Ruth Reichl's Chocolate Cake
I get emails in my inbox from Inspire, which is an online forum for people with lung cancer sponsored by the American Lung Association, and I try not to click on them. But I do. I'm a sucker for postings like: "Three years on Tarceva and going strong." But I sometimes click on the sad ones too, postings with titles like "Seven years and bad news" or "Fatigue and weakness--is this normal?" Those were actual postings this morning. You would think I have enough of my own rabbit holes to burrow into without seeking out the stories of my fellow travelers. But sometimes it feels like a test I need to take, this reading of other peoples' stories to find myself in them, or, perhaps to see the ways I am not in them. I tell myself it's important to know what happens to other people on Tarceva, and inevitably I grieve. (But I do get great tips from these forums. I learned to rub tea tree oil into my nail beds to help with the cracked, dry-to-the-point-of-bleeding nails, which is a side effect of Tarceva. I also learned to wrap my fingers and toes with a kind of bandage called micropore paper tape to prevent the splitting of my skin, which is, yes, another side effect of Tarceva. ) Reading these entries makes me face cold facts, without a lot of context--the fatigue and weakness of the man whose wife wrote in on his behalf yesterday--they thought he would be back to work by now, and instead he is finding himself, in his own words, "dead tired." I spent some time imagining his wife, crowdsourcing for comfort and hope, typing on her laptop while her husband dozed on the couch. Or the seven years writer, whose doctors just found two small tumors in his brain, after seven years of, again, his words, "buying time" on various clinical trials. I imagined the pit in the man's stomach when he entered the doctor's office and his doctor greeted him with a serious, this is business face. I can't read these posts too often. I've learned I shouldn't let myself exist on a diet of only words about cancer because my thoughts narrow to a frightening place where I can't be reached easily by the people who love me so.
I recently read Being Mortal: Medicine and What Matters in the End, by Atul Gawande, who you know as a writer if you read the New Yorker. Gawande doesn't mince any words here--he essentially reminds you, you who adhered to the paleo diet and then whole 30, you who knows where your meat was sourced, you with your flax seeds and chia seeds, you who rides the Pan Mass Challenge, you with your sleek black fitbit, you with your love of avocado and turmeric milk, or your thoughtful meditation and yoga practices, that you are going to die, and likely your death will follow a long period of decline and debility. You already know this, because you have cared for your mothers and fathers and sisters dying early of breast cancer and brothers dying early of heart attacks, felled by the latest blizzard. But Gawande wants us to know that the tragedy of old age and death can't be fixed by modern, Western medicine, so we need another plan. And he suggests that nursing homes and assisted living facilities are not places where the very old are often content. Family is another alternative. "Your chances of avoiding the nursing home are directly related to the number of children you have," he writes, "and, according to what little research has been done, having at least one daughter seems to be crucial to the amount of help you will receive." I know a lot of these daughters personally, and most of them have big, bustling careers, and I bet that wasn't a factor they looked at in the little research that has been done.
The hardest chapter in the book for me is called "Letting Go." I had read a version of this when it was published in the New Yorker in 2010 and when I read it then, it made me weep, but I am certain I did not see it as applicable to me. He tells the story of a woman with inoperable lung cancer, a young woman in her thirties, with small children. It takes her eight months to die, eight months during which she undergoes multiple rounds of chemo, radiation of her entire brain, and multiple hospital stays. As Gawande puts it, in words that feel like the words I live by now, "death is certain, but the timing isn't. So everyone struggled with this uncertainty--with how, and when, to accept the battle is lost." How do we decide what measures to take to survive--I know these questions will come to my doorstep and soon, and I am just beginning to understand how to answer them. I want to say I don't want heroics, but as soon as I write those words, I panic inside, suddenly filled with fear and anxiety. I don't mean don't try, I think. And no one around me would ever think I meant don't try. Gawande doesn't spare his readers how terrible Sarah's death was, and he blames doctors and he blames patients and he blames the loved ones. Doctors, for not talking with their patients about death. Patients for not talking with their doctors and families about death. The loved ones for clinging to the miracle around the corner clinical trial. Doctors think months. Patients want years.
