We Wait. We wonder.

Many have reached out to our family recently with help or requests to offer help. For that we are grateful. Many have said, “what can we do?” We invite your support. I want to address what is so challenging about living life with advanced cancer. If you are interested, I encourage you to read on, to learn more about the difficulties of “survivorship.” If you would like to help, you can find information near the end of the post. If you are facing your own experience of illness or are affected by those who are, this post may shine a light on these challenges, so that you may be supportive to your loved ones. We truly are in this together.

 

When facing a serious illness, in our case, a terminal cancer, the diagnosis–receiving it, I mean, sitting beside your spouse or loved one, across from your oncologist, while their nurse reaches to grasp your hand–is a watershed moment of devastation and uncertainty, but before planting your feet on the ground, you are undergoing more scans, preparing for surgery, coordinating daily rides to the radiation therapy treatment center, and learning how to mitigate the side effects of chemotherapy. This is “active treatment,” and for all of its complications, interruptions, and social costs, at least you are “doing something.”

After active treatment, after the diagnosis is accepted, after life with brain cancer shifts from the center of your life toward the background and casts a shadow to shade every experience, this is when we feel most helpless; frustrated.

This is survivorship.

I’ve talked about this before to describe the uncertain period of time after active treatment, but before “disease progression,” the clinical language for the growth of cancer.

Brain cancer, even after near-total surgical removal, can, and often does, “recur” because microscopic cancer cells are difficult to distinguish from healthy tissue in the brain, and these hidden cells grow quickly to form new tumors. In the words of my neuro-oncologist, “it is extremely unlikely that you will not have a recurrence.” It is so unlikely, in fact, that we wring our hands nervously every eight to twelve weeks, waiting for the MRI results, for “disease monitoring.”

Scanxiety.

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An MRI scan showing the “surgical cavity” after removal of Adam’s brain tumor. The darkened area is the void left after removal. The lighter areas are inflammation and possible cancer cells.

But regular episodes of brain scans, or “imaging,” and the 24 to 48 hour lag time to meet with our oncologist to hear the results, does not adequately capture the full experience of living each day with this ambiguity. Imagine that regrowth of cancer is imminent, but when the recurrence may occur is totally uncertain. There are no preventative measures to be taken; no clear actions to mitigate the risk factors; the risk factors, themselves, are unknown.

People often say, “I could get hit by a bus tomorrow.” Yes, you could, and yes, that’s a good reason to put your heart and head into something that matters to you every day, but waiting for disease progression is different. See, I know the bus is coming, I just do not know its route; whether it’s running on time. I do know that as my disease progresses I may be subject to a second (or third, fourth) surgery, or more radiation therapy, likely to cause cognitive impairment after the first round beamed a lifetime dose into my brain as part of the standard treatment protocol. With progression, I may expect language impairment, loss of memory, personality changes, inability to read or write… these are all possible symptoms to present if (when) the bus shows up.

So we wait.

We wonder.

We dress our children and stir the oatmeal. We sign homework folders and take out the dog. We manage the logistics of three children and a single driver. We swim against the current of cancer to create a childhood for our kids that resembles normalcy.

But it isn’t.

It isn’t normal.

We sign up our kids for soccer, and another in art class, and we move money from one credit card to another with a lower interest rate, and we scribble back of the envelope calculations every month to make sure we’ve earned enough to pay the bills, always mindful that if my income exceeds the Social Security Administration earnings cap, which is federal poverty level, my disability disbursements will be cut back or suspended, disincentivizing work, even the little I can tolerate on a restricted hours, work-from-home status.

We wake up some days and speak to 130 first year medical students (like I did recently), and we take the main stage of conferences to motivate change in healthcare (like I will next month), and we organize local fundraisers to raise thousands of dollars for brain tumor nonprofit organizations (like a team of us have done for two years), and we put on scrubs and help care for people after strokes, trauma, amputation, while our loved one struggles with their own health at home (like Whitney does each day).

We wake up other days, nauseated, lightheaded, and we wonder if these are early signs of recurrence. Or maybe just a headache.

We wait.

We wonder.

It isn’t normal.

