What Do Cancer Survivors and Diamonds Have in Common?

Diamonds...how do you make one? You bury carbon dioxide 100 miles inside the earth's core and then you heat it to 2,200 degrees Fahrenheit. It's all about high pressure and high heat. But a raw diamond isn't really all that amazing, is it? It becomes something special when it is transformed.

Raw diamonds do very little to let in the light. They are obtuse rocks, chunks of pressurized carbon that don't shine, glitter, or gleam.

Ordinary...common...plain.

The other day, I read a very touching obituary about a woman whose struggle with cancer began back in the 1970's...forty years ago...four decades of battling this disease...can you imagine the pressure she faced to live her life in spite of cancer? This isn't an undertaking for the faint of heart.

Cancer survivors live their lives under enormous pressure. They constantly rework the details of their lives around the disease, making the necessary accommodations that enable them to continue reaching their goals, even when they don't know if they'll reach them all.

It's a myth that diamonds are unbreakable. Sometimes it happens. A tiny fracture, one that might exist as the stone is forming, creates a vulnerability that puts the diamond at risk. Sometimes if it's struck at that vulnerability, it will crack, divide, or even chip. If the damage isn't great, it can often be repaired.

Sometimes people, like diamonds, can break. No one is invincible. But the human spirit that chooses to rise above turmoil, that seeks to endure the unimaginable, often finds there is opportunity in wise design. Knowing our own flaws helps us to figure out our strengths and use them to our advantage when we construct, and sometimes reconstruct, our lives with cancer.

The myth about cancer survivors is that they somehow achieve greatness because of their experience with the disease. People expect cancer survivors to be extraordinary beings, super heroes who do amazing things because they have the Big C. In reality, cancer patients are human. Who and what they are is decided, not by disease, but by self-determination and wise counsel.

Cancer survivors aren't all equal. Some are so overwhelmed by the rigors of cancer management that they lose themselves in the pain and uncertainty. Some stop living their lives. They lock themselves away and grieve for the time they won't have, rather than living the time they do.

And some, despite being overwhelmed, in pain, uncertain, rise above the limitations of disease and move forward, upward, onward. They don't do it because they have super powers, but because they gird themselves with courage they hope will hold them up. They are willing to take one little step more by drawing on their inner strength.

Most long-time cancer survivors can teach the world much about personal resolve, about what it's like to find yourself knocked all the way back to Square One when you least expect it. Fighting cancer isn't about sweating the skirmishes, but about surviving to fight another day. Seasoned veterans of the battle know that the first time you hear that diagnosis is horrible, and it never really gets easier to hear it again...and again...and again. But it sometimes happens. You do the best you can and you go on.

Some cancer survivors seem to thrive as human beings, and we often mistake this phenomena as a byproduct of the disease. Cancer didn't improve them. Sure, it pressured them, heated them until they were sure they could take no more, but they CHOSE to transform themselves.

It takes a jeweler to see the beauty inside a raw diamond, to chip away the cloudy bits, to cut away the flaws, until it is transformed. Every facet of a well-cut diamond allows in light, and where there is light, refracting on those hard surfaces of the diamond, there is sparkle. But it is the human hand and the human eye that finds the beauty in the raw stone and turns it into a gem.

Every cancer survivor has the power to transform. Choosing the kind of life you want to live WITH a cancer diagnosis allows you to take back your personal power. That mindset, that self-determination in the decision-making process, is what empowers us as people to take what we have and make the most of it. If we believe we can find opportunities even in crisis, we will seek them out. And when we recognize them, we will use them to our advantage.

When selecting a diamond, most jewelers advise paying attention to the four c's -- cut, clarity, color, and carat. A good raw stone will yield an attractive gem in the hands of an experienced diamond cutter. It's a matter of knowing what goes and what stays. The same is true for cancer management.

Long-time cancer survivors, honed by experience with the disease, often develop extraordinary clarity -- they come to recognize their vision of what life should be and they work towards making it happen, even when there are obstacles in their way. They add deliberate color to their lives by being selective of time, energy, and desire. Things that don't serve a purpose or nurture are cut away, until what's left is the beauty they've created in a life touched by cancer.

To become extraordinary as a cancer survivor, it's all about the four P's -- perseverance, personality, psyche, and passion. When you live mindfully, focused on what matters most to you as a human being, your determination makes you extraordinary, not cancer. Cancer is just the crisis that helped to form the rock. Without a master jeweler to cut and shape it, it is destined to remain just that...ordinary...common...plain.

You, cancer survivor, are the master jeweler, the artisan who will transform the ordinary into the extraordinary, the common into the remarkable, the plain into the magnificent. It doesn't happen in an instant. You must work at it. You must become skilled and knowledgeable about the disease, about how to survive it. The more you know, the better your decisions will be. Seek out those people who have managed their cancer through the years. Recognize the efforts they make to stay on top of their disease and to maintain their quality of life. Let them share their wisdom with you, so that you, too, can be extraordinary. Fate brings cancer into ordinary lives, but ordinary people choose their own destiny. You can, too.

Do Cancer Caregivers Have a Role in Medication Management?

My mother was a big believer in quality of life. It mattered to her that her life with cancer was meaningful. She didn't just want to exist. Knowing that helped me to be a better cancer caregiver. It enabled me to focus my efforts towards making her life as comfortable and active as possible.

I recently had a conversation with an elderly woman who wanted to share her discomfort with me. She wanted someone to know how difficult her life had become. In listening to her tale of woe, I was reminded once again that caregivers are often critical in making patients' lives better. Here's why. Her physician put her on a very powerful medication, one that my mother refused to take, and this elderly woman wanted someone to know that she hated it. I let her talk because she needed to "get it out of her system". She was clearly frustrated with her medical situation, but it was more than that. She felt had nowhere to turn for answers or options. When she told me that the doctors never listen to her, I cringed. The truth is that doctor-patient communication is absolutely critical in pain management. Without effective and honest conversation, there's no way a doctor is going to be able to solve a solvable problem. Doctors aren't mind readers.

Neuropathy was one of the most frustrating side effects of chemotherapy for my mother. But the pain medication she was prescribed for this condition turned out to be more debilitating than the "pins and needles". She felt like she was separated from her body and it "creeped her out". When a patient reports feeling that abnormal because of a drug, sometimes it's a drug interaction or reaction. The patient might need a lower dose or even a change. But if a patient doesn't report this to the prescriber, how will the situation get better?

As a cancer caregiver, it was my job to understand how well my mother was tolerating the treatments she was receiving and to figure out ways of helping her meet her needs better. Sometimes that meant making sure that the medical treatment team had the important information they needed to make the best decisions. But for many cancer patients, it's not always easy to share what's really going on. Doctors often are busy, with back-to-back appointments. Cancer patients with fatigue are already dragging their feet as they go through the day. A high-energy doctor and a low-energy patient aren't always a good combination. That's why a wise cancer caregiver may sometimes need to step in and prompt a patient to share what's really going on.

When you only have so much energy to get you through your day, when your thoughts are muddled by drugs, treatments, or even just the stress of having cancer, the path of least resistance can seem attractive. That means raising the white flag in defeat. Too many cancer patients turn away from the fight to get problems fixed.

This is why many cancer patients benefit from having cancer caregivers. We serve as support teams for our loved ones. We also serve as advocates. By accurately observing the symptoms our loved ones experience, and by putting these into logical context, we can often intercede to get the right help for our loved ones. We are sometimes the bridge between doctor and patient, and the better we can understand our loved ones' experiences, the more likely we are to help them get what they need.

Is it because our loved ones feel like the walking wounded? Is it because they fear that the discomfort they experience is symptomatic of new issues? Or is it just that they don't think there is any way to make a bad situation better? Sometimes cancer patients, especially those who have been in treatment for a long, long time, just kind of shrug off new problems with resignation. That's why cancer caregivers have to pay attention and guide their loved ones to effectively communicate with the medical team.

In my mother's case, the medication was just too strong for the amount of physical pain she had, and that meant that the medication, rather than relieving the symptoms, only made her feel "loopy" and not at all like herself. The solution was simple enough. She stopped that medication and went to something milder.

This wasn't the only time that my mother was prescribed a pain medication during cancer treatment that made her miserable. She once was given a pain patch that drove her bananas. Some patients really don't tolerate pain medications very well, and for them, the standard course isn't always the right course. A good palliative care specialist always takes that into consideration when making adjustments. That's the goal of pain management; to find the right balance between taking enough of the pain away to enable the patient to function at the highest level and making sure that the patient isn't overmedicated. But, as always, the level of medication can be adjusted only when the patient and caregiver are able to effectively share the information with the medical team.

The loss of hope can have a profound effect on doctor-patient communications, especially when your loved one assumes there are no more options. A wise cancer caregiver understands that it's not a matter of taking over and reporting to the physician on a patient's situation. But it's your duty to get real answers for real issues.

My mother was delighted to learn that things could indeed get better. Once she had the chance to see that the physician really did want to help her, she admitted she was having difficulty with medications. Mind you, there may be times when there aren't a lot of alternatives. And sometimes where your loved one is with the cancer can effect the medication. But you should always encourage the dialogue. because sometimes the "not knowing" is worse than the truth.

