Soldiering on

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By Caitlin Kelly

One of my favorite films is Dr. Zhivago, with an unforgettable scene of a long line of exhausted, worn-out soldiers trudging forward.

To “soldier on” means to keep going, doing something that’s difficult, not giving up when you’re tired and discouraged and just fed up.

(It’s also a non-profit group dedicated to ending homelessness for veterans.)

It’s now been five months since COVID began to dominate our lives — with more than 137,000 Americans dead, thousands more soon to join them.

It’s been a long time to readjust, albeit immediately, to a world we never wanted: terrified of catching a disease that, if it doesn’t kill you, can radically damage your health for years to come. A world where parents, somehow, have had to school their own children or supervise their online learning in addition to earning an income in a full-time job.

And there’s no end in sight.

I live in New York, now one of the few states that flattened the curve because we listened early to the directions of Gov. Andrew Cuomo.

Is it fun to isolate?

To stay home most of the time?

To avoid all social gatherings?

To postpone medical, dental and grooming appointments?

Let alone to miss culture-in-person — dance,  music, museums theater, movies.

Hell, no!

And the single greatest problem with being a soldier right now is the stunning lack of leadership, of a general with a clue, with a strategy and tactics. We’re fighting the virus with very few weapons — masks, social distancing, ventilators, proning, remdesivir — and losing what feels like an endless battle.

Still.

I often deeply wish that the veterans of WWII were not so old, the few left alive, to share more widely and consistently the shared sense of sacrifice and solidarity that somehow got them through it all.

The enemy, Nazism and genocide, was clear(er) then and the fight, however long and expensive and bloody, was one most people agreed was essential to win, no matter the personal sacrifices. It was a matter of pride, then, to share the sacrifice, to know what you were doing to help really mattered and your colleagues, friends, family and neighbors largely agreed.

Not to whine that a mask contravenes your liberty — just like blackout curtains or rationing once did as well.

Today, somehow, a lethal virus is still not as clear an enemy — and thousands refuse to believe it even exists, like the 30-year-old whose last regretful words were: “I thought it was a hoax.”

 

But soldier on we must.

COVID’s challenge: moral injury

By Caitlin Kelly

I hadn’t heard that phrase until September 2019, when I sat down to interview an American physician, Dr. Emily Queenan , describing why she stopped working in her native country and moved to work in Ontario. It wouldn’t have been the easiest choice, choosing small-town Ontario with mixed-race children and having her husband leave a corporate job.

But it was absolutely the right choice for her.

From my 2020 story for The American Prospect:

 

Dr. Emily Queenan, who is American, also voted with her feet; after studying biology at Williams College, working for Americorps in Peekskill, New York, in community health, and attending medical school at the University of Pennsylvania, she did her residency in Rochester, New York. She opened a family medicine practice there in June 2009, closing it in May 2014—and moving to Canada.

After being recruited by an agency of the MOH, Queenan visited four cities selected from a list of rural communities needing a doctor, She chose Penetanguishene, a middle-class town of 8,962 in northern Ontario on Georgian Bay, a beautiful area that welcomes many summer-home visitors.

“It was a wrought decision to close my practice,” Queenan says, sitting in the 1920s-era red-brick house in small-town Ontario whose main floor is now her office. “I envisioned having my [U.S.] practice for decades. But I was really burned out by the burden of being someone’s family doctor and the moral injury of denying care versus the lack of payment versus dealing with your own medical bills. This is not asked of other professions.”

Still in New York, Queenan attended a local meeting of Physicians for a National Health Plan, an American advocacy group founded in 1985 by Dr. Steffie Woolhandler and Dr. David Himmelstein, “trying to decide what was next. I was on the cusp of turning 40 and saw a career of fighting stupid fights. Doctors across the country were going through exactly what I was going through. I am not unique.”

 

 

Maybe you are, or know, a physician or nurse or other healthcare worker; my first husband is a physician I met when he was finishing med school at McGill so I watched him through his residency and early practice — which brought him to some unpleasant realities.

Most healthcare workers choose their profession because it expresses their values — to help and to heal, whenever and wherever possible.

