Coffee heat rising

$tunned

Totally whipped this evening: busy day.

The list, partly left over from yesterday:

• Post Office: Mail checks to subcontractor, vet
• Apple Store: What’s with the iPad?Pool Dude: figure out his pay…2 days off
• Call Mayo: $2,935????
• Landscape Dude: Install anti-puppy pool fencing
• Clean bedroom closet; get rid of old shoes
• Cope with classes
• And so on, and so forth…

Yeah. That’s twenty-nine hundred and thirty-five dollah that, says the Mayo, “You are personally responsible for…”

Yeah?

Since this little horror show began, I have called the Mayo’s billing department four times — make that five, counting today’s. Every time I call over there and ask for an estimate of how much I’m going to owe, after all is said and done. They sent me an itemized statement, just for the first surgery, totaling $13,000, but I was assured that Medicare and Medigap would cover virtually all of it except 15% of the surgeon’s fee.

Every time I call over there, I get a different story. Evidently, the truth is they simply do not know.

So today I call Billing and complain that I haven’t heard a straight answer since this started, that I can’t afford another three grand for the second surgery, and that if I have to pay for yet another repeat performance, the tab is going to come to around $10,000. She suggests I call Medicare and ask them what they cover. Then I could call my Medigap insurer and ask them what they cover. And I could go through the three-inch-deep pile of paper in my file drawer and compare the checks Medicare has issued with the charges it has approved.

To date, Medicare has approved every charge that I have been informed of: to my knowledge Medicare has rejected nothing. So why, pray tell, the $2,395 bill? And does she even vaguely grasp what is involved in trying to get through to a Medicare bureaucrat? Or in what is involved in trying to translate what such a creature utters into something comprehensible that applies to real life? Has she ever talked to an insurance company factotum?

Frustrated, I dropped it and, if not forgot it at last tried to forget it.

Ran around the city. Persuaded an Apple employee to unjam the iPad. Inspected Apple MacBook Airs as potential substitute for rather useless (for my purposes) iPad. After listening to the usual unending pitch, did a little Web research. Learned the 13-inch Retina MacBook Pro may beat the 13-inch MacBook Air. Suspect 13 inches is going to be unnervingly small after all these years of 15 inches.

Fight traffic fight traffic fight traffic fight traffic drop off mail at USPS fight traffic fight traffic fight traffic

FLY IN THE DOOR FREAKING STARVED and the phone rings from the Mayo: nurse asking how I’m feeling. I’m about to explain exactly how I feel about being called by a nurse and told that my surgeon wants to see me right away but by the way she’s on vacation, out of town when the dogs go freaking BERSERK: Richard and underling here two hours ahead of schedule.

Fight crazy puppy fight crazy puppy fight crazy puppy see that Richard has brought black fencing not the off-white I asked for grab a bite to eat scarf down food try to calm crazy puppy look out and see Richard & his guy have moved the august and venerable potted ficus tree out from under the patio overhang and parked it in the scorching hot sun (108 degrees by then).

So outside, socialize with Richard and workdude socialize socialize get a frost cloth throw it over the ficus hope to god the thing isn’t fried do you KNOW how many years it’s taken to for that tree to reach its present stately size?

Make three mosquito traps, experimental. More about which later, if I live that long.

Shovel out closet. End up with large trash bag filled with worn shoes; set aside to schlep to Goodwill.

Answer student emails. Answer endless telephone calls.

Richard and underling finish building fence and gate. Arrange for Richard to build a replacement for decrepit back gate. Shovel Richard and underling out the door. Get mail as the men drive off into the distance.

Pick up envelopes from mailbox. One is from Medicare. Throw all the other envelopes into the recycling bin.

Open Medicare envelope. Find check: $1100.42.

Dayum!

Welp, it’s not good, but it’s sure better than a hit on the head. It cuts the amount the Mayo is trying to extract from $2935 to $1835. That’s a lot better than $2900 x 3 + x + y + z.

$1835 x 3 operations + ($280 doc fee not covered by Medicare x 3) = $6345
$2935 x 3 + ($280 x 3) = $9645

Not good at all. But it could be worse. $6350 is bad, but not quite as bad as almost 10 grand. And more funds may come forth from the Medigap insurer.

I do intend to ask if the Mayo will reduce or comp the cost of whatever Dr. P proposes to do next, whenever she drifts back into town. But unless the proposal is made by a lawyer, I kind of doubt that one will get very far.