My philosophy of listening and guiding paid off for the elderly woman. She called me a few days later, wanting to ask me some more questions about my mother's experience with the drug she was taking. As she spoke, she acknowledged that her physician had previously prescribed a lower dose of the drug and she had felt much, much better. She couldn't remember why he had recently increased the dosage, but he had. And the more she thought about it, the more she wished she could go back to the way she felt when the dosage was lower.

But she had already ruled out talking to the doctor, to the physician assistant, and to the nurse practitioner (right there you know there's a significant communications breakdown.) What was left? The local pharmacist. Believe or not, sometimes the pharmacist who dispenses the medications can be a significant resource for caregivers and patients. Once I established the fact that she not only knew him and liked him, we discussed how approachable and personable he was. Could she feel comfortable asking him about the medication? Could she trust him to be straight with her on options?

The local pharmacist is often someone who can play a positive role in pain management, if for no other reason than he or she can be a fountain of information on side effects and ways to effectively manage these. Pharmacists can help patients and their caregivers navigate the issues without interfering in the patient-doctor relationship. If anything, a pharmacist can often help a patient understand better ways of communicating the real problems to the medical team. Is it because pharmacists aren't usually perceived as intimidating, short on time, or uninterested, or is it because they understand drugs and drug interactions? Who knows. What's important is that patients get what they need, and wise cancer caregivers know that any way you can make that happen, it's a positive step in the right direction.

Don't Flee the Cancer Community! Embrace It!

Life isn't fair. It never really was. Some people seem to live charmed lives, enjoying idyllic days and happily ever after. Others seem destined to live in chaotic times, with moments of heart-pounding terror, when everything seems to be up in the air, the outcome can go either way, and life becomes a game of chance. It can turn on a dime, when you least expect it, ruining the best laid plans.

Cancer is a terrible disease. Well, actually cancer is a label for several hundred different diseases that we call by this one name, but it's still horrible. And the outcome, depending on the type and stage, can be positive or negative. If you think I'm talking solely in terms of life and death, black and white, you're wrong. I'm talking about how we face cancer. Our reactions, our actions, even our inactions -- they all define us. Cancer may choose among us, but how we choose to manage this disease can make all the difference in the world.

Each of us knows someone who died from cancer of one form or another. Each of us knows many survivors in varying stages. But we are human, and in that humanness, there is a tendency to want to flee the sick. Maybe it's a survival thing. Maybe we just don't want to be reminded of our own mortality. Inevitably, many cancer patients find their social circle growing smaller when their cancer grows larger, as friends and family sometimes turn away, unable to face the expected heartache of saying goodbye to someone presumed to be on the road to death.

Is it the bald head of chemotherapy and the pallor that makes one look like a prisoner from Auschwitz that we can't stand to see? Maybe that's part of it. Or is it that we can't seem to bear the struggle of day-to-day living with cancer, the inability to eat, to walk, to function? What if that impression is wrong? What if, rather than seeing the worst of life, we might see some of the most glorious moments of human spirit and endurance? What if there's another way to look at cancer patients that will help us to live better, more meaningful lives?

When we embrace the cancer community, it's not all pink ribbons and "life is good". We know that as surely as we know some people will not be cured and their lives will end too quickly, some people will manage their disease for a while and we will have those precious months and years to enjoy, and some people will survive the disease and eventually die of other causes. But when you or someone you love lives with cancer, the quality of that life becomes paramount, no matter how much time on this earth is left.

The pain of having cancer is never more apparent than at the holidays. This is the time of year we so love to celebrate, and when someone we love can't find the energy to do normal things, it's a tough reminder that magic doesn't happen for everyone. This is the season of miracles and the sharp jab to our hearts might make us hesitate or turn away. But we should never turn away from a cancer patient or from the cancer community, especially at this time of year. Why? Because we might miss some of the most important lessons of spirit and courage and love.

I say this as I follow several long-distance friends with cancer. Some have found success this year. Remission is a glorious word, one we celebrated with great expectations for continued success. It makes us want to do the happy dance.

Others haven't been as lucky. New tumors arrived with a ferocity that is both stunning and terrifying. Old treatments failed, new treatments failed, and we watched as friends fell into that black hole of uncertainty. Every time another person teeters on the edge of life, we ache, but we ache together. Every time a member of the cancer community dies, we die a little too, but we're there for each other. There is strength in numbers.

Recently, I read a heart-wrenching message from one long-distance friend. Someone she cared about lost the battle and she raged against the unfairness of it all. She was angry. She was passionate. I took heart from her diatribe against cancer. I thought about the young woman who passed away and what she would have taken from this. To know that you matter, that you were someone special in the eyes of such an eloquent and fiery champion, who wouldn't want that kind of friend? No one is ever really gone with so many wonderful people to insist on remembering.

But the most glorious lesson I've learned in recent months comes from a young mother who has faced some enormous obstacles in her cancer journey. She has young children who depend on her. She has a husband, parents, in-laws, siblings, other relatives, friends, and even strangers hanging on her every word. We follow the ups and downs of her cancer treatment with hands on our hearts and prayers on our lips. "Please let this go well for her."

Cancer really is a soap opera of the heart. We never know when an infection might set in and spoil everything or some tiny miracle might be found as a tumor is pushed back. In some ways, living with cancer is the ultimate melodrama. Sometimes that's where the human spirit makes the most progress, whether we want it or not, whether we're ready for it or not.

During Christmas week, I followed the postings of this long-distance friend as she tried to pack as much fun into the holiday as she could, not for herself, but for her kids. "They deserve this," she insisted, and she's right. She reached out to her following, explaining what she wanted to do, asking for help to make it happen. People responded. It was more than just hopes and prayers. It was a community's belief that good things can still happen, even when cancer knocks you on your fanny. That's why it's so important for cancer families to remain connected to the support circle at every stage of cancer treatment and management.

A mother really can fight tooth and nail for her kids, even as this disease continues to smack her to the ground. Why is that important? Because she still has power to change the world. Every time my long-distance friend stands up to get something for her kids, she's stronger than the disease. Her body may not be able to support her at this moment in time. She may feel unable to do the very simple things in life. But there's still a fighting spirit here who demands to be heard, who insists on succeeding. She is motivated by love to give her children what they most need, the very best of her, and in that effort, everyone wins.

Her children will carry these lessons with them through life. The tough times have shaped them in ways that other children will never know. Was it unfair? Absolutely. Was it painful? Without a doubt. But these children have the gift of love like no other children have it. Come what may, they will know that you keep fighting to do right by those you love. They will know that when the chips are down, you find ways to get around the obstacles. They will know that love matters, family matters, and you don't walk away. That's because they have an amazing mother. Cancer didn't make her that way. She was amazing before cancer. But when the disease took hold of her body, she decided how she would live her life with cancer. She recognized that she had the power and she grabbed it, refusing to let go. Cancer would not defeat her, because her spirit was greater than a disease. And she was right. She is so much more than cancer. That is what we celebrate with her. That's what we learn when we follow her journey. And that's what we can apply in our own lives.

When we come together, when we share, we're learning to help each other rise above the hardships, the brutality of cancer, to embrace what really matters and to leave behind those ordinary things that have no real value in the struggle of life over death. It's the triumph of spirit over sorrow, of determination over despair. A cancer community really isn't just about cancer or about living with cancer. It's about surviving and thriving despite the cancer and about not letting cancer have the power to decide how you find the true joy in life. Fate may have brought cancer to your doorstep without your permission, but your destiny is still your own to make. Learn from the cancer community and choose wisely. Live life, love life, and love.

Wishing you all a Happy, Healthy New Year.

How Could She Die of Cancer Without Anyone Knowing?

I lost someone precious. She was more than a relative. She was more than a friend. She was close to my heart. We shared laughter and tears as our lives traversed the years, she on that side of the Atlantic, and me on this side. And she died without anyone knowing she had cancer.

You would have loved her if you had the pleasure of meeting her. She had a great sense of humor and a wonderful laugh. She was a compassionate person and had a long career as a nurse. I can still remember when I showed up on her doorstep all those years ago -- a young college graduate, with tennis racquet and duffle bag in hand. She greeted me with open arms at her front door, introducing me to joys of afternoon tea. Tea bag? Never. Coffee bag? Of course.

I went off to the local tennis courts to practice my serve or wandered around her village when she went to work. She wore her uniform to the hospital, looking very smart, right down to her starched cap and nurse shoes. She loved her job.

She had the quintessential cottage garden, a charming spot on a hot summer's day. For her, gardening was a labor of love. Double petunias and begonias, she recently told me, were what should go in flower boxes. I couldn't find double petunias for my garden, but I did think of her every time I looked at my abundant Wave petunias. I managed to plant some white begonias. They, too, thrived this summer, keeping alive our connection.

She was there to help me stay the course when my mother was in the final throws of cancer. She sent me little packages she knew would appeal to the caregiver in me. Those tiny gestures of comfort were like hugs across the ocean: a daffodil pin from the Marie Curie Cancer Center, a star pin from the Light Up a Life hospice organization, cheery offerings to let me know I was not alone. My favorite gift of all was a tiny package wrapped in turquoise paper and a red ribbon. It came with this beautiful sentiment:

"This is a very special gift
That you can never see
The reason it's so special is
It's just for you from me.

