The Assertive Cancer Patient

Dying Without Health Insurance

A friend of mine at WashingtonCAN, a lobbying group, forwarded a report about the number of people without health insurance who die every year, nationally and here in Washington state--because they don't have health insurance.

Now, I'm not sure how they were able to determine that these people died because of lack of health insurance (in other words, that they wouldn't have died, regardless), but I'm willing to take their word that they have a formula for estimating this.

Here is a piece of the report:

The number of uninsured Americans reached 47 million in 2006, and it continues to rise. For many of the uninsured, the lack of health insurance has dire consequences. The uninsured face medical debt, often go without necessary care, and even die prematurely. In 2002, the Institute of Medicine released a groundbreaking report, "Care without Coverage: Too Little, Too Late," which estimated that, nationwide, 18,000 adults between the ages of 25 and 64 died in 2000 because they did not have health insurance. Subsequently, The Urban Institute estimated that at least 22,000 adults in the same age group died in 2006
because they did not have health insurance.

To find out what this means for people across the nation, Families USA has generated the first-ever state-level estimates of the number of deaths due to lack of health insurance. Our estimates are based on both the Institute of Medicine and The Urban Institute methodologies applied to state-level data.

In 2006, there were nearly 3,505,000 people between the ages of 25 and 64 living in Washington. Of those, 14.6 percent were uninsured. Uninsured Washingtonians are sicker and die sooner than their insured counterparts.

Families USA estimates that one working-age Washingtonian dies each day due to lack of health insurance (approximately 380 people in 2006).

What are 380 lives worth?

Read the report: Families USA Study

@ Jeanne Sather 2008.

The Dog Has Died

Younger Son's Golden Retriever, GB, died Saturday.

I had to give YS the news yesterday, Mother's Day, when he got home from a weekend retreat sponsored by his school, Seattle University.

Older Son was home as well, but none of us felt like going out for dinner, so we postponed that until Wednesday.

We decided to have GB cremated, and we will take his ashes and scatter them at the beach next time we go. GB loved the beach more than any place else on earth.

The photo at the top is Younger Son, incognito, walking both dogs on Christmas Day. The lower photo is me at the beach with the dogs, two summers ago.

@ Jeanne Sather 2008.

One of Amorette's Babies Has Died

My dear friend and fellow cancer blogger (and bento artist) Amorette was about 18 weeks into her pregnancy with twin girls when she lost one of the babies.

Little Cécile was born on Sunday, April 13, after a premature delivery, Amorette writes on her blog. "She was too tiny to breathe on her own and died shortly after the cord was cut."

The funeral is today, and sadly Amorette cannot be there, because she is still in the hospital, fighting to save Cécile's identical twin sister, Madeleine. Her mother Pam is with her.

Please go to Amorette's blog to leave her a message, and keep that number 24 in mind--that's how many weeks old the baby needs to be to survive.

Go to Amorette's blog: Cécile

@ Jeanne Sather 2008.

The Assertive Cancer Patient: Keeps the Doctor From Going MIA

This is a chapter from the book I'm working on, called 'The Assertive Cancer Patient: A Troublemaker’s Guide to Getting the Best Cancer Treatment Possible.' I hope to have the book done by the end of 2008, but who knows? This blog takes up most of my time. Jeanne

I call them “MIA doctors”—doctors who go missing in action when their patients are dying.

Cancer patients do not expect the doctor who has cared for them throughout their illness to turn and walk away once they are terminally ill. But that is what happens more often than not. The doctor hands them off to hospice for palliative care or sends them home to die, and that’s it: These dying patients never see or hear from their doctors again. Often, during their last appointment oncologists don’t even say goodbye or acknowledge that they will not be seeing the patient again.

Before I get into the reasons for this, how things are starting to change, and what you can do, a couple of stories:

When my friend Surain af Sandeberg was dying of cancer in the spring of 2002, her husband Robert told me how distressed he was that they had not heard from Surain’s doctor since her last appointment.

Surain had metastatic breast cancer. Late in 2001 her doctor discovered that the cancer had spread to her brain, and she had radiation therapy to the head. Then cancer was found in her upper spine, and in January 2002 Surain’s doctor told her that it was unlikely further treatment would work.

Surain went home to the houseboat on Seattle’s Lake Union where she had lived with Robert since 1994, and a group of friends helped Robert care for her during the remaining months of her life. But during this time, and even at the time of Surain’s death in March, her doctor never once contacted her or her husband. She never called; she never sent a note.

