February 19, 2011 – Incidentaloma

A couple weeks ago, I had another of my periodic PET/CT scans, which are becoming as routine as that sort of thing can possibly be. When I called Dr. Lerner’s office for the test results a week later, the nurse called me back and said the PET scan had revealed some unexplained “uptake” on the left side of my thyroid gland, in the area of the small nodule detected last time around.

On that earlier occasion, Dr. Lerner had referred me to Dr. Jay Sher, an endocrinologist. After subsequent tests, Dr. Sher pronounced the nodule too small to be concerned about, and not large enough to biopsy. He did say it bore watching, though.

Well, it’s no longer so small. On Wednesday I had a follow-up CT scan and ultrasound. Yesterday, I got a call from Dr. Lerner, who informed me it’s doubled in size, from about .80 cm to about 1.60. A centimeter and a half still sounds pretty insignificant to me, but I suppose in the world of endocrinology that calls for a closer look.

So, that’s what we’re going to do. As soon as I hung up after Dr. Lerner’s call, I phoned over to Dr. Sher’s office – it was just before closing time – and left a message. Dr. Lerner’s staff is faxing the scan results over. Someone from Dr. Sher’s office wil call back on Monday, presumably with a referral for an ultrasound-guided needle biopsy.

Dr. Lerner assured me there’s nothing to worry about just yet – most thyroid nodules are benign – but, still, it’s not something to leave unexamined.

Doing a little online research, I came upon a retrospective research study that calculated a malignancy rate of 28.8% in small thyroid nodules discovered in this way. I even learned there’s a name for this phenomenon. Abnormalities that show up on scans ordered for some other purpose are called incidentalomas. As high-tech scans proliferate, more and more of these tiny, mostly benign tumors show up – tumors that would, in an earlier era of medicine, have gone unnoticed.

That’s both a good thing and a bad thing. To the extent that incidentalomas turn out to be something truly serious, early detection is a fortunate – sometimes even lifesaving – coincidence. Yet, most of the time they’re just benign growths. Still, they trigger anxiety in patients who would otherwise go through life blissfully unaware of their existence.

I’m not feeling especially anxious about it, myself. I’m more annoyed, I suppose, that I have to go through this whole biopsy thing again. Having stumbled over the rock, though, we’ve got no choice but to turn it over and see what may be crawling around underneath it.

September 4, 2009 - PTSD?

Here’s a selection from a recent entry in the blog of Kaylin Marie, a young adult with cancer:

“...cancer doesn't end once you're in remission. It becomes a terrifying part of you, kind of like how Tom Selleck and his moustache have become one single entity. It haunts your dreams. I could go on.”

She then quotes D.H. Lawrence:

"...Slowly, slowly the wound to the soul begins to make itself felt, like a bruise, which only slowly deepens its terrible ache, till it fills all the psyche. And when we think we have recovered and forgotten, it is then that the terrible after-effects have to be encountered at their worst."

– Cancer Is Hilarious blog, August 13, 2009

That’s pretty heavy. But it’s the reality of cancer. Once you have the disease, the thought of it never completely leaves you.

There are triggers that can bring the whole experience roaring back. I remember I had an old, green shirt I used to wear to my chemo sessions. It had buttons down the front, which was a convenience when it came time to access my port. It was old and just a bit threadbare, which meant I wouldn't much care if some Betadine stained it. For months after my treatments were over, I could take one look at that green shirt and feel a wave of queasiness come over me. The shirt was a trigger.

The good news is, this sort of thing does get better with time. I don’t imagine Kaylin Marie has discovered that yet, because her treatments were so much more recent than mine. Yet, even so, that shirt will be, forever after, my chemo shirt. It hangs in the closet. I rarely wear it. These days, though, I can stand to look at it without it carrying me instantly back to the chemo suite, like some magic carpet.

I suppose there are some elements of post-traumatic stress syndrome (PTSD) in the cancer experience. Time may not heal all wounds, but it does seem – gradually, imperceptibly – to heal this one.

June 26, 2009 - High Anxiety Threshold?

This afternoon I have a routine office visit with Dr. Lerner, my oncologist. He’s received a report from Dr. Sher, the endocrinologist I met with a week or so ago (I didn’t blog about that visit at the time).

Those who’ve been following this blog for a few months may recall that, back on Valentine’s Day, I had a PET/CT scan that revealed a possible nodule on my thyroid gland. A subsequent ultrasound confirmed that, yes, there was something abnormal growing out of the left side of my thyroid.

Dr. Lerner told me he didn’t think it was anything significant – most of these growths are benign, he explained, and this one was pretty small, at that – but he thought it was worth seeing an endocrinologist to get it checked out.

Through a series of scheduling misadventures, it was only a couple of weeks ago that I finally got in to see the endocrinologist. Dr. Lerner had given me the name of a Dr. Asnani, saying he wanted me to see that particular specialist, and none other – although he emphasized it wasn’t urgent, and I could meet with him any time in the next several months. Well, Dr. Asnani’s office staff told me he was in India on an extended visit, and they weren’t even making appointments for him until after his return. I called back over a month later, as they had instructed, and it turned out they had no free appointment for about another month and a half. The long and the short of it was that I finally got into his waiting room on June 16th – just over four months after the nodule first appeared on the CT scan!

Come to find out, Dr. Asnani wasn’t available that day, as he was making hospital rounds. I’d be seen by a resident, Dr. Lee, instead, and then by Dr. Asnani’s partner, Dr. Sher. Dr. Lee was actually the most helpful. She spent a lot of time with me, explained everything, and was very responsive to all my questions. She carefully probed my thyroid with her fingers, taking great pains to see if she could feel the nodule. Then, I saw Dr. Sher for all of about 2 minutes – no examination, just a reiteration of what Dr. Lee had already told me.

When I explain all this to Dr. Lerner today he says, that’s fine, Dr. Sher’s name would have been one he would have recommended – even over Dr. Asnani – but the last several times he’d tried to refer patients to Dr. Sher, they were turned away with the explanation that he wasn’t accepting any new patients! (The ways of medical scheduling are exceeding strange.)

So, what did Drs. Lee and Sher tell me about my thyroid nodule? That it’s very small (0.8 centimeters), too small to biopsy. They recommended I have another thyroid ultrasound in 6 months, and if it’s bigger than a centimeter, it may be wise to have it biopsied. Even so, they reassured me, I shouldn’t worry about it – only a small percentage of such nodules are malignant, so it’s just a precaution.

