A trip to DMV

Who knew a trip to a DMV could create so much emotional turmoil? As I was sifting through the mail two weeks ago, I noticed that the reminder for my driver’s license renewal had arrived in mail and I needed to go in and do my vision screening. I kept the envelope aside as I went through the stack of solicitations, reminders for medical conferences and the latest issues of Psychiatric journals in duplicate. My husband is also a psychiatrist and we receive two copies of everything. And that is a lot of mail.

Today I had nothing on my calendar so I decided that I will go in and get my license renewed before its expiration next month over lapping with my birthday. Birthdays after metastatic cancer are achievements in themselves. Since last year, I can roll out of bed and post on social media, “I got through another day and I am still breathing “and my wall floods with congratulations and support.  Just staying alive has taken on a special role in my life. Before I had to make major accomplishments, receive awards and trophies and then someone would say, “Well done!” and now I say “Look I am standing up” and it is seen as an inspirational statement. Such is life with its ever-changing perspective and appreciation. Being alive every day and living it to the fullest no matter how cliché it becomes remains the center of my universe.

I wear a black shirt since I want to wear something with a collar for the License picture. I remember last time wearing an Ann Taylor suit to the DMV in March 2013. I was a working mom of two kids, 2 and 5 with a part time psychiatric practice recently recertified by the American Board of Psychiatry and Neurology. I was fit and fully in the competitive game of life. I remember chatting with the receptionist and her discussion with me about her antidepressants and how much they had helped her. People are willing to share a lot when they find a doctor in social settings. I think she was on Lexapro.

I stand in line looking around the office. A sign says “Senior citizens, Expectant mothers and persons with disabilities” can move in front of the line. I have been an expectant mother and currently a person with disability, a life threatening disability I might add and then I stared at the words “Senior Citizen” which seemed so far away and inaccessible. Even though I get told that I will be the statistic of my own, the median three year survival puts me nowhere close to the senior citizen line, EVER. The gentleman ahead of me is being told by the clerk that he will be 75 soon and will need to repeat a driving test again. As they say old age is a privilege denied to many, I see needing to be alive for another 30 years to be in his shoes. I try and distract myself and look at the people in the waiting area. It’s a busy place, filled with people of all ages and ethnicities. Music is blasting taking the edge of this depressing experience.

I get a number and sit down.  Numbers are being called at the counters and this reminds me of the American consulate in Islamabad twenty years ago.

A young physician, wanting to go to the US and get psychiatric training. Wanting to be the best psychiatrist that she could, clenching her degree from an institution known for its academic excellence and waiting for her turn. Exactly twenty years later, sitting in the DMV, unemployed and disabled, waiting for her vision test. Another form sits on her desk, renewal of DEA number as in her prescribing privileges, a fees of 735 dollars and she contemplated if she should renew it or not.

I look at the infinite number of posters and signs pasted on the wall behind the counters. A poster with a little kids in the cape “Be my superhero, donate an organ today”.  I whisper to myself, I am so sorry, I cannot be your superhero, my dear, and I have cancer. My organs have betrayed my own body, how can they ever be helpful to you?

 I had learned after a discussion with few physician colleagues that those with metastatic cancer cannot be organ donors. Another wave of grief rises and subsides in my heart. I look around, numbers are being called out and people are responding.

A mother walks in with her teenage son and they sit down together barely looking at each other, both on their phones but it appeared that she had brought him for his driving test.  I envied her, sitting next to her son and my heart broke for my children and mentally I created a picture of my son and his father sitting chatting with each other as he waited his turn. I want that turn too, to bring my son and daughter here someday for their driving test. It has been only two days since my daughter and I have been trying to help her ride the bicycle without training wheels.  May be she will remember that too if I am not there to take her for her driving test, maybe she will.

Finally B222 gets called at Counter 7. The pleasant middle aged lady is anxious to get done with me. She sees a healthy young woman standing in front of her. Her questions to me about having a disability or medical condition are a mere formality unknowing how it is my overarching reality. She has no idea that I have metastatic cancer. She quickly checks marks no on all the questions and I ace my vision test. She then asks me if I still wanted to be an organ donor and I meekly reply, I don’t think I can be. She doesn’t bother much to explore that further. She asks me if I was still the weight I was four years ago. I could have explained to her why I am not, why I am carrying the extra menopausal weight and why I am unable to exercise to the fullest but instead I gave her a number that I remain unhappy with, the number at which my Ann Taylor Suit no longer fits.

