Sheila Flaherty's Blog, page 3

Repost: Hope and Action

We are coming to the end of Breast Cancer Awareness month, and I want to share my personal experiences—yet again. I am now a two-time survivor…fourteen years and almost two years. Both times, my cancer was found through my yearly mammogram and caught in the very earliest stages. I remain profoundly grateful. While there is an abundance of confusing, conflicting, and scary information out there, one thing holds true—early detection saves lives. It may have saved mine. My mission, in continuing to share my story, is to inspire readers to take action on their own behalves, as well as to bring comfort and HOPE to those who are struggling with their own diagnosis—or love someone who is.

Original published: October 22, 2012

I didn’t realize what a daunting task it would be when I decided to write my very first blog in October on the topic of breast cancer.  The original idea came from a celebratory place—on Friday, September 28, I had my yearly diagnostic mammogram and was declared cancer free.  I am now a 10 year survivor—which puts me in the 82nd percentile of women who make it this long.

Evanston Northwestern Hospital Breast Cancer Treatment Advertisement. Photo & Advertisement © 2003, ENH

In the past 10 years I’ve walked for hope, run for hope, spoken about hope, and even been in an ad campaign about hope.  And now, I want to write what may inspire hope— for those going through what may feel like the scariest and loneliest ordeal of your life.

I have much to say, but there is already so much out there.  There is certainly no need to remind anyone that October is breast cancer awareness month—everything is festooned with ribbons the color of a new scar.

As survivors our stories are all unique and all similar—the terror, the tears, the pain, the awkwardness in ourselves and others.  I’ve learned that when you tell people you had breast cancer most of them reflexively glance at your chest!  Although many women would argue that every month is breast cancer awareness month—as the fear is always in the periphery of our minds—there is a need for it to be so in our faces that we cannot hide beneath layers of fear and denial that it can happen to us.  We cannot just hope it won’t happen to us or to women we love, we also have to take action.

I have long known I was at increased risk for breast cancer.  It was 1972 when my mother sat me down to talk.  I was 24.  Mom was pale and trembling, and I had never seen her eyes so desperately sad.  The story was that she had been pregnant once before me and she had miscarried.

During her pregnancy with me, mom was prescribed diethylstilbestrol (DES), the first synthetic estrogen hormone.  DES was created in 1938 and was regularly prescribed for “problem pregnancies” until November 1971, when the FDA told doctors to stop prescribing it for their pregnant patients.*

We, the female children born of those pregnancies, are called “DES Daughters.”  We are at increased risk for a number of health issues including cervical cancer, structural changes of the reproductive tract, infertility, and depression.  Those of us over 40 are almost twice as likely to get breast cancer, and the relative risk is estimated to be even higher for DES Daughters over age 50.

By 1972, articles were being published describing the outcome of long-term studies of the effects of DES.  Mom had read one of those articles.

“I’m so sorry I did something to put you at risk.”  Her eyes filled with tears.  “I was so afraid I’d lose you.”

Of course I understood.  1948 was a time when no one, especially women, questioned their doctors.  DES seemed like a miracle drug—the answer to prayers for those longing for babies.  I comforted Mom with gratefulness at being alive and reassurances that I would be just fine.  Four years later, at age 28, I was diagnosed with cervical cancer and successfully treated with conization surgery.

In my early forties I developed fibrocystic breast condition, characterized by lumpy, painful breasts.  Self-exams became an exercise in terror.  Around that time I had a patient who also had the condition.  She raved about her breast specialist, a surgical oncologist, exclaiming, “I will pay him to examine my breasts for me.”  I thought, “This is my man,” got his name, and made an appointment.  Dr. Stephen Sener turned out to be the man who saved my life.

Over the next ten years I had a number of fine needle aspirations of suspicious cysts, two hollow-core needle biopsies, and the surgical removal of a lump.  Every time I waited with dread for the nurse to call with the pathology reports—which always came back benign.

In October 2002, that wasn’t the case.  My routine mammogram found a suspicious area and another hollow-core biopsy confirmed malignancy.  On Friday afternoon, October 25, Dr. Sener called with the news I had always feared—and I came undone.

The following Tuesday, October 29, I had a lumpectomy.  After the pathology reports came back, my final diagnosis was ductal carcinoma in situ (DCIS)—the most common type of non-invasive breast cancer.  The cancer was microscopic and therefore would not have been discovered without a mammogram.  The chances of recurrence of DCIS are 30% and most happen within 5 to 10 years after the initial diagnosis.  DCIS isn’t life threatening in itself, but having it increases the risk of developing invasive breast cancer later on.  To lower that risk I was advised to have radiation therapy.

I qualified for and chose the option of the brand new (at that time) Intensity-Modulated Radiation Therapy (IMRT).  Since this radiation focused exclusively on the cancer site, I only had to go 16 times, instead of the usual 32.  I went to the Kellogg Cancer Center at Evanston Hospital where a team of lovely women—my “radiation angels”—measured where the radiation beams should go, permanently marked my chest, and worked hard to save my life while I stared up at the picture of a Ragdoll kitten taped on the machine.  They kindly scheduled my appointments at 7:30 a.m. so I could keep my usual work schedule.  I never missed a beat, and none of my patients knew what I was going through until long after the fact.  Working was what kept me (relatively) sane.

There were months of extreme fatigue and distorted sense of smell and taste—all the usual side effects of radiation.  Not to mention depression, abject terror, self-pity, and many, many sleepless nights.  But the total love and support from my husband, family, and friends helped get me through.

After radiation therapy was completed, I was prescribed Tamoxifen which is supposed to prevent breast cancer.  I stopped taking it when the immediate and long-term side effects began to outweigh the potential benefits.  I figured that twice a year diagnostic mammograms would be enough to catch any cancer that might return.  Fortunately, I was right.

After 5 years, my diagnostic mammograms were reduced from twice to once a year.  After 10 years, I’m left with a scar that has faded to white and one tiny black dot in the middle of my chest that I refer to as my tattoo.

In the intervening years, I’ve exercised and focused on a healthy diet, choosing mostly organic fruits and vegetables and dairy.  I have limited meat and stayed away from anything that has hormones or additives of any kind.  I drink gallons of green tea in a week, and still enjoy red wine in moderation.

I admit that my yearly mammograms still fill me with terror and dread.  And I find it ironic that I’m not allowed to wear deodorant on the one time a year I need it the most. But during the actual procedure I find comfort in focusing on the date of inspection on the mammogram machine—March 11—my mother’s birthday.

Because psychologists know that hopelessness combined with helplessness is an often lethal combination, I professionally and personally contend that when all else seems out of our control, it becomes our responsibility to do whatever is within our power.  To my women readers, take action!  Know your risk, including your mother’s possible use of DES.  Do self-exams and have regularly scheduled mammograms when recommended.  (Remember, a mammogram saved my life!)  To all my readers, action in the form of good self-care and education to increase awareness is the only way to create more hope—for ourselves, the women we love, and future generations of women.

Since, for me personally, the wolf will always be at the door, I will keep doing what I have been doing—it has worked so far.  On September 28, 2012, I became a 10-year survivor!  On October 6, 2012, I danced at my son’s wedding!  Life is beautiful.