Well, I went away from the endocrinology office thinking it’s probably a good thing I’m going through this thyroid stuff after having been through a lymphoma diagnosis, chemo and all the rest – I might have been a nervous wreck, otherwise. My anxiety threshold when it comes to things medical has certainly gotten higher!

Dr. Lerner hands me a script for my next PET/CT scan in early September: time to start the whole cycle again.

February 21, 2009 - And Now, For Something Completely Different...

Yesterday I received a phone call from Dr. Lerner, who gave me some good news and some bad news. The good news is, my recent PET/CT scan reported no change with my lymphoma. It’s been that way for a while now. My indolent disease is continuing its shiftless ways, which is just fine with me.

The bad news is, the scan picked up some abnormalities on my thyroid gland. Dr. Lerner wants me to have an ultrasound of the thyroid, to check it out.

He didn’t sound too concerned. In fact, he said he didn’t think it was much of anything, but he wants me to have the ultrasound just to be sure.

I heard Dr. Lerner use the word “adenoma” as an explanation for what this could possibly be. On the web, I found this description from a medical textbook:

“Most [thyroid] nodules rather than being cancer (carcinomas) are actually tumorous collections of benign cells variously called adenomas or adenomatoid nodules.

Whether nodules are ‘cold’ or ‘hot’ on thyroid nuclear scanning relates to their ability to trap and collect radioactive substances such as radioactive iodine or other radioactive elements used in nuclear medicine. These isotopes are either swallowed or injected intravenously and their extraction from the blood and concentration within the nodules causes the areas corresponding to the nodules to show up as black ‘hot’ spots on the scan image.

Hot nodules are rarely cancer and most often represent benign follicular adenomas. In addition, such hot nodules may in fact be overproducing thyroid hormone and may cause hyperthyroidism. The larger the ‘hot’ nodule the more likely it will be associated with hyperthyroidism.”

I thought about asking him some questions about various scenarios that could ensue, but thought better of it. He’s not going to be able to tell me anything, I reasoned. That’s why he’s asking for the ultrasound. You’re just going to have to suck it up and wait.

So, that’s what I’m doing. Dr. Lerner is going to have someone from his staff call me next week, to set up an appointment at Ocean Medical Center. Then, it will be more waiting, while the radiologist interprets the results and shares them with Dr. Lerner.

I’m not feeling too concerned about it. Seems like “waiting” is my middle name, these days. Several years ago, I might have gotten anxious, but after undergoing a couple of biopsies plus chemotherapy, an ultrasound is a piece of cake. I’m actually feeling more anxious about the wisdom tooth I’m scheduled to have my dentist extract on Monday.

It’s just another test. I’ll be hoping that, like all the other recent scans I’ve had, this one, too will prove to be of little concern.

February 11, 2009 - Time: On My Side?

Today’s my PET/CT scan. It’s routine, but – as always – there’s low-level anxiety as I prepare to await the results.

At Jersey Shore University Medical Center, the PET/CT machine sits on a trailer pulled up to a sort of loading dock at the hospital. It’s here a few days a week, and at other hospitals the rest of the time. (I think I heard a tech say this one migrates between here and Massachusetts.) That’s how expensive these machines are – nobody can afford to have them sit unused for any length of time, so they take them on the road. Deals on wheels, for the hospital bean-counters.

I think it’s a pretty ingenious solution, actually. You know, bring the mountain to Mohammed, that sort of thing.

My visit is utterly unremarkable. I’ve had 3 or 4 PET scans in the past, so I know what to expect. First, I get jabbed in the fingertip to have my blood sugar tested (no diabetic worries, the tech tells me, peering into her little handheld device: my blood sugar is 94, which she says is excellent). They have to do the blood sugar test because the PET scan centers around an injection of a radioactive glucose solution, which – the theory goes – gets sucked up by any ravenous, fast-growing cancer cells, which are subsequently revealed to the scanner’s inquisitive electronic eye. (It wouldn’t be a good idea to send sugar solution racing through the bloodstream of a diabetic, which is why they do the precautionary test first.)

Next is the injection itself, which is no big deal: an IV line inserted for a few minutes, to receive the injection from a syringe enclosed in a shiny, lead-lined cylinder (this, to protect the technician from frequent exposure; we patients – who are getting the radioactive slurry injected right into our bodies – are on our own).

After that, I sit quietly in a chair for 45 minutes or so, while the stuff makes its way through my body. Then, it’s time to lie down on the narrow, sliding table whose motorized works will trundle me in and out of the donut-hole of the scanner.

The hardest thing is lying on my back absolutely still for a half-hour or so, with my arms extended over my head. It’s not the most comfortable pose to hold, despite the best efforts of the PET-scan techs to position me just right. (Fortunately, I have no claustrophobia problems, which could be an issue for some people as they lie inside the scanner, looking up at the top edge of the donut-hole just a few inches in front of their nose.)

On other visits, they’ve had relaxing, new-agey mood music playing through the unit’s PA system. This time, they’ve got the thing dialed to some classic-rock radio station, complete with commercials – not the most optimal programming for getting through the long minutes of lying still. I find the best way to get through this sort of experience is by seeking to go somewhere mentally far away, which soft instrumental music helps me do. No help from the rock-music deejays, on that account.

One of the songs that comes on is the Rolling Stones’ “Time Is On My Side.” “Time, time, time is on my side, yes it is," croons ol’ Mick.

Is it, I wonder? Am I continuing to stay ahead of the curve, on this cancer thing? Or, will this scan reveal something new and disturbing?

No way of knowing, at the moment. “So do not worry about tomorrow, for tomorrow will bring worries of its own. Today’s trouble is enough for today.” (Matthew 6:34)

December 30, 2008 - Christmas Haste

Christmas has come and gone, without a blog entry. That’s mainly a function of my being so busy.

It was a good Christmas. Ania was back from Chapman University for the holidays, and Ben continues to be living here at the house, as he works full-time giving guitar lessons. My mother, Shirley, is now living back in New Jersey, having moved up here from North Carolina in September. Brother Jim came down from Boston for the holiday. From Claire’s family, we welcomed her sister Eva and her daughter Elizabeth (who also live in our house), as well as her brother Victor from Baltimore, with his kids, Chelsea and Nick; and Claire’s sister Ramona, from New York City. There were a few friends here, besides.