Whenever you are lonely
Or even feeling blue
You only have to hold this gift
And know I think of you

You never can unwrap it
Please leave the ribbon tied
Just hold this closely to your heart
It's filled with Love inside"

Even as I recovered my bearings and moved from caregiver back to career, she was there for me every step of the way, encouraging me to keep at it. That defined her as a person. She was a lovely human being.

For the last year and a half or so, she had been sharing her health woes with me, telling me that she was fatigued, she just didn't feel right. Her pain was getting worse in the last six months. It was clear from her notes that she was dismayed. She went back and forth for doctor appointments. Was it her heart? Was it something else? No one seemed to know. Maybe it was just old age. Except her symptoms never seemed to fit that diagnosis either. The pain just got worse and worse, and as it did, so did her misery. She did not deserve it, not after all the years she spent caring for others.

Sadly, it was only after she died that her cancer was diagnosed. All those months -- nay, the last few years, were spent in needless suffering, even as the cancer invaded her body and spread, moving from organ to organ. No wonder she felt so terrible.

Whenever doctors wave away a patient's complaints, whenever we caregivers accept the status quo for our loved ones, we truly miss the boat. Palliative care is about helping loved ones live as well and as comfortably as possible, but doctors need to know what they are treating. She should have never fallen through the National Health Service cracks like that, especially not with her experience as a nurse, and especially not with all her support of cancer and hospice organizations. She deserved much, much better than that. Someone should have listened, should have tested, should have made the effort. This was not just some little old lady with a touch of arthritis. This was a woman with undiagnosed cancer. It's a travesty.

I know that there is one thing she would want me to urge you to do, something I wish I could have done for her. If your loved one has symptoms, but no diagnosis, ask this simple question: Could it be cancer?

Cancer is a sneaky disease. It can hide in organs. It can mimic other diseases. If your loved one doesn't feel right and that sense grows over time, demand to know -- Could it be cancer?

Many times, the symptoms don't show up until it's too late for cure, but that doesn't mean it's too late for comfort. Every person deserves comfort care and pain management. It never occurred to me that cancer was her problem. I thought it was her heart. I expected her to tell me she needed a stent or new medication. Anything but cancer. But I know now I should have asked. Could it be cancer?

For that reason, and because you care, make sure to ask when your loved one doesn't get better. Could it be cancer?

And if it is, don't stop there. Ask what can be done, not just to cure, but to comfort. Tuck this reminder away in your mental caregiver file. Don't stand on the sidelines and hope for the best. Don't wait for a doctor to suddenly become telepathic. If your loved one is not feeling better, act. How I wish I could have done more. Please remember her, remember her story, and do for your loved one what I could not. Press for answers. Could it be cancer?

Cancer Taught Me Not to Sweat the Small Stuff

It's been a tough couple of weeks for me. I was hit with some rather unsavory cyber stalking. My FB account's been repeatedly manipulated by some creep with too much time on his hands and no conscience to speak of. Some strange woman has decided to launch a very nasty Internet rally of her like-minded friends because I don't recognize her telepathic powers. (She's decided I'm some kind of menace to humanity and she's going to wage an epic battle to save the planet....) I've got bills to pay and things to do, but someone's always stepping into my path as I try to get there. And today, I received news that my beloved cousin passed away. No more sweet letters. No more cards with that familiar handwriting. No "one last time" to say I love you. Life is so fragile at times, so unexpectedly fraught with ugly surprises and uncertainty.

Last night I started the preparations for Thanksgiving dinner, even as I tried to meet a publishing deadline for a holiday novella. I'm so far behind in my housekeeping, the Dust Bunnies have their own zip code. I decided that rather than try to squeeze all my work into one day, I would multi-task and do what I could in the time frame I had. I got my turkey ready (I know it sounds odd, but I'm not really expecting a huge crowd and I have a little trick I like to do with the bird, the stuffing, and some gravy). I cooked my carrots, made the glaze, and then got busy with the broccoli with cheddar sauce. I even prepared my potatoes. And I did it even though the microwave conked out on me. That's right. My carousel popped a wheel. It's the harried cook's equivalent of a flat tire.

There was a time I probably would have thrown up my hands and walked away from the kitchen. I certainly did consider having a pity party for myself. After all, preparing the Thanksgiving meal is a lot of work for me and I have so many other things that need doing. But then my father mentioned my late mother and how she used to do Thanksgiving. His favorite thing? Helping her lift the big turkey out of the fridge, onto the counter, and then into the oven. We forget sometimes that it's the little things that matter most, those tiny moments when we have a place in the world.

That's part of why I cooked the turkey yesterday. I want my dad to be able to slice it with his carving set, to feel like he's a part of the effort. He misses my mother, no more so than at the holidays. The idea of rushing him, of being tense and crazy as I try to put dinner on the table, made me want to shuck that nonsense and concentrate on what really matters.

My life as a cancer caregiver taught me to multitask in ways I never thought possible, to focus on what has to get done and forget about what isn't really viable or necessary. I am, after all, just one person. I don't leap tall buildings in a single bound. I can't heal the sick with a wave of my hand. I wish I could, because I would use those powers to help the people who really make a difference in this world.

With all of my frustrations over the past few weeks, it's easy to get wrapped up in my own drama, to feel frustrated. But I sit here now on Thanksgiving knowing that my mother's cancer experience changed me as a human being. On this day, I do give thanks for the many blessings. For all the strange people who feel compelled to trip me on life's highway, there are so many more who have offered me a hand up, who have shared a kind word or thought, who have impressed me with their grace under fire. I have met many cancer survivors who have done incredible things with their lives as the result of their experiences with the disease. Would they have tried so hard or dug so deep without that cancer? Maybe not. Sometimes it's the hardships in life that define us as human beings.

I'm so glad that I didn't walk away from the cancer community after my mother died. I certainly could have. But those people who share with me are my teachers. They constantly remind me that tomorrow is promised to no one and we must take advantage of today. When I think of the young mother trying to boost her immune system so she can survive to see her kids grow up, when I think of the cancer survivor who shopped for a fancy pair of shoes for a cancer gala with such delight, when I think of each and every cancer widow and widower,and the children left behind, struggling to find the joy in the holiday without a beloved spouse or parent, I am reminded that I am blessed with more than I realize.

Cancer is a cruel disease. It can wreak havoc and ravage the beautiful landscape of the human body. But in those moments of choice, when we men, women and children stand on the precipice, looking down on what is right there in front of us, across at what is out of reach, and above at what we aspire to overcome, perspective is everything. Sometimes it's not what we expect to do that makes us amazing human beings. Many of us don't set out to be heroes. But every time we reach out to other human beings and push back at that darkness, we do more than just gain some ground in the fight against cancer. We come back stronger, wiser.

Cancer doesn't just affect the human body, it shapes the spirit. Fate hands us the circumstances of our lives, but destiny forces us to choose the path, even when we don't know the outcome. When we take charge of our own selves and how the world affects us, we are no longer victims -- we are survivors of the Great Lemon Wars, servers of the world's best lemonades, sweetened with our compassion and commitment to do right by those we love.

We forget that cancer survivors are sometimes the greatest givers of love. Even when a cancer patient can't do all the things he or she wants to do, the hand can reach out and touch another human being in need. For many cancer survivors, time becomes a tool for a purpose-driven life; they are thrust into the realization that "it's now or never!" Until that final breath, there is time for one more moment of joy.

When a disease like cancer robs people of options to achieve their dreams, it's easy to believe that there is nothing left to work for, to strive for, to hunger for; and yet, wise teachers that some cancer survivors are, there are those who show us that dreams can and do evolve when the spirit is determined to make the best of a bad situation. For every frustration, every failure, every fluke of nature, we can and should look for hope, for help, and most of all, for happiness.

To all of you cancer families out there, I wish you a bountiful Thanksgiving. Eat at the table, but don't forget to feed your soul. Believe in something bigger than this senseless disease. We have much to be thankful for on this day. It's not about a boatload of people who stumbled onto the shores of Plymouth Rock and sat down to share a meal with the Native Americans they met. It's about life and the people we treasure. Without them, our world is a lonelier, colder, darker place. Long after they are gone from this earth, they still remain with us, We will treasure this day and what we make of it, so go have some fun today. Don't sweat the small stuff. Hug and be hugged. Laugh. Share. Even if it means shifting your path for just a moment, make one person happier today. Life is for the living, but it's also for the loving. We have this moment in time, so savor it. God bless you.

Would Real-Life Cancer Survivor Michelle Make a Great Character in a Novel?

I first met Michelle Hastings at the Cancer Treatment Centers of America facility in Goodyear, Arizona almost a year ago. I was sitting at a table in the conference room when in blew this vision in wildly colored, spiked hair, looking like a rock star. A generation younger, with a very positive energy, she bustled around with the confident air of a regular visitor to the hospital. That's because she is.

Back in 2008, Michelle found out she had colon cancer, but she was determined to beat it. She wrote about her journey in her blog; once known as Michelle Will Win, it has transitioned to Mission: Remission. (It's a great resource for anyone facing a tough cancer battle of any kind. Her spirit, her energy is uplifting and inspiring. Check it out.)

