they will pull the trigger, or even if they will, but every minute you are conscious of them being there. I find this metaphor quite powerful, you never know if or when your cancer will return and this uncertainty is something that you must accept as part of your everyday life. A cancer recurrence happens because some cancer cells were left behind and eventually grow and become apparent. The cancer may come back to the same place as the original tumor or to another place in the body. According to the Ovarian Cancer Research Alliance around 70 per cent of patients diagnosed with ovarian cancer will have a recurrence. However, one of the most important factors in determining an individual’s risk of recurrence is the stage of their cancer at diagnosis.

Patients diagnosed with stage I have a 10 per cent chance of recurrence.

Patients diagnosed with stage II have a 30 per cent chance of recurrence.

Patients diagnosed with stage III have a 70 to 90 per cent chance of recurrence

Patients diagnosed with stage IV have a 90 to 95 per cent chance of recurrence.

Recurrent ovarian cancer is treatable but rarely curable. Women with recurrent ovarian cancer may have to undergo another surgery. Many women with recurrent ovarian cancer receive chemotherapy for a prolonged period of time, sometimes continuously for the rest of their life.

Elly Mayday (1988-2019) continued her modelling career while undergoing treatment for ovarian cancer.

Braver Than I Thought

I’ve certainly learned that when you are diagnosed with cancer there are moments when you become overwhelmed and sense that your world is spinning violently out of control. The fundamental paradox for me is that I’m often in situations where I feel a sense of power, combined with courage and self-assurance. It’s as if I’m standing in life’s Category 5 hurricane and remaining steadfast and unbroken. I certainly don’t aspire to become a legend like Terry Fox or to be anything resembling a saint or a cancer hero. But still, I’ve discovered inner qualities and personal strengths that I never appreciated or properly acknowledged in myself. Subjected to the ultimate test, I’ve sometimes shocked myself with my enormous capacity to overcome adversity and to confront physical pain and suffering.

If These Walls Could Talk

Women in southern Alberta who are diagnosed with gynecologic cancer become patients at the Tom Baker Cancer Centre and are treated by the gynecologic oncologists there. However, when surgery is required we become patients on Unit 42 B, located in the adjacent Foothills Hospital building. I first enter the unit like almost all of us do, I’m wheeled in on a gurney following major abdominal surgery that has just been performed by one of western Canada’s top pelvic cancer surgeons. It’s the evening of December 13, 2011, and I can vaguely remember being transferred to a bed in a darkened room, beside me is one other patient. Outside the sun has already disappeared, and as I drift in and out of consciousness I visualize the rush hour traffic—thousands of people racing home for dinner, perhaps some rushing to the nearest mall for yet another round of Christmas shopping.

The first night I struggle with some post-operative vertigo and I can hardly focus each time I open my eyes. The room gradually stops spinning as the dawn approaches, meanwhile morphine dulls my pain and I reach down once or twice to feel a large compression bandage covering my abdomen. At first, I mistake the female resident who comes to examine me on rounds in the morning for one of the nurses. I don’t yet realize that residents do most of the rounds on the Foothills cancer wards and report back to the oncologists and surgeons. The other morning routine that soon becomes engrained in me is having my blood drawn, the hospital lab technicians regularly make their rounds of the unit at five or six in the morning. 

So, what is the worst thing about being on Unit 42 –aside from being sick or having cancer of course? A number of things: the helplessness; the feeling of anonymity; the rote and the repetition; being talked about and talked to, rather than talked with; the waiting; and the loneliness. I watch as the occasional short-term stay patient is relegated to the hallway due to the unavailability of rooms. It’s a reminder to me how drastically the situation for patients and their families has changed in recent years. Once hospitals were where you stayed when you were too sick to return home; now you go home anyway, cobbling together your own nursing services from friends, relatives and drop-in professionals.

In hindsight, I admire the nurses who work on Unit 42— I remain grateful for the ones who went out of their way to make me more comfortable, especially those who took a couple of extra minutes to offer me some needed words of encouragement. In general, the staff does their best to provide first-rate care, even on an overcrowded unit in what is unmistakably a vintage 1960s building.

