The Final Reckoning
Anastasia Rowland-Seymour and I are ticking through our familiar checklist. Sitting across her ten-by-ten exam room on a black plastic chair is a young, second-year resident whom she’s asked to sit in and observe. Like Rowland-Seymour, he’s not wearing the requisite white coat. He learns fast.
“We were going over your file,” Rowland-Seymour says. “There are a few things I haven’t asked you about for a while.” Her papers are out. All of them. “How are your headaches?”
For a moment I am baffled. “Do I get headaches?” I cock my head and ask this question with total seriousness. Then I remember. I was getting severe headaches with every menstrual cycle and we did talk about how painful they were—but somehow I’ve forgotten I ever had them. Or, maybe it’s just that when I do get them, they don’t have their old staying power. They last for half an hour, not two days.
Rowland-Seymour lets out a little laugh. “Good. And your irritable bowel? You haven’t mentioned it for some time.”
It doesn’t take much to recall the gut-twisting pain I used to feel the first hour or two of every day. I remember worrying that I might not be able to handle morning yoga classes because of it. Then, slowly, the problem just went away.
“I’d forgotten all about it,” I say. “I don’t know if I could really describe myself as someone with irritable bowel. Maybe occasional touchy bowel syndrome.”
Rowland-Seymour lets out another of her short, happy signature laughs. She flips through her notes. “I haven’t written you any new referrals for physical therapy for your back, your bladder, or pelvic floor spasms, or your tendonitis for more than six months,” she says. “Looking back at your history that’s impressive. You’ve been in physical therapy for the past decade.”
“Ninety percent of the time my back pain and pelvic pain isn’t enough to enter my radar,” I say. “I have to think about it to realize I still feel some twinging. When it’s an issue I’m mindful of the pain and why it’s happening and I adjust my posture. I do more yoga. More forward bends.”
“Pelvic floor spasms?”
“Clearly the trick for pelvic floor spasms is to do lots of hatha yoga lunges and standing poses,” I laugh.
“Has the yoga translated into the increased agility and endurance you were hoping to find?”
“I am not sure I will ever be able to describe myself as agile,” I say. “But my core is getting to be . . . dependable. And building that strength makes me feel . . . ready for life in a way I never have before.” I think of something else. “I haven’t been wearing my hand and wrist braces for four or five months. I just haven’t put them on.”
“You would be if your tendonitis and inflammation were causing you the habitual pain they did a year ago.”
I turn toward her resident. “I used to wear wrist and hand braces at night and when I was working on my computer. They’re both in a drawer now.” I smile and shrug again. “I can pick up heavier objects. Like large iron skillets. And I’m not dropping smaller objects quite as much. Things do still fly across the room—like my toothbrush this morning. But I hadn’t dropped anything in so long it surprised me when it rolled across the floor.” I rub my palms together as if to test my own words. Yes. I am better able to feel my own skin.
“What about your overall fatigue level?” We both know that for me this has been the big bugaboo. The joy thief.
“I sometimes get an echo of that old whoosh of fatigue. When I feel that first terrible sensation that my cells are all sliding south toward the floor I pay attention. I spend ten minutes meditating. Five minutes in sun salutations. See my acupuncturist. Write in my gratitude book. Walk outside. Stare at something small and startlingly beautiful. A leaf. A cloud. Send a deep layer of loving-kindness to someone who’s driving me absolutely around the bend.”
Rowland-Seymour and her resident exchange a glance. He slightly shakes his head as if to say, “I had no idea.”
“And getting up the steps?” Dr. Rowland-Seymour asks. “That, I think, may tell us more than any of the lab work we’re about to run. I’d go so far as to say it’s your personal litmus test.”
I relay how I recently went up two flights of steps, taking the last two steps at once. “I didn’t realize what I was doing at first. It took me a minute to realize I’d raced up the steps and hadn’t collapsed.” I pause, worrying that in my excitement to relate how things have changed for me I might be painting a rosier picture than I intend. “Of course it isn’t always like that,” I caution. “Some days the stairs still seem evil. But that’s the exception. And I can’t think of when I last had to stop halfway up. Or lie down at the top.”
Rowland-Seymour sits back in her chair, giving me that familiar, happy back-and-forth shake of her head, her dark brown curls, corralled by her ponytail, waving slowly in and out of view. “Incredible.” She gets up, gesturing for me to stand up, too. “Let’s see how your balance is.”
