Today's Qi Gong class was canceled, but I had my first meditation session.  I wanted to sign up for an ongoing weekly meditation class, and they require that you have an individual meditation session first before joining the class.  The instructor (let's call him James) took me into his office. At first we talked about my history and why I was there.  It's interesting what you choose to reveal about yourself when you have to sum it up in a couple of minutes. I told him that I was a doctor, that I had been treated for Stage IV lymphoma, and that since treatment was finished I was finding it hard to adjust to my "new normal" because I liked my "old normal."   

When he asked what I wanted to get out of meditation, I told him that I seem to always have to occupy my mind with something-- work, reading, writing, some activity-- and that I wanted to find some peace with letting my mind be still.  He told me that the mind is never entirely still, that the thoughts still come, but your relationship with the thoughts can change.  He told me that meditation is directed attention, so my directing my mind towards these activities could be considered a form of meditation-- but rather than directing the mind outwards (as I've been doing), you can learn to direct it inwards.

We spent a few minutes doing a meditation.  For this meditation, you sit back and close your eyes and focus on your breathing.  You breathe slowly in and out.  You start counting the inhalations, very slowly, and do that for a few minutes.  Then, you start counting the exhalations.  It's funny how focusing on the exhalations changes your perspective.  It reminded me of an episode in the Aaron Sorkin TV show The West Wing.  Some visitors to the White House give a presentation to the Press Secretary, CJ Cregg (played by Allison Janney), in which they propose a change in how we look at the map of the world.  Instead of the usual ethnocentric picture with North America on top, they suggested that the image be flipped 180 degrees to put South America and Africa on top.  Of course that image is equally accurate, but it looked incredibly strange (CJ said, "You're freakin' me out!").  That's how it was to focus on the exhalations.

Cancer and its treatment change you.  You can feel like a part of who you were you that gets lost, and when you lose, you mourn.  At one point during the meditation, James said, "Honor your pain."  My eyes were closed but I immediately responded,"I don't want to honor my pain, I want it to go away!"  The problem is that ignoring it and hoping it will go away doesn't really work.  It's pointless to dwell on pain and loss, and it's pobably equally pointless to pretend that they don't exist.  Maybe it's best to be able to acknowledge when there is a change in our lives, learn to come to some peace and acceptance, and focus on the things that we have and who we are rather than on the things that we've lost and who we're not.  Maybe the meditation will help me do that.

On the Stairmaster today, I finished Committed: A Skeptic Makes Peace with Marriage, the sequel to the mega-bestseller Eat, Pray, Love by Elizabeth Gilbert.  In EPL (which will be a movie with Julia Roberts), the author describes the one-year voyage she took after a bitter divorce in which she went to Italy and partook of the pleasures of the body ("eat"), to Indonesia to partake of the pleasures of the soul ("pray"), and to Bali to experience both ("love").  At the end of EPL, she fell in love with Felipe, an Australian citizen born in Brazil who lived in Bali.  They plan to live together, traveling between Brazil, America, and wherever else the spirit moves them, in unwedded bliss forever after.   

In Committed, the author describes how she and Felipe were detained at an airport Texas when they tried to re-enter the US, and were told by the Department of Homeland Security that in order for Felipe to enter the country, they would have to get married.  Both Liz and Felipe are skeptics about the institution of marriage, both having been through painful divorces.  The couple spends the next year traveling in Southeast Asia, waiting for the US government to complete the paperwork that would allow them to return to the US and get married.  Liz uses this year to research the institution of marriage and come to grips with matrimony in her own life.

It's hard to write a sequel to a huge best seller.  In the introduction to the book, Elizabeth Gilbert discusses how difficult this is.  How can you write without being self-conscious, when you know that the book will be scrutinized by so many millions of people?  If you do something similar to the previous book, people might say you are a one-note wonder (or that you didn't do as well with the second as the first); if you do something different, they might say you should have stayed with what worked the first time.  In the end, she says she wrote the book that she had to write.

