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)

Enough!

I am sick and tired of dealing with stuff.

I’ve had it up to here with calmly facing reality.

I am well and truly fed up with creative problem solving.

I have metastatic cancer. I am in pain. I am going to die much sooner than I should. Isn’t that enough? Will someone please turn off the shit faucet?

It’s nothing huge this time, but even a feather can be just that little bit too much. I’ll write again when I’ve calmed down.

Isolation

Different!Last week I posted The Electrician Didn’t Come, in which I rambled on about nothing in particular for 600 words. I asked if anyone had a suggestion for a topic for future posts. In the comments, MC wrote:

Not to be maudlin, but I would love to hear about how you avoid becoming isolated – like I wonder if support groups and that sort of thing really help. To me, it is like getting sucked into a cesspool and running out of arms reaching down to pull you up. Or mabe you are just more resilient because of the tool chest of coping mechanisms you learned as a therapist? Also, is the medical system there a lot different than in the US? Your entries are very encouraging and uplifting, by the way so thanks. 

There are a few interesting topics there, so thank you very much, MC!

Isolation is a big problem for the subset of people with serious disease who live alone. My friend and fellow blogger Scorchy Barrington recently wrote an incredible post about her experience being alone in an emergency room. If you haven’t read it yet, please do.

In my own experience, it’s important to differentiate being alone from being isolated. I love being alone and even before I became so ill I chose to live a relatively solitary life for spiritual reasons, as well as due to my natural inclinations. However, I still left home for work, worship and occasionally to see friends. There were usually just a day or two in a week that I was really alone at home.

At the end of 2011 my neutrophil count (a type of white blood cell) became severely low due to chemotherapy. This kind of side effect is usually self-limiting and/or corrected with injections of granulocyte-colony stimulating factor. In my case, however, it never did correct and I now have to be very, very cautious about exposure to infection. Since my job involved contact with a lot of people from many different places, my employer very graciously changed my duties and allowed me to work from home.

As I became more ill I became less able to perform even those tasks and the organization I work for gave me a completely different job that could be performed from home on my own time schedule, working around my good and bad days. I’m very grateful for that.

The upshot is that I am home alone most of the time now. I would not say that I am isolated because there is someone who comes to do the heavy cleaning, someone else who has my prescriptions filled and runs little errands, and a neighbor across the courtyard who frequently invites me for a meal. In fact, I am quite fortunate in that regard. But even so, my main outside contact now is online.

There are lots and lots of online resources for the homebound these days. Besides blogging, Facebook and Twitter, there are specialized groups and forums for cancer in general, breast cancer specifically, and metastatic breast cancer even more specifically. I have made friends and found soul mates online.  With such real, intimate contact so easily available to those who have Internet capability, isolation is far from inevitable.

To answer the more specific part of MC’s question (“…like I wonder if support groups and that sort of thing really help. To me, it is like getting sucked into a cesspool and running out of arms reaching down to pull you up.) Support groups have definitely helped me at various times. As well as being a ready-made peer group, they are also a way to meet people who  have been through what you are experiencing. As I got to know the people, I was able to to discern which of them were more like me and which were not. I was able to make friends from among the peoknow what youple I met and learn how to respectfully keep my distance from some others. In that respect it’s no different from any other social setting, really.

Serious illness can easily feel “like getting sucked into a cesspool”; I get that. You will never hear me refer to cancer as a blessing or a gift or a good thing. It sucks. But that does not mean I cannot use the experience to learn and to grow. It’s largely a question of balance and attitude, I believe. I wrote a little about that in one of my earliest posts, Fundamentally Happy. Even though I am much sicker now than I was then, it still rings true to my ear.

Reading what I just wrote has inspired me to add a page of online resources to Telling Knots. Look for it in the next day or two. If you have a favorite resource, please mention it in the comments.

From Denial to Acceptance?

acceptance is keySlowly but surely, cancer is chipping away at my dignity, my autonomy, my self-image.

