January 16, 2022: Altered Body: Altered Self-Image

And the body, what about the body? –Jane Kenyon

“Would you be willing to write a short piece for the patient website?”  It was a request sent in a short email from Samantha, who does much of the behind-the-scenes coordination and publicity for “Writing the Heart,” the expressive writing workshop I lead through Ted Rogers Center for Heart Research.  I didn’t hesitate and said, “yes,” and agreed to brainstorm possibilities together in a short virtual meeting two days ago.   What I didn’t expect was to find tears running down my face as we explored possibilities.  The topic I suggested as we chatted was, as it became apparent (no pun intended…) close to my heart.

In my cancer writing groups, I often invite the participants to explore their feelings about their bodies, before and after a cancer diagnosis.  Cancer patients often feel betrayed by their bodies—and at the same time, they are more apt to define cancer as an invader, a foreign aggressor.  The metaphors they use often include a sense of fighting back, overcoming the invading cancer cells.  Bodies are altered; body parts sometimes lost or scarred by the disease or treatment.  Yet cancer research and treatments continue to advance, and there is, for the majority of those I’ve experienced, hope for a cure.

 By contrast, the heart is our life-giving pump, not an invader, and while advances have been made in heart transplant and medications for heart patients, heart failure is not curable.  It is progressive, and the medications I take twice daily are those that help aspects of heart functioning so that I might “keep going a little longer.” The irony for me is that in all likelihood, as my cardiologist suspects, my cancer treatment twenty-one years ago, specifically, the radiation to my left breast, is likely the culprit in my diagnosis of heart failure.

Since my diagnosis of heart failure in 2008, I have, in comparison to so many people similarly diagnosed, been doing relatively well, and given the privilege to encourage and hear cancer and  heart patients’ stories as I do in our writing groups, I am humbled:  my own experience seems relatively lightweight.  More than a few times, I’ve said to my husband that in comparison to other heart failure patients, I am very lucky.  So when I suggested to Samantha I could write a piece on coming to terms with an altered self-image due to heart failure, I was surprised to find my eyes teared up quite unexpectedly. 

And while I do feel “lucky” in many ways, it also masks the emotional impact of living with heart failure I’ve experienced, a progressive condition that, thus far, has no cure.  I was first diagnosed in late 2008 after collapsing on the sidewalk while I was walking my dog, rushed to emergency, hospitalized for three days of tests and observation, undergone an angiogram and, without much discussion or explanation, while I was still regaining consciousness after the angiogram, asked if I “wanted” an ICD.  Unsure if an ICD was warranted, I reluctantly agreed when the cardiologist said, “think of it as insurance,”  and after it was inserted, then spent another three nights in the hospital.   I spent the days dazed and feeling as if I was living in a strange dream. The only heart failure patient I had ever met was a 90-year-old neighbor.    

For the first months after the entire episode, I settled back into a life that was relatively unchanged.  Other than the bulge on the left side of my chest, nothing seemed very different as far as my daily life was concerned.  I had regular cardiac visits, but they were little more than a 15-minute conversation and the assurance, “You’re doing fine.”  My ICD checkups came every six months—and once I’d struggled to understand the technological explanations by the ICD specialist, assured “everything was fine.”  I felt like my ICD got more attention than I did in my hospital visits!  What wasn’t at all clear to me is that my heart failure was progressing, and it wasn’t until we’d  returned to Toronto, and I became a patient at the Peter Munk Cardiac Centre, that I began to understand the impact heart failure would continue to have on my life.

Within the first year back in Toronto,  I noticed I was a little shorter of breath than usual.  As the year progressed, I began having more and more difficulty climbing the stairs—something I blamed on a case of Achilles tendonitis.  The tendonitis is long gone, but stairs have now become even more of a challenge.  When we relocated to our current building, one with elevators, then I noticed that walking uphill on  Yonge Street was becoming more difficult than it once was, gradually, forcing me to pause multiple times to regain my breath when I ran errands on foot.  While my husband and still I walk together from time to time, it’s me who asks, “Can we go a bit slower please?” unlike a few years ago, when he would complain about my brisk pace.   

The deceptive thing about heart failure is that I don’t look different.  Oh sure,  I’m older, like all my friends, and one’s body shows those signs in little, but persistent ways:   graying hair, more lines in the face, declining muscle tone, stiffening joints–the complaints common to advancing years.  But I look normal. My ICD is beneath skin and clothing:  there are no visible markers as there often  are with cancer patients that tell people “She’s a heart failure patient.”   And unlike in cancer, there is no “hope for a cure” among heart failure patients, just the increasing number of medications, to “help you last a bit longer.”  Don’t get me wrong:  I am very grateful for those medications and for the exceptional medical care I get at Peter Munk, but I am much more aware of living with heart failure —and the insidious way in which doing so  sneaks up on me, sometimes triggering the blues.

The impact of living with heart failure is to challenge the very me I always believed I was.  My body’s betrayal has forced me to re-evaluate the image I have always had of myself—that active, healthy, fast-moving, multi-tasking self.  Mortality then seemed a long way off.  Now I realize that my heart might be concocting other ideas about my longevity.   Yet admitting all this is something I rarely do, and when  I opened up about it to the TRCHR team members in our meeting, I was embarrassed and surprised to find tears streaming down my face.  Obviously, I’d hit on a topic I felt strongly about—more than I was previously willing to admit. …Looks like I’ve got some writing to do.

This long struggle to be a home

In the body, this difficult friendship.

From “Cages,” in Collected Poems, 2005, by Jane Kenyon

Writing Suggestions:

  • Has a debilitating illness or progressive medical condition changed your life?  In what ways?  Write about its challenges to your self-image and how you manage those.
  • How has your relationship with your body changed due to a serious illness?
  • How has your relationship with your body been affected by physical aging?
  • Use the lines from Jane Kenyon’s poem, quoted in this post, as a place to begin writing.

December 18, 2021: Winter Solstice: A Time of Hope and Renewal

For the past several days, I’ve been struggling to write.  It’s not just about cobbling together a blog post appropriate for the season; it’s a malaise that has also rendered my precious morning writing time a struggle of inspiration and motivation.  I am following my own advice:  keeping my routine of writing each morning, but more often than not, my pages are filled with thoughts that go nowhere and brief, unrelated paragraphs.

Now, at a time when this blog post might be oriented to a more “seasonal” theme related to the holiday season, I don’t feel anything close to the holiday spirit as I usually do.  There seems to be less in the world to celebrate with the very present impact of climate change, a worldwide fourth wave triggered by the relentless spread of the Omicron variant, and daily, news of political unrest, poverty, hardship, and suffering, overshadowing themes of “comfort and joy” in this usual holiday season.  I have, as many have, been infected by a kind of spiritual malaise:  call it “pandemic fatigue,” whether a constant low level anxiety or a persistent sense of languishing.  Whatever we call it, it’s nigh impossible to summon up a sense of genuine holiday cheer.  Rather, I can’t shake the undercurrent of more primitive fear lurking somewhere in the shadows, one that whispers that things will never be as they once were.

