Please follow me at my new website

Hello, thank you for your interest in my writing about life and conflict competence.

As my life evolves, I’ve improved my website and soon will move it to deborahsword.com. Once that happens, this site, writing4life.ca, will vanish.

I do hope you will check out and subscribe to follow me at my new website and on other social media.

For over 25 years I’ve promoted conflict competence. Blogging has been a major part of my platform. Nothing will change in my commitment to writing about how being conflict competent enhances life and deals with life’s adversities. Only my platform changed.

 

Best wishes

Deborah Sword
(The Conflict Doctor)

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Rob Ford; leadership guru

Rob Ford, 1969-2016

I wrote a post nominating Rob Ford as a guru during the height of the wreckage he wrought at Toronto City Hall. Rob Ford’s leadership offers all kinds of lessons, so that post still applies, and I repost it now in his memory. Perhaps it applies south of the Canadian border as well, to another constituency of angry, alienated voters.

photo credit: City of Toronto website

photo credit: City of Toronto website

I nominate Toronto Rob Ford as guru of the year.

No, seriously. Buffoonery aside – and that’s a huge aside – his ability to keep voters willing to vote for him defies credibility. It’s what I find most astonishing – his self-imposed implosion and dizzying public unraveling hasn’t deterred his Ford Nation from believing in him. That means he has something to teach.

Had Mr. Ford behaved and been competent, no one outside Toronto would know his name. Now he’s stratospheric famous, enjoying status as a late night joke and top ten list attraction. How does he foster such devotion? Are other politicians paying attention? 

Clearly it isn’t his charisma and charm attracting such loyal and loving constituents. Then what, I ask, accounts for it? 

Rob Ford’s simple rules for finding and fostering love and faithfulness.

What I uncovered from Mr. Ford’s musing are life rules to follow for conflict management and living joyously. Surprise – it turns out Mr. Ford’s good, bad and ugly behavior all conceal useful lessons. It’s a shame Mr. Ford subverted these to the Dark Side:

The Good

1. Respond to people, such as return phone calls 

When his loyal fans and constituents explain clinging to his failed leadership, their refrain goes: “He called me back.”

2. Get involved in small problems people care about

Sure, people seek to save the world, but it’s problems on our doorstep that relegate the world’s problems to second billing. When asked about their loyalty, Mr. Ford’s constituents said: “He had an interest in my problem and tried to help me.”

3. Show up

He had an important title and lots of staff, but when he got a call from a constituent, Mr. Ford rang the doorbell. Those who plan to vote for him in his re-election bid maintain: “I needed a solution and he came to my house to discuss it with me.”

4. Have a clear message

Without more evidence, devotees believe he’s great because Mr. Ford says he’s wonderful and does his job well: “I don’t want to toot my own horn here but I’m the best mayor this city has ever had.” (from NewsTalk 1010, November 3, 2013).

The Bad

5. Pay attention

When Toronto City Council held a vote on honoring Canada’s Olympic athletes and the late Nelson Mandela there was only one vote against – Rob Ford. Upon noticing he was on the wrong side of no-brainer issues, he requested a revote to rectify what he claimed was a mistake. Consensus appears to be he voted ‘no’ because he wasn’t paying attention. People have compassion so long as we’re trying our best. Ford’s theory is that if experts urge you to get fit, eat better, pay attention, and be honourable, he’ll purse his lips, curl his tongue, expel a burst of air, and go ‘pthut.

6. Strive for a goal and then share successes and failures

We know 90% of New Year’s Resolutions are broken before January ends, but we make them anyway. We cheer for milestones along the way, and, most important, we tolerate slippage if we believe the person is striving to achieve the goal. We forgive failure if there’s a perception of effort.

The Truly Ugly

7. Be consistent

Toronto still functions despite the gong show at City Hall, but each exhausting eruption of bad behaviour and expiatory explanation drains its energy. The ups and downs keep everyone off balance.

8. Keep expectations reasonable

Communicate boundaries as well as openness, because people react badly when their expectations are disappointed.

9. Apologize as soon as you’re sincere

If Decker apologized to me so insincerely, one of us would sleep in the guest room. No one except die-hards in Ford Nation believes Mr. Ford’s delayed, vague and hollow apologies. Sincerity matters as much as the words.

10.  Hone good judgment

The questionable company he keeps can’t be justified with noble theory such as, ‘I don’t throw my friends under the bus.’ What’s being judged is that those people are his friends in the first place.