You affirm every day that it is good to be alive. And it is good to have the opportunities to take a terrible circumstance and channel that energy toward good works. You are grateful for supportive employers who let us get away with far too much, and appreciate our work all the same. You acknowledge a terrific community of friends and family–and strangers–who send gift cards in the mail to buy groceries, or cut generous checks that cover a month’s worth of rent, or discreetly hand over folded bills to purchase nutritional supplements for your oldest child who’s at risk for developmental delays, if he doesn’t gain weight and increase calorie consumption, so they tell us.

But you recognize that community support has a limit. And asking for help is humbling, if not humiliating, and you think maybe you should bite the bullet, find a way to return to work full time, lose the benefit status, but make up the earnings in income. But you reflect that people with “normal” life expectancy end up wishing they pursued something more aspirational with their lives, and you do not have normal life expectancy–”it is extremely unlikely”–so why fight symptoms and fatigue in a modified or adaptive work setting, when your time can be filled reminding healthcare that it’s a human practice more than it is a scientific one (as I have tried to do speaking and writing). With all of these thoughts circling your mind, you are grateful you’ve lived for three years with something that kills some people in ten months, but you ask, how can we live three more years this way?

We wait.

We wonder.

I was diagnosed with glioblastoma 38 months ago. Our community has carried us these three years. You gave generously to our family in the Fall of 2016, immediately after diagnosis.

Now we invite you to support our family again.

Whitney and I have lived in the open with blogging, speaking, and often, wearing our hearts on our sleeves. It is in this spirt that I tell you, we have deliberated the publishing of this post for the past several weeks. The problem we face after three years of survivorship is summed up in this article review of a recent National Cancer Institute (NCI) report: “patients with malignant brain tumors accrued health care costs that were 20-times greater than demographically matched control subjects without cancer.”

Despite Whitney’s tireless work with four (yes, four!) jobs (1. inpatient occupational therapist; 2. sub-acute care for the elderly occupational therapist; 3. developmental preschool occupational therapist for children; and 4. part-time yoga instructor), and my part-time work and occasional honoraria for public speaking, plus my disability benefits, we close the monthly budget gap with credit cards. Copay expenses go toward my medications, specialists, and our share, after insurance, of the $115,000 brain surgery that gave me the best chance at longer-term survival.

We must ponder the following questions:

Medications or kids sports?

Copays for the best doctors and mental health professionals for our kids or trips to the zoo and new clothes for school?

The freedom for me to speak at medical conferences, publish articles, and continue work on my book manuscript or exhaust all of my energy reserves working as much as my income cap allows?

Maximize each day of my limited life that remains, whether that is three months, three years, or thirty, or sit at the dining room table with Whitney for another month worrying about bills?

The choices we make are choices of personal goals and values. Whether your values align with ours, influences your decision to help in the way we are asking. If we are not so aligned, that is OK, too, we are still in community.

For those who have helped us: friends, family, siblings, parents, cousins, faith community, former professors, we thank you.

For those curious how you may do more, we have launched a GoFundMe to help our family close the monthly budget gap. If nothing, we have tried our best to be transparent through illness. We thank you for donating toward meeting a $8,000 goal to give our family a little breathing room this Fall.

A&W | #AandWTumorTakedown

You Might as Well

“Go home and eat some ice cream …you might as well.”

This advice was given by a doctor who cared for me during a phase of the “standard of care” protocol. This statement reflects a familiar theme for those of us with serious illness, specifically, a haphazard, anything goes attitude toward self care. There are at least two reasons for this: first, most physicians are trained within the rigid medical school curriculum that is shaped by the ‘biomedical model.’ Do not be intimidated by the phrase: biomedical. What it refers to is the Western tradition of medicine especially over the past couple hundred years, beginning with the germ theory of disease, then the discovery of the structure of DNA, and now dominated by genomic sequencing. The guiding thesis is that biomarkers and lab work reveal all, or at least most, of what clinicians need to know to diagnose and treat diseases. In other words, there is not much to do ‘personally’ beyond what the treatment protocols call for clinically.

The role of nutrition in cancer care is unknown, other than burgeoning evidence linking fiber intake to improved outcomes following the diagnosis of colorectal cancer, and studies attempting to correlate consumption of red meat and processed foods to cancer risk. There is not (yet) a decisive trial arguing for any therapeutic efficacy or improved clinical outcome tied to diet.