“Winter Solstice,” a poem by Jody Aliesan, captures those feelings in the first stanza:

when you startle awake in the dark morning
heart pounding breathing fast
sitting bolt upright staring into
dark whirlpool black hole
feeling its suction…
(In: Grief Sweat, 1990)

This morning I remembered that the winter solstice occurs in the Northern Hemisphere on Tuesday morning, December 21st.   It’s the day when hours of daylight are the shortest and the nighttime longest, marking marks the start of the astronomical winter.  It is after the solstice that our days grow longer and our nights shorter, as we gradually move toward spring.  According to the historians, our traditional December holiday celebrations had their beginnings in the winter solstice, as early as the latter part of the Stone Age, somewhere around 10,200 B.C. 

For our ancient ancestors, the winter solstice was also associated with the concept of death and rebirth.  The weather grew cold, the growing season had ended, and stores of food grew scarce as the life-giving sun sank lower in the sky. They feared the sun might disappear completely, leaving them to suffer in bitter cold and permanent darkness.  But the winter solstice marked the gradual return of the sun, and its growing strength as it rose each day in the morning sky.  Winter may have been far from over, but because it signaled the return of warmer seasons and new life, the solstice was a time for celebration.

As this year’s solstice approaches, we are again facing restrictions:  the Omicron variant is spreading everywhere at a pace far outstripping the previous waves of the pandemic, throwing our everyday lives into question again: what life will be like when we have gained the upper hand on this virus? So much has changed because of the pandemic:   our sense of freedom in our daily lives, faces still masked for protection, and interaction with others, relegated the virtual world of email and ZOOM.  The toll on our personal lives has been quietly relentless.  Now, more than ever, we need a re-kindled sense of hope and at the same time, to find gratitude in our here and now. That, for me, is a daily exercise.  

As I was writing this post, I remembered a favorite children’s book, Frederick, by Leo Lionni.  Published in 1967, I originally bought the book when my daughters were toddlers, it became a bedtime story staple for several years.   Yet Frederick has such lasting charm, I’ve given it as a gift to other children, and a few adult friends as well.   Frederick also accompanied me to my writing groups, its collage illustrations, wonderful storyline, and message a gift for anyone.

Frederick is about the story of a group of field mice who are gathering their supplies for the long winter ahead—all but one, that is, Frederick.  He is shown basking in the late autumn sun or sitting and staring at the meadow. When asked why he isn’t working, he replies he is working:  gathering “sun rays for the cold, dark winter days” or colors, “for winter is gray” or other “supplies” of his own.  Winter comes, and the mice take refuge among their hideout in the stones, at first, enjoying plenty of food and conversation, but as the winter months lengthen, they run low on supplies. They remember what Frederick had said and ask, “What about your supplies, Frederick?”    Frederick climbs on a big stone and instructs them to close their eyes.  He begins to share descriptions of the sun, the colors of summer, and finally, his words:  a poem about the four seasons, all to the delight of the mice, who have been transported to sunnier memories, hope, and gratitude for Frederick’s supplies – his poetry, just as I was again transported, my spirits warmed, in re-reading Lionni’s priceless little story.  

We will, in a week’s time, huddle together for a quiet Christmas with our Toronto daughter and her family, all of us vaccinated with our booster shots and exercising similar cautions.  Just knowing we won’t be alone, as we were a year ago during COVID, is comforting.   We’ll have plenty of food for our cold, dark days, and the shared stories of Christmases past will warm our spirits and hearts.  Having at least part of our family nearby, to weather this fourth wave together in our familial cocoon, is a sustaining antibody against falling into despair.   Maybe that’s also something to do with hope for the season to come.

…already light is returning pairs of wings
lift softly off your eyelids one by one
each feathered edge clearer between you
and the pearl veil of day

you have nothing to do but live

(Grief Sweat,
by Jody Aliesan, Broken Moon Press, 1990)

I wish you a peaceful holiday season, gratitude for those in your lives who make a difference and for our beleaguered healthcare workers, and the hope we may find renewal and better times in the months to come.  

Writing Suggestions:  (Set the timer for 5 minutes and write—as fast as you can, without stopping.)

* Where do you find hope in your life? 
* What, despite everything, are you grateful for?
* How has the prolonged pandemic affected your life? 
* What’s kept you going through this protracted and altered time?    

December 4, 2021: Thinking about Courage

cour·age:  noun

  1. the ability to do something that frightens one.
  2. strength in the face of pain or grief.

–(Oxford Languages)

It is in the small things we see it.
The child’s first step,
as awesome as an earthquake.
The first time you rode a bike,
wallowing up the sidewalk.
The first spanking when your heart
went on a journey all alone…

I doubt you need to look beyond your neighborhood or community to name more than one cancer survivor, a patient living with a progressive heart condition, or some other debilitating or life threatening illness, whose determination and bravery in the face of considerable odds has inspired you. You may call them courageous, and in fact, I think they are, but it’s not a kind of courage that comes easily or without its familiar sidekick, fear.  In life-threatening, terminal illnesses, fear is never far from consciousness.  Courage won’t cure a terminal diagnosis, so I wonder what we mean when we call someone living with a progressive and life-threatening illness “courageous.”   

Courage, for me, seems to have more to do with putting one foot in front of the other, in not putting on a mask of a brave front for our loved ones, even though we may feel we should.  I think courage has much more to do with honesty, with facing the truth of our situation, the fears and the sorrow, and yet, not letting those emotions overtake us.  Courage is facing up, to the fear of mortality and the progressive reality of the medical condition we have and yet, to find ways to live as fully as possible despite the odds.   And that’s not easy.

It’s one of the reasons I am continually inspired by the men and women who participate in my writing groups.  We mean well, calling someone with a life-threatening illness, “courageous” and ignoring the fact that the very label denies them the freedom to express the truth of what they are experiencing. Expressing the truth of one’s experience is one of the powerful aspects of the writing groups I’ve led for so many years.  Having the freedom to relieve the burden those fears and concerns on the page, that simple act of honesty and release, is freeing, but it is far more than just release: it is the discovery that they are not alone in what they are feeling or fearing.  The honest expression and release, coupled with the support of others similarly diagnosed offers a chance to discover they are not alone in what they feel or fear—and out of that shared experience, a sense of community begins to form. 

That sense of community–of finding others who share similar fears and feelings–is part of what helps many patients feel less alone. I think it also enables them to be more courageous. I remember one particular l one cancer patient who participated in my writing groups several years ago.   Diagnosed with breast cancer, S. first attended an introductory workshop I led at a San Diego cancer center in 2008.  More than a year passed by before our paths crossed again.  When we met a second time, she enrolled in the ten-week writing workshop series I was leading for another cancer center.  Her cancer had, unfortunately, become metastatic, and its spread was rapid. When we began the series, she often volunteered to read aloud. I could hear the shift in her writing as it grew in expressiveness and depth, something I’d witnessed before with terminal patients.  Coming to terms with mortality forces us to go deeper into the unexplored regions of our own darkness and to write honestly and authentically from that place.  Simply put, it is having the courage to “tell the truth,” what writer Maxine Hong Kingston advised the veterans do as they wrote with her about their traumatic experiences of war.

