Acceptance is Badass - A Reading From Coping Courageously

This week I share the story of one of my patients and the woman he loved. Nick was a man in his 20s with an advanced cancer and caring for him touched my heart.

He had to face the difficult reality in front of him in order to create the life that he wanted. He embraced acceptance and it changed his future.

Come listen to a reading from Coping Courageously: A Heart-Centered Guide for Navigating a Loved One's Illness Without Losing Yourself. You'll hear Nick's story and several others and you'll come to believe that acceptance is badass.

My patients who practiced acceptance resolved to live their life fully, regardless of their diagnosis. Whether they were facing chemotherapy, radiation, surgery, or an end of life illness the squeezed all the juice out of life that they could.

They coped courageously.

This week I challenge you to consider your own life through the lens of acceptance. 

Let me know what you come up with.

Celebrating the heart-centered healer that you are,

Dr. Delia
Delia Chiaramonte, MD
www.copingcourageously.com

Coping Courageously: A Heart-Centered Guide for Navigating a Loved One’s Illness Without Losing Yourself is available here: www.copingcourageously.com

Free Guide: 5 Things Women With an Ill or Aging Loved One Should Stop Doing Today https://trainings.integrativepalliative.com/pl/2148301062

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Transcript

Delia Chiaramonte, MD: 0:00

Welcome to the Integrative Palliative Podcast, where we help physicians and other clinicians master the art of integrative symptom management so they can wholeheartedly care for themselves as they expertly care for their patients. Welcome, I'm Dr Karimanti, and this week I'd like you to think about acceptance, and I'm going to cover it by reading you a chapter from my new book Coping Courageously a Heart-Centered Guide for Navigating a Loved One's Illness Without Losing Yourself. Okay, this is from chapter 5 and it's called Except Like a Badass. I had been Nick's doctor for more than a year. He usually came to the office with his girlfriend, nina, who kept a notebook with questions for Nick's doctors and her purse. Nina was on top of everything. She knew which chemotherapies Nick had tried and what the side effects had been. She kept track of his pain and his nausea and she usually had a question about a potential treatment that she had researched on the internet. We used to joke that she was an honorary nurse or doctor. Nick adored her.

Delia Chiaramonte, MD: 1:04

This day, nick came to his appointment alone. When I saw him in the exam room, I was thrilled. Vastly different from the last time I'd seen him. This time his posture was straight, his voice was strong. He looked robust. Nick's advanced cancer was obviously responding to his new treatment. He looked great and he seemed to be feeling like his old self again.

Delia Chiaramonte, MD: 1:24

Dr C, can I tell you a secret? He asked me excitedly. Of course I said Once I'm clear for a full year, I'm going to propose to Nina. He looked at me expectantly. I wonder if I disappointed him, because I have no idea what came across my face. But two powerful thoughts collided in my head all at once that's wonderful and don't wait a year. I took a moment to decide how to respond. I started with the obvious oh, I'm so happy for you. This is fantastic news. She's a wonderful woman and you're so lucky to have her in your life. And she's lucky too is what I said. I wholeheartedly believed it all. The next part was harder. So tell me about waiting a year? I started gingerly. He had a clear answer I don't want her to marry me and then have to deal with me dying. He said. I get that. I said will waiting a year to propose take away the risk that you'll have to deal with you dying? He took a deep breath. I focused on his puffed out cheeks and the noise his breath made as it passed his purse lips. I felt badly that I'd injected this painful reality into his good news, but I knew that it was important that we talk about his future. No, nick said it won't, but it would make me feel better if I could just get through.

Delia Chiaramonte, MD: 2:41

A whole year Nick had been riding a roller coaster. He'd been down then up, then down then up, more times than seemed fair. He had been near death and then responded to a new medication and then, just as he was feeling normal again, a new pain would start or a concerning spot would show up on his imaging. His cancer had returned, not once, but over and over and over, and he was sick of it. I totally get it, nick. I said You've been through it and you deserve some time to just be normal.

Delia Chiaramonte, MD: 3:08

It struck me that Nick was mixing up two powerful ideas that deserve to be considered separately. Firstly, he was hoping for at least a year without a cancer recurrence. That was a reasonable hope, and everyone in his life was hoping for it too. Secondly, he had decided that he wanted to marry Nina. It was the overlap of these two goals that was causing me concern. The chance that Nick's cancer would be permanently cured was close to zero, barring a miracle or not yet invented medication. Nick's cancer would almost certainly eventually take his life. He was young and it wasn't fair.

