Help for Healing

Bitter & Sweet, living daily with grief


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Taffy

Our girl

Taffy is our border collie mixed with I-don’t-know-what. We rescued her so we also aren’t sure how old she is. Our best guess is about 12. I know she has been our family member 10 years.

I remember we got her on a Saturday. Tim had a wallpapering job that day. He had been a “no” for 8 years or so. No dogs. Absolutely not. Then that particular Saturday, he said, “I suppose you should have a dog or else you might get a different husband.”

He was barely in his car when I grabbed seven-year-old Frankie and told him we had to strike when the iron was hot. At the animal rescue, there were 3 families that wanted her. We were the lucky ones.

Over the years, she also had to bond with our other furry friends.

Taffy, Herbie

In 2015, we acquired Herbie and Matilda. Herbie clearly has always thought Taffy was her best friend. Taffy just found him particularly annoying. Taffy would lay on the floor and Herbie would want to spoon. She figured out quickly that Taffy wasn’t a fan so she would lay slightly away from her. Then he would stretch over and over until she had crept next to him. In about 30 seconds Taffy would move and the process would start all over again. But one of their favorite things was to hang out at the door and bask in the sun.

Matilda, Herbie, Taffy

Besides not cuddling with Herbie, Taffy was also not a fan of playing games and would do her best to stop it.

Taffy

Anyhow, my next couple blogs will probably be about her as well so I hope you are a dog lover.

Why now? Ms. Taffy is on steroids. We are all too familiar with those in our family. She has a degenerative spine. It also appears that she may have a cancerous tumor on her spleen. (The tumor is not a maybe, the cancer is most likely.) Yesterday I found myself thinking that perhaps we are wrong because she seems like her old self. Then I caught myself. Remember what the vet said about our cat Oreo. Remember what Hospice said about Tim. Steroids only provide comfort. Don’t let yourself be fooled. Your loved one is dying.

We are all doing our best to enjoy her company every day. We spoil her every moment we can. She deserves it!

Taffy


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Re-read and Re-write

It’s been six years since Bitter and Sweet was published. I have some speaking engagements coming up so believe or not, I decided to read my own books. I can remember the really big things, but there are lots of details that I don’t recall anymore. It’s been an interesting process, to say the least.

True to my self-critical form, I have to admit I’m disappointed at times. First of all, I can’t believe some things were missed typing or grammatically speaking. They are small things, but geeze! It was edited and checked over and over and over. How did we still miss things?

There are things about the layout I don’t care for. Margins should have been bigger. I use the word “that” too often. Reviews said there were too many redundant guestbook entries. Boy, were they right.

Once in awhile, I do come across a statement or paragraph where I think, “Nicely done” or “Now that was pretty poignant/powerful.” I would really like to edit another edition, but it’s too daunting a task. First of all, my graphic artist no longer has the computer program to do it. Secondly, I think you need to purchase new ISBN numbers whenever you do another edition. That opens another whole can of worms.

Right now, I am in the middle of Bitter and Sweet. I just got to the chapter where we discovered Tim was not getting better and cancer had spread everywhere. I got lost in the story and couldn’t put it down. That sounds goofy, I know, but it was an odd emotional experience. In some ways, I felt detached and like I was reading it like any other person and I couldn’t stop myself from turning the page to find out what was next. On the other hand, I know how intricately I am attached to every word and I can’t believe we went through it.

It will be interesting to keep this going and then tackle the second book. I may not blog again about this, but if I do, I promise no spoiler alerts once I get to the ending!


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Genetics Update

Yesterday I posted on Facebook that I was sitting at Roswell and was unnerved and anxious. I was overwhelmed with the responses of support and curiosity that I got. Thanks to all of you! Let me back up and explain.

This whole world of genetics is new to me and it carries a whole lingo and mindset that needs to be learned. To understand how I even got involved with it, check out my blog from September 22 of this year called “Genetic Markers.” Initially there was a whirlwind of research to do and then there was a waiting period until this appointment came yesterday.

Whenever I go to Roswell, there is a slight PTSD type of reaction. It’s not that we had an awful experience there, it’s just having cancer is awful. The place triggers it all- just the sight of it, the smells, the atmosphere. It all comes back. Not rushing back, but it comes back nevertheless. I was waiting to register when a lovely woman brought a tea cart over. It is one of those little things they do there that makes a big difference. I find tea comforting.

