The Big Picture

Yesterday a friend posted this quote on Facebook. “Begin with the end in mind”. His professional life includes project management and he was using it in that context but it turned out to be a well-timed quote for my cancer battle.

Today I headed back to Sydney for an ultrasound. My last trip to the oncologist was encouraging. She felt the cancer was softer and smaller and today was about checking that and seeing my surgeon again.

I was excited about the ultrasound. I was hoping to see some change and even allowed the possibility that there might be radical change. Wouldn’t that be great.

But the ultrasound shows all of the tumours are still there. According the the doctor at the imaging centre, they haven’t changed substantially. They may even be slightly larger.

Begin with the end in mind.

If you’ve been down the path of chronic illness before, or accompanied someone else on that journey, you know about the risk of the emotional roller coaster. It’s tempting to latch onto the good stuff, to give it too much emphasis. It’s dangerous to obsess about the bad staff and to allow it to feed your fears. Some people swing from their certainty that they are going to be suddenly cured to their despair at results that lead them to conclude that they are surely going to die.  Neither of these is ever true. One result is just one result. Attach your emotions to every single result and you’ll be exhausted.

When I get good news I’m cautiously optimistic. I’m grateful for the good news and the fact that I can use it as a sign that my treatment is working. When I don’t get good news I’m pragmatic about it. It’s the nature of this illness to be difficult to treat. Sometimes things don’t respond as quickly, or at all. It’s okay. We keep trying. We keep going. Sometimes it’s a case of two steps forward and one step back. It’s not over until the cliches are exhausted!

When I get any results I remind myself that it’s important to keep my eye on the top of the mountain, and not at the various places I stumble along the path. Fighting cancer is not about one test result, one treatment, one appointment. This is a long slow climb and some days you just have to put your head down and keep going. Nobody is going to climb the mountain for you.

On a really good day you’ll have a bit of a break from the climb and you’ll get to enjoy the view. You get good news, you measure your progress and then you put your head back down and keep climbing.

My ultrasound result is not what I wanted, but it is what it is. My surgeon wasn’t particularly worried about it. There’s still time. Let’s keep going. She agrees with my oncologist that, in spite of the ultrasound, my cancer looks and feels smaller. In terms of treatment, beginning with the end in mind means staying focused on getting well, and an appreciation that it’s likely to be a reasonably lengthy process.

I think it’s also important for me to imagine my life beyond cancer, to have a clear idea of what it will feel like to be well again. This is another way of beginning with the end in mind. I need a clear, well imagined visualisation of myself as a healthy person.

When I see people with chronic illnesses that fail to take the advice of their medical team I’m always shocked.  They seem to choose poor health over being well. Why do they pay highly qualified medical professionals for their advice, only to ignore it? I wonder if, for some people, their illness has benefits that they don’t want to give up. Perhaps it pays dividends in sympathy or allows them to avoid responsibilities that they would be obliged to assume if they were well. I can see how this could happen. At the moment I have no responsibilities other than healing my body and doing as I please. I suspect that chronic ill health is potentially seductive.

I don’t want to suggest that any sane person would want cancer, or that they would resist being cured, but it certainly is nice to spend some time just doing whatever I feel like, without any of my usual responsibilities.

If only I didn’t have cancer!

For me, it’s important to hold an idea of myself as a well person going through a temporary illness. I want to come out the other side of this in better health than I was when I went in. I want to live a long, healthy life without chronic illness. Begin with the end in mind.

There’s also another ‘end’ that I think it helps to keep in mind. Death.

I know a lot of people find it very uncomfortable to deal with and most people certainly don’t think a discussion about death has anything to do with staying positive. I disagree.

When you spend time working as a police officer, as I did, you see a lot of death. In particular, you see a lot of random, accidental death. You really do get a good appreciation of the possibility that any of us, at any time, could suddenly find ourselves the victims of a freak accident, a natural disaster, an act of violence or some human-made trauma. Life is fragile.

Some Buddhist centres teach a meditation on death. They believe that we cannot live a happy life until we acknowledge two facts; firstly, we will die, and secondly, we have no way of knowing the moment of our death. I understand the sense of this. Live as if you will live forever and you’ll probably keep putting off your heart’s desire. You’ll fill your days with functional things and ‘go with the flow’.

They say that nobody is ever the same after cancer. I think part of the reason for that is that, if we haven’t already done so, we are forced to confront our own death. At some point we need to deal with the reality of cancer; this could kill me. At the start of this journey, that was a statement I made, or thought, with considerable dread. I was terrified. This could kill me!!! At some point the terror subsided and now I can say, very calmly, that I understand that this could kill me.

Or I might have a stroke.

Or a heart attack.

Or something else.

The only thing I can really be absolutely sure of is that I will die. One day. And that’s okay. Because knowing that means that I appreciate every single day of my life so much more. This is the main event. There is no dress rehearsal. I am going to die, but probably not today.

Am I going to die of cancer? Honestly, I don’t know. I know I’m going to do everything I can to stay alive and to be healthy. I know I’m going to keep following medical advice, imagining what it will be like to be well and doing everything I can to support my recovery. Will I still be here in six months? I don’t know. But when wasn’t that true?

When you confront death you either come away happy with your life and the choices you’ve made or determined to change things for the better. Both are great outcomes.

Of course my life is not without regrets. Roads not taken, things not said. Things I wish I hadn’t done or said! I’m human. We make mistakes. We move on. We learn to let go of the past and to be gentler and kinder to ourselves. Regrets aside (and ‘aside’ is surely where regrets belong) I’m very fortunate to have lived the kind of life that I’m proud of. I’ve been true to myself, I’ve done things that were important to me, I’ve made a positive difference in the world, I’ve loved with all my heart, I’ve built wonderful relationships, I’ve trodden lightly on the earth, I’ve raised a child to be an amazing adult and I’ve made a garden.

I suspect that my approach to life is due, at least in part, to confronting death when I joined the police force. I am so grateful for that lesson. It’s allowed me to focus on what really matters. For me, that’s been about the quality of the relationships I have with other people, the good I can do in the world and the joy I can share with others. I’m planning on doing a lot more of that.

Begin with the end in mind.

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