If Our Heads Weren’t Attached

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We’ve gotten into smoothies. Thanks to a recently acquired Ninja Blender (blatant product plug: it’s great and not all that expensive at Costco), and recipe guidance from our good friend Sherry, we have been churning out delicious concoctions to start many days. 

So the other morning we were cleaning up after a delightful mixed-berry smoothie and we couldn’t find the top of the milk container ANYWHERE. We knew it had to be there. We had JUST used it for goodness sake but it was nowhere to be found. Both of us kept moving in circles, opening drawers, lifting cutting boards, looking down the disposal and in the fridge but nope it wasn’t in any of those places. It had completely disappeared. But of course it hadn’t. After about ten minutes of futile searching and eye rolling, it turned up stuck under the top of the blender. We both laughed but we also sighed in virtual unison because this wasn’t close to the first time that we found ourselves feeling more scattered, disorganized and generally unmoored since Cassie’s diagnosis.

There were those times (many, many times) immediately post diagnosis, when Dan went to pay for something only to find that he had none of his credit cards, having left them scattered at different restaurants all across town. Or that time we nearly ran out of gas driving to a doctor’s appointment (thank God we noticed at literally the last moment). Or when we recently lost our checkbook for over three weeks only to find it in the same backpack we had already checked a dozen times. Cassie backed out of the driveway and smashed into our handyman’s car which she had just passed pulling in five minutes earlier. Dan went to get something out of the freezer only to leave a really good box of Sitka salmon (there’s a another product placement for you) out to spoil. The front door is often left open — that’s mostly Dan truth be told — and the degree to which we misplace our phones or get lost driving somewhere we know can’t be overstated.

Now some of this is of course normal (everyone loses their keys and phones right?) and even more so in the midst of a disorienting pandemic. That said, we are both pretty organized people and the frequency that we are losing, forgetting, misplacing and not remembering things is not typical for us. Or rather it is not typical to who we were pre-Metastatic Breast Cancer diagnosis. We sometimes refer to it as “cancer” brain and it impacts us both. It’s so easy to get frustrated and to channel the larger anxieties in our lives on to these smaller lapses. We  yell out of exasperation and beat up on ourselves with some regularity and one of us is constantly having to remind the other that this all makes sense. That of course we are going to lose and forget shit because our brains are otherwise consumed with big issues, concerns and fears. It’s requiring us to practice patience, gentleness and self-compassion (none of which come naturally to either of us) and to accept that this is just part of our “now” normal. It’s not a huge deal, especially compared to other challenges, but it’s a pretty constant pain in the ass and just one more reminder of how our lives have changed, in ways big and small, and how we have to practice changing (or at least better accepting ourselves) in response. 

P.S. The secret to Sherry’s smoothies is frozen bananas. 

The Cancer Couple’s Conundrum

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There was a lot of crying in our home over the first days of the new year. More accurately at the end of the days. When we would get ready for bed. Take off Cassie’s back brace and turn off the lights. There in the dark we found ourselves engulfed in sadness. Sad that the holidays were over. Sad that Cassie was still in a horrible back brace. Sad that we had little to look forward to. Sad about the pandemic and the state of the world (and that was before the coup attempt). And of course sad that on top of it all, Cassie still has Metastatic Breast Cancer. This unrelenting disease that is always with us.

We also felt disconnected. Dan was exhausted from days of holiday preparations and cooking. He needed to sleep and sleep some more. He wanted to take some long walks to clear his head. To lose himself in a book without talking to anyone. Cassie, while super understanding of Dan’s exhaustion and supportive of his self-care also needed him close and present. In times of greater sadness and loneliness it only makes sense that you want to be as close as possible to those you love most. But it also presents a conundrum that we have experienced at different points (usually very stressful points) since Cassie’s MBC diagnosis. 

How do you center both the care-getter’s need for more sustained connection at especially hard and challenging times and the caregiver’s need for greater self-care at those exact same moments?

Neither of us wants the other to suffer. Both of us are naturally inclined to sacrifice our own needs. Neither of us wants to make the other sad. Both of us see the need for Dan’s intentional self care and for deeper connection as a couple.

Figuring out how to balance all of this is a recurring and core conundrum for couples dealing with a late-stage cancer diagnosis. 

We’ve been trying to talk about it more explicitly — and not just late at night when we are tired from the day and the darkness is both literal and figurative. We are also working on getting back into more of a routine (abandoned since Cassie’s surgery). We try to think of the mornings as our “alone” or individual time — perfect for calling friends, walking, reading, journaling, going back to sleep or working out. Doing all of that may not be possible in the limited morning hours but some of it most certainly is and right now that’s more than sufficient. It also leaves the afternoons and evenings for doing things together — being more connected. 