A Voice of Reason

Yesterday the boob cancer flap flared up again! And I got REALLY exercised this time.

The surgeon’s nurse called to report the new pathologist’s report. In short, once again the surgeon “didn’t get it all,” to use the old-fashioned terminology. Surgeon wants to see me again, ASAP.

Then she informed me that said surgeon has left town. The soonest I can get in to see her is next Wednesday! And again, I’ll have to trudge through godawful rush-hour traffic to the Mayo Clinic’s offices halfway to freaking Payson, endure another stress-making talk with the doctor, and watch this whole mess go from bad to worse.

Damn!

So I got pretty upset. When this woman called, I was flaked out on the bed with ice packs on my boob, and believe me, I do NOT want to go through this again!

In discussing the path report, she said that the pathologist noted that the tumor has “spread throughout the breast.” I said, “Well, then you’re saying it’s NOT a DCIS, but that it’s metastasized throughout the breast?”

She now says “We don’t use that word.” (Yeah: your doctor doesn’t call it “cancer” — she keeps saying it’s a “precancer” — but you and all your nursing colleagues and every underling who gets on the phone or ushers me up a hallway call it “cancer,” a fact that does little to engender confidence!) and that it IS a DCIS.

Uh huh. Well, to my mind a tumor that has “spread throughout the breast” is not something one would characterize as “in situ.”

This is beginning to spell “complete mastectomy” to me. And now I’m starting to freak totally out.

By mid-morning I was just beside myself. So I called Young Dr. Kildare’s office, just because the man has the deepest fund of common sense of any man I’ve ever met and I wanted a sane shoulder to cry on. He agreed to see me in the early afternoon.

My son wastes his lunch hour, poor guy, to come over and try to calm me down, but he succeeds only in making me feel he’s speaking to me as though I were a ten-year-old, which gets me even more upset. Can’t blame him: I used to do the same thing to my mother when we all thought she was a hypochondriac. That was, yea verily, while her innards were merrily filling up with columnar tumors.

On the way out the door to YDK’s office, I printed out a 2010 article summarizing and commenting on research suggesting that DCIS lesions known to be “indolent” (i.e., slow-growing or possibly not growing at all, as mine is) should a) no longer be designated “carcinomas” at all and b) should be left alone, in favor of a “watch and wait” approach.

2010, mind you. This isn’t exactly breaking news.

He was startled to see it — he said he’d never heard about it. Well, YDK is a kind of GP — basically a door-keeper who tries to guess whether patients need specialized care and who refers or doesn’t refer based on his somewhat educated opinion. He’s certainly not an oncological specialist…on the other hand, this controversy hit the news in 2010; I get my news almost exclusively from Google and The New York Times, and even I had heard about it back then. So it was sorta surprising. Anyway, he said he would read the article and look up the actual science, so that was nice.

By the time I got to his place, the Mayo had faxed the pathologist’s report over to him. So he sat down and translated it, as follows:

The new excision showed the carcinoma coming right up to the inked margins, meaning she did not remove enough papilloma-free tissue to leave any margin of normal flesh. The term “metastasize” is used only to designate cancer that has spread outside of the organ where it originated. If it has not left the organ, it is not said to have metastasized. Where the pathologist says “spread throughout the breast,” YDK believes he means the tumor has grown large enough to fill most of the breast. The good news, though, is that there still is no sign of any invasive cancer.

Well, of course, this raises as many questions as it answers. For example, if the tumor is that large, why would that not have been visible on the umpty-umpteen mammograms and sonograms I’ve been subjected to? If it’s that large, why would it not be visible to the surgeon’s naked eye? And how many more of these time-sucking, stress-inducing, hair-pulling, life-disrupting, painful surgeries am I going to have to endure????? More to the point, are we looking at a complete mastectomy here? And of course, that’s all before we bring up the question of why, if as early as 2010 experts felt it was safe to simply leave a low-grade, indolent item in place and watch it, why we’re doing all this in the first place?

Arrrrrrrgghhhhhhhhhhhhhhh!

Well, he said that no matter what, at this point the best thing to do is to get the abnormal cells OUT, since what’s begun is begun and it would be unwise to leave the job unfinished. He did think a full mastectomy is entirely possible, but, said he, so what? Better to be rid of the boob than to keep cells that may or may not turn into invasive cancer. It will not, he observed, be the end of the world. He said he believes this is the best approach because, given my overall health, it’s likely I’ll live at least to 85 or 90. Since I’m just pushing 70 now, that means that even a very slow-growing entity could cause some very serious problems or death before a heart attack, stroke, or other issue carries me off.