When you look at Michelle's definition of herself, you'll see this: wife, mother, daughter, sister, friend. She doesn't talk about her career as an astronaut on the last space shuttle or her amazing stint as a famous movie star in Hollywood. She never mentions anything about winning the Miss Fabulous beauty contest or how she learned to conquer her fear of octopuses by scuba diving to 1000 meters without a spear gun. Oh, no. That's because Michelle is a people person. It's all about connections. It's all about love, life, and loving life.

If you stuck her in an isolation tank, you would break her heart, not to mention the hearts of all those people who love her. That's because Michelle embodies the very essence of humanity -- the ability to connect with other people in a way that leaves you feeling like the world is a better place because she's in it.

As a mystery writer, over the last few months, I've toyed with the idea of creating a new series, wondering if I could ever invent a character with her joie de vivre, her tenacity, and her single-mindedness to overcome adversity. Is it even possible? What kind of storyline would I write? And what would that character be like?

I can tell you this much. It would be a "cozy mystery", without gruesome, bloodsucking beasts or insidious villains who practice unspeakable cruelty. It would be the perfect story to read while curled up in front of the fireplace on a rainy night with a cup of hot cocoa, because that's the kind of person she is. Michelle was so happy the other day when the Christmas lights went up and she could revel in their twinkling glory. She even remarked that most people would think it was too soon to start decorating, but she didn't care. She was going for it. This young woman knows too well that you must seize the moment when it presents itself. She does not procrastinate when it comes to embracing fun. She grabs it with both hands and holds on tight.

And as far as the action part of my tale, it would have to be a good match for Michelle's vibrant persona to be believable. I'd give my heroine a warm, supportive family for her crime-solving activities, a fun cast of characters, and more than one wacky sidekick. Maybe I would send her off to Disneyland, and have her discover a lost child in the crowd. Michelle is the kind of woman who would recognize that "deer in the headlights" look from a frightened youngster in a crowd. She is, after all, a mother. I could have her search for the missing adult, letting the story take a thrilling, twisting trajectory, but with a happy ending, because that is what Michelle constantly seeks in life.

Or maybe I would send her fictional alter ego on a vacation to a dude ranch, and while on a trail ride, let her stumble upon an abandoned horse in the middle of nowhere. She could track down and rescue the rider. Michelle could certainly hold her own out in the Wild West. After all, she's been battling cancer all these years. Why, I bet she could scare the rattle off a sidewinder with just a look and some of her fierce determination.

Then again, with her work as a cancer advocate, maybe I could create a mystery in a hospital, with a patient who is too overwhelmed to reconnect with family. Michelle's character could reach out to all her social media contacts and help a patient reunite with a lost family member, someone who slipped away decades before, and they could come together when it matters most. It would have to be a heartwarming tale, because that's the epitome of the real Michelle, overcoming adversity with gumption and guts. Perspective is half the battle when it comes to conquering cancer. You might not beat the disease, but you can beat the hold its terror has on you, and when you do that, another door opens, or another window, and you're off on your next adventure in Cancer Land, finding those hidden moments of beauty, those tender minutes when the universe seems to stop spinning out of control and life, in that brief few seconds, all makes sense. We are here to love, to laugh, to share with one another, and nothing else really matters except what passes between united hearts.

As you can see, an inspirational character can drive a storyline in all kinds of wonderful directions for an author. A wise writer lets the heroine go her own way, in her own style. In Michelle's case, her fictional counterpart would have all of her amazing qualities to lead her down the path to adventure, and she would take her ever-widening circle of family and friends, her "peeps", along with her. They are so much a part of her that I can see them having a hand in solving the "cozy mystery".

Oddly enough, in my vision for this mystery series, I wouldn't want to bump off lots of victims, leaving a trail of dead bodies strewn across Arizona, California, Colorado, or anywhere else I sent her. I'd pack the stories with lots of frights, and maybe a few bang-ups, chills, and spills, but my fictional heroine would be about saving lives, not taking them. Michelle is, after all, a healer. She's not here to destroy the world; she's here to save it. The fictional Michelle would want to do the same.

But there's only one problem with the idea of creating a heroine based on a real woman for a new mystery series. How can my character ever hope to compete with the real thing? She would be forever a poor substitute for Michelle Hastings. That's because I never really know what I will find when I see she's added a post on her Facebook page. It could be just about anything. One day, it might be that things are going great for her. Another day, it might be that her blood work is absolutely dismal. Michelle is a very real cancer survivor, struggling with managing the disease. She's allowed people like me a glimpse into her visit to Cancer Park, where she sometimes gets to ride the Ferris Wheel and take in the pretty vista, and other times, goes into the House of Horrors, where the floor slips out from under her as she tries to navigate the dark and scary maze that is cancer. The hardest thing to watch is when she climbs into a car on the roller coaster and it leaves the platform. I never really know if she's coming back in one piece. But as scary as it is for someone like me, that's nothing compared to the whirlwind emotions that Michelle and those with her on that ride must experience.

And yet, I am still tempted to create a series with such a heroine. The truth is the world needs people like Michelle -- to teach us what really matters about life, about living. We need to know that our circumstances aren't always very fair, but that shouldn't stop us from pushing back, from striving to be more tomorrow than what we are today. Could I create a cancer character that would move readers to embrace the good in life? I probably could, if I stick to the heart of what makes the real Michelle tick. She's been a great teacher to many, a winner several times over, even through her toughest battles. That's because she's Michelle, one-of-a-kind and unique. I'm glad I had the chance to meet her in Arizona, all those months ago, but I'm delighted that I had the great wisdom and curiosity to listen to this voice of courage.

What Do Cancer Patients Need for a Happy Thanksgiving?

Oh, I'll bet you're expecting me to tell you all about how to teach your loved one with cancer to appreciate being alive at Thanksgiving, how to embrace the mood, the moment, the celebration. After all, we gather to give thanks for what we have, as extended families bring green bean casseroles and pumpkin pies in Pyrex and Tupperware. What could be a bigger downer than having a loved one with cancer at Thanksgiving? I'll tell you. It's having a loved one who is disrespected at Thanksgiving.

That's right. Disrespected. Flat out disrespected.

How can I even suggest that, when everyone is trying so hard to be inclusive of someone who's struggling with survival? I'll tell you how. That's because I've witnessed it more than once. (I've also heard it from a number of cancer survivors, how the family dynamics change.) The loved one with cancer becomes overwhelmed, physically and emotionally, trying to keep up with the party, and suddenly it's an up-in-your-face reminder that you're dining with the Big C.

The trouble is that healthy folks, who may not have any insights into how cancer takes its toll, are still in B. C. mode (that's "before cancer" for those of you who are new to the game.) They often like to eat themselves silly with all of the classic Thanksgiving Day staples, like cheddar broccoli and stuffing with sausage. They can't wait to get their hands on the drumsticks, the dinner rolls, and especially the desserts. Nothing is going to stop them from partaking in all the food and fun. They're on a mission, a Thanksgiving Day mission.

Meanwhile, your loved one may be struggling with some very real physical and emotional issues that need addressing. Now that cancer has rocked your loved one's world, it's time to adapt to the reality of those changes.

Does that sound complicated? Do yourself a favor and don't over-think it. Concentrate on two things. Food and rest. It's really that simple.

For a cancer patient, especially one still undergoing chemotherapy, the holidays can be exhausting in many ways you have probably never experienced. Here are some important questions to answer:

1. What time of day does your loved one have the most energy?
2. What time of day does your loved one have the least energy?
3. What time of day is your loved one best able to enjoy a meal?
4. Will your loved one's chemo fatigue kick in, and will he/she need to take a break?

Bottom line? It's just possible that your loved one just doesn't have the stamina to endure the Thanksgiving Day celebration. Are you hosting or are you visiting? If you're hosting, it's fairly easy for your loved one to slip away and lie down when he/she is tired. But if you're visiting, you'll need to speak to the hosts ahead of your arrival. Ask if there is a quiet room where your loved one can rest, should the need arise. Sometimes just lying down for an hour or so can keep a loved one at the party.

Some cancer patients make special arrangements for chemo treatment to accommodate the holiday, so that they don't "crash and burn" on Thanksgiving. They talk to their oncology team early and discuss strategies to cope with this issue. Encourage your loved one to do this and sit in on the discussion, so you understand what's going on in chemo treatment.

Remember to err on the side of caution if your loved one's immune system is conked out. Better safe than sorry, especially during flu season. Hand washing by guests is critical. Avoid kissing and hugging. If the risk of infection is too high, consider staying home and having a video chat with those near and dear.

If you and your loved one have a long drive to make, be sure to bring along a pillow and a lap blanket, so your loved one can get comfortable. Consider the drive to be "rest time" and make it relaxing for him/her.

When it comes to the Thanksgiving meal, know what your loved one is able to tolerate. Many cancer patients can't eat certain foods. If you're hosting or you have a good relationship with the hosts, work on a menu that will please the turkey traditionalists, but will also provide foods your loved one can and will eat.

Very often, families aren't aware that cancer patients find eating to be an exhausting process. Chewing will actually tire them out. The nutrition team at your loved one's cancer center can help you plan a banquet that includes foods that will provide the necessary calories and be easily digested. They often have all kinds of tricks for adapting foods to make them even better. Not every cancer patient is going to have the same diet. Different chemo drugs and different types of cancer create different dietary needs. If your loved one is experiencing diarrhea, for example, greasy foods may exacerbate that situation and cause distress. That's why it's important to sit down with a cancer nutrition expert and understand how best to meet your loved one's specific dietary issues. Consider it part of the medical treatment plan.