Covid has torn their world to shreds, as evidenced by the recent suicide of Dr. Lorna Breen, an ER physician who had worked in a New York City hospital under such terrible circumstances that her sister said she called it Armageddon.

Her father is also a physician, so she would have grown up with this moral code.

From The New York Times:

 

“She tried to do her job, and it killed her,” he said.

The elder Dr. Breen said his daughter had contracted the coronavirus but had gone back to work after recuperating for about a week and a half. The hospital sent her home again, before her family intervened to bring her to Charlottesville, he said.

Dr. Breen, 49, did not have a history of mental illness, her father said. But he said that when he last spoke with her, she seemed detached, and he could tell something was wrong. She had described to him an onslaught of patients who were dying before they could even be taken out of ambulances.

“She was truly in the trenches of the front line,” he said.

He added: “Make sure she’s praised as a hero, because she was. She’s a casualty just as much as anyone else who has died.”

 

When patients die in the ambulance, on stretchers, in waiting room chairs, or after appearing to be recovering, your skills, strength, speed and teamwork still aren’t enough.

 

You just can’t help.

You can’t comfort.

You can’t save.

 

You feel angry and helpless and overwhelmed — for doing everything you know and it’s not enough.

Let alone re-using PPE.

Here’s a definition from a PTSD website run by the VA:

In traumatic or unusually stressful circumstances, people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations (1). Moral injury is the distressing psychological, behavioral, social, and sometimes spiritual aftermath of exposure to such events (2). A moral injury can occur when someone is put in a situation where they behave in a way or witness behaviors that go against their values and moral beliefs.

Guilt, shame, and betrayal are hallmark reactions of moral injury (e.g., 3). Guilt involves feeling distress and remorse regarding the morally injurious event (e.g., “I did something bad.”). Shame is when the belief about the event generalizes to the whole self (e.g., “I am bad because of what I did.”) (4). Betrayal can occur when someone observes trusted peers or leaders act against values and can lead to anger and a reduced sense of confidence and trust (5).

 

Trying to be normal

 

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By Caitlin Kelly

So we’re doing some of our usual silly banal things, like watching Jeopardy and playing gin rummy and tossing a softball into our battered leather gloves then sitting for a while on a bench in the sun — far away from anyone on our building’s property.

They are comforting and familiar and we need them so so badly.

We haven’t yet, thank God, lost anyone we know to COVID-19 but our minister has it and two of our parishioners, (who are recovering.)

Those of us old enough to remember it, the only time, domestically, that feels like this was the 1980s and the AIDS crisis, which I covered for The Globe & Mail and the Gazette in my native Canada.

Thank God, we still (for now!) have the same smart, tough, wise, no-bullshit public health expert today that we turned to back then, Dr. Anthony Fauci.

But, no matter where you live, we’re all grappling with a sort of life that makes no rational sense right now:

— millions out of work

— no idea if, how or when the economy will recover

— millions still at work endangering their lives and those of others, whether healthcare workers, first responders, police, grocery staff, delivery staff, to care for us

— the world’s richest nation with so few ventilators, let alone trained ICU staff, that triage is going to become brutal for everyone

— a “leader” who babbles and lies and and sneers at and insults any journalist who dares to challenge or question him

 

We are lucky, so far, to be healthy.

 

We are lucky, so far, to have continued freelance work.

 

We are lucky to live in a quiet suburb with places we can go out for a walk safely without dodging dangerous/selfish crowds of people.

 

We are lucky to live in New York, a state massively whacked by this disease, but led by a governor, Andrew Cuomo, who is calm, empathetic, tough. His daily 11:30 EDT press briefings (available on CNN) are a morning ritual for us now.

 

From The New York Times:

The governor repeatedly assailed the federal response as slow, inefficient and inadequate, far more aggressively than he had before.

Mr. Cuomo was once considered a bit player on the national stage, an abrasive presence who made his share of enemies among his Democratic Party peers. He was too much of a pragmatist for his party’s progressive wing, too self-focused for party leaders and too brusque for nearly everyone.

But now, he is emerging as the party’s most prominent voice in a time of crisis.

His briefings — articulate, consistent and often tinged with empathy — have become must-see television. On Tuesday, his address was carried live on all four networks in New York and a raft of cable news stations, including CNN, MSNBC and even Fox News.