Second, following the deterministic ideal from biomedecine, that diseases are governed by microscopic physical laws, and that what matters to care is what happens in the clinic, health outcomes and prognosis follow a disease trajectory that is well established through population-wide statistics. Because the outcomes for my serious illness are grim and options for curative therapies are limited, the take on self-care is “anything goes.” Go eat some ice cream. You might as well.

This post is not about ice cream. Rather, this post is about the attitude. Anything goes.

The problem with this attitude is that if anything goes–if everything is permissible–than nothing matters. If nothing matters, it is easy to become disenfranchised. If nothing matters, we lose grip on our “agency,” or feelings of control. When feeling out of control, our mental health suffers. We believe things like, “you might as well.”

The anything goes attitude is especially damaging when we peer through the lens of nutrition: choosing what to eat, when to eat is an exercise in self control. Amidst the uncertainty of serious illness, when threats to our agency loom large, patients may express their control through diet. In the absence of clinical data to argue for (or against) nutritional solutions for cancer, clinicians are often silent. Meanwhile patients ask their peers what diet others are following. No doubt patients are interested in enhancing and extending their lives and so are interested in the potential outcomes associated with diet, but more so, I think patients are desperate to compare their experiences, share what decisions each other is making on their own, and validate their choices through peer support. The anything goes mindset undermines what patients seek: agency, control, and support. When these pillars are chipped away, our health suffers.

You might as well eat what you want.

You might as well have a few drinks.

You might as well charge that to credit; take shortcuts on the job; skip the difficult conversation; give up on that goal you set for yourself; stop going to the gym; do not fix the strained relationship with your family; just do what you want. You might as well.

When diagnosed with a serious illness it is very, very easy to slip into the anything goes mode. When we are in the middle of it, recovering from surgery, nauseated by chemo, weak from fatigue, in short, when we are in the shit, it is easy to believe that we *deserve* to treat ourselves. That our compensation for getting blindsided by a life-limiting or chronic illness is to eat the ice cream.

I agree that serious illness carries a privilege. Yes. A privilege. And I think further that serious illness does license an attitude to seek more enjoyment in the good moments and savor our time with family and friends. Even to, sure, go home and eat some ice cream, but not because anything goes; instead, because well being is possible within serious illness, and that is something we discover for ourselves by living life, not through microscopes or biomarkers–not that these are not integral tools to practice medicine–but because health and illness are bigger than medicine.

We are privileged to confront mortality in a robust and meaningful way; in a way that opens new vistas; in a way that we might serve as a beacon to others to live a life seeking wellbeing. We are privileged to learn the intimate secrets of life. So tell your story. Enjoy living. You might as well.

 

Camp Kesem BSU Make the Magic 2019

Our family has been uplifted in so many ways by our experience with our Camp Kesem local chapter at Ball State University. Camp Kesem is a week-long summer camp for children whose parents or guardians have been affected by cancer, CK supports kids, “through and beyond a parent’s cancer.” The camp is provided at no cost to eligible children, supported by the generous donations of their national network. For this year’s annual gala, Make the Magic 2019, I was invited to share our family’s story. I delivered the following remarks on Saturday, April 13, 2019. Please consider a donation by following the link. Thank you, CK at BSU, for your love and care. xoxo ❤

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Glioblastoma. An aggressive brain cancer with a five-year survival rate of 5-8%. Abbreviated usually to its medical moniker, GBM, this cancer is so-far incurable, and sadly, treatment options are strikingly limited: only three new chemotherapeutic agents have been approved for the treatment of GBM in the past 30 years. The disease presents with a host of neurological disorders: seizures, called “tumor-associated epilepsy,” severe headaches, memory loss, confusion, often personality changes, and depending on the location of the tumor in the patient’s brain, the size of the tumor, and the side effects from surgery and radiation, other impairments can develop, for example, my left-sided sensory and motor impairment, which affects my balance, and my sense of where my body is in space, a sense called “proprioception.” This proprioceptive impairment is like a blind spot on your car’s rearview mirror. This explains why I constantly run into door frames or furniture and the one awkward time I unwittingly stood too close to a woman old enough to my grandmother in the deli line. “I thought you were my husband!” she exclaimed when I brushed against her. I was surprised as she was.