Of course, my experience is likely influenced by the fact that it’s only the second time in my life that I’ve been hospitalized, and the previous time it had not been on a large oncology unit. This time my situation seems more unbearable to me, I feel somehow traumatized. Being on a cancer unit shakes your illusions of immortality. It robs you of the sense of invincibility and innocence that once protected you. I’ve never directly experienced such an atmosphere—one filled with hope, fear, anguish and despair. There are times during my stay when I can almost see it oozing out of the drab, greyish walls that surround me.

LIke many of the other patients my surgery has been fairly extensive, it has ultimately involved a small bowel resection as well as the removal of my appendix and omentum. Time creeps slowly as my condition gradually improves. Due to some minor complications, it takes until December 24 for the oncologists to finally agree that I am well enough to be discharged. During the course of my stay I have endured blood transfusions, numerous tests and scans and too many IV medications for me to keep track of. I am so incredibly anxious to go home that I’m already changing into my clothes when my mom and brother appear in the door of my room. As I leave the building through the busy lobby on Christmas Eve, I realize that psychologically I will never actually leave behind the experience of being a patient on Unit 42. I know it will influence the remainder of my life.

Celebrating the Ovarian Cancer Community

In the past few years I’ve noticed a growing amount of energy and a stronger sense of purpose within the Canadian ovarian cancer community. Not that we haven’t always been a small but passionate group, committed to fighting this disease and the devastation that it inflicts on women and their families. However, I’ve noticed a gradual shift from when I was first treated six or seven years ago. When I was initially diagnosed with ovarian cancer in November 2011, I can remember that Ovarian Cancer Canada’s primary focus seemed to be on awareness and prevention as well as on support and better resources for women already fighting the disease. But now they have adjusted their mandate to involve more advocacy at the level of the federal government. Pushing for additional research and better treatment options for women with ovarian cancer has become their most important objective.

An estimated 2,800 Canadian women are diagnosed with ovarian cancer each year, an estimated 1,800 die from the disease. There is no question that ovarian cancer research is significantly underfunded and that more has to be done to develop better treatments. Scientific progress in the field has been agonizingly slow, more than half of women who are diagnosed with ovarian cancer still die within five years. Like many who have battled the disease, I dream that perhaps one day soon there will be a test that can detect ovarian cancer in its early stages. The majority of women are currently diagnosed after the cancer has spread beyond their reproductive system. Meanwhile, additional research in the area of immunotherapy might give renewed hope to many of us living with ovarian cancer or facing a recurrence.

 

ParliamentHill

 

It was a major triumph for the Canadian ovarian cancer community when the latest federal budget allocated 10 million dollars to ovarian cancer research. Over the past four years I’ve cheered on the efforts of Ovarian Cancer Canada as they relentlessly lobbied the federal government to invest the much needed 10 million. Numerous meetings with survivors on Parliament Hill helped persuade key politicians that better funding is needed to save thousands of lives. “Today, the Government of Canada has taken steps to invest in needed research which will translate into scientific progress against this disease. This announcement makes an important commitment to women’s health and equity in health care – and it is a milestone made possible because of you,” wrote Ovarian Cancer Canada CEO, Elisabeth Baugh.

While it’s true that ovarian cancer is most often diagnosed in women in their fifties or sixties, it’s a myth to believe that it is only an “old woman’s” disease. I was 46 years old when I found out that I had ovarian cancer. I’m always shocked when I learn about women much younger than I was receiving a similar diagnosis, my heart aches as I witness a life-threatening disease try to shatter their hopes and dreams. It hurts me to see the impact that ovarian cancer can have on their relationships, careers and future ability to have children. I have deep admiration for younger ovarian cancer patients, they often possess a wisdom and maturity that seems beyond their tender years.