*Although doctors were told to stop prescribing DES in 1971, it wasn’t banned for use with humans until September 2000. Therefore, an estimated 5-10 million people in the United States were exposed to DES, including pregnant women and the children born of those pregnancies. DES sons and grandchildren are also at risk for health issues caused by DES. Read more about DES to find out about your risk or the risk or someone you know at www.desaction.org.

Shukran

This is one of those stories that, if written in a novel or as a scene in a movie, would be dismissed as contrived. Unbelievable. And yet, it happened just as I describe. And all the circumstances, the timing, the spontaneity suggest more than mere coincidence. For me, it was the most profound experience of my entire ten-day trip to France.

Thursday, July 21st was my last day in Paris. In three days, I’d only seen the Eiffel Tower from afar, so I decided to pay her a visit. Recent flooding on the Seine had closed part of the subway system, resulting in a long, circuitous metro ride from where I was staying on Isle St. Louis to the tower. I had to change lines in the middle and close to an hour had passed when I finally reached my stop.

All of Paris is on heightened alert. The terrorist attack in Nice happened on July 14, my second day in France, while I was in the far north, near the English Channel. At the airport, the train stations, and on the streets, heavily armed soldiers and police patrol in packs of three. Vigilant. Hand-held automatic weapons at the ready.

Nowhere in Paris are the extra precautions more apparent than at the Eiffel Tower. The entire perimeter at the base is fenced off, and to enter one must go through a rigorous security check. Every time I’ve visited in the past, I’ve wandered about freely, walked into the base, and gazed straight up. This time I chose to stay outside the fenced area. Still gazing up, but nowhere as close as before. The Eiffel Tower is still magnificent. Even more striking and awe-inspiring in reality than in pictures.

I took shots from every possible angle, then, spontaneously, decided to check out the river cruises called Bateaux Parisiens. I walked down the steps to the banks of the Seine and there was no wait for tickets. It was 7:15 pm and the next boat was departing at 7:30. I paid my 15 Euros and joined a zig-zagging line like those at amusement parks and airports.

Ahead of me were six Arab women in hijabs and full-length abayas. Their faces were uncovered. The four oldest wore all black. One of the youngest was covered in taupe, the other wore navy. Standing in line, I had the chance to study them.

One in particular seemed to be in charge of the rest. I guessed she was about my age, but it was hard to tell because all her hair was covered. She had a round face, dark eyes behind large, black framed glasses, and her complexion was light olive. With only her face visible, it occurred to me she had the look of a nun.

She was looking at me and smiling. She had a beautiful smile that lit up her face. When she saw me looking back, she made a slight waving hand gesture. I smiled and nodded. Still smiling she turned to the other women and spoke to them, nodding toward me. The others all smiled and looked as if they recognized me. As if they knew me. Had I known them in Saudi? They kept looking at me and I wondered what they saw. An American tourist? A woman alone?

One younger one was pretty in a plain, round-faced way. No make-up. The youngest was striking with fine, beautiful features. Her dark eyes were thinly lined in a “cat-eye” look, beneath them, like I’ve never seen.

When we boarded the boat I watched where the women went, hoping they would sit up top where I wanted to be. They did, all lined up on a bench. Looking out toward the banks. Taking pictures with their iPhones. I sat close by, on the next bench down, and surreptitiously tried to take pictures of them.

The boat ride was a lovely hour. The weather had cooled from the brutal heat on Monday and Tuesday, and there was a pleasant breeze off the water of the Seine. There were many children on board and every time we passed under a bridge a roar went up, like we were in a tunnel.

French music played along with commentary on the bridges and buildings we passed. Parts of the river bank were covered with sand, blue umbrellas, and lounge chairs replicating a beach. People waved at us from bridges and the shores, and we waved back. It all felt light and joyous. We had beautiful close-up views of the Eiffel Tower as we ended our tour.

Once docked, we began disembarking. There were two sets of stairs on the roof leading down to the interior of the boat—one fore and one aft. The five women moved toward the front stairs, as I lined up behind others who started down the back. I was downstairs and halfway through the cabin as the group of women reached the bottom of their steps.

Suddenly, I was facing the woman with the glasses. She stopped walking and smiled at me. I smiled back. Still smiling, she nodded and raised her left hand, holding it palm toward me in a motionless wave. I did the same. At that, she reached out her right hand to me and I took it. She squeezed my hand firmly, leaned close, looked me directly in the eyes, and said, “Thank you.”

I was stunned, speechless. She quickly let go of my hand, turned, and the six women walked away. I was left fighting tears, pushing back a sob. Overwhelmed with emotions I still cannot completely articulate.

I can still see every detail of this woman’s face. I can feel her hand in mine—large, soft, strong. I hear her voice and feel the powerful emotions of the moment. I will never forget her and I will forever feel connected.

People I’ve told have theories. Maybe she knew me in Saudi. Maybe she was thanking me for making eye-contact and smiling, not looking away in fear, hatred, or mistrust. Upon hearing the story, my intuitive spiritual adviser immediately said, “She’s read your book and she recognized you from your picture. She thanked you because you wrote her story.”

I know there was a sense of recognition from the moment we first made eye-contact. Maybe we just recognized each other on a different level, as two women from totally different worlds who are somehow very much the same.

All I know for certain is that I received a gift when she thanked me—and for what, I will never know.

 

 

 

Reflections on Motherhood and Loss

Last week I sat with a man talking about his eight-month-old son—his antics, amazing accomplishments at his early age, how much he loves him. Suddenly the dad stared off with a pensive expression. “I told him he’s growing too fast,” he said.

All I could do was smile gently and nod. He’s right. They all grow too fast.

Loss is on my mind this beautiful spring day, when, finally, it’s warm enough to be outside without a down jacket. I’m on my enclosed front porch, my cat Blue curled asleep in the chair beside me. The sun is shining, birds are chirping. A woodpecker is climbing the trunk of the catalpa tree, making that familiar tapping sound. Bees harvest pollen from the bright yellow forsythia blooming just outside my window.

I once read an essay about spring being the “treacherous season.” I wish I knew the author who wrote of vulnerability—tiny baby birds, blind puppies, toddlers walking outside for the very first time. All tragedy needs is a hard wind, a fast rain—a moment’s distraction. Just weeks ago a late snow blanketed my tender lilac buds.

As an almost grandma, I’m tangled in conflicting emotions of late. I accost new mothers everywhere I go—beaming at their babies. Last month in Whole Foods I met a young mom with her eleven-day-old son, Quinn. He was strapped to her body with what I learned was a Solly Baby wrap. The mom said she loves it. I jotted down the name, researched it, checked in with my daughter-in-law, and ordered one by the end of the day. In black. For my very chic Brie and baby to be.

The Solly Baby website has a video tutorial about how it works for both babies and toddlers, so it’s useful for more than just infants. I told my financial advisor Jillian all about it, as she is pregnant with her second child. Jillian said, “Hop in! Time for soccer practice!” We laughed for five minutes.

I miss being a mom with young children. I remember an early morning in the spring of 1986 when my sons were already twelve and eight. I was on my way to Illinois Masonic Hospital, where I was a psychology intern, and had parked my car on a street lined with charming turn-of-the-century brick row-houses. As I rushed down the sidewalk, burdened with my purse and briefcase, I noticed a young woman standing on her front steps. She held a baby, less than six months old and wearing footed pajamas.