Empathy. Intentional conversations. Developing routines and practices that work for both of us. We find ourselves returning to these tools over and over on this Metastatic Breast Cancer (and now back surgery) journey. Yet we also find ourselves forgetting them over and over again too. We now see that’s the nature of being in a perpetual crisis of unrelenting stress and anxiety. It’s easy to forget what you know. To lose sight of what’s working. To abandon routine. To stop sharing what you’re feeling.

So we re-learn as we need. Re-discover as we have to and remind ourselves that together we can do this. 

A Poem

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This poem by Rumi was shared with Cassie by a dear friend. It really hit home for us.

“The Guest House” 

This being human is a guest house.

Every morning a new arrival.

A joy, a depression, a meanness,

some momentary awareness comes

as an unexpected visitor.

Welcome and entertain them all!

Even if they’re a crowd of sorrows,

who violently sweep your house

empty of its furniture,

still, treat each guest honorably.

He may be clearing you out

for some new delight.

The dark thought, the shame, the malice,

meet them at the door laughing,

and invite them in.

Be grateful for whoever comes,

because each has been sent

as a guide from beyond.

— The poet Rumi, translated by Coleman Barks

Not gonna lie.  We are going through a rough time right now (and we were feeling that before the failed coup attempt this week). Our family and friends are life preservers, for sure. But, in the end, it is the two of us navigating rough waters alone. How do we do as Rumi says and be open to all that we are experiencing – both good and bad? How can we together as a couple manage all of the different “visitors” that are streaming the doors of our Guest House? We’re not sure. We know though that  this is the  challenge to focus on right now and we suspect that as Rumi suggests, gratitude may be the key to this house.

 

 

Hope

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When Cassie first tried on the back brace that she now has to wear she burst into tears. When Dan had to put the brace onto her for the first time he hyperventilated, broke into a sweat and had to take multiple breaks. Neither of us could imagine doing this for eight weeks (or God forbid possibly up to six months which we have now discovered is a possibility). On top of Cassie’s Metastatic Breast Cancer it was just too hard. Too uncomfortable. Too much to learn. Too difficult to adjust to. Too scary. Too unknown.

Jump forward to yesterday when Cassie said: “I have hope for next year. I think 2021 is going to be a more hopeful year. A better year.” She went on to suggest that we set some goals as a couple for next year and for each of us individually as well. She said she might even share her personal goals with Dan.  

We will leave the sharing of our couple’s goals for another day (after we actually know what they are) but for today we find ourselves grateful for the gifts of adaptability and resiliency. The brace is as uncomfortable as ever but it now comes on without tears or hyperventilating. We are learning what we can and can’t do. We are tailoring our days differently. We are even figuring out how to nap with the damn thing. 

We are adapting and that gives us hope.

Too Much

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“I don’t want to do today. Can we just fast-forward past it?”

Those were Cassie’s first words this morning.

And they make so much sense. Of course she doesn’t want to “do today.” She’s reached the point of beyond too much.

  • A Metastatic Breast Cancer diagnosis was too much.
  • Being told she might only have 5-6 years to live was too much.
  • The extreme fatigue from the cancer medications was too much.
  • The pandemic was too much.
  • The summer murder of George Floyd was too much.
  • Four years of Donald Trump and his hateful racist politics was way too much.
  • Recurring back pain from a herniated thoracic disc was too much.
  • Learning she might be paralyzed if she doesn’t address the disc/spine issues was too much.
  • The seven and a half hour back surgery was too much.
  • Being alone in the hospital post-surgery because of Covid was too much.
  • The first four weeks of excruciatingly painful recovery and little to no sleep was too much.

And that was all before Tuesday when we learned that Cassie’s back isn’t healing correctly. That there is too much pressure being placed on the new bolts in her back. That her Mayo doctor is very concerned. That she has to wear an incredibly restrictive brace (it looks like some sort of medieval torture instrument) sixteen hours a day for at least eight weeks!

We don’t list all this out by way of complaining. We share it because at every step we said to ourselves. “It’s too much.” And then Cassie would always say: “But it doesn’t get to be too much.” So what do you do?

How do you handle life when too much doesn’t get to be too much. When you feel so overwhelmed and hopeless (even always optimistic Dan) you don’t know how to move forward but you know you have to?

For us it starts with remembering that as bad as this is, others (many others) have it even worse. We have support (thank goodness for Cassie’s parents right now), health-care, resources and a home we love that serves as a refuge. None of this diminishes how hard this is but all of it makes it easier to navigate the hardness.