I know the drill. The “drunk driver” test. How many times have I tried this, either in my neurologist’s office, or here? And to no avail? I start across the tiled floor as Rowland-Seymour hovers a few feet to my left. One step. I place my left heel to my right toe as I start to take a second. And then . . . my right heel fits neatly against my left toe and I am . . . stable. Rowland-Seymour’s hands are a few millimeters from my left arm, which I’ve stretched out along with my right in airplane mode. But I don’t need her open, steady grip this time. There’s no need to catch me. A half minute later I’ve crossed the entire, albeit small, room. I reach the wall and stand normally. “Wow,” I say. Or maybe I say, “Whew.”
Rowland-Seymour has the facial expression of someone whistling.
“That’s incredible,” her resident says, standing up.
Rowland-Seymour talks over her shoulder to him, her bright, warm eyes still on me. “She couldn’t take two steps a year ago without losing her balance.” She is visibly moved.
I feel, in that moment, like the rats that experience “spontaneous locomotion.” “Watch this,” I say. I am being a bit show-offish and obnoxious, but I am on a roll now, and I have so rarely been in a position to show off when it comes to my legs. I balance on one foot and go into tree pose, planting my right foot on my inner left thigh, slowly extending my arms overhead. I hold the pose, wobbling at first. Then, slowly, I center myself and move into the full expression of eagle pose, standing on one leg, my right leg wrapping around my left knee, my arms curling around themselves and rising in front of my face as I sink lower, holding in my core, holding. Muscle energy.
“You shouldn’t be able to do that,” Rowland-Seymour says, her arms rising, uncertainly, back up in the air to spot me. “That is not something I was ever expecting to see.” When I don’t fall, her palms turn up and her shoulders rise in what I recognize as her glad “wow” gesture. She breaks out laughing.
“If this isn’t a testament to how we should rethink health care,” Dr. Resident says. “I wish we could get every patient to do half of what you’ve been doing.”
“I wish every patient had even half as good a doctor as I do,” I say. “I hope you know you are learning from the best.”
“I know,” he says. “I know.”
As we all sit back down, I nevertheless feel the need to follow my exhibition with a slightly more cautionary tale. “I don’t want to overstate my case. It isn’t that I don’t still get fatigued, or ever have trouble with the stairs or feel my hands go numb. It’s that my symptoms come less often, and when they do come, my baseline has changed. The starting place isn’t quite so bad, and I come back to a place where things are tolerable so much more quickly. It’s a bad afternoon instead of a bad month—or year.”
“Your symptoms are quiescent,” Rowland-Seymour says. “And when those symptoms flare you know what to do to help them return to that quiescent state.”
I smile. “I like that word. Quiescent. Exactly. Things don’t feel resolved, or as if they are gone; they feel as if they’re not being provoked into agitated overactivity.”
“There is something else really important,” I add. “I used to have a symptom, and my worry over what it might mean would hit me like an almost physical second injury—that flood of cortisol, that negative floating brain coursing through me like a toxic injection. But now the ghosts of old memories of all the physical trauma I’ve ever known don’t flood me with fear in the same way. I can ignore and even turn those ghosts away. Symptoms arise and I’m able to tell myself a new story.”
“And how does that story go?”
“These symptoms are present now, but they will go away again. And, if they don’t go away on their own, I can take action, call the appropriate doctor, go in for tests if need be—and yet still remain free in my mind to find beauty and joy and quiet as I do so.” I think for a moment. “In turn, my symptoms don’t seem to be as traumatic, perhaps because I don’t feel as traumatized. It’s not that my life or body are entirely different. I’m different in my body and in my life.” I pause. “You could say my body is under new management.”
“And do you feel going back to look at your childhood—your ACEs—has played a part in this change?” Rowland-Seymour says this gently, as if she’s been waiting to get to this point in the conversation.
I sit back. “Yes. I have to say I wasn’t prepared for how painful the process of meditating and being mindful and getting quiet to reflect on those connections would be.”
Our visiting resident looks quizzical. He leans forward, his hands folded in a soft fist between his knees.
“It’s as if, by getting quiet and going within, I discovered all these bandages that had been covering up a gaping wound I never knew was there,” I say. “The kinds of wounds we all carry inside. I had to peel off that bandage.” I search for the right words and they come. “After forty years I’ve aired out the wound and it’s healed properly. The cellular pain of it is gone.” I give a little head shake. “It’s hard to believe I am sitting here still talking about my childhood—and I’m fifty-one years old.”
Rowland-Seymour tilts her head, her brown eyes soft and thoughtful. “I have patients who are eighty-one and are still talking about their childhood,” she says. “It’s never too late, as long as you’re willing to ask the question of what might be getting in the way of creating the joyful life you want to live now.”