In a rush of longing, I felt the soft, moist, warmth of the baby’s skin, the weight of his body in her arms, the smell of his hair and the cereal and strained peaches she had fed him for breakfast. The young mother and I locked eyes, and in that moment I wanted to be her. And, I imagined, she wanted to be me. We smiled at each other, and I continued on, but the moment has stayed with me for thirty years.

That baby would be in his thirties now, maybe with children of his own. The young mom would be in her fifties. How quickly time passes. They grow too fast. Hold on.

No one tells us, when we anticipate motherhood, of everything we will experience along the way. When pregnancies or adoptions are announced, we are told, “Your life will never be the same!” This most profound truth is often delivered with a teasing laugh.

In psychology we call it “parental emergency.” It is the state of being we enter upon first learning of impending parenthood. It is the forever awareness of our child hovering in the periphery of our minds—no matter where we are or what we are doing—no matter the age of the child. Parental emergency is the primal bond forever linking us to our children—the psychic/emotional equivalent of an umbilical cord, except it cannot be severed.

Parental emergency is critical to the survival of our infants. It manifests in the physical pain new mothers experience when their babies cry, and the addictive pleasure found in touching, smelling, and watching our children, even when they sleep.

Parental emergency is when we feel their pain more than they do. When we grieve their loss of innocence when they go through bad times. When we feel their sorrow more than our own.

Parental emergency is what jolts us from sleep to see if our adolescents are home safely when we fell asleep waiting for them. It is why, when a child isn’t home on time, our minds immediately go to “dead in a ditch.”

Parental emergency is the pervasive sense that something is wrong, and the sudden urgency to connect—even when separated by states, time zones, and countries. And when we do, we learn they’ve been hurt in some way or another.

Parental emergency is the need to know they’ve made it home safely, even when home is only thirty minutes away, even when they are adults with children of their own. When they, or we, are traveling, it is the need to check in and say, “I love you.” Just in case.

Parental emergency is what makes us act like overprotective crazy mama bears! It is what those without children will never know. It is what parents are referring to when they tell their children, “You’ll understand when you have your own.”

The other thing no one tells us as we anticipate motherhood is all the losses we will experience along the way. One by one, we lose our soft, cuddly infants, our tentative and determined toddlers, our snuggly, adoring preschoolers, our ever-growing, peer-driven grade-schoolers, our truculent, confused adolescents. Our children are truly the loves of our lives, and while some traits and physical characteristics last a lifetime, with each new year and new stage in childhood and young adulthood, we lose the one that came before. We lose our child who came before. And we miss them! (Admittedly, some more than others!)

Our tears on their first days of school and at their graduations are as much for us as for them. We are proud when they leave for college as we grieve our empty nests. We celebrate their accomplishments and dance at their weddings. Our hearts are full and our arms empty. Pride and loss intermingled.

And if we have done our jobs well, their first tenuous steps away from us will continue our whole lives together. Every step they take is one more physically and emotionally away from us.

Marriage or partnership is a mighty leap. We lose a daughter/son and gain a daughter/son—but, if we’ve done our job well, it’s never, ever the same. And it shouldn’t be. And when they have children of their own—their own families—we have to learn a whole new way of being their parents. And that’s where I am right now. Learning a new way to parent.

As an almost grandma, I’m often told by already grandmas, “Your life is never going to be the same!” It’s said with nods and warmth and knowing smiles. “Being a grandmother is the best!”

I’m already attached. From that moment on the evening of October 11th, when I heard the tentative news, “we might be expecting,” I’ve been in a state of joyous anticipation. I suspect parental emergency can easily become “grandparental emergency,” and I’ll soon be a crazy, overprotective grandma bear!

Life as a grandparent, I’m told, is being given the opportunity for a “re-do.” Another go at the pleasures and pains of parenting, one step removed. And we get to start over with a soft, cuddly infant—mindfully savoring each stage of childhood because of what we know too well. They all grow too fast.

All is Well!

All doubt, despair, and fear become insignificant

once the intention of life becomes LOVE.

~Rumi

We who are cancer survivors have different kinds of anniversaries. We speak in code to one another, inquiring about health, sharing the latest—especially when it is good news—because we know the wolf is always at the door. We are in a club none of us chose to join, but we cherish our fellow members.

On January 23rd, a friend in my club asked how I’m doing. He asked in the nuanced way we ask. And when I inquired about him, he quietly told me he’d had his four-year check up the week before, and, “All is well.”

My check up, a diagnostic mammogram, was scheduled for the following week, Tuesday, January 26th. Last year, I had a recurrence of cancer after twelve years and had the first of two lumpectomy surgeries on January 28th. While anticipating a mammogram is always anxiety provoking, this year I was terrified.

The morning of the 26th, I spent time reading my spiritual material, reflecting, writing in my journal, and praying. I prayed all would be well. But I was afraid. I was afraid of the outcome, and I was afraid of the process.

The Evanston Breast Health Center is not a happy place. Working in health care can be stressful—especially dealing with exceedingly anxious, terrified patients who fear a negative outcome, but also dread the procedure.

In addition to being a scary harbinger of possibly devastating news, the mammogram machine is a known instrument of torture. According to unofficial polls, breast size doesn’t matter. Everyone experiences extreme discomfort to excruciating pain—mashed against unforgiving metal and glass, body twisted into unnatural positions, intimate flesh pulled, pushed, and, finally, crushed.

“Take a breath. Hold it. Don’t breathe!”

Over the years I’ve had some good technicians and some not so good. Not mean, just remote or impatient. Being told, “relax!” in a stern tone is definitely not helpful.

I’ve often remarked on the irony of not being allowed to wear deodorant on the very day I need it the most!

I always show up for my mammogram a rigid bundle of nerves. I tuck myself in and avoid any unnecessary interactions and eye contact. I put up my shield and get in and get out as quickly as possible.

The morning of the 26th I decided to do it differently. I set an intention to bring comfort and peace to all the worn and weary and worried women in the breast center—patients and staff alike—and to consciously spread love throughout the hospital. I know when I focus on comforting others I always think less about myself. Working was the only thing that kept me sane when I went through radiation therapy in 2002.

I had just entered the hospital when I came upon a tall, elderly man—clearly in pain—limping along the corridor. As I passed him I turned, smiled and said “Good Morning.” His face lit up with a smile. “Good morning, to you.”

Once in the breast center, I was the only one in the waiting room, so I smiled at the three receptionists behind the desk. No one smiled back. They were very business-like. Hard job, I reminded myself. I filled out a form and only had to wait a few minutes before I was called.

A small, solemn woman led me to examination room 4, where the machine waited. She gave me a pink gown.

“Open in the front,” she said, and left the room.

After putting on the gown, I walked to the machine. I always take comfort in the inspection date on the mammogram machines at Evanston Hospital. March 11—my mother’s birthday. Last year, the date let me down. But I found it again, and prayed it was a good sign.

A knock on the door and another woman entered—my technician, Tatyana. She read though my file.

“You’ve been through a lot,” she said, quietly. She had an accent.

Already, it felt different. No one had ever acknowledged that before. She told me she would be taking two shots on each side, four films altogether. Then she examined me.