“It’s is definitely true that [the doctor] disappeared completely after she told us that Surain had one to two months left to live,” says Rain Robert af Sandeberg (who has since added his wife’s nickname to his name). “Surain and I were surprised by that—I might say a bit upset.

“Surain liked her doctor very much. She was a famous doctor, yet she seemed to give preference to Surain’s case and gave her quick appointments when it was possible in her busy schedule.”

I was one of the people who helped care for Surain at the end of her life, and I was shocked when Robert told me Surain’s doctor had gone MIA. At that time I had no idea that this was standard practice for most oncologists. Once they feel they can do nothing more for the patient medically, they hand them off to hospice, to a social worker or pastor, or just send them home to die.

Since then, I have heard a number of similar stories, and each time I hear one, my outrage grows. These dying patients are not asking for a lot: a phone call, a chance to say goodbye and thank you, some acknowledgement of the relationship they have had with their doctor.

The family doctor goes MIA
A woman I know told me a similar story, but in this case it was the family doctor who went MIA when her mother-in-law was diagnosed with metastatic cancer at age 82.

“This was the most difficult thing for us as a family—feeling that her family doctor of 25 years farmed her off to an oncologist, and then as soon as he handed her off we never heard from him again,” she says.

Several years after her mother-in-law’s death, these memories are still painful. She had accompanied her mother-in-law to a number of doctor’s appointments over the years, and saw what she thought was a warm, caring relationship. But once her mother-in-law was diagnosed with cancer, she says, “It was as if the relationship they had was phony; it didn’t exist.”

And when her mother-in-law died, she says, “We had expectations—it would have been just common courtesy—for the doctor to make a phone call when she died or send a little note. But nothing. A gaping vacuum. It was hard for us.”

Her husband adds, ”There was no good-bye, no card, no appearance at her bedside or funeral.”

These stories are difficult to read, I realize, but read on, because it gets better.

One thing that makes these experiences so painful for cancer patients and their families and friends is that they were unexpected. If you know that your doctor might behave this way at the end of your life, there are some things you can do to change the script. These including choosing a doctor early on who you know won’t go MIA on you at the end.

Why doctors go MIA
Doctors are taught in medical school to keep an emotional distance from their patients to protect themselves from burnout. And oncologists are taught to hand their patients off when there is nothing more that they can do for them medically—no more drugs to try, no clinical trials left that might prolong their lives for a little while—and turn their attention to patients they can help.

What they don’t seem to realize is that we patients experience our relationships with our doctors as so much more than a “medical” relationship.

In addition, many oncologists experience the death of a patient as a personal failure, when, as one woman points out, “It’s not all about them.” Also, several doctors have told me that giving bad news, telling a patient that he or she is terminal, for example, is one of the of the most stressful things they do. And to top that off, the vast majority of oncologists were never taught how to talk with their patients—so they avoid having these difficult end-of-life conversations, and the patients are left confused and sad and feeling abandoned.

“We are expecting that physicians have a level of emotional maturity and a level of comfort with all aspects of life, including death, and most of us are not OK with it,” says Karen Gorrin, a therapist who works with cancer patients.

“It’s not what our culture has taught us,” Gorrin says. “We don’t grow up with this and we aren’t taught this in schools.” She adds that in her training as a therapist she was also taught to distance herself from her clients, but she has broken ranks and doesn’t do things that way any more.

“In my training one of our mentors was really clear: ‘You don’t go to funerals; the way you do this is you do your work as a professional and you keep a distance,’” she says. “But I found that this didn’t work for me. I had a relationship and I needed closure and I needed to see through the relationship. That works for me.”

Change is coming
Dr. Anthony Back, a medical oncologist at the Seattle Cancer Care Alliance in Seattle, Washington, is doing research on doctor-patient communication and training doctors to have what he calls “difficult conversations” with their patients. He says, contrary to the conventional wisdom, doctors benefit from being able to have these conversations with patients and are less likely to burn out.

Dr. Back is one of a handful of voices in the wilderness at this point, but his work offers hope that the next generation of oncologists will be able to talk openly with their cancer patients throughout their diagnosis and treatment and at the end of life. (A side note here: Some oncologists have figured this out, despite what they were or were not taught in medical school, and do a wonderful job of having difficult conversations with their patients. My own doctor is one of them.) Dr. Back’s work may well mean that the next generation of oncologists will be able to say goodbye to dying patients and not go MIA on them.

