Resolutions, Reflections and Such

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Like many, we have a long and complicated relationship with new year’s resolutions. For years we made and promptly ignored them. Then we simply ignored making them. There was a good multi-year streak when Cassie’s annual resolution was to “drink more sparkling wine” and Dan was all too happy to tag along with that one. Finally, because he is prone to over complicating things, Dan developed a tradition of starting to think about a resolution on New Year’s Eve and then adopting it by the end of the first quarter and letting it run for the next year. That approach actually seemed to work for a while as Dan focused on things like being less judgmental, more grateful, choosing without regret, etc. 

Last year following Cassie’s diagnosis, we simply let NYE pass without giving thought to resolutions. We were just trying to hang on. During this past year though we have learned that our life now requires a much higher level of intentionality. That can look different for each of us. Dan tries to set a daily aspiration. Cassie focuses on intentionally slowing down. We are checking in with each other more often and adjusting our schedules and plans on the fly. We have also talked about maybe needing or wanting a “theme” for our year to anchor us and provide some direction or sense of purpose for the year ahead.

So whether you call it a resolution, reflection, aspiration or theme here are a few things we are thinking about for the coming year.

  • Embrace a sense of adventure and all that comes with it — the excitement, fear, anticipation and the unknown to name just a few things.
  • Lean into gentleness — for us each individually and together as a couple. We aspire to “radical self-acceptance” but even just a little more self-gentleness will be good.
  • Ask for help/accept help. We are so lucky to have a loving support community and we can let them in even more.
  • Slow down.
  • Be generous.
  • Don’t wait.
  • Have fun.
  • Drink more bubbly. 

Happy New Year!

 

The Holidays

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This is our second holiday season since Cassie’s diagnosis. Our first one, last year, did not go all that well. Like most families we have our share of holiday traditions. Parties we attend. Celebrations we host. Silly sweaters we wear. Foods we love. Foods we quibble over (like Dan’s annual attempt to update the old fashioned green bean casserole at Thanksgiving). Gifts we send. On and on. 

Traditions are good. They are something to look forward to. They’re fun. They anchor us and provide comfort. So last year we didn’t really change a thing. We did it all. Actually, we did even more as we raised the bar on ourselves by adding new dishes to some meals and cramming in new events between Thanksgiving and Christmas. We thought that we had better pack it all in because “who knows what next year will bring or how Cassie will feel?” It was too much.

To be clear last year’s holidays weren’t horrible. They just didn’t turn out as we had expected. Of course it was great to spend time with family and to see friends and without question the food was delicious (well not the “new” green bean casserole but everything else). It was just that we really wiped ourselves out and for the first time in our lives together we couldn’t wait for the holidays to be over. We were also so busy (and Cassie had so much less energy) that we wound up being disconnected at different times as Dan tried to compensate all on his own for Cassie’s diminished capacity. Finally, we came to realize that last year we had inadvertently made ourselves really sad. That’s because we had set up a direct comparison between the way all of our traditions used to feel (pre-diagnosis) and how they felt in our first set of holidays post-diagnosis and that turned out not to be a good comparison. 

We have subsequently discovered that having hard holidays is pretty common for couples wrestling with a terminal cancer diagnosis. We have both heard lots of stories in our support groups and discussed it during therapy. One wise person observed that you have to go through “all of the seasons” to truly understand how much everything — every holiday, occasion, anniversary, tradition, etc. — has changed. 

So now we’ve been through all the seasons, and while we still have lots to learn, we are approaching this year’s holidays differently. We are creating some new traditions for our “new normal” so that we are no longer making side-by-side comparisons to the way things used to be. We are doing less and asking for more help. We are building in down-time. We are checking in with each other often and altering plans as necessary to stay healthy and connected. We are trying hard to appreciate these holidays for what they are and for all that we have right now and not look backwards with nostalgia or forwards with angst. It still feels really different but at least so far it’s a lot better than last year and our hope is that along with our ever-present sadness we are also creating room for some holiday joy to return. Oh yeah and this year’s re-imagined green bean casserole was better too so we have that going for us, which is nice. 

A Rabbi, a Death Doula and Mr. Rogers

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When Dan’s mom died this past May the Rabbi at her St. Paul Shiva shared an interesting observation. He explained that Jews traditionally avoid euphemisms like “passing” or “moving” on. They speak directly of death and dying. Now the Rabbi wasn’t being critical of other faiths or traditions he was just noting that death is certain and unavoidable and that confronting this certitude directly and head on can actually be healing. 