I actually had to register Frankie as a patient because he is the one who is eligible for genetic testing. When you are a patient at Roswell, they make you a green, plastic card with your name and a patient number. You have to use it every time you go for an appointment or test. That became a major trigger for me. No amount of rationality helped me. By the time I was in the waiting room at the clinic, I was worried I might have a panic attack. That was when I posted on Facebook. Telling someone, even if it just posting in cyberspace, somehow seems to help me. Then all those amazing responses got me through.

Once I got in, it was actually quite great. Mary was warm and engaging. She was clearly prepared. She had all of the information I had sent in and had organized it and done her homework. She knew everyone’s names and has a brilliant, scientific mind. I told her at the end that I could follow her when I concentrated fully, but I don’t totally wrap around the concepts overall. My brain just doesn’t work that way. My strengths are in an entirely different area of the brain.

Anyhow, this is a lot of information but so many people expressed interest in it for their own families, I will tell you everything. Your situation won’t be the same of course, but I think you can get the basic ideas through my information. It is all quite fascinating (even though it makes my brain hurt!).

First step is to gather all information possible on both sides of the family. The paperwork was done around Frankie, but Mary wanted to redo it with Tim as the center. I don’t have very much information on Tim’s side of the family but I did what I could. Death certificates are very helpful because they usually have the cause of death. You can get copies if needed, but they do cost money. Just like in the mental health field, what you look for is patterns. Also, you look for other contributing factors. Was this person in the family a smoker? Did they have other related diseases (in Tim’s family it was diabetes)? One of the most curious ones was is there any Jewish ancestry anywhere?

I remembered while I was there that at one point I did a genogram (family tree) of Tim’s family to try to figure out who everyone was. I found it later and took photos of it to send to Mary. That required me going through the two memory boxes I have stored in my closet. I haven’t pulled them out in a while. I had forgotten some of the things I had put in there.

The majority of people who have cancer, have a “random” form of cancer and don’t need a genetic evaluation. One of the ways they determine that, is to look for a cluster of diseases and other such factors. There are some things Tim does not fit the criteria for, but he does hit three major points; 1- he was under the age of 50 when diagnosed 2- his form of cancer was rare 3- he had a family history of it (his dad’s cancer was also at a rare age). Those three things make it appropriate to ask the question, “Is there a possible genetic contribution”?

Now, of the people who fit the criteria to even ask the genetic question, only 20% of those get an answer to what they are looking for. Sigh.

With current technology/research, there are 50 genes that are known to have a cancer connection. Everyone has these genes. What they are looking for is an alteration of the gene of some sort. Because gallbladder cancer is so rare, there are no known genes that are directly linked at this time. There are however, two possibilities that could be correlated.

The more likely of the two is Lynch Syndrome (HNPCC). It should be “considered”, but gallbladder is less likely to be correlated than other types of cancer. For example, colon cancer has a 50-80% chance; uterine 60%, etc.; so the chances are much less likely but it should still be considered. Having said that, this type is adult onset, meaning there is no testing until age 18, and no screening until age 25 so Frankie is at no immediate risk. However, the older three kids are exactly at the ages where it could be relevant. There are five genes associated with this, and they are found by a blood test. If it is a no with the test for the five genes, that doesn’t necessarily mean the family doesn’t have Lynch Syndrome. It just means we are at the end of the limits of our current technology/research at this time. If Tim does have it, each child would a 50% chance of having it. It would also mean at least one of Tim’s parents had it. That would mean this information would be relevant to all of Tim’s sibling and their children as well. I’m sure I lost a lot of readers by now. It makes your brain tired, doesn’t it?

Even less likely, is the second possibility, the link to the BRCA1 and BRCA2 genes that have been studied. For women this usually plays out with breast and ovarian cancer; for men in breast and prostate cancer; or generally in melanoma or pancreatic cancer. This is hard to detect because Tim’s siblings were all male so no chance of the female occurrence. The same information is true for this as far as if he tests positive, each child has a 50% chance, etc… (Who wants to read all that again?)

One thing to remember in general with genetic testing, is that the risk is NEVER 100%.

One of the vast improvements in recent years, is that historically a separate test would be required for each of the genes in question. This was costly and time prohibitive. Now they do what is called panel testing, and there can be many tested all at the same time. This is cost and time efficient.

