The Invisible Snake

Empty TankI was listening to an audio book, a detective novel by Jeffery Deaver called XO, part of the Kathryn Dance series. The story is about a young country singer who is being stalked. This stalker is very clever, very intelligent, very skilled at not being where he might be expected to be and showing up in unexpected places at unexpected times. The singer, not surprisingly, is terrified.

A local police detective tells a story. (I’m paraphrasing because I don’t have a print copy of the text.) One summer, he recalls, he saw a huge rattle snake in his back yard. The biggest rattler you’ve ever seen. He went into the house to get his handgun to kill it, but by the time he got back outside it was nowhere to be seen. Was it under the steps? Behind the barbecue? In the shrubbery? Underneath the house? Inside a pool toy? He couldn’t find it anywhere. “The invisible snake,” he called it, making it a joke for the sake of his frightened children.

But that invisible snake, he said, ruined the back yard for him and his family that season. They couldn’t go outside and enjoy it because no one knew where the snake was, and one of them might end up getting bit, maybe even one of the small children. That snake was more frightening invisible than it was in plain sight.

I thought of this during a Facebook conversation with Jody Schoger about a blog post by Uppity Cancer Patient called “If, Not When“. Uppity Cancer Patient (UCP) and I have different points of view about this, and Jody and I differ, too. I don’t know UCP personally, I’ll leave her out of this for now (but if you’re reading, please jump in and join us in the comments).

UCP writes about the “land of if” (treatments stop working) and the “land of when”. You really should read the entire post (at the link above), but here is a taste:

I don’t want live in the Land of When.  That’s like living in Purgatory, and I hear from the Catholics that that’s not a pleasant place.  I want to live in the Land of If instead. A land where the question is, if the cancer progresses?  If I am disabled? If.

That’s the land that most people live in. Most people don’t go through the day thinking, I will be disabled, I will be in pain, I will suffer.   What can it hurt for me to live in the Land of If too? I might be disappointed if the cancer progresses? 

I’d rather experience disappointment if the cancer progresses, than to experience  that disappointment every day of my life.  Even if I only live 30 more days, living in the Land of If sounds much more pleasant than living in fear.

I don’t know anything about UCP’s current health status, other than that she is living with metastatic cancer. I don’t know how long ago that started or where her mets is or any of the rest of it. I know that Jody has written in her blog that after fifteen years of being NED (having no evidence of disease):

The scans showed a different, but not rare, metastatic trail. There is nothing in the lungs or liver; but lymph node involvement and small nodules in the peritoneum and along a lymph chain that travels behind the diaphragm. There are positive nodes in the left axilla and neck, which were discovered by ultrasound. There is NO second primary cancer.

Jody has said online that although she has lost a lot of weight, she doesn’t feel particularly unwell at this point.

My metastasis was found by the end of my first year living with breast cancer; it is in the bone. I’ve had these bone tumors for over eight years now. They hurt. They interfere with my daily life and I’ve had to start taking narcotics for the pain. Over the last year, the mets has progressed more than it has in the several years prior and I’ve been having increased pain.

I am most definitely living in the “land of when”. I have kind of a theory that people who are newly diagnosed and those who are NED populate the “land of if”. I know I can’t live there any more. For me, it would be flying in the face of reality. For me, it is not a question of if treatment stops working but when it will.

This is one of those issues with no right or wrong answer, and I am very interested in what other people living with cancer and their family, friends and caregivers think about living in the “land of when” and the “land of if”.

How do you feel about the invisible snake?

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Cancer, anxiety and mindfulness

It’s no secret that a cancer diagnosis makes people depressed and anxious. It is less known that some medicines used in the treatment of breast cancer can cause anxiety, particularly hormonal treatments.(1)

It is even less well known that, in contrast to the depression, which tends to decrease over time, the anxiety tends to persist and may even become worse.(2) This study was cited and discussed in the New York Times “Well” blog post “Anxiety Lingers Long After Cancer” by Jan Hoffman.