 

RIP Mr. Ford

How did national elections descend into a reality TV show?

If cancer reinforced any lesson, it’s that fear is paralyzing. This troubled world needs leaders, not fear-mongers. I expect shenanigans from the Kardashians. None of their clan expects to emerge as elected leader of a democratic nation. Maybe democracy is now courtesy of “reality TV” producers Jeff Probst, Ryan Seacrest and Simon Cowell. Why else would election candidates resemble contestants on Survivor and Big Brother?

I envision a panel of Jeff, Ryan and Simon, seated behind desks, as a candidate enters the audition room and pivots to face the judges.

Jeff opens. “Tell us what’s unique about you that we should pick you to compete in an election.”

The candidate: “Well, Jeff, I’m average, middle class, very wealthy and know every important person on the planet. So I completely understand the challenges ordinary people face in their little lives. I’m committed to helping them overcome those challenges.”

Ryan says to the camera: “Beautiful answer, love it.” He turns to the candidate. “Tell us what kind of experience qualifies you as a contestant – er, I mean, candidate, in our game, uh, I mean our election?”

The candidate: “Great question, Ryan. I’m a true player; competitive, argumentative, no pushover, can’t be persuaded to change my mind, don’t see other’s perspectives, and I win at all costs. I don’t let others finish a sentence. People will root for me because I’m ruthless and good-looking. You should select people like me. No one would watch or vote for unattractive people.”

Simon leans far back: “So, if you see people arguing, I take it you’d look for strategic ways to make their situations worse and your situation better.”

The candidate: “Of course I would.”

Hmm, this candidate must have been selected to appear in the election debates.

Here’s my message to candidates: Jeff, Ryan, and Simon aren’t your judges, voters or pollsters. Ditch the divisive fear, and expensive promises no one expects you to keep. Show leadership to solve the planet’s many problems instead.

3 questions better than ‘why me’

I get it. Living is deadly. The risks are huge and, in time, death is certain. So, my first question on learning I had advanced, aggressive, rare breast cancer was too obvious: “Am I going to die?”

My partner, Decker, said: “Yes.”

When we were done laughing, my next question was: “Soon?”

He said: “I hope not.”

The last question I asked my wonderful oncologist: “How will I know I’ve survived cancer?”  “When you die of something else,” he said as he cheerfully discharged me from care.

Yippee. I’ve survived cancer if I die in a car accident, have a fatal heart attack, or win the Darwin Award.

If I want different answers, I have to ask different questions. Here are my replacement questions:

1. What do I fear? I survive ’til I die and not longer. All the expensive powders, pills and lifestyle secrets won’t deliver immortality. Survival is day-by-day, much like life is. Once I accept this, I can, at the same time, want to avoid and yet not fear dying.

2. Why do I want to know? It’s tempting to ask “why me” but that isn’t the right question for at least four reasons. First, there often isn’t an answer. Second, knowing “the” reason buys into blame as if I should regret my past that ’caused’ the cancer. Third, ‘why me’ makes me anxious about my actions now, when really, I’m doing the best I can. Fourth, ‘why me’ is a despairing cry for my future, as if I have no reason for optimism.

3. How can I express my authentic feelings even if they aren’t happy? Yes, cancer patients do better with positive thinking and good attitude. ‘Positive’ and ‘good’ are twin tyrannies, judging when I think negative with a bad attitude. I  could suppress my authentic feelings or just accept that’s how I feel right now and it’ll change. Conflict teaches that feelings, like relationships, can change, be enriched, repair, heal.

Cancer reduced my ‘bucket’ list to three entries: do volunteer work, write publishable novel(s), and enrich my relationships. Volunteering and writing are my solitary tasks. Relationships – now that’s something I work on with others. After all, everyone still alive is a survivor like me.

I try to ignore or manage the daily risks, live a meaningful life despite those risks, and to delay the certain end. That’s my current answer to the questions for life itself.

Is peace a reward for patience?

German Israel lapel pin

Photo from thegalileeexperience.com/

Is peace imaginable even though it isn’t yet within reach? Is there a vision of what the other side of our current age of turbulence might look like?

The entwined German and Israeli flag lapel pin surprised me. Bigger shock; the lapel pin was on a German army officer’s uniform. I accosted the officer in our hotel lobby. Smiling, the officer explained.

“Israeli and German troops are colleagues. Training in Israel was the highlight of my career.”