While technology/research is constantly advancing, that means what is tested today could be very different from what they would be able to test for in the next five years. For example, just two years ago there were only 40 genes, and now there are 50. Roswell cannot legally contact patients to let them know of new research. So they will encourage myself and any other patients to call in yearly to check on any new advances in a relevant field.

For Tim specifically, we have the option of testing his tumor. The hospital keeps samples seven years, and we are at six and a half. However, the current tumor technology is specifically geared toward treatment planning for those patients who are still alive. To test his tumor would cost about $4,000 and would not yield information that would be useful for our purposes.

The really great news, is that Tim signed up when he was a patient to allow his blood to be used for research at Roswell. I don’t remember that detail, but I am pleasantly surprised because he was not an organ donor. That concept kind of creeped him out. Mary contacted their research lab and found out that Tim’s blood has not been used for any research yet and I have the legal right to get it back!

The lawyer is looking into what legal document is necessary to prove my right to it, but I need something that shows I was married to him at the time of his death. While that sounds simple, so far that has proven to be more difficult than it should be. There are marriage certificates and divorce decrees, but no one has thought of a document to say, “Hey, this couple never got divorced.” Go figure. Anyhow, once that is all taken care of, Tim’s blood will be sent to Prevention Genetics in Wisconsin, which is a DNA bank. They will keep it until we know exactly what we want to test for. The cost is $149, a one-time fee.

Any testing though, will be an out-of-pocket expense. It’s one of those insurance rules that lacks common sense. It would be cheaper to do genetic testing and prevent cancer than pay for treatment for cancer if the person gets it. But, nope. (Just wondering why they cover birth control because it’s cheaper than paying for pregnancy. Same logic, isn’t it?) Mary is looking into how much blood is available and if there is enough for more than one round of testing. Once I know that, I will have to make a decision: test now, or wait several years until Frankie is older. The advantage of waiting is that by the time he is old enough, technology/research will most likely have advanced significantly. However, testing now would help the older kids. The question is, do the older kids plan to follow-up on the information now or not? Many people do NOT want to know the results of such testing. This is a conversation I will have to have with my older kids.

By the way, the current cost of panel testing is $1000 smackers. When the time comes, maybe I will try to set up one of those “gofundme” accounts. I have seen them for much less noble causes, so why not try? If not, I will certainly pay for it myself. Possibly saving one of my children’s lives would be worth much more than that. By the way, I will be asking Mary to read this to see if I slaughtered the information or did it justice. If I screwed anything up too bad, I will write corrections on next week’s blog.

Last night I had a tough time. I thought I was all good but after spending the evening alone, I laid in bed and felt all the tears well up. Looking through those memory boxes (ever so briefly!), thinking about cancer, talking about Tim so much, and worst of all imagining my children having to possibly deal with their own diagnosis someday caught up to me. Haven’t had a tough night like that in a while. But I got through and today is a new day. I hope this is helpful to some of you. I hope some of you found it interesting. And for those of you who were bored to tears, thanks for reading anyway :)!


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More on Genetic Markers

Thanks to all of you who did some research after last week’s blog. You guys rock! It wasn’t even an issue I had thought about asking for help with and yet you jumped in anyway.

At the end of last week, I was able to locate the woman I needed to speak with who had approached me at the conference. It was a combined effort with a couple of agencies, but I found her. I went to meet with her this week and came home with that same mixture of intense emotions – excitement and energy, mixed with a sick stomach all at the same time.

Truthfully, it’s a bit overwhelming. I don’t really have a scientific mind so it’s a bit out of my comfort zone just to wade through articles and learn new terms and jargon. And I have my moments where I just plain get angry and say out loud to no one, “I don’t WANT to talk and think about cancer anymore.” At least not when it’s personal like this.

I wasn’t expecting the first big piece of information. It is best to start with testing Tim’s tissues. They recommend a “tumor panel” vs. just looking for one thing or another. Unfortunately, the hospital did not suggest we do a DNA bank when Tim was a patient there. Supposedly, anyone under 50 that is terminally diagnosed is supposed to be flagged for this but we obviously were not. If we had been, Tim’s insurance at the time would have covered the expenses. Now I could be looking at a $4,000 bill. This is a good reason for me to blog because I’m sure most other people aren’t aware. IF YOU ARE UNDER 50 AND HAVE A TERMINAL DIAGNOSIS, REQUEST YOUR DNA BE STORED AND STUDIED. That should be standard procedure, but it is not.