I recently wrote about the things I do to (attain and) maintain mental health, and in an earlier post I wrote about my choice to live intentionally, to live an examined life:

This business of living intentionally isn’t New Age or mystical or Buddhist or maladaptively introspective.  It only requires pausing in your day, or even in your week or month, to be aware of your interior and exterior worlds. What am I doing? Is it what I want to be doing? Is there a change I’d like to see? Can I bring it about? What path am I on; is it likely to bring me to where I want to go?

I started this practice when I was about fifteen years old. I was a member of a dramatics group and the director used to have us sit quietly at the beginning of each lesson or rehearsal to do a “here and now” exercise. It’s very simple. You start by sitting still in a comfortable position and saying, “Here and now, I am aware of…” and naming what you see, hear, smell, feel. You do this quietly, in pace with your breathing. As you physically relax, you can close your eyes and your awareness gradually switches to the interior world.

By interior world I mean thoughts, feelings, wishes, desires, discomfort, contentment, hopes, satisfaction, anger, delight… a kind of mindfulness. It was a great exercise for me at that difficult age, and it remains so when I am in a tizzy or need to get back in touch with myself.

I was very interested to see that my intuition about using mindfulness to cope with stress and anxiety was borne out in a small Danish study that was published this past April in the European Journal of Cancer.(3) The investigators provided a “structured, eight-week group mindfulness-based stress reduction program (MBSR)” and found that even a year later it had “clinically meaningful, statistically significant effects on depression and anxiety after 12 months’ follow-up, and medium-to-large effect sizes”.

The women participating in the study had been diagnosed with breast cancer at Stage I, II or III and had undergone surgery. I wonder if the results would be different with participants who have Stage IV cancer (advanced or metastatic breast cancer). As usual, however, we mets-ers were not included. (A topic for another post.)

In any case, the statistical results are far less important to me than my lived experience: mindfulness exercises and meditation and living an examined life help me to cope better with stress and anxiety, and that is all the proof I need. Studies like this one, however, might lead cancer centers to provide MBSR or similar approaches to patients in their survivorship programs, and I think that would be a very good thing.

Notes:

(1)See, for example, this page at BreastCancer.org.

(2)See, for example, a UK study published in Lancet Oncology online in June of this year. The abstract can be accessed free of charge at PubMed. (Click)

(3)The abstract can be read free on line at the journal’s website. (Click)

Pain, physical and mental

Collage of words: pain, anxiety, stress, depressionFirst a quick update on the cancer front. There is new pain in my ribs. The diagnostic radiologist didn’t see anything on the ultrasound, so she’s recommending a PET-CT as the next step. I haven’t been able to reach my oncologist (who is the one who has to order it) through the clinics where she works, so I’m going to call her on her mobile. I don’t like to do that, but after discussing it with my GP, that’s what I decided to do. I’ll try to reach her today. I don’t like being importunate and I always avoid taking advantage of anything that might smack of privilege, so it was a difficult decision for me to make.

Then there are the mental health issues. When I saw the onco a week or two ago I discussed my anxiety with her, and we talked about the prevalence of anxiety in people with cancer. She was very emphatic about it being a quality of life issue and strongly encouraged me to talk to my GP about it.

Now, I have never explicitly stated in this blog that I used to be a mental health professional, but perhaps the time to “come out” has arrived. Like many MH providers, I apply a double standard to myself, preferring to think that I can deal with just about anything using my own resources. Like many MH providers, I’m full of bull puckey. In point of fact, I am well past the point at which I’d suggest to friends, let alone patients, that they need help.

So I packed up my false pride and machismo (machisma?) and asked my GP, who is a former colleague, what he thought. He kindly and matter-of-factly asked a few open questions and offered me Venlafaxine (also known as Effexor), a drug that is used for depression, anxiety and even neuropathic pain (like post-mastectomy pain syndrome). I’ve agreed to give it a try, along with my usual routine of quiet prayer and meditation, mindfulness exercises and as much exercise as my exhausted body can tolerate.

