August 2005 Archives

Living and Health

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Living & Health: A Personal Account

(DRAFT)

By Bill Ratliff

"Mr. Ratliff, can you come in today, to talk about your CT scan results?" These words began an odyssey that resulted in two major surgeries, recovery, and ongoing discovery about ways my life is now different. I want to begin by listing the major medical events, followed by the way I responded to these events. Finally, I want to reflect on what I have learned.

Medical Events

In August 2004, I had increasing pain on my left side, when I went to bed one night. It did not seem like a heart attack, but it was bad enough that I was not going to be able to go to sleep. I asked Virginia to drive me to the Emergency Room at Loudoun Hospital, 30 minutes away. After testing, the diagnosis was pulmonary embolism, although the cause of the blood clots could not be explained. While in the hospital for five days, I was put on Coumadin, to prevent future clots.

I was also found to have anemia. In November, I was referred to a gastroenterologist for a possible colonoscopy. Possible blood leakage from my intestines might account for the anemia. During a routine physical exam in preparation, a physician's assistant found what felt to her like a protrusion of my liver. She ordered a CT scan, which came back showing that I had masses in both kidneys..

We chose an oncologist, suggested by a good friend. He was particularly helpful in sorting through the diagnostic tests with us and ordering us. He also spent considerable time calling the major cancer centers around the country and concluded that UCLA Med Center was the best for my situation. In December we went there for a consultation. Dr. Reiter assessed that there was a 50/50 chance of saving a third of my left kidney, which would be sufficient to avoid dialysis. The right one would need to be removed completely, and could be done later.

We consulted several other physicians and considered two options: that of two operations, as mentioned well, with the hope of retaining enough working kidney to avoid dialysis. The other option was one surgery, with a mid-line incision and the removal of both kidneys, then going on dialysis immediately. With the goal of avoiding dialysis, if possible, we agreed with Dr. Reiter's recommendation and returned near the end of January for the partial nephrectomy.

Because of the placement of the tumor, Dr. Reiter in fact was able to save 2/3 of my kidney and with little loss of blood. The mass was found to be papillary renal cell carcinoma. Dr. Reiter was working at NIH in the mid-1990's and did research on this particular kind of cancer. This kind of cancer, thankfully, tends not to spread beyond the kidneys, but there is a hereditary component. Both of our daughters need to have a CT scan every five years. I started again on Coumadin while at UCLA. Five days in the hospital and five days in nearby Tiveton House and I returned home, to heal and prepare for the second surgery in seven weeks.

Two and a half weeks into my recovery, a routine Coumadin check found that it had skyrocketed. At the first symptom, I went to Loudoun Hospital Emergency Room with internal bleeding. The bleeding was stopped, but more blood clots had formed in my right kidney, which could easily break loose and become lodged again in my lungs or other vital organ. I stayed in the hospital until my right kidney was removed mid-February, three weeks after the first surgery rather than seven as originally scheduled. Performed by Dr. O'Connor, the surgery went without complication and again little blood was lost. The normal 4 ounce kidney weighed 40 ounces, and a 12 inch incision was made to remove it, along with my appendix. My body had apparently reacted the previous August to the cancer by producing a blood clot. With no more apparent cancer in my body, I was taken off Coumadin.

One apparent consequence, of total bed rest during the time of the internal bleeding, was that I developed a pressure sore on the back of the heel on my right foot. My heel was painful after surgery, and I assumed that it had gotten caught in an awkward position. Weeks later a dark spot came to the surface and was identified as a pressure wound. After a lot of searching, I finally found on the internet a wound center in Frederick, MD, and went for one visit. By then, a scab had formed, and I was advised to avoid placing continuous pressure on that spot; and it healed on its own. Good blood circulation, with no history of diabetes or smoking, helped it to heal.

About two and a half weeks in to my recuperation, I stood up quickly from a reclining position, fainted, and fell to the floor on my face, smashing my glasses and cutting my face around my eye. Another trip to the ER resulted in a dozen stitches around the bony edge of my left eye, and more tests to see if the fainting spell was the result of another embolism. When no embolism was found, I went home.