Imagine. 70+ years ago Germany exterminated Jews and now they train together. Later, I hiked on the red soil of East Africa’s beautiful, peaceful Rift Valley. Imagine. 40+ years ago Idi Amin Dada took power and slaughtered Ugandans. 20+ years ago Rwanda was riven with genocide. Tourists on safari now watch big game roam where people once ravaged the land and each other. My mind whirled at the passing time and effort that healed three massacres with three reconciliations.

Peace isn’t evenly distributed and there’s never a guarantee of permanent peace. Peace is too big a miracle to expect in a world of escalating violence. Transforming societies post-genocide is not an overnight miracle. It’s many people working hard and forgiving the unforgettable.

Here’s my belief – no, more accurate to call it a prayer – as expiring 2014 bequeaths expanding war zones to incoming 2015:

History is dynamic; the future undetermined. People get exhausted with war, money for munitions dries up, governments change, dictatorships collapse, policy catches up with new realities, evil runs its course, and peace gets a chance. Unknowables include how long it may take and whether it’s minimal peace, or social justice with a real future.

At a personal level, would the cancer treatment that saved my life have been available if I lived in a war torn country? Probably not when resources are disproportionately budgeted to military over healthy people and environments, and education. Headlines in the global news include child soldiers, abducted girls, death from curable diseases, poverty, food insecurity, and many barriers to health and education. World-wide hatred, fear, distrust, and anti-Semitism abound.

And, in these amazing months of travel, I’ve seen resilient peoples rebound and offer a vision of what peace brings. Peace in East Africa has meant healthier children, opportunities for universal education, and awareness of environmental needs.

Since no war lasts forever, what sustainable vision of peace can we work for, each in our own way?

red soil

Queen Elizabeth National Park’s red earth, Uganda

Healthy Child Uganda

Healthy Child Uganda is an NGO helping mothers help families thrive.

Girls go to school, women in cities attend university and achieve high positions at work.

HCU clinic

Dr. Ida reviews the Impressive child immunization rates with Decker at a Healthy Child Uganda District Clinic.

Dr. Ida shows Decker the data

Toronto Mayor Rob Ford’s Valentine’s Day simple rules for love and loyalty

photo credit: City of Toronto website

photo credit: City of Toronto website

I nominate Toronto Rob Ford as Valentine guru of the year.

No, seriously, he could teach Cupid. Buffoonery aside – and that’s a huge aside – his ability to keep voters willing to vote for him defies credibility. It’s what I find most astonishing – his self-imposed implosion and dizzying public unraveling hasn’t deterred his Ford Nation from believing in him. That means he has something to teach.

Had Mr. Ford behaved and been competent, no one outside Toronto would know his name. Now he’s stratospheric famous, enjoying status as a late night joke and top ten list attraction. How does he foster such devotion? Are other politicians paying attention? 

Clearly it isn’t his charisma and charm attracting such loyal and loving constituents. Then what, I ask, accounts for it? 

Rob Ford’s simple rules for finding and fostering love and faithfulness.

What I uncovered from Mr. Ford’s musing are life rules to follow for conflict management and living joyously. Surprise – it turns out Mr. Ford’s good, bad and ugly behavior all conceal useful lessons. It’s a shame Mr. Ford subverted these to the Dark Side:

The Good

1. Respond to people, such as return phone calls 

When his loyal fans and constituents explain clinging to his failed leadership, their refrain goes: “He called me back.”

2. Get involved in small problems people care about

Sure, people seek to save the world, but it’s problems on our doorstep that relegate the world’s problems to second billing. When asked about their loyalty, Mr. Ford’s constituents said: “He had an interest in my problem and tried to help me.”

3. Show up

He had an important title and lots of staff, but when he got a call from a constituent, Mr. Ford rang the doorbell. Those who plan to vote for him in his re-election bid maintain: “I needed a solution and he came to my house to discuss it with me.”

4. Have a clear message

Without more evidence, devotees believe he’s great because Mr. Ford says he’s wonderful and does his job well: “I don’t want to toot my own horn here but I’m the best mayor this city has ever had.” (from NewsTalk 1010, November 3, 2013).

