Two Important Words

The 1^st Word

On “that” beautiful mid-July afternoon, I was finishing my salad at lunchtime, looking over emails, and waiting to see my next patient when the phone rang. In my typically rather positive phone voice I answer, “Good afternoon, Dr. Berry speaking”. My urologist, Alan Kowitz, was on the other end of the line. In a rather somber tone, Alan said “I am sorry but I have some bad news for you. The CT scan showed a small tumor on the upper part of your right kidney.” Did he just say that word…TUMOR?

Immediately my psychological defense of denial kicked in. Of course, Alan called to tell me about some mutual patient who has a tumor on his kidney…poor guy…ugh what was his name again. Sorry Alan, I missed the name, whom are we talking about? After Alan repeated himself, reality kicked me in the gut. Of all those hundreds of people I have worked with throughout the years who have had tumors, now it was my turn?

What do we know about the tumor, I asked. “It is a bit less than an inch in size. There is a 95% chance of it being Renal Cell Carcinoma. But then there is the 5% chance it could be Renal Oncocytoma, a benign tumor. There is no evidence that it has spread.”

After the immediate spinning of my mind, I was able to listen to my options and immediately chose to have surgery (bypassing a biopsy) performed by one of the best. Dr. James Porter, in Seattle, is a leader in this type of surgery that uses a robot named, Da Vinci. The problem is that because of his busy schedule I would have to wait months for even the initial consultation. By that time would I be sporting a football-sized tumor on my kidney? “Hard to tell, but likely not since these tend to be slow growers”, said Alan.

I am sure now, that I was pretty useless as a psychotherapist, ten minutes later in my next session. Though I appropriately completed my chart notes, I frankly now have no idea who the next couple of patients were that day.

Between the next few hours and the next few days, my mind was a constant swirl. I had so many question, and far fewer answers. After disclosing the news to my wife and children I began to strategize on the best way to disclose the news to my friends. Then what about the larger concentric social circles? What approach to take with my patients? So many questions.

Admittedly, time moved quite slowly towards October 12, the day of my surgery. There are stories to be told about my experience in the hospital, but they will have to wait.

The 2^nd Word

Fast forward to October 18, 2016. I am sitting in my surgeon Dr. Porter’s office for my one-week post-operative follow up. After discussing a few of my post-operative issues, he presents me with a sheet of paper. “It is the pathology report regarding the tumor. He smiles and says, this is the best news I have been able to give someone today. Your tumor was benign. It is called a Renal Oncocytoma.” That news made the discomfort around my six incisions hurt about 50% less! Yes, I was in the 5% of those with kidney tumors. He said the word: BENIGN. I beat the odds…but then someone had to, right. Why not me?

Was this grace, luck, good fortune, healthy lifestyle…I have no idea. But I will take them all. While I was feeling so very pleased with the outcome I also found a puzzling lack of excitement as I sat with Dr. Porter. I think I know why. There are two reasons.

The first reason that I didn’t start singing and dancing with the news that my tumor was benign rather than malignant is that from the beginning I always thought that if it was cancer, I perceived myself as having “a” cancer rather than having “cancer”. Twenty years ago I had a squamous cell carcinoma removed from my nose. It has been gone for a very long time. Then a couple years ago I had an early melanoma removed from my leg. I have a scar but no cancer. Guess who grew up in Southern California wearing only shorts during the warm summer days?

Somehow I simply pictured my kidney tumor in the same category as my skin cancers. It was an inconvenience for sure, but it was “a” cancer. Certainly if the CT scan on my kidney found that the “cancer” would have metastasized I would be in a different situation. But my mind rarely went there, it stayed with what we did know, not what might be.

The second reason I was so subdued to the good news from Dr. Porter likely has to do with my intentional practice around the “two darts”.

It is not beyond my ability to have an exaggerated response (positive or negative) to something. Throughout my short 69 years I have been thrilled by some events and have also been anxious by other events. It is not really that hard to swing from one extreme emotion to the other (and no I am not bipolar). But what I have been consciously practicing for the past few years is trying to stay in the balanced middle.

Thousands of years ago the Buddha said: “Monks, when the uninstructed worldling experiences a painful feeling, he sorrows, grieves, and laments; he weeps beating his breast and becomes distraught. He feels two feelings—a bodily and a mental one. Suppose they were to strike a man with a dart, and then strike him immediately afterward with a second dart, so that the man would feel a feeling caused by two darts. So too, when the uninstructed worlding expresses a painful feeling, he feels two feelings—a bodily one and a mental one.”

The Buddha went on to describe how it is typical for the “uninstructed worldling” to respond to pain first with aversion and then typically move into psychological avoidance. There are of course numerous ways to try to avoid our pain: work, numbing chemicals, food, sex, depression/anxiety, etc.

Perhaps the strangest thing for most of us is to accept the painful situation, just for what it is…a painful situation. In the Buddha’s metaphor, we can’t avoid the first dart of pain. We all get sick. We all will die. We will all lose loved ones by one means or another. But the second dart may be avoided. By practicing acceptance of that which is in our current situation, we save ourselves from the second ghastly dart…our dramatic reaction to the original pain. This in no way means we don’t feel the pain of the first dart-pain. No, the point is to feel it in its entirety. Grieve appropriately for the current situation…but not the beyond reality measure.

So was I successful in accepting my first dart? Most of the time, yes. There were other times I found myself on either end of the spectrum. I did participate in catastrophizing and I also participated in avoiding my feelings through numbing tactics. But by in large I was able to live moment by moment. I prepared for the worse, but lived in the best…that I had. Focused practice is our friend.

What if my outcome would have been “worse”? What if my tumor was not benign? Would I have been as successful with detaching from reality? I don’t know. What I do know is that I will most certainly be given the opportunity to practice again in the future.

Tim Berry