It made for a full table at Wigilia, the traditional Polish Christmas Eve vigil supper from Claire’s family tradition, which we somehow squeeze in between the 7:00 and 11:00 pm Christmas Eve services. (Here’s a picture of Claire spreading some straw on the dining-room table, assisted by Murphy the cat – the straw goes under the tablecloth, and is symbolic of the straw of the manger.)

A few days before the holiday, we had about 30 members of the Youth Connection group here for pizza and snacks, after their annual Christmas caroling expedition to homebound and nursing-home folks.

As for the Christmas Eve services, we had the usual children’s service at 4:00, followed by Candlelight Services of Lessons and Carols at 7:00 and 11:00. My sermon, “A Hasty Christmas,” focused on that line from Luke’s Gospel that describes how the shepherds “went with haste” to Bethlehem.

It’s a perfectly ordinary phrase, but to me it seems to offer a basis for reflecting on how many of us tend to approach the holiday. There are two kinds of haste: the stressful kind that pushes you, and the wondrous kind that pulls you. While the shepherds may have had good reason to fear the angels (who, in good biblical tradition, were anything but gentle emissaries of sweetness and light), I like to think they rushed down off that hillside because of the wonder of Word-made-flesh that was apparent in that humble stable.

From the sermon:

“There is another kind of haste, besides the sort that pushes us. There’s also the haste that pulls us. It’s the same sort of haste grandparents feel, as they’re waiting in an airport lounge to go visit their new grandchild for the first time. It’s the sort of haste a young man feels, when he’s off to pick up that special young lady to take to the prom. It’s the sort of haste that says, ‘Come on, let’s go – every minute we delay is a minute we won’t be there!’

It’s the sort of haste we’ve all come to know, when Christmas is at its very best. It’s not the tyranny of the to-do list, but the joy of a churchful of people singing carols; the glow of the candlelight, passed from hand to hand during ‘Silent Night’; the swell of the organ, as we roll into that first stanza of ‘O Come, All Ye Faithful.’ It’s the sort of haste that beckons us onward, that wins cold hearts over, that pulls us out of the December doldrums and sets us gently down into a holy place, a place of light and love and faith.”

One of my growing edges, in these days of watch-and-wait monitoring of my lymphoma, has to do with maintaining the right kind of haste in my life. Better to be pulled than pushed. Better to be motivated by wonder than by worry.

It's a tough balance to maintain – but I’m working on it.

November 21, 2008 - Always On My Guard

Busy week. So busy, in fact, that I’ve been meeting myself coming and going, as they say.

Diane, our church secretary, gave notice a couple of weeks ago – early retirement – and, as of this week, is no longer on the job. We’re muddling through with the help of Dottie, our part-time secretary, who’s graciously agreed to give us a few extra hours. Last week, we ran an ad in the classifieds for our modestly-compensated, 30-hour-a-week position. Bam! In no time at all, there was a stack of over 120 resumes spilling off my desktop. (That compares to about 25, the last time we ran a similar ad in response to a secretarial vacancy.)

I’d originally booked the classified ad to run for 10 days. I called the newspaper up and canceled it after 4.

It’s a comment on the state of the economy – not only the sheer number of applicants, but also who they were. Real-estate agents. Legal secretaries. College graduates. Even two or three people with MBAs.

It’s also a comment on the state of health care in America – because, even though our pay scale is barely competitive with for-profit businesses, we do offer excellent health-care benefits: Blue Cross/Blue Shield, through the Presbyterian Pension Plan, for the employee AND family. I think that’s what sent them flocking to our door (or, I should say, to our e-mail address and fax machine). Decent, employer-funded medical insurance with a 30-hour-a-week position is pretty uncommon, it would seem.

But, I digress. I started commenting on how crazy-busy I’ve been, as a prelude to talking about an annoying little medical problem I’ve developed. It may or may not have been exacerbated by lack of sleep.

I’ve got a mouth ulcer, inside my cheek opposite my gums, that’s getting more and more painful. My cheek’s even starting to get a little swollen. Time to see the dentist, I guess. I wouldn’t want to think it’s some kind of abscess, though I suppose it could be – even though there’s no pain coming from any of the nearby teeth.

I have to confess, though, that one of my first thoughts was, “What if it’s cancer?” My rational mind says it couldn’t really be lymphoma, because I’m not aware of any lymph nodes in that part of the face (I checked a couple of anatomy diagrams on the web, just to be sure). The very fact that this thought came to mind, though, is a side-effect of my cancer survivorship.

The thought of recurrence is never far away – even more so for someone like me, whose cancer has already recurred, though it’s been advancing at a snail’s pace.

Most likely, it’s a minor dental problem of some sort – although it’s hard to keep my mind from jumping to the worst possible alternative.

I suppose my mind will always play such tricks on me. Goes with the territory, I suppose.

October 22, 2008 - Keeping Faith in Anxious Times

I’ve just finished a 3-part sermon series on living with anxiety. What I had in mind, as I preached these sermons, was the current economic situation. After enduring the one-two punch of collapsing real-estate values and the Wall Street meltdown, the American public has been living with high levels of anxiety.

Here’s a short excerpt from the first of these sermons, “KEEPING FAITH IN ANXIOUS TIMES, I: REPAIRING THE CISTERN”:

“Some psychologists – borrowing language from medical science – draw a distinction between acute anxiety and chronic anxiety. Acute anxiety, they say, is related to some immediate threat. If you step out of your front door, for instance, and come face to face with a grizzly bear, that’s acute anxiety you’re feeling. No surprise, there. Yet, if you wake up each morning with a sense of free-floating dread – but have little idea where these dark feelings are coming from, nor any idea when or how you’ll break free from them – then, chances are, you’re a victim of chronic anxiety.”

Acute anxiety, anyone can understand. A newly-diagnosed cancer patient, getting ready to scoot over onto the operating table or receive that first chemo treatment, will quite naturally feel anxious. It’s the patient in remission, or maybe – like myself – out of remission but in a long-term watchful waiting regime, who feels chronic anxiety.

Here’s another excerpt, from the same sermon:

“The word “anxious” is historically related to a Latin word, angere, which literally means “to choke or strangle.” If anxiety gets its bony fingers around your neck for any length of time, you’ll soon be gasping for breath. There’s another English word that races its lineage to the same Latin root. The word is angina – which, as you surely know, describes the sharp, piercing pain that precedes a heart attack. Angina arises when one of the coronary arteries is choked off by arterial plaque, blocking oxygen from reaching the heart muscle. Anxiety, in other words, can kill you.