GBM is thankfully rare, affecting only three people in 100,000. When I was diagnosed in June 2016, I was 34 years old. The average age of diagnosis for GBM is 56. Our family faced a rare, life-limiting disease, and in this rare population, I fell into a smaller sub-group, 20 years younger than the average patient. For other parents or guardians diagnosed with GBM, if they fall into the average patient profile, that could mean another two decades for their children to age. Our youngest, Gideon, was only eight months old, when we received my diagnosis. Noah, two, who gave himself his camper name at the Friends and Family reunion this Spring, “Green Bean,” and our “Cheese Pizza,” who is our first camper to join the CK family was four. For our family, common to many families affected by brain cancers, educational resources are few. For a family with very young children like ours, there are practically no resources for educational tools or books. I recall our family therapist being so excited to give me a book about talking to kids about a parent’s cancer she picked up at a local meeting of this or that society. Thumbing the pages, my enthusiasm dimmed when I read, “Doctors are the good guys and can wipe out the bad guy cancer!” Not only am I not a fan of this oppositional good guy-bad guy trope, the doctors told us that I had a cancer that they couldn’t “wipe out.” Of course, the grimness of this reality is not limited to brain cancer. Breast, lung, melanoma, pancreatic, our lives are threatened by the primary cancer, and if manageable in the near term, for our entire lives the threat of “mets,” or metastasis, looms large.

This is not the end of the story, but the start of something new. Us parents and guardians diagnosed with cancer and our loved ones understand in the fear and uncertainty, we may also find tremendous joy. A source of that joy for me and Whitney are our children, the “Hayden Hooligans,” as our favorite preschool teacher dubbed them. Whitney and I shared the difficult news of my diagnosis with Isaac by treating him like a partner in my care. We empower our kids through our vulnerability. Cheese Pizza, “Cheesey,” is a smart guy. We practice seizure drills with him to know what to do if I lose consciousness while Whitney is at work. We ask our kids to help dad get a blanket and glass of water on bad days. Isaac’s school recently had a “Senior Citizens Day” for spirit week, and he used one of my adjustable canes to complement his outfit. He shuffled around the house saying, “I’m an old man.” (This is sort of a dig on me, because hey, it’s my cane, and I’m not an old man!) I joked with Isaac, “How cool, I bet the other dads don’t have canes for their kids to borrow!”

The first step in my treatment was surgery. A brain surgery called a craniotomy. My operation was an awake procedure allowing me to interact with my surgeon and follow commands. My 7cm tumor—about the diameter of a baseball—pressed and invaded my sensory motor cortex, in the right parietal lobe of my brain. I was kept awake to allow the surgeon to carefully “map” the functional areas of my brain, while removing cancerous tumor. During the operation we reached a decision point when the surgeon said to me, “it is difficult to see the ‘margins’ between tumor and healthy tissue. I can continue to remove tumor, at the risk of permanent left-sided paralysis, or we can end the procedure now, leaving tumor remaining.” After brief discussion, I replied, “I have three young kids. Permanent paralysis is not compatible with rolling around on the floor and playing with my kids. Let’s stop the operation now.” Making difficult decisions with our kids in mind is a responsibility parents and guardians with cancer know too well.

Adults are fortunate to have access to support groups, therapists, books, and often faith-based communities to process our complicated emotions. These resources are not so readily available for kids. Camp Kesem, as their mission and purpose states, “is there for children through and beyond a parent’s cancer.” Nervously approaching the campgrounds last summer on the last day of camp, Whitney and I prepared to pick up a sobbing mess of a Cheese Pizza. It was his first sleep-away camp and one of the few times Whitney and I left one of our kids for more than a long weekend. Instead, Cheesey ran over, offered a half-hug, and sprinted back to GaGa Ball. On the hour car trip home Whitney and I could barely get a word in between Isaac yelling, “Heeeeeey Burrito!” He told us all about camp and how he plans to be a counselor when he’s too old to be a camper. Tonight, we make the magic, and we do it for our kids, our source of joy in the darkness of cancer. Let’s give generously to spread this light.

 

2019 Tumor Takedown Tailgate

Join us Sunday, April 28, 2019 at Revery in Old Town Greenwood, Indiana, to raise money, awareness, and connectedness with and for the National Brain Tumor Society (NBTS)! Tickets are available now from our Eventbrite ticketing site. Tax-deductible donations can be made at any time to our NBTS event donation page.

