“D” is for: Decide what you will think and how you will act

One of the most influential books I ever read was Victor Frankl’s “Man’s Search for Meaning.” So much can be gleaned from this masterpiece, but one of my favorite lines has to do with the “choice” of what and how to think.  As Frankl writes from the concentration camp in which he was a prisoner, “Everything can be taken from a man but …the last of the human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s own way.”  Indeed, everything was taken from him and his fellow prisoners as they lived through unthinkable suffering at the hands of the Nazis.  And yet, his choice was to not only live through the experience with grace and dignity, but to describe an entirely unique therapeutic method of finding meaning and a reason to live.

It’s a bit of a stretch, but perhaps it can be useful to compare living with a severe chronic disease with living in a concentration camp…at least this might work with the chronic diseases that are not self imposed, that cause pain and suffering, and that end in death.  Extrapolating Frankl’s quote to chronic diseases such as these would be something like, “Every part of health can be taken from a person except the choice of how he/she will respond to the situation.”

Yesterday, I had an “opportunity” to try out this tip.  As many of you probably know, the experience of going in for “routine” pulmonary function testing can be quite anxiety provoking for someone with CF.   It’s just a number…a measly “percentage of predicted”…. but that FEV1 result (the volume of air you can blow out in one second) carries with it amazing psychological power.  It’s no wonder, really.  Doctors use it to gauge how much of your lung tissue is still useful.  A sudden drop will land you in the hospital faster than you can say “pseudomonas.”  Transplantation becomes a dinner table topic when it drops to around 30%.  The progressive nature of CF dictates that it doesn’t improve much really (unless it drops acutely due to an infection that is then  treated successfully).  Over the long haul…it only drops.  We all just pray that it drops VERY slowly.  We worry about it.  Some lose sleep over it.  The kicker is that we have virtually no control over how well we do.

So yesterday, as part of a clinical trial I am volunteering for, I went in to Stanford for my baseline exam, and of course, spirometry was done.  I was a bit nervous about it, because the previous time I had been tested, I did so well that I didn’t believe it (see previous post).  My hope was that I would do as well this time, but deep down, I didn’t believe I would.  I would then have to accept that the previous measurement was a fluke (and I really didn’t grow a new lung in 90 days).

My nervousness turned out to be justified.  In fact, I was a good 25% below that previous unbelievable number.  Worse, I was 10% below the baseline I had been at for years.  The maddening part is that I had no idea why my numbers were down.  Not being artificially high, I could handle.  10% down made no sense.  I didn’t feel sick.  I had been coughing a bit more…but not that much.  I was bummed, and my research nurse friends knew it.  It was all I could do not to cry right then and there.

Driving home, I had a tiny epiphany.   I had already started this post.  In fact, I was stuck at comparing disease to concentration camps.  Suddenly, I knew that the “universe” had just presented me with a way to finish my article.  I realized I needed to “decide” how to think about this new development, and what to do about it.

Guess what I decided to do?  That’s right.  I went directly to the gym.  I did not pass GO.   I did not collect $200.  I hopped on a treadmill and ran intervals.  I proved to myself that a number was a number, and what mattered was how I felt.  And I felt great on that treadmill!  Then I lifted weights.  Then I decided that for the rest of the day, I wasn’t going to think about it…period.  And I didn’t.  I got busy working on a project and busied myself doing what I love to do.

The next day, when I was calm enough to be rational, I came up with a plan.  I will have to repeat my PFT’s next week when I go in for my quarterly appointment, so I’m not going to overreact.  If my numbers are truly down as much as it appears, I will talk to my doctor and get his input.  Maybe I will need some sort of intervention, maybe not.  What I do know is that I need to go back to the P90X program (or something equally intense).  It seemed to work before, so this would be a good chance to recreate my previous success.

What I will not do is panic and let fear cloud my decision making.  The worse case scenario is that I have a new baseline. If this is the case, I will choose to respond rationally.

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