 

How are you doing?

 

What are some of your coping mechanisms?

Getting through this

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We need this tree’s determination to thrive. Split rock, as needed.

 

By Caitlin Kelly

It’s not a joke or a hoax.

It’s forcing everyone to re-think every element of our lives: work, relationships, employment, money, access to government aid, education, worship, mourning, celebrations, trust in government, the safety and reliability of medical and hospital care.

Many people have died. Some are very ill. Some wonder — without easy access to testing — if they’ve even been infected with COVID-19, its now official name.

 

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It’s forcing Americans, especially, to behave in ways that run counter to how they’ve been socialized for decades — i.e. to behave as individuals, to behave as they please, free of most government interference, (but also government aid.)

Writing in this week’s New York Times, Donald McNeil says:

Is that what some countries are missing? This sense of collective action and selflessness?

That is absolutely what many Americans are missing — that it’s not about you right now. My parents were in the World War II generation and there was more of a sense of, “Hey, we did something amazing; we ramped up this gigantic societal effort.” It was this sense of we’re all in this together.

We’ve got to realize that we’re all in this together and save each other’s lives. That has not penetrated yet and it needs to penetrate because we all have to cooperate.

 

 

When you grow up not giving a damn about “the other” — people unrelated to you or you’ve never met and why would you even consider universal healthcare for the “undeserving”? — a pandemic throws this thinking out the window.

The nation’s addiction to capitalism and for-profit healthcare and limited government has also led to this crisis — you can’t keep an economy centered on consumer spending alive when no one is shopping or traveling or buying a house or a car.

The wealthy? They’ve already hopped aboard their private jets, and are safely ensconced in their third or fifth home, like the guy writing to The New York Times who fled New York for his house in Rhode Island.

In a time when Americans have never been more divided racially and economically and politically, this virus doesn’t care.

 

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Like it or not, ready or not, we’re all intertwined now

 

People may look, sound, earn and vote just as you do — and still be carrying and widely spreading this lethal virus.

I finally went out for a walk yesterday on our town reservoir path — lots of people (safely distant!) walking, running, biking. It felt great to be out of the apartment and moving.

It’s no fun being stuck indoors all the time.

It’s really hard not to get irritable and snappish if you share a small space with others.

Yes, people are really disappointed by cancelled parties and weddings and kids’ sports and graduations.

But seriously?

Stay home and be responsible.

We have to buck up.

 

I wish,  more than anything, we could still hear the wise and seasoned voices of those who survived WWII, who knew the kind of shared terror we’re only now beginning to feel — and who can share the mental strength and stamina they all needed to get through it.

 

Here’s my new theme song, from one of my favorite bands, The Talking Heads:

 

 

The art of interviewing: 11 tips

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By Caitlin Kelly

I’ve been interviewing people for a living — journalistically — for decades.

These include the former female bodyguard for New York City mayor Rudy Giuliani on 9/11 (global exclusive), a female Admiral, Olympic athletes, an NHL coach, convicted felons and just regular people, aka “civilians”, people who may never before have spoken to a journalist and realized that every word counts.

My 11 tips:

Always start and end with a sincere thank-you for their time and attention.

 

Very few people have to speak to us, and for some, it can feel like an ordeal. The more warm, empathetic and human you are, the better it will go. Yes, some interviews are very tough on the subject, even adversarial. That’s also our job. But being an efficient robot is rarely the best way to elicit great stuff.

 

Prepare, prepare, prepare.

 

Nothing is ruder than waltzing into someone’s home, office, or life without knowing who they are, why you are speaking to them and how they fit into your story. Do your homework! It shows respect and will, always, elicit a deeper, richer exchange as a result.

 

Consume everything you can on this person before you speak so you’re easily able to reference their books, videos, TED talks, podcasts, essays, journal articles.

 

Obviously, if you’re writing 300 or 500 words, you can’t afford to do this. But a story of 1,000 words or more means digging deeper. Few moments are as flattering to an interview subject than letting them realize you’ve really done your prep on them and their ideas and accomplishments. Sometimes I go all the way back to college or high school yearbooks and friends from those years.

It only appears social.