“Speaking of that,” I say, rummaging in my workbag. “The joy test.”
* * *
A YEAR AGO, Sanzone administered a test to me she developed known as the SJCQ-Inventory, or Sanzone Joy and Contentment Quotient Inventory, which captures one’s daily perceptions of the world. Each question is answered on a scale of one to ten. I took my second SJCQ-Inventory last week. Rowland-Seymour spreads the two tests out side by side on her desk, comparing the results of the inventory I took a year ago with the new one.
The number 1 equals “Does not apply much at all/hardly describes my experience.” A 10 equals “Nearly completely describes my perception/applies to me.”
Here are my results:
1. “I feel deserving of a calm mind and a joyful life.”
A year ago I scored a 2. Now I scored a 10. There is no question, in my mind, that we all deserve and can have a calm mind and a joyful life.
2. “I am more self-critical and judgmental than I wish I were.”
A year ago my score was a 9. This week I scored a 3. I’m never going to lose my inner voice of self-criticism. But I do know how to hit the mute button.
3. “I recognize and value unique contributions I bring to the world.”
I was a 4 then. An 8 now. I doubt it sometimes, my ability to make a contribution to the world—but I have more faith that some small act of mine, whether it’s smiling at a harried new mom in the grocery store, or writing about how to activate the healing areas of the brain, will help someone somewhere in some small way.
4. “In general, my negative feelings and thoughts impact my ability to fully engage with my life, including but not limited to people and situations or events.”
An 8 then. A 4 now. I used to stew over pain and symptoms and painful people or what I did or said and I shouldn’t have. I just don’t do it as much now.
5. “I am more critical and judgmental of others than I wish I were.”
A year ago I scored a 6. Now I score a 3. I still snipe at crazy drivers. I don’t like it when the electric company forgets to put us on the electric grid. I get mad. But I hear my thoughts. I’ve become a cultivated self-observer. As such I have, I think, learned how to put a protective layer, a buffer, between what is happening and how I respond.
6. “Daily, I am touched or moved emotionally by things in my environment to a degree that reminds me of the goodness around me.”
This was already high for me a year ago when I scored an 8. Now my score is a 10. There is not an hour that goes by that I’m not struck by something beautiful. The way water trembles in a glass. The way Christian is taller tonight than he was this morning. The glint of light through the prism of a pane. A neighbor smiling and raising her hand as she drives past. It’s everywhere, every minute, the beauty of the natural world. The beauty of us.
7. “Generally speaking, my feelings or emotional states overwhelm me.”
I scored a 4 last year. This year, a 2. When my negative feelings overwhelm me, I execute an exit plan. If it’s joy, I hold on.
8. “At least once a week, I allow myself to be spontaneous or playful without feeling guilty, despite my daily obligations and responsibilities.”
A year ago I scored quite high on this—a 6—solely because of my kids. If I were not their mom, and they were not so funny, I’m not so sure I would have scored above a 2 because so much of my adult playfulness has had to do with them. Or with Zen. Today, I score a 10. But it’s a 10 that focuses on being playful in my own right.
9. “My feelings provide me information, but they do not control me or my decisions.”
I scored a 4 last year. An 8 today.
10. “In going about my daily routine I have difficulty being productive or completing necessary tasks without detaching from or shutting off my emotions.”
This is a big change. I scored an 8 before. Today, my ruminating or spinning thoughts get in the way of my getting things done about 2 percent of the time.
11. “I know specific things I want or need to change in my life, but I have a hard time putting forth sufficient effective effort to effectively implement them.”
A year ago I responded to this with a 5, because fatigue got in my way so much of the time. Now, my answer is a 1. Even when I don’t feel like going out the door to yoga class, or meditating, I get up and go. And the rest of my day is easier because I do.
12. “I am open to new and different interpretations of my experiences.”
I was an 8 a year ago—now I’m a 10. This past year I’ve learned that my entire way of interpreting the world was based on a well-trained but flawed view. I’ve learned to deconstruct my experience and reconstruct it with a new worldview that’s based on what’s happening, right now, rather than on what’s happening in my fear, my amygdala-fired-up imagination. I am open to interpreting the world through the Life Channel. I’m not saying I succeed, but I am open to it. And that opening is everything.
* * *
“AND WHAT IS Marla’s take on all this?” Rowland-Seymour asks.