Later,
if you faced the death of bombs and bullets
you did not do it with a banner,
you did it with only a hat to
cover your heart.
You did not fondle the weakness inside you
though it was there.
Your courage was a small coal
that you kept swallowing…

To write the truth of our inner lives, of our experiences, is a courageous act. To write honestly avoids the pretense of being “brave” or “courageous.”  It avoids showy descriptions or flowery language, because living with the reality of a life threatening illness forces us to confront all we taken for granted and define what, in our lives, is truly essential—what matters most. That honesty in the face of dying is probably what I find most courageous among many patients who have participated in my writing groups.

As the writing series progressed, so did S’s cancer.  The toll on her body and spirit was apparent to the group.  When she began struggling to attend the sessions on her own, another group member volunteered to drive her.  She lost the use of one arm, but determined to write, she bought a laptop to the sessions and tapped out her stories with one hand.  One morning, late in the series, S. lost her balance and fell as she tried to take a seat at the table.  Several members jumped up and rushed to her side, but she brushed them away, determined to get on her feet by herself and take her usual place.  But we all knew the progression of her illness was quickly intensifying.   By the final weeks, she had been forced to give up her apartment and move to assisted living, no longer able toc attend the writing group.  We dedicated our booklet, a collection of shared writing, and sent it to her.

Nearly three months later, as another writing workshop series was beginning, S. sent me an email.  Wheelchair bound, she was now receiving full time care in a nursing home, but she still wanted to participate in the writing group.  She asked if there was a way she could do it by email (ZOOM was an unknown in those years). My “Yes!,” was immediate.   I sent her the prompts ahead of each session, and in turn, she emailed her writing to me to share them with the group.  The group members, in turn, offered their positive comments to her writing which I captured in an email and sent to her after each session.  By then her writing was little more than a single, brief paragraph in length, but her tenacity, honesty, and humor were as present as ever.  There was rarely a time that members didn’t have tears in their eyes when I shared her writing aloud. 

S’s courageousness and determination to accept her illness and yet find ways to do what she loved and what kept her connected to others is only one small example of the kind of courage I witness repeatedly among the men and women who participate in my writing groups, whether living with cancer or heart disease.   Courage, as defined in the Oxford American Writer’s Thesaurus (2004), is a quality that endures through difficult times, as so many of these of these men and women have demonstrated.

Courage is what makes someone capable of facing extreme danger and difficulty without retreating…it implies not only bravery and a dauntless spirit but the ability to endure in times of adversity.  (p. 187)

True courage, as S. and so many others have shown me, endures.  It doesn’t retreat despite great difficulty or danger.  S. openly shared her journey with us, and as her life was ending a few months later, she was supported by many who had also been in the writing group, who had experienced cancer but who had been touched by her indomitable spirit.  I have often wondered if I were faced with the same hardship as S. and as many others in my groups over the years, would I be as courageous?

Later,
when you face old age and its natural conclusion
your courage will still be shown in the little ways,
each spring will be a sword you’ll sharpen,
those you love will live in a fever of love,
and you’ll bargain with the calendar
and at the last moment
when death opens the back door
you’ll put on your carpet slippers
and stride out.

(From “Courage,” by Anne Sexton, In:  The Awful Rowing Toward God, 1975)

Writing Suggestion:

  • This week, think about courage, what it is, how you define it.
  • Have you discovered unexpected courage in yourself you didn’t know you had? 
  • Has someone else inspired you with their courage? 
  • This week, explore courage:  what it is, and what it looks like, where you find it, or someone who has inspired you with their courage.

November 22, 2021: Everyday Heroes: People Who Make a Difference in Our Lives

A positive role model serves as an example—inspiring children to live meaningful lives.—M. Price-Mitchell, PhD

I hadn’t thought of my fifth-grade teacher for a very long time until last week, when I read Garrison Keillor’s November 19th post on the daily Writers’ Almanac, my daily accompaniment to my first cup of morning coffee..  https://www.garrisonkeillor.com.  The Almanac is a delightful blend of literary history and a daily featured  poem.  On the morning of the 19th, however, it wasn’t the poetry he featured but the snapshots of literary history.  He reminded his readers that November 19th was the anniversary of Abraham Lincoln’s Gettysburg Address, remembered as one of the greatest of American speeches. Less than 300 words long and  only ten sentences, Lincoln wrote it to deliver at the dedication of the Soldiers’ National Cemetery in Gettysburg, Pennsylvania, where one of the bloodiest battles of the US Civil War had taken place.

I can still recite much of the Gettysburg address by heart, many, many years after reciting it in a show for parents of my fifth-grade classmates. I revered Lincoln and had, ever since my maternal grandfather gave me a volume of  Childcraft (a children’s encyclopedia) two years earlier when he visited.  Crippled since childhood, he had traveled by Greyhound bus from Los Angeles to Northern California to see us, his first and only time.  After he left,  I pored over the Childcraft volume again and again, memorizing poetry, reading—and re-reading—stories of Abraham Lincoln.  What I recall now, as I remember Lincoln,  is also the extraordinary gift—and wisdom—of my teacher, Mrs. Starritt

Mrs. Starritt had announced a class project in the spring of fifth grade.  We would be creating a puppet show about American history for our parents.  Each of us would have a role, beginning with the Pilgrims and up to the current time.  As she named different historical figures to be portrayed, classmates raised their hands and called out  “me, me!” to be chosen.   I waited until she came to the role of Abraham Lincoln.  Then I raised my hand in hopes of being selected, the only girl to do so, along some of the boys.   My teacher was, I realized much later, attuned to the passions and aspirations of her students, but at that moment, I nervously sat waiting, my heart beating, and hoping against hope I’d get to “be” Lincoln in the puppet show. Then I heard her say, “Sharon, you have the part for President Lincoln.” 

What I realize now, in hindsight, was how Mrs. Starritt understood how important Lincoln was to me and, instead of assigning the role to a boy, she gave it to me, a girl.  I was to have the honor of playing the part of the president I revered.  And, for all of us, our roles involved much more than recitation.  We were to make a marionette for our characters.  I remember how carefully I molded my Lincoln puppet’s face, painting in his beard and dark hair, how I filled the body with cotton and assembled it, and how  meticulously sewed his dark suit by hand.  It was a labor of reverence, and when the time came in the history show for Lincoln to appear, I controlled his movements from above the little stage and recited the Gettysburg address with as much fervor and authority as I could muster.  Somewhere, in my fifth-grade dreams, I wanted to make Mr. Lincoln proud.

To this day,  Lincoln remains one of the heroes in my life, but in my mind, he stands next to Mrs. Starritt, because I learned, even as a young girl, it was an important moment: I had been chosen to play the part of Abraham Lincoln over the boys.   I had a voice.  I was an equal.

Remembering the Gettysburg address and that fifth grade moment,  I began to think of others who’d made a lasting difference in my life, teaching me life lessons, inspiring me to try harder, have confidence and show kindness to others.  I jotted their names down on a page in my journal, remembering each and  noting why each person was important.

