Troubled? Then stay with me, for I’m not.
—Hafiz via Martha Beck
The end of 2023 involved three skin biopsies. My daughter, who is terrified of needles, was present at my dermatology appointment when these incisions took place. So I put on a nonchalant mask as the doctor injected the first dose of lidocaine. I do believe a gasp escaped from my lips despite my best efforts to keep a lid on it. That shit hurts going in!
All three lab results were positive for basal cell carcinomas, a thankfully less pernicious form of cancer than melanomas. This wasn’t the first time a doctor removed cancerous cells from my body. It was, however, the first time that one of the biopsies, the one on my ear, didn’t clear them. So I began 2024 with a Mohs surgery. The first excision didn’t get all the cancerous cells so the surgeon went in with the knife again. I was less in touch in that moment with the removal of body parts than thoughts and fears about the health insurance estimates I chased before the surgery. Each cut cost more money. With that particular surgeon, I made the mistake of voicing my financial fears out loud. She told how many people she’s seen people with chunks of their face missing. So I should count myself lucky. Nothing like a good shaming on the surgery table! Thankfully, the removal of a second skin layer resulted in a cancer-free lab result. Several stitches later, I was sent back into the world and set up a payment plan with my insurance company.
I kept a bandage on my ear for several weeks that made me look like a doberman following an ear cropping (a horrifically inhumane procedure, yes, and an image etched in my mind from childhood). I was and remain a very good patient. I made sure to carefully apply sunscreen to the tops of my ears and wear hats that cover them while playing in Colorado’s UV-drenched outdoors. And I began taking Nicotinamide, a supplement the surgeon said would help to prevent future cancer. “Go me!” said my internal achiever.
In the last year, I also learned about Ruth Cohn’s work on the character patterning that results from neglect. This pattern consists of three P’s—passivity, procrastination, and paralysis—as well as self-reliance. As Cohn writes,
The hallmark of neglect…became clear only secondly, after the unmistakably consistent P’s: A ferocious self-reliance. In the US, with a cultural history and iconizing of ‘rugged individualism,’ self-reliance is admired…Being pack animals, humans are by nature dependent and interdependent. Attachment is a survival need, and interpersonal need is nature’s design. Neglect is the failure or absence of reliable care. A child left alone too much has nowhere to turn but inward…Self-reliance is a defense mechanism and a survival strategy originating with pain. It may evolve to become a haven of safety and the only comfortable way to be in the world. It may also be a point of pride…Self-reliance, although exquisitely adaptive, also makes havoc in the world of relationship. Satisfying relationship involves reciprocity, and if we don’t let the other give also, they may feel unequal, rejected or unsafe. Or they might also appear to take advantage, which ultimately results in messy and often terminal ruptures. It took me decades before I could keep anyone in my life for long, before I learned how unsatisfying and controlling my over-giving might feel to the other, and how disempowering of them my inability to receive could feel.
I said, “Oklahoma,” and Cohn delivered hard (see Ted Lasso). I like to say I am fierce not ferocious, having asked a tattoo artist to create a small panther on my back with that description. To hear my self-reliance described as ferocious underlined with a thick marker how very not-neutral this adaptation is. Until learning about Cohn’s take on neglect, my mind’s eye associated it with a soiled, starving child in a basement, chained inside a cage. I hadn’t connected neglect to the emotional loneliness we experience when we feel disconnected in our relationships with others and ourselves.
Even though I’m a four on the enneagram, I also know I’m not the only one who struggles with allowing interpersonal need. As cultural truth teller Martha Beck points out, it’s a U.S. phenomenon to rely almost singularly on the left hemisphere of our brain, which involves being analytical, detective-like, and fear-stoking. This is NOT the land of relational needs. In contrast, and in her words, “If you go to the right side of the brain—the awe-inspired, non-mechanical, non-material, uncontrolled part of your brain—you will find that you can drink in inspiration, courage, love, joy, beauty, and that these things actually feed the soul.”