So that is what taking care of myself looks like today. Writing openly about these difficulties is also a way of taking care of myself, and maybe also of encouraging other people to take care of themselves. That is the paradox of writing a blog like this. I started it for myself, and its primary purpose is still to provide an outlet for my thoughts and feelings. Over time, more and more people have started reading it, and some people have told me that they are able to relate to it and get something positive from it. That makes me very happy. Thank you.

(When I get news about the PET-CT, I’ll post an update here or on the blog’s Facebook page Telling Knots, the 30%.)

I have WHAT? Coda: Mastectomy

Breast cancer cellThis week I posted the last of three posts about my diagnosis with breast cancer at the end of 2003. Now it seems appropriate to post about my mastectomy. This post, originally called “Valentine’s Day 2004 or… I left my breast on the Mount of Olives” first ran on February 14, 2012. To recap: Part 1 (discovery), Part 2 (biopsy), Part 3 (diagnosis).

Fourteenth of February, 2004. There was a heavy snowfall. In Jerusalem that is almost as rare as it is in Los Angeles. Many streets were closed, and many people were afraid to drive on the streets that were open because, after all, Who knows how to drive in the snow in Jerusalem?

I was in my bed in the hospital and prepped for surgery. The orderly came to take me up to the operating room and I freaked out. No, don’t want! Stop – there must be a mistake – no, no, no! But all that was mostly on the inside. On the outside I appeared anxious (who wouldn’t be?) but rational.

In pre-surgery a male nurse came over to take report on me and check me over. He introduced himself and asked all the questions. He took a marking pen and made a huge mark on my left breast. Goodbye left breast. I made some feeble joke about not getting the wrong one, and he kindly and seriously told me that he would make sure of that. He stayed with me until I went under the anesthesia.

They wheeled me into operating room. People were bustling around doing their jobs. The nurse stayed with me. I heard two other nurses talking about the snow and wondering aloud if the surgeon would make it in. What? He’s not here yet? Please don’t tell me I’ll have to go through this again.

A surgery tech brought out the instrument tray. I looked at it with what I hoped was an interested expression on my face. It was probably more like sheer terror, because my nurse asked another one to set up the screen in front of my chin. “But isn’t she having a general?” “Please, I’m asking you. She’s looking at the tray.” So they set the screen up. But now I can’t see! How can I be sure you’ll do everything right? I can’t see! 

All of a sudden I felt a bustling, a purposefulness in the room. “Is the surgeon here?” “Yes.” Terror. Oh dear Lord! God, my God, bless his hands. Bless the work of this team. Bless me and give me strength to get through whatever comes next. Dear God, I am so afraid! Be with me now.

The anesthesiologist came up next to me and uttered the canonical phrase, “You’re going to feel a little prick now.” Excellent! The pleasantly heavy calmness settled over me, and…

* * * * *

Pain! I started panting like a woman in labor. Hoo hoo hoo hoo. My friend Jeannie, also a nurse, was standing next to me. She signaled the Recovery nurse who came over with an injection. I slept again.

The next time I awoke, still in Recovery, I was in pain again but aware of my surroundings, aware of Jeannie. Aware of the bulky dressing and the surgical drains where my breast used to be. Aware of the drain under my left arm. Aware that the surgery was over. Aware that pain could be controlled.

Aware that my life had forever changed.

My friend Aliza wrote about this day from her point of view. Please read her guest post here

I have WHAT? Part 3 – You have cancer.

Breast cancer cellI wrote Part One (Discovery) of this series last December, followed quickly by Part Two (Biopsy). It’s taken me over half a year to write the third part of the series. The biopsy was a traumatic experience for me and the way I write is to bring myself back to the experience itself. Writing about it left me more upset now, years later, than I was then. At the time I was shell-shocked and didn’t have the internal resources to really feel everything. Now I do have those resources. Something of a mixed blessing, to tell the truth.