Then he said, “Look, what you really want to know is how to bring a stop to the repeated surgeries, right?”

Yup, yup!

“So here’s what you’re gonna do, and you’re gonna use these words: When you see her, say to her ‘If we are going to do another surgery, I want that to be the last one. What can we do to make that happen?'” That, he believed, would elicit an effective response.

At any rate, a half-hour or forty minutes with YDK calmed me down some. But I am still not a happy camper!

Another Country Heard From…

And to complicate matters, SDXB’s daughter, an RN who has been a military nurse for decades, e-mailed her advice from Germany:

There is no excuse for a doctor not to get a mass and have the margins clearly defined on the first go, let alone the second try.  Did he pick any nodes to determine if the cancer has spread to the lymphatic system?  Did he determine the cancer type?  Did he grade the cancer?  If she doesn’t know the answers to these questions then she is not informed.  Also, Every time he is there fucking around and cutting on her he is stirring up the cancer and increasing the chance he is going to spread it. It takes one seed to get into her blood stream through her lymphatic system to become metastatic cancer,   Fire his ass and get her PCM to write a referral to MD Anderson.  You have a great MD Anderson in Phoenix.  This is a no brainer.  Why would you go to McDonalds if you want French food.  Yes, they serve French Fries, but they aren’t French.  This guy may call himself an Oncologist, but he sure isn’t acting like one.  I am surprised they haven’t removed both breasts.  Seriously.  With her family history…as her friend I would be encouraging her to get someone better. .  See list below:

We know that it’s an encapsulated papillary carcinoma, DCIS. So far, no evidence of invasive cancer has appeared in any of the path studies. When we believed we were looking at two lesions, the surgeon assigned a grade of 0. After excision revealed that it was really one entity, it was upgraded; because it’s still noninvasive, we’re at grade 1. Because EPCs are extremely indolent, it was decided that sentinal node biopsy is unnecessary, and so no; no nodes have been removed & biopsied. I’ve thought about MD Anderson…on the other hand, the Mayo isn’t exactly McDonald’s. 😀  I have no family history of breast cancer, ovarian cancer, colon cancer, or BRCA mutation; my mother died of what apparently was a gastric cancer, probably related to her 6-pack-a-day smoking habit. There’s no indication of any neoplasms in the other breast, and the chance that a another papillary carcinoma will arise in that one is set at .3%. In the first one, though…hmmmm…

1.  Get all medical records copied and sent to MD Anderson.  Their fax number is online. (Just call each doctors office and give them MD Anderson’s fax number). Give them a suspense date of 3 working days. Stay on their ass and make sure they comply.

2. She needs the hard copies or discs of all X-rays, mammos, ultrasounds, and labs done on her breast.  Gather them together…again giving each place a suspense of 3 days and hand carry or overnight them.  Some offices will do this for you.  Stay on them and make sure they comply.

3.  Have primary doctor write a referral to MD Anderson and fax it over to them.  This has to happen before they will see her so definitely push this to the max.  Be concerned if her doctor says..”.I just don’t think we are there yet.”  That just means you have probably saved your friends life.  He doesn’t know what he is doing.  Tell him you just want a second opinion.  Lie.  Just get the referral.

4.  On line there is a self referral form…the patient fills it out.  You explain what is going on…the basic history of her disease.  Your family history and past medical history. They will want to know pawn at her doctor has done up to this point and why she wants to go to MD Anderson.

After all this is done, the whole team at MD Anderson will review the chart, tests and her letter and determine if they can help her.  I got Joe Senior to go for his prostate cancer.  He was amazed at the treatment he received.  Here is the wonderful thing about MD Anderson…you don’t lose control of what is happening.  You are part of the team deciding how things are going to go.  You have the best doctors finding out the best plan of treatment, nurses finding out the best diet to support you through treatment, pain specialist to ensure your quality of life is not affected by the drugs, and a pharmacist reviewing all treatment to ensure that no medication interactions happen and chemo doses are correct, and psychiatrists to ensure that depression doesn’t kick in and your outlook is positive.  But, you have the final say in all treatments.  There is no judgement.  And, for once in a lifetime, you will be treated like a person in a doctors office.