Last week I agreed to my oncologist’s suggestion of treating my apparent depression and anxiety disorders as a quality of life issue, and accepted my GP’s prescription of an SNRI. I know that objectively that was a good decision. I know that this is one way of taking care of myself and being sure that my needs are met.

Nevertheless, it feels like humiliation. I wrote about that recently, so I won’t repeat myself here.

Back to pain management, a quality of life issue par excellence. For a year or so now I’ve been white-knuckling, trying to avoid taking the narcotic pain relievers and when I eventually do take them, I’ve been taking minuscule doses that have little or no therapeutic effect. It’s not like I don’t know that; I’m reasonably conversant with these dosages.

As I’ve written before (as in this post from about nine months ago), my issues with narcotics are dual. On the one hand, I hate the way they make me feel. I hate that sleepy-dopey feeling, the impaired judgment, the excessive emotionalism, the lack of impulse control, the inability to do things that have to be done. I live alone. I have a house to maintain. After requiring my medical retirement, my employer was kind enough to give me alternative employment that I can do at home when I’m up to it. That has to get done if I want to keep getting a paycheck.

The other issue with narcotics is that I’m mildly allergic to them. My whole body starts itching, inside and out, and so I have to take an antihistamine at the same time as the narcotic. Antihistamines feel yucky, too.

So the decision for me involves balancing two elements. Which will be worse at any given moment: the narcotic-antihistamine impairment and discomfort or the unmanaged pain?

Last night I realized that (yet again) I’ve been an idiot, that my pride and self-will, my “machisma” has been causing me to make really bad decisions. I took a ridiculously tiny dose of Percoset last night and not surprisingly was up pretty much the whole night in pain.

So, a bit more of my self-image crumbled away last night. My image of myself as strong in body, mind and will, as a person who copes, a person who is in control… *poof*. I need to find a new base to stand on, and I’m going to try to start thinking of myself as a person who does whatever is necessary to take care of herself, even when that means adjusting long-held ideas and values.

Reality changes. Fundamental human values, in my opinion, do not change, but other kinds of ideas do. It is time for me to adjust the way I gauge my personal strength. It is time for me to step out of these last tattered remnants of denial and squarely face the reality of where I am with this disease.

I have metastatic breast cancer. I will never be healthy again. My pain and disability will increase. That is reality plain and simple, and as I wrote in a post about another issue:

Accepting an unpleasant or bad situation – war or abuse or cancer, for instance – doesn’t mean that I endorse it or like it. It just means that I have looked at reality and noticed that it is real. Not accepting reality is fairly insane. I can’t even work to change something until I have noticed and accepted that it is real.

At the same time, I am still the same person I was before diagnosis. I am still bright, I still have talents, I still have the ability to love and be loved, the ability to work effectively. The disease has not yet taken everything from me, and I still have the ability to cook, to watch movies, to read or listen to books, to be in touch with friends, to tell abysmal jokes, to help others and be helped by them. I can be grateful for these things while still acknowledging the devastation my disease has wrought.

It’s not going to be easy, but I’m pretty sure that this what is the landscape of the next part of my journey will look like.

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.

Tired to the point of tears

I cried this evening.

I began to get tearful while talking to a friend on the phone, describing how tired I’ve been lately. Just tired. “It scares me,” I said, and I welled up. I did my best to keep it in but only partially succeeded, so I went and blew my nose and splashed water on my face and came back to the phone, declaring myself to be “just fine”.

After the phone call I set about doing evening things  – tidying the house, wiping the kitchen counters, going upstairs to get ready for bed – and I burst into tears. I feel like I’m declining – slowly, but inexorably. 

I’m not ready yet. So much left to do! There’s a major writing project that is barely off the starting block. There are people I haven’t yet told how important they are to me. There is a broken relationship in my family that I’d love to mend before I leave. 

