There are eight billion people on this planet, and all of them will die. Why share a story about one of them? One day, your partner may die, and you better be prepared. And if you go first, you may have questions about that, too.
Let’s get started. If this Substack were to become a book, 1) It would begin with Karen swimming across the lake on a summer afternoon, and 2) I would be hitting you up for a review.
Karen turtle-bobbed behind me as we swam toward the dock. I grabbed the ladder and swung my sopping face.
“Wanna kiss?” I teased.
“How about a beer,” Karen grinned.
We swam across our little lake every afternoon for more than exercise. Each crossing celebrated Karen’s triumph over terminal cancer. The third of a mile, there and back, honored Karen’s determination to beat a grim diagnosis — just eight months to live, now eight years running.
I popped open the IPA, shoved it in a koozie, and handed the well-earned Tropicalia IPA to my gloriously spent wife. Karen spread out on the dock, looking sixty-something svelte in a Lands End suit designed to hide her non-existent flaws.
BEEP.
“It’s a text from Derya,” I said. The magic had sputtered, so I handed her the phone.
Karen read haltingly due to a vision disability: “Hi Karen,” she struggled. “I need to talk to you as the program director, not my former supervisor. Can we set up a Zoom? I’m having a difficult relationship with Suho and need your help understanding each other better.”
Let me shine a light on this intrusion into our glorious afternoon. In the movies, every story begins with an inciting incident, and this unsolicited text message set our drama into motion. My screenwriting teacher, Robert McKee, once explained,
“The inciting incident radically upsets the balance of forces in the protagonist’s life.”
Here are three inciting incidents from the movies:
The attempted theft of Clint Eastwood’s prized Ford Gran Torino kindles an unlikely friendship with the young Asian gang-banger living next door.
In Sleepless in Seattle, Tom Hank’s eight-year-old son calls a radio show to solve his dad’s unending pain from losing his wife, ultimately sparking a cross-country romance. (Hmm… interesting idea.)
In Die Hard, Bruce Willis heads to the bathroom to change clothes just as kidnappers take everyone hostage at an office party.
And I will add one more: A casual text message on a summer afternoon leads to the demise of a husband’s beloved wife.
My philosophic mentor, G.I. Gurdjieff (1866–1949) called the inciting incident an “outside shock.” He explained how life proceeds like a musical scale (Do-Re-Mi-Fa etc.) until a “shock” upends the routine and releases stuck energy for transformation to proceed. This shock occurs between Mi and Fa on the musical scale (where the black piano key is conspicuously missing).
With pop music, we experience a shock — or uplift — when a song moves into the bridge. The bridge might shift the tune through a change of key, melody, or rhythm. Paul McCartney’s mastery of the bridge (often called the middle eight) explained how The Beatles hooked a generation.
In movies, we experience these shifts as plot points. The three acts follow a typical structure:
1. Exposition and inciting incident — While learning about the character and his world, something unexpected sends the protagonist on a soul-defining journey.
2. Mid-point confrontation and loss — A big setback forces the character to go all in.
3. Climax and denouement — Whether it’s a big battle, a fight with a villain, or an emotionally complex confrontation, the character must go for broke.
In real life, unexpected events can take the form of a marriage proposal, job loss, bankruptcy, or a medical diagnosis — events that “radically upset the protagonist’s life.” The outside shock can be big and dramatic or subtle and minor, for example:
Two bullets fired at the Archduke of Austria and his wife Sophia in 1914 escalated into 40 million World War I casualties.
One guy feasting on a badger from the Huanan Seafood Wholesale Market led to 20 million COVID-19 deaths (maybe).
At a South Carolina Baptist funeral, Janny Jones, a 76-year-old church usher, whispered to Rep. James Clyburn, “Who are you going to vote for?” That whisper propelled Joe Biden from fourth place in New Hampshire to first place in South Carolina and onward to an insurmountable lead in the 2020 primaries.1
“Inciting incident” is a movie term for “one thing leads to another.”
While Karen soaked up the sun after her swim, she wasn’t thinking “inciting incident.” She couldn’t even read without glasses, so she handed me the phone:
“I’m feeling discriminated and discouraged by Suho.” I continued, “And it’s causing serious problems between us.”
I turned to Karen. “Who the heck is Suho?”