 She then, asks me to go to the cashier.

It was two days ago that I survived the anniversary of my metastatic diagnosis. My heart still raw from the anniversary reaction. A year plagued by dreams reworked, goals adjusted, pain, scans and heart ache had just ended. I wonder if I will ever be back here to renew my license again. Four years seems a long time.

The cashier is swift and quick and I step up to the Camera waiting area.

I am feeling emotional exhausted by this time. I had not realized how much grief this visit would trigger. Dates and years and expirations have become painful to deal with. Planning the future is illusive, a “what if” follows me in all my plans. I have had stable disease for the last year but I wonder, what if, I wonder, what if.

Holidays and Cancer: some suggestions

A note about cancer and holidays: If you have friends or family who have cancer or had cancer, make sure you treat them extra special. Even those who are done with treatment struggle a lot with energy levels. They may not have the energy to stand in lines at the mall or gift wrap everything nicely. Their gifts might be late or they may resort to just buying gift cards. When cancer strikes , holidays can feel like a burden. If you want to buy them gifts, do consider their situation. Service gifts are excellent like cleaning service gifts, gift certificates to restaurants or their favorite pizza place, hair salon etc. Sometimes, when struggling with energy its hard to deal with handling gifts at all.
Offer to take them out for lunch or breakfast. Offer a day of friendship. Not all gifts are sold at the mall.
Help out with their home, or tree clean up after the holidays.
With cancer, its the gift of time that is most valuable.
Not all cancer patients need cookies and chocolates. A lot of women struggle with weight during cancer treatments. A tower of chocolates or cookies may be the last straw. If in doubt, ask the recipient if there is something they would really like.
If you have them over, be considerate of what they may or may not be able to eat. Again ask if they are having any side effects or food that they can no longer tolerate.
A little consideration and caring goes a long way in strengthening loving relationships.
Many cancer survivors deal with sadness and depression around holidays and fears about the next year. Be patient with them. They may not be feeling the holiday cheer. Don’t push them to feel happy either neither guilt them to feel grateful. Allow them the space to grieve if they need to.
Dealing with Cancer around holidays is complex and exhausting.
All they need is to know that you care and gifts aren’t the only way to show that.
Have a very blessed holiday season.
Uzma Yunus

To the radiologist who was supposed to read my films…

Hi Dr.

You will probably never meet me in person. Your name will be on the bill my insurance receives from the hospital. Your signature will be on the line after the end of report as you mumble report after report into the system. You will never know my story. I am my organs to you, organs will anomalies that you have to squint and sometimes lean back to look for.  You look for lesions and growth and progression on my scan. A body riddled with cancer. It can be quite challenging to look through all the cuts of the CT scan, day after day, hour after hour.

 In each of those films, is a story hidden beyond a 40 some year old woman with metastatic breast cancer. A story that starts a whole month before the upcoming scan appointment when she starts to wonder what her scan will show this time. She pretends to ignore those thoughts because her cancer is incurable. She secretly wishes that everything disappears this time. She looks at her young kids and hopes that your scans aren’t able to see cancer this time. She hopes that her treatment continues to work. She stays up at night and contemplates various scenarios should things change. She wonders if she will see thanksgiving next year. She wonders how many more CT scans she has left in her life time. She wonders if she can just cancel all her appointments and move to another country where she will pretend she didn’t have cancer. She then shakes her head and gets busy.

Then the day before the scan arrives, she is more nervous than usual. Kids irritate her and she loses her appetite. All she can think of is the possibility of her life changing after 24 hours. She wonders if she gets another extension for 3 months on her treatment. She barely sleeps that night. She wonders and thinks.