Then I realized that it’s still not death that is worrying me, but the inactivity of end-stage illness. I am nowhere near that point, but I find myself thinking about it more often recently. This increasing fatigue makes me think of it.

Being the person I am, I began researching cancer-related fatigue. This is a way of gaining control: perhaps there are factors I can influence. Even if there are not, knowledge is a kind of mastery for me. Things are less intimidating and frightening if I understand them.

I found this diagram at CancerNetwork, home of the journal Oncology. It is from an article called “Fatigue and Dyspnea” by  Sriram Yennurajalingam, MD and Eduardo Bruera, MD of the Department of Palliative Care and Rehabilitation Medicine at M. D. Anderson Cancer Center and was published on 11 November, 2011 in the online edition of Oncology.

Factors in cancer-related fatigue

I can see I’ll be referring to it frequently in the coming days. I already see some factors that I can influence and probably change with a resultant improvement in my energy level.

  • Dehydration. I am very bad at getting enough to drink, especially in the winter. I already have a medicine tracking sheet, so I’m going to add a column to it where I can keep track of how much I drink each day.
  • Pain/drug side effects. I need to rethink my decisions about pain control, to discuss it again with my doctors.
  • Psychological distress. I will stop diagnosing myself (I’m fine!) and arrange to be evaluated, especially for depression and anxiety.

And now I feel much better – for real this time. I’ve gathered information and started to make an action plan. It’s a quarter to one in the morning; I should probably think about getting some actual sleep after all this talk about fatigue.

Fundamentally happy

October being Anniversary Month, I am republishing some of my favorite posts. This one seems appropriate after my drama queenery of last week. It was originally posted on January 25th of this year. I chose it because it’s always good to remind myself that I am in charge of deciding where to put my attention. Thank you for reading.

Today I read a post called “Pigeons” in one of my regular blog-reads, Table for One by Solitary Diner. I stopped short at this:

But as I thought about it, I realized that despite having a long list of potential self improvement projects, I am fundamentally happy.  Not all the time, certainly not at 4 am on a night float shift when I want to toss my pager into the fires of Mordor, but overall I’m happy.  And with very good reason.  Balancing out my list of pigeons of discontent is a very long list of things to be happy about. 

And I thought – hey, me too! I am fundamentally happy. My next thought was – When did that happen? Without going into a lot of detail, I can say that I have had a lot of pain in my life. I’ve lost people I love; I’ve been betrayed by people I trusted unconditionally. I have experienced catastrophic illness in my loved ones and in myself. I have been in material need. I have been in spiritual desolation. I have borne intense physical and emotional pain. Somewhere along the line, though, I slowly came to the deep realization that even though I cannot always control what happens to me, I can control how I relate to it. Even though I cannot control what feelings come up in me spontaneously, I can choose which ones to allow to stay. I can choose how I react to situations and feelings. “Feelings are not objective reality; they are our subjective reactions to objective reality.”

Ten or fifteen years ago I decided to make being kind to people my default mode of behavior. Aside from the positive results one might expect – more friends, people enjoying my company, better relationships in work and private lives – I noticed my inner world changing, too. As I began to be gentler with the people around me, I somehow started to become gentler with myself.

A few years after that, I began to realize that “feelings are not the boss of me”. I can feel like moldy bread warmed up on a rusty shovel over a cow dung fire and still smile at the person who comes into the room. I discovered that I am not unidimensional or monotonal and that I can feel sad about something, can feel grief and pain, and be honest about those feelings without letting them take over my essential being. My fundamental happiness takes nothing away from being sad or angry at a person or a situation, and the sadness or anger do not destroy the fundamental contentment.

I am a deeply spiritual and religious woman with an intense prayer life. This, I have no doubt, plays an important role in my fundamental happiness. My Creator created me as a human being with emotions, “and He saw that it was good”. I am grateful for the ability to feel emotions, because I have also known the flat, internal deadness of depression. But just as I do not have to allow myself to be ruled by my appetite for food or sex or exciting adventures, I do not have to allow myself to be ruled by my feelings.