Delia Chiaramonte, MD: 3:42

I don't want Nina to be a widow, nick blurted out. I nodded and we sat in silence for a while. If it comes to that, I started do you think Nina would rather be a widow losing her husband, or a woman whose boyfriend died? Wow, nick said, nodding. I never thought about it that way. I never, ever thought about it like that. I know she thinks I'm going to be cured, but I think she'd rather lose her husband than her boyfriend. Yeah, I replied. I think so too. Nick and I both smiled. I felt pretty sure that he'd proposed soon, and I think he started planning his proposal right there in that exam room. I was thrilled to receive the invitation to Nick and Nina's wedding. I was proud of Nick for accepting his reality and speeding up his proposal. It would have been easier to look away, refusing to accept that a recurrence free year was unlikely. Instead, nick bravely accepted what he was facing and romantically asked Nina to become his wife. Their wedding was beautiful and moving and I was honored to be invited.

Delia Chiaramonte, MD: 4:50

Gloria painted rocks. She made funny rocks, rocks with colorful magnolias and rocks with words that sparked her soul. Her rocks made her feel light, she told me, and they were a window into her spirit. They were a meditation for her as she painted them, and for her friends and loved ones who were lucky enough to receive one. I have three of Gloria's rocks on my desk and I feel peaceful and vibrant energy whenever I look at them.

Delia Chiaramonte, MD: 5:14

I started my first visit with Gloria in my standard way Hi, I'm Dr Karamanti, welcome to the Integrative Palliative Medicine Program. She responded with I want to do this right. That wasn't typically how my patients started their visit, so I was intrigued. I leaned in. Tell me more about that. I know all about this palliative care thing. Gloria said I'm here because I want to do it right. A pile of words tumbled out I have ovarian cancer and I'm trying to live, but I imagine it will get me eventually. I've looked it up. I know the odds. I'm going to do my best, but I don't want to be one of those people who pretends it isn't happening. I want to look it in the face and stand up tall and do what has to be done. Does that make sense? Am I crazy? I just want to do it right.

Delia Chiaramonte, MD: 5:57

I let some silence blossom before I spoke. I wasn't sure if Gloria was expressing anxiety, perfectionism or acceptance, and I imagined it was probably a brave and scary soup of all three. I wasn't clear on what she most needed from me, so I reflected back what I'd heard. So you understand that your ovarian cancer is advanced and can't be cured. You're going to do treatment, but if there comes a time that your treatment doesn't work anymore, you're ready to accept that and face it head on. Did I get that right?

Delia Chiaramonte, MD: 6:24

Something shifted in the room. Gloria's forehead softened, her lips parted and her jaw unclenched. Her shoulders drooped, but not in a sad or giving up way. It was more like a weight that she had been tensing to support got lifted up and away. Yes, she said yes.

Delia Chiaramonte, MD: 6:43

I was inspired by Gloria's eyes, wide open approach. She stood bravely in the complexity of it all. She held herself with a strong back and an open heart. She adored her husband, her kids, her graceful dogs and the beautiful view from her porch. She desperately wanted to live. Yet she took nothing for granted. She practiced gratitude daily and she appreciated each moment, even the sad ones. She was able to fully embody the joy of her life and still let in the reality of her disease. She managed to stand with one foot in each world. Gloria was gloriously alive and also courageously facing the reality of her death. I was struck by her clear-eyed acceptance of what was coming alongside her fierce engagement in this beautiful world.

Delia Chiaramonte, MD: 7:30

Acceptance gets a bad rap In the serious illness world. It gets mixed up with giving up or not fighting or being depressed or not caring. Acceptance is painfully misunderstood. It isn't weak and it doesn't make you a quitter. It is brave and tough and fierce. Acceptance looks the monster in the eye, puffs at its chest and says, yeah, I see you. Acceptance is badass.

Delia Chiaramonte, MD: 7:55

I once got called to the intensive care unit for a planned compassionate extubation. Often there are tearful family members at the bedside. Sometimes they look lost and numb. Usually the patient is sedated or unconscious, but not this time. When I slid the glass intensive care unit door open, I was surprised to see Mr M, fully awake with bright, piercing eyes. He caught my gaze and neither of us looked away.

Delia Chiaramonte, MD: 8:21

Mr M was clearly aware of what was happening to him. There was a tube protruding from his mouth, connected to a humming machine that was breathing for him because he could not manage this life-sustaining act on his own. He was unable to speak because of the tube in his airway, but he communicated nonetheless. Mr M's wife was rubbing his hand methodically. She looked terrified. I'm Dr Karimanti from Palliative Care, I said as I took his other hand.