Generally, hospitals and labs keep samples for seven years. It’s hard to believe, but it has been over six years already since Tim’s initial tests were done. That gives me less than a year to track it down, if it is even still available. I am starting that process this week as it is the first step to all of this.

Second step is family history. I will be researching some programs that can be distributed to Tim’s family with the help of his brother. People will be able to add information they have (you never know who has the scoop on how Aunt Gertrude died type of thing) and then the program spits out the results in an organized fashion. Tim’s brother has been very kind and willing to help with this. The results could be very important to his family as well.

After all of that, we start talking about “germline” testing with 1st, 2nd, and 3rd degree relatives. How effective that is will depend on the results of the first two steps. It will most likely be covered by health insurance because being related to Tim meets the criteria. From there, a positive or negative result will have a domino effect on what happens after that.

Phew.

I’m already exhausted and all I have done is take the information I have and map out a plan of action. Part of me is glad to have my brain stimulated with something new. Part of me is scared to death for my kids. It is bad enough to watch your spouse suffer. The only thing worse than that is to watch your kids suffer.

This totally makes sense to me though. It is very unfortunate there is little emphasis placed on this. I hadn’t even thought about it until now. I just looked at this doctor and said it so makes sense to try to cure cancer. But doesn’t it make even more to prevent it before it even happens? That look passed over her face. The look that said, “Welcome to my world. I think that exactly so why doesn’t the rest of the world? It just makes sense.”

Wish me luck. And energy. I need both 🙂


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Genetic Markers

Last Saturday I was part of a medical conference that was wildly successful. The focus was to start the conversation with doctors, nurses, medical staff, and social workers about starting the conversation with patients/clients regarding end of life planning. The resounding message by speaker after speaker is that our current model is sorely lacking and in particular NY is behind the rest of the country. Right now, the conversation doesn’t occur until you are already in a major crisis or actively dying. This is much, much too late.

Truthfully, the conversation belongs anywhere that people gather. It should start in the home. But the first step is to get medical professionals to be comfortable with the concept. And it is my very strong opinion that the main reason this isn’t already happening is that they aren’t comfortable with dying themselves. How can they help someone else navigate those waters? If docs get it though, they will start to get their patients to talk about it at home. Eventually.

Anyhow, I was part of a six person panel that spoke for about 10 minutes (each) and then fielded questions from the 180-person audience. The conference ended with five skits that showed most of the concepts we were trying to teach. Sometimes the docs in the skits did great, other times they missed the mark. The intent was to generate conversation with the audience and it seemed to do a great job. I was in the skits, but more importantly for me, I wrote them. This was a huge stretch for me professionally. My books and blogs are always about personal things that actually happened. I have never written before by creating scenarios/characters so I was terrified of the outcome. However, it seemed to be go over extremely well. Yay!

On one of the breaks, someone from Roswell (the cancer hospital here in Buffalo) approached me. Bottom line is that apparently they have recently discovered a genetic marker for gallbladder cancer. I was extremely busy preparing for the next section of the conference, but I tried to process the implications of what she was saying. I told her that was incredibly important because the hallmark of gallbladder cancer is there are no symptoms until stage IV when it is already too late to hope to treat it effectively. Of course she knew this. She said she hesitated to approach me, but knew from my lecture that I had kids. Could mean life or death for them.

Could mean life or death for them. That is really the bottom line. I have thought of this repeatedly since the weekend. I didn’t have anything to write the information down at the time, but she told me to google it. I attempted to, but the only articles I could find said there are no genetic markers. I have started looking for the proverbial needle in the haystack in my efforts to find this woman at Roswell. So far no luck but this is worth being my relentless self to find her.

So many, many questions. What if one of Tim’s kids have the marker? What would they do? Remove the gallbladder? Or just run tests every year? Does it ever skip a generation? If the kids don’t have it, should their kids be tested anyway? And would this be important information for Tim’s brothers too? Is there a particular age to utilize this information? I get a physical reaction whenever I start thinking about it. It’s a cross between literal illness from being reminded of the nightmare Tim went through and the utter terror of my kids or grandkids going through it someday, and excitement and anticipation at the possibility of being able to stop it. Thank God I wrote those books and started to lecture or I wouldn’t even know about this information. I think when they have a breakthrough, they should be required to seek out all former patients’ families and make them aware. That’s a pipe dream.