Another English word that grows out of this Latin root, angere, is “anger.” Anxious people, as it so happens, are often angry people. They sense the breath of life being choked off from their soul – and so they lash out, flailing wildly in an effort to remove the threat, whatever they imagine it to be.”

I borrowed some of this stuff from Peter Steinke's book, Congregational Leadership in Anxious Times (Alban Institute, 2006).

I was preaching, that day, on a passage from the book of Jeremiah. The prophet blasts certain faithless people: who – in his eyes – “have forsaken [God], the fountain of living water, and dug out cisterns for themselves, cracked cisterns that can hold no water.” (Jeremiah 2:13)

I think that cistern image has a lot to teach us. If the spiritual sustenance God provides for us is like a spring of water, then religious practice is a method of gathering that water into cisterns. It’s a beautiful thing when God provides us with what we need, spiritually, right on the spot, but it doesn’t always happen that way. Sometimes we need to rely on water stored in the cistern. If we neglect the regular practice of our faith, we can end up with “cracked cisterns that can hold no water.”

Many of us cancer survivors live with chronic anxiety every day. A significant step in the journey towards healthy survivorship is learning to recognize it for what it is, and name it – but not letting it master us.

I don’t think we ever solve our anxiety, or cure it. We’ve got to learn to live with it.

Much as we learn to live with our cancer.

September 22, 2008 - Scanner Doubleheader

Today I go for a scanner doubleheader: a PET scan and a CT scan at Jersey Shore University Medical Center.

I’m using Jersey Shore this time (a Meridian Health hospital), rather than the for-profit Atlantic Medical Imaging (where I had my last PET scan, a PET/CT fusion) because my insurance situation has changed. Because Claire’s now working full-time for Meridian (as director of the Bereavement Program of Meridian Hospice), I’ve now got secondary medical insurance through QualCare (Meridian’s employee health-insurance provider). They reimburse at a higher rate for services performed at Meridian facilities, so it makes sense to switch providers.

I checked with Dr. Lerner about this first, of course. The message came back, through one of his office staff: if it would save me money, a PET scan at Jersey Shore, followed by a CT scan, would be fine.

I’m just as glad. I had a good experience at Atlantic Medical Imaging, but I’m aware of how much of a financial threat these physician-owned, freestanding diagnostic and surgical facilities are to hospitals. They skim off many of the most profitable portions of the hospitals’ trade, leaving them to handle less lucrative procedures – not to mention the charity-care patients who cannot pay. I went to Atlantic initially because they were the only facility in the area offering the PET/CT fusion scan, but since Dr. Lerner wants me to have a regular CT scan along with the PET scan anyway, it seemed like the right time to go back to patronizing the hospital.

Things go well, all in all. The PET scan technician tries and fails twice to get my IV line in properly, then has to call a nurse – but that’s a small matter. The PET scanner itself is located on the back of a tractor-trailer truck, that pulls up to a special access bay at the side of the hospital. The truck shuttles this expensive machine between several hospitals on a regular basis. Once you step aboard, though, it feels no different than any other room – a little smaller, that’s all.

It’s not pleasant to lie on my back, absolutely still, with arms extended over my head, for the 30 minutes or so the PET scan takes, but I get through it. Fortunately, the tech guides my hands to a mesh strap that some thoughtful designer included at back of the headrest. By hooking my thumbs through the strap, I’m able to take some of the pressure off my upper-arm muscles. Ah, the little things – they make such a difference. After the protracted PET scan, the CT scan is a piece of cake.

I’m not sure to what extent these scans are routine, for me. Last time I met with Dr. Lerner, he said he wanted me to go for another CT scan before our next 3-month appointment, but he was going to wait to decide about a PET scan until he’d seen the results of my detailed blood work. I guess there must have been something in those results that makes him want to err on the side of caution – though his office staff provided no details when they told me the doctor’s written instructions indicated a PET scan as well as a CT.

Maybe this is cause for concern, or maybe it’s not. I’ve been feeling a little anxious about it. I’ll find out for sure at my next appointment with him on October 1st – or maybe sooner, if I get a phone call reporting on my test results.

In the meantime, I’m in that medical-test limbo that’s so familiar to anyone who’s gone for a radiological scan: nobody can tell me anything until after the radiologist has examined the signs from the oracle.

(In case you're wondering about the picture to the right, it's the Oracle at Delphi - obscure mythological reference.)

September 7, 2008 - Living in the Future

Today, I run across a column by radio psychologist Dan Gottlieb that has a lot to say to anyone with a chronic illness – or, well, to just anyone. He’s writing about fear – about how so many of our anxieties and frustrations in life can be traced back to an underlying fear of death.

Reflecting on the “battle” language so many of us use when speaking of cancer, he observes: “Most of us battle things like this not because we are pursuing a vision of victory, but because we are terrified of what will happen if we don't fight. And what is our ultimate fear? Death.

All things living one day stop living. But we may be the only species that knows we will die. How we deal with that piece of information day to day can determine the quality of our lives.”

A little later, Dr. Gottlieb goes on to share this bit of practical wisdom:

“All fear is about the future. And when confronted with the fragility of life, it’s hard not to think about the future. When we do, however, we are at risk for living in the future. That is the real tragedy, because living in the future takes us away from the life we have today.”

“Living in the future” – is that really such a bad thing? When it comes to technology, for example, there are rewards aplenty for those who are forever scanning the horizon, scouting out the next new thing. The “early adopter” gets the iPhone, if not the worm. In the world of finance, stock analysts who can pull off the trick of living in the future – however briefly or imperfectly – rake in millions.

Yet, these are specialized cases. When it comes to everyday life, living in the future is rarely a good thing. Those of us who do so miss out on the present. And the present – as messy and chaotic as it can sometimes be – is where we live our lives.

Gottlieb continues, “Readers who are hoping for a list of practical ‘tips’ of the type we so often see in the news media may be disappointed. I can only offer one big one: Don’t spend so much of your energy pursuing the life you want or avoiding the life you fear. Have the faith to live the life you have - and live it fully, with great love and gratitude.”

Amen.

