The Eternal Process of Becoming: Learning to Live With Change

The phone rings and wakes me. It is a frigid Wednesday in January. My medical oncologist breaks the news that my cancer has spread to my hip bone and vertebrae and jumps immediately to our next plan of action. He knows me by now. He knows that I do not want a pity party, that I do not need to hear him say “I am sorry.” The love language in the relationship between me and my oncologist is action. We plan to return to a chemotherapy drug I took prior and hope for success in slowing the disease. I know that my treatment is palliative, that it always has been. One day, according to every cardiac angiosarcoma case that proceeds to me, I will run out of options and will have no other choice but to accept the disease’s lethal chokehold; however, for now, I do what I can to breathe with hopes of also living.

We are conditioned to believe that the state of being alive in an anatomical sense and the act of living are one in the same. However, living spans beyond palpable heartbeats and respiration. When one rests within the “kingdom of the well,” it is easy to take for granted the rhythm of life. One’s heart beats involuntarily. School, work, and family create a steady routine that mimic this anatomical rhythm. The concept of living as a deliberate action becomes lost. That is until illness enters in through back doors and robs one of the steady routine and future plans that shielded them from the threat of death as a real possibility. 

I was one year into my diagnosis and experiencing the worst cabin fever of my life when I received the call that my cancer had spread and was now even more likely to kill me. I awaited the phone call with a crystal castle of majestic desert dreams, and I hung up with a handful of glass shards. While cancer and cancer treatment require the body to make significant physical adjustments, they also require the patient to reframe their notion of what it means to live fully even in situations where many physical aspects of life lay beyond their control. Living becomes a beautifully deliberate act when one searches for joy and fulfillment amidst the destructive force of disease and learns to accept mortality not as a threat, but as an eventual and inevitable facet of life. 

My disease’s interference with my trip to Arizona is one of many instances in which cancer reminds me of the sacredness of our health. Without our health, we have nothing. Without my health, I cannot make the trip to Arizona. Without my health, I cannot plan months out and expect to be well enough to follow through with these plans. When our health becomes compromised, we realize just how much we took for granted in our lives prior to diagnosis. While strength, endurance, patience, and willpower are virtues that we may or may not practice as physically “healthy” individuals, they often fade into the background of our mechanic lifestyles. However, when we experience chronic illness, these 
once optional traits become necessary pillars of living and healing. Harsh medical treatments push the ill body to physical and emotional limits the well body never knew existed. The passivity with which we once viewed the state of being alive is a death sentence that kills us while we are still breathing. By threatening our breath, illness teaches us that living has little to do with anatomy and much more to do with the deliberate and mindful actions that constitute our days on Earth. As patients, we exist with the constant reminder that we will one day cease to breathe. The inevitability of death and the little control we often have over the progression of our illnesses weigh heavy on the body and soul. Yet, through the mindful practice of strength, endurance, patience, and willpower in our daily lives, we can enjoy the time we do have, rather than sit in our grief. 

I know that you may be thinking, “But Sarah, some days I can’t even get out of bed.” 
I often sit in my body, weak, tired, and overridden with a depression that makes rising each morning equivalent to climbing a mountain. I compare this version of myself to the previous year’s, and disappointment clouds my vision. “I used to believe I could conquer the world,” I reflect. “Now, I do what I can to get through the day.” Other days, my tears glimmer with gratitude. “I am breathing,” I remind myself. “And as long as I am breathing, I must live.” To live no longer means feeling unstoppable like my naive self believed it to mean at the start of my diagnosis. Instead, to live is to wake up each day with the willingness and the intention of doing my best, both for myself and for others. This year, like never before, I realized that what I see as “my best” in one moment is nothing close to “ideal”; however, the key is that I do what I can with what I know and what I have in a given moment.

 
Even when exhaustion and pain crush our bodies and assert their control, we have the power to practice one of the four pillars: strength, endurance, patience, and willpower. On the days where you cannot get out of bed, you are capable of practicing patience by letting your body get the rest it needs. On the days where you want to run a mile, but you can barely walk down the hall, you practice strength in the deliberate act of standing up and getting to the end of the hallway, even if it takes you a day. Regardless of where you are in your journey or how illness may affect you, you can take back control of your life in redefining what these four pillars mean to you and in finding new ways to live despite your physical limitations. 

I used to fight any kind of numbness, any ounce of fog. I refused numbing medications for dental fillings, alcohol (for at least the majority of my young adult years), and pain medications (up until the pain caused by my cancer at this time last year became paralyzing). It took constant pressure from doctors and nurses to convince me to accept even the most minute dose of a pain reliever. I grappled with the self-held notion that living required me to feel everything fully all of the time. I lived by the Lumineers’ line: "It's better to feel pain than nothing at all." I still identify with the lyrics, but I no longer believe that I must prove my strength through the level of physical pain I can endure. Cancer brings me enough physical and emotional pain that there is no need to sit through high levels of pain that can be controlled through medication and rest. However, I am intense and extreme by nature. Before cancer, I was not able to complete only part of a task, nor give only a piece of myself to a cause. My worldview was dictated by the mantra: "all or nothing." My decreased physical capabilities since my cancer diagnosis cause me to dedicate greater energy to balancing these extremes. In forcing myself to accept my physical limitations, I better align my mind and body, slowing down and finding inherent value in moderation. We can find strength and endurance in moderation, allowing our bodies what they need while also challenging ourselves to reach our goals over time.

 
I type “Sedona, Arizona” into the search bar. Hundreds of photos of luminous skies and crimson rock come into view. A cathedral of stone and light sculpted by wind and time. I recall my grandfather telling me that he had seen the whole world through images and felt like he had been in these photographed places. I never agreed with him. In fact, as a child, I became angry. How could you lock yourself in your house and see the world without actually seeing it?  I dreamt of traveling to all 195 countries, and of living on the road, touching, smelling, living in a new landscape. However, as I "immerse" myself in the oasis of color on my computer screen, I understand my grandfather for the first time. It was never that he didn’t want to travel. It was that his physical and financial conditions never allowed him to do so. I am lucky. I have travelled more than the average person my age. Soy bilingüe. And, the person I am today is a mosaic of all of the places I have been and all of the people I have met along the way.

 
Just as wind, water, and sun carve their stories into the crimson cliffs, strength, endurance, patience, and willpower carve their stories into us. We, like the landscape, are in constant dialogue with time, which both shapes and weathers us. Illness, grief, and change may strip away what once seemed essential, yet in their wake, they reveal the deeper contours of who we are. Like Sedona’s red rocks, we stand as testaments to endurance. Sedona’s red rocks remind me that permanence is an illusion. To live is to be continually molded by both suffering and grace. I may never walk the golden city’s desert paths, but I recognize within myself the same eternal process of becoming.