“So many scars,” she said, softly. Shaking her head.

Before a mammogram, scars are marked with tape embedded with thin wire or tiny ball bearings so they don’t show up as something suspicious on the films. She put five pieces of tape on me.

Tatyana was efficient, but gentle. She kept asking how I felt, if I was okay. I felt human, whole—not just manipulated flesh. Halfway through, I looked at her.

“Thank you for being so kind,” I said. My voice cracked and my eyes filled with tears.

Tatyana looked surprised, nodded and smiled. When she was finished taking the last shots, she gestured to a chair.

“Please sit. I’m showing these to the radiologist. It might take a while.”

I sat and waited. Not playing with my phone, just breathing and trying to feel hopeful. I’d waited about ten minutes when the door opened. I stood up. Tatyana was in the doorway, smiling at me.

“Everything is good. You can come back in a year.” Tatyana held her arms out, inviting me for a hug. No one at the center had ever offered me a hug. I stepped into her arms and we hugged for a long moment.

“Thank you,” I said.

Walking out through the waiting room, I grinned and gave the three receptionists the thumbs up.

“Tatyana is a lovely woman!” I said.

This time they all smiled back.

It was only in the car, driving home, that the total experience of relief hit me. The intensity of my gratitude took me by surprise. I cried all the way home.

I will never know for sure if setting my intention that morning really played a part in the outcome of my day, but I believe it did—and that’s enough for me. Maybe, by taking down my shield, I allowed Tatyana to feel comfortable letting hers down. What I do know is I will make it my practice moving forward.

This past Thursday, I had my yearly appointment with my oncologist, Dr. Yao, whose office is at the Kellogg Cancer Center. Once again, I set my intentions. After examining me and studying the mammogram results Dr. Yao made the final call on outcome—All is well!

After note: During my appointment, Dr. Yao asked me to participate in a research study of women who have had contralateral breast cancer (CBC). The study is looking for specific DNA changes or other variables associated with CBC. Although the development of CBC is very low, many women choose to have invasive treatment to prevent it from happening. Learning more about who is at higher risk of developing CBC will help physicians better advise and guide patients with treatment decision in the future. I readily agreed.

Reflections and Hope

“New Year’s most glorious light is sweet hope!”

~Mehmet Murat ildan

Of the many milestones in a year—birthdays, holidays, anniversaries of any kind—none force us to reflect or compel us to look forward as much as the New Year itself.

In late December, we are bombarded with “Best of” lists—movies, music, theatrical productions, and books. There are also “Year in Review” lists—recaps of newsworthy events occurring over the past twelve months. Photographs. Last week, a posting of 2015 in international photographs brought me to my knees. There is no denying the world is a hot mess.

For months we’ve been encouraged to book reservations for New Year’s Eve. Book early, lest they sell out! Then, what? We might be forced to stay in and watch the bell drop on television! Even if we prefer to stay in on New Year’s Eve—which I do—there is the pressure to make it a special night.

While the New Year is universally recognized (on different dates in some cultures) the way it is celebrated varies greatly. It is not all fireworks and champagne.

Years ago, I had a patient who is Buddhist. She taught me, in her religion, the New Year was not about wild parties and resolutions that won’t be kept. She said it was, instead, a time of meditation and contemplation. A time to reflect on the past. A time to learn from and rectify any mistakes.

I have another patient who is Chinese. She has taught me, in her culture, the New Year is a time of leaving behind the negative in order to attract health, prosperity, and happiness moving forward. Houses are cleaned, old and worn objects are discarded, and debts are repaid in preparation for the New Year. In addition to fireworks and parades, Chinese New Year celebrations focus on family gatherings and strengthening of core values.

My personal practice, like my life, is still a work in progress. I love what I’ve learned from these women and I have incorporated their lessons. In addition, I find it crucial to focus on gratitude. Whenever possible, I reframe negative experiences as opportunities for learning. Sometimes, all that can be learned is empathy—which may be the greatest gift of all.

Here is an example of how my process works. Last week, I started reflecting on my personal 2015. It started with a cancer diagnosis last January. My first thought was, “I had a rough year!” My reframe was, “I beat cancer once again!”

I then made a list of everything wonderful I could remember—We Move Forward 2015 in Isla Mujeres, Mexico, making new friends, visits here and in Arizona with long-time BFFS, a wonderful vacation in Maine with my husband, my fabulous family reunion in California, East of Mecca making the semi-finals in a screenwriting competition, East of Mecca (Kindle version) making the best-seller list in Middle Eastern fiction on Amazon, being accepted into Ragdale again for next year, my everyday blessing of being a psychologist, and—most wonderful of all—the news that I will be a first-time grandmother next June!

My life is filled with abundance, and I am filled with gratitude.

This list is not inclusive of all the good things that happened in 2015, and I do have a (mental) list of things I’m not so happy about. There are mistakes I am reflecting upon and learning from. I have an amends to make. I wish to begin 2016 wisely, mindfully. With hope.

I’ve long stopped making New Year’s resolutions, but I have plans! I plan to continue to let go of what no longer serves me. (Code for de-cluttering!) I plan to pursue good health with the long-term goal of watching my first granddaughter graduate from college in twenty-something years! I want to spend more time with family and friends. I want to laugh more. I plan to be kinder, gentler, and more aware of what really matters on a daily basis. I plan to live more passionately and compassionately. I plan to continue to grace the lives of others in truly meaningful ways. I plan to continue to express gratitude for all the blessings in my life.

Thank you, my readers! Thank you for supporting me. Thank you for being in my life. I wish you all health, prosperity, and joy in the New Year. And, above all, I wish you sweet hope.

East of Mecca on sale for 99 cents! 

On December 31, my novel East of Mecca is on sale for 99 cents. Available on Apple iBooks, Amazon and Barnes & Noble.

Finding Family

“If you cannot get rid of the family skeleton,

you may as well make it dance.”

~ George Bernard Shaw

Really, George? The skeleton? Just one? Most families I know have many more than one skeleton in the closet. Tis the season when shrinks’ couches are filled with people stressing over their families. In my family, the skeletons could form their own dance troupe.

I’ve written about the skeletons on my mom’s side of the family (Am I Blue?) and within my own immediate family of origin (Word Salad). My family is so dysfunctional that I could write about it for years. But, today, I am writing about finding the joy in family.

Last month, there was a reunion in Granada Hills, California at the home of my Uncle Dick, my last remaining uncle on my daddy’s side. Daddy was the oldest of three boys, and he died young, at fifty-eight. Uncle Earl, the youngest, died in his seventies. Uncle Dick, the middle brother, is ninety-five.

Uncle Dick and Aunt Betty, who died in 2006, had two sons, Brad and Larry. I never knew my cousins. My baby brother Joe and I grew up in the South and Texas. They grew up in California. As kids, Joe and I had little contact with any extended family. Everyone lived in different states. Brief visits occurred only as we moved locations or took road-trip vacations in our Studebaker station wagon. We never made it to California.

This past spring I saw Brad when he was visiting Chicago. We met for a couple of hours at a Starbucks. It was lovely, but far too brief. It was the first time we had seen each other since we were kids. Before our reunion, I had last seen Uncle Dick in Jackson, Mississippi in 1995, when a small group of family gathered for a surprise fiftieth anniversary party for Uncle Earl and Aunt June. Larry and I cannot remember when we last saw each other, but it was as children.

