Thursday, September 5, 2013

Anatomy of an Upset

Back in the '80s I was very active in Werner Erhard's “est” organization. I know he has received a lot of bad press. Some people like him, others hate him. From my perspective I gained a lot of knowledge and skills from my participation. One of the most valuable, practical, and enduring pieces of knowledge that has helped me is the “Anatomy of an Upset.”

An upset contains one or more of these components:
  1.  An unfulfilled expectation: You were expecting something and that something wasn't deliver
  2.  A thwarted intention: You were going to do something or go somewhere and something,  sometimes unexpected, prevented you from doing so.
  3. An undelivered communication: You wanted to say something to someone but something prevented you from doing so, and now every time you see that person the communication is sitting in your craw. Or someone should have told you something but didn't, and had you had that information your choice of action may have been different producing a different outcome.

The next time you feel upset check to see if the Anatomy helps you identify exactly the source of that upset.

A Personal Example

On Tuesday, June 25th, I had my annual mammogram. On Wednesday, June 26th, they called me back to schedule another mammogram. This was my first callback in 6 years after having been diagnosed and treated for DCIS (ductile carcinoma in-situ), a form of breast cancer.

Anatomy: Unfulfilled expectation of a negative report.

Friday, June 28th, I went in for the mammogram, after which the radiologist recommended an ultrasound. "Uh oh, I don't like the way this is going," I said to the technician. And then the request for an immediate biopsy put me into a full spin; fear and upset.

What has been the most difficult trial is The Wait. Everyone who has had a diagnosis of some importance has gone through The Wait. Waiting for the results from the pathology lab.

The biopsy was done on Friday, June 28th, and from that day to the following Monday seemed like forever. My physician called me with the results: invasive carcinoma, and I felt as if my stomach flipped over.

Dr. Laura Esserman is the surgical oncologist who treated me in 2004 for DCIS, and I called UCSF immediately to set up an appointment. "Sorry, Dr. Esserman is on vacation until July 31st.”

My heart sank. It felt like a blow to my already sensitized body. "May I see her associate, Dr. Ewing?" They replied that I needed to get copies of my mammogram to them and they would review the materials first. I arranged for all of this.

They were sent to the wrong address. Thwarted intention!

Sent out again to right address. No word from UCSF. Follow up phone call, "Have you received the mammogram report?" "Yes, but they didn't send the biopsy pathology report and slides." "You didn't ask for them so I didn't know to ask them to send them to you." Undelivered communication!

"Well, we need them before we can decide if you should see Dr. Ewing, because once you see her, you can never return to Dr. Esserman." I think at that point I didn't care who I saw. My anxiety was building because I had no idea how invasive the carcinoma was. I had no plan of what was to come; I was out of control.  Finally all the pertinent information arrived at UCSF and after the powers that be went over my medical records and deliberated, it was decided that it was best that I wait for Dr. Esserman. More waiting. More anxiety.

I had come to my own conclusion that I did not ever want to go through mammogram anxiety again. You know, it’s a routine thing but there is always a small amount of anxiety attached until you receive the diagnosis. So I had decided on my own that I would tell Dr. Esserman I would have a double mastectomy and be done with it! I would have lovely perky breasts out of this ordeal.

During my consultation with Dr. Esserman she assured me that we had caught the cancer early and she recommended performing a lumpectomy with intraoperative radiation. That by radiating directly into the tumor site that it would most likely not necessitate having a mastectomy. She indicated that a mastectomy would be like using a tank to kill an ant. And although I agreed with her to proceed as she suggested, I was disappointed to not have a mastectomy. Thwarted intention!

We set the date for surgery Tuesday, Sept. 17th at 11 am. If the pathology report from this procedure indicates that further radiation is called for, that I should do a 5 times a week for 3 weeks series of radiation, then I have the option to choose a mastectomy instead.

Somehow having that option available has been comforting.

I know that every woman who has had a diagnosis of breast cancer can relate to my story. And the sad part of this is that it is not unusual. Some staggering statistics can be found at the site