Wish me luck on this latest endeavor. I need to find this person and I need lots more information. And then I need to approach my kids. I talked to Colin and Frankie the minute I got home from the conference. Colin (age 32) just looked at me like I was insane. Frankie (age 14) told me he will never get cancer because he is immortal and will live forever. Later I thought of course this would be frightening for them to even think about, no matter how much they try to be cool on their exteriors.

Yes, wish me luck and say some prayers too!


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Medical Favorites: The Mammogram

It’s that time of year for me. The yearly ob/gyn appointment, which leads to the yearly mammogram. It’s a favorite day for women everywhere. A few years ago there was all this hype because they were recommending only getting them every two years. The biggest reason is that they just cause so much damn stress for women.

I went Monday and it started off the usual way. Pink top, open in front. Arms up. Smooshed breasts, etc. Nothing attractive. When you get a good tech it is not terribly painful. Very uncomfortable, but not actually painful. Then you go in the special waiting room with the other women in the pink tops. They bring you a carnation when they clear you to leave.

“Do you want the new 3D mammogram? It is $60 if your insurance won’t cover it.”

“No thanks. My insurance won’t cover it. I already know that.” That was my first mistake.

I watch several women get their flowers and leave. I always take a long time. I start the usual mental gymnastics of talking in my head. Don’t get nervous, that’s bad for you. You always wait and worry and you are always ok. It actually got explained to me this time, partly by the poster on the wall and partly by the tech. There are four levels of breast density, A through D. I am a level C. Dense breasts make for difficult readings.

That’s what the tech tells me when she pulls me out of the room to talk to me without bringing me a flower.

“Because you are a level C, your doctor now has a standing order for you for a follow-up ultrasound after your mammogram.”

“Ok. I know I’ve had them before.”

“You should know it costs $200 if your insurance won’t cover it.” Crap, they should’ve told me I was getting a bargain earlier with the 60 bucks.

“Ok. So will you call insurance before?”

“No. You have to call them. You can use this room.”

This is when I start to get infuriated. I go through this with my orthotics too. Since when is it the patient’s job to make medical calls? I happen to lecture in the medical field and know how to be a patient advocate, but the average person does not have that experience. And even with that under my belt, I still am lost with this one. My niece works in a medical office and she explained that there are thousands of insurance companies that all have different rules. I get it, but isn’t that why docs hire office staff?

So you know how this goes. On hold. On hold. Verify who you are a thousand times.

“I’m sorry, what is the technical term for the procedure?”

I ask the tech.

“Breast ultrasound.” She seems a little shocked by the question because it wasn’t a tricky answer.

On hold. On hold.

“I’m sorry, but we need to speak to a medical professional about this.”

“Gee, that’s what I suggested.”

I walk over to the tech and have to practically force her to take the phone. She gives the woman the medical code and hands me back the phone.

I feel like pickle in the middle and I think this entire scenario is ridiculous. I’m now on hold again and this time there are two confused techs standing in the doorway because they can’t believe I can’t get a straight answer from my insurance company. I can’t believe I’m the one trying to get the straight answer.

“Good news. Your insurance will cover the ultrasound, but only if your doctor has pre-authorized it.”

I repeat it to the two techs in the doorway like a parrot who look at each other and shrug their shoulders. They have never heard of such a thing. Is that the same thing as a standing order? Back and forth, back and forth.

Finally I have enough.

“I WANT TO GO HOME. CAN I PLEASE JUST GO HOME? I’VE HAD ENOUGH.” I am now crying at this point. The techs feel terrible and say of course I can go home. I hang up the phone and I go take off the hated pink shirt.

On my way out, the techs try to nicely tell me the test can be done anytime. I just need to straighten out the insurance thing and reschedule. I ask her if anything in the regular mammogram came back questionable. She said no. I told her I wasn’t straightening anything out through my tears. I tell her I’m not coming back. And because my depression level has been super bad for 24 hours before I ever walked in the door, I tell her I don’t even care if I have cancer.

(Now right now, I apologize deeply to my dear, dear brave friends who have survived breast cancer. Several of you amazing powerhouses read my blog, so please know I mean no disrespect. All I can say is that depression makes you think terrible thoughts. That day I was sure that a mistake had been made and I was the one who was supposed to have cancer and die instead of Tim. Frankie desperately needs his father. At the time, I meant it, but I know it’s depressed thinking. Forgive me?)