So back to skin cancer, which is a very material thing to which I have brought a lot of left-hemisphere activity. I have loathed my skin from the time I was in a very white, wealthy, and so competitive elementary school. I looked around at the popular kids who regularly went to places like the Bahamas for spring break and came back bronzed and beautiful. In comparison, my fair, freckled skin made me ugly and defective. I definitely read Freckle Juice but didn’t internalize the lesson from Miss Kelly that my freckles looked wonderful on me. Instead, I got the message, and reinforced it with that left hemisphere, that I was much cuter when there was only a smattering of freckles on my nose.
I don’t know exactly how old I was when I experimented with cutting freckles out of my forearm with a pair of scissors. Turns out those spots came back even bigger and darker much to my chagrin, with scarring to boot. I had enough sense in that environment to know this behavior was bad. So I stayed mum about it and the shame grew. I did not yet know about the phenomenon of cutting as a Gen X’er with no internet. Still, I discovered a physical way to momentarily release the pain of my self-hatred. As Dick Schwartz might say, I burned down the house to put out the fire.
In the ‘80s and ‘90s, my immediate family and community didn’t take calls for sunscreen seriously. I recently heard some family folklore about how we all got burned to a crisp during a childhood vacation. Years then followed of me unsuccessfully trying to tan my stubbornly fair skin and so abusing it. When I went to Senegal for the Peace Corps after college, I also began to take doxycycline as my malaria prophylactic after experiencing the insomnia, wild dreams, and anxiety that mefloquine induced. Doxycycline was definitely easier on my system but also made me more sensitive to Senegal’s blazing sun. (Non sequitur as wildfires blaze in Los Angeles and climate-change-denying oligarchs vie for more power: Wikipedia just let me know that mefloquine was the first public-private Venture between the U.S. Department of Defense and a pharmaceutical company, and the FDA skipped the phase III safety and tolerability trials.)
As skin issues began to crop up following my return to the U.S., I began visiting the dermatologist more regularly. I had some great experiences with them and some horrible ones. One particularly bedside-manner-impaired doctor asked me where I grew up during our first appointment as she looked me up and down in my skin-exposing gown. “Colorado,” I answered. “That explains the damage,” she replied.
Fast forward to me doing a bunch of therapy, becoming a therapist, and completing sensorimotor psychotherapy trainings. During my second training on healing developmental wounds, I volunteered to be the client for a clinical demonstration with my trainer. Because of Covid, we were online. So I could mostly hang on to my self-reliant delusion as I exposed my internal wounds to this seasoned therapist in front of the other training participants. Nobody could see my squirmy legs outside the video camera frame.
She helped me to contact the little girl inside who used to express her uniqueness by wearing brightly colored elastic headbands laced with gold threads over her braids. We connected with her spunk and curiosity, and my trainer assigned me the homework of calling her to mind on a daily basis. When I look at her, I see her bright eyes and smile, not her flaws. After this session, I didn’t wear concealer or other make up on my face when I went out into the world for the first time since middle school. I remain amazed at the impact of receiving this skillful healer’s warmth, acceptance, and genuine delight in that child part.
Another contributor to the erosion of my ferocious self-reliance occurred this past year when a friend told me she had recently gone to the dermatologist for a biopsy. The stitches from it were smack dab in the middle of her upper back. A fellow self-reliant master, she risked voicing aloud that she wasn’t sure how she was going to care for her wound as the sole adult in her household. I offered to help her care for it, and she consented. When we met for this care-giving, I first slowed down so I could be gentle and intentional. I made sure to get her permission around every step of cleaning and covering her wound. Her willingness to accept this help felt incredibly courageous, and I experienced the entire encounter as sacred. She inspired me to keep connecting with that little one inside and also to let in the care from the trustworthy relationships I have in my present-day life.
When I went to the six-month follow-up appointment for my ear, the dermatologist noted a red spot on my shin. She said the edges weren’t irregular and so she just wanted to keep an eye on it. The spot didn’t go away despite me again being a good patient and applying vaseline to it every day. Toward the end of 2024, I went back to the clinic. A nurse agreed we should biopsy my shin. Alas, the lab test revealed more cancerous cells and also a positive margin. Given the location of the cancer, I was referred to general surgery. Panicked about the medical costs of another surgery if I didn’t complete it while my deductible was met, I immediately scheduled the procedure.