This was affirming to both of us because we had already started to do this. As we shared in a previous post, Cassie was a little obsessed with planning the details of her death, burial and funeral and we have been doing that in fits and starts for almost 14 months. There is also a lot of dark death humor in the Cramer household these days. And while this often takes our friends aback, it helps us to talk and joke about it. This is our life now and while hopefully still many years off —the previously abstract and far-removed idea of death has been replaced by a new and more immediate reality. Death now seems closer than we would ever want or have imagined and we just have to deal with that fact.

So with all of this on our minds, Cassie signed us up for a Community Education Class called “Death: It’s a Collaborative Event.” We walked into Central High with some trepidation but also open to what we might learn. And we learned a lot. First though, we were a little surprised to find that the class wasn’t filled with people like us who were confronting what could be the imminent death of a loved one. Instead it was attended by people who were seeking to better understand death and how to navigate this one great certainty that we all confront. 

The class leaders, a “death doula” and a celebrant (who helps create traditions and lead ceremonies) explained that we can “have the death we want” but only if we talk about it and plan for it. They led us through a visualization asking us to picture our final days. The room we are in. The way it looks and smells. The art on the walls. The photos by the bedside. The music playing. What surrounds us? Who surrounds us? Is someone with us all the time or do we want to be left alone at some moments? Have we written goodbye letters? Recorded video? Have we put ourselves in a position where we can let go? Are we set up to die on our terms or are we leaving all that to chance?

We sat there with our eyes closed imagining all of this. We reached for each other’s hand. We cried. But we also appreciated the questions and the conversation that followed. The biggest piece of advice — create a death “plan,” write it down and share it with our loved ones. Now on the one hand that seems hard and scary but on the other really liberating. So that’s what we are doing — together, one plan for each of us, and we have given ourselves a deadline so we can be done with the fits and starts and focus our energy on living. Then as a final affirmation, we learned that even Mr. Rogers talks about death. We recently saw the new movie “A Beautiful Day in the Neighborhood” and both walked away with a Fred Rogers’ quote about dying stuck in our heads: “Anything that is human is mentionable. And anything that is mentionable can be manageable.” Even, or especially, contemplating death. Thanks Mr. Rogers, Death Doula Jane and Rabbi Latz for the inspiration.

 

A Gratitude Post

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We are grateful for…

  • Macaroni and cheese
  • Friends who listen
  • Good health insurance
  • Snow (this one is all Cassie)
  • Laughter and hugs from our nieces and nephews
  • Long walks
  • A cuddly basset hound
  • Jeopardy (especially the episodes with James Holzhauer)
  • New restaurants and dining experiences
  • Good books
  • Dumb jokes
  • Red wine (OK, white and rose too)
  • Holiday parties
  • Caregiver support (Jack’s Caregiver Coalition)
  • Caregetter support (Firefly Sisterhood)
  • A superb oncology team
  • Soft blankets
  • Colleagues who have your back
  • So many good local breweries
  • Clarity about what matters most
  • Sweat pants
  • Winona
  • A crackling fire
  • Exceptional therapists
  • Binge worthy television
  • The Highland Grill
  • DB
  • Brothers and sisters
  • Parents
  • Turkey and stuffing
  • Things on the calendar to look forward to
  • Enduring love

Resilience

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Today Doc got his tail caught in a door. Dan was taking him for a walk and heard him yelp but didn’t notice anything wrong and assumed the door had just banged on him a little. He finished the walk and left Doc at home as he headed out to meet a friend for breakfast. Cassie was already out having breakfast and preparing to go to her favorite exercise class.

Then Cassie got a text. It was our cleaning person, Emily, expressing concern about Doc. She said there was blood everywhere. The house looked like a crime scene. Doc’s tail looked cut but Doc wouldn’t let her near him. Cassie rushed home calling Dan as she drove. We were both really worried.

The house was as reported. Blood on the carpets. Blood on the sofa. Blood all over Doc. Emily told Cassie she had been so worried when she walked in that she looked all over to see if we were ok. We were — Doc wasn’t. He was crying and still bleeding. Cassie called Dan on her way to the vet and he literally came unglued. She couldn’t understand a word he was saying as she sought to learn what had happened. He was sobbing, the dog was whimpering, Cassie was driving fast. It was a little chaotic to say the least.

After the rapid trip to the vet Doc now has a long pink bandage on his tail and is drugged out of his mind. There is some concern about whether he will fully heal and if not he will have to have the tip of his tail removed. Poor guy. 