We thank Erin Lisch from RTV6 who is serving as emcee for the event. Your general admission ticket includes live music from J. Elliott and band Free but Not Cheap, food from the Revery kitchen, including sliders, Chicago style dogs, and Italian beefs, with Tailgate sides. Also, enjoy two complementary beverages with an opportunity to purchase more, featuring Mashcraft Brewing, Central State Brewing, organic Italian wine spritz from NYC-based RAMONA, and wine provided by distributor RNDC. For dessert, grab a donut, courtesy of Jack’s Donuts.

A ticket also entitles you access to our silent auction, which includes a signed Pacers team basketball, thanks to Official Sponsor of the Pacers, Jack’s Donuts, a branded sweat suit from high-end sneaker retailer Stadium Goods, services from Hope Plumbing, swag from local soccer club, best in the midwest, Indy Eleven, distillery tours, photography packages, workout classes from 317 Fitness Studio, restaurant gift card to Morton’s courtesy of Berkshire Hathaway Indiana Realty, Sushi Boss, salon and massage certificates, artwork and more!

Stop by our Mission and Education table, where you can chat with folks directly impacted by brain tumors, and learn more about National Brain Tumor Society. Also, joining us for the first time this year is Cocktails and Chemo, a local non-profit with national reach that is focused on caring for the caregiver for those care partners who are the unsung heroes in cancer care.

Featured image, Adam Ramsey Film, who will photograph our event for the second year!

Massive thanks and applause to our gold Sponsor, two years running, the BlakeStrong Bowell Fund!

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Many thanks to our silver sponsors Stadium Goods, the Luminous Fund, Bookends Financial Planning a Raymond James Company, and Hope Plumbing.

 

And shout out to our bronze sponsor, J Dog Junk Removal.

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All event proceeds benefit the National Brain Tumor Society | $40 | 21+

To stay up to date on #TumorTakedownTailgate news, drop us your contact info!

 

 

Unraveled

“I think this is the winter everything unraveled.”

 

I sent this text to my spouse, early Sunday morning, February 2019, calculating battery time remaining on our family iPad, as the kids huddled on our bed, while the neighborhood lie dormant with a power outage. Thick February skies quieted our home, and a drizzle of late winter rain needled dry, fallen leaves as they leapt from brown grass, animated by gusts of wind.

I took my usual position, leaning against the kitchen counter, near the coffee maker (currently, useless), and I scrolled my Twitter timeline. Social media is one of a few avenues for my peer engagement. My driving restrictions limit my time outside the home, and so, my adult interactions. My spouse and I desire, naively, for ourselves, parts of the lives each other leads. She prefers to stay home with house chores and our kids. I prefer to be in the world of work and errands, engaging peers and colleagues.

Or so each of us thinks, anyway.

The grass-is-greener phenomenon describes our envy. I suspect many working parents or guardians, with an at-home partner, relate to these emotions. We sell short the feelings of our partners when we project our idealized circumstances onto the other, “if I were in your shoes…” This tendency to imagine the best case scenario and fault our partners for either complaining about, or failing to recognize, the privileged position in which they hold, may be explained by a failure to listen closely. The daily texts, abbreviated and curt phone calls, the end of day exasperation, sighs heavy with frustration, and hyperbolic complaints (“I just can’t do this anymore”) indicate that we feel our voices are not recognized; that we do not feel heard. Quieted.

Empathy is something like the ability to take on the mental states of another person, but too easily do we slip into ourselves, experiencing what the other faces, rather than stretching our imagination to consider how might we feel if we were the other person, replete with their body, feelings, emotions, circumstances, and standpoint, facing those same circumstances. Sympathy describes the former; empathy, the latter. Sympathy is the identification of challenges facing another, and we consider what if we were “in your shoes,” as I mentioned. Empathy requires deeper consideration. We may ask, “what if I were this gender, with this age, with those lived experiences, with these responsibilities, facing this situation. That is empathy. We won’t get it right. Sympathy is cheap, and empathy requires practice. Cheap and easy often trumps deeply considered and practiced.

