I remember well a conversation I had about ten years ago with one of my brothers. At the time, he was completing his medical residency in psychiatry. He was also a smoker. We were having a drink together and as his older (and overbearing) sister, I couldn’t stop myself from asking him: “how is it that you have gone through medical school and you continue to smoke, given you know how bad it is for you?” After hearing my question, my brother paused, took a long drag on his cigarette and replied: “Do you know what is really bad for you? Stress.” We both had a good laugh at this point, but more and more I realize he had a point: stress IS really bad for you.
I am acutely aware of the effect of stress on my health at present for two reasons. First, I am under a lot of stress. Being sick, whether it is acute or chronic illness, is stressful. Pain, troubling symptoms, uncertainty, tests, doctors appointments are stressful. Second, given I still have carcinoid syndrome, stress manifests itself physically in unpleasant and distinctive ways these days. When I have encountered acutely stressful situations in recent months, whether it be an uncomfortable encounter with someone, a letter from the IRS (handy tip: doing your own taxes a month after brain surgery may not be a great idea), or finding out I need another surgery, I end up running to the bathroom with what feels like dysentery and I start wheezing and break out in hives. Sometimes, it is only when I start breaking out in hives that I actually realize how stressful a particular encounter is! My body has developed a finely tuned stress-o-meter that is very hard to ignore. As weird as this sounds, this is actually quite common for patients with neuroendocrine tumors and it has a medical explanation: neuroendocrine tumors produce hormones (such as serotonin and histamine) and stress can cause large amounts of the hormones secreted by the tumors to be dumped into your system, causing exactly the kinds of symptoms I have been experiencing. These days, I often have a stress-o-meter reading right about here:
This basically means it doesn’t take much additional stress for me to get physically ill. I don’t want to live in the red zone on my stress-o-meter and am working very hard to try and get as far into the green zone as I can. As a result, stress management has become an important part of my plan to stay sane and get my health back. It is just as important as being careful about what I eat and continuing to chase down and treat the remaining medical problems in the queue. Part of my stress management plan involves reducing stress through things like gentle exercise, petting the dogs, reading a book. The other big part of my plan that has made a major difference is avoiding stress: limiting the amount of stress I allow myself to be exposed to.
One of the most important lessons I have learned from being sick is the importance of saying no and creating healthy boundaries. I am by no means great at doing this, but as time goes on I am getting better and better. There is a certain amount of stress in my life I cannot avoid at present, but this stress really is limited to my body, my finances, and anything that happens to my inner circle of loved ones – that’s a tiny set of people and issues, at the end of the day. And when I do face stress that cannot be avoided, I force myself to set limits on it. Upset about a bad doctor appointment or a negative test result? I give myself exactly 24 hours to mope about it and then I let it go. Period. Ruminating over something that I have no control over and that happened last week, much less six months ago, is a really dumb way to use up my limited resources for handling stress today.
The rest of the stress I face in life is stress I can choose to avoid. And I am making every effort at present to do just that. I cannot – and will not – cope with drama when I am already in the red zone. I will let passive aggressive (or aggressive) comments or questions slide off my back. I will not worry endlessly if someone is upset at me over an unintended slight. I will not feel obligated to help other people fix their problems. I will not take the bait when I am poked. I will quickly and quietly escort troublemakers to the door. And I won’t beat myself up for that. This doesn’t make me a selfish or callous person – I am simply putting my own oxygen mask on first. If I allow myself to get sucked into avoidable stress right now, I have no one to blame but myself.
Saying no and laying down healthy boundaries stressed me out at first. It is hard to do this and not feel guilty. But with practice, this is getting easier and easier. I am still far from being a Zen master, but I am getting better every day. Not everyone has reacted well to the new boundaries, but I am okay with that too. People that get mad when you put your own oxygen mask on first probably also failed to notice you were struggling to breathe in the first place. Those aren’t the kinds of people you want in your life anyway.
You are the only one that can limit avoidable stress to protect your health, just like you are the one that is responsible if you get sick because you decided to eat fried chicken instead of kale (and sometimes it is worth it!). If you want to have an oasis of calm, in spite of the stress you cannot avoid, you have to create it yourself. No one can or will do it for you.