Ditching people pleasing behaviors and saying no was scary at first. However, the chronic toll that cancer took on both my health and bank account meant I was finally forced to learn this essential life skill. With 22 rounds of chemo and seven surgeries, including the removal of both of my breasts and a full hysterectomy, I am finally on board with incorporating new changes to the way I think and act. In the past two years, I have racked up major bills from hundreds of hours of medical treatments related to breast cancer — so prioritizing my own needs is literally a matter of sink or swim… life or death.
As a working wife and mother, with a large extended family, I have spent a lifetime juggling endless to-do lists on paper and in my head. I worked for many years as a cook, caterer, and events manager, which often meant I felt like I was trapped in a catering nightmare: All sweaty and beyond stressed, working with four pots of boiling water on the stove. Each pot is overflowing and way too hot, and I am too exhausted and amped out to figure out what to do next.
I used to collect titles: workaholic for this company, president of this club, boss of this group, editor in chief of that paper, etc. While I often repress my anger and other emotions (at least in public), I also tend to throw myself into doing, doing, doing for others — particularly family members and romantic partners. When not mulling those tasks and the machinations of any and all humans I encounter, I am often future tripping on what today, tomorrow, next week, and next month will bring.
This operating system is exhausting and has roots tied to trauma, isolation, and coping behaviors I learned at a young age. My can-do personality, complete with often-gritted teeth and a wide smile, is about getting things done, but it’s also about getting attention (preferably the positive kind) and love from often-remote sources.
Having time to myself is the ultimate in self-care, and like many of the patients profiled in Dr. Gabor Maté’s book, When the Body Says No, I do struggle in my brain with the notion of putting my needs above the demands of others so I can take the necessary time required for self care. Thankfully, Maté’s book came into my life when I was ready for the information and stories of patients who are often in the same boat as me. Maté shows the fault and fallibilities of the patients without blame (critical!), so that his patients will not feel attacked or further stressed.
“In important areas of their lives, almost none of my patients with serious disease had ever learned to say no. [And the] underlying emotional repression was an ever-present factor.”
Telling others what to do, using stress as a drug, and going without healthy boundaries means I could easily be one of the patients that Maté writes about. Like them, I have my own need for safety since I have often had to fend for myself in dangerous situations. In my mind, staying busy equals safety, but it also keeps my cells in stress mode for far too long. The consequences of this are discussed in detail in Maté’s book. In this passage, he breaks down the pattern and effects of stress:
“The research literature has identified three factors that universally lead to stress: uncertainty, the lack of information and the loss of control. All three are present in the lives of individuals with chronic illness. Many people may have the illusion that they are in control, only to find later that forces unknown to them were driving their decisions and behaviors for many, many years… For some people, it is a disease that finally shatters the illusion of control.”
For me, it took getting a surprise cancer diagnosis at a relatively young age to finally see that I am not in control of what other people do or say. Like Maté’s scleroderma patient Gabrielle, I could say, “All my life I’d been the one in charge, taking care of everything. Suddenly now with the disease you are totally out of control.”
At age 42, saying no and setting boundaries is new, exciting, and yes, scary. I was only able to even think about saying “no” to personal and business requests when I became so ill that my body was literally doing what my brain (and mouth) could not. Saying no lets me keep the focus on myself instead of what my husband, son, relatives or friends are doing. That’s so weird, but healthy! When I say no, it carves out more time to do what I enjoy, even if my gut instinct can still be to worry and fret versus meditate, sleep, take a bath or cook a too-elaborate dish.
Maté, a denizen of British Colombia and noted public speaker, has used his decades of scientific and medical research and work with patients to ably define how much our thoughts and actions (or inactions) and repressed emotions effect overall health. The lives of patients that Maté has studied and spoken with at great length are afflicted with various forms of cancer, ALS, multiple sclerosis, heart disease, rheumatoid arthritis, irritable bowel syndrome, and other ailments and diseases; some even have a combination of ailments or recurring disease.
Sadly, some die from their disease(s) and seem to be unable to identify the roots of their health issues (even with Maté’s kind prompts). More importantly, they’re unable to implement the personal daily changes needed, from expressing anger to setting boundaries with overbearing romantic partners or relatives.
Maté also mentions the personal stories of famous folks: Lance Armstrong, Gilda Radner, Ronald Reagan, and Lou Gehrig. The powerful book is one reminder after another to be open to trying different — saner, kinder, and healthier — ways of being.
Saying no means taking care of myself first and foremost. That goes against many cultural traditions for females and moms. With four-plus decades of caregiving and bossiness under my belt, I decided to attempt saying no to people and things that I don’t need or want. It helped that Maté counsels an ALS-breast cancer patient named Laura on the idea of saying no.
“How about saying,” I suggest, ‘Dear corporate guest: I have this condition that makes life very difficult for me. I am not up to the work involved in looking after people.’ [Laura] responds with, ‘I could say that. But…’ And goes on with details about how and why she needs to work even if it causes physical pain and discomfort.
Maté gets her to laugh and Laura responds to his ideas on how to say no with something I understand by telling Maté:
“You make it sound so simple. I’d have to take a course, or maybe get some counseling with you.”
When I first decided to give “no” a try last year, it was tricky because I did not know how to say “no” — especially to work projects or family obligations. My thoughts were filled with fear and anxiety at the prospect of declining the requests made of me by others. I felt I had to serve up the reasons why I was saying no. Eventually, I learned to stop making excuses, and was able to shorten it to “No thank you.” In person, that means I must be still and keep my gaze on the person I am talking with. Being still is another uncomfortable practice that comes with saying no, at least for me personally. The reality I’ve seen is that folks are busy and may not care too much about the reasons why I am saying no, or no thank you as it were.