Dr. Back and several co-authors published an article, “On Saying Goodbye,” in the April 2005 issue of the Annals of Internal Medicine that has attracted a lot of attention. Dr. Back says the article was needed because, “There was kind of a gap in the medical literature about how to close a relationship with someone who is dying. … There is something about modern medicine—our huge job is to keep people alive as long as possible. It’s not as much about honoring and respecting the life. There hasn’t been a lot of talk about that.”

Dr. Back helps train young doctors, including medical students, residents, and fellows, and he says they don’t see their mentors having these conversations with patients who are at the end of their lives. “There is not a lot of role modeling about it,” he says. “They are learning by trial and error.”

In the journal article, Dr. Back and his co-authors walk doctors through seven steps in the process of saying goodbye to a dying patient. These include choosing an appropriate time and place, giving the patient a chance to respond, and my favorite, “Number Six: Articulate an ongoing commitment to the patient’s care, to make it clear she is not being abandoned.”

It is clear that this is needed. After the article came out, Dr. Back says he received one phone call and four e-mails from people saying that their veterinarian did a better job when a pet died. He says, “I got phone calls and e-mails from people who said something like, ‘When my dad died I didn’t hear anything from the doctor. But when my cat died I got a handwritten note the next week and a call.’ One woman said the vet made a donation to PAWS [the Progressive Animal Welfare Society] in honor of her pet rabbit. The contrast is a little creepy.”

What you can do
1. Know what you want
The first thing you can do, to help keep your doctor from going MIA, is to think about what you want from your doctor at the end of your life. I am not terminally ill, but I have an advanced cancer that cannot be cured, so I’ve spent some time thinking about these issues.

I want my doctor (by which I mean my medical oncologist) to tell me, clearly, when all of my treatment options have been exhausted and I am dying. At that time, I want the opportunity to thank him for all that he has done for me, and I want the opportunity to say goodbye.

And I want my doctor to stay in touch with me during the time I have left. This doesn’t need to be a personal visit, a phone call or two is fine.

My doctor will also be invited to my funeral. Whether he attends or not is of course up to him, but he will be invited.

2. Choose a good time for you
If possible, you will want to carefully choose the time to have this conversation. For example, I did all my end-of-life planning, including rewriting my will and making plans for my funeral during a period when I was in remission and feeling physically and emotionally strong. Don’t kid yourself that this will be an easy conversation, for either you or your doctor. Choose a good time.

3. Give your doctor some warning
Once you’ve prepared yourself to have this conversation with your doctor, give your doctor a verbal warning that you are going to bring up a tough subject. “It’s a little tough for some doctors to hear this out of the blue,” says Dr. Back. “You might say something like, ‘I’ve been doing some thinking and planning and there are a couple of things I want to request.’”

4. Be specific about what you want
You may want to go into this meeting prepared with a written list of the things you want to talk about to make sure you don’t forget anything. Then just tell your doctor what your concerns are, whether it is making sure you have a chance to say goodbye, or wanting reassurance that you will still have contact with your doctor at the end of life. Dr. Back says he encourages cancer patients to raise these issues. “I think most doctors would appreciate this kind of invitation,” he says. “It could be uncomfortable, but just hang in there.”

5. Enlist help to get what you want
You, or a family member, can enlist the help of your doctor’s nurse, suggests Dr. Back. “Family members could call the doctor’s office at the end of life,” he says. “It is totally fine to say to the nurse: ‘It would mean a lot to us to have a call from the doctor. We just want to talk a little bit.’ Most doctors would respond to that. It is a respectful request about something you need.”

6. Be prepared for the possibility of an MIA doctor
You’ve told your doctor what you want, but that doesn’t guarantee that the doctor will be responsive. You need to be prepared for that possibility. Some doctors, for all the reasons mentioned above or for personal reasons of their own, may not be able to maintain contact with you at the end of your life. That’s sad.

If this does happen to you, don’t put too much energy into trying to change the doctor. Acknowledge to yourself that it’s not what you want, and find someone else who will be comfortable being present for you in the last weeks and months of your life. This could be a pastor, a therapist, or a close friend.

See also:

Discovering the power of goodbye

@ Jeanne Sather 2008.

Do You Have an Updated Will?: The Assertive Cancer Patient Poll

I've been wondering about this, so decided to put it out there and find out--

How many of you had your will and other end-of-life planning in good order at the time you were diagnosed with cancer?