Dr. Campagna, a neurosurgeon who saved my life when I was a teenager, came immediately to mind.  While I have been told repeatedly by other surgeons that Dr. C.’s surgical handiwork on my skull was “a work of art,”  what I remember most was his compassion, how he listened to what I had to say with the same attention he gave to my parents.  Then, for the days I was recovering from my surgery and still in the hospital, he encouraged me, head turbaned and my eyes ringed with blue and purple from the surgery, to visit other of his patients in the hospital.  “Go visit Mrs. — she could use some company…”

At his suggestion,  I timidly called on and ended up spending time with  a young mother whose two-year-old was dying from a brain tumor, sat by the bedside of an eighteen-year-old boy seriously wounded in a car crash, and visited an elderly woman who was recovering from surgery after having a steel plate inserted  in her skull (as I would several months later). Whether intended or not, Dr. C. was not only helping me heal emotionally and physically, but teaching me about compassion.  Despite the seriousness of my surgery, I realized that there were many people experiencing far greater trauma than I had.  As his grateful patient, I continued, through adulthood and the many places I lived,  to write Dr. C.  occasionally until his death a few years ago. He always responded with a note of gratitude.  It’s little wonder to me that he saved so many lives.

Every culture has its heroes, but the people who’ve made a difference in my life are not well-known, stars or honored frequently for their acts of valor or kindness.  They made not even be aware of the impact they have had on others’ lives.  Rather, these are the ordinary, everyday heroes, acting with compassion, insight, and generosity without expectation for gain.  These are people whose warmth, compassion and unique gifts are given freely and generously and whose warmth, compassion and unique gifts are freely and generously given.

For me, the important and lasting impact on my life is about these everyday heroes, ordinary people with with extraordinary qualities, like my fifth-grade teacher and my surgeon, and many others over the years.  They are people whose generosity,  wisdom and understanding shaped me in particular ways, and their impact on me has been a lasting gift.  Triggered by an anniversary date of a famous speech on Keillor’s site, I discovered a good exercise for me in recaling the people who had such  an impact and made a difference, in my life.  “I’m a lucky woman,” I remarked to my husband over dinner as I told him all that Keillor’s post had triggered in my memory.  “I’ve had such remarkable people and experiences in my life.” 

Now, I wish I had realized sooner, in some situations, just how important their presence in my life became—but that’s the wisdom of hindsight… Writing about them is, I suppose, one way to articulate and show gratitude for who they were, and who they were to me

Writing Suggestions: 

  • Write about someone who has been a role model or “everyday hero” for you.  In what way have they been important to you?  Describe the situation, how you came to know the person, and what you learned from them. 
  • As an alternate idea, write about the experience of being a positive role model for a younger person. What was the situation that began the relationship?  What impact did you hope to have/or had with this younger person?   Were you challenged by them?  What did you learn from being a role model?

November 8, 2021: Using Metaphors in the Medical Experience

Poetry and medicine share a long history, something for which we can thank Apollo, the Greek god responsible for both healing and poetry.  If you had any idea that metaphors are only the creativity of poets and poetic imagination, think again.  Metaphors are common and pervasive in our everyday lives, influencing the way we think and act.  Metaphors, which compare two seemingly unrelated things, are not only common in poetry and everyday life, but also in medicine.  (Lakoff & Johnson, Metaphors We Live By, 1980).

Consider the sports talk that dominates the televised football or hockey seasons.  Sports metaphors are commonly used to describe experiences in our daily lives, for example, in companies, where employees are encouraged to be team players” or “run with a good idea.”  When I was young, high school football games were not only popular, but the language of the game made its way into aspects of our teen-age dating lives, as when someone might “made a pass at you,” or behaved in a way that were “way out of bounds.”

Why do we use them?  Metaphors are visual and illustrative, but they sometimes run the risk of creating stereotypes, confusion, or becoming clichés.   Some, like sports and military metaphors are so common in our daily language, they are frequently used to describe the medical experience.  Common examples include parental metaphors, “she’s too sick to know the difference,” engineering metaphors, “coming in for a tune up”, or the commonly used military metaphor of cancer as a “battle” to be fought and won.  Nevertheless, metaphors are essential in our ability to describe and convey the experience of illness—and not just for the patient, but for the physician as well.

Dhruv Khullar, MD, in a 2014 article, “The Trouble with Medicines’ Metaphors, “published in The Atlantic, stated:   

The words we choose to describe illness are powerful. They carry weight and valence, creating the milieu in which goals of care are discussed and treatment plans designed. In medicine, the use of metaphor is pervasive. Antibiotics clog up bacterial machinery by disrupting the supply chain. Diabetes coats red blood cells with sugar until they’re little glazed donuts. Life with chronic disease is a marathon, not a sprint, with bumps on the road and frequent detours...  Military metaphors are among the oldest in medicine and they remain among the most common. Long before Louis Pasteur deployed imagery of invaders to explain germ theory in the 1860s, John Donne ruminated on the “miserable condition of man,” describing illness as a “siege…a rebellious heat, [that] will blow up the heart, like a Myne” and a “Canon [that] batters all, overthrowes all, demolishes all…destroyes us in an instant.”

As Khullar points out, “…we’ve internalized these metaphors, so much so that we often may not recognize how they influence us.”  Nevertheless, they are important and necessary to help convey what is difficult, at first, to describe, offering a shorthand way of making sense and communicating the experience of serious illness.   Just as we use metaphors to communicate to our friends and others, physicians use them to help patients understand the ramifications of their illnesses.  Interestingly, Khullar cited a 2010 study finding that physicians use metaphors in nearly two-thirds of their conversations with patients diagnosed with serious illness.  In fact, the doctors who used more metaphors in explaining medical conditions were seen as better communicators. Why?  Because “patients reported less trouble understanding them, and felt as though their doctor made sure they understood their conditions.”

 Metaphors get our attention.  They offer us a vivid way to communicate in an understandable way our experience of serious and life-threatening illnesses, whether patient, physician or care-giver.  If you explore any poetry of the medical experience, you’ll discover it is rich with imagery and metaphors that resonate with your own experience. For example, I have often used Mary Oliver’s poem, “The Fourth Sign of the Zodiac,” with its extended metaphor to encourage writing group members to explore their metaphors used describe the experience of diagnoses and treatments.

Why should I have been surprised?
Hunters walk the forest
without a sound.
The hunter, strapped to his rifle,
the fox on his feet of silk,
the serpent on his empire of muscles—
all move in a stillness,
hungry, careful, intent.
Just as the cancer
entered the forest of my body,
without a sound…

(In: Blue Horses, 2014)

Donald Hall, in his poem, “The Ship Pounding,” creates a powerful, visual metaphor of a great ship to describe the hospital and his experience of the final days spent with his dying wife, the former poet, Jane Kenyon.  He first describes going to the hospital to visit his wife:

Each morning I made my way   

among gangways, elevators,   

and nurses’ pods to Jane’s room   

to interrogate the grave helpers   

who tended her through the night   

while the ship’s massive engines   

kept its propellers turning…

—–

At first the tenor of the poem feels almost hopeful:

—–

The passengers on this voyage   

wore masks or cannulae

or dangled devices that dripped   

chemicals into their wrists.   

I believed that the ship

traveled to a harbor

of breakfast, work, and love…   

When the infusions

are infused entirely, bone

marrow restored and lymphoblasts

remitted, I will take my wife,

bald as Michael Jordan,

back to our dog and day.