“She’s a student educator from Korea,” Karen explained.
“And Derya?”
“She’s a chaplain student from Turkey. She was my student last unit. Now she’s in Suho’s class.”
I read more: “I just left our group, and I encourage you to watch the video — especially the last 20 minutes. If I need to file an official complaint first, please let me know how I should proceed for this situation.”
Karen put her beer down. “This is bad.”
“Bad? If Derya’s no longer your student, what does this have to do with you?”
“Derya’s educator is Suho. Suho’s supervisor is Theodora. Theodora is my boss, and she’s on sabbatical. Derya, Suho, Theodora — now it’s in my lap.”
Karen closed her eyes and took a breath. I watched her transform — what I called “putting on her Bother Boots.” Imagine a five-foot Wonder Woman, quiet on the outside, fiery on the inside, sweet inside and out, elderly but playful, and wielding the moral force of the universe. When the Bother Boots go on, no stone goes unturned, person unrecognized, concern ignored, lead not followed, or heart un-mended. This was one of those moments.
Let me shift gears.
Twenty years ago, Karen returned from a deep and consequential walk through the Mendocino redwoods and announced, “I’ve decided to go to seminary and become a chaplain.”
My first thought was, “Oh great, Jewish boy married to a minister.”
Like all seminary students, Karen struggled to learn Greek, Hebrew, and Bible history. With her trademark determination, Karen became ordained as a Presbyterian minister despite not attending church in decades.
Side note: Karen and I met as Sufis on a blind date, followed Rumi, practiced Vedanta meditation, and performed the turn of the Whirling Dervishes — so, we were your average Sufi-Jewish-Christian-Vedanta-dervish couple.
As a former labor and delivery nurse, Karen wielded special grace as a chaplain — she helped people embrace their wholeness amid despair. I was once privy to her half of a pastoral phone call while we were driving.
“That was amazing,” I said when she put the phone down. “You hit all the saintly notes — way beyond my reach as a wise-ass Chicagoan.”
Karen’s gifts did not go unnoticed. Her supervisors at Emory Healthcare invited her to become a Chaplain Educator — a rigorous professional certification that demanded years of supervision, reams of documentation, theory papers, videos, and facing the “committee” — the equivalent of a PhD dissertation defense. Karen aced it all except the last little bit. The scrutiny of the committee triggered deep trauma from childhood abuse.
Karen prepared for months, documenting her pastoral excellence, but like a K5 climber forced off the mountain by a freak storm, the committee tripped her up. As a slight consolation, Karen used the “f” word on her way out.
Karen’s perseverance was a legend. A mere mortal would throw in the towel rather than restart a grueling 12-month process, but Karen went up against the committee a second time. We were in a DC hotel room when I watched the predictable cloud of anxiety roll in like the San Francisco fog — or, a better metaphor, a demon buzzard snatching her readiness like roadkill.
Barely awake at 6 am, I managed to mumble, “Are you okay?” Karen paced the room, dialing her vast network of friends and colleagues for moral support. My worst fear materialized when her anxiety got the better of her in front of the committee.
A year later, Karen tried again.
We walked to a local hotel for Committee Number Three — this time, a few blocks from our house.
“Hold my hand,” Karen instructed as we walked. “That’s too fast.”
So I slowed.
“Stop, I want to take a breath.”
Like an executioner’s walk, Karen measured each step. Between our house and the hotel, we stopped maybe 20 times. Her peers received her warmly when we reached the hotel, so I knew the Committee gods would be kind.
I was in a workshop when my phone rang.
“Bruce, I passed, I passed.” Karen reveled as if waking in a fairy tale.
“Bruce, it was the most amazing moment,” she continued. “Right before I started, they said, ‘We want to certify you today.’ I couldn’t believe it; my anxiety left; I got into this place; I was in command; I stayed engaged the whole time. Oh, Bruce, I am so happy.”
By now, we were both crying. Three fucking long years: Committee One and the “f” word, Committee Two and DC devastation. Finally, Committee Three and success. In theory, it’s possible to pull free from karmic gravity — your emotional escape velocity — but I was never convinced until that moment.
That night, the four walls of our kitchen burst with love and celebration. Food and friends appeared, wine was poured freely, toasts were made, music throbbed, and we danced. Karen’s hero’s journey was palpable — the ordeal, the reward, the resurrection, and now, the elixir. Karen’s underworld had been unlocked; Eurydice ascended her throne of Light at last.