Answer: yes or no

Six months after diagnosis: How many of you had taken care of your will and other end-of-life planning?

Answer: yes or no

One year after diagnosis: How many of you had taken care of your will and other end-of-life planning?

Answer: yes or no

Please answer with a comment (below), or send me an e-mail if you want me to post your answer anonymously. Feel free to elaborate on the simple yes/no answers. jeanne.sather@gmail.com

I'm very curious about this, because I know how hard it is to face end-of-life planning when you're healthy, and I think it is in some ways even harder to face when you are sick.

And I'll start the ball rolling by admitting that at the time I was diagnosed, I did not have a formal will. Only a handwritten letter spelling out my wishes for my sons if I should die.

This, despite the fact that I was a single parent, with (at that time) sole custody of both my sons. This was criminal. What was I thinking? (I know, of course, that I WASN'T thinking. I didn't want to face these issues, or something else was always more important--one thing single parents are is time-starved.)

Since then, I've done my will and other documents twice, and I'm due to update them again, now that Younger Son is 17 and counting. Older Son is 23.

Sorry that I don't have the HTML ability to build a snazzy little poll that will tabulate answers automatically. I'll just have to do it by hand.

Answers, please.

See also: To be dead sure you get the last word, write your own obit
(Note that I was interviewed for the above story FOUR years ago. Women with metastatic breast cancer are living longer.)
@ Jeanne Sather 2008.

Keeping Secrets

Here's one secret I won't have to keep anymore: Amorette is pregnant!

Read all about it on her blog, in a post that breaks my heart even while I'm feeling such joy for her. Amorette was never supposed to be able to get pregnant, because of some heavy-duty cancer treatment at a very early age. (Radiation, age 3.)

Read: Wait, aren't I infertile?

Amorette does such a great job of feeling what she feels and then bleeding all over the page, in a way that is impossible not to empathize with.

I've known about this pregnancy for a little while, because we communicate by e-mail as well as on our respective blogs, and I was really afraid that I was going to slip up and say something in a comment that would out her before she was ready (chemo brain, you know).

So now I can relax about that.

Totally Shitty Day
Despite the beautiful weather, and the good news from Amorette, and the good news from my oncology appointment this afternoon (more on that later), I have been in a totally shitty mood all day, topped off by an upset tummy--Tykerb, lots of trips to the bathroom--and a swimmy/dizzy feeling that made me wonder if I was safe to drive myself to and from the doctor (of course, I drove).

I think I know why I'm in this mood.

One of the readers of my blog had a mastectomy this morning, and even though I only know her from the blog, it really got to me. I was right back there when I had my own mastectomy, nine years ago.

Back then, mostly, I felt numb. I walked, I talked, but I was numb. And this morning I think I was having a little sympathy numbness for my friend, who was in surgery.

I sent her some flowers, which seemed like such a small thing to do. Trite, even. (But I hope she likes them.)

I wanted to do so much more: Hold her hand. Tell her everything would be OK (even though we both know that no one knows if everything will be OK, but sometimes you just have to pretend, you know?). Tell boob jokes. Or boob-less jokes.

@ Jeanne Sather 2008.

Food Is Love

By Krista Winjum

“Food is love,” was my mom’s mantra.

She taught me the connections between the earth, food, and seasonality. We grew many of our own herbs, vegetables, and fruits wherever we lived. On school holidays, we ate our way across Europe.

Joanne Winjum, my mom, was a small-town Minnesotan farmer’s daughter with a Ph.D. in art history. My dad, Jim, is a small-town Minnesotan trucker’s son with a Ph.D. in accounting. Due to my parents’ advanced degrees, we lived in England when I was 4 and 8.

At home in Ann Arbor, Michigan, starting at the age of 10, I watched Julia Child on Saturday mornings instead of cartoons. She was just as funny as a cartoon, but real. She taught that while technique was serious, cooking and eating were fun.

Mom shared my enthusiasm for food, fun, and Julia.

Our bible was “Mastering the Art of French Cooking,” co–authored by Julia and Simone Beck. Our favorite dish was her famous French onion soup, which became the centerpiece of our New Year’s Eve dinners.

We never made recipes as written. Co-conspirators, our love of flavor lead us to add extra this, an extra spoonful of that. If a recipe called for one clove of garlic, Mom added three. If it called for two, she added five. Most nights, we left the table with garlic breath.