 

A great interview can be conversational or feel like it. There are times I just lay down my pen and stop writing,  preferring just to listen, watch their body language and take a breather. I also, when it feels legitimate, may share a personal detail with them that’s relevant to the story and its focus. This can build trust. Why would anyone just spill it all to a stranger?

 

Allow at least 30 minutes unless you truly only need a very quick quote.

 

My interviews are routinely 30-45 minutes, often an hour, sometimes 90 minutes and (whew!) rarely, two hours. After that I am utterly whipped and so are they.

 

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One of my old notebooks — coffee stains and all!

Tape or take notes on paper or computer — whatever works best for you — as long as you are accurate!

 

Do what works for you. Fact-check!

 

Make sure, whenever possible, no one — pets, children, the mailman, an assistant, your cellphone — intrudes and interrupts.

 

This is a sacred space. Don’t check your phone! Create intimacy and trust. Focus.

 

Allow plenty of time beforehand, certainly when doing this face to face, to find the right place, settle in, use the washroom and steady your nerves.

 

We all have those “ohhhhhh shit!” moments — your kid melts down as you’re leaving the house, you feel ill, the bus/train/subway is slow or late or cancelled. Give yourself plenty of time to get calm. Your subject needs to feel confidence in you.

 

Ask them who else they consider essential for you (and your audience) to understand and explain the story properly.

 

If you’re done your job well, they’ll share some great intel they might not give someone less skilled.

 

 

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What’s the story’s direction?

If this feels comfortable, consider sharing the focus, length and direction of your story, and maybe some of the other sources you’re speaking to.

 

Some journalists totally refuse to do it. I do this, judiciously, for strategic reasons.

 

Ask them, at the end, what you failed to ask.

 

Always.

I also coach other writers to excellence for an hourly fee. Details here!

The altered body

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By Caitlin Kelly

This week, a year ago, a female surgeon — wearing monkey socks she proudly showed me beforehand, sharing a laugh I needed — removed a small growth from my left breast.

Today it’s a thumb-length pale pink scar I see every day. Since the end of 20 days’ radiation treatment in November 2018, my skin there is now brown and freckled, unlikely to change. The skin is also still orange peel-ish in texture, odd and unpleasant to the touch or appearance.

The minuscule black dots on my back and stomach, used to guide the radiation machine, are still there as well.

And there’s nothing to be done but accept it.

Serious illness will knock any vanity out of you, no matter how we hope to remain forever pretty or thin or strong.

If we survive it, we’re forever altered, our bodies a map of our journey.

After a decade or two, our bodies bear witness: scars, wrinkles, a few persistent injuries that twinge us on a rainy day.

My two favorite scars are maybe half an inch in length, almost matching, one on the inside of either wrist — both the result of great adventures I thoroughly enjoyed at the time.

One, falling off a moped in northern Thailand, as I and my first husband rode to the Burmese border. The other, sustained by scraping against a metal cable while crewing aboard a Long Island yacht in a fall race.

I have three little scars on the top of each knee, like the top of a coconut, from meniscus repairs, also the result of a highly active life.

Friends who have faced multiple surgeries know this all too well.

Our bodies demand repair.

If we’re fortunate, we’re treated with skill and kindness and heal.

As long as my body is able to function freely — and thank heaven, for now it still is — I don’t care as much how it looks as what it can do.

Grateful to be here, scars and all.

 

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“You’re normal”

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Fragility is humbling and frightening

 

By Caitlin Kelly

It’s been a rough week, slowly recovering from my last radiation treatment — October 15 — and still fighting its cumulative fatigue and insane itchiness on my left breast. I was at my wits’ end, crying in public, (I almost never cry anywhere), just done.

I had a follow-up meeting with the radiation doctor, to be told I’d gained (!?) 10 pounds in six weeks and now needed blood tests to see why. This despite seeing my clothes fit more loosely and gaining compliments on my apparent weight loss.

Our GP, thankfully, saw us an hour later and did the tests; (I’m fine.)

But I started crying in his office, weary of all of it.

I apologized for being a big blubbering baby, ashamed and embarrassed by my inability to control my emotions.

“You’re normal,” he said, calmly and compassionately.