The Bad

5. Pay attention

When Toronto City Council held a vote on honoring Canada’s Olympic athletes and the late Nelson Mandela there was only one vote against – Rob Ford. Upon noticing he was on the wrong side of no-brainer issues, he requested a revote to rectify what he claimed was a mistake. Consensus appears to be he voted ‘no’ because he wasn’t paying attention. People have compassion so long as we’re trying our best. Ford’s theory is that if experts urge you to get fit, eat better, pay attention, and be honourable, he’ll purse his lips, curl his tongue, expel a burst of air, and go ‘pthut.

6. Strive for a goal and then share successes and failures

We know 90% of New Year’s Resolutions are broken before January ends, but we make them anyway. We cheer for milestones along the way, and, most important, we tolerate slippage if we believe the person is striving to achieve the goal. We forgive failure if there’s a perception of effort.

The Truly Ugly

7. Be consistent

Toronto still functions despite the gong show at City Hall, but each exhausting eruption of bad behaviour and expiatory explanation drains its energy. The ups and downs keep everyone off balance.

8. Keep expectations reasonable

Communicate boundaries as well as openness, because people react badly when their expectations are disappointed.

9. Apologize as soon as you’re sincere

If Decker apologized to me so insincerely, one of us would sleep in the guest room. No one except die-hards in Ford Nation believes Mr. Ford’s delayed, vague and hollow apologies. Sincerity matters as much as the words.

10.  Hone good judgment

The questionable company he keeps can’t be justified with noble theory such as, ‘I don’t throw my friends under the bus.’ What’s being judged is that those people are his friends in the first place.

 I want my oncology team to adhere to these rules and earn my undying (especially the not dying part of ‘undying’) appreciation. And, this Valentine’s Day, these rules apply to Decker and me too. 

Resilience helps after a quadruple mastectomy (yup – 4 of ’em)

Oops, I did it again. As in two original breasts, four total mastectomies. Think of that when ordering a double double coffee at Tim’s. After the shock of the first two mastectomies, undergoing another two was – well – a shock. I mean, who has four mastectomies?

Paul comic

“Decker,” I negotiated with my partner, “since you have two nipples to my none, how about a nipple donation? Then you’ll have either a left or right, your choice, and I can have one transplanted to the middle.” He declined.

At least this double mastectomy, on 18 September, was preventative, not because cancer returned. Whew.

remaining breast tissue crop

The July chest ultrasound revealed the bulges were remaining breast tissue and not pooled lymph fluid as we’d believed. Quick consensus followed. Yes, mastectomies may not improve survival. Still, it seemed unwise to leave a potential home for an aggressive cancer while my risk of recurrence is so high. I figured the worst that could happen if I repeated the double mastectomy was that my wardrobe would need adjusting. The worst that could happen if I didn’t have it repeated was too awful to accept as reasonable risk.

Dr. Kanashiro masterfully retraced the incisions she’d made the first time, flattening me further. ‘No’ is still my final answer to reconstruction.

The third and fourth mastectomies were just as miserable an experience as the first and second. Compared to the chemo blowing out my brain, when I fell deep into a non-functional state of profound sadness, repeat mastectomies were only inconvenient. 

Seriously? Have body parts amputated sequentially, endure life alterations in what I’ve dubbed Post Change Syndrome (PCS), and just bounce back? Well, yes. Although ‘bounce’ might be defined as dragging myself up a ragged mountain wall, but that’s where resilience comes in.

In 21 August’s post, I mused about the four qualities that supported my recovery after chemo beat me up:

Resilience, Mindset, Optimism and Discipline.

Once again I relied on these four qualities to recover from drastic change.

The Resilience Project defines resilience well: “In the context of exposure to significant adversity, resilience is both the capacity of individuals to navigate their way to the psychological, social, cultural, and physical resources that sustain their well-being, and their capacity individually and collectively to negotiate for these resources to be provided in culturally meaningful ways.”

I use conflict competence skills to navigate through adversity and negotiate for resources to make my body inhospitable to cancer. But which came first in my case – resilience or conflict competence? I had to trawl my memory for this because, as a professor once said: “scratch a theory, you’ll find a biography.”

Scratch my theory that conflict management is a great skill and you’ll find my biography included battling parents, a home with hostility expressed in screaming insults, leaving me insecure and prone to outbursts. I sought conflict management training to deal with my biography and wound up with a rewarding career and the skills to get through PCS. In my storyline, through negotiation training I gained conflict competence and became resilient.

Grandparents Etta and Meyer Switzer

Grandparents Etta and Meyer Switzer

But I my path to resilience was easier because of one stable person in my childhood – my grandfather.