Now, here's a little something from the recent "Stand Up 2 Cancer" TV special. Just enjoy it - in the present:

August 10, 2008 - Keeping Fear in Perspective

My sermon this morning – first one after my vacation – is about the story from Matthew 14:22-33 of Jesus walking on the water. One of the things I focus on is fear – which, oddly enough, is the disciples’ first reaction when they see Jesus coming towards them across the waves. “It is a ghost!” they cry out.

Here’s an excerpt:

Fear is a primal emotion. It’s one of the most compelling motivators of human behavior. Seven years out from the events of September 11th, 2001, we’re just beginning, as a nation, to appreciate how frightened we’ve been, these past years: and how that fear has affected our behavior.

Remember how it was, back then – how suddenly and how disturbingly those images of burning skyscrapers affected us? Remember how we felt so certain there was going to be another terrorist attack, within days if not weeks? Remember how the news media ran scary stories about the power of Al Qaeda – how it was a worldwide network, closely controlled by Osama bin Laden, who was in command of dozens, even hundreds, of undercover “sleeper” operatives, living beside us in our towns and cities, waiting to wreak havoc?

Any American of Middle Eastern, or even East Indian, origin can tell you about how our national fear impacted their lives. There was, for example, the family who owned a gas station in southern Ocean County, who became the subject of vicious rumors that they had terrorist connections. Suddenly, their business dropped off to almost nothing. It didn’t matter that this family wasn’t even Muslim (being Muslim, of course, doesn’t make you a terrorist). They were Christians from Egypt, and had been so for many generations. When their customers looked at them, it was as though they had seen a ghost.

This week’s news has brought a possible explanation for the anthrax scare that followed the 9/11 attacks. Everybody was so rock-solid certain, back then, this had to be the work of Al Qaeda, or maybe Saddam Hussein and Al Qaeda working together. Now, the FBI claims to have chemical evidence that the anthrax spores in those letters originated not in the Middle East at all, but in a U.S. Army laboratory. They think the perpetrator was that mentally-disturbed American scientist named Bruce Ivins, a man who had no connection to Middle Eastern terrorism. Ivins, as you probably know, recently took his own life – so the case may never be proven – but it’s looking more and more likely that the ghost we thought we all saw, back in 1991, was no ghost at all.

Fear will do that to us. It’s that sort of deep-down, primal emotion. When fear walks in the front door, reason frequently climbs out the back window. Fear, the psychologists tell us, comes from a primitive part of our brain, a part that’s less about logical reasoning and more about quick, emotional response. Fear is like an emotional fire alarm. If our early ancestors saw a saber-toothed tiger cross their path, fear would set their feet to running before their brain even had time to figure out whether fight or flight was the better option.

Fear is a good and useful thing in situations like that, but when it comes to more complex sorts of problems, it’s much less useful. In fact, fear can be a hindrance. Fear can actually block our reasoning capacities for a time. It can lead us to say and do things we’ll later regret. This is just as true for nations as it is for individuals: when we respond in knee-jerk fashion, out of unreasoning fear, we often make big mistakes.

Getting cancer is a scary experience, no doubt about it. I would never be one to suggest that we deny or belittle our natural fear. It’s real. It’s part of the cancer experience – a big part.

Yet, our fear is something we can and should try to manage, just as we try to manage any other side effect. After some time living with cancer, we may even be able to say to our fear, when it does show up again, “Hello, old friend,” then make sure we keep our distance. We can acknowledge our fear, but that doesn’t mean we have to hand it the key to our house.

August 8, 2008 - Watch and Wait Some More

Late this afternoon, I have an office visit with Dr. Lerner. It’s a follow-up to my July 1 CT scan. I already know the results, as I walk through the office door, because the doctor phoned me while I was on vacation to let me know the results look pretty good.

As it turns out, the hardest part of today’s office visit is the port flush. The nurse has a tough time getting the needle into my implanted port, and has to call in another nurse to give it a try. It seems the port has shifted a little, with its business end no longer facing upward, towards the skin. At least, that’s what the first nurse thinks, as she sticks the needle in a couple of times and feels it hitting something hard – probably the metal casing of the port, she tells me.

Nurse number two does a lot of manipulating of the port with her fingers, before she gives it a try. Something she does must be right, because the needle goes right in. I suppose she managed to turn the thing, somehow. She even manages to get a blood return out of the port for my blood test – something that hasn’t always worked for me in the past. She has to flush it twice with the heparin in order to get the blood to flow backwards through the port and into the plastic tubing, so she can drain a little off into a couple of test tubes.

Both nurses are apologetic about having to stick me multiple times with the needle. They couldn’t be nicer. At least they saved me from getting stuck in the arm for the blood test, they reassure me (which is what’s happened in the past when they couldn’t get the blood return to work).

It’s really no big deal, I tell them – and I mean it. One of the realities of being a blood-cancer patient is that, after a while, needle sticks become routine. Back when I was new at this, I used to cringe a little each time, preparing myself for the worst. Now, I just roll up my sleeve (or, in the case of a port flush, unbutton the top buttons of my shirt) and say bring it on.

I get a favorable report from Dr. Lerner. He explains that the radiologist’s estimate of 17% growth in my abdominal mass (which we’ve been assuming is residual scar tissue) may sound like a lot, but that amount is not statistically significant. It’s within the margin of error. Measuring these things is not an exact science, he tells me. The radiologists use a little measuring widget on their computer screens, and it all depends on where they choose to click the mouse to indicate the outer border of the structure being studied, before they drag the mouse to the opposite edge to make the measurement. The border’s not always that distinct, so there’s a bit of scientifically- informed guesswork involved.


Dr. Lerner says he’d like me to come back in 3 months, and have another CT scan or PET scan a couple of weeks before. Which one it will be this time, he can’t say just yet. He wants to wait for my detailed blood test results to come back from the lab. The instant CBC (complete blood count) report they handed me looks fine, but there are more detailed analyses the alchemists down at the blood lab have to perform, and these take time.

So far, so good. Another three months, another scan. Watch and wait some more.

June 14, 2008 - Atlantic City Rules

I’m thinking, today, about something that happened to Claire and me last weekend. We were attending a fund-raiser for a local non-profit organization that aids the mentally ill. It was, rather unusually for us, a “Casino Night.”

We’d been given free tickets, as longtime supporters of the organization. So had Robin, our church’s associate pastor, who joined us for the first part of the evening. Turns out, none of our local ministerial colleagues had been willing to show their faces at an event featuring gambling. The organizers seemed glad the Presbyterians didn’t have such scruples.