Sometimes I just shake my head and wonder what has happened to the world. When did it get all mixed up? Why the hell was I even on the phone trying to get medical codes? Aren’t I the patient? I got the flower because they didn’t find cancer, but I admit I came home and threw it out. I was just angry. And I spent almost two hours in that office.

The next day my doctor’s office called. I assumed they were going to talk to me about the debacle of the day before. Nope. Just wanted me to know my pap came back positive for HPV virus. She explained it’s something you can get the first time you ever have sex, it just doesn’t show up. Nothing to worry much about though, just make sure you come every year to your check ups so we can keep on eye on you.

I always go to my appointments but I ask her what they are keeping an eye on? Oh. Higher risk of cervical cancer.

Perfect. I figured that’s just the universe being pissed off at me for saying the day before that I didn’t care if I got cancer.

I love being a woman.


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Women

Admittedly, I am more of a glass half-empty person that I am a half-full. I think most people err on one side or the other. If you’ve ever been to one of my lectures, you know my philosophy is that the key to healthy living is to balance both truths.

I have a few half-full folks in my life. They enjoy my blogs and Facebook quotes that are more upbeat and positive. The thing is, I’m a professional writer whose specialty is the topic of death/dying and grief/loss. In my practice, my specialty is relationship counseling, but you can’t talk about any of that without a healthy amount of focus on grief/loss. So my half-full friends, you will just have to be patient with my emphasis on being in touch with the pain in people’s’ lives. It happens to be what I am good at.

Sometimes there is so much happening around me, it’s hard to decide what to write about. (As opposed to those weeks when my mind is blank.) Last week I wrote about some great men. This week I”m going to focus on a couple of women that I know that have amazing strength.

My readers are already familiar with Summer. She was a rock for me while Tim was dying. She is a pillar in her church family and the community she lives in. It makes it hard to be her BFF sometimes because often we only get brief moments to chat every so often. That’s the life of someone who so many people depend upon. The year 2016 has been fraught with challenges for Summer that I can’t even begin to enumerate. I mean it’s stuff that tops the stress chart scales. Day after day after day. The last week she has been working with the hospice team to help usher her 93-year-old father-in-law to his final home. It brings memories of Tim flooding back. Listening to her exhaustion from the roller coaster of that daunting task is about all I can offer her. Her “dad-in-law” is one lucky man to end his life with the dignity that Summer and her family are gifting him with.

The second woman who has recently touched me is Ray. She is only 33-years-old, but I think her soul is much older and wiser. She is one of my students. We still chuckle when we talk about how we first met. She was being a bit overly assertive and feisty along with some of her peers. Our first class together started with my own assertion of myself as the graduate college professor- i.e. I was the one who called the shots, not the students. We laugh because we all have grown to deeply respect each other (and very quickly!) that it’s hard to imagine we had a rocky start.

Ray is a cancer survivor. I don’t know what the details are, but I know that she walked into my classroom already having learned so much about life, that some will never accomplish at twice her age. Ray was just told the cancer is back. Yep, cancer is such a beast. An unfair, vicious monster. This time, it is in her spine. It requires surgery, affording her a whopping 50-50 shot at walking again. Oh, by the way, Ray, did we mention we also discovered that you have MS?

We decided that we couldn’t possibly have our last class as scheduled, because it is the same day as Ray’s surgery. It just wouldn’t feel right. And it isn’t exactly appropriate for us to have class in the hospital. We all adore her, but I’m sure her family would like to take up the space around her. We are having our last get together at my house tomorrow night around a campfire. They are all of age so I told them they could bring their beverage of choice. And we are all praying Ray is feeling up to attending.

My first cohort of students I had for one semester. I still keep in touch with one student on occasion, and another student I talk to regularly, even after her move to North Carolina. This group of students I’ve had for an entire year. I feel the weight of grief and loss already. I try to give them my heart and soul and they fill me up with their appreciation. I’m sure we will stay in touch, but let’s face it. Things are never quite the same.

But I’m never away from the thought that the weight I carry from knowing I will miss the amazing women I have grown to admire over the last year, is nothing compared to the weight Ray carries. She is a rock star in every sense of the word. She has acquired strength and experience that a woman her age should never have to have earned the right to own.

My hat is off to you, Ray. And to Summer. And to countless others of the women I know who are towers of strength. When my life feels overwhelming, part of what brings me back is knowing some of you carry much greater burdens than I, and with such grace and love and power and inspiration. Know you are loved!