Sunday, July 18, 2010

When N = 1

blue egg & wisteria
Originally uploaded by Seeking Tao

An uncomfortable feeling is not an enemy.
It’s a gift that says, "Get honest; inquire.”

The world is nothing but my perception of it.
I see only through myself.
I hear only through the filter of my story.

Byron Katie.

Katie gives us lessons that we all can use, but today I want to approach them through the lens of cancer… and statistics.

When I revived after surgery, I asked my first question of my doctor and chemotherapist: "What is the best technical literature about mesothelioma?"
She replied, with a touch of diplomacy… that the medical literature contained nothing really worth reading…

The literature couldn't have been more brutally clear: mesothelioma is incurable, with a median mortality of only eight months after discovery.
I sat stunned for about fifteen minutes, then smiled and said to myself: so that's why they didn't give me anything to read.
Then my mind started to work …
Stephen Jay Gould, The Median Isn’t the Message

My niece, Eve, has had a recurrence of her cancer.
Since we got the news several weeks ago, all my spiritual learning seems to arise from that reality.
I have been questioning many of my beliefs with new urgency.

I have been reading the latest literature on Hodgkin’s lymphoma, stem cell transplants, curcumin, inflammation, macrophages, CD68...
I have been pushed to look deeper until there seems no difference between the spiritual and the totally pragmatic, nitty-gritty of “you bet your life.”

So much is shifting, I have been struggling to process all of it into a useful form.
I can only imagine how it’s been for Evie.
It doesn’t feel like I have been all that successful in my efforts to organize my thoughts and now, the easiest way of sharing seems to simply tell a story.

Ah stories, I love them. What else is there?
Byron Katie

So, here is one regarding N = 1:

My internist and I spent at least two years trying different medications for lowering my blood pressure. Then, I happened to get laid up in bed unable to eat. That got me off drinking coffee without even trying.
After that, I noticed that my blood pressure finally normalized.

I took a month’s worth of the numbers to my doctor.
Yes. Caffeine seemed to be the culprit.
We were happy for a moment, and then he said, (I guess because he knows I do research)
“N equals one.” … in short, my experience didn’t prove a thing to him.
It took a few hours before the stupidity of his comment really began to sink in.

Well, Hell!
N did equal 1, but when that One refers to me, that’s all I need to know!

Suddenly, I realized that my doctor and I had different interests, maybe even conflicting interests.
He wants to know what will work in general for the whole panoply of patients that cross his threshold.
Meanwhile, I want to know what will work for me.
And now I see, the same holds true for cancer patients.

What does "median mortality of eight months" signify in our vernacular?
I suspect that most people…would read such a statement as "I will probably be dead in eight months" - the very conclusion that must be avoided, since it isn't so, and since attitude matters so much.

Stephen Jay Gould

In his essay Dr. Gould explains his rationale as a scientist who knows statistics.
And I wish all cancer patients could know his story.
He didn’t swallow the statistics naively.
He interpreted them with an eye to N = 1 and in a scientific manner.
He lived for twenty years after his diagnosis with his mind clear, at least on this point.

He lived to tell his story.

Which kind of brings me back to Byron Katie.
She likes to begin spiritual inquiry with two questions regarding the thoughts we think:
Is it true?
Can you absolutely know that it’s true?

Ask yourself these questions and you’ll soon discover that usually the answer is either “No” or “I don’t know.”

For instance with Hodgkin’s statistics, by the time my head allows for four different forms of the disease, four stages, two sexes, a bimodal distribution in age, bulky or non-bulky, treated with these drug or those drugs, that number of cycles, radiation or no radiation, I have no idea how many in the study are actually closely matched to Eve.

So, what do these statistics really say to me, the N = 1 that really matters?
I don’t know.
The doctors don’t know.
NO one really knows.

The door to God is the insecurity of Not Knowing anything,
Bear the grace of that insecurity, and all wisdom will be yours…

Adyashanti, Emptiness Dancing

Not knowing isn’t an easy place to be. It can be quite uncomfortable.
But it is an honest place.
And it is as good a place as any to rest and to take the next step forward.

How do you get back to heaven?
To begin with, just notice the thoughts that take you away from it.
You don't have to believe everything your thoughts tell you.
Just become familiar with the particular thoughts you use
to deprive yourself of happiness.
It may seem strange at first to get to know yourself in this way,
but becoming familiar with your stressful thoughts
will show you the way home to everything you need
Byron Katie

Enjoy Gould’s essay and grow strong.

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