All that is to say that you may want to read those first two posts before this one.

Almost a month after the biopsy, I received a phone call, telling me I had an appointment with the same professor who had done the biopsy. I wanted to ask if there was anyone else who could see me, but I was still too much in shock to speak up for myself. Oddly, I chose to go alone.

The appointment was in the same place as the initial mammography and ultrasound and the biopsy–the general x-ray department of the clinic. I arrived about fifteen minutes early and checked in with the very busy receptionist. I took a seat as she instructed.

I waited and waited, growing increasingly nervous and agitated. I could hardly speak when after about an hour I went up to the receptionist and asked what was happening. She curtly told me that “they” knew I was here and to take a seat and wait patiently. (Why do some medical and ancillary personnel feel that they have the right to speak to patients as if we were small children?)

After another forty-five minutes or so, I saw a nurse coming out of the hallway where I knew the professor’s office was. I went up to her. “Excuse me.” Her eyes widened. Clearly she was not used to being accosted by patients. “Do you work with Professor Tact?” “I do.” “Could you please tell him that Knot Telling is here and I’ve been waiting for a couple of hours now to hear the results of my biopsy?” Her expression changed to one of pity and she said, “Wait here,” and stepped into the professor’s office.

Now, it must be said that by this time I knew it was a malignancy. You don’t get called to an appointment with the professor to be told nothing is wrong. I sort of knew it was a malignancy from the moment the mammography technician told me to sit in the hallway and wait for an ultrasound. But still…

I am sitting at my computer in my home. This is just a memory. So why do I feel the icy fist clenching my heart and why are my breaths  quick and shallow and why are there tears backed up behind my eyes? Hey, here’s a good thing about having metastatic disease: you never again have to be afraid of hearing the words “you have cancer”. But back then I was still irrationally hoping for it to something else, anything else.

The nurse opened the door to the office and waved me in. She left and shut the door. The professor was yelling into the telephone, demanding to know who was at fault for something. The young doctor who had done part of my biopsy was standing behind his chair. I stood just inside the door, not sure if I should wait outside until he was done with his call or what. He looked up and waved me to a chair in front of the desk. I sat down.

“Tell her to come in here,” the professor shouted as he banged down the telephone and picked up my file. He turned a few pages back and forth and then looked up at me as there was a brief knock at the door and a secretary came in. “I’m busy,” he yelled at her. “You just stand there until I finish with this.”

I was beside myself. I didn’t want an audience while I got this news and I didn’t want to be an audience to whatever scolding that lady was going to receive. I was still too cowed to say anything. Professor Tact glanced at me and then back down at the file. “Okay, it’s malignant, but we knew that.”

I felt as though the top of my head was floating away. I couldn’t feel my hands or feet. I heard him yell at the poor secretary to leave and come back when he called there. I saw the top of the desk, I saw the young doctor’s pitying face, I saw the professor’s hands turning pages in my file.

I don’t remember leaving the office or the building. I remember calling my GP and telling him I needed to see him, and he said he had the results on his computer, too. I don’t remember where I went when I left the clinic, if I went home or to my GP or my priest or what.

I do remember knowing that things would never again be the same.

I am the 1% – Guest Post by Greg Smith MD

It is my great pleasure to host a guest post by Greg Smith MD, an American psychiatrist who blogs his “mental health musings” at gregsmithmd.com. We sisters in mets often feel sidelined by the breast cancer awareness movement, but Dr. Smith draws our attention to an even more marginal group: women suffering from both breast cancer and schizophrenia.

I am the 1%

Schizophrenia affects 1% of the population in the United States. Many of these patients are women. Patients with schizophrenia and bipolar disorder are 2.6 times more likely to develop cancer than the general population according to one Johns Hopkins study.

Just because they have a diagnosed mental illness, these women are not immune to the development of serious medical problems such as diabetes mellitus, hypertension, heart disease, and cancer. Some studies have gone so far as to say that merely having a diagnosis of schizophrenia is a risk factor for developing other major medical illnesses such as cardiac disease.