Got a good recipe for butternut squash soup that you know your loved one enjoys eating? Serve it as part of the family meal, so your loved one won't feel singled out for special treatment. Will there be appetizers before dinner? Cancer patients sometimes do better when they nibble than when they sit down for a huge meal. In this case, he/she won't "ruin" his/her appetite. Don't draw a lot of attention to your loved one's eating. With healthy, digestible food choices present, your loved one can eat as he/she sees fit.

Understand that chemotherapy can change how foods are digested. It can also change how they taste to your loved one, and that can and will affect appetite. This is usually a temporary thing. Some cancer patients who love dairy develop lactose intolerance, much to their dismay. Some patients can't digest raw vegetables, so cooking them can make a difference. Some fruits go down easier than others. Very often, the recommendation from nutritionists is to puree foods, to make them easier for cancer patients to eat. Smoothies don't require chewing and they're usually quite soothing to sip. (Have I convinced you yet to talk to the cancer center's nutrition team yet? I hope so. They're more than willing to help you feed your loved one.)

Remember to leave the food police at the door when guests arrive for the Thanksgiving celebration. No one should be commenting on your loved one's food intake, insisting he/she eat this or skip that. Sometimes a spoonful of sugar, in the form of human compassion, is the best medicine to go down. If you and your loved one know ahead of time what foods will work and what will not, there's no need to explain or defend yourselves. Just smile and say, "Thank you for your concern, but we're following doctor's orders."

With all this talk about food and fatigue for cancer patients, I don't want to neglect a very delicate subject. Holidays can bring out the worst in some people. Tensions run high with elevated expectations of "instant happiness". Some families bicker. Some families think there are only certain ways of doing things. A cancer patient's needs can and should come first. Work around them. Adjust the celebration to accommodate your loved one at that moment in time. If that means you eat an hour or two earlier or later, so be it.

What do you say if a family member balks? You say this: "I know we normally do things that way, but this year, we're going to do it this way. And I'm sure when our loved one is back on his/her feet, we'll go right back to doing it the way we've always done it." Treat any changes in holiday traditions as temporary, because they usually are. When families know that you're not throwing out the time-honored traditions permanently, you'll often find greater cooperation and willingness to sacrifice.

Most of all, when you all sit down and look across the table at each other, focus on why it's so good to be there. Appreciate the family for the people in it. Take the time to laugh, to share stories, to toast another year of life for all of you. You have this time, this moment to share. Make memories.

A Mother Faces Her Grief

I was out to dinner last weekend, enjoying myself thoroughly. As is my usual custom, I did a little people-watching. The restaurant was busy, especially after a flood of patrons arrived for a party in one of the private dining rooms. There were chattering children and cheeerful adults...lots of smiling faces. Was it a birthday party, or perhaps an anniversary celebration? I couldn't guess, but it was obvious from all the hugging that these people were close.

After finishing my coffee, I excused myself to use the ladies room. A long line of women and children greeted me at the door. They quickly rushed me in because they were only conversing there. Once inside, I found an empty stall, and that's when the conversation began. A voice on the other side of the stall made a comment. I answered back. As someone who loves parties, I mentioned they seemed to be having fun. "Do you know why we're all here?" asked an unseen woman. "My son died September 30th."

My heart sunk as I heard those words. In a million years, I never would have thought that the people enjoying their gathering in the private dining room were in mourning. "I'm so sorry," I quickly said. "That's so hard."

"My son was an artist," the proud mother told me. "But he never really made any money at it." I assured her I know all about that, since I'm an artist, too. We emerged from our respective stalls and continued our conversation as we stood at the sinks. Her son had lung cancer. So did my mother. "Small cell," she confided to me. I knew what she was talking about. "That's tough. My mom had non-small cell," I replied.

I looked down at this tiny sprite of a lady -- she barely came up to my shoulders, but in her I saw a tower of strength. She had endured the pain, the grief, by reaching out. And in that moment, we were connected as part of the extended cancer family. She needed to tell me about her son, and I wanted to listen.

Stephen's struggle was over in less than a year. There wasn't much that doctors could do for him. She wished it had been an easier journey. I understood exactly what she was saying. We never seem to have enough of the right medicine for someone whose cancer has advanced beyond repair. There is no magic left to conjure up. How hard it must have been for this mother to watch her son fade away -- this child she gave birth to, nurtured, and even relied upon. Stephen was only 53.

Was there comfort in the sharing? I'd like to think so. As I learned the details of what made Stephen who he was as a man, I found we had much in common. And as I learned the details of what he endured, I connected the dots to my mother's cancer care. One of the first things she wanted to know about my mother's lung cancer was this. "Did she smoke?" I gave the answer that I came to appreciate more and more over time, with every asking by doctors, nurses, and others who "needed to know". Yes, but lung cancer runs in my mother's family, I told her. Not everyone who got it was a smoker. "Yes!" she cried.

In that one emotion-filled word, I understood her sense of relief. Not every smoker gets lung cancer. And not every lung cancer patient ever smoked. We are sometimes too quick to assume that patients cause their own cancers and judge them as they slide towards death. Clearly there had been much passing of the "guilty" verdict in her son's case. He must have brought it all upon himself. What other explanation is there?

I was saddened by this thought. No mother should have to feel she must defend her dying son when there is already no hope for a cure. This is here. This is now. Leave the past behind. Let go of the need to be a medical historian. Cancer is what it is, and at the end of life, do we really need reminding of cause-and-effect, or do we need to embrace life, even in its last few breaths?

That's why I wanted to hear more of Stephen's life, of the positive things he did, of what he liked to do, of the people who cared about him. His mother began to list all of the unexpected visitors at his funeral. She was stunned that the secretary of the oncology department came, but I thought that spoke volumes about her son as a man. "He clearly touched a lot of people," I told her. She nodded. As I stood there, taking in all the details, I thought about so many things. Stephen must have had a lot of his mother in him. Her generous and kind spirit guided him, encouraged him, wanted the best for him.

I thought about the months to come, as the holidays approach, when we most miss those who have left us. It's so critical to remember the positive, to embrace the good times of the past, and to forgive the human frailties that make us stumble and fall. None of us is ever perfect. We can only do the best we can with what we've got. We can only get up each morning and start fresh.

As we left the ladies room, we paused a moment, and I felt her hand slip around my waist in a hug. She could go back to the party again, be with family, and know that Stephen was still with her in spirit. A perfect stranger understood what mattered most to her about her son. She slipped his mass card into my hand, that one final gesture of sharing. I took it and tucked it into my purse. I didn't want to lose it. I am already connected to Stephen because he was a talented artist, loved the frog statues on the bridge that spans the Willimantic River in "Thread City", and had lung cancer. But now I am also connected to his mother, the woman who misses him dearly and just wants the world to focus on what was good and decent about her son.

I share this story on her behalf. The next time you meet someone from the extended cancer family, don't turn away. Cancer has brought us together to remind us we are all here too briefly. Though the light may seem to dim now and again, and the memories begin to hide away in the darker recesses of our minds as we try to cope with our loss, it only takes a moment to bring it all back. Who was that glorious shining soul who was so well loved by family and friends, that source of joyful laughter and random acts of kindness? He was here and he left his footprints behind as he left this world. He will not be forgotten.

Brain Cancer or Not, Valerie Harper Has Got Happy Feet

Let me start by saying I'm not normally a fan of "Dancing with the Stars". Frankly, I don't particularly like watching folks trip their way across the stage in belly-button exposing outfits (male and female), shimmying unlike your sister Kate, with lots of hair extensions, makeup that's been troweled onto faces (male and female), and a whole lot of attitude. Give me Ginger Rogers and Fred Astaire in an old Hollywood flick any day. And yet....

I heard Valerie Harper was going to be on. At first, I thought it was a mistake. Wasn't she in the process of dying from terminal brain cancer? But then I heard it again. This woman was going to dance on the show.

Was it going to be sad? I considered what I had observed in other brain cancer patients. For some, balance was an issue. For others, changes in personality. And that wasn't even including the fatigue factor....

The anticipation was killing me. Long a fan of both the old "Mary Tyler Moore Show" and "Rhoda", I've always enjoyed Ms. Harper's acting -- her comedic timing is impeccable. Nobody delivers a line like she does. Ba-ding ba-dang!

Then someone mentioned her age. Seventy-four. Say what? Didn't Cloris Leachman dance years ago on the same show? God love her, the fellow alumnus of "The Mary Tyler Moore Show" huffed and puffed her way through some very challenging dance moves, but in the end, the eighty-two-year-old didn't have the finesse necessary. What could we possibly expect from Ms. Harper, a seventy-four-year-old brain cancer survivor?

Know what? Valerie Harper was amazing, especially compared to some of the other contestants. She knows how to move on the floor. Obviously, she's had some experience and real training. When she got done with her foxtrot, I thought, "Isn't it a shame that she gets that 'cancer' label?"

She should be applauded for dancing that well in her seventies. She should be applauded for dancing that well with brain cancer. But both? What a show-off! Okay, I'm kidding, but think about it. She was good no matter how way you look at her, as a cancer patient or not.