As scheduled, a month later Dr. O'Connor attempted to remove the stint that had been put in during my first surgery at UCLA. The stint was placed in the ureter between the reduced kidney and the bladder. On his first try, Dr. O'Connor found the lower end of the stint had come unhooked and the stint had migrated upwards. So two days later, under anesthesia in outpatient surgery, the stint was removed. I was sent home the same day in great pain.

I quickly recovered from the stint removal and began to return to daily activities and gradual involvement outside the home. In mid-April I began to see the nephrologist, who will continue to monitor the functioning of my partial kidney. It seems to be functioning at a very acceptable level. The little kidney needs no special care or medications except I need to keep my protein intake to less than 60 grams/day, and watch salt intake. An appointment with a dietician in August was helpful in providing specific details.

Response to Medical Events

I want to divide my responses into two areas, the inner, personal ones and the interpersonal resources used.

Emotional response

I was in denial when I was given the diagnosis of pulmonary embolism and tried to bargain with the doctor to let me out to lead a weekend retreat, then return. He replied, "This condition is as serious as a heart attack and you could die if another clot broke loose." I decided to stay in the hospital!

I quickly recovered and went on with my life, only having to take a daily dose of Coumadin and see the pulmonary physician for monitoring. The Coumadin level had to be adjusted often, but that was no problem. When the Coumadin seemed to be stabilized, Dr. Rosenthal picked up on the anemia and referred me to a gastroenterologist for a possible colonoscopy. Upon finding the apparently distended liver, the physician's assistant to the gastroenterologist ordered a CT scan.

When I was called to come in to hear the results of the CT scan, I had an inkling that something negative had been found but was in denial again as to how bad it might be. I took my gym bag and planned on working out on the way home. The full impact of the results did not hit me right away. I decided to return straight home. I remember thinking on the way home that this event marked a watershed in my life, and that life would be different from this point forward.

As I shared the news with Virginia, the information began to sink in and tears started to come. In the early days I felt overwhelmed and had lots of questions. But a rising determination came from deep inside. I slammed my hands on the kitchen counter and declared that this disease would NOT do me in. I was too young to die and I wanted to be part of my grandchildren's lives as they grew up. I would not succumb, and that basic stance never wavered.

This strong determination provided great energy that I used for my healing and for preparation of body, mind, and spirit for surgery and recovery. I felt a sense of purpose and calmness during this time of organizing my healing network.

At the end of the consultation at UCLA, I wrote in my journal: "Why did this happen to me? What does it mean? My body image and the way I approach old age has changed forever, and I don't know the long-term consequences. . . . How to live in to this day with all this inside? I don't know. One minute at a time, and give thanks for this day. Yesterday is now in memory and tomorrow Is not yet. I have today, though. Make the most of it."

Although I ended up being grateful for the time, the seven weeks between the consultation at UCLA Medical Center and the return for surgery seemed, at first, a very long wait. And we did not know the surgery date for several weeks. Once I received the surgery date, I became more focused in my preparation, and wrote in my journal:
"How to prepare for something I've never experienced before and whose outcome is uncertain? Only the spiritual will work. Got to go to bedrock. My biggest challenge yet. I need you, God, like never before. 'Be Thou between me and all things grisly.' Help me to remain open, grateful for each day and each relationship." The bedrock image recurred during this time before the surgery.

In mid-December, I did important inner work on anger, as symbolized in a vicious leprechaun who appeared during a meditation time. I worked intensely with befriending the leprechaun and healing the damage he had done inside my kidneys. As I worked with the image, the leprechaun moved outside and relaxed and later entered into conversation.

The most intense emotional period was at the end of December, when I wrote letters to each person in my family to be read if I did not survive. More will be said later about this experience. The writing made me face my own death in a powerful and real way. I wrote and cried, took walks and wrote some more. I struggled with what I wanted to say to each person. In doing so, I had to bring them to mind and review my relationship with each one and imagine their future without me. In the letters to my grandchildren, I wanted to share the bsic principles that had guided my life. Wow! Writing those letters was hard and heavy! I was emotionally wrung out afterwards.

