In keeping with recent posts on mindful grounding and chronic pain, I wanted to share with you a very personal experience of the use of mindfulness as a coping strategy for the chronic nausea I experienced whilst having chemotherapy for breast cancer. It reminded me how important it is to stress to you that although the term mindfulness is used extensively now, with instructions to "be more mindful" and "live more in the present moment", being mindful is not easy. At the time of my treatment, I had been teaching and rehearsing mindfulness for around three years, and even with that experience behind me, it took me until I was three cycles into chemotherapy (approximately four months after diagnosis) to even think of using any of the coping tools in my toolkit!
I'm constantly reassuring clients that it will be virtually impossible in the beginning of your mindfulness practice to ever utilise it effectively once you're already in the midst of your emotional distress or physical discomfort. In my experience, you need to practice it consistently and persistently when you are feeling good in order for it to become a habitual way of thinking or living for yourself.
It's a coincidence, but just recently I have had three long-term clients come back to me and say, "I finally get it!" and they went on to describe some momentous mindful moment they'd experienced between sessions. I'd been working with each of them for two to three years. This stuff takes time. Be patient.
Below is an excerpt from one of the chapters of my memoir A Hole in my Genes.
I hope it helps you develop some idea about how you might use mindfulness to cope in a situation where you are experiencing physical or emotional discomfort.
MOVING INTO THE MOMENT
I adjust the headscarf on my bald head and shiver. I can’t seem to get warm despite the layers of clothes. I let Remi, my Staffordshire Terrier, inside. My skin is pale, almost grey, and my once petite frame has been replaced by a swollen face and body due to the drugs I'm forced to take. I’m tired even though I spend most of my day sleeping. Hunger taunts me, competing with constant nausea. I can’t eat because my mouth is full of ulcers and yeast.
To my dismay, despite all the medication, acupuncture, friends and hamburgers, the larger dose of anti-emetics didn’t even touch the sides of my nausea. Alas, just like cycle one, the unrelenting hideousness stayed with me for the entire five days again.
I go back to bed with Remi, snuggled under my doona, staring out of the windows draped in white lace. A slight breeze cools my too-hot face. Thoughts of death provide a sense of relief.
Cycle two had hit me like a truck that drove through me, then reversed back over me, driving forward and backward a few more times before the driver spat out the window and threw his cigarette butt at me.
I wanted to die.
My brain, slow and sluggish, still tried to problem-solve. Escape, escape, please help me escape... I begged my own brain for hours. I had nothing else to
"... sitting by the overcoat...”
Randomly, my mind began to sing Long Day by MatchBox 20. Well okay, my mind didn't so much sing as replay a memory from seven or eight years earlier when a full moon sat low in the autumn sky. The moonlight sparkled over a natural amphitheatre in front of cellar doors. Dampness from light rain on the lush green lawns filled my nostrils, as I sat on a plastic chair, surrounded by row upon lovely row of grapevines and thousands of screaming people. Delicious, fruity red wine satisfied my nostrils, tastebuds and my mood. The place was Tempus Two, a winery in the rolling hills of the Hunter Valley in New South Wales. The occasion, a Matchbox 20 concert.
Rob Thomas had the crowd eating out of his hand and just began singing Long Day when the sky opened up and the rain began to fall. Dave and I had sung every word to each of the songs so far that evening and we weren't about to stop. The rain fell heavily, but instead of seeking cover, we along with the 10,000 other people there that night, shed our ponchos and turned our faces to the heavens. My grin grew wider as we sang louder, feeling every drop of rain on my bare arms and face. In an act of solidarity, Rob and the band joined us in the rain by stepping forward on the stage, allowing all five of our senses to be engulfed by the moment. Right then, nothing else mattered. Calm infiltrated my being. That must be what people refer to as high on life. And then it occurred to me - that was mindfulness.
Flash! The light bulb went off.
Loving and reliving that Matchbox 20 moment, I noticed my breathing had slowed and the feeling in my abdomen that had previously resembled the La Brea Tar Pits had relented slightly. Oh my goodness. A reprieve! Up until that point, and all through the aftermath of the first cycle, I had endured solid torture for a week after the poisoning. So horrendous, that even this brief and minor improvement felt nothing short of a miracle. The realisation that something I had done - chosen to do - had impacted on how I felt was gradual, made more significant due to the rarity of feeling any sense of control on the cancer train. It took a while for this revelation to develop fully but it led to a significant change in the way I'd been coping.
For the first time since diagnosis I realised that I, as a psychologist, had a whole professional toolkit of coping strategies that could be useful to me. Call me a genius.
Okay, so I knew how to be mindful. I'd certainly taught many patients to practice mindfulness. Why hadn't I thought of this before? All I needed to do was observe whatever was happening, then and there, using as many of my senses as I could, without any judgement. How hard could it be?
I began by taking a few deep breaths as I scanned my body from head to toe. I looked for the ‘loudest’ sensation in my body to focus my attention on. The nausea won hands down.
Next, I pretended I was a curious scientist who'd never experienced such a feeling before. I kept in mind that Hamlet quote, “There is nothing good nor bad, but thinking makes it so” as I asked myself some questions.
If I drew an outline around the nausea, what shape would it make?
It would trace the outline of every individual organ, in infinite detail, including every centimetre of intestine.
If I could touch the nausea, what would it feel like? Would it feel wet or dry? Rough or smooth? Sharp or soft? Solid or hollow?
It would feel wet and sticky like they were covered in black tar, like a dense sponge, with no sharp edges.
If the nausea was a temperature, what temperature would it be?
It'd feel luke-warm.
If it was a colour, what colour would it be?
Shades of black and grey. Very dark.
The entire time I managed to ask and answer those questions, I was in-effect sitting with the discomfort. Accepting it. Allowing it. Without judgement.
Within moments, I'd already noticed a shift in the intensity of the nausea when I began to focus on my breath. I imagined breathing into my organs. Slowly breathing, deep breaths, imagining the air moving around each organ. Making space, allowing it to simply be. Willing to have all of it.
What I noticed was an ongoing calming of the nausea that lasted the whole time I practiced mindfulness and continued to calm it even after I'd stopped. Merely removing that ‘edge’ from the nausea provided such relief. It brought me the space I needed to cope a whole lot better.
Bringing another tool from my 'toolkit', I imagined the struggle as a big, black bottomless pit between myself and the nausea, both of us holding the end of a tug-o-war rope. The nausea pulled me toward the edge of the pit when I got caught up in all of my sooky-la-la thoughts about how much I hated the feeling and how I thought I couldn’t tolerate it for a minute longer. What choices did I have as I was pulled towards that fearsome pit? Sometimes I pulled back by trying to argue with my thoughts, but then they just seemed to get louder and louder, in effect pulling harder on the rope, luring me back towards the edge of the pit. The tug-o-war could often go on for hours. What other options did I have?
Of course, I could simply drop the rope. By refusing to struggle with my unhelpful thoughts or the nausea, they couldn't influence me. They couldn't pull me into that menacing pit. Acceptance, with detachment. Finally, a real breakthrough with my nausea management and overall coping with cancer. Relief. Hope.
A few days later, I was able to return to my beach side cafe with the sun streaming in through the windows, warming my skin. Despite my pants feeling that little bit too tight, I ordered a chocolate-chip muffin to go with my soy latte. The smell of coffee filled my nostrils and the sound of people getting on with life filled my heart with hope.
For the first time I felt present in my situation. Cancer wasn’t something I just had to get over like a long trip to the dentist, it was a path and I finally realised, and accepted, I was on it.