Since July 2006, I’ve connected with my Uncle Dick semi-frequently through emails, phone calls and Skype. He’s shared stories of his life and about growing up in Chicago—stories about my daddy. His voice reminds me of Daddy’s.

Through the years we’ve grown closer and I’ve longed to visit. Longing became urgency in September, and I emailed Cousin Larry, suggesting a visit. Larry lives only minutes from Uncle Dick, and I knew I’d need his help to pull it off. Larry’s response was immediate and enthusiastic. We started considering dates and on October 15th I booked my flight.

Larry and Uncle Dick picked me up at LAX on Thursday morning, November 19. As I walked outside, Larry rushed up, saying, “I saw you right away!” He led me to the car where Uncle Dick sat beaming. I leaned into the window and we hugged and kissed. Looked into each other’s eyes.

We drove to Uncle Dick’s house, where Brad and Larry grew up. It’s a lovely, comfortable, ranch-style, filled with paintings, figurines, matching green-striped recliners—mementos of his life and long marriage to Aunt Betty. One room is totally devoted to stereo equipment and an extensive collection of LPs and CDs, another to his lapidary workshop.

Uncle Dick is a serious rock-hound! Shelves groan with rock and mineral samples from all over the world, and he has machinery to polish stones and create bolo ties and jewelry. Years ago, Uncle Dick sent me a beautiful pendant he made of Montana moss agate set in sterling silver. It is one of my most prized possessions.

Cousin Brad and his daughter Esther arrived soon after I did—having flown in for the weekend from San Rafael. As we all sat talking in the living room, I gazed at my family.

Uncle Dick looks great! He has always been a handsome man, with brown eyes and a beautiful smile. When he was young, his hair was dark brown and straight, and he was clean-shaven. For decades now, his hair has been silver. He sports a white beard and mustache, and, with his penchant for bolo ties, he resembles a dapper Colonel Sanders.

Brad, the oldest of my two cousins, is tall and lanky with dark hair, brown eyes, and a beard. He resembles my brother Joe. Brad vibrates with energy, ideas, and anecdotes. Spills stories into the room—tales of when he and Robin Williams worked as busboys. Brad exudes enthusiasm.

Larry is blond and fair, with light eyes and a beautiful smile that lights up his face. He is the more introverted of the brothers—quiet and watchful in the midst of a crowd, but full of his own fascinating life-stories when one-on-one. Of the two, I am most like Larry, in both looks and nature.

Both men are bright, funny, talented, and kind-hearted. They love their dad and their kids, and they are great fathers.

Esther is twenty-four. She is lovely, bright, and funny, with her father’s dark hair and eyes. Initially reserved, she soon jumped right into the conversation. Esther’s older brother, Morgan, was unable to join us, as he is in Colorado training to qualify for the U.S. Olympic wrestling team.

That first day we had lunch at Denny’s, seated together in a large booth. Filling up the space with talk—eager, not awkward. And laughter. It felt easy and fun.

Later, I spent a couple hours at my hotel, swimming and resting, before being picked up for dinner by Larry and his wife. Debra jumped from the car to give me a warm hug. I discovered her to be creative, funny, intelligent, and generous of heart and spirit. Debra is also an avid Packers fan, so we had something to spar over!

Dinner was at a steak house—again, all crammed into a booth. There was talk, sharing stories, Uncle Dick’s jokes I heard as a child, and much laughter. Brad and Esther even broke out in song! I admired their loving, easy relationship.

Friday morning, I had breakfast with Debra and Larry. Cousin time. When we got to Uncle Dick’s, he was in his recliner, covered with a blanket. Looking tired. But his energy increased throughout the day and over the weekend.

My husband Barry arrived that afternoon, and was warmly welcomed into the clan. That night’s dinner was at a lovely restaurant called Odyssey, set high on a hill above the valley. Larry’s daughter Meagan joined us, and we dined at a long table as lights twinkled in the city below. Meagan, twenty-nine, is a smart, funny young woman, with long blonde hair and Larry’s beautiful smile.

Throughout our entire weekend we shared spontaneous stories, anecdotes about ancestors, family history and family secrets, jokes, laughter, and song. Guitars appeared. Saturday afternoon we snacked on beautiful food, listened to music performed by my family, and sang along.

Both my cousins are musicians. Larry is a professional musician, playing guitar in rock and roll bands. In fact, all the men on Daddy’s side of the family have musical talent. Uncle Dick plays the guitar and sings and Uncle Earl drummed. My daddy played the trumpet and loved to sing, Joe played the drums, and my older half-brother Mike, who died in 2006, played just about everything.

I have video clips of Larry, Brad, and Uncle Dick sitting together on the sofa—Uncle Dick in the middle. Brad and Larry play guitars and the three of them sing. Waltzing With Bears, Worried Man Blues, Folsom Prison Blues. Uncle Dick is full of life! Strong of voice!

I also have a short clip of Esther singing The Girl from Ipanema, then laughing, sipping her wine.

For hours, we pored over Uncle Dick’s photo albums and the pictures I’d brought, while he filled in family history. Sadly, there were no pictures of all of us cousins together. Not a one. Brad and Larry both remember a time visiting my family in Mesquite, Texas when I was in high school. I have no memory of that visit, but I trust theirs.

Saturday night, we stayed at home, drank wine, and ate Kentucky Fried Chicken while sitting around the kitchen table. Comfortable and easy.

While I will forever grieve the lost years, there is much to be said about meeting in late adulthood. There is no need for posturing, pretense, drama, or competition. There were honest revelations. Painful disclosures. Connections made far transcending those that might have been made as children playing ball and board games. The weekend was perfect beyond my wildest hopes. Everyone brought their best selves to the party. There was love and there was grace. As Larry wrote me afterwards, “It was all joy!”

Usually it’s easy for me to walk away or say “goodbye” without falling apart. When a patient walks out my door for the last time, I cry in private. And then—I tuck it away and move forward. Just like I was taught as an Army Brat. Just like I’ve learned to survive loss in my profession. I mourn everyone who has ever sat on my couch and left—some more than others. How ironic that my chosen profession demands I get close to people who will ultimately leave me.

That Sunday, leaving my family, I cried as I hugged each one and said “goodbye.” I cried as we drove away, waving until they were out of sight—like a child in the back of a Studebaker station wagon. I cried for much of the way to the airport.

I went into our November reunion without expectations and left richer than I could ever have dreamed. I have family. My dear uncle. Two cousins who are beautiful, loving men. Two lovely young women—my cousins once removed. Sweet Debra. Now, there are promises of more reunions to come—next April, for Uncle Dick’s 96th birthday—where we hope to bring even more family together.

Sometimes you don’t know what has been missing from your life until you find it. Along with the profound joy I feel from finding family, I’m also left with a nameless sorrow—filled with a missing as acute as any I’ve ever felt.

But there was love, laughter, and song that long November weekend. Legions of skeletons were freed from closets and allowed to dance!

