As someone who has lived my life in the driver’s seat, it’s not easy being a passenger. As someone who has been the proverbial giver, it’s not easy being the receiver. As someone who has nurtured a career as a healer, it’s hard to be the patient. Of course, no one has such a binary life and I am better at both sides of the equation as I have gotten older, but still!

As I am full swing in my second round of treatment for leukemia this month, I find myself the lead character in an organ recital, where I could have each system of my body declare the cumulative impact of numerous chemotherapeutic agents alongside all the other medications given to address side effects. I have never taken my pristine health for granted, and I will spare you the details, but when so many places don’t feel right, I am humbled, and moments can be tough-going. On a positive note, I HAVE side-stepped any of the major issues that can arise, for which I am deeply grateful.

I have written elsewhere about the prescribing cascade, defined as a first drug given that causes signs or symptoms of a new condition, for which a different medication is prescribed. Suffice it to say, this concept is alive and well in cancer care. And so, I look for small ways to sidestep the prescribing cascade, as some side-effect drugs cause further side-effects that are worse than the symptoms they’re trying to prevent!

I would like to give one very small example, among many, Zofran—the miracle anti-nausea medication, which can also cause all kinds of challenges. High on the list is backing up the digestive system. For that you might be given a stool softener and maybe some Miralax, though those may cause the opposite problem. You can always ask for Imodium if that happens. As you plan your dance near the restroom, it’s like a pendulum swinging, with intense sensations, that may last for days, either way you go or don’t go.

This time around, I am smarter. When I have a big bolus dose of methotrexate, I take the full dose of Zofran, but I also use high fiber cereal and ground flax seed and I am sure to hydrate. And when less chemo is dripping into my veins over the next twenty-two hours, I shift entirely to ginger-based foods: cookies, crackers, candy, not my usual fare, to counter the nausea and they do the trick. I am able to  skip the problem, and therefore the other drugs that might be used for that side effect.

We also know that anxiety and nausea often go hand in hand, so I further lean into my head game with meditation, prayer, breathing exercises, and yoga to keep paving the way for worry and stress to dissipate. I run my high light reel; I zip through my gratitude Rolodex; I listen to a book on tape (The Heaven and Earth Grocery Store, by James McBride, highly recommended,) I do a NYTimes Crossword Puzzle. I try to conjure the perfect combination of rest, mindfulness, intentional relaxation, and pure escapism, each essential ingredients to make this recipe work.

I am not in control of the schedule, the medication route, where and when I have treatment, even how my marrow responds day-to-day, but there are small ways I bring back a bit of self-agency, which feels just about right. May we all find the balance among being fully present to the moment, to worrying about only what we can control, and when we are able, to let go, open-hearted, entirely to the mysteries of our precious lives.

Love and light from Middle Street