One of the examples used last night in the re-framing exercise was about a patient who struggled with "why me?" given their healthy lifestyle, lack of risk factors, etc. I was motivated, after the end of the discussion, to read about Jackie in Chapter 27, who had to work on forgiving herself. That is me! I think this review will assist me in finally letting go of guilt, anger and other emotions I've somehow held onto despite other work I've done to try to overcome it.

I am one of about 6% of breast cancer patients diagnosed as metastatic right from the beginning. I had eaten healthily, am not over-weight, had exercised regularly, had a wonderful supportive family, no family history, and not overly-stressed. I was in the final stages of taking the nursing refresher program to go back into my profession when I noticed a lump under my arm-pit, along with some red scratches on the skin there. My mind immediately jumped to inflammatory breast cancer! But for a few days I did nothing, hoping it would go away. My old family doctor had retired and I had a new one who had taken our family on as a favour to another friend of mine "because we were a healthy family" (as I was told). Doctors are hard to find here and can be choosy!

I did, however, end up getting it looked at by her. As I suspected she wanted to complete a round of antibiotics first....which did nothing for the lump but the scratch marks were gone. I was still nervous so my doctor agreed to do a mammogram and ultrasound, even though my prior mammogram within the year was fine. I heard nothing back but felt like the lump was growing. A month later I returned to her. She reminded me that lymph nodes can take a while to shrink back down after an infection and advised me to give it more time. She read the report to me: "there is no mammographic evidence of malignancy" and (ultrasound) "no suspicion of malignancy". She appealed to my nursing background to remember how it is with Mono. I felt chagrined but relieved. I did not ask for a copy of the report, which also happens to state: "negative breast imaging should not delay aspiration or biopsy of a clinically suspicious mass." My doctor believed the tools and, although I was still worried, I was happy to get back to my nursing studies with a clearer mind. I also decided to see a holistic practitioner who assured me my lymph system was acting normally following the stress of the recent death of my mother, and that seeing her could help this healing along.

A month later, I was starting to have pain down my left arm with moderate activity; it started to intensify over the next week. I called my doctor who agreed, finally, to arrange for a fine needly biopsy. I could see that the pathologist was holding back his judgement when I asked if all seemed well when he did the aspiration. Sure enough, I was called to my doctor's office for the results. She stood with her head down and said it was metastatic breast cancer and she had never seen a presentation like this before. I was linked up to our Tom Baker Cancer Centre where further tests and scans revealed a 7 cm mass encasing the left sub-clavian artery (and tumours elsewhere as well) and wide-spread, extensive bone involvement. The shock was immense for our family; it felt like the hole kept getting deeper and deeper that we needed to climb out of.

My husband is incredibly supportive and is a naturally mindful, joyful person who has been there for me every step of the way. I have a great circle of supportive friends as well. I belong to a metastatic breast cancer support group and attend sessions at our Wellspring. Despite all this, distressing thoughts have returned, triggered at different times, which cause me grief and guilt.

"Did I drink too much wine in my life?" "Did I stress too much through the Nursing Refresher program and my mother's death?" "Why didn't I ask for the reports and not worry about being a 'Nervous Nellie'? Why didn't I demand that biopsy earlier?" "Why didn't my Doctor act sooner, based on good clinical skills or even on my concerns?" I do realize that I was metastatic already but the delay made things seem worse, especially for my feeling so very helpless and worried for an extra 2 months.

So, I have been sitting here and really exploring these feelings over again, with the re-framing technique you recommended. The feelings are destructive, causing me sadness, guilt, frustration, and anger. I think I deal with them.....but then they come back!!! I am going to use the three columns from now on whenever such a thought re-surfaces. I'll do it very time. The compassionate parent would say: "your doctor is not perfect and has probably learned a lesson from this. You trusted in her judgement and also in the tools. Trust isn't a bad thing. It may have delayed treatment but you still responded very well to the chemotherapy which followed. You were able to manage to move up some of the tests that were ordered. Cancer is multi-factoral and you will never know why it occurred in you the way it did so dwelling on it only makes you feel bad." And finally: "After 3 1/2 years with this disease, and four chemotherapy lines I AM STILL HERE! And despite some physical disabilities now, I can still see, hear and smell the spring and rejoice in the love of family and friends."

Somehow, I feel like this is the answer for me. I deserve better than I've given myself and it's time for some loving kindness from myself to myself. Thank-you so much for an incredible series that I can apply to my life. And thank-you also for listening to my story. I am looking forward to continued growth and learning.

Anonymous