What does that say to cancer patients everywhere? It really is never over until the fat lady sings, and she was nowhere near Ms. Harper during her dance. Every day, patients are gaining ground when it comes to managing cancer over time. Sometimes it's just a matter of staying the course, making it through the tough days. That's why it's so important that cancer patients maintain good nutritional intake, because cancer drugs can be so rough on the system, and losing too much weight or being unable to eat can turn the tide. In a published interview, Ms. Harper's husband explained how she managed to continue her medication while appearing on the show. It's all about knowing when the "up" time and "down" time is for cancer patients and scheduling activities around these.

I have no idea what will happen as the dancing series continues. From what I saw the other night, she seemed to be in the running, well ahead of some other folks. Pity vote? Hardly. She earned each one of those points. It had nothing to do with her cancer, or her age either. Sometimes people get to succeed without having that cancer label as a constant in-your-face reminder, and boy, are those moments sweet! Whatever the result, Ms. Harper is a winner in my book. She's earned respect for being herself -- likable, active, living in the moment with joy and determination. I wish her all the best for the future -- sunny days, blue skies, and happy feet to carry her over the rough terrain that is cancer management. You go, girl!

For help with cancer caregiving, visit The Practical Caregiver Guides

Match the Cancer Support to the Cancer Needs

I remember a very trying time, when my mother was dying of lung cancer. Someone who knew that she had been treated for cancer asked how things were going. Short answer? Not good.

Normally, most people might ask if there's anything they can do to help. In this case, the person proceeded to launch into a long description of her husband's long-time prostate cancer situation, and ruminated about his once-in-awhile pill treatment regimen. At the time, I was spending my days and nights providing physical, emotional, and even mental support for a woman who was very frail as the result of the progression of her cancer.

What do you do when someone "ups" you after inquiring about a loved one's cancer? Walk away. In this case, I learned the hard way that this woman was claiming her husband's cancer as some kind of badge of honor. She was in her glory, suffering alongside him. Guess what...after another five years, her husband's still going strong, still living a great life, without any serious health issues. And she's still playing the cancer card, to make herself seem important. Goes to show you that not all cancer is equal and that cancer survival depends on the type, stage, and treatment options.

It's sad, but true. Many people who have loved ones managing what we might term "highly survivable" cancers often lump themselves into the same group as those of us who are struggling to help our loved ones with progressive cancer. What does this mean? We have two very different kinds of caregivers.

If you are providing physical care to a cancer survivor who is not thriving, especially if the treatment is harsh and the side effects are debilitating, it's important for you to recognize the stress you and your loved one are under and to acknowledge it. This is not a death sentence for your loved one -- far from it. You may be on that roller coaster as a family, riding the ups and downs of cancer management. When you accept the reality, that your loved one is struggling, you can take advantage of a very important caregiver tool -- the chance to decide how your relationship will be defined.

For those of us who have walked in these shoes, we know that having the chance to make these decisions allows us to find peace at a critical time in cancer care. When we see the struggles of our loved ones, when we understand their impact on the family and our extended social circles, we take actions that often times make an enormous difference for all of us.

Not all cancer is equal, so when cancer becomes the greater part of a loved one's life, that is the time to up the family bonds. In the short summer of sunshine and butterflies, we move about easily, finding food abundant and life pleasant. In the long winter of despair, we need warmth, comfort food, and laughter to see us through the dark hours.

Having a woman compare her husband's non-debilitating prostate cancer to my mother's debilitating lung cancer was a real eye-opener. It was hurtful, to boot. I knew I wasn't going to change her opinion or mindset. That was too wrapped up in her personality and her need for attention, both of which existed before her husband's cancer came along. But it did give me a good kick in the fanny that I needed. It made me determined to fit my caregiving to what my mother really needed. More enabled activities to please her through difficult hours. More emphasis on asking her what she needed to do, rather than focusing on my own needs. More determination to make good things happen for her while she had the energy to accomplish things on her "to do" list.  Knowing that my sacrifices would soon end enabled me to make greater sacrifices  for her while there was still time.

There is honor in helping another person live. It's easier to defer one's own satisfaction for a year when one knows that life is finite, to put goals and plans on hold. We can make better decisions that produce better results and greater rewards by being mindful of reality. We are not waving the white flag of surrender. We are living in the moment and making the moment count. If anything, my mother lived longer because she was able to do what mattered to her, instead of spending her days feeling like a helpless victim. And I was able to get through the trying times by constantly reminding myself that my days as a cancer caregiver would soon end. Like a marathon runner, I learned to pace myself as I ran up the hills and around the curves in the cancer road. I took advantage of the good days to make progress, to find the joy. When you look for something to celebrate, some little snippet of goodness, you will often find it. When you assume there is no light, you will see only the black night of the soul. Choose wisely. What does the heart need, even as the body fails? What does the spirit seek, even as the body fails? When we give a loved one wings to rise above the mortal limitations, we enrich our bonds in amazing ways. This is the time to build lasting memories to remind us that love is a powerful thing.

The fact is, sadly, that for some cancer patients, there is no cure, no magic wand to wipe away this hideous disease. When we are mindful of the level of struggle our loved ones are currently experiencing, we are able to take advantage of the information in ways that can be life-changing. By realizing just how far my mother's health had deteriorated, I was able to understand that the cancer and related complications were progressing. That meant that the hourglass was running out. As a caregiver, I would soon be out of a job. I needed to know that, in order to maximize the support my mother needed and to pace myself, to accommodate my own life.

A cancer caregiver may go through a number of periods of providing care, and that care may be of varying degrees of hands-on involvement. Very often, especially for the newly diagnosed, the treatment itself is overwhelming to the physical body. Our loved ones look like the Walking Dead until the impact of chemotherapy, radiation, and even surgery kicks in. We may go back to our normal lives and forget about cancer until the next scan shows something or a new symptom appears. Then we jump in again and help out until our loved ones are back on their feet again. But if and when there comes a time that the cancer proves too great a foe, we need to accept the reality and maximize what time we have left with our loved ones. We need to take the trips, have the parties, be together in ways that allow our loved ones to embrace the life that is still with us.

Some people think it's best to soldier on, to pretend things are good when they are not. Denial prevents us from embracing the love, from finding the opportunities to live life out loud. When you see the changes in your loved one, when you feel that dread in the pit of your stomach because you can recognize the physical signs, consider this the winter of your loved one's life. Don't run away or hide. Build a mental refuge where the family can gather. Fill it with warmth, laughter, and comfort, with people who love your cancer survivor. Reach out to those who are receptive to your loved one's plight. Ignore those who are not.

What did we find in my mother's last months? The good friends who cared about her kept calling. The fair weather friends fell away. The relatives who understood the importance of sharing the love came calling. The ones who didn't stayed away. The real tears were shed outside my mother's room. The crocodile tears were shed for effect, with a lot of hand-wringing, lamenting the situation in public settings.

When people ask a cancer caregiver what is needed for a loved one whose condition has deteriorated, it's hard to sometimes say. I can tell you what my mother told me. She wanted cards and letters. She wanted to know that, even as she was confined to home, she was not a forgotten prisoner, locked away. Did she still matter to people? Did they think of her? Did they want to share what mattered most, in their hearts, their minds?

When a cancer survivor begins that last descent, it doesn't happen overnight. It happens over time. Months, weeks, and finally days. If a cancer caregiver recognizes the signs when death is still months away, there is time to build some very wonderful memories. If a cancer caregiver only pays attention in the final weeks, there can be a great rush to get so many important things done, it's exhausting. And if a cancer caregiver only wakes up to the reality days before a loved one takes his or her last breath, the result can be devastating for everyone.

My mother benefited from being able to express her worries, her hopes, and even her dreams as her life drew to a close. That enabled us as a family to find ways to comfort her, to encourage her to speak up about what she wanted, for herself and for the family, and even to address the future without her. Many people think that speaking of death is a grim subject that only hastens the end of life. But for many cancer patients, having the opportunity to live the reality means freedom to enjoy the time that is left. Life becomes a great gift, all the sweeter because we know we will soon say farewell, and in the knowing, we have the chance for that one last dance.

Diane Mapes and Her Amazing Reconstruction Journey After Cancer

Black, brown, yellow, orange, red, violet, blue, green....If you ever were a kid and colored with Crayola crayons, you're probably familiar with the Crayola eight-pack of standard colors. Those are the ones teachers hand out in school -- the basic drawing choice for chunky little hands that are still learning that there are lines in which we are supposed to color, and the penalty for drawing outside those lines is...well, is it a penalty to grab life, shake it by the horns, and live by pure, unadulterated passion? Diane Mapes is like a box of 64 vivid crayons (sharpener included), with expressive names that conjure up instant images in your mind....Electric Lime, Hot Magenta, Jazzberry Jam, Outrageous Orange, Purple Pizzazz, Razzle Dazzle Rose, Screamin' Green....

As an experienced journalist, dating humorist ( Single Shot Seattle ), and lover of living life out loud, Diane is not your typical wallflower, content to sit on the sidelines and watch the party. She jumps in with both feet and lands where she lands. She rolls with the punches, and trust me when I say that, as a boxer, she can give as good as she gets. Feisty, funny, fiery...this is not a woman who will ever go gentle into that good night. You'll see her kicking and screaming the whole way. I was lucky enough to meet her earlier this year, and believe me when I say she's a memorable personality.