Our kitchen accommodated several cooks. Dad wired speakers in every room of the first floor, so we’d blast music, chop, stir, sing, and dance.

Mom’s favorite song was Three Dog Night’s “Joy to the World.”

“Jeremiah was a bullfrog,” she’d sing. “Was a good friend of mine.” Then we’d get silly and start imitating Julia: “Save the liver!” and toast each other with “bon appetit!”

While we both loved food, we had different favorites. Mom drank iced white wine. I liked red wine. She loved anything crispy-–the tiny French fries that fall to the bottom of the bag, the sugary, brittle corners of brownies, and the crunchy caramelized end pieces of roasts were her favorites.

I liked the softer bits, so I got the bigger French fries, brownies from the middle of the pan, and the rare slices from the roast. We snuck food onto each other’s plates, trading crispy bits for soft.

However, dislikes were not coddled. Mom loved certain vegetables that I hated. This meant that I had to eat green-pepper-laden goulash, Brussels sprouts, and piles of lima beans.

We repeated our favorite dishes throughout the seasons. The classic French recipe "40 cloves of garlic chicken" (Mom used 60), and boeuf bourguignon were standard on cold winter days. Summer brought salade nicoise and pitchers of homemade sangria.

She made special treats when my brother and I were sick. A cold meant perfectly poached eggs on buttered toast. The flu meant real brandy in our lemon tea and rich chicken and dumplings.

When I had back surgery in 1996, Mom flew out to Seattle with bags of Hungarian paprika. She made pork paprikash with homemade spätzle (noodles), coq au vin, and chicken and dumplings. I still have a bag of the paprika in the freezer.

Mom was diagnosed with end-stage lung cancer in December, 2001. During 2002, I visited several times, making her favorite foods each time.

I cooked gyros with ground lamb and lots of garlic, but left the lemon out of the sauce because it hurt her mouth. She enjoyed my homemade baklava, and my bread pudding was sweet and soothing.

I returned to Michigan when Mom went into the hospital the day after Thanksgiving 2002. She was so sick that she hadn’t cooked Thanksgiving dinner. After dad and I visited her in the hospital, he asked me to cook the full dinner.

For our family, Thanksgiving dinner was about cooking together, music blasting, drinking wine, and having fun. That day I cooked alone, tears running down my face. I roasted the turkey, made stuffing, and tried to remember exactly how mom made her incredible brown-sugared yams.

When the dinner was ready, I couldn’t bear to sit down to eat it alone with my dad. We packed it up, took it to the hospital, and ate with mom. She was thrilled.

I haven’t been able to cook Thanksgiving dinner since.

When mom went into a hospice a few weeks later, I brought smoked salmon linguini and lasagna, fresh fruits and vegetables, and chocolate cake. I topped toasted English muffins with poached eggs.

I don’t know if she was actually able to taste the food. The cancer was in her brain, affecting her senses.

She couldn’t smell very well, and I think her sense of taste was also affected. However, she declared everything “delicious” and I quoted her back to herself, “Food is love, Mom.”

On New Year’s Eve, we had Julia Child’s French onion soup. Mom’s eyes sparkled as I brought it to the table, and she held my hand while we ate.

That was the last meal I cooked for her.

When she died a few days later, we wrote in her obituary:
“Joanne never wore perfume from a bottle–-her signature scent was that of delicious meals. When we smelled the aroma of olive oil, garlic, and onions, we knew that Mom was in the kitchen.”

At her funeral, the only song we played was “Joy to the World” from Three Dog Night.

On Aug. 13, 2004, I logged on to my computer at work and read that Julia Child had died. It was as if my second mother was gone. I burst into tears when I read that Julia Child’s last meal had been her own French onion soup, the same as I cooked for Mom.

I felt the loss of my mother all over again in Julia’s passing. We were so intertwined. From them both I learned that food is love–-put your heart into it and share it with as many people as you can.

This story was written by Krista Winjum, a student in my writing class at the University of Washington Extension during fall 2007.

See also: My Mother’s Garden

@ Krista Winjum 2008.

Dina Rabinovitch Dies

No sooner had I posted my piece about Tykerb, with links to Dina Rabinovitch's blog, than I received an e-mail from my friend (and fellow blogger) Jacqueline telling me that Rabinovitch has died at age 44 of breast cancer.