Just as I choose to “live with” cancer, I choose to live with my feelings, knowing that they come and go, ripples on the pond of my contentment.

In the 13th century, Clare of Assisi wrote to Ermentrude of Bruge:

Our labor here is brief, the reward eternal; may the excitements of the world, fleeing like a shadow, not disturb you. […] Gladly endure whatever goes against you and do not let your good fortunes lift you up: for these things destroy faith and those demand it.

Living intentionally and being the master of our feelings are far from new ideas. Having found my center, my fundamental happiness, I can afford to take a couple of steps back from the “excitements” of my inner world and decide where to place my energy.

I have no idea if I’ve made any sense in this post. I’d be grateful for some feedback.

I hate feeling like this

Sometimes I just can’t tell the difference between being in touch with my feelings and expressing them appropriately – or playing the Stage IV card and milking it for all it’s worth. I’m having a rotten week or so and you, Internet, are the lucky puppy who gets to hear all about it.

First of all someone I care about a great deal is going through a terrible life-changing passage right now and I can’t do anything to help. That makes me feel helpless as well grieving for the losses in my friend’s life.

Next. Remember my friend who was found dead, murdered, in his home? I have had to be involved in some of the settling of his affairs because I was listed as next of kin. This week I had to pay a large bill to the water company for water usage after his death. The company does not care that he is dead and the flat is empty and doesn’t belong to me. They dunned me anyway. (My lawyer is on it.) This added to my feelings of impotence and frustration and grief.

Then there’s been my health. Mundane little health things, not cancer. I had a little bit of a fever (which is an issue because of the low neutrophil count) and stomach problems. I stumbled and hurt (fractured?) another toe. My chronic cough worsened (probably because of staying in bed with the fever). Nothing dramatic, just enough to make me feel like something you’d scrape off the bottom of your shoe. The stupid toe hurts and so do various other joints. The weather’s changing and I’m not twenty anymore.

And the pain, of course. (We’re on to the cancer now, if you’re playing along at home.) The bone pain is increasing to the point where I don’t know how much longer I’ll be able to cope without narcotics. I’m taking maximum daily doses of Advil supplemented with something called Tramadex (known as Tramadol in the US). It is a very weak  μ-opioid receptor agonist but provides pain relief similar to that of codeine, which I can’t take, and I don’t react to it badly as I do to stronger opioids. But I think I’m coming to the end of that road. Not sure what the next step will be.

What else is driving me nuts? Well, since you asked…

  • My house is not as clean (spotless) as I’d like it to be. I don’t have the strength or balance to do any more than I’m doing, and my household helper can only do so much in the hours I can afford to pay him.
  • My eyes are not as good as they used to be, which means that I have had to give up making lace. I still hope I’ll be able to take it up again, but the knitting I’m doing instead just isn’t the same. (Though it is very cool that I knitted my first pair of socks with a turned heel.)
  • My attention span is shorter and more variable than it used to be, which means I can do even less work than I used to do. Ditto my memory.

None of this is as bad as what many other people are dealing with – bringing us back to my drama queendom. I was hesitant about posting this for that very reason, but decided to go ahead. Why? Because when I started this blog I made a decision that I would be as honest and transparent as prudence allows, and that means sometimes showing these less attractive view of my life.

Thanks for being here.

Bullied

I am twelve years old. Clutching my new red vinyl binder to my chest like a shield and standing with my back against the wall in a corner of the girls lavatory at the new junior high school.  A gang of girls surrounds me on the other three sides. They are jeering, mocking. Something snaps in me. I hurl the binder like a hand grenade into the midst of the girls and hear an endless, wordless scream coming from my mouth.

The music teacher comes running in “What did you do to her?!” and gathers me to her bosom. I cling to her, sobbing.

Forty-five years go by.