Breast cancer, prominent already in international discussions of illness, research, prevention, staging, treatment strategies, and cure, is no respecter of women who already suffer daily from schizophrenia.

This post is not to go through the basics of the presentation, diagnosis, staging and treatment of breast cancer. There are many resources one can study to learn more about that in as much detail as desired. It is, however, meant to make you think for just a minute about how this illness affects women whose view of the world is already skewed, whose cognitive processes are already impaired, and who are already prone to anxiety, depression and psychosis. Suicidal ideation, a risk in patients who feel pain that will not go away (physical or psychic, which may actually be a bigger risk for self-harm), may be a serious complication of an illness such as breast cancer as well and should not be ignored.

Women with schizophrenia have trouble cognitively, affectively and with their perceptions. That is to say, their illness impairs their thinking, their mood, and how they see the world.

Now, imagine that you have dealt with a major psychotic illness such as schizophrenia for two decades. You developed a thought disorder, auditory hallucinations and paranoid delusions in your early twenties, you were diagnosed with schizophrenia after an initial hospitalization that was very traumatic to you, and you have taken antipsychotic medications for years in order to control the voices that plague you and the fear that grips you every time you go out in public. You function fairly well with the help of family and friends, and you have a team of caring mental health workers who support your ongoing recovery. You are by no means well, and you have never gotten back to your baseline functioning after your initial diagnosis, but with treatment you are able to live independently and enjoy your life.

Now, in your forties, you discover a lump while taking a shower. In the fog of the steam in your bathroom and the fog of the medications in your brain, you may not fully understand what this means. You may ignore it completely. You may immediately hear the chorus of voices in your head commenting. See? We told you so. You’re in for it now. You’re going to die. You’re going to die. You may experience an exponential rise in anxiety because you had an aunt who died from breast cancer.  Just because you have schizophrenia doesn’t mean that you are immune to the sudden shock, the denial, the anxiety and the sheer terror of thinking that this might be cancer.

Now, this is where it gets tricky. Whereas a woman without mental illness might deny and rationalize and delay going to her doctor to have the new-found lump checked out (all perfectly expected responses to this very frightening experience, yes?), a woman with schizophrenia already walks a very precarious tightrope between independent functioning and clinical illness. Her balance is delicate. Any little stressor might be enough to upset her equilibrium and cause her to fall. A new physical illness in one who already deals with psychosis and disordered thinking every day may be just enough to precipitate a marked decrease in ability to perform self care and remain independent.

Once she does realize that this potentially serious finding must be checked out and she does get to her doctor, the problems don’t stop. There are issues of getting through diagnostic tests, informed consent, discussions of treatment options, explanations of surgery versus chemotherapy versus radiation or combinations of all of them.

If you have had breast cancer, do you remember the first time you were told? Do you remember the first time your doctor discussed treatment options with you? Were you in shock? Were you afraid? Did you have someone with you, a trusted family member or friend, another set of ears to hear what you simply could not hear the first or fifth or tenth time?

Women who suffer from schizophrenia are often alone, with no family members active in their lives, no loving and supportive spouse at their side and few friends who can be there for them. They hear this news with a backdrop of paranoia, hallucinations and disjointed thought that makes it very, very difficult at best to even consider any of their responses to the doctor about treatment “informed consent”.

Clear these hurdles and the treatment and recovery phases are still very difficult for these women. Some studies have revealed that there is a very real danger of violent acting out in women who are frightened and disorganized as they face potentially life threatening illness. While most psychiatric patients may be victims and not perpetrators of violence, cancer pushed coping skills and emotional reserves to the limit.

Finally, simply having a diagnosis of schizophrenia may shorten one’s life by as much as fifteen to twenty years. Adding a diagnosis of breast cancer to the mix, especially if the disease has progressed and is metastatic, is potentially devastating to a woman who has already lost much of her ability to live fully, love deeply and experience the world as most of us can.

