I had my third round of chemotherapy on Monday. It didn’t go as well as the previous two. I know why.

I started treatment with a really strong focus on doing everything I could do to support the process. I paid close attention to all of the advice I was given about caring for myself and minimising the side effects of treatment. I made notes. I wrote lists. I ticked things off.

Then I started to backslide.

I struggle to remember my mouth care. It’s not pleasant for follow a meal with a wash of carb soda, so I put it off and then realise when I get to my next meal that I didn’t do it.

I struggle to drink enough water. I thought I had this one sorted. Just fill a big jug at the start of the day and drink it all by the end of the day. Brilliant! Unless I somehow just don’t get around to filling the jug.

I became upset at an offhand comment my husband made and ended up in tears, lost a night’s sleep and then wondered if this might have something to do with menopause kicking in. (To be fair, what he said was unkind. Just so we’re clear.)

If you’ve read my post on breast cancer and alcohol you’ll appreciate my ongoing concerns about a nice glass of red. I made a commitment to never drink more than 200 mls in a night (a standard drink is apparently 100 mls but seriously, who pours that glass of wine?) and I also made a commitment to only have wine on the weekend, if at all.  I’ve broken that commitment twice. Once because I wasn’t thrilled with a test result and once because friends called by and it was just nice to sit and drink wine and feel ‘normal’ again.

I’m not doing nearly enough yoga or meditation. Daily means EVERY day! I keep forgetting to take my vitamin D.

I’ve over exerted myself a couple of times and even managed to pull a muscle in my shoulder moving some dirt around. I am not very good at resting or relaxing and I need to remind myself that eating to be polite is a bad idea when you’re feeling nauseated.

Today I woke up with an awful, phlemy cough! I’ve been so careful with hand wipes and hand gel and avoiding crowds but I don’t want to spend my whole treatment at home. Maybe it was the trip to a restaurant on the weekend, or the 20 people at the Buddhist class. Maybe someone in my family carried the germs home. Who knows! Off to the doctor for antibiotics so I can avoid the serious complication of neutropenia; when your white blood cells are low a mild infection can become life threatening very quickly. I’ll be wearing my in-ear thermometer like an accessory today.

I’m not beating myself up.

Backsliding is to be expected. Change takes effort and time. I’m breaking old habits and building new ones. If treatment is a mountain that I need to climb then slipping on the path occasionally or putting a foot wrong is no reason to give up.

I remember that when I worked in general duty policing we were sometimes called to the death of a person with a chronic illness. It struck me that many people died prematurely because they failed to properly manage their condition. I saw a young man in his 30’s, grossly overweight because he refused to manage his diabetes, and a woman with asthma that consistently failed to take her medication. Why? Why is it that we can have access to some of the best available medicine and medical advice on the planet and refuse to take it. Why is there a gap between knowledge and behaviour?

It’s a recurring theme for me. I also saw young people ruin their lives with addictive drugs, knowing the whole time that what they were doing was dangerous. It made me confront my own smoking (cigarettes, just to be clear) and the fact that I had all of the information in front of me to know the damage I was doing but continued to smoke in spite of it. Why?

You don’t just see this gap in policing. You see it everywhere. People that are chronically overweight that consistently fail to lose it. People that drink too much, or continue to gamble or smoke or participate in any other kind of destructive behaviour in spite of the overwhelming evidence that what they are doing is self destructive. Why?

One of the most destructive habits is self delusion. I know people that lie to themselves (and often to others) on a regular basis. They seem completely unaware that the rest of us know they are lying, and that not calling them on their lies is about being kind, or at least courteous, rather than a sign that we believe them.

So what are the keys to change? I don’t think it’s as simple as those self-help books that recommend the SMART method; they tell you that you should set goals that are simple, measurable, achievable, realistic and time bound. That’s a good starting point. Plenty to be going on with. But probably one step further on than where we need to start.

I think the keys to change start with how much we value ourselves and to what extent we believe we are worth the effort. Many of us treat our bodies like a car, forgetting that we can’t trade it in when it breaks down. Many of us don’t even treat our bodies that well. If your car gets a regular service and you don’t, you have to wonder about your priorities. We get one body for the whole of this lifetime.  How we look after it will have a huge impact on how well we live and how long we live.

I think an excellent test of self worth is to think about how we would treat someone we love in the same situation. If your partner, your parent, your child was treating themselves as you are treating yourself, how would you feel about it? Would you treat them the same way you are treating yourself? Why not? Don’t you deserve to be treated as well as you would treat them?