But Kenyon’s illness is terminal, evident in the final lines, and as her disease progresses, his trips to the hospital become anxious, as he and his dying wife return to the hospital:

I listened in case Jane called

for help, or spoke in delirium,

ready to make the agitated

drive to Emergency again

for readmission to the huge

vessel that heaves water month   

after month, without leaving   

port, without moving a knot,   

without arrival or destination,   

its great engines pounding.

(In: Without, 1998))

“The Ship Pounding” is a moving and visceral image offered by Hall, one that makes experience of the narrator and his dying wife readily understood.

I often return to the wonderful book by former literary critic, Anatole Broyard, who died in 1990 from prostate cancer.  Entitled, Intoxicated by My Illness and Other Writings on Life and Death (1993) Broyard also explored the use of metaphor to think about and describe his illness:

Always in emergencies we invent narratives. . . Metaphor was one of my symptoms.  I saw my illness as a visit to a disturbed country. . . I imagined it as a love affair with a demented woman who demanded things I had never done before. . .   When the cancer threatened my sexuality, my mind became immediately erect. 

Medicine continues to advance and offer us much more precise understanding of medical conditions and diseases, yet “metaphor,” as some authors have stated, “remains essential” as a way to convey the experience of illness.  As Broyard remarked, “Metaphors may be as necessary to illness as they are to literature, as comforting to the patient as his own bathrobe and slippers.”

Writing Suggestions:

What metaphors have you used to describe your illness?  How did they change as your condition changed?

  • Think about the ways in which you have used metaphors with family, friends or your doctors, to describe your experience of serious or debilitating illness.  How have they helped you understand and communicate?
  • Explore the different metaphors that describe your illness or condition.  Begin with a phrase, for example such as “Cancer is a…” or “Living with heart failure is like a…,”or “A heart attack is like…”  and finish the thought, noting what image or word emerges.  Remember, write quickly, without editing. Set the timer for five or ten minutes and keep your pen (or fingers) moving. Generate as many comparisons or metaphors as you can.  Once you’ve finished, read over what you’ve written.   What surprises you?  Do you discover any unexpected insights to your feelings?  How do your metaphors you navigate and explain your illness to others? 
  • Try writing a poem or narrative using the metaphors to describe your experience of illness or disease.
  • “Physicians who used more metaphors were seen as better communicators.”  True or False for you?  Has your physician used metaphors in communicating aspects of your diagnosis?  If so, do any stand out?  Were the metaphors useful in helping you understand your illness?

October 24, 2021: Writing From the Fault Lines

“You must learn to live on fault lines.”
― Suleika Jaouad,Between Two Kingdoms: A Memoir of a Life Interrupted, 2021

My childhood and teenage years were spent growing up in Northern California, a life that included annual water rationing during summertime, seasonal forest fires and the expectation that periodically, the earth could move beneath our feet, something which had little to do with a sudden jolt of teenaged romance.  The occasional movements of the earth were due to the sliding boundaries, the fault lines that define the earth’s tectonic plates. California has many of these fault lines, and sometimes, as witnessed in the Loma Prieta quake of 1989, significant upheaval and damage–even loss of life—occur.

Living on the fault lines is not something Californians have to learn; it’s what they do.  But the periodic upheaval created by the “fault lines” is an apt metaphor for what happens in our emotional lives when unexpected trauma or life-threatening illnesses occur.  In those periods of stress and anxiety, old emotional wounds can also make their way to the surface, adding to the emotional challenges facing you in the midst of a new life crisis.   

In 2007, I began teaching creative nonfiction writing for the UCLA extension Writers’ Program.   My first course was one of several other offerings, and I titled my course “Writing from the Fault Lines:  Writing to Heal,” a title that lasted for three years, until expressive writing gained a foothold in public popularity. To distinguish it from the many and varied writing workshops that seem to blossom everywhere, the course was re-named “Transformative Writing.”

Now many years later, I live far from California, having returned to Toronto in 2017. I no longer teach for the UCLA program, but I continue to lead expressive writing groups for cancer and heart patients.  This past weekend, while working with an inspiring group of young adult cancer survivors, the Young Adult Cancer Canada “YACCtivists,” I re-read portions of Suleika Jaoaud’s extraordinary and thoughtful cancer memoir, Between Two Kingdoms:  Life Interrupted. I paused when I read her sentence, “You must learn to live on fault lines.” The young adult survivors representing YACC had definitely learned that lesson—and then some. 

I thought back to the time the word “cancerous” was spoken to me in a physician’s office in California.  My husband and had returned to California after nearly 26 years in Canada, only to run headlong into a family crisis full of resentment, accusations and the losses of my parents:  my father had died of lung cancer and my mother was lost to Alzheimer’s disease.   At the same time, I was overseeing a difficult and emotional downsizing of a nonprofit organization while trying to navigate the unexpected familial acrimony.  Writing was my refuge.   I filled page after page in my notebook with disbelief, questions that couldn’t be answered and even some misplaced sense that I must have brought on the cancer myself.  Yet my initial outpouring soon gave way to the deeper wounds, to losses and hurt I’d amassed in trying—and failing—to deal with the estrangement from my two siblings.  My “real” story was not about cancer; it was what lay beneath the surface, pressures within my emotional interior begging to be released.

I have often witnessed similar struggles for some individuals in my writing groups.  The experience of a life threatening illness can unearth other, unresolved, feelings.  Painful memories or traumatic events of the past can be triggered by the most benign of writing prompts, and as they rise to the surface, they too are expressed in what gets written.  Writing our healing stories often goes well beyond the experience of serious illness as some plumb the depths of their lives, bringing into the open what they were not able to do before.  

Did you ever think there might be a fault line
passing underneath your living room:
A place in which your life is lived in meeting
and in separating, wondering
and telling, unaware that just beneath
you are the unseen seam of great plates
that strain through time? And that your life,
already spilling over the brim, could be invaded,
sent off in a new direction, turned
aside by forces you were warned about
but not prepared for?


From:  “Fault Line” by Robert Walsh (in Noisy Stones:  A Meditation Manual), 1992.  

Emotions can inspire us or hold us hostage.  Negative emotions—anger, fear or feelings of unworthiness—accumulate, just as stresses along the earth’s plates.  They weaken our ability to fend off illness, depression or disease.  Writing allows us, if we let it, to translate those negative emotions into words, make the connections between what we feel and why, and begin to understand or even forgive ourselves and others.  It is in the act of writing and sharing our stories that we release the pressure of old wounds, that we begin to heal.

Writing Suggestion:   This week, write from your own fault lines.  Go deeper in your writing. Explore those sometimes difficult and painful life experiences that still linger beneath the surface.  

September 22, 2021: Our Stories: Our Legacies

“Death steals everything but our stories.” – Jim Harrison (“Larson’s Holstein Bull”)

She was first diagnosed with metastatic cancer in 2014, but N., one of my former writing group members recently died after a valiant struggle less than two months ago.   Her struggle was a valiant one amidst considerable odds, but she began, in the months after her diagnosis, collecting poems and quotations that, as she put it, “uplifted me.”  A year or so later, N. joined one of my “Writing through Cancer” workshops.  She. embraced the expressive writing approach and continued to explore and deepen her writing, studying with author Natalie Goldberg and poetry with haiku masters.  She also a two year study of teacher training in mindfulness meditation training with Jack Kornfield, even as she was weakening and hospitalized for infections.  In short, N. was a person a who inspired not only me, but many of the people who knew her.