There is an on-line game I sometimes play, an MMORPG (massively multi-player on-line role-playing game) – one of those games where lots of people are on at the same time and there is a chat box where you can interact with one another. This is not a “shooter” or a particularly strategic game and many – perhaps most – of the players are children in junior high and high school, with a sprinkling of middle-aged women. It’s fun.

I was playing yesterday and noticed some of the players taunting another player. From what was said, it seemed clear to me that the bullies were a couple of years older than their victim and that none of them were over 15 or 16. With every bone in my body, I wanted to intervene, I wanted to be the music teacher who came running into the girls lav, but I also felt scared because I knew that if I said anything, the bullies would turn on me. For a minute or two I was twelve years old again.

Then I gathered myself back up into the present. “Stop bullying him, you guys!” I typed into the chatbox. Predictably, the bullies turned on me. One of them said something like, “Who do you think you are, stupid?” “I am an adult who cares about this behavior,” I typed. And the bullies shut up. Just like that.

Why am I writing about this minor incident? Because it was not minor to me. All these years later – almost half a century! – I am still marked by the bullying in my childhood. While I was writing the first paragraph of this post tears came to my eyes. I felt old, familiar feelings of vulnerability and anxiety and fear of ridicule. All the self love and self confidence that I have gained over the years melted away and I had to make a conscious effort to regain them.

So why did I put myself through that? Because yesterday’s incident reminded me that bullying is significant. Bullying on-line or off-line hurts people. Children and teens who are bullied will carry that around with them for a long, long time. But if someone intervenes, they will carry that with them, too, like I do the music teacher who held me and comforted me.

Please don’t stand by and watch.

The Solanum: A Story

Once upon a time there was a little middle-aged lady who didn’t feel well. She had an uninvited guest that had come to stay. The guest stayed and stayed and just wouldn’t leave. Sometimes the guest stayed quietly in a back room, so quietly that she barely remembered it was there. But at other times, the guest would rampage through the house, breaking things and making terrible messes and leaving nothing but destruction in its wake.

This was one of those times. The lady was angry at the destruction left by the uninvited guest. She was frustrated at her own helplessness and inability to evict the guest. She was very, very sad at this impasse. The lady was full of uncomfortable feelings and didn’t know what to do.

She sat outside her little house and gazed blankly at her little garden. The flowers weren’t blooming and that made her feel even sadder. “Even the flowerbed seems to be in darkness today,” she thought to herself.

“Wait… darkness? That doesn’t make sense. It is a bright summer’s day, there is not a cloud in the sky. Strange.” Looking up, up, up, the little middle-aged lady’s eyes fell on the big solanum that was blooming abundantly, thank you very much. “Aha!” she thought triumphantly. “That’s the problem!” In fact, the solanum, much like her uninvited guest, was taking up more than its allotted space and keeping the sun away from the geraniums and the chamomile and the marguerite and all the other flowering shrubs.

The little middle-aged lady got up and went to the garden shed. She put on her pretty yellow gardening gloves and armed herself with the blue-handled secateurs. “I can’t do anything about the uninvited guest in my house,” she said to herself, “but dang skippy I can take sure care of that solanum.” So she cut and cut and cut.

An hour later, with scratches on her legs and sweat on her face (for it was a sunny summer’s day, after all) and a deep sense of satisfaction in her heart, she stood back to admire her work. “There, that should take care of it. Now the sunshine can reach the other plants in the flowerbed and they will start to bloom again. Good work, self,” she said to herself.

The little middle-aged lady no longer felt sad and angry and frustrated. Even though her body was very, very tired after the work, her spirit was soaring and her soul rejoiced at the thought of the many-colored flowers that would soon fill her garden again.

She took off her yellow gloves and put the blue-handled secateurs back in the shed and went into her little house and ate some watermelon.

The End

If you would like to know more about my cancer/uninvited guest metaphor, please take a look at Have I survived yet, Part I.