Get her into MD Anderson now.  Seriously.

To coin a phrase: Holy shit!

Bizarre Day on Wisteria Lane…

Yesterday was bizarre. That’s about the only word for it. I swear, we no longer live in a Monty Python Show. We seem to have moved to Desperate Housewives’ Wisteria Lane.

I’m racing around trying to get out the door to meet my friend and business partner in Tempe for lunch at the fancy restaurant we favor, there to celebrate her birthday. The doorbell rings. The dogs go batsh!t.

It’s my neighbor cattycorner across the street. She’s sold her house and is moving out, apparently having fallen on hard times. The sale closes on Friday, the 29th.

As it develops, she has not found another place to live. She had arranged, she says, to stay with a friend who was going to put her up for a month while she looks for a new place. But said friend went on vacation to Puerto Rico and just returned to the states — with a Boy Toy in tow! This guy is moving in with the woman, and now Neighbor is dis-invited to stay there. Would I do her a favor and let her move in here? Otherwise she doesn’t know what she’s going to do.

Holy sh!t.

A month or two ago, when the house sold (it was underpriced by about $30,000 and so got snapped up instantly), while the three neighbor ladies on this end of the block were out in front yakking, she mentioned that she hadn’t even looked for a place, and I said, jokingly, that if push came to shove she could move in here.

That was before I had the last surgery and long before I was told I have to have MORE surgery tomorrow.

Caught point-blank and face-to-face, I didn’t see how I could say anything else than “uhhh….ohh-kayyy….” The puppy is squirreling around. I pick her up and put her in her X-pen to get her out of the way.  Now suddenly Neighbor is planning where she’s going to put her bed (meaning I have to move furniture out of one of the rooms) and talking me into letting her put her refrigerator in my garage (do you know how much a fridge running in a 110-degree garage will run up a power bill?!?) and saying words like “one to three months” and going on about how she’ll start looking for a place to stay after she gets her money from the sale (while I’m thinking…don’t you get your money on closing day? the kids aren’t moving in for a month because they want to do a bunch of renovations…can’t you ask if you can rent the place for a week or two while you look for an apartment?)

She wants to start moving in on Thursday. That’s the day after tomorrow: when I’ll be recuperating from surgery!

This conversation goes on until I say I have to leave because I have to drive to the far side of town. Neighbor is shoveled out the door.

Now I’m running late. I fly around the house trying to finish getting dressed and write a check for the  editorial work my friend has done, which I intend to pay her for over lunch, and get ready to shoot out the door. Last task is to stick the puppy in her crate so she can’t defile the floor. And…and she’s GONE!

I call and call, search and search, and I can’t find her. I figure she slipped out the door when Neighbor left. So next thing I’m out in the street screaming like a fishwife for Ruby. Neighbor comes over; they look around. Finally she explores the house and finds Ruby in her X-pen, where of course I’ve  forgotten that I stashed her. This is what happens when old ladies get distracted by unexpected and potentially hassle-laden new developments when their lives are already disrupted by repeated cancer surgeries.

I thank Neighbor, pick up Ruby, and shovel Neighbor out the door. Ruby, squirming in a frantic effort to get out the door, too, hooks a hind claw in my shirt — my favorite shirt — and tears a hole in it.

Shit.

Lock up the dog. Change my clothes, fly out the door. Meet my friend.

Have an amazing meal, as usual, at Tricks. Then we go over to The Shoe Mill, the single best shoe store in the Valley, where I need to buy a couple of pairs of the expensive Europoean shoes that don’t hurt my feet. There I buy two pairs of Naot sandals, all my sandals having simply worn out, and we each buy a pair of Pikadillos, actual shoes of the sort grown-ups wear. None of these are cheap: my tab is almost $600.

Well, I figure since I buy good shoes about once every four years, that works out to $150/year, so I don’t feel too bad about it. And I wear those kinds of sandals almost every day, since I live in jeans. One pair is a little dressy-looking and will be perfect for church (we’re required to wear black shoes to process), and another is an amazingly cute and astonishingly comfortable platform.