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Repost: Hope and Action

October is Breast Cancer Awareness month, and I want to share my personal experiences—yet again. Last year at this time, I was a twelve-year survivor. Those who know me or follow my posts are aware that I had a reoccurrence this past January. Once again, it was found through my yearly mammogram and caught in the very earliest stages. Once again, I am profoundly grateful. While there is an abundance of confusing and conflicting information out there, one thing hold true—early detection saves lives. My mission, in continuing to share my story, is to inspire readers to take action on their own behalves, as well as to bring comfort and HOPE to those who are struggling with their own diagnosis—or love someone who is.

 

I didn’t realize what a daunting task it would be when I decided to write my very first blog in October on the topic of breast cancer.  The original idea came from a celebratory place—on Friday, September 28, I had my yearly diagnostic mammogram and was declared cancer free.  I am now a 10 year survivor—which puts me in the 82nd percentile of women who make it this long.

Evanston Northwestern Hospital Breast Cancer Treatment Advertisement. Photo & Advertisement © 2003, ENH

In the past 10 years I’ve walked for hope, run for hope, spoken about hope, and even been in an ad campaign about hope.  And now, I want to write what may inspire hope— for those going through what may feel like the scariest and loneliest ordeal of your life.

I have much to say, but there is already so much out there.  There is certainly no need to remind anyone that October is breast cancer awareness month—everything is festooned with ribbons the color of a new scar.

As survivors our stories are all unique and all similar—the terror, the tears, the pain, the awkwardness in ourselves and others.  I’ve learned that when you tell people you had breast cancer most of them reflexively glance at your chest!  Although many women would argue that every month is breast cancer awareness month—as the fear is always in the periphery of our minds—there is a need for it to be so in our faces that we cannot hide beneath layers of fear and denial that it can happen to us.  We cannot just hope it won’t happen to us or to women we love, we also have to take action.

I have long known I was at increased risk for breast cancer.  It was 1972 when my mother sat me down to talk.  I was 24.  Mom was pale and trembling, and I had never seen her eyes so desperately sad.  The story was that she had been pregnant once before me and she had miscarried.

During her pregnancy with me, mom was prescribed diethylstilbestrol (DES), the first synthetic estrogen hormone.  DES was created in 1938 and was regularly prescribed for “problem pregnancies” until November 1971, when the FDA told doctors to stop prescribing it for their pregnant patients.*

We, the female children born of those pregnancies, are called “DES Daughters.”  We are at increased risk for a number of health issues including cervical cancer, structural changes of the reproductive tract, infertility, and depression.  Those of us over 40 are almost twice as likely to get breast cancer, and the relative risk is estimated to be even higher for DES Daughters over age 50.

By 1972, articles were being published describing the outcome of long-term studies of the effects of DES.  Mom had read one of those articles.

“I’m so sorry I did something to put you at risk.”  Her eyes filled with tears.  “I was so afraid I’d lose you.”

Of course I understood.  1948 was a time when no one, especially women, questioned their doctors.  DES seemed like a miracle drug—the answer to prayers for those longing for babies.  I comforted Mom with gratefulness at being alive and reassurances that I would be just fine.  Four years later, at age 28, I was diagnosed with cervical cancer and successfully treated with conization surgery.

In my early forties I developed fibrocystic breast condition, characterized by lumpy, painful breasts.  Self-exams became an exercise in terror.  Around that time I had a patient who also had the condition.  She raved about her breast specialist, a surgical oncologist, exclaiming, “I will pay him to examine my breasts for me.”  I thought, “This is my man,” got his name, and made an appointment.  Dr. Stephen Sener turned out to be the man who saved my life.

Over the next ten years I had a number of fine needle aspirations of suspicious cysts, two hollow-core needle biopsies, and the surgical removal of a lump.  Every time I waited with dread for the nurse to call with the pathology reports—which always came back benign.

In October 2002, that wasn’t the case.  My routine mammogram found a suspicious area and another hollow-core biopsy confirmed malignancy.  On Friday afternoon, October 25, Dr. Sener called with the news I had always feared—and I came undone.

The following Tuesday, October 29, I had a lumpectomy.  After the pathology reports came back, my final diagnosis was ductal carcinoma in situ (DCIS)—the most common type of non-invasive breast cancer.  The cancer was microscopic and therefore would not have been discovered without a mammogram.  The chances of recurrence of DCIS are 30% and most happen within 5 to 10 years after the initial diagnosis.  DCIS isn’t life threatening in itself, but having it increases the risk of developing invasive breast cancer later on.  To lower that risk I was advised to have radiation therapy.

I qualified for and chose the option of the brand new (at that time) Intensity-Modulated Radiation Therapy (IMRT).  Since this radiation focused exclusively on the cancer site, I only had to go 16 times, instead of the usual 32.  I went to the Kellogg Cancer Center at Evanston Hospital where a team of lovely women—my “radiation angels”—measured where the radiation beams should go, permanently marked my chest, and worked hard to save my life while I stared up at the picture of a Ragdoll kitten taped on the machine.  They kindly scheduled my appointments at 7:30 a.m. so I could keep my usual work schedule.  I never missed a beat, and none of my patients knew what I was going through until long after the fact.  Working was what kept me (relatively) sane.

There were months of extreme fatigue and distorted sense of smell and taste—all the usual side effects of radiation.  Not to mention depression, abject terror, self-pity, and many, many sleepless nights.  But the total love and support from my husband, family, and friends helped get me through.

After radiation therapy was completed, I was prescribed Tamoxifen which is supposed to prevent breast cancer.  I stopped taking it when the immediate and long-term side effects began to outweigh the potential benefits.  I figured that twice a year diagnostic mammograms would be enough to catch any cancer that might return.  Fortunately, I was right.

After 5 years, my diagnostic mammograms were reduced from twice to once a year.  After 10 years, I’m left with a scar that has faded to white and one tiny black dot in the middle of my chest that I refer to as my tattoo.

In the intervening years, I’ve exercised and focused on a healthy diet, choosing mostly organic fruits and vegetables and dairy.  I have limited meat and stayed away from anything that has hormones or additives of any kind.  I drink gallons of green tea in a week, and still enjoy red wine in moderation.

I admit that my yearly mammograms still fill me with terror and dread.  And I find it ironic that I’m not allowed to wear deodorant on the one time a year I need it the most. But during the actual procedure I find comfort in focusing on the date of inspection on the mammogram machine—March 11—my mother’s birthday.

Because psychologists know that hopelessness combined with helplessness is an often lethal combination, I professionally and personally contend that when all else seems out of our control, it becomes our responsibility to do whatever is within our power.  To my women readers, take action!  Know your risk, including your mother’s possible use of DES.  Do self-exams and have regularly scheduled mammograms when recommended.  (Remember, a mammogram saved my life!)  To all my readers, action in the form of good self-care and education to increase awareness is the only way to create more hope—for ourselves, the women we love, and future generations of women.

Since, for me personally, the wolf will always be at the door, I will keep doing what I have been doing—it has worked so far.  On September 28, 2012, I became a 10-year survivor!  On October 6, 2012, I danced at my son’s wedding!  Life is beautiful.

*Although doctors were told to stop prescribing DES in 1971, it wasn’t banned for use with humans until September 2000. Therefore, an estimated 5-10 million people in the United States were exposed to DES, including pregnant women and the children born of those pregnancies. DES sons and grandchildren are also at risk for health issues caused by DES. Read more about DES to find out about your risk or the risk or someone you know at www.desaction.org.

