Exposed. A flimsy gown, the glare of fluorescent lights, the dog-eared pamphlets and outdated magazines. In an instant, time unravels. Five years slips away to another waiting room and another decision forced into my hands. To remove my breasts. Cut out the risk of a future diagnosis. Dismantle me.

I grip the vinyl seat, breathe deeply through my nose and the scent of antiseptic triggers an onslaught of PTSD induced images. A resident calls me in. Her wide eyes blink as she clears her throat and the pen shakes above my chart. She asks if she can go over my medical history.

I hate her. An irrational disdain for her timid questions. Her inability to fathom what it feels like to be sitting on my side of the table. My lip curls into a sneer. My answers are curt monosyllables. Then, swallowing hard, I force a smile as I ask her about medical school. We make awkward conversation while we wait. I hate myself for hating her.

The clock ticks behind me, a trumpeter announcing the march of time. Reminding me of a day 15 years ago when a genetics counsellor told me about my BRCA1 gene mutation. Alluded to the future removal of my breasts and ovaries to reduce my risks of dying of cancer. The doctor strides in. Shakes my hand, scans my file and lifts her head with a warm and easy smile. The conversation begins. Options scrawled on a white piece of paper. Risks of Surgery. Potential side-effects. A stack of forms bound with a massive paper clip materializes.  My hand reaches for the pen long before my heart catches up to what has happened.

After it’s over, the elevators doors close behind me and I descend into the bowels of the parkade. Numbness makes way for anger, fear, and frustration.

“I’m not ready.” I long to scream into the echo of the cement pillars as I get in and slam my hand against the steering wheel. Emotions from five years ago bubble to the surface. Feelings I thought I had long since put to rest. Like a jumbled game of pick-up-sticks, I can’t separate the old sadness from the fresh grief of my cousin Donna’s passing from the rage at the DNA mutation. This cellular deformity that has the doctor advising me to carve out both my chance at carrying a child as well as my risk of disease or even death. To her, it’s simple. She wants to protect me. To make sure I’m clean of cancer cells. To prolong my life. To me, it is anything but simple.

With trembling hands, I turn the ignition and wind from the depths of the building out onto the street. Determined to rise through the layers of fear and back to the present moment, I scramble for something to feel grateful for. An image of Cape Town flashes through my mind. Cape Town. It pulled me through the dark days post-treatment. Reminded me of what is still possible. I think of our program launching in November and for the moment my breathing steadies.

For the next week, a kaleidoscope of emotions prevails. Peace during a heart thundering hike amidst towering timbers. Excitement after a phone call with news that could make all of our A Fresh Chapter dreams even more audacious. Sadness melding into uproarious laughter on a Vancouver patio with a friend who knew the 23 year old version of me and who continues to love and appreciate every version in between.

How do grief and joy, love and hate, fear and opportunity all coexist like this? How do we keep moving in the face of impossible decisions? How do we stay present and trust ourselves to make the right choices? How do we seek happiness while making peace with the darkness life brings?

Perhaps Rachel Naomi Remen said it best in this passage about joy in her book “Kitchen Table Wisdom”.

I have learned a new definition of the word “joy.” I had thought joy to be rather synonymous with happiness, but it now seems to be far less vulnerable than happiness. Joy seems to be a part of an unconditional wish to live, not holding back because life may not meet our preferences or expectations. Joy seems to be a function of the willingness to accept the whole, and to show up and meet with whatever is there. It has a kind of invincibility that attachment to any particular outcome would deny us. Rather than a warrior who fights toward a specific outcome and therefore is haunted by the specter of failure and disappointment, it is the lover drunk with the opportunity to love despite the possibility of loss, the player for whom playing has become more important than winning or losing.

The willingness to win or lose moves us out of an adversarial relationship to life and into a powerful kind of openness. From such a position, we can make a greater commitment to life. Not only pleasant life, or comfortable life, or our idea of life, but all life. Joy seems more closely related to aliveness than happiness.

The strength that I notice developing in many of my patients and in myself after all these years could almost be called a form of curiosity. What one of my colleagues calls fearlessness. At one level, of course, I fear outcome as much as anyone. But more and more I am able to move in and out of that and to experience a place beyond preference for outcome, a life beyond life and death. It is a place of freedom, even anticipation. Decisions made from this perspective are life-affirming and not fear-driven. It is a grace.”

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