My new theory: the influence of one stable person plus conflict competence help in adversity. I’m grateful for so many things, including my family and Resilience.

 

4 days after the Calgary flood – #YYCflood, #abflood

This weekend we were environmental refugees. It happened so fast. On my commute home across the Bow River foot bridge June 21, I marveled at the water’s height, speed and ferocity, and took a video. Twenty-four hours later the spot I’d videoed was under six feet of water.

Bow River June 20, 2013

Here’s the screenshot from 5:30 PM Thursday; happy summer solstice. I continued home to make dinner – how extraordinary that ordinariness seems now.

When something’s so ferocious as to make me marvel, I should pay attention to what that’s telling me.

The news reports all evening were dire pronouncements of mandatory evacuation orders of our surrounding neighbourhoods and early indications of devastation to come. Thursday midnight our city councillor texted, tweeted and emailed to “abandon ship” as floods endangered our streets too.

If all around me there’s risk being managed, I should pack an overnight bag to grab on the way out.

Interesting to reflect on what we threw into bags on short notice. Our computers, iPhones and iPads, then some clothes, dog food and other stuff Trail needs, and house insurance policy. No photos, sentimental treasures or souvenirs, no important papers such as passports or financial documents. Just basics to get through the night even though we had no idea how long the emergency would last. We locked the doors, and taped a giant X to our door so emergency crews would know we’d evacuated (and shrugged off that it said the same to looters). I was ok leaving, knowing our possessions could be destroyed. It’s just stuff, right? Such rationalization.

It’s helpful to have ID and money, just in case i should have to prove my identity or pay for a hotel room,

So, after 1 AM Thursday, we and two other neighbours and dogs, imposed ourselves on the kind family in a dry house on the hill. All communities with names like Ridge, Hill and Heights look very attractive now. We fell into Mark and Giovanni’s guest rooms, almost comatose with exhaustion and stress. Imagine Roman, age 8, and Ani’s, age 6, surprise to wake up with 4 people and 2 dogs extra at breakfast. They were beyond gracious and wonderful and the first of many such experiences over the next four days. Patty Nowlin, a co-owner of our superb local Sunnyside Natural Market, closed, flooded, and with no power, let me shop for essentials while she skillfully organized food boxes to donate to streets around us. Meanwhile, a market clerk hand wrote a list of what I took, trusting I’d come back to pay for it when the store reopened. And remarkably, looting was minimal if at all.

Strangers helped out with no thought for their own convenience.

The rivers continued to rise and became tourist attractions despite official pleas to stay away. We became a city of gawkers, driving vast distances to – well, to gawk. One man stood outside his flooded home and yelled at gawkers taking photos to either come down from the hill and help or go home. For the most part, people came in droves to help. That was the next amazing sight to behold; Saturday, the sun and volunteers in the thousands appeared to lift the gloom. Sunday repeated and then Monday the same. With so many offices ordered closed, people had free days to help out. They just turned up to volunteer – in the thousands.

I also understand wanting to see it first hand in ‘real time’ because this event should be a game changer for the city.

Poppy Plaza: Calgary freelance photographer Chantelle Kolesnik.

Poppy Plaza: Calgary freelance photographer Chantelle Kolesnik.

It isn’t easy to visualize the narrow blue Bow River as an angry brown lake, rushing with determination to some point past our horizon. The inscriptions on Poppy Plaza, normally towering over the riverside path, were almost obliterated. The waves crashed against Poppy Plaza’s steps that sit about 20′ above the normal river bed. Poppy Plaza is on high ground at our corner, where Memorial Drive parallels Bow River, thus sparing our street. It may not be an attractive monument but I’m grateful it was big, blocky, and there.

Parts of downtown still aren’t open for business, four days after the river went to bed though it is still, in Olympic spirit, “Faster, Higher, Stronger”. Short-term costs are unpredictable and long-term consequences are unforeseeable.

Get comfortable with ambiguity.

image004 image003Calgary downtown was a dangerous mess and the famous Calgary Stampede became an uncertainty. Last year was its centenary of unbroken yearly events and this year – who knows. Calgary’s known for its spirit and might find a way to remove the broken infrastructure that collapsed onto its famed festival grounds. There’s less than two weeks until the fair grounds are due to open and the horse barns, livestock pens, agricultural buildings, famed Saddle Dome (in my opinion the only iconic building in Calgary), might as well be rafts. They’re submerged to the door knobs with a layer of sludge under the water. Friday the relentless rain added to the woes. But, they say the Hell or High Water Stampede will go and they might pull it off.