But meanwhile, as time has passed and discussion has been had, the whole idea of Neighbor moving into my house at all, to say nothing of one day after I get my boob cut open again, sounds worse and worse. I didn’t like the idea much at the outset but now I’m getting worried. I’ve lived alone for 20 years, and I like it that way! If I wanted someone living with me, I’d have someone living with me. Notice that I live with dogs: they can’t kipe my food, they don’t talk back, they don’t leave their makeup on the bathroom counter, and they don’t want to watch mindless television into the middle of the night.

I discuss this with Wonder Accountant, also a Wisteria Lane resident and friend/acquaintance of Neighbor. She suggests a written agreement and points out a number of pitfalls, not the least of which is “what are you going to do if she doesn’t want to move out after three months?” I want her out after one month, not three months.

Discuss with Insurance Broker to see if taking rent money from this woman will affect my homeowner’s insurance. He says not but is concerned about liability if one of the dogs bites her. He suggests I require her to take out renter’s insurance, about $15 a month. He asks what I’m going to do if she doesn’t want to move out after three months…

Discuss with Realtor Pal, to see if he can help find her a place to rent — he says the rental market, especially in the “reasonable rent” category, is impossibly tight right now and it could be difficult to find her a place to live. Because she’s getting so little from the house sale, it’s not going to be easy to get her into a condo or patio home, either:  she underpiced to begin with and then she agreed to give huge allowances to rereoof the place ($10,000) and do the pool repairs and apparently some other things, and then she discovered the house had a $45,000 lien against it to cover the care of her crazed father, Carlos the Knife, as he descended into his final dotage. He says that she should get her money on Friday when the deal closes and in fact if she asks they should cut her a check on the spot. By the way, Realtor Pal asks, what am I going to do if she doesn’t want to move out after three months?

Now I’m feeling behind the barrel.

Phone rings: it’s my son, wanting to see how I am and, while he’s standing in line at a deli to buy his dinner, to lay plans for the next Surgery Day. I explain what’s going on. He says, “I’ll be right over.”

He arrives, riding his white charger.

This man is an automobile insurance adjustor. His job is to spend the whole damn day, every day, listening to people’s sad stories, fielding their demands for compensation, and telling them “no.”  He pours a bourbon and water. I tell him the story with all its convolutions.

He says, “You stay here. I’ll take care of this.”

Mounting his white charger and taking up his white lance, he gallops across the street and presents himself at Neighbor’s door. Drawing from deep wells of testosterone-fueled swagger (God, but men are amazing creatures!), he informs her that he has unilaterally decided that his mother is not taking on a roommate one day after she has breast surgery. He tempers this by claiming that I’m actually a great deal more fragile than I look, and says he has decided this is all a very bad idea.

She says no problem, she’s sure she can find someplace else to stay.

So. Thank God and my doughty son, I’m out from under that. What a flap!

Today, then, all I have to do is deal with the plumber, deal with the cleaning lady, deal with the new 102 class, deal with new copy sent by paying client, prepare for surgery, and call in to the hospital after 4 p.m. to find out when it’s scheduled. Doesn’t that all sound like jolly fun?

At least I won’t be moving furniture out of the spare room…

Rain! Actual RAIN!

Check out the photos at this news report — hope they stay online for a while, long enough for readers to get an eyeful. More entertainment appears here.

About ten after six this morning the dogs and I rolled out of the sack, late because it was so dark outside. A menacing gray-black mass of clouds filled the western sky, thunder rumbling all around us, and I thought it must be raining in Sun City. Twenty minutes later, le déluge! An amazing quantity of rain fell out of the sky!

The French well scheme I had the guys build on the north side of the patio doesn’t seem to have worked. Or maybe it did: maybe it kept water out of the house. Lake Patio came right up to the back doors.

As usual, click on the image for a larger, clearer version.
As usual, click on the image for a larger, clearer version.

Fortunately, the house is built on a slab that rises about four inches above grade, so an even more phenomenal amount of water would have to pour down to get into the house.

The sky cleared, and I hit the road to find out if the Leslie’s guy knows anything about pool alarms, by way of managing Ruby’s proclivity for tiptoeing around the edge. He didn’t. Then it was off to the Safeway to get Sergeant’s dog vitamins. They didn’t have them. Neither did Walgreen’s. So to Home Depot to see if I could find someone to discuss the use of their order-your-own fence sections. Not a soul, in the entire lumber and fencing section!

Geez.

By the time I got home, more banks of dark clouds were closing in. Started to rain briskly as I turned into the ’hood, delivering a free car wash before I turned into the garage. All that remained was to dry the car off with some microfiber rags!