I believe the greatest teachers in my life have been the men and women in my writing groups, like Nan, who have shared their experiences of living with metastatic cancer over the years.   While I have mourned their deaths, even years later, their memories are vivid in my mind.  The writing they shared was as powerful as any found in published memoirs and poetry collections—even more so for me, for they are the living legacies of who they were, what they experienced and what they endured.

“I will tell you something about stories.  They aren’t just entertainment.  They are all we have to fight off illness and death.  You don’t have anything if you don’t have stories.  (Leslie Silko, Ceremony)

N. was such an inspiration.  She was, I knew, intent on writing a book before she died.  We had exchanged emails about the possibilities—and challenges—a year before her death.  Her plans crystallized in Spring of this year:  it would be a book to give to her partner, family, close friends, and teachers before she passed.  And, at the end of July, I was delighted to receive her gift of the book in the mail.  Entitled Legacy of Love:  Gifts I Received on the Path of Life, it is a beautiful book:  professionally bound, illustrated with her partner’s nature photographs, and filled with the reminiscences, stories and learnings from her life and cancer experience.  Quotations, meditations, prayers, and poetry that she found meaningful are interspersed among the stories of her life’s journey.  Writing prompts she’d experienced in the writing groups and other workshops are followed with her written reflections and haiku. 

It was a deeply moving experience for me to read N.’s book; I lingered over the pages, remembering her presence, the enduring love and support of her partner she’d often written about, and her deeply moving prose.  I immediately wrote to her, expressing my gratitude for such an intimate gift of her life.  In the weeks that followed, I returned to it again and again—and a week or so ago, I was moved to write her again to express my gratitude.  But unlike before, I heard nothing in return from N.  I contacted her partner and learned she had died, apparently within a day or two just after I had received her book.  My sorrow was softened because I felt Nan’s presence so vividly between its pages.

My story is myself: and I am my story. This is all you will know of me; it is all I will know of you. This is all that will survive us: the stories of who we are. — Christina Baldwin, Story Catcher

Her death saddened me, yes, as the deaths of others have who have been part of my writing groups.  Yet I was reminded again of how fortunate I am to witness and experience the many gifts of poetry and stories written and shared in the workshops I have led for so many years.  I still hear their voices and remember their faces as I read and re-read some of their stories or poems—ones that frequently took my breath away with its power and depth, ones that still bring tears to my eyes with its honesty and poignancy, writing that was lyrical, poetic, profound—the stories of their illness experiences, of their lives.  Writing I have wished more than once could have been shared with their doctors to illuminate the patients’medical experiences:  the good, the difficult, and the sometimes cold and impersonal.

Their stories, yours, mine—it’s what we carry with us on this trip we take…we owe it to each other to respect our stories and learn from them.

Advice to a medical student by William Carlos Williams, physician and poet

Patient stories have begun to be recognized as important to the medical experience, thanks to the work of Rita Charon, who created the term, “narrative medicine,” a medical practice that uses patient stories in clinical practice, research, and education as a way to promote healing.  Storytelling, as several researchers suggest, is a powerful tool for patients and healthcare providers alike.  It provides the patients with a way to give voice to the experience of illness and, in turn, to begin to confront their illness, questions of care and mortality. 

Stories offer insight, understanding, and new perspectives. They educate us and they feed our imaginations. They help us see other ways of doing things that might free us from self-reproach or shame. Hearing and telling stories is comforting and bonds people together….Being able to narrate a coherent story is a healing experience.2,3… stories keep us connected to each other; they reassure us that we are not alone.Miriam Divinsky, MD, Can Fam Physician. 2007 Feb; 53(2): 203–205.

Illness, unexpected tragedy or hardship may be the triggering event in our lives that ignites the desire to write, but what I experience with every writing group in the weeks together, is that other stories begin to be written — stories of love, loss, family, childhood, life’s joys and sorrows.  These are the stories of the experiences that make us unique, that make us human.  Writing and telling our stories offer a way to understand and make sense our lives.  In sharing them, our lives are affirmed, our legacies articulated.   Our stories say: “This is my life.  This is what I have experienced.  This is important to me.  It is what has shaped me into the person I am.” 

But in order to make you understand, to give you my life, I must tell you a story—and there are so many, and so many—stories of childhood, stories of school, love, marriage, and death. — Virginia Woolf

As I write now, I instinctively reach out and touch N.’s book—her stories and poetry; her life captured in its pages, her willingness to look death in the face, to ask herself the hard questions, to give us glimpses of what she suffered, feared, learned and loved and ultimately how she prepared herself for death, just as others faced with the prospect of mortality have written and expressed, sharing their lives, their fears and courage, so honestly and poignantly.  It is an extraordinary gift, a way to remember, a gift from the heart.

Poetry, stories:  it’s what I carry with me…and, I hope, what I can leave behind to say, “This was my life.  This is what mattered to me.”  (N., 2021)

Writing Suggestions:

  • What are the stories you want to tell?  The ones about you, your life, what matters most?
  • Has your illness broken you open?  Offered new insights or ways of seeing your situation?
  • What has had the most impact on your life?  Try this three part exploration:
    • Who were you?  (Look to your past)
    • Who are you now?
    • Who are you becoming? (What are you learning about yourself now?)
  • Use a line from a poem, essay or story that you love.  Begin with that line and then keep writing—wherever it takes you.  Here are a few you might try:
    • “Starting here, what do you want to remember?”
    • “Before you know what kindness is, you must lose things…”
    • “It is in the small things we see it.”
    • “Let the hard things in life break you.”
    • “I am falling in love with my imperfections.”
    • “But my heart is always propped up in a field on its tripod…”

August 31, 2021: I Guess That’s Why I Called It the Greys

Everywhere in North America, children are heading back to school…only it’s not with quite the same unabated enthusiasm for many youngsters and their parents.  COVID, despite the many months of lockdowns, social isolation and available vaccinations, hasn’t finished with us, as the Delta variant and climbing case numbers demonstrate.   Since my three grandchildren are beginning another school year, I can’t help but wonder about the spread of the virus among schoolchildren who have not, as yet, been eligible for vaccinations. 

That low level anxiety lingers–all too frequent a visitor in my life during the past year and a half. While my husband and I enjoyed some of the gradual opening up of restaurants, galleries, and stores during the summer months, we also remained cautious.  Then the dog days of August descended with haze, heat and oppressive humidity. That, coupled with the daily reports of drought and wild fires around the world, put the reality of advancing climate change into sharper focus, and coupled with the rise in COVID cases, my anxiety rose.  The blistering heat forced me back indoors, which was all too reminiscent of the months of lockdown.  Days dragged, headlines screamed disaster, and my spirits took a nose dive.

Mornings, which are my quiet time for writing, offered little relief.  For many days, my notebook pages contained more white space than words.  I couldn’t seem to get inspired, unable write through my monumental case of sagging spirits.  The days seemed cast in muted, colorless tones. And worse, when I looked at myself in the mirror, my image reflected back seemed dull and grey, just like my mood. I remarked to a friend, “In these times, grey has become a primary color.”