Delia Chiaramonte, MD: 8:47

I was used to talking to families in this situation, but having the patient wide awake was a new experience for me. I found it unsettling. It was hard to know what to say. Your doctors asked me to come see you because your condition is very serious. I started. His eyes never unlocked from mine and he nodded in understanding. They don't think you will ever be able to breathe on your own without this machine. Do you understand what I'm saying? I asked him. He nodded and tears spilled from the corner of his eyes. I wiped my own eyes and took a deep breath. Do you want us to keep this tube in your throat? I asked him. He very clearly shook his head. No, I tried a different way to be sure he understood. Do you want us to take out the breathing tube? He nodded yes, his wife spoke in a clear, resolved voice. He always made me promise that I wouldn't keep him on a machine. We talked about it. I know what he wants. I asked again If we take out this tube, your doctors think that you will probably die. Do you understand what I'm saying? He didn't look away or flinch. He was steely-eyed. He looked determined and certain as he slowly nodded his head. Yes, do you want us to remove this breathing tube? He nodded yes. Do you want us to do it today? He nodded yes, and so we did.

Delia Chiaramonte, MD: 10:15

Mr M's body was coming to an end, but his spirit was fierce. I was struck by his wholehearted and brave acceptance of what was in front of him. In no way did he give up. He faced his opponent with power and courage right up until the end. He left this planet on his own terms. Mr M was tough, he was fierce, he was a badass.

Delia Chiaramonte, MD: 10:39

Acceptance of death is one kind of acceptance, but there are endless other hurdles, detours and shoe pebbles that we will all confront in our time on Earth. Developing a healthy relationship with acceptance is a skill that we all need, yet few of us have. Let's break it down. There is a massive misunderstanding about what acceptance is at its core. Acceptance is not the opposite of fighting. Acceptance is the opposite of pretending. If Gloria had rejected the reality that her cancer was progressing, she might have lost the opportunity to take a special trip, share her feelings with her loved ones, have meaningful conversations with her children and fully review her beautiful life.

Delia Chiaramonte, MD: 11:21

One fabulous patient of mine, a kindly woman in her 60s, bought a brand new shiny red car as her disease progressed. It was a sports car. She showed me a picture of it and we laughed and laughed. Can you believe it? She asked me Me driving a sports car. She giggled. But really, if not now, when I completely saw her point and I love that she bought that car.

Delia Chiaramonte, MD: 11:44

Accepting what is in front of you gives you the power to choose how you want to show up for this part of life. It does not mean giving up. That's worth saying one more time. Acceptance is absolutely 1,000% not giving up. It is the opposite. Really. Acceptance is looking the beast right in the eye and saying loudly and clearly I see you. Life will give you many opportunities to practice acceptance. Babies leave us for kindergarten and then college and then they get their own apartment. Beloved pets die and we lose jobs, spouses, friends or the dream of having a biological child. Sometimes people lose a breast or a leg or a uterus or a dream.

Delia Chiaramonte, MD: 12:25

Acceptance is a kind of spiritual practice. Clear-eyed vision is a more powerful position from which to face life struggles than pulling the covers over your head and mumbling la la, la, la, la, la, la, la la. Don't shy away from acceptance because you are confusing it with giving up. Also, practicing acceptance of a difficult situation does not mean that the universe will heat more of it upon you and break your back with the weight of it all. I believe that the reverse is true. It takes a supreme amount of energy to keep the covers over your face or bury your head ostrich style. Also, it doesn't work. The thrumming of your fear will continue to get louder and louder. Facing that fear around pleasantness head-on can be a huge relief. Acceptance usually begets lightness. Once you are looking your reality clearly in the face, you can loosen your tension just a little, because it is often a bit less overwhelming than you imagined. It takes much more from you to keep it locked in the basement than it does to bring it into the light.

Delia Chiaramonte, MD: 13:26

There is a subtlety here that is important. The goal is to accept the reality that is in front of you, the straight-up, ugly, warts-and-all reality. My daughter could die in a car accident. Your mom might die of cancer, but we aren't mind readers and we can't see the future, so we don't know what will happen. Acceptance does not mean fortune-telling. It is the acceptance of what is true, but there is always room for the universe or God or chance, depending on your belief system to take the story in a different direction. We are not predetermining the outcome by practicing acceptance. Instead, we are standing tall and gazing at our challenge with clear eyes and a brave heart. Your homework for the week is to ponder this question Is there anything in your life that you should work on accepting? Thanks for being here. I'll see you next week.