The next day, Karen drove to her group therapy — 20 minutes by freeway. We kissed, but something didn’t feel right.
“You okay?”
Twenty minutes later, my phone rang. It was Karen.
“Bruce, I hit a car!”
“Are you all right? Where are you?”
If there were a scale for panic, Karen was at a 10, maybe 12. Karen grew increasingly frantic.
“I don’t know where I am,” she cried in terror. “I don’t know what’s going on!”
The desperate exchange continued.
“Are you pulled over? Are you hurt?”
I put on my jacket one-armed to keep the phone against my ear, jumped on my bicycle, and peddled in dark rush hour traffic up the steep road toward our house. I was in the control tower, desperately instructing a terrified passenger on how to land the plane.
Karen screamed, “Oh my god, oh my god, oh my god!”
I felt powerless, with no idea what was going on.
“Oh my god, Bruce. I think I hit another car! Oh, Bruce, I can’t see. I can’t see.” And then a little later, “I can’t move the car. I’m on a ramp. People are honking. I don’t know what to do!”
“Where are you?”
“I don’t know. I don’t know. I have no idea where I am.”
Through luck, a good Samaritan got hold of her phone and guided us to Karen. We chalked the whole incident to stress from the committee.
A week later, Karen landed her dream job as the Director of Pastoral Education at an Atlanta non-profit. After years of stress, everything was looking up.
But two weeks later, on the afternoon of New Year’s Eve, while riding up a medical office elevator, that happy moment crash-landed again. As the doors creaked open, Karen’s body collapsed full weight into my arms. It felt like a slo-mo dream or even freeze frames, but it was all in real time.
“I’m really not feeling well,” Karen mumbled tenderly.
Karen’s naturopathic doctor rushed down the hall. “Go straight to the hospital!”
Like terrified bunnies, we raced through the streets of Atlanta to the ER.
“Your wife has a significant lesion on her left occipital lobe,” the doctor explained, looking at the scan. “It will take further testing to determine the full extent of what is going on.”
More tests revealed stage-four lung cancer metastasized to her brain. Weeks of ignored symptoms, including that slo-mo walk to the hotel, suddenly made sense. Karen underwent brain surgery, radiation, and chemo — “the full Megillah.”
I made a note at the time:
After the tumor was removed, a sizable “mass” of Karen’s chronic anxiety was removed as well. This lays to rest any questions on the mind-body connection.
Karen’s prognosis was grim, but for the next year, we ignored fate’s hammer, focusing instead on our magic word: “buoyancy.” We smooched in medical elevators and visualized an invisible current guiding us through the rocks and rapids of the cancer world. We refused to use the “C” word and described our wild ride as a healing journey. And why not? If our primordial state is to be whole, why not follow the inner riptide to that place?
Two weeks after brain surgery, and still receiving radiation and chemo, Karen started her dream job as the Director of Clinical Pastoral Education. Yes, Karen was a fighter. She followed her intuition through the twists and turns of the C-world. She ultimately returned to vibrant health, taking yoga, hikes, therapies, exotic supplements, and swimming across our little lake every summer afternoon, sharing a kiss and a beer.
The big question: Was it the alternative regimens or a god-given miracle that delivered Karen into remission? Bhagwan Awatramani, our meditation teacher from India, scoffed at both possibilities.
“It’s all about the will to live,” Bhagwan explained.
“What does that even mean?” I asked. “Nobody wants to die.”
I began to see the “will to live” as the anchoring force that keeps us in this world. It’s akin to “showing up” — showing up to life. Will to live describes our resolve, motivation, attention, and choices coalescing into a core willingness to face life head-on.
Karen’s newfound sense of purpose pushed the C-story into the background.
Seven joyful years later…
We were locked down in our cabin, watching Rachel Maddow's report on the thousands of COVID-19 patients dying in New York City hospitals, when I turned to Karen and asked, “Could you imagine getting a cancer diagnosis at a time like this?”
“Oh my god,” Karen shook her head. “Could you imagine?”
Four weeks later, seven years after the elevator, and during our first COVID telehealth on Zoom, Karen’s oncologist announced, “We found some thickening on a retroperitoneal lymph node. Could be a return of the cancer.”
