Magic Moments: Learning to choose to live these moments.

We call it the “magic moment.”

We use our diesel engine to get from the marina, down the channel and onto Lake Michigan. In the open water I hoist the sails. When the boat starts to be powered by the wind, the time comes.  We reach down and pull the T-handle that controls the fuel to the engine. Pulling it out shuts down the engine.

What comes next is wonderful:  Silence.

In that moment I can feel myself relax. I didn’t realize that I was tense. The noise of the engine didn’t seem to be much of a bother but the quiet that comes after turning off the engine is a special feeling. 

Take a minute. Force yourself to set aside any worries, things to do, or things that are pulling at your mind. Take a deep breath and then slowly let it out.  That moment – that feeling – is what I am talking about. 

This is something that I am working on. Let me explain.

First, a quick update on my health journey:

• I am coming up on 4 years since my diagnosis with adrenocortical carcinoma and the subsequent surgery, radiation, and chemotherapy.
• I am getting CT scans every 6 months now. My last scans in May 2022 showed no evidence of recurrence.
• I have been left with adrenal insufficiency. 
  • The adrenal glands produce various hormones but most importantly cortisol. Normally the adrenal gland cycles up and down the amount of cortisol that it produces to match the demands (or anticipated demands) on the body. In the non-stressed state, cortisol levels are the low. When the body faces stress, cortisol levels go up. 
  • In persons with normal adrenal glands, the cortisol levels are lowest in the evening as they go to sleep. Starting in the very early morning (around 3 am) the adrenal glands start to produce ever increasing levels of cortisol, with the levels peaking around 7 am. This is part of a normal pattern of rest and then preparing the body to wake up and be functional. Have you ever noticed that chilled and achy feeling that you have if you wake up in the very early morning? That is because your cortisol levels haven’t risen enough yet.
  • If you are exposed to stress the adrenal glands will surge and produce extra cortisol to respond to the stress.
  • After the removal of my left adrenal gland and then a period of taking mitotane to suppress my other adrenal gland, I don’t make enough cortisol to keep up with what my body needs.
• I take replacement cortisol, but there is no easy way to match the sophisticated up and down patterns of normal adrenal glands.  For me this creates a variety of symptoms that I have been learning to live and cope with.

I am continuing to learn.

If I am under stress my symptoms of adrenal insufficiency get worse.

Not all kinds of stress make me worse. I seem to do okay with some physical stress (exertion). I am surprised that I can do well with stressful medical situations at work (patients in cardiac arrest, ECMO cannulation, intense goals of care discussions, etc…) Some emotionally stressful situations I do fine with. Others can destroy me. I will suddenly feel weak, lightheaded, with my muscles aching and a sense of heavy fatigue.  It is like a car that sometimes runs fine and then other times, without warning, starts bogging down and loses power.

I have been trying to learn and understand the patterns to figure out how to cope with it all. 

Some tasks or situations are well suited to my personality. Other situations go against the grain of who I am. In those situations, I am supposed to step up and be the person that I need to be rather than the person that I am.^[1] I have learned that those situations are the ones that can be more likely to drain me and make me feel the low cortisol symptoms.^[2] I can’t avoid, and I may not want to avoid, all of those sorts of situations, but I can strive to be in places that fit me and my strengths most of the time.

I have also been working to learn more about how to deal with stress in my life in general.

There was a time when I would feed off stress. When we are young, we often pursue whatever is exciting. I can think of lots of examples: roller coasters, adventure movies, exciting stories, etc. I can remember the heart pounding thrill of each call for the ambulance. I would act casual (no big deal) about it. I was professional and calm. But each time, driving down the road with the lights and siren, I would feel a surge of adrenaline. It was addicting. 

It reminds me of Dr. Gerald Abrams. He was one of the pathology professors at the U of M medical school. He was famous for telling us that we all crave to learn pathology (what is wrong.) People say they like what is normal but they really don’t. They are drawn to the excitement of the abnormal. He would tell us that all of us were secretly longing to see and learn what goes wrong with the body (the pathology). He would then go on with his lecture and show us gory slides of all sorts of maladies. As young medical students we would eagerly take it all in.

We say that we want calm and peace. We spend most of our lives looking for adventure and trouble.  That is fine. Life is an adventure, and we should live it in all of its glory.

But we need moments away from the stress of the world. I am learning that I need these brief breaks. I am also learning that I am not very good at taking them.

One of the nurses I worked with told my wife that I was like a little duck. I would be floating on the surface of the water looking completely calm. But underneath, my little feet would be paddling away with full force. I pretend to be a sailboat, peaceful and calm. The truth of the matter is I tend to push the throttle forward, with my engine clanging away and then wonder why I am running out of fuel.  I am learning that I must make myself reach for the T-handle and cut off the fuel to the engine. I need these quiet “magic moments” and when they come, I need to experience them and enjoy them.

When I have a moment of quiet, my habit is to immediately fill it. I instinctively reach for my phone. I open up Facebook, LinkedIn, Twitter, Instagram, the news, Worldle, etc. I should be savoring the moment of peace and calm.  Instead, I keep running in my mind seeking out the next thrill. 

• Sitting in a moment of quiet, my mind races ahead to things that I need to do or the worries of my life or the world.
  • It is okay to admit that I can’t and don’t need to solve all the problems around me (“all the problems of the world”) in that moment. It is good for just a little while to let go of all the worries and stress.
• Driving in the car I flip through the satellite radio stations and if there is nothing I like, I click on a podcast. 
  • Sometimes I should just take a deep breath, push out the worries of the world, and in silence enjoy just rolling down the road. 
• Sailing on the boat, I get up and fuss and tweak this or that sail.
  • Sometimes I should just be still and experience the moment.  I am learning to take a deep breath and let myself be still. 
• In a conversation with someone, I let my mind race ahead to my next comment or to the next topic.
  • I am learning to instead just listen and experience being with them. Life will go on if there is a gap in the conversation. It is not a performance. The moment is about being with them. 

Pull the T-handle back and let the engine shut down for a little while. Let the wind push you forward in wonderful silence. We don’t have to always fix, do, or perform. There will be time to do that later. 

I also don’t have to stay in those moments. Life is full of adventures and stress. That is just the way things are and normally we can rise up and meet the challenges that are presented to us. I do enjoy a thrilling show on satellite radio or when I have the energy to take on a new project.

But we also need these “magic moments.”

It is good for me to look down the road, or at the scene on the lake, or at the face of my dinner companion, and give up trying to achieve something. I take a deep breath and for a moment, let myself just be.

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^[1] https://manmedicineandmike.com/can-you-be-the-person-that-the-uniform-demands/

^[2] https://manmedicineandmike.com/the-deeper-lessons-from-twelve-oclock-high/