What Shrinks Know (#20): It is Never too Late to Learn More About Yourself

“The problem with introspection is that is has no end.”

~ Philip K. Dick

It is late August and there is a chill in the air. The temperature is 73 degrees, but the breeze I feel on my porch makes it seem like early fall. Makes me want to pull on soft, worn jeans and a roomy turtleneck sweater.

The chill is coming way too early. Normally this time of summer, I start to weary of the heat. The grass is usually parched and my herbs and impatiens wilted from too much sun. The constant din of cicadas makes me feel like I have tinnitus. This year, June was cold and wet and summer weather didn’t launch until July. And even though July was the hottest on record, our indecisive August makes me feel gypped.

My summer list is only partially checked off. There have been art fairs and festivals. A Tuesday night concert by the lagoon. Time spent watching kids play in the Millennium Park fountains. July 4th parade and fireworks. A wonderful visit with my longest BFF, Tanya. A bike ride to the Botanic Gardens with another friend, Sheila. The Air and Water show enjoyed from my kids’ terrace in the city, accompanied by margaritas and lobster tacos—all in celebration of my August birthday.

There have been long bike rides, but only one walk and no time at all basking in the sun on the beach. I’ve yet to relax in the hammock with a book and a Corona. Ravinia is yet to be, but it is on the calendar—Alan Jackson. Mostly, there has been far too little time chilling with friends.

This summer has also been funky in other ways—leaving me feeling a little unhinged. In late July, I had a “routine” ultrasound, and was immediately propelled into the now familiar follow-up, meet new specialists, have other procedures, and wait routine. My next “procedure” is on September 3 and, while I try to tell myself everything is okay, my “okay” track record is not to be trusted. “We’ll see” is a much better bet. I’m scared.

And, I’ve had two big disappointments. The first was the Writer’s Lab screenwriting competition sponsored by New York Women in Film and Television and funded by Meryl Streep. I worked my butt off to get my script adaptation of East of Mecca in perfect shape and even submitted it a day early. I worked and reworked my bio and synopsis until they were perfect. Then I indulged in what turned out to be totally magical thinking. I was so sure I would be chosen that I was watching flights on Yapta. I felt the excitement of winning. When I got the “Dear Applicant” letter on August 1st, I was sure I’d receive an “Oops!” letter soon after. No such luck. That night I went out for comfort food—Chicago style deep-dish pizza and red wine.

I wrote my mentor Meg who gave me wise advice—put it behind me and “write something else…if the goal is writing then write.”Meg’s right, I know. I’ve tried to do just that, and consoled myself with the fact that there were 3800 entrants for twelve spots. But, still.

Two weeks ago I had the second disappointment. My photographer friend was doing a shoot for the American Cancer Society he thought I’d be perfect for. At the casting call there was a line of almost a hundred people of all ages, shapes, and sizes. I was happy and grateful to be there—mostly to see my friend, but also to enjoy the unique experience.

Waiting in line gave me a great opportunity to people-watch. I chatted with others as we slowly moved forward. At the end of the line there was a white background screen, lights, and photographers. Women were having three angles shot. Men were also required to scream. When it was my turn they took three smiling shots. But then they also asked me to look angry. I tried to frown. Covered my face with my hands. Tried to think of something maddening, but came up with nothing. I failed miserably.

The next week, when I was told the client didn’t choose me, I wasn’t surprised. But, I was disappointed. After I got the news I went for a long bike ride by the lake. It was a beautiful summer afternoon, and it helped.

Since then, I’ve been very introspective—thinking about disappointment, ego, and anger. In the first wake of disappointment, I always feel sad. I cry. Then I reach for something comforting. Deep-dish pizza and wine isn’t always the best choice, but it worked. The bike ride was a healthier choice and worked better.

As for the why of these disappointments, ego plays a huge part. In terms of the Writers Lab, in addition to the opportunity to get my story to the masses, I wanted to be chosen for the experience of working with women in the film industry. I wanted to be chosen for recognition of what I’d written in the screenplay competition—my talent and skill. Not being chosen meant that I didn’t measure up. That hurt my ego.

In addition to the importance of giving something back to the American Cancer Society for all the work it has done for me, I wanted the experience of the shoot with my lovely photographer friend and his amazing crew. The fact that I wasn’t chosen because of how I look, or how I could not look (angry), also hurt my ego.

Looking at all three events—the health issue and two lost opportunities—I realized I usually react with sadness, disappointment, feeling bad about myself, and even fear. Rarely do I experience anger—even when I should.

Anger wasn’t allowed in my home when I was growing up. Both my parents had experienced too much rage in their childhoods. I think Daddy would have been fine with it, but Mama would have none of it. It was more than okay to be wounded and hurt in our family, but never to be angry.

When I was about five I remember being angry about something. I tried to express it verbally, but was shut down. Then I scowled and was told to “wipe that expression off” my face. I remember tensing my legs, standing for a moment on rigid sticks of rage. Mama saw that, too, and made me stop it. I did. I don’t know where it went, but from that moment on my anger was suppressed.

My defense mechanism of choice has always been dissociation. I bring down a wall separating me from my negative emotions. Problem is, dissociation isn’t terribly specific—it also prevents one from truly feeling all other emotions. When I do feel anger, it is always hard to express. I can be the tiniest bit passive aggressive. And I’m a master at being passive!

When I do feel anger, I know it doesn’t always serve me well. I am quick to let go and forgive, even when I’m the only one aware that I’ve forgiven. In any case, I don’t carry anger around with me and certainly cannot access it on demand!

The lesson is that we all need to learn healthy ways of expressing anger and other negative emotions—and to allow our children and loved ones to do the same. The power of introspection is that it can turn bad experiences into valuable gifts. I’ve learned much about myself from exploring my own reactions to these recent painful experiences.

Moving forward, I’ve taken my mentor Meg’s advice and I’m working on my next book, Orchard Road. I will continue to embrace all wonderful opportunities sent my way, trying not to let ego steal my joy in the face of disappointment. And, I’m also trying to  access and express my anger in healthy ways, knowing it will probably take a lifetime to change a lifetime of habits. In the meantime, I’m also okay embracing my serene, happy self—because I’m exquisitely aware of all for which I’m grateful.

Repost: What Shrinks Know (#16): The Complexity of Suicide

A year has passed since the death of Robin Williams sent the world into mourning. I received so many moving and grateful responses to the very personal post I wrote in reaction to his suicide, that I am reposting it now. Please share if you know anyone whose life has been touched by suicide. Together we might ease the pain of a “survivor”… or even save a life.

 

 

I attempted suicide when I was sixteen. Over the almost fifty years since, I have told very few people. I’ve only shared when the importance of disclosure felt greater than my desire for privacy. I have shared with others who have survived suicide attempts. I’ve also shared with those in danger of succumbing to their suicidal urges—when the sharing of my personal experience would have more impact than my professional experience—when it might save a life.

Suicide is not a conversation-friendly topic. Like most provocative subjects, it makes people uncomfortable and can generate rigid opinions. But, there has never been a greater need for education on the complexities of suicide. One thing shrinks know for sure about suicide is that it is contagious. Hotlines and ERs have been on high alert since Robin Williams committed suicide. If someone who has so much going on for him cannot go on living, why should I? Maybe opening the discussion is Robin’s last gift to us—not through laughter, but through tears.