Sympathy is extended in virtue of a power dynamic, where the person expressing sympathy assumes they understand what the other person is experiencing and takes license to dole out advice. Empathy reveals vulnerability because it undermines our power. A truly empathetic expression–if one is achievable; see: consideration and practice–reveals that we have limited means to truly imagine our way into the experience of another. We are restricted and biased by our own experiences. We cannot separate completely our unique perspective and position from the perspective of whom we are attempting to relate to empathetically. And so our power, our confident, arrogant, envied, “if I were you,” power must be set to one side. We must admit we are powerless to adopt another’s perspective. We are mistaken to think our “if I were you” advice is either helpful or relevant. At best, we practice empathy.

Practicing empathy requires a commitment to listening closely. Like reading the words of a compelling novel, we must give ourselves over to the narrative. We cannot hear the story through our eyes. We must stretch ourselves to becoming that character featuring in the narrative, while admitting our ignorance and powerlessness to achieve this aim. The attention paid to our favorite novels guides the attention we are to pay to our loved ones. Though, in the real life interaction, our imagined character has a voice, speaks back to us, co-creates a shared space for meaning, where the words and events one person selects to construct and share are risk-laden sacrifices because we offer ourselves with no guarantee the stories we tell are interpreted with the intended significance. Our meaning may be lost in the transmission. The author of the novel recognizes this tacitly: the words on the page are open to interpretation. We do not recognize this so easily as speakers in relationship because we rely on the nuance of verbal communication. Still, interpretation features saliently in how we perceive others.

In this way, sacrificing ourselves on the alter of intended meaning is an act of vulnerability. We give away our power to create meaning for ourselves by transmitting our meaning-laden experiences of the world into the shared space of co-creation, between ourselves and another. If I were to generate the confidence to share my feelings, I cannot be certain those feelings are respected with the same reverence for which I hold toward them, in virtue of those being my feelings.

Practicing empathy forces us to pursue an unachievable end, and to admit our powerlessness to embody the experience of another. Even a very close, intimate other. We act vulnerably when we admit we have little license to say confidently, “if I were you.” Sharing our experiences is likewise an act of vulnerability. We are powerless to convey the deep, personal meaning of our experiences. And so, interpersonal communication, by virtue of its very nature and aim, is a resignation of power. Those with whom we communicate most intimately, where the stakes are highest, with our loved ones, is where we stand to lose the most. In this shared space lies the recognition of our failure to empathetically relate; in this shared space lies the failure to guarantee the transmission of how we feel. Admitting failure, or admitting our limitations, at any rate, is giving up power.

We often do not recognize this because rather than practice empathy, we slide into sympathy: “Oh, if I were leaving the house each day to go to work I’d have richer interactions with peers and not feel so burned out at home”; “If I were able to be home each day with the kids and stay up on organizing our house, I’d have much less anxiety.” These sympathetic, power-reinforcing dynamics, that fool us into thinking we understand the circumstances of another, and so have the warrant to offer advice, protect us from pain because they protect our power. But to connect empathetically, to stretch ourselves beyond sympathy and practice empathy, requires we flatten the power dynamic. Empathy acknowledges authentic communication seeks for itself vulnerability and humility.

When power is resigned, we open ourselves to pain. We may feel quieted when our voices are not heard. Our power has not been given freely. Our power has been taken from us. Powerless, we seek ways to take punitive action. We hurt and so we look to regain power through threats, angry statements, and nonverbal signals. Avoiding affection, restraining intimacy, limiting authentic communication, seeking emotional relationship with others are actions the vulnerable take to restore the power balance.

 

“I think this is the winter everything unraveled.”

I recognize that I feel powerless. I do not pretend to speak for my spouse. I’ve claimed in this post, we cannot achieve a fully empathic connection. Though I have not said a goal should not be pursued only in virtue of its far and uncertain reach, even if beyond our grasp. In other words, connecting empathetically is a goal worthy of our practice. Without claiming too much, I imagine my spouse to feel powerless, too.

Freely giving up our power, it turns out, is a powerful act. It is an expression of trust, an expression that I can share my feelings and experiences and my partner can be trusted to tease out subtle and nuanced meaning. Freely giving up power is an effective response to feeling our power is taken. Quieted. We affirm, others may affect our powerlessness, but vulnerability is an act we may attend to on our own terms.

I am powerless, vulnerable, and from this place, maybe I am prepared to achieve a greater degree of empathy.