If anyone can put on a rocking Stampede #101 a mere 12 days after tragedy, it’ll be this city.

There’s a certain liberation in not knowing where the water would go and being impotent to do anything about it anyway. Our local streets were impassable but everywhere beyond the flood plain was as usual. There were two cities; one was under water, and one was completely unaffected, as if it were happening on the other side of planet Earth.

On Friday we moved from our rescuer’s welcoming home to our friends the Reynolds’. Six of us elegantly dined, like nothing in the city was amiss, in an upscale restaurant – fiddling while Rome burns. We felt displaced yet not so disrupted. How ordinary in an extraordinary time.

Carpe diem – live the day, eat well and laugh because the river doesn’t care.

Meanwhile, some of our friends were in nail biting races against a combination of sewer water from pipes that couldn’t cope with the surge and cold river swells raging at four times normal speed, throwing entire trees downstream. It’s possible friends will be displaced, possessionless, for months; many, many months. It puts my laissez-faire attitude of “can’t change anything so might as well dance” in perspective. I had the wonderful Reynolds family’s lovely home to escape into and resources to cope with whatever happened next. Lots of people have neither – lots, and lots and lots of people.

Pets needs their people, people need people too.

When we accepted Trail into our home, it became our ethical responsibility to keep him safe. And he’s family. We asked the kind people who took us in if we could bring Trail. I don’t know what we’d have done had they said no. Now we read of the many pets left behind, or even stolen in the confusion.

John & Trail enjoy the flood 2013

We had the opposite problem. Trail had the time of his life; everyone fussed over him at both our temporary billets. The Reynolds family is now Trail crazed, even wonderful Kathy who’s allergic to dogs. John Reynolds came home from work and lay down on the floor beside Trail before saying hello to us. Kathy, John and their fabulous daughters Lauren and Julia took Trail walking while we loaded the car for home.  As we called Trail to leave, he walked over to the porch and lay down at their feet to watch us go. He loves us, he really does, but we’re apparently not exciting enough, or at least not as exciting as the Reynolds.

http://past.theweathernetwork.com/news/storm_watch_stories3&stormfile=Albertans_search_for_pets_lost_during_floods_24_06_2013

photo

We went home Friday morning to clear out the fridge and freezer before everything spoiled, and returned to our Reynolds refuge. Tweets flew fast. When we learned all our neighbours were home bound Saturday, electricity or no electricity, we packed the car. An official “Welcome Home” flyer at our door listed how to safely re-enter. Wow, this is a city with a great emergency plan.

Our house was dry at 9:00 PM Saturday. No gas smell, no river or sewer water in the basement and no power. And then, at 10:40 PM, power was suddenly wonderfully restored. All the lights we hadn’t turned off because we didn’t know they were on just sparked and lit up like beacons guiding us home. A spontaneous street party erupted as neighbours rushed to porches to cheer the lights coming on with a chorus of John Lennon’s Power to the People Right On.

We slept at home  – safe, dry and beyond grateful for everything that did and didn’t happen.

The budget for clean up is in the billions of dollars and the total damage hasn’t been assessed yet because the rivers are still high, rainstorms are still forecast and buildings are still sloshing with water in their basements.

2013-06-24 09.54.09

The City of Calgary and its impressive Mayor Nenshi had a disaster emergency plan that worked. Within hours of the peak water falling, trucks, equipment and people were on the job. Monday I walked to my Parks Canada dream job to get my computer and mobile. I passed this line up of trucks awaiting deployment around the city. As I worked from home, a stream of uniformed people came by as part of the door-to-door check-in, assessing needs and offering information. The other hordes, aside from the efficient emergency workers and caring volunteers, are the opportunistic mosquitoes thriving everywhere.

Sometimes, just sometimes, the politicking, the squabbles, the pettiness and the politics of fear just don’t matter and people show off their kinship to the angels. This weekend was one of those times for many of us in Calgary. As a conflict manager and as a human being who received help when in need, it warms my heart to see the impacts on our collective humanity from this collaboration at all levels.

May it continue in this spirit.

How can we make the choices better?

Asking ‘what are the other choices’ is often the right question

The oncologist offered me a choice of do nothing (die within four to nine months) or have six cycles of a chemo cocktail called FEC-D (fuck-D my dear friend Barbara called it).