We are trying to lean into kindness. To each other and to others. We can’t do a damn thing about Cassie’s pain and discomfort but we can keep expressing our love to each other (more daily kisses and hugs — but watch that back!) and we can keep trying to send goodness and love out in the world. That we can do. 

We are trying to adopt a “beginner’s mindset” when it comes to Cassie’s back and living with this damn brace. What can we learn from yesterday that might make today just a little easier? What hack’s might make the brace just a little more comfortable? How can we kill time together when reading and even watching TV are basically out? How do we stay more present than usual with each other (maybe Dan stops checking his texts and emails as much because that’s an activity not available to Cassie right now and it creates an imbalance)? How do we navigate the day with an openness to trying new and different things even if most of them don’t wind up actually improving Cassie’s situation?. 

Finally, we are desperately trying to stay focused on today. Not the eight weeks in front of us. Not the fact that when Cassie eventually heals from her back surgery she will still have Metastatic Breast Cancer. We are trying to avoid “future-tripping” as Dan’s brother often says and just deal with what’s right ahead of us. For now that might mean some days where the best we can do is endure. Since we can’t hit “fast-forward” we just have to be in it. 

Yesterday, Dan’s therapist shared a poem at the end of his session. It’s called “Start Close In” by David Whyte and the first stanza spoke to both of us:

Start close in,

don’t take the second step

or the third,

start with the first

thing

close in,

the step

you don’t want to take.

So that’s what we are doing since too much doesn’t get to be too much. We are starting close in. Together.

Surrounded

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To say that our anxiety level (like many people’s) has been high these past couple of weeks would be a dramatic understatement. There’s been our normal anxiety of living with Metastatic Breast Cancer. The unfortunately “now” normal stress of living in an ever-lengthening pandemic. The anxiousness and fear leading up to the election and the unbelievable anxiety on election night and the days that followed. 

On top of all of that, we also knew that we had Cassie’s impending back surgery awaiting us on November 12.  What truly put us over the top anxiety-wise though, was learning that Cassie has to go it alone in the hospital. Thanks to the recent Covid spike, Dan can’t be in the hospital at all — not before, during or after the surgery. No matter what. No exceptions. So that sucks.

We started to process this latest curveball (see our last blog post for more on those) on our drive home from the Mayo Clinic where we had been given this crappy news. We both felt our chests tightening, our throats drying and our heads throbbing. One or the other of us kept audibly sighing. Dan can’t bear the thought of Cassie waking up alone in a strange hospital after a really long and risk-filled surgery. Cassie hates the idea of Dan not being there and worries about him at home in Saint Paul while she spends what could be a lot of days in Rochester. Our anxiety rose. Our fear was palatable.

At the same time, we also recognized that we are actually becoming pretty adept at living with anxiety. That’s what life with Metastatic Breast Cancer means and requires. As we talked, and looked back over the past couple of years, we realized that we’ve adopted a couple of informal rules or practices for anxiety/stress management that help us deal with the stress together as a couple. 

  • Rule 1: Name the anxiety. That helps take some of its power away. 
  • Rule 2: Create room for the anxiety because it’s not going anywhere. That means slowing down, letting other things go, being gentle with ourselves, and asking for help (to be clear all of these are still a major work in progress for both of us). 

Now, as the stress around Cassie’s imminent surgery piles on, we’ve identified a third practice that we have been exploring.

  • Rule 3: Surround the anxiety. While we can’t make the anxiety go away we can decide what to put around it that might make it easier to live with and get through each day (and night). For us, we decided to surround our newfound stress with love and gratitude. That has looked like hugging each other more, spending more time with friends, checking in even more regularly with family and sharing our gratitude with each other and our support community. 

These little acts of love and gratitude don’t mitigate the anxiety but they do provide a nice accompaniment. It’s kind of like when we used to do a beer chaser with a shot of booze in our younger days — it didn’t make the shot taste any better but it sure helped it go down easier. OK, maybe that’s an imperfect analogy but hopefully you get our meaning. 

Cassie’s surgery is Thursday and even as we remain scared shitless we continue to surround our fear with love and gratitude and for us, right now, that’s helping.

Curveballs

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We are both big baseball fans. The Twins and the Cubs are our favorite teams and we are more than a little heartbroken that they both had early exits from this year’s playoffs (though given that the Cubs won the World Series in 2016 and then Trump won, maybe their early loss this year is a good thing?) 

Dan’s dad was a HUGE baseball fan. He often used to say that baseball is a great analogy for many parts of real life. That observation has felt especially relevant to both of us recently. 