She gets to radiology and gets a number. She looks at others who look much older and much sicker. She wonders if that would be her in few months. She gets called and is rushed off to the changing room. She wonders if her kids made it to school. She thinks of her husband in the waiting room. She changes into her gown and with her clothes hangs up her control in the locker. She then waits again. Until another rushed technician gives her a vat of barium to drink. She sits and sip the barium listening to Anderson Cooper complain about a mosquito bothering his sleep to Kelly Ripa. She sips some more barium. She tries to cope with the nausea caused by anxiety and barium and wonders when she will get called so she can be done with this ordeal.

She lies down in the scanner. She has an IV in place for which she was poked 3 times and was called a “hard prick”.

She has a pillow under her knees and she is slid into a giant machine in a cold room. She holds her breath when instructed, lets it go when told. She hears the machine and the circular gadget spins around. She is being seen by the technician in the other room, both from inside and outside. She lays as still as possible. Nausea and anxious she lays there.

Then the contrast is pushed and a bolus of heat travels through her body till it hits her lower body and it feels warm as if she just peed in her pants but this is her umpteenth scan so she knows that it is the contrast. She knows also to drink 6-7 glasses of water that day to keep her kidneys flushed. That’s what the nurse told her who put her IV in. She knows that she will later have diarrhea due to the barium she drank and the goddamn mocha flavor has ruined the flavor of her favorite latte for her.

But she does all this. Just to live, to survive metastatic breast cancer with scans every three months. The machine stops. The IV comes out and she is let go. She quietly goes back to the locker and changes tired from this morning of scans. She still has to go to nuclear medicine to get her bones scanned, perhaps another 45 minutes to get scanned. Another machine to make friends with.

Then she goes home and she waits. The clock ticks slowly. She tries to distract herself. She could never decide if the bone scanner moves slowly or her life.

Now it’s more than 24 hours later, she is barely breathing with anxiety. Those who love her also wait. Her life is on hold. She wants to sign up for another art class but not sure if she would be on same treatment or not. She needs to do Christmas shopping but she cant get herself to go out. She needs to sign her kids for classes but isn’t sure how available she will be. She needs to respond to that job offer that came through.

And when she can’t take it anymore, she gets her oncologist paged who is slightly short with her.

It has not been reported by radiology.

She tries to breathe. There is another night ahead of her, while those films sit in your office to be read.

She has cancer, this is her life, and she has to cope.

You must be really busy, you have a life too.

So when tomorrow you look at those lesions, you will at least know what it would mean to her to get her results. You will know what she went through to hear your “impression”. It may be just another scan to read but when you read, she can resume that fragmented thing that she currently calls life.

Please dear doctor, give me my results, my life is on hold.

Conserving Emotional Energy

I have often through my career as a psychiatrist remarked to my patients, “You need to work on conserving your emotional energy”. Too often, I have heard from patients, I am overwhelmed and tired and can’t think straight anymore!”

While depression and anxiety can become psychiatric disorders needing professional treatment, being overwhelmed is usually something that requires active management of life circumstances.
We either take too much on, don’t get enough rest or down time or are holding on to long term unresolved emotional issues. We currently are a nation of overwhelmed folks, one crisis away from a complete breakdown( if it hasn’t already occurred) . And it is because we have cumulatively exhausted our emotional energy.

Now let me explain what I mean by emotional energy. Emotional energy is the energy that controls the ability of a person to connect with their own feeling without it being clouded by extraneous factors. This is the force that assists us in coping with difficulties and understanding and processing meaningful emotions. We all have a reserve of emotional energy. It is the emotional energy or lack there of,  that in turn impacts our mood and subsequently our behavior.

 Presence of emotional energy is like a soft cushion that absorbs the jarring and daily falls in life and therefore we bounce back.

As we take on more and more and spend less time in self care, this cushion thins out, the less the thickness, the lesser the ability to bounce back and more hurt we feel when we fall. After going through the election season, we are all falling on thinned out cushions. Is there any surprise that our joints hurt and we are short and angry?

We are literally the sum of positive and negative energies driven by emotions. Happiness, contentment and peace add significantly to the reserve of our positive energy while anger, lack of satisfaction and sadness are extremely draining to the reservoir of emotional energy. Even though we have no control over external factors that control our lives, we retain the ability to manage our emotional responses to these agents. A lot of people find refuge in externalizing the blame and finding the person at “fault” to deal with their angry emotions and make an effort to focus the anger on the said party. It may make us feel a little better for a short period of time but it is unable to bring us to a resolution emotionally because that situation and its residual emotions still persist.