Yucky options both.

We asked for a week to research other treatments. We learned of one that, although it wasn’t yet in our health system’s protocol, had hopeful outcomes for Triple Negative Breast Cancer. We brought this third option and my oncologist agreed. After treatment ended new research confirmed our choice improved my chance of survival. Whew.

Maybe this is the wrong question: How can we make better choices?

What would happen if the question was: How can we make the choices better?

When my conflict coaching clients produce a choice of either X or Y, and then agonize over whether to do X or Y, I ask: “What are the other choices?”

Changing the question creates a new conversation

Here’s an example from the news: Canada’s federal politicians debated sex selection abortion; that is, should there be legislation banning termination of female embryos because of a cultural or other preference for sons? Debates included the usual pro-choice and anti-abortion arguments.

The better questions weren’t asked: how do we change mindsets so that girl children are as valued and loved as boy children? What would it take to have the gender of the child irrelevant in matters of wedding costs, succession planning, inheritance patterns, and looking after parents in their old age? If women were valued the same as men, domestic security and outcomes for all children would improve.

How to recognize wrong questions?

Here are two familiar choices I consider the wrong question:

Shall we have an intact environment or have jobs fuelling the economy?

Is it better to reduce taxes so people keep more money each month or fund adequate public services so people spend less on the service individually?

And so on. The best answer is – it depends, but the question is a forced choice.

Wrong questions limit the answer. They’re easy to spot in ‘either – or’ simplified extremes pitted against each other. Does asking better questions generate more (better?) options?

Problems reduced to forced choices often result in decision paralysis. Complex human values reduced to rigid simplicity make both choices feel wrong and decisions become hard.

Choice is a blessing if the options are good

Tuesday I go to my office after almost two years on disability. Am I excited to return to work I love? Yes. Scared? Absolutely! Did I enjoy being home? Yes. Which would I rather do – go to work or stay home? It stops at a simple yes because that question is limited. In this time of transition, I’m grateful to have a choice of two wonderful ways to spend my days.

Having choice is such a luxury. The wisdom in the cancer field is that patients involved in their treatment decisions do better. So, on my last weekend before going back to work, I’m sitting in the spring sunshine appreciating the privilege of having choices because of an expanded list of options.

Conflicts and health are frozen accidents

medical equipmentIt turns out my story falls right into the confusion about how and when to test for breast cancer and whether doctors order too many diagnostic tests. Throughout my forties, I followed the routine wisdom of annual mammograms. Then, the wisdom changed. Had I followed the new recommendation to skip a year after a normal mammogram, I’d have waited for 2011 and been dead in 2010. Late stage Triple Negative Breast Cancer was overlooked in the 2009 mammogram. So, in theory, I shouldn’t agree with the changed recommendation. Yet, based on my experience, I do agree.

Some of the injected uncertainty surrounds good questions: What’s an effective test – Breast Self exam? Mammogram? Ultra Sound? Needle Biopsy? How many is too much? What is over-testing? When is standard cancer treatment necessary? The Medical Associations say it isn’t about the money spent on over testing and over treating, but I doubt real people believe that. People aren’t statistics. I ache for the 24 year old who’s stage 4. Her doctor, damn him, didn’t diagnose it because his guidelines ruled out breast cancer at her age. But my perfectly healthy breasts were over-tested and over-treated for about a dozen years and then, when I did have breast cancer, the radiologist missed it.

I had dense breasts. Mammograms throughout my forties were unclear so next I’d get sent for ultrasound. Those showed anomalies, which landed me in the needle biopsy lineups. Ambiguous results there got me an excision under local anesthetic with regular Oncology followups. That happened almost every year. And, my breasts going into my fifties were great (as in normal pathology as well as nice breasts).

I got upscale diagnostics and that saved my life, and yet, I intuitively support the new recommendations to reduce testing. How’s that again? Well, it depends on where one draws the boundaries. Short term, if I hadn’t had the 2010 mammogram I’d be dead. Those boundaries are linear and close in time.

But health is a time series and nonlinear. So, let’s expand the boundaries. My medical intervention started long ago with breast cysts that doctors poked, radiated, and needle biopsied.

MR900281051Had they not stuck needles multiple times into cystic breast tissue, would I have gone on to develop breast cancer? That’s the nonlinear question without answer.