Very nice.

Again a deluge fell. The water rose up to the door threshold again, then finally receded. It’s fairly clear in the west now, but dark and threatening to the east.

I felt lucky to get back to the house before it started to really rain hard. Also feel very lucky that I live in the central city and not out in the ’burbs or outlying semi-rural areas, where residents are having to be rescued from their homes.

It’s only 79 out there, so the air-conditioning is off — a whole day without an expensively powered machine trying to hold the interior 30 degrees below the ambient temperature will make for a nice little saving on this month’s electric bill! And I suppose I can turn the watering system off again.

Looks  like the excitement is about over, at least for now. And so, to work.

Slouching toward Bethlehem…

OLYMPUS DIGITAL CAMERA…or toward Armageddon. Or some such.

So today M’hijito drove me halfway across creation to a noon appointment at the Mayo, to get radioactive markers injected into my boob so the surgeon can find the two DCIS’s she wishes to extirpate. Other than being extremely time-consuming — it’s almost an hour’s drive one-way — it wasn’t too horrible. At every turn I find myself saying “It could be one hell of a lot worse.”

But it was annoying. First they do a mammogram. Then, guided by a sonogram, they stick these objects in you, through a needle — this requires a local anaesthetic, to which, fortunately, I seem not to react as most people do. I do not find the injection of Lidocaine to be especially painful; apparently most people do. Then they drag you back into the mammogram room and X-ray your boob again.

It is essentially painless. And actually, it’s quite interesting. The technology and the skill of the operators are just amazing.

There’s something a little unnerving, though, when you realize the eminently professional (and very beautiful…oh, to be the Mother of My Grandchildren!) radiologist is probably younger than your son. This extraordinary young woman is in her fifth post-graduate (i.e., post MD) year and is a wonder of confidence and ability.

The annoying part coalesced when the second mammogram showed that the damn seed had gone into the wrong place.

So they had to do the whole unnerving procedure OVER AGAIN!!!!!

Ugh. More time consumed, more trapped-in-the-doctor’s-office claustrophobia, more leave-me-alone stress. Oh well.

It was around three, I think, by the time we got back to the house. We’d left at 11 a.m. So that was four hours of time consumed.

Tomorrow, the actual surgery. We have no idea how long it’s likely to take.

A friend of mine, who also had a lumpectomy only, said as she recalled they were at the hospital about four hours. However, hers was done so long ago that they were still sticking guide wires into your boob, instead of these little glow-in-the-dark markers. That meant the equivalent prep work had to be done on the day of the surgery.

So…with that already done today, presumably an hour or so could be cut from the time my friend reports.

It seems like every step along the way since that first “routine” mammogram at St. Joe’s — the one made after my gynecologist said everything was OK in there — every single step has gone wrong in some manner. So I have to say, I don’t feel at all comfortable about tomorrow’s adventure. The everything goes haywire effect has erased any confidence I might have had in anything anyone — even the redoubtable Dr. Paczgai — has to say about the thing.

She claims it’s fairly harmless at this stage, no need for radiation or chemotherapy. Right. I’ll believe it when I see it.

M’hijito reminded me this afternoon that Dr. P said it is not yet cancer: that it’s a pre-cancer that should be removed lest it decide to develop further. And I try to keep that in mind.

But damn. Every which way I turn, someone else is calling it cancer. The radiologists called it cancer today. The hospital staff call it cancer. When you hear that word thrown at you from every direction, it’s a little hard to regard it as anything other than a cancer.

And when every step has been an ankle-twister, it’s a little hard to keep the faith that tomorrow’s surgery will go the way you’d like.

Image: Ductal carcinoma in situ. Wikipedia. Gnu Free Documentation License.

Coping

Two really interesting posts went up last week, on two very different sites. I think they relate to each other, in that they address issues of coping with the various personal demons that beset us. One post was another of Donna Freedman’s amazing reflections, quite a complex and sophisticated train of thought about accepting responsibility for, placing blame for, and coping with difficult circumstances in your life. The other, a peppery extravaganza at Penelope Trunk’s site, at first felt so off the wall (ah, she’ll know how old I am from that!) that I thought it was a put-on, but then on reading all the way through realized that it’s a deeply felt cri de coeur that comes at many of the matters Donna speaks of, but from a different direction.