My journal entry following the letter writing follows:
"God, I am even more determined to make it through these troubled medical times and enjoy life and grandkids and Virginia for another 20-30 years. Too soon, too soon, too soon! What am I being prepared for? What do I need to learn? What is the meaning of my recurring kidney problems? Lots of questions surrounding my life right now. I want to live with the questions and uncertainty and hold them gently, while not yielding center-stage to them."

On New Year's Eve night, I had a dream that showed me that my old anger at my father had been resolved. Old issues were getting resolved during this medical crisis, and I was enormously grateful.

When I received my pre-surgery instructions in mid-January, I was overwhelmed again, as noted in my journal:
"The enormity of this has now sunk in! What in God's name am I doing with having at least two surgeries. . . ? Am I nuts? Major, major surgery. . . . Am I up for this? No. This is beyond me. God, I'm in your hands. Surround me, protect me from all things grisly. Help me! Help me see the grisly facts in the light of your love and strength and all the prayers and support. Give me courage for the moment. . . . Bedrock, I need bedrock on which to stand. Not this shifting sand. Scary--absolutely terrifying. I am weak and afraid."

As my inner work continued, an internal shift occurred, so that before surgery at UCLA, I wrote the following: "I am not afraid. Amazing! Thank you, God. Thank you. I am at bedrock. So many, many resources--and care--and prayers. My plate is overflowing."

Recovery after the first surgery was easier than expected; I got to leave the hospital after five days. I was pleased and apprehensive to leave so soon and to face flying across country after a few more days. Using a wheelchair in the airports and a first class plane ticket helped the return trip to go smoothly. I was exhausted when I got home, but so happy to be home again.

When I began to bleed internally three weeks after surgery, I was in an initial daze with the rush of events. I was admitted to the hospital and knew that I was in a precarious state, but I felt a sense of peace and calm. I used the time in bed to rest, meditate and pray. Five days later, the decision was made at 9 in the morning that the second surgery would be performed at 3 that same afternoon. I asked for quiet time from my family as I did some focused preparation. I felt ready when the time came, although a bit off balance, unlike the first surgery. I was, of course, delighted and thankful with the good news following the total nephrectomy.

My lowest time, emotionally, was when I had to return to the ER for stitches around my eye, and I was informed that it may have been cause by another blood clot; and if so, I would have to be on Coumadin for the rest of my life. I felt flattened on the ground, spread-eagle, face down.

On Easter Sunday near the end of March, I was feeling depressed, as this journal entry reveals:
"Loss: of health, energy, self-image and future self in world, of mental sharpness. And I don't know how much, or if, any of those will come back. Such a long, slow process. Much to be thankful for. . . . But I have lost much--and I grieve that. I miss the way I used to be. . . . I feel old and doddery and vulnerable and muddle-brained. And I don't like it."

The trouble with removing the stint was difficult emotionally for me. I was well on m way to full recovery, so that the difficulty and pain felt like an insult. I did not tolerate it well and hated the awful pain, which probably made it worse. Thank goodness, the recovery was rapid.

In April and May, I recalled more dreams than any other time in my life. Most seemed to be dealing with loss. At one point, I reflected on a series of dreams:
"What at first appears to be lost has been put in a safe place for me. And enjoy the ride! I can trust people and ask for what I need as I need it. Then in mid-June, the dreams revealed a real turn-around: "Moving from feeling lost a month ago to feeling grounded and declaring who I am. I feel a surge of good energy, with relief after the good report from Assefi (nephrologist) yesterday. I feel that I can control my life and the way I use my time and energy."

After my body had recovered and I was enjoying my usual daily activities again, I continued to have trouble reading and in hearing and remembering things. This was to be expected, I suppose, following three bouts of general anesthesia. But I was ready to be done with it all, and found my reading, hearing, and memory problems exceptionally frustrating. They gradually subsided with time.