Once angry without resolution, we behave like loaded guns responding to any minor provocation as if it were a major crisis. Most people experience unresolved anger as persistent low grade irritability and get annoyed easily. Again the issue is that anger very quickly depletes emotional energy and then we are fall hard and fall painfully.

Disappointment is another very hard emotion to cope with. Disappointment usually comes with a mixture of anger and sadness. It may be a situation or an expectation that did not turn out as we had hoped. This often leads to us generalizing our anger or disappointment on to other situations and instances and an expectation that things will get worse. This apprehension feeds the cycle of fear and anxiety, another duo of emotions that then lead to loss of emotional energy.

In this very interconnected and immediate world of ours, we don’t have space for ourselves. Our minds are flooded with bytes of information that may or may not be relevant to our lives. Our shortened attention spans get in the way of properly processing our own thoughts because someone just wrote an article about exactly how we “should” be feeling after this election.

It is prudent though that we connect with our own feeling about an issue and understand them fully. We cannot do that unless we replenish our emotional energies.

Last weekend, I took a step back from Facebook myself. There was intense affect everywhere. A whirling storm of anger, insults and disagreements and posts about hate crime were flooding in. I do care very deeply about the political direction this election took and now the country will take but at the same time reality of my own life remains vivid. I live in a world of incurable cancer and perpetual treatment with grave uncertainty. Getting through each day is an exercise in positivity.

So Friday I logged off of Facebook . I decided I would not post any statuses for a whole week neither would I comment on anyone else’s . It has been two days. I have removed myself from the duel between the supporters of the two candidates rather I put myself squarely in the middle of my own life. I took a step back to rehabilitate myself emotionally. Being on social media and disclosing aspects of your own life always comes at the cost of vulnerability. Opening yourself to affect of others which is constantly with you can be exhausting. My face book feed was a combination of grief and gloating, of anger and insults, of rational people losing their sanity over petty things and catastrophizing over situations . I asked myself, “Do I need to expose myself to this?”

I love being able to connect with people. I have grown so much by being able to reach and connect with breast cancer survivors all over the world. I have had such opportunity to have dialogues with people about their most intimate thoughts and fears and the honor to help them and sustain them. Social media is an amazing medium. But its toll on emotional energy can be very hard.

With a surgery looming in front of me, a long overdue elective procedure for removal of my ovaries,  I needed to work towards filling up my emotional energy reserve. I have many friends who fill me up with happiness on social media however after the elections, the virtual world was adding to stress, negativity and apprehension, none of those that I need in my life riddled with cancer and its accompanying uncertainty.

Friday evening I sat and chatted for a while with my mother-in-law while my daughter ran her “bakery”. Saturday we had a meal with conversations that had nothing to do with elections and then watch a live show. Sunday was full of errands and chores. Pretty normal weekend activities but the extraneous windows open in my mind were closed. I wasn’t peeking and neither was anyone else. I did have a strange sense of privacy and it felt good. I laughed at my kid’s jokes and not on Obama and Biden memes. And that was alright. Social media is an important part of my life and activism and will remain as such. But I do think it’s great to take a break every now and then.

I hope to return actively on Facebook after my surgery but I wanted to say, that I am glad I am taking this break and I don’t believe that people as wonderful as Americans, are a nation full of racist, bigots and sexist. I will hold on to hope and optimism as long as I can. I hope you can too and I hope that we can all stand together as one to support each other irrespective of color, religion, race or nationality. I hope.

October for me isn’t just about Breast Cancer, its about living life.