My first (admittedly selfish and rather black) thought was: That's not much of an advertisement for Tykerb!

That kind of black humor comes easily to those of us who live with this disease. And I think Rabinovitch would not have been offended.

In addition to her blog, Rabinovitch was a long-time columnist for the Guardian newspaper, and she wrote her final column only two weeks before her death. (Her final post to her blog is dated October 23.)

In her final Guardian column Rabinovitch speculated on death. "Because I am young -- 44 feels young to me, too young to die -- or perhaps because I haven't had much to do with dying, I compare it with the things I know," she wrote.

"What it felt like most of all was that moment towards the end of labour, but still with hours to go, when you utterly reject any lingering notions of natural childbirth and you are yelling for the epidural. In this case it's morphine. Something to take away the physical pain, to relieve the fear."

That exerpt is from a longer piece in the Guardian that ran October 30: Guardian columnist Dina Rabinovitch dies

@ Jeanne Sather 2007.

A Death in the Family

I just got a phone call from my aunt, telling me that my brother, Eric, has died.

Eric Sather, 54, dead of colon cancer.

Right now, I don't feel much. A big blank.

Eric's death was expected. He was diagnosed with metastatic colon cancer about two years ago. He lived in Alaska, but was back and forth to Seattle for surgery and treatment.

I haven't written about my brother on my blog before because we were pretty much estranged for the past 10 years or more. He did e-mail me, along with my sisters and cousins, during the time he was in treatment, but I didn't see him.

This was one of those topics that I had decided NOT to blog about. For good reason.

But now, my big brother, my only brother, is dead. And it's raining in Seattle.

What DON'T You Blog About?

Well, I thought this was a great idea, but obviously I was wrong.

Last week I got some very upsetting news concerning a member of my family, who is apparently dying of cancer. And I desperately wanted to blog about it, because blogging helps me cope with so many aspects of my life with cancer.

But one topic I have NEVER written about, in my blog or in my other writing, is my estrangement from most of my immediate family. There are good reasons not to write about this; the biggest reason for me is that I don't want readers to give me advice or tell me what to do.

However, I wanted the relief of blogging, so then I thought about rounding up all the usual suspects, my cancer blogger friends, and asking them to write linked posts on what we don't blog about. This seemed like a way to write about the topic of my family and cancer without really giving the personal details or, hopefully, opening the door to criticism of my way of coping with the situation.

That's what I thought, anyway.

But, when each and every one of these bloggers declined to participate, I decided to listen to them. And I agree. There are some topics that I don't want to discuss in detail on the Web.

For the record, the one topic I won't touch in my blog is family estrangements. How about you? What don't you blog about? No details needed, just the topic. Add a comment below, or send me an e-mail: jeanne.sather@gmail.com

Feedback From a Smarter Blogger Than I
Here's what one smart blogger had to say in response to my request:

The few specific things I don't and won't blog about are so sensitive that I don't even want to
list them, much less discuss them to the extent of explaining why I don't blog about them. They're not secret; they're just out of bounds for public discussion. Period.

There is one tip I would give your blogging students, though, and you have obviously already thought about this, but I would just second it: Even though the blog is a great place to spill one's guts, get things off one's chest, think things through, etc., I still recommend maintaining certain boundaries. You never do know where information will wind up, or how it will be distorted by the filter of other people's experience. People can get hurt by what you say about them behind their backs, even when you think there's no way they can ever find out, and even when they never do find out.

Also, it's very important to think about whom you would let into your personal relationships. Everyone has an opinion, and what, one in twenty? one in a hundred people who read what you say will actually post a comment? And they don't know you, or him (or her), and yet it's crazy, or maybe just naïve, to think that what they say won't affect you.

Boundaries are good.

As I said, smarter than I. I'm taking this advice.

Reader Alert
I've posted this message, or one very like it, at the bottom of several posts that were on sensitive topics, and so far my readers have been very thoughtful in their responses. What I mean is, they didn't e-mail me and tell me how to handle the situation, or that I was full or it; they just wrote messages of support--without the usual cliches, too! For this I am profoundly grateful.

Note: If you are new to my blog, you may not realize that I am extremely sensitive about people giving me unwanted advice.

Please do not e-mail me telling me what I should have done in this situation. Or post a comment saying something like, “No matter what happens, it will all turn out for the best.” Or, “You did the best you could.” This is not helpful.

Words of sympathy and support are gratefully accepted.

@Jeanne Sather 2007.