I'm not going to compare Committed to Eat, Pray, Love;  it's a different book.  The author's voice is engaging.  She is honest and insightful.  She taught me stuff about marriage that I didn't know.  I didn't know about the theory from the ancient Greeks that humans were created with two heads, four arms, and four legs, and that (according to ancient legend) we were cleft in two, with the result that each of us spends our destiny searching for our missing half.  I didn't know that 25% of seagulls (birds who have the reputation of mating for life) split up-- and that apparently most of their "second marriages" are successful.  And if the ending isn't a surprise, that's OK-- there are other reasons to read a book than to find out whether or not the couple gets married in the end. 

And I just realized-- both Eat, Pray, Love and Committed are examples of Method Journalism, the genre in which the author spends a year exploring a particular project.  A la Julie and Julia, a la Happiness Project.  A la Survivor to Survivor (S2S).  

Today I went to a play called "Time Stands Still" by Donald Margulies, which is in previews at the Friedman Theater.  The story is about a couple named James and Sarah, a journalist and photojournalist, respectively, who return to their apartment in New York after covering war-torn Afghanistan.  The play is about the challenges of returning to "real life" after being at war, about what covering war does to family relationships, and about the impact of post-traumatic stress disorder (PTSD) on individuals, families, and friends.  The acting was wonderful, with Laura Linney, Brian d'Arcy James, Eric Bogosian, and Alicia Silverstone.  The writing was also wonderful, as to be expected from the Pulitzer Prize-winning playwright who wrote Dinner With Friends. 

After the play, David Shookhoff, the Manhattan Theater Club's Director of Education, led a panel discussion for the audience.  Panel members including the director Daniel Sullivan (who also directed other fabulous plays including Proof, Rabbit Hole, and Dinner with Friends); Sebastian Junger, an award-winning journalist and author (he wrote The Perfect Storm), and Jack Saul PhD, a psychologist at Columbia University School of Public Health who treats journalists and others returning from war and other humanitarian crises. 

In their discussion, the panelists talked about how when you're in a war zone, you go into "survival mode."  The adrenaline is pumping; sometimes you can't let yourself fully experience your feelings (like fear) or you couldn't function.  The journalist or soldier can be traumatized by the atrocities he/she sees and at the same time have difficulty adjusting to the life at home, which pales in comparison to what is going on in the war zone.  They talked about individuals at the front sometimes find it difficult to relate to their loved ones who are back at home.  On occasion, the soldier or journalist may not share certain experiences so as not to worry the loved one (or to prevent the loved one from issuing an ultimatum that they can't go back for more).  This secretive behavior can create a schism in a relationship. 

The panel focused on two disparate emotions experienced by those who return home after being on the front: (1) a sense of missing the excitement and drama and bonding with others created by the war and (2) being haunted by the memories of the atrocities, which may appear as flashbacks or nightmares.  The latter is part of post-traumatic stress disorder (PTSD).  Is the former?  I don't know.

Some of what they were saying about PTSD sounds similar to the experience of a cancer survivor.  During treatment, you are in "survival mode."  The adrenaline is pumping and you may not allow yourself to experience emotions like fear so you can do what you have to do.  Treatment ends-- and what then?  I'm not aware of cancer patients having flashbacks to episodes of treatment (does that happen?).  However, I do know that cancer patients may have trouble adjusting to life after treatment.  Can some of the strategies used to help people returning from wars be useful for cancer survivors?

It's been a great week at Barnes & Noble!  Tonight I saw Gretchen Rubin, who wrote a recently published book called The Happiness Project.  I saw the book in the bookstore on January 2 (the day after New Year's) and made a beeline for it-- the turquoise blue color on the cover leaps at you from across the room.  And who can resist the subtitle-- "Why I Spent a Year Trying to Sing in the Morning, Clean My Closets, Fight Right, Read Aristotle, and Generally Have More Fun?"   

The author is a former lawyer turned writer, who is married with two little girls and lives on the Upper East Side of Manhattan.  One day, when riding the cross-town bus, she looked out the window and wondered, "What do I want out of life?"  She realized that she wanted to be happy.  She decided at that moment that she should figure out what to do to make herself happier-- to start her own "happiness project."  She subsequently spent a year researching happiness, from sources including philosophy, biography, literature, psychology, and popular culture, and then tested the different theories by making specific resolutions and acting on them each month. 