The story of the 30%, as articulated by this blog and others like it, is very important.

The story of the 1% is often lost in the hoopla, but is no less important.

More scans (Update 2)

CT scannerAfter speaking with my oncologist, my GP called me back this evening. The onco asked for more tests: CT scans of my chest, abdomen and pelvis. The referrals were faxed to me this evening – they’re marked “urgent”. The oncologist said that after the CTs are read she may ask for a biopsy (I suppose of the finding at the sternoclavicular joint) and then they will discuss the skull mets.

So. Okay then.

I didn’t think I was having any particular problem with going for the scans; it’s a pretty routine procedure at this stage of the proceedings, after all. I went about making a nice dinner (pasta with button mushrooms in a peppery cream sauce and a tomato-fresh basil salad). I carried the plate from the kitchen out to the table and… the whole plate of food slid on to the floor. Then I noticed my hand was shaking.

This was upsetting in all kinds of ways! I hate to waste food, and I’m kind of a nut about a clean house, and I hate it when my emotions control me instead of the other way around. Harrumph. I cleaned up the floor and threw away all that perfectly good food because I washed the floor today and there was probably still detergent residue on it. I washed the floor again because I clean when I’m anxious.

What’s with this anxiety, anyway? The tests are expected and routine in my situation. The results will not change the fact that I have Stage IV breast cancer. Yet, I suppose I’m anxious about the possible outcomes, that is, that the cancer may have spread to lung or liver as well as bone, or to my ribs or pelvis. It’s still Stage IV, though; there aren’t any more stages than that. I don’t know what I’m anxious about. I just need to accept that I am and move on.

Treatment at this point is about prolonging my life. Once all the data is in, I will make a decision about that. Do I want to prolong my life with cancer treatment? How much quality of life am I willing to sacrifice to that end? There is also the issue that it is much easier to say “no thank you” and not start treatment than to say “enough” and stop it. Easier in terms of the Israeli medical establishment, and perhaps easier on the people I love and who love me.

There is also a moral issue. My life does not belong to me; it belongs to God. That raises another question. When I stand before my God, will he be disappointed in the choices I’ve made? At what point can I morally choose to prolong my life no more? If I suffer, is there redemptive value in my suffering? (Yes, there is.) Do I have the right to curtail that before time? How will I know?

Big questions, all. Too big for me right now. I go back to the psalm that I love so much, that I quoted earlier this month, this time as a goal to move towards and not as a description of a state attained.

For right now, I’ll just keep breathing and turn off the speculation machine in my head.

I’m fine, I’m angry, I’m crying, I’m fine…

I’m not a pretty picture at the moment. Today is Friday. On Tuesday morning I’ll have the bone scan to verify the extent of the new mets (metastasis), and the results from that should probably come in a few days later. I am stressed and anxious and my mood is changing with astonishing frequency.

For the first few days after I learned about the new lesions in my skull I was doing the Denial Dance with great energy. It’s a clerical error; they sent me someone else’s results. Well, okay these are my results but the radiologist read the pictures wrong. Okay, the radiologist saw what she saw, but it’s artifactual; nothing wrong with me at all. Okay, there really are skull lesions, but they are from a childhood injury. And so on.

Huge debts of gratitude to the dear friends who supported me while I went through those painfully distorted maneuvers, especially to the MD down south and the RN up north. You two have been wonderfully supportive and also demonstrated great forbearance by not laughing at me until I was ready to laugh at myself. Thank you.

So, I’m pretty much past that now (except for occasional moments of “No! Nonononono!”), but still very stressed. My mood is… labile. I switch from finding everything funny to sobbing pitifully in nothing flat. At times I can pray and find my center in prayer, and at other times I can’t sit still for two consecutive minutes. I can work productively or not at all. I frenetically clean my house or I sit motionless.

I’ve never been one for half-measures, but this is ridiculous!

