Acceptance is Badass - A Reading From Coping Courageously

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 . 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 . 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 . 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 . 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 .

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 .

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 . 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 . 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 ? 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 . 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 . 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 . 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 .

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 . 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 . 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 . 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 .

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 . 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 . 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 .

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 .