Do not go gentle into that good night, and many of us will not, because the last days of our lives may be unspeakably difficult. It is so hard to think hard about this--friends, I know it. We want to live and our mind races to life--to thoughts of our children, to my thin-as-a-rail Elijah who sat at breakfast this morning doing addition, to my sturdy Asher and his rejection of kisses--"only hugs'--for the last several months and my teasing ("but it's so hard for a mommy not to kiss"), to my marvelous Zoe and her quick wit and withering glances and late night texts of love, to my lovely Avery with her deep abiding love of trees and birdsong and family, to my tall redhead, Zachary, with his long-limbed climb up walls of rock and his easy brilliance, to my just-so Cameron, with his meticulous shirts and careful plating, which belie his ability to galumph around the living room, making the twins snort with laughter, to my fretful, thoughtful Kyle, who will chase down the last tiny ounce of the tea I love which is no longer sold, eeking cupfuls out of eBay and Amazon simply because I love that tea, to the beautiful bog with its icy trails and frosty unharvested cranberries, to the lush blue of cape cod bay, to the silent moon hanging as if on a magical thread in the dark Massachusetts sky. But we have to also keep close our endings, and talk to one another of pain and promises and hospice and deaths at home, of cremation and burial, of last wishes. I just encourage you to have your voice heard in that conversation, because the conversation will happen, whether we add our words or not.
Did I tell you I have begun to meditate? It's been months now, not weeks. And it is changing me. I secretly and not-so secretly scoffed at meditation such a short time ago, and who was that woman so sure she had decades to work through her views on death and dying? Meditation has already changed me. It is helping me be present, and then to return to the present when my mind leaps into a fearful future where death is my true and only companion. Meditation helps me breathe and label my fears as the emotions that they are. I can honor that fear without feeding it, I can live in this day which, so far, does not appear to be the day I am dying, but the day in which I am writing, and in which Zoe is rearranging my closet and unearthed the missing companion of a favorite pair of slippers, a day where I will make lemon chicken, with its crisp bits of salt and lemon clinging to the roasted bird, a day where I read poetry this morning and meditated and drank turmeric tea and finished the last piece of Ruth Reichl's chocolate cake. I was at the hospital the other day and something went wrong with an infusion of dye into my veins and it burned and my mind immediately went into breathing mode: breathe in, breathe out. Meditation was second nature to me at a moment when I needed it, and I marvel at that, at the change practice has made. I was sure I did not have the time to meditate, and now, when my time seems eclipsed, I find that meditation saves my time from being devoured by the fears of the future or longing for the past.
I recommend the book and the cake. You should probably buy the book from your local bookstore. You can get the cake recipe through the New York Times Cooking section--Ruth Reichl's Giant Chocolate Cake. You can easily halve the recipe if you don't want a giant cake. I used Scharffen Berger cocoa, but that's just because that's what I had on hand.
I recently read Being Mortal: Medicine and What Matters in the End, by Atul Gawande, who you know as a writer if you read the New Yorker. Gawande doesn't mince any words here--he essentially reminds you, you who adhered to the paleo diet and then whole 30, you who knows where your meat was sourced, you with your flax seeds and chia seeds, you who rides the Pan Mass Challenge, you with your sleek black fitbit, you with your love of avocado and turmeric milk, or your thoughtful meditation and yoga practices, that you are going to die, and likely your death will follow a long period of decline and debility. You already know this, because you have cared for your mothers and fathers and sisters dying early of breast cancer and brothers dying early of heart attacks, felled by the latest blizzard. But Gawande wants us to know that the tragedy of old age and death can't be fixed by modern, Western medicine, so we need another plan. And he suggests that nursing homes and assisted living facilities are not places where the very old are often content. Family is another alternative. "Your chances of avoiding the nursing home are directly related to the number of children you have," he writes, "and, according to what little research has been done, having at least one daughter seems to be crucial to the amount of help you will receive." I know a lot of these daughters personally, and most of them have big, bustling careers, and I bet that wasn't a factor they looked at in the little research that has been done.