She has a different focus for each month, specifically: January, boost energy (vitality); February, remember love (marriage); March, aim higher (work); April, lighten up (parenthood); May, be serious about play (leisure); June, make time for friends (friendship); July, buy some happiness (money); August, contemplate the heavens (serenity); September, pursue a passion (books); October, pay attention (mindfulness); November, keep a conented heart (attitude); December, "boot camp perfect" (happiness). 

She defines what she calls the 12 commandments: 1. Be Gretchen; 2.  Let it go; 3.  Act the way I want to feel; 4.  Do it now; 5.  Be polite and be fair; 6.  Enjoy the process; 7.  Spend out; 8. Identify the problem; 9. Lighten up; 10.  Do what ought to be done; 11. No calculation; 12.  There is only love.  She also defines what she calls the "secrets of adulthood." They're too numerous to list here, but some of my favorites are "People don't notice your mistakes as much as you think," "By doing a little bit each day, you can get a lot accomplished," and "What you do every day matters more than what you do once in a while."

She states the Splendid Truths: 1.  To be happy, think about feeling good, feeling bad, and feeling right, in an atmosphere of growth.  2.  One of the best ways to make yourself happy is to make other people happy; and one of the best ways to make other people happy is to make yourself happy.  3.  The days are long, but the years are short.  4.  You're not happy unless you think you're happy; and (corollary) you're happy if you think you're happy.

The reading and signing at B&N was packed-- people were standing at the back.  Gretchen Rubin also has a popular blog on the subject, and apparently there are groups all over the country who are developing Happiness Projects of their own.  The author tapped into a need-- lots of people are looking for things to do to be happier, particularly in a time of stress, war, and economic recession.  Most of the ideas Gretchen proposes don't cost money, but rather represent personal improvement steps that you can take within yourself and in your interactions with others.  I learned that the idea of doing something for a year-- a la Julie and Julia (cook your way through Julia Child's Mastering the Art of French Cooking) or the Happiness Project is called Method Journalism.

I have several thoughts about The Happiness Project.  It was a lovely book to read; I think it will help people; and it gave me ideas to implement in my own life.  On the other hand, you could argue that you have to reach a certain comfort in life (ie not worrying about physical safety, financial security, physical health, etc.) to have the luxuy of being able to be concerned about increasing your happiness.  The author raises this concern herself and addresses it in the book.   She's not suggesting that you make yourself happy to the exclusion of doing things to make the world better; in fact, she points out that one of the best ways to make yourself happy is to make other people happy.  And what she's talking about seems to be of interest to others-- as of now, the book is #2 on the New York Times Bestseller List.  

I guess what I'm doing this year could be considered a form of Method Journalism-- checking out the survivorship classes and other activities that might be helpful to fellow survivors.  Maybe it's The Happiness Project: Survivors' Edition. 

Last night I went to another reading and book signing at Barnes & Noble featuring David Servan-Schreiber MD PhD, who wrote the book, Anticancer: A New Way of Life.  In the book, the author describes his personal experience as a doctor and cancer survivor.  He was a working neuroscientist in his early 30s, studying functional MRI of the brain, which was at that time a new technology for determining which parts of the brain are activated while performing certain tasks.  One night, he and his research partners were doing brain scans on students who had agreed to be subjects, and one of the students didn't show up-- so he went into the scanner instead.  After a few preliminary pictures, his colleagues stopped the scanner and told him there was something in his brain.  That's how he found out he had a brain tumor. 

The book is both the story of the author's personal journey with brain cancer (which was treated, recurred, and was treated again) and his search through published literature and discussions with experts regarding approaches that an individual can take, in conjunction with conventional treatment, to get the best possible outcome after a diagnosis of cancer.  He presents an evidence-based assessment of cancer prevention and risk reduction strategies, including discussion of nutrition, physical activity, and the mind-body connection.  The author argues that traditional approaches to cancer treatment focus on killing the cancer; he is suggesting that we should also strive to strengthen our body's natural defenses against cancer, or our own natural "terrain."  He also gives tips from his own personal experience on fear, telling your loved ones you have cancer, and other survivorship issues.

He was a passionate speaker.  He made sure to emphasize that the approaches he was discussing are not a magic bullet and can't be guaranteed to prevent or cure cancer, or even to improve outcomes.  He also stated firmly that these approaches, if used, should supplement, rather than replace, conventional treatments.  And he made the eminently reasonable point that even if one is engaging in conventional cancer treatments, it makes sense to do whatever is possible to maximize the odds of success. 