They say that the hardest act in all sports is hitting a baseball. It’s hard to prepare yourself for the different pitches because you never know what’s coming. Fastballs are probably the easiest to hit but then there is that damned curveball.

We’ve been talking about curveballs a lot lately. It seems like each time we feel that we are beginning to settle into a groove with this whole Metastatic Breast Cancer thing (learning to hit the fastballs) along comes some new crazy curveball.

The latest unexpected curve doesn’t even have anything to do with Cassie’s cancer. About a year ago, she began to experience bad pain in her back. After ruling out further cancer metastasis, it was diagnosed as a herniated thoracic disc. While it’s pretty uncommon to have a bad disc in that region of the back the doctors still thought it would cure itself as do most similar injuries.

Well it didn’t. The pain has only gotten worse and after a number of further consultations, and a second opinion at the Mayo Clinic, the recommended course of action is surgery. Yes, even surgery for someone with Metastatic Breast Cancer. It’s suggested because the risks of NOT having the surgery are potentially severe including what the doctors termed “a real possibility of paralysis” if we don’t act. 

And of course it’s not just any surgery. It will be a complicated procedure likely necessitating multiple days in the hospital and a long and hard recovery. So once again we feel like we have been hit by a truck, or rather to torture the baseball analogy, like we have been hit in the head by an errant curveball. We are worried and frightened. We feel isolated (thanks Covid) and overwhelmed. We keep saying “enough already” and it’s “too much” but then one of us always says — “yeah but it doesn’t get to be too much” and we just have to deal.

So that’s what we are trying to do. Even though, like almost everybody else in the midst of this pandemic and election season, we are exhausted and depleted. We don’t get to pick and choose the curveballs that come at us, we only get to decide how we react to them. To us that means remembering that every day we get to make a choice between hope and despair. Most days we choose hope and we move forward. And on the days that we can’t choose hope, where it all just feels too overwhelming, well on those days we remember that we get to make the same choice all over again the next day.

This latest curveball sucks. The surgery is going to suck and the recovery will probably suck as well. But all that said, we choose hope because that’s the only bat that will allow us to hit this curveball and the next. And who knows, a little more hope may even get the Twins and Cubs back to the World Series one of these days. 

What Cancer CAN’T Take Away

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Recently we learned that Cassie’s cancer has started to progress. Not a lot at this point but definitely the wrong direction. Upon hearing that news, we felt like we had been punched in the gut all over again even though we both know that this is just the deal with Metastatic Breast Cancer. It’s unrelenting. 

We realized right away that it would be easy to fall back into a complete sense of sadness and grief for what we are going through. Not surprisingly perhaps, in Cassie’s metastatic cancer support group that week the subject turned to all that the women in the group have lost and all the ways their lives have changed. One woman spoke up and said at this stage of her illness, she is more focused on what her cancer can’t take away.

We decided that might be a good exercise for us, too. . . . . 

What cancer can’t take away

Craft cocktails 

Stylish shoes 

Delicious wine

Corny jokes and laughter (“Woman walks into a bar. Bartender says what are you having? She says — A Corona and Two Hurricanes. Bartender replies: That’s 2020!”)

Playing games

Time with our friends (even if six feet apart)

Walks with Doc the dog

Grilling good food

Zoom poker

Celebrating milestones 

Bloedows donuts (go to Winona and check them out they are seriously the best)

Sunsets over the river 

Family zooms

22 years of marriage full of love

Death Plan

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Observation One:  We are planners. Both of us. We like order, clarity, direction and very few things get us as excited as a detailed timeline or a successful couples “scheduling meeting” where we plot out the days and weeks ahead. 

Observation Two: Since Cassie’s metastatic breast cancer diagnosis we’ve both become a little consumed by death. How can you not when the median five year survival rate is less than 30% and you’ve been told probably not to expect more than 5-6 years? We’ve written about this before in a 7/2/19 post titled “A Focus on the End” and more recently in December 2019 in a post called “A Rabbi, A Death Doula and Mr. Rogers.” 

When you combine these two observations it might be natural to think, as we did, that creating a “death plan” for Cassie wouldn’t be that much of a challenge for us. Sure, we knew intuitively that it wasn’t going to be easy because talking about death is one of the furthest things from easy that you can imagine. However, at the same time, we thought that once we had accepted the importance and value of death planning we would just get it done. We were wrong.