The hardest chapter in the book for me is called "Letting Go." I had read a version of this when it was published in the New Yorker in 2010 and when I read it then, it made me weep, but I am certain I did not see it as applicable to me. He tells the story of a woman with inoperable lung cancer, a young woman in her thirties, with small children. It takes her eight months to die, eight months during which she undergoes multiple rounds of chemo, radiation of her entire brain, and multiple hospital stays. As Gawande puts it, in words that feel like the words I live by now, "death is certain, but the timing isn't. So everyone struggled with this uncertainty--with how, and when, to accept the battle is lost." How do we decide what measures to take to survive--I know these questions will come to my doorstep and soon, and I am just beginning to understand how to answer them. I want to say I don't want heroics, but as soon as I write those words, I panic inside, suddenly filled with fear and anxiety. I don't mean don't try, I think. And no one around me would ever think I meant don't try. Gawande doesn't spare his readers how terrible Sarah's death was, and he blames doctors and he blames patients and he blames the loved ones. Doctors, for not talking with their patients about death. Patients for not talking with their doctors and families about death. The loved ones for clinging to the miracle around the corner clinical trial. Doctors think months. Patients want years.
Do not go gentle into that good night, and many of us will not, because the last days of our lives may be unspeakably difficult. It is so hard to think hard about this--friends, I know it. We want to live and our mind races to life--to thoughts of our children, to my thin-as-a-rail Elijah who sat at breakfast this morning doing addition, to my sturdy Asher and his rejection of kisses--"only hugs'--for the last several months and my teasing ("but it's so hard for a mommy not to kiss"), to my marvelous Zoe and her quick wit and withering glances and late night texts of love, to my lovely Avery with her deep abiding love of trees and birdsong and family, to my tall redhead, Zachary, with his long-limbed climb up walls of rock and his easy brilliance, to my just-so Cameron, with his meticulous shirts and careful plating, which belie his ability to galumph around the living room, making the twins snort with laughter, to my fretful, thoughtful Kyle, who will chase down the last tiny ounce of the tea I love which is no longer sold, eeking cupfuls out of eBay and Amazon simply because I love that tea, to the beautiful bog with its icy trails and frosty unharvested cranberries, to the lush blue of cape cod bay, to the silent moon hanging as if on a magical thread in the dark Massachusetts sky. But we have to also keep close our endings, and talk to one another of pain and promises and hospice and deaths at home, of cremation and burial, of last wishes. I just encourage you to have your voice heard in that conversation, because the conversation will happen, whether we add our words or not.
Did I tell you I have begun to meditate? It's been months now, not weeks. And it is changing me. I secretly and not-so secretly scoffed at meditation such a short time ago, and who was that woman so sure she had decades to work through her views on death and dying? Meditation has already changed me. It is helping me be present, and then to return to the present when my mind leaps into a fearful future where death is my true and only companion. Meditation helps me breathe and label my fears as the emotions that they are. I can honor that fear without feeding it, I can live in this day which, so far, does not appear to be the day I am dying, but the day in which I am writing, and in which Zoe is rearranging my closet and unearthed the missing companion of a favorite pair of slippers, a day where I will make lemon chicken, with its crisp bits of salt and lemon clinging to the roasted bird, a day where I read poetry this morning and meditated and drank turmeric tea and finished the last piece of Ruth Reichl's chocolate cake. I was at the hospital the other day and something went wrong with an infusion of dye into my veins and it burned and my mind immediately went into breathing mode: breathe in, breathe out. Meditation was second nature to me at a moment when I needed it, and I marvel at that, at the change practice has made. I was sure I did not have the time to meditate, and now, when my time seems eclipsed, I find that meditation saves my time from being devoured by the fears of the future or longing for the past.
I recommend the book and the cake. You should probably buy the book from your local bookstore. You can get the cake recipe through the New York Times Cooking section--Ruth Reichl's Giant Chocolate Cake. You can easily halve the recipe if you don't want a giant cake. I used Scharffen Berger cocoa, but that's just because that's what I had on hand.
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