Four months later, Karen entered a phase one clinical trial. Like all things Karen, she rose to the top. The experimental drug, U3-1402 shrunk the lymph thingy from 17.5x21.4 mm to 5.5x11.1 mm in a year’s time.
“Most people are stable,” Mashunte, the trial coordinator, explained. The drug basically stops the progression. We’ve never seen results like Karen’s — not once in the entire trial.”
Another triumph? Maybe.
Years ago, my teacher, Reshad Feild, explained, “Until you face what you have to face, you can never be free.” In other words, U3-1402 can only take you so far.
Let me replay that note-to-self from years ago:
After the tumor was removed, a sizable “mass” of Karen’s chronic anxiety was removed as well. This lays to rest any questions on the mind-body connection.
A sizable mass was removed, but was the underlying trauma still driving the story?
After our swim, Karen and I climbed the steep walk from the dock to our cabin.
Karen clicked the link to watch the recording of Suho’s class. Her jaw dropped.
Instead of a safe and loving space to learn pastoral care, Karen observed bullying, blame, and hostility. Adding to the trauma, Suho elected to expel Derya from the program. With her Bother Boots on, Karen sought an equitable resolution for all involved — a near-impossible needle to thread.
Karen immediately contacted her boss, Theodora, writing: “This puts me in a difficult position that Suho is dismissing Derya from the program without discussing her decision with me.”
Karen sent Theodora the video link and waited for her response.
Theodora texted back:
“There is also a videotape that shows Derya’s rage when her educational/written work is discovered as incomplete. ‘Cheap Grace’ would create an illusion that Derya is ready to be a clinical chaplain, which, in my opinion, she is not.”
As Karen read the text, the phone trembled in her hand.
“How could she say that?” Karen wondered in distress.
I never fully understood what it feels like for your superior to challenge your reality.
Author and therapist Stephanie Sarkis, Ph.D., explained: “Telling a victim that something never happened or that it occurred differently than how they remember is a covert form of gaslighting. It causes someone to doubt their perceptions and feel confused.”
“Gaslighting can be very traumatic,” Danielle Hairston, M.D., of Howard University said. “It can be a very negative experience when you’re trying to express something that happened and someone is repeatedly telling you, ‘No, it didn’t happen.’ This leaves victims of gaslighting questioning a past or present situation …and whether they’re reacting appropriately.”
Karen enlisted a third-party expert to review the video, and she concurred with Karen, but it was too late. A deep childhood trauma had been activated. Fortunately, Theodora came to Karen’s side. Karen invited Derya to leave Suho and join her class. With that, Suho’s bullying was stopped — sort of.
Five months later, right before Christmas, Suho filed a formal ethics complaint against Karen and Theodora, stating in broken English, “It was disrespected for my dignity and worth as a human… because of my Korean accent.”
Say what?
There were other charges. Fortunately, Karen’s professional organization threw out the complaint for technical reasons. Unfortunately, they insisted the parties “mediate” — like making up after a schoolyard fight. This little nicety dragged Karen into an abyss.
“Karen, let go of it; it’s a nothing burger,” I pleaded. We all pleaded. But Karen’s sense of justice, worth, and self-identity was on the line in ways we couldn’t understand. Even worse, the making-up process dragged on for a year. And the mediator was Asian.
My friend Bridget calls this sticky anger.
You won’t find sticky anger in the DSM, Web MD, or even in casual conversation, but sticky anger seems to play a leading role.
Cancers involve some unknown combination of genetics, environmental stress, and psychology. Sticky anger goes straight to the latter point. It’s the emotional residue from trauma, the feeling of lingering injustice, powerlessness, resentment, grief, or the biggie — loss of agency. This residue sticks like an emotional Velcro and becomes deeply wired into the emotional body.
Doctors and scientists should skip over this next part:
With cancer, scientists can readily observe complex biological mechanisms that impede nucleotide repair, mismatch repair, homologous recombination repair, cyclin-CDK complexes, tumor suppressor genes, and how that causes MHC down-regulation, immune evasion, and suppression of apoptosis. Thank you.
But scientists can’t explain why cells go rogue, go wild, and do their own thing. One could argue that sticky anger hijacks cellular intelligence and propels the cell’s rebellious streak as a reaction to the suppressed agency. In Karen’s case, the reaction to unjust authority and inability to show up expressed itself deep in the cell.