Donna, contemplating the difficult passages in her life, suggests that a key part of dealing with one’s own mistakes and with the pain that we did not, after all, bring on ourselves is to recognize what parts of our actions and reactions are really our responsibility and which are not, and then move on from there. This is easier said than done, as anyone who’s lived more than about twenty years recognizes. She observes that many of those “I can’t believe this is happening” moments are consequences of choices we make. We need to acknowledge those choices, examine them closely enough to understand why we make them, and decide what to do about it.

Penelope, in an extended riff on the angst of aging, considers the art of self-acceptance. She passes, entertainingly, through several strategies and finally lands on the idea that one must accept one’s shortcomings, “one narrow arena at a time.”

We’re born, we live, we get old (if we’re lucky), we die, and along the way a helluva lot of stuff happens. Some of it is stuff the strongest person on earth would have a difficult time coping with…and none of us is the strongest person on earth. So how do we cope? As Donna puts it,

How do you accept responsibility or place blame for the less-than-optimal situations in your life? If the conditions are truly out of your control — illness, unpaid child support — then how have you coped and what advice can you offer others?

Well, first off, in the “acceptance” department, I do think you can save your hide by trying to come to a clear-eyed understanding of what is and is not someone else’s doing. My natural inclination is to blame everyone else for everything, and from there to conclude that they have somehow — directly or indirectly — “made” me do things that were not in my interest, that made me miserable, or that were out-and-out disastrous mistakes. Although it’s true there are some things we can’t help, it’s also true that most of the time no one can make us do anything.

Case in point: I stayed with SDXB for years after realizing that the relationship was toxic, that it had done irreparable harm to my life and my son’s, and that I needed to end it. Why? It’s hard to say. Probably the main reason was fear: I had noplace to jump and did not know whether I could get by alone. Nor did I believe I could. Secondarily, I was brought up to be compliant — oddly, considering what a bold bitch I am, I’m seriously submissive. If a person who appears to be in authority (for real or psychological reasons) says to do X, Y, or Z, as often as not I will do X, Y, or Z without talking back and without considering whether I really have to.

My son was in high school when we decided to take him and two of his buddies on a hike up Mt. Rainier. SDXB had said we would camp overnight at a site that overlooked a glacier, and so we started up the mountain assuming that’s what we would do.

It turned out the way was a lot longer than he remembered. We walked and walked and walked and walked and walked — uphill — and still did not come to the campground where he’d stayed on a previous visit. We passed people coming down who were clearly experienced hikers, who remarked on the difficulty of the hike.

Finally, late in the afternoon, we came to the campground. And that was when he told us he had failed to get us a permit  at this place!

Holy sh!t.

So nothing would do but we had to continue on to our next day’s destination, where we could camp. It was late in the day, we were all tired — the boys and I were very tired — and he now announced we would have to do a hike we had planned to do the following day.

We continued uphill. My son was having trouble, and he began to fall behind. When I slowed down to pace my son, SDXB, who had decided HE “had to get these people there,” as though he was totally in charge of what everyone was doing, demanded that I stay with him. Feeling browbeaten, I complied.

My son fell further and further back, and soon he was gone. As in completely out of our sight and hearing, alone on the side of Mt. Rainier as night was falling.

It was dark when we got to the lake. We pitched the tents, and then SDXB turned around and went back down the trail in search of my son. He had no idea where the boy was — the kid could have turned around and gone back down the mountain, he could have wandered off the trail and become lost, he could have fallen.

Eventually, they did show up. I was too tired to be furious then, but there was nothing I could do at the time, anyway.

During the night, it rained. A lot. As in a downpour. In the dark, we had set up the boys’ tent in a low spot. Water seeped through the bottom, and by morning, everything they had — all their clothes, all their gear — was soaking wet.

SDXB proposed to go fishing.

I announced that we were going back — he could stay there if he wanted, but the boys and I were going back down, and if I had to hire a cab to drive us back to Seattle, that is what we would do. Angrily, he conceded.

Now we march downhill at a breakneck pace, far faster than we should be going over some parts of the trail, which had loose scree over various stretches. I say we’re going too fast, but nothing will do but what we have to keep up with our fearless leader.

Not surprisingly, my son slips on the rocks and falls, hard, on his back. He was using a frame backpack, and, to give you an idea of what happened, the metal frame broke from the impact.

Fortunately, he didn’t break any bones. But it was a scary moment.