Now unexpected things like this happen all of the time (though thank goodness this particular one hasn’t happened before). Historically when things arose we would just deal (just as Cassie did today) and then move quickly on. We have long prided ourselves on being pretty good in challenging situations and even better in a genuine crisis. Now though, following Cassie’s diagnosis, things like this knock us on our heels. We cry more easily. We worry more. We obsess in ways we didn’t before. We overreact. We catastrophize. Today it was about Doc. Last week it was a challenging work call for Dan. The week before a hard series of events for Cassie. What we are noticing is that we simply aren’t as resilient as we used to be. We are raw. Most of our energy goes to getting through the day and trying to stay as positive as we can. So when something unexpected and hard arises that extra gear we used to rely on isn’t as easy to access or maintain. Recognizing this lack of resilience helps. Naming it is even more important. And the best antidote we have found is to slow down and be gentle — on ourselves and each other (and on Doc).

Owning Your Own Story

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It is so easy to take on other people’s bad news and transfer others’ suffering to your own life. Someone else’s cancer spreads to their central nervous system. The wife of someone in a caregiver support group has a bad scan.  You get a blog update that describes another MBC patient’s significant disease progression. Or a blogger you follow stops posting altogether because they have died. And you think, “we’re next.” 

We’ve learned that taking on others’ experiences as our own leads us nowhere good! It is so easy to end up in a downward spiral and in a puddle of extreme hopelessness. But, as Kelly Grosklags, an oncology psychotherapist who spoke at the recent Midwest Metastatic Breast Cancer conference, reminded us: “Those are not our stories.”  We can feel empathy and concern for others without taking on their experiences as our own. Their story is not our story. Our story will be different from everybody else’s. All of us dealing with metastatic disease will experience the illness in different ways. The ups and downs. The test results. The side effects. All are unique to our situation. Our story is our own.

We found that bit of advice — to own our story – to be extremely helpful. Not just in dealing with cancer, but in living life. How many times have we heard a piece of bad news and taken it on as our own? Too many to count and it only leads to more anxiety, fear and dread.  So now we are committed to listening to the stories of others and empathizing with their experiences but owning only our own.

Caregivers Have Feelings Too

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Last weekend Dan and I, along with my parents, attended the Midwest Metastatic Breast Cancer Conference. It was interesting and we learned a lot about medical research, clinical trials, palliative care, integrative health, and advocacy and got to connect with others living with MBC. Dan co-led a session on being a caregiver and that, combined with some thinking I was already doing, has me reflecting on the role of caregivers. 

The life of a caregiver is tough. Always putting the needs of the “care-getter” above their own. Sacrificing personal wants and needs for the other. And sometimes minimizing their own emotions and feelings of sadness about their loved one’s illness in order to keep a brave face.

As a care-getter with an amazing caregiver, I need to remember how hard this is for Dan. My cancer affects him deeply . . .And, he is allowed to show it. To others and to me. 

For the last couple of weeks, I’ve noticed Dan feeling more down than usual. He was going about his day-to-day life, but I sensed an unusually deep layer of sadness and discontent. Kind of one of those things that when I was healthy I’d wonder whether I’d done something to piss him off! But this time I heard the voice in my head saying: “Of course he is sad, his wife has a terminal illness.” Dan’s life has been turned upside down. Much of what we had hoped for and expected from our lives together is different now. 

It is interesting to experience how our relationship has changed since the early days of my diagnosis. Moving from “deal” mode, to settling into the ongoing reality that this is our life now. 

How do I as a care-getter support my caregiver? Can our roles ever switch back and forth? I’ve been trying to encourage Dan to do things that are fun for him and that don’t necessarily include me. However, he is often hesitant to do that because he wants to maximize our time together. But self-care for both of us is now more important than ever. How do I help him with his? Is there a way for us to have days where we step out of our caregiver/getter roles? Maybe not but perhaps we can redefine those roles to fit where we both are and what we both need right now. 

The Shallow End of the Swamp

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It’s been roughly 15 months since Cassie was diagnosed. In that time, we have learned that one of the most challenging things is balancing conflicting realities. For example, on many if not most days, Cassie feels pretty crappy (not that you could tell by looking at her but that’s a whole other blog post). She’s got far less energy than she had before — a third less on a stellar day — her joints hurt and she often just feels what we have come to call “ooky.” It’s a pretty crummy way to have to live but it’s Cassie’s reality.

Another reality is that this period of time, right now, in the years immediately following diagnosis likely represent the best that Cassie will ever feel again. This is it. We are in the MBC “glory days.” On the top floor. In the rose garden of terminal diagnosis. This is as good as it will probably ever be and that’s a reality too.

So you put those two realities together and it can make your head spin. Cassie feels pretty crappy. This is the best that Cassie will ever feel. WTF? 

Dan was talking about this in therapy a while back and his therapist got it right away and said: “Yeah you are in the shallow end of the swamp.” That framing immediately resonated with both of us. We are most definitely in the swamp and the swamp sucks. There are metaphorical snakes and alligators and bugs and it’s hot and unpleasant. But in the shallow end you can still move around and occasionally find dry land. You can navigate and get some relief. For us, being in the shallow end of our cancer swamp means that’s Cassie side effects are pretty minimal. That she can still drink wine and travel and that we do a lot of the things we enjoy, even if we have to do them differently than before.