Doc, I trust you skipped that. If you did, you really, really need to skip this:
Decades ago, Harry Edwards, a famous spiritual healer from England, concurred. He wrote:
The general conclusion is that in all forms of cancer, there is a psychosomatic origin; there is frustration that upsets the orderly conduct of the human mind, consciously or subconsciously, and this is received by the cell's intelligence, frustrating the genes and causing them to go berserk.2
I’m no psychologist, but Karen was in a tight spot — either steel herself against the bullying or let her deep nature get triggered. I wished she could have told everyone to shove it, but I failed to recognize how deeply Karen’s cellular intelligence had been frustrated.
Susan Sontag famously took the illness out of illness, calling it a “metaphor” and describing it intriguingly as “the night side of life.”3
I would go further and see illness as a healing event. Let me reiterate from Reshad:
“Until you face what you have to face, you can never be free.”
By April, Karen’s clinical trial doctors noted a sudden and dramatic weight loss. This was ignored — perhaps because hitting your twenty-something weight in your sixties looks pretty hot.
By July, the promised mediation finally took place. Instead of defending her professional authority, Karen’s colleagues advised her to let the whole thing go.
Around this time, Karen started to experience excruciating back pain.
The oncology doctors chalked it up to too much Zoom and prescribed three weeks of physical therapy. The physical therapist could not understand why Karen, an avid yoga practitioner, walker, and swimmer, was not getting better. At one point, the PT said, “I’m beginning to think this is all in your head.”
A month later, a radiology report noticed a urinoma — a collection of urine that forms in the back of your abdomen. After a few weeks of trying to get a urology appointment, Karen was seen, but the symptoms were dismissed.
“These things usually clear up on their own,” the doctor advised. “Let’s plan on seeing you again in four months.”
Karen’s pain continued to grow. I felt powerless as two guys hauled a $2000 Posturepedic mattress up the stairs to alleviate Karen’s pain. A week later, Karen decided it was too soft, and they hauled it down.
Getting nowhere with the urologists, Karen went to her primary care physician, who became five-alarmed that Emory was not treating her pain seriously. The doctor phoned in a prescription for OxyContin.
I was walking our dog when I got the text from CVS. Looking closer, I realized the prescription was sent to Blue Ridge, GA, in the mountains, hours from Atlanta. I called Blue Ridge, begging the pharmacist to redirect the prescription. With Catch-22 logic, she explained, “Because of opioid regulations, we cannot transfer your wife’s prescription.”
By now, it was after-hours, but I took a chance to call the doctor. Another doctor picked up the phone. He offered his apologies, but because of opioid regulations, the best he could do was write a paper prescription and tape it to the door.
An hour later, after a 60-minute trip in driving rain, I faced my local pharmacist, script in hand, dripping wet. She shook her head. “We don’t have any OxyContin.”
“What do you mean?” I protested. “The whole country is on OxyContin!
Call another store!”
“Because of opioid regulations, I can’t.”
I drove to another CVS, now in a downpour. The pharmacist shrugged, “Maybe in a couple of days.”
I see life through the lens of movies, and now I sat fuming in a plastic chair at Walgreens, thinking of Martin Scorsese’s nightmarish comedy After Hours. Here’s the logline:
A computer operator has the worst night of his life after he agrees to visit a girl in Soho, but loses his taxi fare and is sent on a hellish journey around the city trying to get home.
That was me, but it didn’t end in Walgreens. Karen’s pain persisted, so we sent Karen’s records to a friend of a friend — a retired nephrologist in Connecticut.
“I can’t believe these urologists would let a urinoma grow that large,” he exclaimed in disbelief. “You need to go around them. Present yourself at the ER first thing in the morning.”
We called Bridget. “Trust me,” she advised. “Don’t wait; go now.”
Entering the ER at 2:00 am continued the full After Hours experience. I wheeled Karen into the basement lobby filled with COVID sufferers, bone-tired cops, and Plexiglas-protected staff.
By 3:30 am, Karen received a shot of Dilaudid and became blessedly pain-free after months of suffering.