We waited, procrastinated, avoided it and then finally gave ourselves a deadline. Then we blew right by it. One of us as a time would remind the other and we would commit anew, only to revert to procrastination mode. Then one day it was done. Cassie sat down and batted it out. She created a Google doc and just started writing. Afterwards, she told Dan that it was done and we scheduled time to go over it together. And waited and delayed and rescheduled and rescheduled again. Dan was scared and sad. He didn’t want to see what Cassie had written even though he knew it was important. Cassie wanted to share what she had come up with but also really understood Dan’s hesitation. As we’ve said before, this shit is hard.

And then we did it. We sat down together while we were in California on a nice, warm sunny day (that helped) and talked it through. First, though, we agreed that it was very much a draft plan AND that even though it was Cassie’s death plan it had to “feel right” for both of us. We talked in advance about how something might feel right to Cassie but not to Dan and agreed to be patient with each other and really try to listen and hear what the other was saying. It’s complicated because of course the wishes of the person dying (or who you think will die first) matter most, but it’s the other person who will be experiencing the results of the plan — being bedside in the final days, reading the obituary, sitting through the funeral, greeting friends and family. Like many (most) things in marriage it had to work for both of us. 

It turned out the dreading and procrastinating was probably the hardest part. Dan looked at what Cassie drafted and asked a bunch of questions. We explored different possibilities, clarified a number of things and made some changes. Then we hit save and it was done. We decided to sit on it for a while and then give it another look before “locking it down” which we have now done. That said, we also agreed that we can revisit it over time as Cassie’s cancer progresses but for now at least we can rest more easily knowing that we have answered a lot of the big questions … for Cassie. 

You see, we’ve also agreed that we should now do the same thing for Dan even though he doesn’t have a terminal illness. When Dan’s dad and mom died one of the few things that made those sad days easier was that they had shared some of their wishes in advance. The death doulas who led the community education class we took late last year made the same point — you might not get the death you want but you certainly won’t get it if you don’t plan for it and instead leave everything to chance. 

So Dan’s plan is next up. To make that a little easier we took the questions we answered for Cassie (many of which came from our death doula class) and created a little planning worksheet (see observation one above). We’ve attached it to this post below in case it might prove helpful for anyone else who wants to tackle a death plan BUT we want to really emphasize that we are not experts nor trying to tell anyone what they should do. ( Death Plan Work Sheet.August 2020.) These are simply the main questions we asked ourselves as we contemplated Cassie’s death and that we will now wrestle with again as Dan creates his plan. That is after we finish the current round of waits, delays and procrastination. 

Dance Moves

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Before we got married we took dance lessons. From a local Arthur Murray studio. Private lessons because, at that time, there was no way in hell Dan was going to learn to dance in a group setting. Cassie loved the lessons. Dan hated them. And he didn’t hide it. Often he would “escape” to the bathroom for a break and Cassie would end up apologizing to the instructor for Dan’s grumpiness. The instructor, who was really good-natured through all of this, suggested we learn the basic dances – foxtrot, swing, waltz – over eight or so lessons. However, at our first lesson, Dan declared he only needed to learn one dance. The one that would best fit the song we had chosen for our first dance as a married couple. One dance only. In Dan’s mind, there was no reason to learn other dances when the sole purpose of these lessons was to get us prepped for the one big dance.

We share this because recently, at a socially distant dinner with friends in our backyard, we were discussing how families change when a kid goes off to college. One person said that when her oldest left it was “like the rest of the family had to learn a new dance.”  Before that, everyone knew their dance steps – their role in the family, But, when one family member was no longer home, they all had to adjust. Learn new steps, a new rhythm, a whole new dance. 

Cancer has forced us to learn a new dance. The music has changed at our house. We’ve each been required to take on different roles and to approach our lives differently — individually and as a couple.

Dan has become a caregiver. Cassie has become (or is trying to become!) a “caregetter.”  Cassie’s new moves include patience, asking for and accepting help (the accepting part is an exceedingly complex and difficult dance step). She has had to practice doing less and sharing more which, for an intensely private person, is like learning to dance without any music. Dan’s had to learn to notice and do more, read Cassie’s energy level and he too has had to practice asking for help and support from friends and family which for him is also not a natural move. New communications challenges have also emerged. Dan is learning (duh) that he can’t encourage Cassie to let him do more and then be resentful when she does. Cassie has had to work on not taking her anger at the cancer out on Dan. New moves abound.

So how do you learn new dances on the fly with no lessons? While we both have received valuable support in our new roles thanks to Firefly Sisterhood and Jack’s Caregiver Coalition, we are finding out that we mostly have to teach ourselves. Try on these new roles. Plan new activities and don’t abandon them right away if they feel a little awkward. Stumble through uncomfortable exchanges and conversations. As we navigate living with metastatic breast cancer, we are learning to dance all over again and this time it’s not just for one song — it’s for our entire lives.