I came out feeling enormous gratitude to Virginia, Betsy, and Greta, the doctors and medical staff.

Personal, Spiritual Work

Before the first surgery, focusing on my healing and on preparation for surgery was the focus of my time and energy. One of the first things I did was to cancel my subscription to the daily paper and to stop watching the evening news on television. The negativity of the news and the sensational stories drained energy that I wanted to put to positive use in healing.

I have believed in the healing possibilities for both traditional Western medicine and for complementary healing modalities. I happened to live in the DC area, where excellent resources abound in both areas. At Virginia's suggestion, we made withdrew money from our retirement investments, to use for self-care and healing. We were very fortunate in not having to worry about money during this time.

I was already involved and continued in the practice of therapeutic massage and personal psychotherapy, walking most mornings with my wife and working out three times a week at a nearby community center; and they continued. Don, my massage therapist is a gifted, intuitive healer, who provided important body work for me before and after the surgeries. I also added the following:

Spiritual Practices. As already revealed in some of my journal entries, this was the center of my responses, and provided the discernment for when and how to use the other resources. While I have had an active spiritual life and been involved in seminary teaching, I have never felt so close to God as I did during these months. I prayed often, during morning meditation, but also when I would awake at night. I often repeated a variation of the ancient Jesus Prayer: "Lord Jesus Christ, have mercy on me and heal me." I also used the prayer of healing said at Iona Abbey: "Spirit of the living God, present with us now, enter me, body, mind, and spirit, and heal me of all that harms me."

During recovery after the second surgery, I was unable to sleep on either side and had a drain tube in, so I slept in a recliner for a few weeks, awaking often to shift my weight. Those became important occasions to talk with God. My most immediate sense of God's presence came at my lowest point, referred to earlier, when I was in the hospital following my fainting spell. I asked God to come and cover me; and God did. I felt comforted.

Before surgery, I sought to ground myself and prepare for what was coming. Meditative reading and reading from Scripture were also important in this process, with Psalm 91, 103 and Isaiah 40:31 being especially meaningful. Music proved to be spiritually nurturing, especially Handel's Messiah and Bernstein's Mass, plus contemporary music by Jesse Paledofsky, Food for the Long Haul and Sabrina Falls' Celtic harp music, Healing River .

Morning practices. Virginia and I walked each morning, followed by visual meditation, imaging healing energy and light pervading my body and driving out the disease in my kidneys. I also journaled regularly. The image recorded in my journal on Thanksgiving Day is typical:
"Light streaming through the top of my head and my turned-up palms--pervading my body, removing my dis-ease, breaking up dark masses and sucking out the liquid. The whole inner and outer body is filled and covered with light. The debris and toxins are expelled. The tissue and cells are clean and healthy. Thank you, God. Thank you."

I thanked my kidneys for having worked long and well for me over the years, and now for bearing the disease on behalf of my whole body. As the first surgery drew closer, my imagery became more insistent in driving out the darkness and disease, toxins and debris. I always felt better afterwards.

I wondered how I would respond if my kidneys were not disease-free when operated on. When that occurred, the question did not arise; I was grateful for the good results.

Guided imagery. Jim, a former pastoral counselor colleague, mailed me a copy of a CD by Belleruth Naparstek entitled "Successful Surgery," that uses imagery in preparing for surgery. Listening to the CD became a regular part of my meditation, and I took it with me to the hospital prior to both surgeries. A second CD in the set was music to play during the surgery. I asked Dr. Reiter to play the music during my surgery, which he did, even though he did not usually play music. I also asked for the surgical room staff to observe a moment of silence just prior to the incision, after I was anesthetized. The second surgery occurred more quickly, so I asked only for silence, which was honored as well.