“She had a number of observations,” I say. I relate what Marla has told me. That this year has allowed me to reclaim a sense of childhood optimism that seemed to be irrevocably lost. Which has opened me up to see the bright and color in the world, the good in people, in humanity and in myself. To be more playful, to “appreciate novelty,” as she puts it, and to have a sense of hope and possibility in my future, even as I grow older. But perhaps most importantly, I tell Rowland-Seymour, Marla “believes that, whereas in the past emotional hurts and losses often became encapsulated in my body and manifested in illness and in pain,” this has changed. As I’m experiencing less emotional inflammation, I am experiencing less physical inflammation as well.
“You’ve moved from fear to excitement about your life,” Rowland-Seymour says.
I think for a moment. “Yes,” I say. “Yes I have.”
* * *
I DIVE INTO my workbag one last time and pull out the inflammation scale I filled out a year ago, as well as one I filled out just a few days earlier. The scale helps to evaluate one’s degree of internal inflammation by asking two hundred questions about symptoms including gastrointestinal problems, neurological issues, headaches, muscle spasms and joint pain, fatigue and exhaustion, sleep disruption and insomnia, skin problems, and much more. A score of 0 to 10 is ideal. One hundred is considered severe.
“A year ago my score was 96,” I remind Rowland-Seymour. “Now it’s 33, about a third of what it was before.” I pause. “Still way above the ideal. But I’m happy with that.”
“It puts a number on what is an enormous and emerging change,” Rowland-Seymour says. “I’m curious. How does the amount of time you used to spend seeing your neurologist, gastroenterologist, otolaryngologist, hematologist, dermatologist, cardiologist, urologist, pelvic floor specialist, or any of your physical therapists compare to the amount of time you spend practicing your current approaches?” she asks, mentally ticking them off on her fingers.
I do a little mental math. “For years I’ve spent three hours a week in physical therapy and another four or five hours a week driving to – ologists’ offices in downtown Baltimore and waiting in clinic waiting rooms.” I pause, checking my mental arithmetic. “That’s about thirty-two-plus hours a month spent with medical care professionals—and that’s when I’ve been stable; it’s triple that when I’ve been in a flare.”
“And now?” Rowland-Seymour is writing this down.
“Add up three hours a week doing yoga, half an hour a week practicing for ten minutes here and there at home, two-and-a-half hours in meditation every week either with my sangha or on my own, about one doctor’s appointment every other month with you, which takes about an hour—and an hour a week seeing Janet. That’s the same amount of time: thirty-two hours a month.” I pause. “And those thirty-two hours are . . . fun.”
Rowland-Seymour’s intern laughs out loud.
“Have you compared it price wise?” Rowland-Seymour makes more notes.
I add up the dollars. “I used to spend roughly three hundred fifty dollars a month on copays to physical therapists and – ologists who have saved my life—and they’ve been worth every penny and more. Lab work and diagnostic tests have meant higher bills. A lot higher. And hospitalizations—that’s a whole other stratosphere. But now my total health expenditure is close to half of what I used to spend on copays for physical therapy alone—about one hundred eighty dollars a month.”
“So what have those thirty-two hours a month, or eight hours a week, taught you to remember when you feel exceptionally stressed? You’re finishing writing a book and building a house that’s been delayed several times. You’re about to move. Again. And you have clients and their deadlines. And two teenagers.”
“And a husband and two rescue dogs,” I smile.
“And just a few chronic conditions,” her resident smiles.
“That’s . . . a lot,” Rowland-Seymour says.
“My emergency toolbox consists of five very simple things,” I jump in. I go over them all:
1. Remember Why. The science is real: your thoughts and state of mind direct your cells. Getting back onto the positive feedback loop isn’t optional. It’s your future outcome. I ask myself, Do I want to meet my grandchildren?
2. Three a Day. Use three of the myriad tools I’ve learned to activate the brain’s healing response each day. It doesn’t matter what they are or where I do them. Just that I do them.
3. Claim a Quiet Space. Take the time to go for a walk alone. Stare out the window. Be on the table at acupuncture. This hunger for my own silent space is why we’ve taken a roomy closet in our new house and turned it into a yoga and meditation space that’s just for me—something I would have felt terribly guilty about claiming for myself a year ago.
4. Take Life Less Personally. Remember that those around me are up against their own evolutionary biology, chemical reactivity, genes, and ACE scores. Recognize that in them as I recognize it in myself.
5. Go to Class. I am sometimes tempted not to go to class. To say I’ll just practice on my own. But the truth is, I don’t and won’t do much on my own. And eventually, without the teacher support, my practice will peter out. And second, there is something that happens when we are with other women who are working to soften the same edges that we are. I do not know every detail of how this happens—the science on this is new and provocative. But the effect is real. Being next to people who are engaged in healing helps us to move forward, faster, too.