That one spontaneous sentence, and the next day, my associations with “grey” came out of hiding.  I recalled Mordecai Richler’s wonderful children’s book, Jacob Two-Two Meets the Hooded Fang, published in 1975, read and re-read to my young daughters.   Jacob, is a  young boy in a large family who has to repeat everything twice just to be heard, which results in his nickname, Jacob Two-Two. His habit is also the reason he is misunderstood and considered rude. All of it results in his being punished and sent to the children’s prison,  “Slimer’s Isle,” which is run by the Hooded Fang.  Slimer’s Isle is a place where captive children like Jacob never see the sun.  The image of that sun-less place seemed a perfect description for the grey mood that had lingered in my psyche for months. 

Yet Remembering Jacob Two-Two and Slimer’s Isle was also an inspirational nudge.  It was enough to inspire me to a fruitful morning writing, and this time, the words came.  I had fun tinkering with the song lyrics of  “I guess that’s why they call it the blues,” substituting the color grey and adding a few lines about COVID in my version. While it’s hardy ready for public consumption, my husband and I had a laugh over my attempt at song lyrics.   A day or two later, time spent with my granddaughter led me to the old memory of the Crayola Box of 64 colors—an item which accompanied every “back to school” bag during my childhood.   Grey was my most unused color in the box, but thinking of it transported me to the memory of  a delightful poem about color written by a medical student in a writing workshop I led for faculty and students of Stanford Medical School in 2015.

I used color as a writing prompt.  To get people inspired, I spread out a handful of paint color chips on a table.  Not only are a full range of colors represented in the interior paint chips , but they have somewhat exotic—one might even say “silly”—names, such as “first light,” “little princess,” “dinner party,” “head over heels,” “windmill wings”…  Whether using the color or the names associated with them, participants had great fun working them into poems and stories.  But one med school writer’s poem stood out above all the others.  She had chosen the least popular color of the lot:  grey, labeled “hickory smoke.”  When she volunteered to read aloud, we were in awe of how she’d brought that mundane color to life.   Here is an excerpt of her poem, simply titled “Grey”:

…“Air with dirt,” they say.

Floating soot clamoring cold and unwanted

against a clean white wall…

…Grey is the color of “yes, life has been here,”

and “don’t you know I have a story to tell?”

Grey is the sidewalk that’s been walked,

the white house that’s been lived in…

White is before, but give me the after

Give me the ninety-year-old under her old grey comforter.

Has she lived? Well, tell me the color of her soul.

Show me the spots of grey, and tell me how you’ve lived,

the story printed dark and true in the deepest, most imperfect,

ugliest and sweetest shade.

–Workshop Participant, 2015

It’s probably no surprise that after re-reading her poem again, my grey mood had begun to dissipate.  Since then, I’ve pulled my ancient and well-worn copy of Jacob Two-Two from the shelf to recall his experiences on Slimer’s Isle, how he won over the Hooded Fang and returned to his family a hero.  I suppose that all the little memories of grey served as a reminder that while life has been difficult, and despite Zoom, lonely at times, it’s within my control to find ways to navigate this rather strange “new normal”  with a more positive outlook.  Even in the greyest of times, it seems we can find new insights, ideas, perspectives.  School is starting for my grandchildren, my teaching daughters, and even for me, beginning new series of writing workshops for cancer and heart patients.  This is activity I truly look forward to, and I am particularly grateful that despite these months of lockdown and isolation, I can be engaged in meaningful ways.  While my mirror doesn’t lie—I am getting grayer–but that would have happened even without COVID! So grey hair or not, I’m engaged in ways that matter to me.  And that’s  how I want to live.

 “Show me the spots of grey, and tell me how you’ve lived…”

WRITING SUGGESTIONS

.  How have you navigated the long months of COVID isolation?  What kept you going?

.  Did you experience “the greys?”  or “the blues?”  What helped you through those less positive moods?

.  Pull up a color wheel on the web—or open a box of 64 colored crayons.  Choose a color, any color. Make a list of what comes to mind for just 3 minutes.  Read it over, then choose one thing from your list and write for 15 minutes.  Try playing with a narrative or a poem that uses that color in it.

.  Did COVID help you gain clarity about what matters most in your life?  Write about the lessons from lockdown.

.  Back to school.  What memories do you have from your childhood about a new school year beginning?

May 25, 2021: Who Were You Then? Advice for the Younger You

Why should we travel back, who’ve come so far— 

We know who we are. 

How can we be the same 

As those quaint ancestors we have left behind, who share our name— 

( by A. E. Stallings, “Written on the eve of my 20th high school reunion, which I was not able to attend”, In: Poetry, 2008)

It begins with a photograph, one of the few from my childhood I have, nearly all others destroyed when my parents’ home, the one I grew up in, went up in flames many years ago.  In it, we are in his mother’s living room, a drawing of the famous “End of the Trail” sculpture by James Earle Fraser, hangs on the wall behind.   I stand by my father, now seeing the resemblance between us—his high forehead, the set of his mouth and narrow face.  I was four, not yet in kindergarten.  My toddler sister stands in front of me, wide-eyed and inquisitive, a mop of curly dark hair framing her face, but   I stand back, close to my father, shy and somber. My hair is neatly braided, tied with large bows, and I’m wearing my favorite Mary Jane shoes with white socks, the straps buckled around my ankles.  I stare at the camera, unsmiling. My discomfort with the camera will last all my life, as will the shyness, which I will work hard to overcome in my adult years.  If I could, now speak to that four year old girl, what wisdom might I have to offer to her?  What care?  What encouragement?

One of the recent exercises I offered in my writing groups these past weeks was the task of looking back at their younger selves, imagining who they were then—what dreams, fears, and hopes they might have had at a much younger age.  I ask the group members to imagine themselves at a younger age, remembering an old photograph of themselves, or, if writing alone, to choose a photo of one’s self at a much younger age.  Then I introduce the prompt by saying something like, “Study the photograph or take time with that image of the younger you in your mind, noticing all the details:  stance, facial expression, eyes, age, clothing, setting, all the details you can take in.   Now, think about who you are now, what you’ve experienced in your life thus far, and knowing what you have experienced and lived as of now,, what would you say to that younger self? What advice would you give the younger you?”

Interestingly, a similar question was at the heart of two studies reported in The Scientific American in 2019, Robin Kowalski and Annie McCord, of Clemson University, asked more than 400 individuals about the advice they’d offer to their younger selves.  They also asked if there had been a pivotal event in the respondents’ lives that influenced their responses.  The majority of answers people gave fell within the categories of relationships, education, and advice do with the self, for example, “believe in yourself.”  Other categories reported included money, health, goals, and addiction.  Not surprisingly, peoples’ advice often reflected missed opportunities and situations that they could not now change.  But some other responses included reflection on circumstances where “corrective action” could still be taken if one was motivated to change, for example, “finish school,” or “drink less and run more.”

For many, their advice to their younger selves related to a positive or negative pivotal event in their lives, most often occurring in the teens, early 20s or 30s. For some, there were regrets expressed in the reminiscing, but the authors wisely remarked that although advice may offer advice to your younger self, it doesn’t mean you must live with regret.  Some of that advice may well be useful to your present self.  Besides, the practice of occasionally reflecting on your past and your experiences may also inform your present and the ways in which you want to change or live your life going forward. 