Things went downhill from there, literally and figuratively. I won’t go into the ensuing fiascos, except to say that during the trip I made up my mind that the relationship was over. At one specific point, I decided that as soon as we got back to Phoenix, I was going to throw SDXB out of my house and have nothing more to do with him.

And here’s where things get even more bizarre: I didn’t.

Some time later, I told this story to a friend of mine, a tough little broad who made her way through life by main force and steely guile, and in describing the events I said, “SDXB made me leave my son behind.”

“No, he didn’t,” she said. “No one can make you do anything. You choose to do things.”

Yeah. Well, it was several more years before I chose to eject SDXB from my home and my life. Even then, he’s still in the offing — not as an item, at least.

It took that long for me to come to terms with the fact that to take anything resembling control of our lives, we have to recognize what we can do, what we will do, what we can’t do, and what we won’t do, and to take responsibility for each of those four things.

Of course, in reality we have no control over our lives. Life is a series of random events, some of which we put into motion and some of which we have nothing to do with. But we can create an illusion of control, if temporarily, by recognizing and, as Donna says, by taking responsibility for what we can do and can’t do, what we will do and won’t do.

Once you become conscious of those parameters — what will you do, what will you refuse to do, what can you do, what is beyond your control — it becomes possible to devise strategies to cope with the problems that arise in life, whether those problems result from your own decisions or whether they’re inflicted on you from without. Over time, I’ve developed a rough outline that I apply when things are headed south:

1. Define the problem. Figure out what really is going on and try to understand it fully.

2. If it’s an extremely stressful or emotional situation, sit down in a quiet place and think through what parts of the problem really matter and what parts don’t matter or are minor enough to be deferred. Most problems have several aspects. Figure out what parts of the predicament you can do something about, and what parts you can’t or won’t do anything about. Then, let go of the things that don’t much matter or that you can’t affect, and address only those matters that you can change.

3. Make a plan.

If something is bearing down on you — the upcoming cancer surgery, for example — prepare, to the extent that you can, so as to minimize grief and extraneous hassles. When I learned the Great Desert University was going to close our office and lay off me and all five of my staff, I took on a side job to pay off all debt, began applying for new full-time work, figured out how to maintain my health coverage, and came to the (difficult!) decision that I would start drawing Social Security early.

If you’re blindsided by unexpected events, as soon as you stop rolling think through what to do first, and then plan out the steps you’ll  take right away and in the near future to recoup.

4. Set a goal (or goals) and make your plan part of a strategy to deal with the problem’s repercussions. Write these things down in the form of a to-do list or a broad strategic plan.

5. Follow through.

These steps apply to many of life’s most troubling problems: money and debt, unruly kids, abusive relationships, unhappy jobs, dieting, bad habits and addictions, all but the most crippling illnesses…you name it.

There’s another aspect to this coping business, one that comes to mind as I reflect on Penelope’s essay. I suppose it has to do with what we choose to do and choose not to do:

We can choose not to buy into the miasma of senseless behavior and thinking our culture lays on us. There’s a lot of that, in any society.

In the West, for example — particularly in the United States — we obsess about youth to the extent that we fear and loathe the simple, unavoidable fact of maturing. We fear aging so much that we loathe the elderly, and we loathe ourselves as we progress through life toward age. Hence those expensive, painful, and time-wasting Botox injections.

As my mother used to say, just because the rest of the sheep jumped off the cliff doesn’t mean you have to.

Humans are given to much stupid stuff. And being social animals, we all want to keep up with the herd, no matter what inanity the herd engages. Sometimes when we do that, we make ourselves unhappy. Indeed, we harm ourselves. It takes us back to the questions of what we can and will do or not do. No one can make us buy into stupid stuff. We can choose to buy into it or not to buy into it.

When it comes to the age phobia, for example, I refuse to buy into it.

I do not dye my hair. I do not have toxins injected under my skin. I do not deny my age. I do not shrink from saying “now that I’m old…” It’s not a crime to reach old age. Au contraire: it’s an accomplishment. I embrace age and all the amazing insights and benefits that come with it. Because I can and I will.

You can refuse to buy into any number of stupid things: abuse, smoking, drinking, drugs, dead-end jobs, dead-end marriages, violent “entertainment,” hate, political correctness, fear, wacky dieting, lies promulgated by political parties, marketing campaigns, suburban living, whatever.

It’s your choice. Take responsibility for it.