I think that even if things like diet, exercise, and meditation don't have any impact on the natural history of a specific cancer, they may improve quality of our lives both by empowering us and by helping us feel better, physically, emotionally, and spiritually.  He spoke about the issue of "false hope," and how he does not want to give people false hope.  On the other hand, he stated, the belief that an individual is powerless to improve the situation is also false: he calls it "false hopelessness."  It is false hopelessness that he is trying to combat in his book.

In the book, David Servan-Schreiber talked about how having cancer changed his priorities.  He had been a scientist, on the fast track, concerned with many of the trappings of success in his career; when he had cancer, he stopped and reconsidered his priorities.  During the question and answer period at the end, I asked him if he has been able to maintain his shifted priorities, since it's now been about 15 years since his initial diagnosis.  He said that one thing that has remained constant since his diagnosis is his desire to focus his energy on things that have meaning for him.  Sounds like a prescription for a good life.

I saw the play "Love, Loss, and What I Wore" on Sunday.  It's adapted from a beautiful little book written and illustrated by a woman named Ilene Beckerman, who tells the story of her life in the context of the clothes she or others wore at specific times.  There's a rotating cast of five members, all dressed in black, who play different characters.  It was the first time I saw Carol Kane live, after admiring her on TV and in films from Taxi (where she played Simka to Andy Kaufman's Latka) to Annie Hall (where she played Alison Portchnik, married to Alvie Singer-- played by Woody Allen).  She hasn't aged a bit.

I loved the show.  It was in the Westside Theater, a small, one-level theater on 43rd Street.  A review in the New Yorker said, "Never has the love of beautiful clothes seemed less frivolous"-- and they're right!  So many of the stories rang true.  At one point, they were talking about black, and how people should stop saying that everything is "the new black."  One character said that once she bought something that wasn't black-- and she was so sorry.  There was a fabulous monologue about how a purse can be the window to your soul, and another about a young woman who survived breast cancer (her hats helped).   And do you think it's true that when you start to wear Eileen Fisher, you might as well say you've given up?  I want to get the script (by Nora and Delia Ephron) when it's published-- some of the monologues aren't in the original book.

Last night, after work, I went to a discussion and book signing at the new Barnes and Noble, on 86th Street and Lexington Avenue.  Carol Sklenica, who just wrote a terrific biography called Raymond Carver: A Writer's Life, talked about her book and about Carver's life.  I've always loved Raymond Carver's short stories and poems but didn't know much about his life before.  He had a hard life-- big struggle with alcoholism, which he finally overcame, and then died of lung cancer ten years later at age 50.  The author talked about the impact that Gordon Lish, one of Carver's editors, had on his short stories.  If you look at the Library of America edition of Carver: Collected Stories, you can read different versions of the same story, with and without Lish's edits.  Look at "A Small Good Thing" (Carver's version) compared to "The Bath" (with edits by Lish).  Carver's version is one of the most beautiful and heartbreaking stories I've ever read.

I got home and watched the first part of "This Emotional Life," a three-part PBS documentary hosted by Daniel Gilbert, the Harvard Professor who wrote Stumbling on Happiness.  The first part was about the role of relationships in making us happy.  They described an experiment done by a psychologist named Harlow on the formation of attachment in young monkeys.  Harlow took a baby monkey and put him in a cage with a choice of two "mothers" (monkey-life dolls).  One of the mothers was made of wire (so not comforting) but was supplied with food; the other was made of cloth (so gave comfort) but gave no food.  Faced with the choice, the baby monkey preferred the cloth mother, hands down.  He kept throwing himself on the cloth mother, trying desperately to get some milk, even though none was forthcoming.  The monkey would rather starve to death and get some comfort rather than be fed by a wire mom.  I thought about that monkey all day.

Today was my first class of the new year.  I decided to try Qi Gong, which is a combination of movement and meditation that's supposed to reduce stress, increase energy, improve sleep, and create a sense of peace and harmony.  I had never done it before. We were in a small, quiet room with soft music playing.  There were four students (all women) and the teacher.  We each had a chair, two blankets, and a yoga mat, which had been set up before we came in.  The practice focused on the combination of breathing and movement. I don't understand it all, but the teacher was kind, and I came out feeling refreshed.  I'm going to try it again.