We’re no supporters of gambling. We went because we wanted to publicly support the organization’s work. We felt completely out of place, but still found it fascinating to watch the crowds of well-dressed people milling around the poker, blackjack, roulette and craps tables. Unlike us, most of them seemed to know what they were doing.

You don’t win money at this kind of event. You buy gaming chips with real money (telling yourself it’s a donation to the mental-health organization), and if you have any left over at the end of the evening, you cash them in for numbered tags you then drop into boxes. Each box corresponds to a prize or a gift basket. If your number is drawn, you walk home with something nice.

The printed program declared, in bold letters, “ATLANTIC CITY RULES.” That’s as opposed to Las Vegas rules, I suppose (whatever those may be). The words have a double meaning: in that place, at that time, Atlantic City did indeed rule. Atlantic City ruled for all those well-dressed people slyly circling the gaming tables, sizing up the risks, trying to decide where on the green velvet to place their little stacks of chips.

It didn’t rule for us. We live just an hour’s drive from the East Coast’s gambling Mecca, but I can count on one hand the number of times I’ve visited there.

Anyway, the dinner was delicious and we had a generally pleasant time walking around and talking to people we know. Then, towards the end of the evening, it was time for the door prizes. Someone was standing up front with a microphone, calling out the numbers. Abruptly, a chair shot backwards – right in front of the emcee – and we saw a woman fall to the floor.

She had collapsed, for some unexplained reason. The whole room had seen it. The cheery door-prize announcers stopped their patter in mid-sentence and looked on, dumbfounded.

“Someone call the first aid!” shouted someone from the crowd. A dozen hands reached into pockets or purses, and emerged holding cell phones (thank God for cell phones).

“Is there a doctor here?” cried someone else. A tall, lanky older man in a business suit stepped forward and knelt down beside the stricken woman.

None of us could see what was happening. Our view was blocked by the tables and chairs, and by the several people kneeling down, assisting the doctor.

Awkward silence. Time seemed suspended.

“Is she alive?”

“I can’t tell. I can’t see a thing.”

More awkward silence.

“What’s taking them so long?”

Reflecting on this rather surreal experience later, I’m reminded of the oft-quoted remark of Susan Sontag, from her cancer memoir, Illness As Metaphor:

“Illness is the night-side of night, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.”

This unfortunate turn of events had abruptly thrust us all into a sort of no-man’s-land: the seedy customs-and-immigration holding area, with dirty linoleum and buzzing fluorescent lights, that marks the border between Sontag’s two kingdoms.

Moments before, everything had been normal: cheerful people doing what passes for fun in our materialistic culture. As soon as that poor woman’s body hit the floor, everything changed. Big time.

Finally, a police officer strode in, pulling behind him an oxygen tank on wheels. A few long minutes later, a couple of first aiders wheeled in a gurney. They lifted the woman onto it, and cranked it up high. At last, we could see. The woman’s eyes were open. She was breathing. Relief.

The crowd looked on in silence as the solemn procession of medical acolytes departed the room. Moments later, the festivities resumed as though nothing had happened. The people with the microphone started up the door-prize drawing where they’d off. They said not a word about the events we’d all just lived through.

If it had been a worship service, we’d have known what to do. We’d have offered a public prayer, asking the Lord to bless our stricken neighbor with healing and to guide those seeking to help her. Yet, this was a thoroughly secular setting, in an increasingly unchurched culture. Atlantic City rules contain no codicil that speaks to such circumstances. You just utter a little sigh of sympathy, then go back to gambling.

The portal opening into the kingdom of the sick had been slammed shut. The memory, and the uneasiness, lingers on.

March 4, 2008 - The Uncertain Now

I’ve been reading Happiness In a Storm: Facing Illness and Embracing Life As a Healthy Survivor, by Wendy Schlessel Harpham, M.D. (Norton, 2005). Wendy discovered my blog a while back, and we’ve exchanged a few e-mails. She thoughtfully sent me a copy of her book.

I’m finding lots that’s useful in it. Wendy is a longtime NHL survivor who, her doctors told her at the time of her diagnosis in 1990, wasn’t supposed to live longer than a couple of years. She’s certainly defied those expectations. After her first recurrence, she decided to lay her medical practice aside and focus on her own healing, during which time she’s authored a number of self-help books for cancer survivors.

Here are some words Wendy wrote that express how I feel much of the time, as I deal with continued, low-level uncertainty:

“A great challenge for me was figuring out how to transform my heightened sense of uncertainty from a source of fear to one of joy. The problem was that after my cancer diagnosis, I knew – really knew, in a way that I think might be impossible without personally facing a life crisis – that all comfort and routine can dissolve in an instant. A worrisome headache, lump, or change in a mole could propel me on another medical roller-coaster ride. For the first few years of my survivorship, my heightened sense of vulnerability caused me great distress and made it hard for me to feel or be happy, even when my medical condition was on the upswing. How could I feel happy today knowing that my health might he worse tomorrow?

Some patients achieve Healthy Survivorship by denying life's uncertainty, and that works well for them. Not for me. So my challenge became figuring out how to turn the same hyperawareness that used to steal joy into a force that would enhance my joy. Consciously choosing to be grateful for life's uncertainty has changed my perception of all I have in positive ways. Clichéd but absolutely true, the only thing that is certain is today, this minute, this moment right now. This is it. Cancer gave me today, every day, in a way I’d never known before. Since I no longer take much of anything for granted, everything has an added element of happy surprise – I made it to see this, do that, stay here, and go there! The ordinary has become marvelous. Even unpleasant times are less painful, for they are proof that I am still here.” (pp. 339-340).

Living in the now – aye, there’s the rub! Easy to say, far from easy to do.

Wendy thinks gratitude is a big part of living in the now, and I think she’s right. Learning to be grateful for the little things, even when a big thing like long-term good health is far from certain, can be a bridge to shedding anxiety and living fully in the present.

“Today’s a gift,” says the bumper-sticker slogan – “that’s why they call it the present.”


May we learn to recognize those gifts all around us, open them with childlike wonder, and be thankful!

July 14, 2007 - How Long Have I Got?

“So, Doc, how long have I got?” That’s the question that often follows hard upon the dread announcement, “You have cancer.” With lymphoma – as an article in today’s New York Times makes clear – that all depends on what type of malignant cells you’ve got (Alex Berenson, “A Disease Affecting White Blood Cells, the Body’s Infection Fighters”).