That's why, when Diane got sucker-punched by breast cancer back in 2011, she came out slugging. Her determination to dominate the disease is no fluke. It's what makes Diane who she is. And that's why I want to share her blog with you.

So many women are grateful to survive breast cancer, and for many, just being alive is enough. For those of us who love them, we learn to appreciate every day as a gift, because we know that tomorrow may never come, that sometimes you can be so overwhelmed by lemons that you are drowning in lemonade.

Diane Mapes is someone who is glad she's still with us, but that doesn't stop her from wanting more. And by more, I mean she wants her "girls" back. For that reason, she is paving the way for all the breast cancer survivors who have ever thought, "If they can put a man on the moon, why can't they give the 'girls' their due?"

I understand that climb-out-of-the-box mentality. Discontent with the status quo, the passionate writer demands more, hungers for more...needs more. And because she does and she's willing to make the effort to grab it, many women are likely to benefit from her refusal to raise the white flag as a breast cancer survivor.

There's a new reconstruction process for breast cancer survivors that is currently being done at the University of Washington Medicine Plastic and Reconstructive Surgery Clinic, and Diane Mapes is a patient there. I can't begin to describe the process and do it justice. To be honest, it sounds more like a wack-a-doodle gizmo thing you see on a 3 AM infomercial, right next to Suzanne Somers' Thigh Master. Or that contraption my mother claimed expanded her chest with every repetition ("We must, we must, we must build up the bust....") The important thing to note is that this is actually a process that is legitimately being pursued by a reputable medical establishment, and if it is successful, women will have an option that doesn't involve removing other body parts to reconstruct new breasts. Fewer scars, fewer complications, and a far more "user-friendly" way to make women feel more like their old selves.

Some people might think it's over the top. After all, lots of women choose more traditional routes in reconstruction. Or they decide that they should just leave well enough alone. But for every breast cancer survivor who has ever looked at the scars, remembered what she's lost, and is willing to admit that she still misses her "girls", Diane's in the ring, duking it out because she really believes that this whole complicated process is worth it.

Visit Diane's blog. Follow her progress and find out whether it's worth all the hard work:

Double Whammied

I'm rooting for her. I'm in her corner, cheering her on. I want this to be a huge success. Not just because Diane is a hoot, which she is, but because there are so many women whose lives have drastically changed after breast cancer. I believe in quality of life. I believe that a woman has to feel good to look good. Our real beauty is actually on the inside, and when we express ourselves, that joie de vivre, that passion, pours out of us in bubbly, effervescent ways that inspire and invigorate others. But if we face the constant, painful reminder that cancer has taken...and taken...and taken from us, it's hard to feel good inside. Good reconstructive plastic surgery is a valuable tool for the wounded psyche, to restore more than just superficial beauty. It allows us to feel less segregated, less isolated, less marginalized by disease. This isn't just a boob job. This is the rebuilding of a woman who wants to take back what cancer stole from her -- the image of herself as a woman. You go, girl!

Book Review -- "Your Brain After Chemo: A Practical Guide to Lifting the Fog and Getting Back Your Focus"

"Your Brain After Chemo: A Practical Guide to Lifting the Fog and Getting Back Your Focus"
by Dan Silverman, MD, PhD, and Idelle Davidson
Da Capo Press (Perseus Books Group)

Let me start out by saying I loved this book. Chock full of important and useful information about chemotherapy and other factors in cancer treatment that can affect memory and the ability to function...all good. Even now, a few years after publication, the information appears to hold up to the test of time.

I say this as an educator, who has some background in how the mind learns, and sometimes relearns information. Having worked with students who have a wide range of learning and behavioral disabilities, I know that the brain can be a complex and challenging organ.

As a former librarian, who regularly compiled bibliographies on subject matter, I would put this book on just about any cancer book list, but especially on one for people interested in breast cancer and lymphoma material. The authors really focus a lot of attention on how these patients endure the cognitive difficulties of chemotherapy, often due to specific medications used to treat certain types of these cancers.

Dr. Dan Silverman has an extensive background in the field of neuronuclear imaging, as well as molecular and medical pharmacology, and is involved in brain studies that seek to demystify neuropsychiatric symptoms of dementia, depression, and even the effects on hormones on the mind. His research aims to better optimize cancer treatments on a biochemical level, while minimizing the invasive impact on cancer patients.

Idelle Davidson, an award-winning journalist who has experience in reporting on health and medicine, had a first-hand encounter with the cognitive difficulties involved in undergoing chemotherapy, and she clearly uses this as a means to help her give voice to cancer patients with similar difficulties.

One thing I've had several cancer patients share with me is just how hard it was to experience the mental fog, only to be told it's nothing to worry about. If cancer patients find it to be a problem, it's a problem. It's sometimes tempting to think that endurance is key in surviving cancer and that patients must take the bad with the good. Some doctors may take a "wait and see" view and expect patients to just sweat it out, but by approaching the subject of how the brain is affected during and after cancer treatment, the authors open a new pathway for treating the whole person. For that reason, I can see this book as being an extremely helpful resource to oncology professionals, including patient navigators in cancer centers.

What sets this book apart? Many people today have gone from talking about "chemo brain" to talking about a generalized "cancer brain". When Dr. Silverman and Ms. Davidson talk about how the specific drugs affect specific regions of the brain, they don't stop there. The authors peel back the layers of scientific research, citing many studies that identify specific chemotherapy agents and measure changes they create in cognitive function. They also produce information on changes that can be directly attributed to hormone therapy for cancer patients. What is measurable? What is not? When you understand that the authors are using hard data to formulate their conclusions about how the brain is affected by cancer, you can appreciate the solid, scientific approach.

For a newly-diagnosed cancer patient and caregiver, this book may start off on the intense side, especially when reading chapters such as the "Q and A With Your Doctor". I personally found all the chemotherapy information a bit daunting, not because it wasn't solid and useful, but because there was so much of it. And yet, when I got further into the book, it all began to make wonderful sense.

My experience as a caregiver for a lung cancer patient put me at somewhat of a disadvantage in understanding this subject matter as it pertains to breast cancer patients, because of differences in the type of chemotherapy regimens. Most breast cancer patients can cite their numbers (HER-2, etc.), their chemotherapy drugs, and even the specifics of their hormonal treatments. In order to better understand, I asked for some perspective from a circle of cancer activists I know, to find out if they would do things differently, had they known what might happen to their cognitive functioning because of cancer treatment. One woman told me she was relieved to find out she wasn't losing her mind, because it felt like that for her. Another said she's just really glad she's alive and it was all worth it for her. She cited Dr. Patricia Ganz as an expert she respected in the field. Ironically, Dr. Silverman also cited Dr. Ganz as one of his trusted resources on the subject.

As the authors explain later in the book, one of the reasons why there is so much material on breast cancer and lymphoma patients is because these are the long-term survivors who are alive to participate in studies of people most affected by "chemo brain". That's a very important point in understanding the value of this book. Cancer that is managed over years can be stressful, and having a strategy that addresses long-term goals, especially in recovering from cognitive disability, is life-changing.

Dr. Silverman and Ms. Davidson offer a nine-step daily program of activities that will help re-pattern the brain to function more effectively and efficiently, as a means to recover what was lost to cancer treatment. They also offer advice on healthy choices. I especially liked the information on nutrition because the authors explained how the nutritional intake affects the mental processes in terms of firing up the brain, the role of protein and amino acids, and even why milk is a good choice of liquid to drink. Their list of resources provides readers with contact information and types of services offered.

One of the strengths of this book is that the authors recognize many cancer patients are emotionally overwhelmed by their experience with the disease, and there is much information on the types of psychological support that can help, while cautioning that some issues are actually the result of how the medication works in the body, thus creating a physiological issue that may masquerade as a psychological one. I found the discussion of the role of the thyroid gland helpful, because of its regulatory abilities within the body, including mental processing. What kinds of psychiatric drugs can minimize the despair or help patients concentrate better? What can yoga, meditation, and even reconnecting with nature do for patients? Some people get swallowed up in "learned helplessness" and that sense of futility when cancer strikes. What can cognitive therapy do for them? The authors guide readers through this maze in depth.

The authors present information on a number of programs that address options to train, retrain and/or strengthen the brain, such as "Memory and Attention Adaption Training". This is a light at the end of the very long tunnel. When a reader learns that there are steps that will help a cancer patient recoup mental fluidity and understands that the process takes time, it's possible to begin to set realistic goals in cancer recovery.

In the future, perhaps treatment for cognitive difficulties will become standard protocol for every affected patient, through physical and occupational therapies. The more we understand about how the brain is changed by cancer treatment, the better we can work to prevent the damage. This book goes a long way towards making that happen.

Note -- I received a copy of this book from the author, Idelle Davidson. She offered it to me as professional reading in my capacity as the Practical Caregiver. I felt compelled to share my thoughts on it in the form of a review, not because I received any kind of compensation, but because I found it has worth for cancer families and health care professionals.

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Idelle Davidson shares more on the subject at her blog, Your Brain After Chemo. It's well worth stopping by, especially if you or someone you love is struggling with "chemo brain".

Take Hold of the Terror

I can still remember one of my first times in dealing with an abused woman. I was manning a psychiatric hotline in the early days after graduation, and I got tossed this random phone call from a very real victim. It was an eye-opening experience that has forever stayed with me for many, many reasons.