Homeopathy. My primary physician is a homeopath. While she does not treat cancer with homeopathy, she offered me a remedy early on for the shock and emotional responses. She also suggested a number of remedies to take with me to use before and after surgery, if needed. I did use arnica before and after each surgery. The others were not needed. Later, when the surgeon tried to remove a stint in his office and was unsuccessful, I was in a great deal of pain, especially when I urinated. When I was unable to get stronger pain killers from the surgeon's office, I contacted my homeopath. The remedy she suggested was of great help in making the pain bearable

Acupuncture & Chinese herbal medicine. I found an excellent acupuncturist who was willing to use needles while I was on coumadin. He worked hard with me before the first surgery. The session just prior to that surgery he used hypnosis, to help me remain calm during the actual surgery and not to allow any side comments made by the staff, while I was under anesthesia, to affect me. When I returned after the second surgery, he used moxa, a bundle of herbs that he lit and moved over my incisions. He then gave us a stick of moxa and recommended that my wife used it on my incisions twice a day. This was to promote healing and smoothing of the skin, so that the energy flow would not be blocked by the 21 inches of scars around my middle. The scars continue to heal very well.

Cancer support group. I joined a cancer support group that met weekly and was led by Ted, my therapist. One important piece of advice to me was to speak up for what I need in the hospitals. I remembered that advice when I was debating whether to disturb the busy staff or intrude on the doctor's time. The witness of the other members who had been living with cancer for much longer time also reinforced my positive outlook.

Legal issues. Virginia and I had already been working with an Elder Law attorney to get our affairs in order after moving to a different state upon retirement. The kidney problem gave us reason to finish the documents. In December, before going to UCLA Med Center for our initial consultation, we signed the following documents for each of us: Advance Medical Directive, Durable Medical Power of Attorney, Durable General Power of Attorney, and Last Will and Testament. The attorney wrote the Advance Directive after we had completed a detailed "Health Care Advance Planning Kit," which helped us sort through various details of our last days and the ways we wanted to be treated and not treated. I took a copy of my Advance Medical Directive and Durable Medical Power of Attorney forms to both hospitals before the surgeries.

Last words. As noted earlier, Virginia and I spent several days at a beach house, after Christmas, courtesy of a friend who owned the house. This gift provided the occasion for my writing letters to my family members, to be given to them if I did not survive the surgeries. Facing my own possible death and what I wanted to say to my wife, two daughters and grandchildren was the hardest thing and the most necessary thing I have done in my life.

Interpersonal Resources

Family. While I taught pastoral care in seminary the importance of family support and care, I now know the deep-down importance of family presence at critical moments.
Virginia was a steadfast and consistently caring presence throughout the entire time. She gave up her agendas and timetables and lived by my doctors' appointments and surgeries. She cared for me without expecting anything in return. To wake up from anesthesia three times and see her face has imprinted her presence on my soul in a new and deeper way.

Both daughters came to Los Angeles, at our request. And I'm delighted they did. We stayed at Tiverton House, across the street from the Med Center and owned by UCLA. It was a calm, healing place, with a sensitive staff. The day before surgery in LA, we spent a delightful day together at the Getty Center. My second surgery occurred at Loudoun Hospital, only ten minutes from where Betsy, my older daughter, lives. She was present with Virginia during that surgery. And when I got better, she brought her two older sons for brief visits. My younger daughter, Greta, lives in Louisville, and had planned to be present at the second surgery. Since the decision was made at the last minute, she was unable to be present for the surgery. She arrived a few days later.

Soul Group. In meditation one morning early on, it came to me that I needed a primary support group during the coming ordeal. I quickly came up with the names of six persons in the region whom I knew: Don and Ben whom I had known for over thirty years and Jesse for twenty and Steve, Sheila and Vic more recently, and all respected as persons of depth and maturity. When I emailed them and invited them to join me in this journey, I knew that I was asking a great deal. For some, it took an hour or more of travel to come to my house. Many worked full-time and had full schedules. But everyone readily agreed. From December through the following April, we met a total of seven times. We met, gathered around a lit candle and with important symbols from my life, overlooking our back yard and the land which stretches over the creek and to the top of the rise beyond. Occasionally we ate together after we met. The usual agenda included a time for me to share what was going on with me, followed by a time for questions and comments, with Virginia sharing from her perspective. People listened prayerfully and asked thoughtful questions and offered feedback or comments. A period of silence followed, where people could speak or pray, as they felt led.