We who grieve Robin’s suicide are on a quest for answers as to Why? That’s often the case for survivors of suicide—those left behind. We want to understand. Sometimes the answers are clear, but most times they are not. Grief is complicated by unanswered questions.

I’ve called suicide the most selfish and narcissistic of all acts—because it is at that point the pain is so overwhelming that it overshadows any thought of the consequences of one’s actions on anyone else. The mind in pain gets sneaky and deceitful, rationalizing how others will be better off without the burden of you, the depressed nonfunctioning one. The only way to imagine feeling suicidal without having experienced it is to try to remember the torture of your most intense physical pain, and how you would have done anything to escape it—with little or no regard for anyone else.

My first thought when hearing about Robin’s suicide and his history of depression, was how much pain he must have been suffering. I hurt for his family and loved ones and I hurt for him. Depression is ruthless. It robs you of your capacity for joy while magnifying the smallest hurts. It steals your energy, leaving you exhausted and making any effort to find comfort feel impossible. It isolates you at the very time you most need human contact. It alternately churns your thoughts and emotions like a high-speed blender, or leaves you curiously devoid of feelings. It has many different faces and manifests with a variety of symptoms. Depression is a heavy, dark, cloak.

Depression alone is bad enough, but when stress is added to the mix the risk of suicide increases. For Robin, the diagnosis of Parkinson’s disease may have been the stressor that pushed him over the edge. Stress adds the “I’m coming out of my skin” factor—the urgency to escape what feels inescapable. The hopelessness of the situation and helplessness to effect change leads people take the leap that those who’ve never been there cannot possibly understand. It is at that time suicide feels like the only solution to a problem that feels permanent.

When I’ve held those sobbing in deep despair, who have just barely survived a suicide attempt, or who are on the brink of making one, and shared my story with them—it was not a “textbook” intervention. It came from a place of deep empathy and intuition. It was the only thing I could do at the moment. And it has worked. I could tell them honestly that life does get better. And that there are many joys and surprises awaiting them once we get them past the pain. And they could see me and trust me and believe it to be true. My wish in sharing my story with you, my readers, is that it will help even one of you heal in some small or huge way.

*****

Over the years, when I have shared my suicide attempt, I’ve often said I don’t even remember why. There was no one major event I recall with certainty. This week, I went back, searching for clues. Trying to make sense of what I tried to neatly file away—hoping my search can give me some peace—while helping my readers who are grieving or struggling to more clearly understand the complexity of suicide. If you wish to read my story, please read my piece entitled “Silent Echoes.”

What Writers Know: It is a Fine Line Between Truth and Fiction

“Hello darkness, my old friend.

I’ve come to talk with you again.”

~ Paul Simon

For the past few months I have been working on a second edition of East of Mecca. It will include reviews from Amazon and Goodreads and discussion questions for book clubs. Also included is a “second edition afterword” where I address the question I have been most asked since the original publication in 2013, “Haven’t things improved for Saudi women since you lived there in the late 1980’s?”

The simple and tragic answer is, “No.” Circumstances have worsened for Saudi women—and for Muslim women and girls worldwide. Because of culturally-sanctioned honor violence and radical Islamic terrorist groups, gender apartheid against women has reached epic proportions.

The not so simple and much more tragic answer is all the horrific ways in which women and girls are oppressed and abused. While writing the afterword, I felt I needed to research and document everything I found. I’ve been plugged into the world of women’s advocacy groups for years, so I get daily tweets, emails, and Facebook updates on the latest atrocities. I’ve read details, seen photographs, and watched videos that I will never be able to erase from my memory. As I collected more data, I fell into a very dark place.

Despite my mission to educate and advocate, I was immobilized. I simply could not write down the details I’ve learned. It was that revelation that finally allowed me to finish. In my afterword I have a list of facts about women in Saudi Arabia and have suggested two resources. Also included is a list of terms to search on Google, for more in-depth and current information.

My writer’s block is almost identical to what I experienced while writing East of Mecca. The following is an outtake from my original manuscript. It was written in July of 2010, but could have been written yesterday—after I rode my bike in the park. Part is truth and part is fiction. The line between the two is so razor fine,  even I no longer remember which is which.

East of Mecca—Outtake

Summer in Chicago has had a late start. A cold wet June has finally broken into a hot dry July. Today, I rode my bike along the path by the lake, pumping hard to waken muscles gone soft in the long Chicago winter. After an hour, my legs were sore. Sweat collected under my helmet and trickled down my cheeks. I wore shorts and a T-shirt and my newly exposed skin felt the slight peppery sting of impending sunburn. Later, when I took off my sandals, my feet had faint, light stripes—evidence of summer and exercise.

Today was an exercise in avoidance. I had stepped back from writing my story. The process of remembering had stirred up demons. My sleep was tormented with dreams of Saudi; fleeting images of barren desert, a blood soaked thobe, blue silk, and torn flesh. My nerves were frayed and a heavy veil of depression fell over me. I wanted to put Saudi back into the box, but repression doesn’t work like that. Once you have exposed a memory to air and tears, it can no longer be contained. Like combining iron with oxygen and water, it turns to rust—the color of dried blood.

As I biked, Lake Michigan was on my right. Sailboats danced in a regatta just offshore and beaches were littered with pale bodies. To my left was a shady park that is a Mecca for those seeking relief from the summer heat.

Rounding a curve, I saw a young Arab woman standing on a blanket. She wore an ankle-length green dress with long loose sleeves. A matching hijab framed her pale face. Her eyes were closed and her lips moving. She faced east, toward the lake. As I watched, she bowed forward, stood up, fell to her knees, lowered her forehead to the ground, rocked back up onto her knees, and bowed forward again. I recognized the graceful, fluid movements from the many times I had seen them in Saudi. The woman was praying.

Looking to the east, I saw pink clouds on the horizon, reflections of the sun setting in the west. I pulled off the bike path, so I could watch discreetly. Hands holding the grips, legs straddling my bicycle, I stood as if poised for flight.

Behind the woman was a gathering of Arab families. Middle Eastern music wafted in the same breeze as fragrant smoke from food sizzling on grills. There was a murmur of accented voices and the shrieks of children. Scanning the crowd, I saw men tossing balls back and forth. Children ran and played. Women sat or reclined on blankets, leaning against each other, talking and laughing. It looked like the perfect world. Standing alone on the outskirts, I felt a wash of longing—the old familiar tug of an outsider yearning for inclusion.

Suddenly, as if aware of my presence, the woman opened her eyes and looked straight at me. The expression in her dark eyes was serious as she held my gaze. I felt a shock of recognition. I had never seen her before, but I knew her. We know each other, I sensed her saying. We are all the same. She nodded, then closed her eyes and continued her prayers.

I stood frozen—awash with images, memories, and emotions. At that moment I knew. I had opened the box and I would be haunted until I told the story. Women need to know how dangerous the world is for us.

But the fleeting glimpses of darkness at the edge of my periphery were not only the woman on the beach. I knew I would never be free until I faced my own shadow. After another long moment, I mounted my bicycle and slowly pedaled home—resolved to tell our story.