Her terror at the hands of her abuser was clear. She was tired of being beaten. She wanted it to stop. Inexperienced, following the volunteer organization's guidelines, I stuck to the protocols and gave her the advice I was told to give her. "You need to get away from him. You need to get help...." Easier said than done. Things have changed a lot over the last four decades, and looking back, I can see what I didn't understand back then. Terror will control your life unless you get a handle on it. No matter what causes it, there are ways to manage the fears, even when the threat of harm is real.

Terror is a hard thing to live with, especially when it haunts your every waking moment. There are so many variables, so many unknowns, so many "could go either way" scenarios. Whether you're a woman facing an abusive partner or you're a woman with breast cancer, there's one thing you know too well. Terror.

Long after the bandages come off, regardless of the type you have, you still have to live with the fear of having cancer. Will it pop back up on a scan? Will it manifest as a new physical symptom? Can you outrun it, outmaneuver it? Will that new treatment work? These are the thoughts many cancer patients experience over their time managing the disease.

Oddly enough, they are so very similar to those of abuse victims trying to outwit their abusers. So, can a strategy that helps victims of abuse also help cancer patients?

Over the years, I've come to appreciate a very complex and layered approach to helping victims of abuse, especially those whose abusers are obsessed with them. Most abusers get fixated on their targets and refuse to let go. Their waking hours, and sometimes even their sleeping ones, are dedicated to figuring out ways to bring those victims back under control.

Imagine what it's like for an abuse victim to be a target of someone who wants control. That's real terror. And real terror very often will actually drive the behavior of the victim, making it an effective control. So, the first step is always to find ways to empower the victim in safe ways.

Safe ways? Isn't any way that you can get a woman away from her abuser a safe way? No. The reality is that you can actually provoke more violence with the wrong approach. You can trigger violence by saying and doing the wrong thing. By backing the abuser into a corner, you may actually find he rallies all of his strength to attack in a do-all, end-all, to-the-death finish.

Many victims of abuse benefit from having a team of people who are all on the same page, who are all working from the same playbook. The idea is to surround the victim with people who help her replace that terror that has become a part of her life with new thinking. "I don't have to live this way. I don't have to always be afraid. I can get out from under this pain."

If you've ever seen movies like "The Burning Bed", you know that sometimes abuse victims go to extremes. But the real solution doesn't involve confronting the abuser and knocking him back. It involves changing how the abuse victim perceives the abuse and the hold it has. Move an abuse victim away from the source of that terror, not by pretending that the fear isn't real or isn't dangerous, but by creating a team of real support.

When an abuse victim is most terrified, there is comfort in numbers. There is a sense of safety in being around people who are reassuring, strong, confident, and calm. Learning to let go of the psychic pain of abuse is a process that takes time, practice, energy, and above all, the right kind of support.

For every cancer patient who can't sleep for fear that as he or she does, the cancer is setting up shop again in the body, who walks through the days and nights feeling battered, real support is critical. It isn't a matter of saying, "Everything will be fine. Don't worry." That's like telling an abused woman not to worry about the shadow she saw outside her window last night. It's probably not the boyfriend who beat her mercilessly a year ago. Cancer patients, like abuse victims, have the right to worry, and they often have solid reasons to worry. But they still need to live life out loud.

How do you do that when there are shadows and unexplained noises and things that go bump in the night? For every cancer patient who feels betrayed by his or her body, being a victim of the disease stinks. Feel vulnerable? Feel weak? Feel useless? You will begin to believe that you deserve what you are experiencing as a cancer survivor. And let's not forget the fact that many cancer survivors and their caregivers find people in their social circles melting away as the disease progresses. It's a fairly common occurrence because we all have those fair weather friends who can't handle the storm, but we also have the diehards who never desert the ship. We need to let go of the people in our lives who don't support us and we need to utilize the ones who do.

When an abuse victim changes his or her mindset, when the feeling of self-confidence, self-esteem, and even personal strength begins to flow back, that's when the real healing begins. You begin to feel worthy of protection. You choose to be proactive in taking care of yourself and preventing any further abuse. You value yourself, your life, and those around you who stood by you in your time of need. Little by little, day by day, as you go on, as you feel the terror fading, you begin to believe in life again, in love, in goodness.

Some people think that anger for an aggressor, confrontation, and even rage is the way to fight back, but in my experience, the best healing is that which takes the victim to a better, safer place by moving him or her away from the source of the continuous violence and psychic pain. Immersion in that lifestyle of repeated abuse only reinforces the terror. She needs a break in the pattern to be able to see that it's possible to live without it. And once there is that light at the end of the tunnel, much is possible. Having an imaginary conversation with her abuser very often allows a victim to put perspective to the abuse, to begin to understand what she's endured, what she's missing in life, and what she wants to change about her life. That conscious process begins to sort out all the powerful emotions she grapples with when terror is in charge.

There's a difference between a woman confronting her fears about her abuser, shouting to the heavens that she's not going to take it any more, and a woman confronting someone who has the actual physical capacity to kill her. Unless she's on equal ground with her abuser and has the ability to safely defend herself, the last thing that's really helpful is allowing her to punch out his lights, especially if he's obsessed with her. It will only feed his need to control, to manipulate, to master his victim. When you come between an aggressor and his victim, and you intervene by distraction, disruption, and deflection, you are interrupting his pattern of abuse, changing his access to the victim, so that he's not as satisfied by the attack mechanism.

Cancer, like an obsessed stalker, is not a person with real feelings or rational thought processes. It's not a person with whom you can argue or negotiate on real terms. Cancer is cancer. You want it as far away from your loved one as possible. You want to intercede as best you can to keep it at bay. And you want your loved one to know that you will do what you can to make that happen. But you also need to respect your loved one's need to understand how cancer has changed life for him or her. There is an internal battle going on, one that will be decided by the cancer survivor. You cannot make your loved one go through the process of making peace with cancer's abuse. You can only be the supporter of your loved one.

In taking that approach, you are mindful of the power cancer has over your loved one. You probably feel some of that terror yourself now and again. But when you think of cancer as something that paralyzes your loved one with fear, you can begin to understand that utilizing your strength as a caregiver means you can help your loved one overcome that terror. You can help your loved one reclaim personal power and personal choice.

Yes, abuse victims and cancer survivors often find themselves trapped by their fear of the next blows, the next attack, the next time it happens, and it's up to those of us who love them to help them find their way out of that horrible darkness, not with fairy tale platitudes or cartoon solutions, but by recognizing the power of the fear over the victim and the need to move the victim into a safer environment, one that offers real support and real strength while the victim heals.

If you really want to help your loved one come to grips with the terror of having cancer, look around you. Who do you know who has been through cancer and survived? Very often, people who have had more than one fight with the disease have developed strategies. Talk to cancer survivors. Get involved with support groups, whether in person or online. Listen to people who have been there, done that, and got the tee shirt. They will tell you what worked for them. It's rare that you will find a cancer patient who has navigated that difficult time and refuses to share insight and wisdom.

But don't stop there when you are forming a support team for your loved one. Who do you know who has had major challenges in life and survived them? Look for people who have had experience in overcoming the odds. These are people who have worked on building their inner strength, and inner strength is required for the battle on terror. They may not have first-hand knowledge of cancer, but they know what it's like to manage terror on a regular basis. Learn from them. How did they handle that constant barrage of in-your-face fear? How did they overcome the endless worries and put things in perspective?

And most important of all, minimize the contact your loved one has with people who secretly feed that terror, who have those all-too-familiar stories, complete with all the gruesome details of how the disease came back overnight and swallowed their loved one whole..."dead within a week...nothing the doctors could do...absolute disaster!" Take heart from the new reality of the war on cancer. Every single day, treatments are being developed. What was the cancer fight ten years ago is very different than the cancer fight five years ago. What was the cancer fight five years ago is very different than the cancer fight today. What matters is what's happening now, not what Aunt Bertha and Uncle Herb went through back in '69. As cancer treatments evolve, much of what went on in the last decade is now almost ancient history in cancer management.

Support your loved one by recognizing that it's not just the cancer and the treatment of the disease that affects him or her. It's also managing the terror of having cancer. Help your loved one to find safe, effective ways to readjust to life, by understanding the grip cancer has on the psyche. When your loved one feels surrounded with genuine support, real strength, and understanding of the healing process, when your loved one feels understood, that's when the real healing begins. You will never be able to promise a cancer-free life, but you can, and should, promise to be there through the days and nights of terror.

There is strength in numbers, in hands joined together, in comfort that is borne of the desire to empower. It's not about having a magic wand to wipe away the pain or fear of having cancer. It's about being there and giving what the cancer patient most needs -- your wisdom, you compassion, and your commitment to provide what is required for healing the body, the heart, and even the mind. When you pull all of that together, the spirit finds its wings again and can fly.

Every cancer patient needs the freedom to live life out loud. That's because it's what every human being, with or without cancer, needs. Getting back to being human is the biggest hurdle for cancer patients, and the road can be bumpy. Smooth the way for someone you love. The rewards are great. Not only will you gain insight and understanding of life and love, your world will be enriched by having the chance to rub shoulders with some pretty amazing people.

For more help as a caregiver, visit The Practical Caregiver Guides