In the morning, the urologists realized their blunder and rushed Karen to interventional radiology, where they surgically implanted a nephrostomy tube and a stent to drain the urinoma. A few days later, Karen was sent home with a tube and a collection bag. I became heroically compassionate at changing her tube dressing.
Karen’s condition worsened, and a week later, another late-night ER visit, another interventional radiology procedure, and two more tubes added to her humiliation. Karen now had three tubes and three bags. She dutifully measured the output morning, noon, and night without complaint.
At this point, we had moved from After Hours and back to the 1944 film Gaslight. Here’s my twist on the synopsis:
A devoted husband feels he's going mad when the doctors refuse to offer a coherent diagnosis.
At wit’s end, I reached out to my New York City friend, Suzy, who was friends with a “medical intuitive” named Shelly, who lived in the mountains of Oregon. I booked a call.
I expected a kook with a crystal ball, but Shelly was down to earth, wholly present, and truly gifted.
“I see a blockage in the kidney,” Shelly reported, “but there’s toxicity throughout.”
Better than an MRI, Shelly suggested a regimen to purify Karen’s system, but it was too late. While climbing the stairs that night, Karen cried, “Something is happening. I can’t climb the stairs, my legs are swelling up, I can’t pee, I’m in pain.”
It was Thanksgiving week. I rushed Karen to the ER for the third time in a month. They admitted her to the oncology floor.
A Russian-speaking oncology woman doctor grimly advanced the plot: “Do you know why you’re here?”
Feeling utterly gaslit, I wanted to blurt, “You’re supposed to tell us!!!”
For the next week, I kept an impossible regimen — waking at 6:00 am, doing yoga, walking the dog, making smoothies, driving to the hospital, waiting for three doctors’ rounds (oncology, urology, and kidney), heading home for my work day, walking the dog, heading back with a cooked dinner, and leaving the hospital at 11:30 pm to walk the dog and go to bed.
One night, while heading home, the Russian doctor gave me stern advice:
“You have no idea how precious this time is.”
Wow.
Still not sure if we had stumbled into Gaslight or After Hours, one more humiliation remained. A year earlier, also on Thanksgiving, Karen and I were sick with COVID. Our best friend was hosting a feast in honor of her father’s 90th birthday. She borrowed our gear for the party while we sat forlornly on a kitchen couch, breathing hydrogen peroxide (off-label) through a nebulizer.
“All I want is a slice of pumpkin pie,” I lamented, hoping our friend would receive the psychic signal and send us a slice of pie — but no pie, just peroxide.
One year later, here we were in the hospital, celebrating Thanksgiving alone. I picked up Emory’s holiday menu of turkey, yams, green beans, and pie and called food service.
“We would like the Thanksgiving special dinner,” I proudly ordered.
“Room number?”
“1214, and be sure to include some pie.”
“Sorry, your wife cannot have pie.”
“Whaddya mean no pie!”
“It says on her chart, milk allergy. The pie has milk.”
“We’ve been married 38 years, and she has never refused pie, not even a sniffle. I beg you.”
“If I go against the order, I lose my job. Ask your nurse to contact her doctor. He can request a change to the standing order.”
I pleaded, “I’m going to find a doctor on Thanksgiving to reverse a no-pie order?”
I got in the car and suddenly remembered seeing pumpkin slices stacked pie-high at Whole Foods. I clicked my phone: “Holiday hours until 3 pm” — 15 minutes!
Lines of people waited for their bagged turkey dinners while I searched frantically for one last slice. Feeling frantic and divinely guided, I thrust my hand under a family-sized serving of mac and cheese. And there it was — the last piece of verboten pie in Atlanta, so I grabbed it.
Yes, there is a God.
From the NY Times: On Feb. 21, Ms. Jones attended the funeral of James White, Mr. Clyburn’s accountant. After serving as an usher at the service at St. John Baptist Church in Hopkins, S.C., Ms. Jones noticed Mr. Clyburn standing against a nearby wall. On the spur of the moment, she said, she waved him over, with a crook of her finger, to the pew where she was sitting.
He leaned over, and she whispered, “I need to know who you’re going to vote for.” He replied: “Joe Biden. Are we together?”
At his Feb. 26 endorsement Mr. Clyburn said, “I decided then and there that I would not stay silent.”
Frontiers of Healing: New Dimensions in Parapsychology. (1977). United States: Avon.