Just yesterday I whined to a friend about not understanding why I’m like this. My friend wisely did not explain it to me at that time, did not say, “Um… can you spell S-T-R-E-S-S?” Today I decided to write a post, and as soon as I opened the interface I realized that this is all just a stress reaction. Why couldn’t I see that yesterday? I was too stressed out, I guess.

Anxiety: A Paradox

Well, this is strange. In the weeks and days leading up to my recent CT, I was a quivering mess of anxiety and drama. I divided my time between obsessively cleaning my house and taking advantage of the kind and patient emotional support of my long-suffering friends. (You know who you are – thank you!)

Now here’s the thing. I had the scan two days ago, and I don’t have the results yet. I still don’t know if the mets has reached my brain, yet I am calm and focused. I banged out two translations in the last two days with no fuss and no muss, even though they were from my L4 to L1. This morning I quietly and easily did the usual morning things, and now I’m waiting for the grocery delivery and writing a self-indulgent, navel-gazing blog post.

What happened to the anxiety?

I don’t know any more about my health than I did last week. The scan itself wasn’t threatening or frightening, and I bypassed the tedious (and nervous-making) administrative hoops by paying for it out of pocket. (Relax, Americans. It is far less expensive in Israel than in the US.) Yet, now that it’s over, the anxiety has just dissipated like early morning mists in the light of day.

Thinking this over (or over-thinking this), I find myself remembering one of my favorite Psalms (131:1-2 NIV):

My heart is not proud, Lord,
my eyes are not haughty;
I do not concern myself with great matters
or things too wonderful for me.
But I have calmed and quieted myself,
I am like a weaned child with its mother;
like a weaned child I am content.

I wonder if, having done everything that is in my power to do in this scary situation, I have somehow “turned it over”, relaxed my white-knuckled hold on events and stepped back, “calmed and quieted myself” in this “great matter” of my health, my future.

I cannot control anything now. In a few days I’ll have the results of the test, and will be that much closer to knowing what’s going on with me. I’m not scared of cancer; we’ve been living together too long now for that. I am scared of losing my independence, my individuality, my identity. But somehow the truth that being anxious and dramatic will not shorten the time I have to wait for a diagnosis has pushed through the layers and layers of my psychological defenses and reached my core belief: God is good, and I am important to him.

As Julian of Norwich famously said, “All shall be well and all shall be well and all manner of thing shall be well.” I’ll close with that.

I need a grown-up to help me today.

I don’t often use this blog to talk in detail about my health issues, but today I’ll make an exception. For the past several weeks or couple of months I’ve been experiencing disturbing symptoms that may be caused by any one of a number of different things, from the dire to the trivial. But since I have metastatic breast cancer and a brain tumor is one of the possible causes of my symptoms, and the brain is one of the places breast cancer metastasizes to, my neurologist is sending me for a CT (computerized tomography scan) of my brain.

She is asking for two sets of scans: one with and one without contrast agent (dye). The problem is that I’ve had a non-life-threatening allergic reaction to the contrast agent in the past, so I need special preparation with cortisone beforehand and a physician must be present when they administer the agent. Without going into the painful details, it is proving difficult to find the place and the people I need to talk to make these arrangements.

I’ve been trying for several days, and I am just not having any success. I’m usually very good at dealing with bureaucracy and administrative requirements, but I’m getting more and more frustrated and confused. And that is worrying me, because part of the reason I need the scan is because of a perceived impairment of my cognitive function.

So here I am. Anxious and tense and knowing what I need to do, theoretically able to do it (having done it in the past), and yet not able to do it. I feel out of my depth. I want a grown-up to take over for a while!

Instead, I’ll have a rest and listen to an audio book or watch a film and forget about it for today. Tomorrow morning I’ll be fresh and alert and I’m sure things will be much easier.

P.S. I’ve been trying to remember a familiar psalm or poem or quotation about anxiety and care being greater at night and less in the morning, but I can’t put my finger on it. Ring any bells? Anyone?