After our first session, I wrote in my journal: "What a wonderful Soul Group that gathered around me and Virginia yesterday! It felt so nourishing and energizing and just right. The group embracing us and humming at the end was just a very moving moment. I think this group is just what I need. Thank you, God, thank you."

Connecting with these friends at this deep level over the weeks gave a solidity at my core that is hard to describe. I knew in my gut that they were there for me, in whatever way I needed. Their caring and support wrapped around me in ways that gave me confidence and strength.

The "Successful Surgery" CD, that I mentioned earlier, used the image of all my friends and family, past and present, gathered in the operating room and supporting the surgery. At the last session of the group before the first surgery, I told them that I wanted to take them with me into the operating room and so I asked them to choose a place in the room where they wanted to be. My coming surgery became real for everyone, as each person took seriously where they wanted to be. I remembered their places and included them in my daily meditation. They were in my mind as I was wheeled in to the operating room each time.

Our final meeting occurred at the end of April, when I was finished with the major recovery and back to daily activities. This occasion provided a rich time of reflecting on what had happened. As they shared, I became aware of the gravity of what I had asked these persons to do. Things could have turned out very differently and they would have been in the middle of it. But it was a time of celebration, discussion of the meaning of pain and suffering, and eating together. I gave each person a copy of a quotation, written by one of the group members, out of his own meditation and prayer time one morning before the first surgery:

"With a knowing that comes only in the Light, I know (emphasis his) that when you need courage, you will be given courage. When you need strength, you will be given strength. When you need a strong center, the center will hold for you. When you need peace, you will be given peace. You will be bathed in the love of all the rest of us. You will know and feel our prayers reaching across the miles, and you will know the Presence guarding your going out and your coming in.

And all shall be well. Love, Steve"

The above quotation now lives in the back of my journal.

Friends. Two good friends met us at the LA Airport when we went in December for a consultation and again in January when we went back for the surgery. They took us out to dinner. They visited me in the hospital and brought flowers. During the few days of recuperation in a hotel before flying back home, they brought food to the hotel for a meal together. They continued to call and email after I returned home.

When we arrived at Tiverton House in December and again in January, a basket of fruit was waiting for us, from a dear friend, plus flowers from Goose Creek (Quaker) Meeting, where we are members. These tangible gifts reminded us of the support we had on the other side of the country. When I returned home, cards began to come from persons in all previous periods of my life. I read them all and put them where I could see them. I no longer discount the value of cards

Visits in the hospital and when I was home were almost always brief and enjoyable. When I was tired and needed to rest, I said that and it was respected. Being able to put limits, if needed, meant that I could enjoy the visits when they occurred. Virginia usually answered the telephone. If I felt like it, I would talk to the person. Otherwise, she would usually fill them in on the latest news.

Meditation Group. I live in a fairly new cohousing community. Of course I shared the news of the upcoming surgeries with my neighbors. At the suggestion of one of the members, I invited via email all persons living in our community to come to my house one night for meditation. Almost everyone showed up. I began by sharing briefly the current issue with which I was dealing and the way I was visualizing healing. We then meditated in silence for half an hour. At the end I shared what images had occurred to me, and others did as well. The variety and power of the images were amazing and wonderful. At the end of our first meeting, I wrote the following in my journal: "Thank you, loving Healer, for the wonderful neighbors who gathered last night to meditate with me. What a powerful experience! Full of energy. Thank you for the night's sleep and the dawn of a new day."

I took some of their images in to my own meditation practice in the days following. We meditated together several more times. While I was recovering, I would email them and invite them to meditate on a particular issue. Many of the participants told me that these occasions of meditating together brought the community together in a different way; and it certainly supported me.