 

It has been about eight months since I have been living with metastatic breast cancer. I had thought I had done a lot of reflection and growing up when I was diagnosed with breast cancer three years ago. I thought I had a better understanding and appreciation of life. I thought I had learned the harder lessons. I was more patient, more insightful and more understanding of the suffering of my patients and my fellow human beings. Little did I realize though that there was still a long, long way to go and when metastatic breast cancer came knocking on my door (yeah I should have not answered) and I faced my mortality in a much closer and clearer way, I realized that there was a whole universe of understanding that had awaited me. When someone puts a time period on your life, mine being an average of 3 years, things get emotionally hectic. It is truly a hurricane that starts to swirl and one has to prepare for the landfall some day. I tried to sometimes close my eyes and not see, but the high winds woke me out of my pretend sleep. It is here it is now and there is no denying it. My life has an expiration date as well all do, except it’s etched in my retina and I can’t removed it from my field of vision. It’s there all the time.

When October rolls around, everything turns pink. There are reminders for mammograms, walks and races and pink socks and pink eggs. Heck some are sitting on pink toilets to fund raise. We are all different. However, they wish to spread awareness about a life threatening illness. I hope someday we will have a cure. I just hope for some life awareness in the month of October. The thought that “What would I change, if I got cancer?” Not just get a mammogram, and when it’s normal forget about living for a whole year.

I want women to see a normal mammogram as a reminder that they got another chance to live life on their terms.

That getting a normal mammogram is also a reminder to take care of you. Don’t wait to be retired and old to live life. I am not going to go over the need for mammograms and self exam, since you better be doing that, I will say, take an inventory of what is truly important in life. Make hard decisions. Get out of that sucky relationship. Let go of that idiot. Make changes. Travel. Spend time with your friends. Read a book that you so wanted to. Take a day off for you. Hire a sitter. Go for a date with your husband. Hang out with girl friends. Ready trashy magazines and catch up on gossip. Help someone. Love yourself. Get a haircut. Change the look. Sleep well at night. See a therapist. Stop smoking. Don’t drink too much. Back off from that recreational stuff. Ask for help. Whatever it is, do it. For me October isn’t just about breast cancer, it’s about life. Go live it. For as they say to me all the time, tomorrow isn’t guaranteed for anyone of us.

Reflect on your actions, meditate. Find your faith and what you believe in. Don’t just flow with life, command your flow and swim in the opposite direction if you need to. If you believe, you were born for a reason, go find it. It is somewhere in your universe that you are shying away from. Don’t spend time looking at what someone else has created, it’s your life, you have every right to create it in a way that suits you. Don’t endorse something that is not you. Don’t care for what haunts you later. Don’t embrace toxic people in your life. Do not feel guilty for taking care of yourself. Work hard and play hard. Retain your ability to enjoy and if you can’t find happiness, ask those who look happy. For God’s sake, don’t embrace a dull boring status quo that leads no-where. There is a path somewhere. If you are grieving, share, if you are hurting, share. Come out and tell your story and I promise someone will join you.

Cancer pushed me to find my path, it haunts me but I keep walking because now what I am doing is bringing me peace and joy. I make an effort every day to heal. Every day I make a choice to live some more. Life is as much about death as death is about life. They are related paradoxically and that is why I have more zest for life because I know that I will die. I see it up close and clearly every single day. To not die is to embrace life in present, to guard your thoughts and to hold on to peace within. Cancer deaths are usually prolonged and painful, I know that, but it’s not happening today to me and neither to you. I am building a life knowing I will likely die in few years. I could decide, it’s futile to go to my art class, or lose weight or eat healthy or even just burst out in laughter. I could be depressed about what is going to happen and what I have lost. Yes, that would be easy because those thoughts live inside my head and never leave. They are a part of my reality. I have to shake them off, every single day for these are powerful and vile thoughts that take me down a very painful and gloomy path and make it very hard for me to run back from them. So I just avoid them like the plague. I do grieve, every single day but my grief is mostly turned into action of healing and kindness towards myself and others.

With metastatic breast cancer, for me, every month is October, for me every day is today. What are you doing today?

I said to her, the one in eight

I have been sitting here thinking of coming up with something meaningful to say. All I can say is hope is living each day well, courage is being yourself when odds are stacked against you, strength is waking up and telling yourself I cando this. This, cancer, is a heavy burden to bear but look around and see the phenomenal women who are here and living to fullest and fulfilling their purpose. You will too. However long or big. You own your life with your attitude, don’t allow cancer to whisper other wise . Hugs . I am so sorry you were put on this path by life, just keep walking. The only way to go. 💕💕💕