There’s some research that suggests a connection between screening tests and cancer outcomes decades later. I read the pathology reports of the tissue formerly known as my left and right breasts. The cancerous micro-calcifications in my late fifties were at the sites of all those unnecessary diagnostic needle biopsies in my forties.

My correlation between where the needle went in and where the cancer was found isn’t proof of anything. However… Maybe the new guidelines will contribute to some young woman not having her breasts over-investigated now, and then she won’t develop breast cancer later. There’s no do over button to go back in time and try the other path, to see if I wouldn’t have gotten cancer had I not been over-tested. I’ll never know if the outcome could have been different. Life doesn’t come with an eraser.

MR900233887Dr. Murray Gell-Mann dubbed the events that create our current life ‘frozen accidents’ – that is, what we think of as history is just a series of coincidental cascades where events happened in a particular order to bring us to today. The answers to our good questions can depend on where we draw the boundary around the history. If I look from 2009, the cancer missed in the tests, to 2010 when it was found, I support all the testing money can buy. If I push the boundary back ten years, to 1999 or more, I was way over-tested. What I see depends on where I stand – it’s path dependent.

And that’s how it is with conflicts. Short term, we see a direct effect or reaction from whatever happened last. But, the helicopter view of the field shows lots of contributions to the situation, some of which were seeds planted years ago by people who aren’t currently participants in the fray. Effects can be disproportionate and indirect to causes. People aren’t statistics in conflict either.

Health and conflicts are both nonlinear time series where anything can happen in any order until the accidents freeze. Then, we call it history. We could as easily call it a randomized crapshoot.

I can’t do it over. If I could, I’d be tested less, just like the new guidelines recommend.

Meanwhile, here are some links to the medical controversy over diagnostic screening and breast cancer.

http://www.ncbi.nlm.nih.gov/pubmed/2828910

[Relationship between biopsy and prognosis of breast cancer].

[Article in Japanese]

Fujimori M, Senga O, Terai N, Miyagawa M, Iida F, Tsuchiya S, Koike Y.

Source

Second Department of Surgery, Shinshu University School of Medicine Matsumoto, Japan.

Abstract

Clinical data from 131 patients who underwent primary radical operation for breast cancer at the Second Department of Surgery, Shinshu University Hospital during five-years from January 1976 to the end of December 1980 were analyzed to investigate for the relationship between biopsy and prognosis. The incisional biopsy group had a significant higher recurrence rate as compared with the no biopsy group, cytology group and the cancer negative group after excisional biopsy. Although the puncture aspiration cytology group did not show significant difference in recurrence rate, an any more than 3 weeks of interval between puncture aspiration cytology and radical surgery associated with a significant high recurrence rate. This suggests that the interval also exerts an unfavorable influence upon prognosis. Puncture aspiration cytology was recognized to be apt to result in distant metastasis than any other biopsy methods and also it is tended to have a higher recurrence rate in scirrhous and mucinous carcinoma of the breast.

PMID: 2828910 [PubMed – indexed for MEDLINE]

http://www.ucsfhealth.org/education/breast_cancer_risk_factors/index.html

http://www.breastcancerchoices.org/faqbiopsies.html

Background: Needle biopsies pierce the suspicious breast mass to draw out tissue for analysis.  Some researchers fear these procedures may spread (or seed) the cancer, causing something called “needle track metastasis.” Others feel this possibility is not a significant concern or that the immune system, surgery and/or radiation that follows will clean up the area. Each individual must review the information that is presented in this BIOPSY section with her doctor and decide for herself whether or not to undergo these procedures.

In June 2004, the results of the bombshell Hansen study, “Manipulation of The Primary Breast Tumor and The Incidence of Sentinel Node Metastases From Invasive Breast Cancer,” were published in the American Medical Association’s prestigious journal, Archives of Surgery, revealing that patients undergoing fine needle biopsies were 50% more likely to have micrometastases spread to the sentinel lymph node than those patients having the entire tumor removed for biopsy.

Over the years, several researchers have voiced serious reservations about routine needle biopsies, but they were mostly ignored by their colleagues. Hansen’s research team cited their predecessors, and the research path leads back several decades. It’s hard to understand why The Archives of Surgery study, which embodies all of these reservations about needle biopsies, didn’t make the front page of the New York Times.

…. Chen (2002) suggested needle biopsies may not only raise the risk of spreading cancer cells within the breast tissue itself to such a degree that radiation therapy is recommended, but Hansen (2004) biopsies may also spread them farther, beyond the breast, to the sentinel node.