“Will my family understand? Will they still love me?” are underlying questions I entertain. In the book, several patients echo sentiments of not feeling loved and not feeling worthy of love, including Anna, who was diagnosed with cancer:
“I didn’t have enough self respect. Am I good enough yet, could you love me yet?”
I have many accomplishments and a family, but feel like I can never be good enough or busy enough. With my own growing self acceptance, I see that his patients are also fearful about giving up attachment to the idea that you are in control of the world or at least the people in your world — which is a coping mechanism that I’ve found to be detrimental to my romantic and familial relationships, even if it arguably appears on the surface to be an organized and even marketable skill (project managers and event planners may relate!).
Life recently gave me many situations to sharpen my no skills: At Thanksgiving, instead of following a self imposed elaborate holiday tradition of making two massive catering-size pans of sausage stuffing for a family gathering, I spent days figuring out that buying the ingredients for an easier and less time consuming veggie side dish sounded more reasonable and appealing. I played over in my head torturous questions of “What will they think?” and “What will we do without my glorious stuffing on the buffet table?” Later, I saw that the no stuffing idea was something of a non-event, and telling my family my idea of bringing something different was not tough — it ended up being lighthearted and painless. (One of them responded on the phone with an enthusiastic, “OK, sounds good,” and we moved on to other logistical details.)
This holiday was a first. I quieted the hamster wheel in my brain and instead spent most of the day away from the kitchen, enjoying myself (cuddling a baby, sitting in a garden in the sun, etc.) and doing very little physical work because my back was tweaked somehow two days before the event — allowing my body to again do for me what I can’t do for myself. I did attempt a few times to remind one relative that I could help. Thankfully, he told me to relax. More than once. I took it as a sign that the holiday had somehow contributed to my back trouble, because as soon as I was back home, the tension seemed to disappear, literally overnight. As if a magician had waved a wand or cast a spell, like they do in the movies.
Another recent try at no came when medical appointments left me too exhausted to even do anything for myself. I felt resentful in my brain to be asked if two consecutive nights would be okay for visiting relatives. Saying no has never been an option, because I start to tally the ways they have helped me in past years, including overnight stays. But I realized that they actually are not able to read my mind and see that the only thing I was fantasizing about after a long day of medical poking and prodding was to spend the evening in a baggy T-shirt and comfy pants, so that I could snuggle and sleep without feeling obligated to cook, clean or host anyone. I don’t know how the communication was received since it was my husband who relayed the message, but it felt like a scary victory to speak up and say no. Once they were in town, I did open our apartment up to them for a one-night stay, an offer that felt more in keeping with the “old” me; I did not want them to do such a long drive home but did end up enjoying a visit, even if it did inevitably tire me out.
One of the first and most memorable times I said no was to my dad, over the phone. He called to tell me he had tickets for us to all go see a music show on a Friday night at a county fair that’s an hour away from my apartment. Traffic and dust were almost guaranteed, as were crowds. I struggled with what to say. If I didn’t have cancer, out of a sense of obligation and guilt, I would have driven in Friday traffic to a show I didn’t really want to see. I felt sad that my dad asked us to go with him to the show and worried that he would not find anyone else to accompany him. But a sense of calm came over me, and I realized that it was too big a thing for me to tackle, that I am not in control of his life or path or whatever terminology you want to use. For the record, this was definitely a night where the comfy pants were used and I felt like my body responded well to the chance to get more rest.
I also used no for work, which brought up strong feelings of anxiety and fear, as well as the haunting question of, “Will they ask me to work again?” The more I practice saying no to things involving my freelance work, the more I realize that the askers move on and tend to come back again when they have a different offer or idea; saying no has not taken me out of their minds as a viable person to work with.
Maté’s book ably shows the connection between how one acts and how one feels, and offers further proof that my own perfectionism and inability to slow down were likely strong factors in why I may have gotten a breast cancer diagnosis at a relatively young age. I am a pro at putting others needs before my own, and I can better see that all the scheduling and upkeep for them means I sometimes had little if any ability to relax and enjoy myself.
As a self proclaimed Chatty Cathy, at first I struggled with the pause that saying no caused in conversation. It may have only been a second or five, but my first attempts at “no” included my own explanations and effusive apologies. In other words, I served up excuses that weren’t really necessary: “I’m getting a cancer treatment that morning, so will be too tired to drive to the music concert.” I also do things like pause, and lower my eyes, maybe even scan the room to see if my mom is watching. (She’s not. She’s in a skilled nursing facility). Like any new skill, saying no takes practice and diligence. It may feel like you’re falling off a bicycle over and over again, and you will want to fill in awkward pauses in conversation that definitely feel like a proverbial eternity.
Currently, my way of saying no has been shortened to a simple, “No thank you,” which allows me to show gratitude. I am happy to be asked. But no, I can’t. Really. And while indulging in rest and relaxation may take getting used to, I will not say no to my own needs any longer. The great news is, I can physically see and feel the benefits and results of saying no: the space between my shoulders feels lighter the more I say “no” — because I don’t feel as if I am (attempting to) carry the weight of the world.
Mary Ladd’s writing has appeared in Playboy, Ozy, San Francisco Weekly, and KQED. She is currently working on The Wig Report, a funny website and book project with an insiders take on catastrophic illness. Mary went through breast cancer via 22 rounds of chemo, 7 surgeries, 8 infections, 49 blood tests, and completely lost her hair, eyebrows, and 30 pounds… but gained 4 wigs and many fashion finds in the process!