Jose, my husband, sat in the room with us, listening as I absorbed this pretty basic fact.

What, I’m not made of steel?

I’m…vulnerable?

Human?!

Kelly’s tend to be (cough) ambitious and driven; three of us won major national awards in the same month, when I was 41, my younger half-brothers then 31 and 18; I for my writing, they for business skills and for a key scientific discovery, (yes, the youngest!)

We tend to aim high, compete ferociously for as long as it takes, (each of my books, later published by major NYC houses, were rejected 25 times), and usually win, dammit!

We keep our emotions very close to the vest and keep small, tight circles of intimates. I don’t really do acquaintance.

 

Being weak, scared, in pain, exhausted and, even worse, letting others see us in this condition?

 

Terrifying.

I’m slowly getting used to it.

Compassion for my fragility is my new oxygen, as much for myself as the gratitude I feel for that shown to me.

 

 

Exposing oneself to millions

By Caitlin Kelly

Thanks to a reader here, I decided to pitch one of my earlier blog posts as a larger, reported story about medical touch — and my own experience of it — to The New York Times, and it ran today, prompting many enthusiastic and grateful tweets.

Here’s the link, and an excerpt:

It started, as it does for thousands of women every year, with a routine mammogram, and its routine process of having my breasts — like a lump of dough — manipulated by another woman’s hands and placed, albeit gently, into tight compression. It’s never comfortable, but you get used to it because you have to.

Unlike previous years, though, my next step was a biopsy, for which I lay face down, my left breast dangling through a hole in the table. Several hands reached for what’s normally a private and hidden body part and moved it with practiced ease, compressing it again into position for the radiologist’s needles, first a local anesthetic and then the probes needed to withdraw tissue for sampling.

I was fearful of the procedure and of its result and, to my embarrassment, wept quietly during the hour. A nurse gently patted my right shoulder and the male radiologist, seated to my left and working below me, stroked my left wrist to comfort me. I was deeply grateful for their compassion, even as they performed what were for them routine procedures.

 

It is decidedly weird to out one’s health status — let alone discuss your breast! — in a global publication like the Times — but it also offered me, as a journalist and a current patient undergoing treatment,  a tremendous platform to share a message I think really important.

 

I hope you’ll share it widely!

 

 

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Every patient needs to be touched kindly and gently

Life in cancerland: 18 tips

 

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By Caitlin Kelly

Some reflections on my having entered — as of June 2018 — a new and sometimes overwhelming world; if useful, please share!

 

You are not alone

You may certainly feel it as you reel with shock and try to make sense of what will happen to you next. My early June diagnosis of DCIS, (a sort of pre-cancer, even though the word carcinoma does mean cancer!) is one shared annually by 44,000 American women.

 

You will likely be in shock and feel utterly disoriented

Even if your prognosis, as mine is, is excellent, you’re stunned.

One minute, you assumed you were healthy, the next…you’ve entered cancerland, filled with sights and sounds and sensations both foreign and unwanted, that you may never have experienced.

What the hell is an aromatase inhibitor?

What are my eight tattoos for exactly?

How tired and ill will treatment make me feel?

 

You face a learning curve

Until you’ve had a biopsy, you don’t know what it feels like, during and afterward. Same for chemo and radiation and other things likely to happen. It’s all new and unfamiliar and a lot to process, physically, emotionally, intellectually — and, in the United States — financially.

 

Ask as many questions as many times, of as many medical staff — including technicians — as you need, and take notes

It’s complicated stuff!

Don’t ever feel stupid or intimidated or rushed or that your concerns are unimportant. Health care includes feeling cared for, not just surgery and medications.

 

People who have never had experience with cancer may behave in hurtful ways

Even with the most loving intentions, people may say things (oh, it’s not that bad!) or do things (send you books about cancer, unasked for) that can leave you even more anxious, scared or disoriented.

They may also tell you to “fight” and “battle” — when (if they don’t know the details) this might not even be necessary, or might not be possible. Ignore them!

This is not what you want!

 

Get off the Internet and listen to your MDs

The first advice my gynecologist gave me — who told me the news by phone — was to not start reading about this on the Internet.

I didn’t and have not and will not.