It’s a companion piece to a news article about the radioimmunotherapy drugs Bexxar and Zevalin, and why doctors have been slow to prescribe them (an issue I dealt with in the June 23rd installment of my blog – “A Smart Bomb that Could Be in My Future”).

The Times article deals with the “Doc, How long have I got?” question rather bluntly:

“Doctors divide the disease’s many varieties into two broad categories: aggressive, and indolent, or slow-growing. Aggressive lymphoma can be cured in 65 percent to 75 percent of the cases. If it is not cured, patients usually die within two years.

Indolent lymphoma, which includes the follicular type, cannot be cured. But it typically responds to chemotherapy and can be put into remission for years in most patients. Eventually, though, it comes back, and each time it becomes more aggressive. Typically, patients survive about 10 years after their initial diagnosis, although the course of the disease varies widely.”

So, what type do I now have, aggressive or indolent? That’s the big question. Back in December, 2005, my grading – according to the Memorial Sloan-Kettering pathologist, who differed from the local pathologist – was that I have “B type, diffuse mixed large and small cell.” This actually demonstrates characteristics of both grades (large-cell lymphoma is aggressive, small-cell is indolent). For treatment purposes, “diffuse mixed large and small cell” is categorized as an aggressive lymphoma.

About a year ago (see blog entry for June 9, 2006 – “Cancer Conference”), I had the chance to ask one of the speakers at a cancer conference – a researcher from the University of Pennsylvania Hospital, Dr. Martin Carroll – about the “diffuse mixed large and small cell” grading. I wanted to know whether it in fact belongs to both categories, or whether it’s simply aggressive. He confirmed that it does demonstrate characteristics of both varieties. Does that mean, then, that I have the worst of both worlds, I asked?

You could say that, Dr. Carroll admitted.

If that’s so, then I wonder how the New York Times’ quick answer to the “How long have I got?” question can be applied to my particular case? Let’s see. With the aggressive component of my disease, I have a 65 percent to 75 percent chance of being cured completely. If I’m in the unlucky 25 to 35 percent, though, I’m likely to be gone within two years of diagnosis – which means that (since I was diagnosed a year ago last December), in the worst-case scenario, time’s wingèd chariot is rumbling rapidly onward on in my direction.

Yet, I have (or, at least, had) both types of lymphoma – indolent as well as aggressive. That means the prospect of a permanent cure is unlikely. Even if I’m in the lucky 65 to 75 percent whose aggressive cancer does get cured, I still have to worry about those pesky, indolent cells of mine – the ones that make for a chronic, incurable condition, whose symptoms can be managed pretty well but never turned back completely. The presence of those small, indolent cells would suggest that the answer to the “How long have I got?” question is “10 years, on the average.” (Of course, “average” could mean considerably more than 10.)

The good news is, I was diagnosed early, without having experienced much in the way of symptoms. I’m also on the younger side of the typical lymphoma patient’s profile – both factors which are in my favor. Furthermore, the field of lymphoma research is developing so rapidly that, even within that 10-year window, a whole new drug could be on the market by then – meaning that all bets are off.

Then, there’s the matter of those enlarged lymph nodes – three of them, at least (one of which was biopsied last week). If lymphoma turns out to be the cause (and not some benign, but long-lasting infection), then what type of malignancy is it – indolent, aggressive, or both?

If it’s more on the aggressive side, that could suggest that I fall into the unlucky 25 to 35 percent, and that it’s time to call out the Special Forces (second-line chemo, radioimmunotherapy or stem-cell transplant). If, as the local pathologist thought – back in December of 2005, before the Memorial Sloan-Kettering expert weighed in – the grading turns out to be indolent, then it’s a matter of just whacking the cancer mole back down again, and waiting for the next recurrence.

As for the CHOP chemo treatment I’ve already received (along with the gentler Rituxan), the Times article is blunt about its side-effects: “While effective, it is highly toxic and can damage the heart, so it can only be given a limited number of times.”

As for stem-cell transplants, that treatment is no bed of roses: “When drug treatments have failed, stem-cell transplants are another option. But they are extremely expensive and carry a risk of mortality of 3 percent to 30 percent, depending on whether doctors are using a patient’s own stem cells or transplanting cells from another patient.”

Bottom line? The answer to the “How long have I got?” question is not at all easy to come up with, in my case. There has always been some uncertainty about the grading of my cancer – an uncertainty that may continue, if this most recent needle biopsy turns out to be (like the last one) not such a good sample. Yet, even if the “diffuse mixed large and small cell” verdict does continue to be in place after my most recent test results come in, it’s maddeningly complex, in and of itself (having characteristics of both aggressive and indolent).

Most doctors shy away from giving a clear answer to “How long have I got?” anyway – any answer can be a self-fulfilling prophecy. So, I continue to live with ambiguity, “delicious” or otherwise.

Today's Claire's birthday, and I've got a party to plan. That's enough of ambiguity, for now.

June 2, 2007 - Fear of Failing

There are few things more refreshing than waking up out of a nightmare.

That's what happens to me, early this morning. I open my eyes, and consciously push back a tortuous chain of thoughts that have been plaguing me for what seems like hours (although I know most dreams are actually of brief duration). I feel like a wreck, physically, but I resist going back to sleep, for fear I'll find myself cocooned in the dream-web again.

Here are the details: Claire and I are leading some kind of international tour (we've done that once before, a bus trip around the Scottish highlands and islands). For whatever reason, everyone's traveling separately. The plan is for all of us to meet up at some rendezvous-point in Britain, for a trip to India. Claire and I are traveling though some country that's a conglomeration of Scotland and Ireland. The airline has checked our luggage through to our final destination, but in order to accomplish the transfer, we've got to do a good deal of walking along country roads n this Celtic country, from one airport to another.

We're walking along one of these rustic roads, when suddenly it occurs to me that I've forgotten to pack any clothing in my suitcase. I realize, to my horror, that, for the next couple of weeks, I'll be limited to what I've got on my back – and I know that, traveling through a land as foreign as India, on a tight timetable, there will be neither time nor place for shopping for the kind of items I'll need.

Calculating the remaining time before our next flight, I realize that, if I rent a car, I have just enough time to drive back to the airport, fly back home, rent another car, drive back to finish my packing, then return. It seems to be the only solution to the problem: but, if it's to work, I've got to turn around and go back immediately. (Our itinerary evidently includes the granddaddy of all airline layovers, but who says dreams make any logical sense?)