Another key is recognising that life is finite. “This is not a dress rehearsal” my wonderful sixth class teacher used to say, “This is the main event!”. We don’t have unlimited time to make changes and sometimes there’s no going back once a decision has been made.

My third key to change is about recognising that change requires effort. It’s human nature to slip back into old patterns. Our habits become our default settings and changing them takes more than just a decision. You need a process. You need to come up with a way to shift your behaviour from how it used to be to how you want it to be. In management you learn various cycles for improvement. My favourite is PDRL (there are many variations) which stands for Plan, Do, Review, Learn. It’s drawn as a circle. Once you learn, you revise your plan and around you go again. The great thing about these models is that they incorporate backsliding, mistakes, miscalculations, errors in judgement and the unexpected. That’s a great lead in to my next key.

My fourth key to change is permission to stuff up. Our culture is mistake averse. In school we get humiliated when we make a mistake. For some people, their parents reinforced this. When my daughter made a mistake growing up I would reassure her. She was ‘still learning’ and never punished. Discipline was reserved for dishonesty and unacceptable behaviour. If you think about it, the phrase ‘honest mistake’ is a tautology; there’s no such thing as a dishonest mistake! In order to change we have to be comfortable with failure. We’re only learning.

I can remember attending a short management course during my career that used juggling as a great analogy. We were all given three juggling balls at the start of the course and told to juggle them. Nobody could. During the course (which I recall was otherwise unremarkable) we were given instruction in juggling at various points. By the end of the course, most of us could keep three balls in the air. There were two points they were trying to make. The first was that even though most of us started the day thinking it would be impossible to learn to juggle, we had. The second was that in order to learn to juggle we needed to learn the most important lesson; it’s essential to drop the ball.

Too often a stuff up is an excuse to beat ourselves up. We need to rewrite that script. It’s part of learning. We usually don’t wake up in the morning thinking “How can I really stuff up today?”

My fifth key to change is to acknowledge what’s working as part of the ‘learning’ cycle. While it’s important to honestly confront my deficiencies it’s just as important to give myself credit for progress. It’s also useful to look at what’s working and why.

My decision to ditch commercial face creams in favour of organic rose hip oil means my skin has never looked better. I’m eating well and improving my ability to rest and take it easy. I’m recognising that throwing my body at the garden is unhealthy. I’m managing my nausea well. It’s not all bad news.

As a consequence of my backsliding I’ve been thinking about the difference between regret and guilt and blame. I think regret is an essential part of learning and my final key to change. Regret can be a spring board. Spending some time honestly acknowledging where I went wrong, and being prepared to experience the regret associated with that, is part of the process. Refusing to look at something doesn’t mean it goes away. Guilt and blame on the other hand are highly destructive.

I’m going to take some time over the next couple of days to think about some strategies for getting back on track.

I’ve recruited my husband’s help by asking him to remind me of all the things on my list. He doesn’t much want to be my conscience but I need his support. My daughter will probably leap at the chance to help. She’s a highly empathic person and really appreciates the opportunity to pitch in.

I think when we backslide, asking for help is a good strategy. So is sharing my commitment to change with people that I care about. Just telling them what I’m trying to achieve helps to strengthen my resolve.

I also find it helpful to link things to existing habits. If I fill my water jug before my morning coffee and rinse my mouth after I’ve cleaned up from a meal it will be easier to remember both. If I do my yoga and meditation before I get to the computer I’ll spend less time on facebook and more time caring for my body.

I suspect the wine will be an ongoing challenge. It’s odd, because I have no difficulty giving it up. I stopped when I was pregnant and breastfeeding and I stopped for five years when I lived with someone that couldn’t drink. It’s really the social aspect of it that appeals to me. Maybe I need to take up drinking soda water with slices of lemon. People will probably assume I’ve switched to gin and tonic. (Why does that matter? Hmmm.)

It doesn’t matter if I’m fighting cancer, addiction, or anything else. It helps to have reasonable expectations about the effort involved in change. I usually like the idea of only trying to change one thing at a time but sometimes you just don’t have that option. Sometimes, like now, I’ve got a combination of temporary practices and permanent habits that all need work at once.

I’m gong to keep planning, doing, reviewing and learning. I know I’ll get there.

It’s okay to drop the ball. It’s having the courage to pick it up and keep going that really matters.

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