Relationships are built on communication, verbal and otherwise, and each act of communicating is open to interpretation. We hold power foolishly when we imagine with hubris that we know what others are going through, but when we freely give our power to another, when we say, I am worried. I am hurt. I am afraid. When we stop thinking, “if I were in your shoes,” and stretch ourselves to imagine the life-world of another, that vulnerable sacrificing of power just might be the way forward.

Living with Cancer: Insidious and Destabilizing

“Don’t think, daddy! You can’t think right! You have a brain boo boo. Just ask me next time.”

Isaac, our confident, insightful seven year old, the oldest of our three boys, said these words to me this morning, when I shoved his lunch box into his backpack while rushing out the door to catch his school bus. The prompt for his cutting remarks was my explanation of the contents I packed for his daily lunch. “I thought you liked that stuff!” I muttered dishearteningly, with a mixture of confusion and exasperation.

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Isaac, seven years old, before school, January 2019

My crime: thinking, or rather, as we may say as adults, assuming, and on that charge, I am surely guilty. I assumed a handful of snacks, protein, a juice box, and a square of chocolate would be a fine lunch for our oldest guy who is limited in his food options, after Whitney and I discovered, with the help a functional medicine practitioner and blood, urine, and saliva testing, that Isaac suffers from several food allergies.

I’ve raised before the issue of talking to kids about cancer, but what we face, the daily grind of parenting three young boys, my spouse who must work outside the home to serve as our primary earner and carry our medical benefits, and the primary at-home guardian, me, suffering from brain cancer and the host of accompanying neurological disorders–namely, headaches, seizures, and motor impairment–is a combination of factors that affects our kids in untold ways. It affects me, too, in a deeply fracturing sense. A fracturing of my will from my ability; my plans for the future and my practical responsibilities.

Surely we all squabble with our kids, and for this reason, motivated by a desire to connect, or to comfort by striking chords of relatability, or for fear of peering too closely at a situation that is all too frighteningly real, friends say to me, “yeah we get lip from our kids, too,” or “we also have a picky eater.” But the burgeoning independence and personality of an oldest child, or picky eating habits or allergies, and even the stressors of an at-home guardian fail to address the insidiousness of serious illness.

“You can’t think right! You have a brain boo boo.”

 

The 17th c. philosopher Thomas Hobbes, in his important work, The Leviathan, envisions conditions for people absent of government oversight: a “state of nature,” he called it. Important to note is that Hobbes is writing in a time when Europe is ravaged by a bloody civil war and political crisis. At any rate, Hobbes considers life to be “solitary, poor, nasty, brutish, and short,” in this state: “a war of all, against all.” Hobbes did not consider this a historically accurate description of pre-political humanity; rather a thought experiment to motivate his political theory.

During my first semester as a philosophy undergraduate we read excerpts from Leviathan. My professor pointed out the “insidiousness” of the imagined “natural state.” The point, my professor emphasized, is not that everyone is locked in combat. Instead, the threat of instability looms large, and this unsettling psychological state is a hinderance on people’s desire to live well.

 

Living with cancer is insidious and destabilizing. A psychologically unsettling state. After active treatment has ended, at least for brain malignancies like glioblastoma, patients enter a period of disease monitoring: MRI (brain) “scans” every eight to twelve weeks. The return (recurrence; regrowth) of glioblastoma is near certain, regardless of surgical success or response to chemotherapy. After recurrence the disease is near universally fatal, and the five-year survival rate is a dismal 5.5%.

 

My working life, that is, “work” in all forms, including: my paid part-time work, and also writing (blog posts like this that you are now reading), speaking, interviewing, advocating, and so on, is taking its toll on me both physically and emotionally. My days end in fatigue, and continuing to tell my story, though with innumerable positive implications for myself and others, is also like retuning to the scene of the crime. I am surely threatened by this destabilizing psychological state. Do I continue to work? Do I retire to a life focused on family and permit myself to let go of self-governed responsibilities, or, like Hobbes, are these self-governing practices the only things separating me from a natural state?

 

Following my son’s ill-delivered but insightful advice: it would be better not for me to assume, but to ask all of those closest to me and to myself, how might I best seek a life well-lived?

Why Disability Doesn’t Work If You Work, with Advanced Illness

The word “financial toxicity” is often used in the context of cancer care. Why is that? Here is my experience with financial instability.