 

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Ashley Shandrel Luther  (Elly Mayday)
April 15, 1988 — March 1, 2019

I recently mourned when the community lost a powerful advocate and inspirational leader. The internationally renowned model Elly Mayday passed away in March. Elly Mayday’s given name was Ashley Shandrel Luther. She was born on April 15, 1988 and grew up in Aylesbury, Saskatchewan. The body positive model and activist was first diagnosed with ovarian cancer when she was just 25. Elly was diagnosed with Stage 3 ovarian cancer around the same time that she had two modelling contracts offered to her. But instead of stepping out of the light, she welcomed it. “I figured that maybe I could help someone going through something similar, while continuing on with my own dreams. I mean, I was going through it either way, why not make it as positive as possible?” she once said. Elly vigorously pursued modeling while bravely sharing intimate details about her cancer treatments with her huge number of fans and social media followers. Her legacy will continue to be an inspiration to many.

The Road Ahead

As 2018 was drawing to a close, I was forced to confront an unexpected bump on the never-ending road that is my cancer journey. In October I went to my family physician with some symptoms that I feared might indicate a recurrence of my ovarian cancer. While she was reasonably certain that my cancer had not returned, she wanted to be safe and made some arrangements for me to see my principal oncologist. It had been nearly a year since my last appointment and I’d almost forgotten the prevailing stress and uncertainty associated with visits to the Tom Baker Centre. When I arrived my eyes scanned the building’s vintage 1980s interior, finally resting on the rows of chairs occupied by anxious patients.

Ultimately the resident who examined me was reassuring, she quickly explained that the medical team would like to order a CT scan as a precaution to rule out the possibility that my malignancy had returned. On a Thursday afternoon, just a few weeks before Christmas, my oncologist’s office phoned to inform me that my procedure had been scheduled. Three days later I was at the hospital checking into diagnostic imaging, it was as if I was walking back into a nightmare that I thought was over. As I positioned myself in the scanner, I prayed that I would soon be facing the culmination of The Great Recurrence Scare of 2018 and not confirmation that cancer had invaded my body for the second time. Rarely have I been so painfully uncertain about what a new year would bring me.

 

simulator

 

To cut to the chase, my test revealed no evidence for tumor recurrence or metastatic disease in my abdomen or pelvis. I’m still cancer free after six years! I’m filled with gratitude when I think of the women who aren’t as fortunate as I am, there are too many of my teal sisters who never achieve a complete remission from their ovarian cancer. Obviously, as I think ahead to how I want to spend 2019 I’m more determined than ever to make the most of each day and not squander the precious moments of life that have been granted to me.

One of my goals for 2019 is to live in the present and not spend an excessive amount of my time regretting the past or worrying about what will happen to me in the future. About six years ago, soon after I was diagnosed with cancer, I discovered a technique called mindfulness. Jon Kabat-Zinn pioneered using this method with cancer patients and other groups battling chronic pain or illness at the University of Massachusetts Medical School. Kabat-Zinn describes mindfulness as follows:

“Mindfulness means paying attention in a particular way: on purpose, in the present moment, and non-judgmentally. This kind of attention nurtures greater awareness, clarity, and acceptance of the present-moment reality. It wakes us up to the fact that our lives unfold only in moments If we are not fully present for many of those moments, we may not only miss what is most valuable in our lives but also fail to realize the richness and the depth of our possibilities for growth and transformation.”

 

hope-hands

 

Whatever transpires this year, I promise to treat myself with kindness and compassion. I pledge to be less critical of myself and to focus more on why I am a special and worthwhile human being. I’ll attempt to concentrate on my positive qualities and the valuable contributions that I am able to make while I’m in this world. Kabat-Zinn stresses that we should nurture our sense of self-esteem and self-worth. At the same time, he acknowledges that many people need help or reminders that they are worthy and deserve to be loved.

“Perhaps we just need little reminders from time to time that we are already dignified, deserving, worthy. Sometimes we don’t feel that way because of the wounds and the scars we carry from the past or because of the uncertainty of the future. It is doubtful that we came to feel undeserving on our own. We were helped to feel unworthy. We were taught it in a thousand ways when we were little, and we learned our lessons.”