I return to study the photograph of my four year old self again.  I still remember the events of that day; I feel tenderness toward that serious little girl in the photograph because she’d accidentally witnessed an argument between her mother and her beloved grandmother in the kitchen. There was a kind of anger between them I hadn’t seen before, and I was confused.  Why were they shouting at one another? How had my petite grandmother had the strength to shove my sturdy mother backwards?  What had made them so very angry at one another?  How could I love them both at the same time?  There is much I would say now, these many years later, to that confused little four-year-old girl.

Looking back may bring up old unresolved feelings or emotions, but there is a plus side too. In doing so, we can learn from the past and how it can inform our present, even our future intentions. Looking back can give us an opportunity to take stock of past experiences and life choices and learn from them. It also reminds us and helps us see of how far we’ve come, and appreciate the life we have.    As Derek Walcott expressed so beautifully in his poem, “Love after Love,”

The time will come
when, with elation,
you will greet yourself arriving
at your own door, in your own mirror
and each will smile at the other’s welcome

Take down the love letters from the bookshelf,
the photographs, the desperate notes,
peel your own image from the mirror.
Sit. Feast on your life.

(In:   Collected Poems, 1948-1984)

Writing Suggestion:

Try writing to that younger self.  Begin with a photograph of yourself at a younger age.  Examine the younger self who looks back at you.   Study it, noticing not only the features, look in the eyes, the facial expression, your stance.  Take time to remember who you were then, your hopes, dreams, fears, sorrows, and questions.

  • How would you describe the person you’ve become from the one you were then?
  • What was it like to be you then? 
  • What hopes and dreams did you have? 
  • What desires?  What worries? 
  • What advice, what words do you want to offer to that younger self.
  • What, in your life now, do you want to change?

Remember, looking back at your past, your younger self, can be more than a passing reminiscence.  Reflecting on who you were then, who you’ve become, can help you feel gratitude for your life but also clarify how the way you want to live going forward and things you want to achieve or change as your life continues.

May 11, 2021: Living the Questions

Like you, there have been many times in my life that questions seemed to dominate my thoughts far more frequently than answers.  In my youth, my burning questions were often about whether or not some high school “love” interest “liked” me or not.  I was terribly shy around the opposite sex, and at the time, as tall or taller than many of the boys in my class, which only increased my insecurities in the arena of teen-age romance.  Then there were questions about college:  Which one?  Where?  Would I do well?  What if I didn’t? 

Some years later and newly married, my first husband and I contemplated his choice of graduate schools.  Questions dominated our conversations for months. In the end, we opted for adventure (it was the time of youthful idealism and protests) and ended up in Ottawa, where he began his doctoral studies.  We were wholly unprepared for Canadian winters or the loneliness we felt at the time, but gradually, Canada began to be “home” to us, especially in the years after his death.    Decades later, after returning to California for several years with my new husband, he announced his decision to retire from academic life.  We had our own questions, but family, friends and acquaintances peppered us with their questions.   “What are you two planning to do now?”  “You’re returning to Canada? Why?”  Their questions prompted our questions of one another: “But what would we do there?”  “What about our friends?”  “Will we sell our house?”  “What if we spent six months there and six months here?” 

Our transition revealed not only questions, but the realization that we didn’t always share the same wishes and wants for our “What’s Next?” chapter.  Nights were often punctuated by restlessness, the questions invading my dreams.  My notebook was filled with questions, a continuous loop of repetition, and I wasn’t finding any answers in what I wrote.  I don’t quite remember how long it took or when, but we stumbled into a joint decision, downsized our lives, sold our home, and watched as the movers loaded up the van with our worldly belongings and set out, as we did, for Toronto. 

This past weekend, I presented a workshop for Young Adult Cancer Canada (YACC) on the subject of writing for health and specifically, writing alone.  The willingness to “live the questions,” to find yourself groping in the darkness, are part of what writing honestly demands. The answers, in life or in fiction, are revealed as you write, gradually writing yourself into knowing, but not without making your way through the dark before stumbling on a new insight..  E.L. Doctorow, author of the award novels Ragtime and Billy Bathgate, famously remarked that when one sits down to write a novel, “You can only see as far as your headlights but you can make the whole trip that way.”  

Life doesn’t come with a set of answers, but it is riddled with questions.  It’s like making our journey in that darkness of the unknown at times.  We navigate through it as best as we can, deal with unexpected events, difficult chapters, the illnesses and losses we experience.  Cancer is one of those unwelcome chapters in your life, and the journey through it is not unlike what Doctorow describes.  You survive the shock of diagnosis, the worry and after-effects of surgery and chemotherapy, roller coaster of recovery, but despite all that, you can’t see very far ahead.  There are no certainties.  Your life is punctuated by more questions than answers. “Has the treatment worked? How likely is my cancer to recur?  What if it has metastasized and is lurking somewhere else in my body? Stage four?  Then how long do I have?”  No one can offer you certainty.  You navigate through it all in the same way Doctorow described of writing, able to see only a short distance along the path, but gradually finding your way into the answers.

 “Questions in the Mind of the Poet While She Washes Her Floors, “a poem by” Elena Georgiou, poses several questions, ones that play in in the poet’s mind, and like life, don’t come with answers.  Here is an excerpt:


Am I a peninsula slowly turning into an island?

If I grew up gazing at the ocean would I think
life came in waves?

If I were a nomad would I measure time
by the length of a footstep?

If I can see a cup drop to the floor and shatter
why can’t I see it gather itself back together?

If a surgeon cut out my mistakes
would the scar be under my heart?

How much time will I spend protecting myself
from what the people I love call love?

Would my desires feel different if I lived forever?

  (In:  Mercy Mercy Me, © 2000)

Georgiou offers no answers to the reader.  Nor did Austrian novelist and poet, Maria Rainer Rilke (1875-1926) when he offered advice to a youthful protégé, published in his wise little book, Letters to a Young Poet.   “Don’t search for the answers,” he wrote, “which could not be given to you now, because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps then, someday far in the future, you will gradually, without even noticing it, live your way into the answer.”

Live everything.  Live the questions…  Live the questions nowLive your way into the answer.   I have often quoted Rilke to the men and women who attend my writing workshops.  His words are as insightful now as they were over a century ago.  Whether cancer or embarking on a significant change, living through the questions is not easy, yet it is all you can do. Your task is to be present, to pay attention and live life fully.  Not surprisingly, when you do, you often stumble upon the answers you seek. 

Writing Suggestions:

  • Whether you’re wrestling with the aftermath of a cancer diagnosis or some other unexpected life challenge, make a list of the questions that keep replaying in your mind.  Choose one and for 15 minutes, explore it as you write.
  • Recall an earlier time in life when you faced the unknown.  What questions did you have then, and how did you find your way into the answers?  Are there insights that may pertain to your current challenges?  Write about that time, the questions and how they were resolved.
  • You might use one or two of the poet Elena Georgiou’s questions as your prompt.  Choose it and again, writing nonstop for 15 minutes.  Then read over what you’ve written, underline those words or phrases that stand out.  In a day or two, you might begin with one of those phrases you underlined and explore it more deeply.  You just might discover some wisdom that leads you to some of the answers you’ve been searching for.