Email List. I believe in, and I have read scientific studies showing, the healing results of prayer. Out of that, I decided to create an email list of family, friends, and acquaintances around the world. If anyone did not want to be on the list, they were invited to let us know. Otherwise, I or Virginia or one of my daughters would send them regular updates and requests for prayer and holding in the Light. The brief responses of support and prayer were helpful to Virginia and to me.

I had been a volunteer for two months at Iona Abbey in Scotland the year before, and know about their prayer circle. I emailed and asked that my name be placed on their prayer list. People around the world, who are connected to Iona, received the requests and prayed for me. My name was also mentioned each week in the service for healing in the Abbey Church. Because Iona is a special place to me, that kind of support was especially meaningful. To think about my name being read aloud in the historic church, where I had once read the names of others sick, moved me greatly. When I recovered, I sent a final email in April, thanking everyone for their prayers and good wishes.

Recuperation

During the recuperation period following two surgeries three weeks apart, 21 days in the hospital and 21 inches of incision, plus the 12 stitches and the stint removal, to say I was weak is an understatement. I walked around the house as I felt like it and sat in a chair in front of the picture window in the living room. Reading has been important to me over the years, but my eyes did not focus well and my brain did not work well. Reading Calvin and Hobbes comic strips and humorous books were all that I could manage. Listening to music continued to nurture me. I took two naps a day, which gradually reduced to one, then one day I became aware that I had gone for three days with no nap. Eating was not satisfying since I had no appetite for the first time in my life. My surgeon gave me instructions to eat fat and sugar, to help me gain weight. Eating a doughnut was a strange experience, after so many years of healthy eating! But my appetite returned gradually, as did my other daily activities, and I gained back the weight I had lost. Returning to work out at the community center, ten weeks after the second surgery, was a big day.

Five days after the stint removal, I returned to the church where I was Interim Minister for Small Groups and Team Leadership. The following week I began to work there again, for ten hours each week.

While my body began to feel increasingly better and back to health, my spirit felt disconnected from my body. In addition, I had felt more pain during the previous ten months than I had ever felt in my life. In May, I began to see a Spiritual Director, to focus on my body/spirit disconnect and the meaning of my suffering.

For some time I was interested in St. Frances. The pain and suffering he experienced caught my attention more directly. With the support of my spiritual director, I read two biographies of his life, plus other materials on the topic. I wrote the following in my journal after finishing the second book: "Frances--a real man who became focused on God. What does he have to say to me today? Something about possessions: don't let my possession possess me; about suffering as a doorway to God; following what I believe I am called to do whether or not society supports it."

A public presentation at the church was used to talk about what I had learned from pain and suffering. Following are the points I made:
1. Pain is not the enemy, even when it comes unexpectedly. It is a friend that signals something is wrong. The question is, how can we befriend our pain and what can it teach us?
2. I live with a new sense of vulnerability. When I am honest with myself, I know that this experience has shaken me to my core. I don't yet know what to do with this perception, but I think it has profound implications for the way I live my life and invest the remainder of my days.
3. My body recovered more quickly than my soul. My body within three months was pretty well recovered, with almost no pain, and rising levels of energy as I returned to working out at the gym. But my soul remains back somewhere after surgery. And my cognitive functioning is not as sharp, especially my memory. I hope that this is a result of having general anesthesia three times in three months, and that it will gradually dissipate. But I am working on accepting what is and living today--although not always easy.
4. I am more off-balance. It shows up, of course, in my intimate relationships. I react too quickly and take offense too easily.
5. I continue to consider the meaning of my period of pain. I can think too long and hard about the meaning of pain, and can take it personally, or perhaps blame ourselves as the cause of the discomfort. Sometimes it just happens. Rather than ask God why, or feel upset with what has happened, "Sometimes our job is just to hit the ball back across the net," as a friend, John, reminded me.