After the class, I went to a talk by the surgeon and writer Atul Gawande about his wondeful recent book called The Checklist Manifesto.  The book describes a project he led for the World Health Organization (WHO) to make surgery safer around the world by designing a checklist to be used by teams performing surgery.  They implemented the checklist at 8 hospitals around the world with approximately a one-third decrease in complications and an almost 50% decrease in operative deaths.  He talked about how medicine is increasingly complex; although as doctors we like to believe we are infallible, there is the potential for error and simple steps like this checklist could keep us safer.  I wanted to ask him how he balances his writing with his doctoring, but they ran out of time for questions at the end.  He apparently was going from the talk at our hospital to Charlie Rose and then to give a talk at the 92nd Street Y.

I'm working tomorrow.  I'll write again on Thursday. 

It's been two and a half years since I went into remission from Stage IV lymphoma.  Since that time, I wrote a book about my experience as a cancer doctor and a cancer patient called I Signed as the Doctor.  I've started to give seminars and to maintain a website for individuals with cancer, their loved ones, and their caregivers.  I'm still working at Memorial Sloan-Kettering Cancer Center (MSKCC), now three days a week, running a program for women doctors and scientists as well as doing clinical work, research, and teaching in breast imaging.  This weekend marks the beginning of a new year and a new decade (2010).  It's a good time to answer the question I posed at the end of my book: what's next?

Going through six months of chemotherapy taught me a lot about how to get through cancer treatment.  What it didn't teach me about was how to be a long-term survivor.  Although a person with cancer is by definition a cancer "survivor" from the moment of diagnosis, the challenges of going through cancer treatment and of living a life after treatment are different.  Wendy Harpham, a terrific physician-writer who also had cancer, describes how after cancer treatment, you need to adjust to your "new normal."  The process sounds easier than it is.  It takes time to understand your new normal, to physically adapt to it, and to make peace with it.  And like so many things in life, your "new normal" is a moving target.

I've got a plan, and the New Year is a perfect time to start.  At my hospital and elsewhere in NYC, there are lots of programs for cancer survivors.  I'm going to attend some of these programs and write about them-- to see what I can learn, to inform survivors and the people who care about them, and to give feedback to the people who run these programs about how they can be even better.  As I'm doing this, I'll also continue to seek out fun things to do in the playground that is NYC as well as books, music, and other resources and write about them too.  Please partake of these activities actively or vicariously, as you like.  I'm going to call this project "Survivor to Survivor" or "S2S."  

Got to go.  This afternoon, I'm going to see Nora & Delia Ephron's play, "Love, Loss, and What I Wore."  I'll let you know how it goes. 

One of my suggestions for coping with cancer is, "Find silver linings.  Don't look at this as losing your hair, but as an opportunity to get new hats!"  Early in the course of treatment, I went on-line with my daughter and found the website of a milliner named Christine A. Moore who makes fabulous hats.  We went to her Manhattan studio, where I proceeded to buy 15 beautiful hats to prepare for losing my hair.

The hats did everything I wanted them to do, and more.  It can be hard to feel beautiful when you're going through cancer treatment; the hats made me feel beautiful.  Getting up every morning was exciting, because each day, I had to decide which hat to wear!  Hats are a welcome distraction from chemo.  They don't have to be fancy--baseball caps are fun too. 

Surprisingly, the hats were a terrific way to communicate with friends.  When people asked what they could do to help, if the answer "Pray for me" wasn't sufficient, I could always ask them to get me a new hat.  As a result, I have a cool collection of baseball caps, including one that a friend wore when participating in an Ironman Triathlon (his card said "Wear it and be victorious.")  The hats set people at ease.  You know how some people care about you, but when they see you with cancer, they feel awkward and just don't know what to say?  In those instances, I could always ask, "Do you like my hat?" and invariably they would reply, "Yes, I love your hat!" and we could talk about the hats. 

On the Hat Board, I'm posting pictures of some of my favorite hats.  I hope you'll post yours too!