But I make my living seeking and processing vast amounts of complex information as a journalist — how could I behave this way?

Because I’m human and had to process enough new information as it is!

I also have avoided any detailed conversations about this unless with fellow patients, and not even a lot of that.

 

Some people will flee

This can be painful. It’s them, not you. As one friend (whose wife died of lung cancer) said: “You don’t know what their vulnerabilities are.”

 

Some people will step up unexpectedly

This is a great gift.

 

You will need to let some new people in, even when that feels weird to you

I find this difficult, as someone who’s always been quite private. But without allowing others to know the details of your situation and to comfort you, it’s too hard.

 

Some people will over-share and overwhelm you with their medical story

Shut them down.

This is not the time for you to hear, process and empathize with others’ details and fears. This is the time for you to focus on your needs. That may feel unkind, even brutal. Just do it.

 

If at all possible, find a medical team and hospital you like and trust

You will be spending a lot of time in their offices, possibly daily, weekly, monthly and for many years to come. If you like, trust and respect them, you will feel safe — literally — in their hands.

If you have doubts, find a team you feel good about; this is more difficult if you live in a rural area or have poor health insurance, I know.

 

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You’ll be seeing, and see and be touched by, a lot of people you have never met

That’s another stressor right there.

So far, I’ve seen more than a dozen different MDs, multiple technicians and been to two different hospitals. It’s a lot of new people, and different personalities, to cope with at once — in addition to your diagnosis and treatment.

As one friend told me, you’re spending a lot of emotional capital.

 

Ignore (most) others’ advice!

People will rush to give you all sorts of advice, leads, insights and tips. Everyone’s body is different. Everyone’s tolerance for pain is different.

Just because they or someone they know had a better/worse/horrific/painful outcome, this may not be your experience.

Don’t let their possibly frightening, unhelpful or inaccurate data bombard you while in a weakened physical or emotional state.

 

Educate a few people about your cancer — and let them do the talking for you

It’s time to conserve all your resources, especially time and energy. People who have not faced cancer, and your specific kind of it (what stage, where are you in treatment, invasive, recurring, metastatic, ER+, etc.) have no clue.

Having to keep explaining things to them can be too tiring and upsetting.

 

Do whatever comforts you most deeply

That might mean withdrawing from most social events to save your energy. Hugging your kids or pets. Knitting or playing video games or binge-watching TV, prayer and meditation.

 

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Rest as much as possible

Your mind and body are under assault. Naps are your best friend.

 

You don’t have  to be “brave”

People will tell you how brave you are.

You’re just doing what you have to to stay alive, even if (as I have) you might be fearful and crying a lot to a few people. Even a good diagnosis is enough to shake you hard.

 

Ask for help — and don’t think twice about it!

You may need help getting to and from medical appointments — tests, bloodwork, chemo, whatever. Even if you’re not feeling tired or weak, it is deeply comforting to have a friend or loved one waiting for you when you emerge from whatever it is you faced that day.

Having someone to drive you there and back is a real blessing. Ask for it, and accept it with relief and gratitude. Same for dog-walking, babysitting, food shopping, cooking, laundry.

Love is action.

 

The power of comfort

By Caitlin Kelly

When we’re feeling anxious, few things are as helpful as comfort.

It can be difficult for some people — private, feisty, super-independent — to open up wide enough to admit: “I need help!”

*cough*

But if you can, and if people respond with love, my oh my…

Self-soothing is also a crucial life skill.

It might be food or drink or a hug or a hand to hold.

 

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My pre-op nerves soothed  by a tiny rhino. (Good band name!) It went well.

 

It might be a stuffed animal, whether you’re six, 16 or 60.

It might be a kind word in the middle of a tough moment or a gentle touch.

It might be a bright bouquet of flowers.

It might be a lovely notecard — on paper, sent with a stamp — that arrives just at the right time.

It might be the loving presence of your dog or cat — or husband/wife/partner.

It might be a view out the window of something lovely that soothes you.

It might be your favorite music.

It might be a familiar poem or prayer.

In a time of some personal anxiety, I have been truly grateful for all of these, arriving from Dublin and Paris and London and Hawaii.

Some of you have commented here and some have emailed me privately.

 

Thank you!