The physician’s assistant (PA) who was available on December 9 told me that the skin around my biopsy was inflamed and angry. In addition to having sensitive skin, I had raked my biopsied shin against the Christmas tree my daughter and I set up the day before. She recommended waiting a month for the procedure. I said my bank account didn’t like that option. So we scheduled as late as she could in 2024—a week and a day later —to give my shin a little more time to heal before once again being cut open. Meanwhile, in the larger world, the public was having an online field day about Luigi Mangione’s recent murder of UnitedHealthcare executive Brian Thompson.
On December 17, I arrived at the clinic for the surgery. As the PA drew the path of the excision on my leg, my eyes grew large. I was unprepared to lose a silver dollar’s diameter worth of skin. I laid back on the table, put one hand on my heart and the other on my belly, and began to cry. Seeing the tears stream down my face, she asked if I was okay.
“Yes,” I replied. “This just sucks.”
She affirmed, “It does suck.”
Instead of stiff-upper-lipping it for her and the accompanying nurse’s comfort, I let the tears flow. I wept for the little me who hated her skin and so did not learn how to love and take care of it. I cried for the ways in which this neglect contributed to me being on that surgical table right before the holidays. I grieved the impending disfigurement of my leg and the temporary loss of mobility I was about to experience. I contacted the hurt under the anger about how healthcare is treated as a privilege rather than a universal human right in the United States.
Since then, I’ve done things a little differently. I did not mask the intense physical pain I experienced right after the surgery with my daughter or others in my closest circle. I therefore received hugs, care, and help. When a very attuned client saw the fatigue on my face a couple of days following the surgery and asked how I was, tears again surfaced. We were human together, and I’m allowing that perhaps this experience was healing for her, too. With a shaky voice and tears in my eyes, I also shared the news of the surgery with the parent support group that I’ve been facilitating since September. I gratefully received their compassion. Small changes, yes, that have been experienced internally as a big shift toward nature’s design.
When I walked into my wound-check appointment on Christmas Eve, my heart rate measured far above normal. I let the nurse know I was dreading this appointment. The PA had told me the wound shouldn’t hurt after a couple of days, and it had been throbbing. Having never taken care of such a large open wound, I found the bandaging process to be quite intricate. My utter lack of expertise in this arena triggered old perfectionism, and I was convinced that the intense physical pain I felt at night meant I had fucked up once again and probably had an infected hole in my leg. The nurse commended my wound care and said it looked great. I again began to cry. I verbally expressed that these were tears of relief and release after a very stressful week. Even though I sensed a little bit of “This lady is crazy,” I stayed connected to myself and grieved how infrequently I’ve held the more difficult parts of my human experience with gentleness and grace, especially in the presence of others.
As I write this essay, I still have the multi-step dressing on my leg and carefully reapply it every other day. My daughter observes that the wound remains disgusting, but the pain is almost entirely gone, and the hole diameter has shrunk to the size of a quarter. I have been tapping into the right side of my brain by offering Morrnah Simeona’s ho’oponopono prayer to my skin:
I am sorry for loathing, mistreating, and neglecting you for so long.
Forgive me for not committing to caring for you more fully until cancer took root.
I love you and the ongoing protection you offer me.
Thank you for reminding me that pain is impermanent and for waking me up to the deeper, fuller love that is here.
Given the wealth of evidence about mindbody unity, will this prayer help to prevent future cancer? I don’t know. That’s also not the point of my offering. As I approach the fifth decade of my life, I am actively relinquishing old beliefs and protective strategies that have limited rather than expanded my life and relationships. I no longer want to collude in the blocking of those beautiful right-brain qualities.
I still can hear the mean-spirited internalized and external cynics chastising all this woo-woo, sentimental bullshit. But their voices are muted. I increasingly trust the curious, compassionate, creative energy of this prayer and its ability to nourish chronic deprivation. I am leaning into the uncertainty, risk, and emotional exposure that make up vulnerability because that vulnerability does indeed sound like truth and feel like courage. Thank you to the growing chorus of voices that are modeling how to live and love out loud as the pack animals that we are.