In July I was at a Quaker conference where I wrote a dialogue between my body and my soul. My spirit, in effect, stated that it was afraid that my body would move on as though nothing had happened. So my spirit was holding out on moving forward. My body asked my spirit to name what it had learned:
1. Last November-April was a time of great focus in my life. Priorities were clear. Other things simply fell away. I knew the work I had to do.
2. The last six months was the closest continuous time I have ever experienced with God. I felt surrounded by divine presence, even when I was most down and flat on the ground after smashing my eye.
3. I can receive love and support and care when I really need it. New!
4. I can ask for what I need--from physicians, hospital staff, friends and family.
5. Love is critical to the healing process.
6. I have the resources--outer and inner--to deal with such a major crisis.
7. Pain--even excruciating pain--did not kill me and can be endured for short periods.
8. Modern medicine cannot control pain very well and that may be/is okay.
9. Virginia is steady, loving, and entirely trustworthy in such situations.
10. Doctors and medical personnel, in my experience, are competent, skilled human beings who do the best they can.
11. My combination of medical insurance thankfully covers almost all the bills.
12. Virginia and I can solicit opinions--second, third, and even fourth--and then I can make up my own mind about the way to proceed, given my values and where I am.
13. Family and friends will stand by me for the whole ordeal.
14. I can trust my intuition and listen to my body and soul for what I need.
15. I can trust the universe and God in all this.

My reflection upon writing the above was the following: "I'm impressed with how much I did learn from the past six months. They are valuable lessons that I will carry with me in to the future."

After writing that afternoon, my spirit felt reassured and rejoined my body. I have certainly felt more integrated since then!

Soon afterwards, I wrote letters of update and appreciation to the five doctors who had been of primary importance to me. These letters, along with this present account, are my final acts of saying goodbye to this episode in my life. I now have moved on.

In August, I saw a dietician to look at my diet, given the new reality of a partial kidney. I am becoming aware of eating no more than 60 grams of protein a day, which is not a burden, since I am a vegetarian. I also watch sodium intake.

Now I work out three times a week, have a massage every three weeks, see my spiritual director monthly, see my therapist on occasion, journal and meditate.

Final Reflections

Gratitude is my dominant response now. I am grateful for all that has happened, and especially to the persons who cared and helped. I am grateful in a strange way for my kidney cancer, for it gave me a crash course in preparation for death and thereby in living more deeply. I constantly practice forgiveness. For me, forgiveness comes before and makes possible the gratitude. I do not want to carry around old hurts and grievances, as well as present misunderstandings and wounds.

After the talk on pain and suffering, the following week I gave my reflections on forgiveness and gratitude, in which I wrote the following:

". . . practicing forgiveness of ourselves, of other people and of God is a way to help us use our energy and intentions for today . Forgiveness frees us to live in the present. Then we are light because we have been freed of a burden. Then we are light, because we reflect the Light of Christ.

"Once forgiveness has occurred, in relation to ourselves, others, and God, then we are grateful. As I grow older, I am increasingly convinced that gratitude is the most important attitude and enduring trait to possess. Meister Eckhart wrote that "If the only prayer we ever uttered was 'thank you', that would be enough."

I now see each day as a gift. In the middle of the day, if I find myself harried, thanking God for the gift of the day changes my perspective and slows me down.

I am also more intentional about time with my grandchildren. I want to be part of their lives as they grow up, as an investment in the future of the planet.

This combination of resources that I used worked well for me in this situation, but it might not for another person or even for myself in a different situation.

This experience has reminded me that life is short; so I am listening for the work I am called to do in this next stage.

Blessing

May you know the lightness of being that comes from confession and forgiveness,
May you experience the joy that comes from living in the present moment,
May you find gratitude as your constant companion throughout your days,
And when the days are long and gray,
May God's light shine on you and guide your way.
May you know the strong arms of God surrounding you when you are scared,
- The secure lap of God inviting you to cuddle in when you are weak,
- The smile of God turned toward you when you are insecure,
- The covering of God when you hurt.
May these attributes of God be mediated to you through loving and caring friends, your spiritual group, and your family .
And through it all, we will say "Thank you, God. Thank you."

Amen

Bill Ratliff
August 2005