 

I became eligible for disability shortly after diagnosis with glioblastoma. This diagnosis qualifies for the Social Security Administration’s list of compassionate allowance conditions, which “are a way to quickly identify diseases and other medical conditions that, by definition, meet Social Security’s standards for disability benefits.” These “conditions” facilitate expedited approval for Social Security Disability benefits. However, my claim as adjudicated by the administration deemed me to be “temporarily disabled.” I am subject to a three-year monitoring period prior to being determined “totally and permanently disabled.” This distinction is important because under temporarily disabled status, my disability benefits do not qualify as income. Without this qualification, my benefits, approximately 60% of my salary at time of disability, do not have bearing on our family’s income-to-debt ratio. Inability to qualify for a mortgage is, to date, the most detrimental impact to our family. We rent a home and pay a premium for our financial insecurity, strange as that sounds. We expend two to three hundred dollars more monthly than a mortgage for a comparable home.

 

What’s more, my earnings are “capped”: should I exceed a threshold of monthly earnings, my disability “cuts back.” That is to say, there is little incentive for me to earn income beyond this threshold, set at federal poverty level. To further complicate finances, my publicly-held student loan debt is dismissed after this three-year monitoring period, but again, should I exceed earnings beyond the annual FPL “cap,” I disqualify my eligibility for dismissal.

 

To put things plainly, if I work to my current full potential I “break even,” contrasting my increased earnings with cut back disability benefit disbursement. There is little incentive for me to earn more, unless I might earn so much that I exceed my disbursement. Earning more harms rather than helps my family. In this sense, I am disincentivized to work. It is better off for me to remain at federal poverty level. Counterintuitive.

 

The fundamental problem is this. Disability benefits, programmatically, are not designed to aid those with progressive advanced illness. True, my family required disability assistance in the months following surgery. We simply could not have lived otherwise. I was completely unable to work, suffering from the most severe of my symptoms: significant motor impairment, frequent seizures, daily headaches, daily nausea, and significant fatigue. Given the nature of my neurological deficits, during my two plus years of survivorship I have learned to mitigate symptoms through rehabilitative therapy, proactive planning, and completing my first “phase” of active treatment. I am now “recovered” enough to return to work, as I have. This recovery, though, is short-lived. Glioblastoma is a recurrent disease, and at the time of recurrence the survival median shrinks significantly. I am currently at my most “able” to work.

 

Contrast my case with others who may become disabled. Imagine an incident: work-related, vehicle crash, unforeseen accident, and so forth, these folks present with most acute trauma in the near-term and recover slowly to return to the workforce. The Social Security Trial Work Program incentivizes people to return slowly to work by suspending medical review, protecting disability disbursement during a trial work period, regardless of the income earned, with the ultimate goal of terminating disbursements after the conclusion of a trial work period. The candidate for this program is the person who is disabled today and is predicted to be able to work in the future. Here the income caps make sense, almost by default, because one may not be expected to reach full earnings potential while returning to work.

 

This is not my case.

 

My greatest earnings potential is now. Though physically and intellectually unable to maintain a full time work schedule, I am able to sustain the part-time, from-home hours as I have been, thanks to my generous and caring employer. A recent work project has demanded full use of resources from the assigned team, including me. This is a great opportunity to invest maximum hours while the work is available and pressing. Though, should I gather the energy to support in the short term to drive the project toward completion, I risk cutting back benefit disbursements and putting my publicly-held loan dismissal at risk.

 

Rather than near-term disability, with the aim to return to work, as SSD benefits and Trial to Work programs are designed, my part-time work capacity is greatest now, and cannot be counted on for more than a few months, given the nature of my progressive advanced illness.

 

Financial toxicity, a buzzword in cancer care and survivorship, is not only the rising cost of treatment and prescription drugs, the inability to work full time, or the loss of care partner income, such as a spouse who reduces hours to respond to increased care needs, it is also, or maybe it is more, about the systemic designs of our assistance programs which are poorly equipped to meet the needs of the seriously ill.

 

When my monitoring period is up after three years from the date of disability, there is only a chance I’ll still be alive to be monitored: the median survival time for glioblastoma with my particular genetic profile is 27-31 months.

 

I will likely die in the home that our family does not even own. This is the damned if you do, damned if you don’t scenario: work more, earn less; earn less, earn less. That is financial toxicity.