Questions and Answers

Dear ones,

Many of you are asking wonderful, insightful questions by email and in person. Boswell has been answering your questions individually, and thought it would be helpful to everyone to post those answers here. Leave more questions in the comments or send them via Boswell-mail: rebecca-dot-lafond-at-gmail.com.

How is Mimi doing?
Mimi's health is pretty much the same since the last post three days ago. Her status probably won't change suddenly, it'll be more of a gradual decline - more on that below. If any sudden changes occur, they'll be posted asap here. This blog server seems to take several hours to send out updates by email, so you might want to check the blog link regularly. You will hopefully see at least a brief update every three or four days. Always, always feel free to email Boswell at any time. You may not receive a long reply, but the more detailed your question is, the more likely you'll get a detailed answer. If you don't hear back within a day, it's totally ok to send another message. Your caring and concern are appreciated!

What spiritual practice is Mimi relying on?
Right now Mimi is especially drawn to Avalokiteshvara and Vajrayogini. Tech-savvy friends have created recorded loops of mantra recitations (OM MANI PÄME HUM and the three-OM mantra) to be played when Mimi's physical and mental activity decline further. From Boswell's perspective, Mimi also seems to be relying on the minds of patient acceptance and cherishing others that she has developed over her years of Buddhist practice and her cancer journey. You can read all about her experience with this on other blog posts. As mentioned in the post prior to this one, Offering to the Spiritual Guide was a particularly energizing practice for Mimi at the beginning of this week. Perhaps another puja will happen here again on August 10th.

Can I come visit Mimi?
Of course! As reported in the last blog post, Mimi's energy is up and down. A few times over the last couple of weeks a visit has had to be rescheduled because she was too worn out to receive visitors. But even though they might not have a chance to see Mimi, visitors are nonetheless most welcome! (The best way to set that up is to send an email to rebecca.lafond@gmail.com.) Kind local friends have been stopping by to help with chores and provide respite care so that Richard can have breaks. Family members are here from out of town this weekend and next week to visit and help. Even if you're not able to be here in person, there is nonetheless a very important way for you to help! Here's what Mimi asked for in a group email she sent a few weeks ago after receiving her prognosis: "Please pray that I continue to have a peaceful mind throughout this dying process, deeply connected to Geshe-la at my heart."

What is Mimi's prognosis?
In the same email quoted above, Mimi says, "Apparently I've come to the last lap of this current 'race' (but not at all at a fast pace for me)." One could read that last part in parentheses in a couple of different ways. It's true that Mimi is spending quite a bit of time in physical inactivity as the cancer and side effects of medications drain her energy, and when she does get up she definitely doesn't move very fast. But she also doesn't seem to be heading very quickly toward the deadline (pardon the gallows humor) she received from her doctor. Five-and-a-half years ago, Mimi was first diagnosed with and treated for leptomeningeal disease, or cancer of the brain lining, which is commonly considered to be a marker of end stage cancer. Mimi's doctors have been astounded by the amazing good health she's experienced over the last 5+ years. (In fact, they call her a medical miracle, to which Mimi's response in a 2013 blog post is, "That probably isn't technically correct: I don't think I've ever heard any Buddhist use the word 'miracle,' but maybe I can get away with 'miraculous' as in extraordinary, as in emanated by the Buddhas.") It seems that her latest prognosis is not at all a departure from the miraculous story of Mimi's cancer adventure. Today is close to the approximate day Mimi was given for when she could expect her life to end, and she's still full of vitality and love! Ordinary prognoses don't appear to apply here - prayers and Mimi's mind of faith have truly worked to sustain her.