Claire and I agree this is the only thing to do, and so we ask someone to help us find a car-rental place. Helpfully, he takes us back to his home, and lays out on the dining-room table a whole collection of travel brochures, telling us there's rental-car information in there somewhere. Aware that our layover time is growing ever shorter, we start riffling through these, trying to find the phone number of a car-rental place. We have no success – and, our helpful host seems to have disappeared. The more time slips by, the more my feeling of panic grows. Maybe we should just forget about extra clothing, I think: I'll just wear what I've got on, no matter how unpleasant that will become in time – for my traveling companions as well as myself. No, I can't do that. Quick, look through those brochures again! There's got to be a phone number in there somewhere...

It's then that, in a semi-conscious decision, I push back the suffocating blanket that is my nightmare, and start repeating to myself the healing mantra, "It's only a dream."

Someone skilled in dream interpretation would have a field day with this one. Even an amateur like me can identify the feeling of isolation, of being a stranger in a strange land. That's cancer, for sure.

Then, there's anxiety about professional competence. Advertising myself as a tour-group leader, then forgetting to pack my own bag, is the height of incompetence (although, to be fair, who knows how to pack for the journey of cancer?).

The tour group – offstage in the dream, and unable to witness my momentary panic – is surely my church.

The fear of body odor, from living in one set of clothes for weeks, could have something to do with the physical symptoms of illness, or even – to be perfectly blunt – the stench of death.

As for the rental car, there's a prosaic explanation for that. I had to rent a car yesterday, a temporary-replacement vehicle provided by the insurance company while my son's car is being repaired in a body shop. I felt frustrated that, for various reasons related to fine print in insurance-company and rental-car contracts, I couldn't avoid paying $20 a day out of pocket, for collision insurance on the rental – even though I can usually avoid the surcharge in other circumstances.

Running through the dream, like a rhythmic scratch on an old, vinyl record album, is the steadily-escalating pressure of time – something I'm very aware of in my life, on the micro-level, as my surgery date looms larger, and also on the macro-level, as I'm dully aware of the possibility that my life could be shorter than most.

Finally, there's the aspect that I'm not entirely alone on this journey. Claire's along for the ride, but she doesn't share my problem, personally (her suitcase, evidently, contains everything she needs, although she's sympathetic).

The most significant aspect – and, perhaps, the real lesson imbedded in the dream's surreal landscape – is that my illness isn't my fault. Much as I'm beating myself up, in the nightmare, for forgetting to pack clothing for the trip, there's nothing I could have done to prevent my cancer. Just keep saying to yourself, It's only a dream, (it's not your fault)... It's only a dream (it's not your fault)...

I'm glad it's only a dream. But, then again, in the usual fashion of dream-logic, it's remarkably true to life – at least, to the way I'm living my life right now, in this surreal, extended layover between medical tests.

February 26, 2007 - Trouble Enough

I’ve been encouraged to learn, in recent days, about a new cancer-related service organization that will soon be opening a facility in our area. The Wellness Community is a national organization that provides supportive services to cancer survivors and their families. The new facility, The Diney-Goldsmith Center, operated by The Wellness Community of the Northern Jersey Shore, will open in Eatontown on April 1, 2007.

I’ve known about The Wellness Community (the national organization, anyway) for some time. I think I first read about it in comedian Gilda Radner’s cancer memoir, It’s Always Something. Gilda found a support system there, as she was coping with her ovarian cancer. The Wellness Community must have been a very significant place for her, because, at her death, her family asked that memorial contributions be made to the organization.

The local chapter’s newsletter speaks of “3,500 square feet of space ample enough for multiple support groups, light exercise, mind/body programs, educational workshops, nutrition and cooking demonstrations, social events and more.” These services will all be provided free of charge.

Visiting their website today, I find some material that applies to my particular situation, as a lymphoma patient in remission:

“Thanks to improvements in early diagnosis and treatment, some forms of lymphoma have become more of a chronic illness for some people. That means that perhaps you might have recurrent cycles of disease, treatment, then recovery. Relapse may occur in all types of lymphoma. A lot of people have shared that the fear of recurrence seems overwhelming, especially when treatment ends. The challenge is learning to live in the moment, balancing the fear of recurrence with the desire to enjoy health and wellness.”

“Relapse” is, indeed, the dreaded word for people like me. My next PET and CT scans are scheduled for a week from now. It’s not that I’m spending a lot of time actively thinking about those scans – but, the awareness is always there, in the background, a sort of low-level emotional noise. When I was initially diagnosed, I was not aware of any symptoms. The disease crept up silently, and ambushed me from behind. I suppose that, should I ever have a recurrence, it could very well happen again in just that way: with no warning.

I’m feeling pretty good these days, physically. I’ve been working out at a local health club, the Atlantic Club, and find that it’s helping my energy level and general sense of well-being. Every once in a while, I reach up to the spot on my upper chest, just below the right shoulder, and feel the little knot under the skin. It’s my implanted port, the only physical reminder I still have of my cancer treatment.

Yet, the disease is still with me, and will continue to be with me, even if the scans come out clean. It’s the nature of cancer, and the reason why facilities like The Wellness Community, and the Cancer Concern Center here in Point Pleasant Beach, are necessary.

“The challenge,” says the write-up on The Wellness Community website, “is learning to live in the moment.” Oh, yeah. That about sums it up. We cancer survivors all too easily live in the past, remembering our past struggles, or in the future, dreading that which could (but may not, in fact) be. In the Sermon on the Mount, Jesus has a little something to say about that:

“So do not worry about tomorrow, for tomorrow will bring worries of its own. Today’s trouble is enough for today.” (Matthew 6:34)

The novelist, Anne Lamott, has that same sort of thought on her mind, as she recalls:

“Some mornings I wake up and I instantly feel discouraged by the world and my government and by my own worried mind. It's like my brain has already been up for awhile, sitting on the bed waiting for me to wake up. It’s already had coffee, and has some serious concerns about how far behind we are already. So I always pray, first thing upon awakening, very simple prayers like the one [my son] Sam prayed years ago when his head got caught in the slats of a chair: ‘I need help with me,’ he whispered…. I know that most of the time, for me, the only real problem is, that left to my own devices, I am on my own mind almost all the time.” ("Every Sandwich," Salon.com)

Let’s hear it for getting ourselves off our own minds! Today’s trouble is surely enough, without borrowing some from tomorrow.