When we think about being in the shallow end of the swamp it’s not the same as saying that our glass is “half-full” (nothing about this glass is good). It is more about acknowledging that our  realities don’t have to be in tension. Both are true. We also have a choice. What are we going to focus on each day? The swamp and how shitty that is, or the fact that we are not yet in the deep? On good days we remind each other that we are in the shallow end and try to take advantage of it. It’s not easy but right now it’s the best we’ve got.

All Too Real and Surreal

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  • Real. Re·al. Adjective: Actually existing as a thing or occurring in fact; not imagined. Real is used when a thing is what it appears to be. 
  • Surreal. Su·re·al. Adjective: Marked by the intense irrational reality of a dream. Also unbelievable. 

For both of us, last Saturday night was equal parts real and surreal. We were attending the second annual “Metsquerade” Ball sponsored by Metavivor — a nonprofit organization dedicated to increasing awareness of advanced breast cancer and equity in research. It was in downtown Minneapolis and we Ubered over thinking we might need a few glasses of wine to get through the evening. 

Now we have both been too a lot of fundraisers. Cassie is a nonprofit fundraising professional and Dan has helped raise money for many candidates and causes. We’ve hosted, sponsored, promoted, and attended more events than we can count but Saturday night was the first time that we’ve been to a fundraiser where one of us was the subject of the appeal.

Two times during the event, Cassie was called to the stage with the other “thrivers” who were in attendance. (MBC patients refer to themselves as thrivers not survivors because, for now at least, survival isn’t a possibility for this terminal disease.) The first time on stage, Cassie looked out at the packed room while a modern dance troupe performed and then each “thriver” was presented with a rose. The second time was for the In Memoriam section of the program which took place while the singing surgeon (yes that’s for real you can google him) sang “Rise Up” and images of those who have died filled the screen. It was all incredibly emotional, and as Cassie got back to our table with tears in her eyes, she said “I don’t like this one bit.”

The rest of the evening was equally emotional. We honored a ferocious local MBC advocate, heard from the volunteers who tirelessly organized the event and raised a significant amount of money for metastatic research. That last part is sorely needed as less than 5% of all money raised for breast cancer research goes to MBC even though 30% of women diagnosed with breast cancer will eventually see it metastasize. When we first learned of this disparity we were shocked and we now want to do our part to support organizations like Metavivor that are committed to narrowing the gap. As an aside, if you are interested in a first-hand account of this research disparity issue check out this local news story (https://youtu.be/TN7QfNcediA) featuring our friends (and Saturday night table hosts) Kim and Dustin Cesarek. 

As the event progressed, we were both overcome. It was impossible to ignore the fact that one day it will be Cassie’s image on the screen being remembered and that is as real as it gets. At the same time, it was all very surreal. We still have trouble believing that this is now our life and how much everything has changed. We sat there squeezing each other’s hands immersed in the reality of the moment but still feeling an intense sense of disbelief. Then we went home and had another glass of wine.  

Birthdays

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Today I turn 52. Historically I have always loved my birthday. You can ask any of my friends and they’ll likely attest to my birthday zeal. I always looked forward to it, counted down the days, and usually planned multiple celebrations including the exact same birthday dinner year after year. This isn’t as self-absorbed as it probably sounds, as I also love other people’s birthdays. I think that all birthdays are special — warranting attention, love and gratitude.

This year though, as my birthday arrives, I am overcome with ambivalence. On the one hand, I am looking forward to spending the day with Cassie and seeing friends and family this weekend. On the other hand, I no longer want to mark the passage of time. Nor do I welcome the sense that the years seem to be speeding up. Since Cassie’s diagnosis, I feel like our relationship with time is changing. I want the years to move slower not faster. If we really only have limited years left I don’t want to acknowledge another one passing. I feel that with my birthday I can hear a giant clock ticking faster and louder and I want to cover my ears.

When Cassie and I were talking about this at breakfast yesterday, she said: “I guess birthdays are like everything else now — they’re different.” That seems right. We are living in a new normal and nothing is exempt not even birthdays or holidays (New Year’s Eve is another tough one when it comes to marking time). We still feel joy but it’s often more muted. We still celebrate but with a different lens. We still embrace gratitude but also accept what we have lost as our life has changed. We know we can’t stop time but we want to slow it down, day-by-day, as much as we can. 

This year, as I blow out the candles on the giant birthday cake that I always share with my niece Sylvia I won’t be wishing for the Cubs to win the World Series in 2020. I’ll be looking at Cassie and wishing for more time.