What happens next?
As mentioned above, Mimi's health will probably continue on the gradual (very gradual) decline it's been on over the last few weeks. Now that pain and other physical symptoms are under control, there probably won't be any further medical emergencies to contend with. If symptom control becomes an issue, there's a very responsive hospice team only a phone call away, and the hospice nurse provided an arsenal of medications to help with common end-of-life symptoms. The hospice social worker provided a booklet called Gone from My Sight: the Dying Experience, written by award-winning hospice nurse Barbara Karnes. The booklet describes the physical changes that can be expected during the dying process. If you're interested, the booklet can be downloaded in Kindle or purchased on Amazon, and you can also find helpful information at Barbara Karnes' website. Boswell has also been reading a book called Final Journeys by long-time hospice nurse Maggie Callanan, which uses real-life (real-death?) examples of hospice patients to highlight important end-of-life considerations and issues. This book is also available on Kindle/Amazon, or you can link to it here.


Hope this is helpful and that you enjoy this quote from a humorous post by Mimi from a few years ago: "It's kinda fun, and interesting, to write about yourself in the 3rd person. I've never thought of this before in terms of writing, but it seems useful as another way of looking at the emptiness of our self. We commonly, instinctively, think of ourself in the 1st person, as me or I. So what happens when we put ourself into a character of she or he? It's a bit like becoming That Mountain, looking back at This Mountain. You see yourself from the outside, as others might view you, but of course everyone's view is different."

To Contentment and Beyond

Hello Friends of Mimi,

Boswell here.  All of your love and wishes are coming through and are deeply appreciated.  Mimi is still looking over her email occasionally so she has seen your kind messages.  In Mimi's own words from a post last April: "I deeply appreciate your prayers for me. You can see that they work. Makes it so easy to have faith."  As always, please feel free to add a comment to this blog post, send a reply message to Mimi, or email me at rebecca-dot-lafond-at-gmail.com.

Just wanted to give you an update on Mimi's current state of health.  As a background, here's a wrap-up of the last 7 years of Mimi's cancer adventure in one sentence: she was diagnosed with ovarian cancer and underwent treatment; has had chemo on and off to address recurring abdominal tumors; had a metastasis to the brain a few years ago and was treated with surgery, radiation and chemo; and was most recently advised by her doctor that curative care is no longer an option.  And so she is now on hospice and preparing for a peaceful death.  The tumors in Mimi's abdomen are growing noticeably, and a recent brain scan indicates that she has cancerous lesions on the meninges of the brain, also known as leptomeningeal carcinomatosis, carcinomatous meningitis, and a host of other long-syllabled medical terms.  The brain cancer causes inflammation, so Mimi is once again taking a steroid called dexamethasone to keep the swelling down.  She's written about taking this medication in previous blog posts - it's the one that makes her really talkative, energetic and HUNGRY!  We can maybe consider these side effects to be a blessing as she has been receiving many visitors from near and far, and she has sufficient energy to engage in conversation.  She's also eating really well which is helping her to keep up her strength.  Many friends are bringing food to share during their visits - in fact, we're expecting Sally with dinner any minute now.  It's a gift for Mimi (and for us all) for her to be able to share these moments with friends and family.  The last few days have brought a poetry reading (Lynn Ann), an industrious cleaning of the master bedroom (Linda L), a tidying up of the garden (Linda S), and many kind and friendly ears to listen to Mimi's thoughts about the end of her life (Heather, Brian, Laurie, Eve, Kit, Noreen).  As the weekend approaches, her social calendar continues to be full and family arrives on Monday morning.

Anyway, to continue the "state of the union" regarding Mimi's current health situation, she's on a transdermal patch to control pain, two medications for nausea, and a variety of other meds to deal with the side effects of the main medications.  As we all know from our interactions with Mimi, she's an amazing example of practicing contentment in the face of adversity.  In a post from January of this year she wrote, "Thankfully I know my body is *not* "me," so I am still happy … and hope you are too."  It's an inspiration to witness how her positive habits of mind continue to sustain her happiness, even as she encounters these challenges.  May we all have such courage and strength!

The brain cancer, the many years of chemotherapy drugs, and the current medications are causing unavoidable cognitive decline.  About this phenomenon, she said in a post from June 2015 that, "my mind is good, my brain not so much."  She seems to lose a little bit of energy each day and yet she's a gracious hostess, always looking after the comfort of her guests.  I'll end this post with her expression of gratitude from a couple of years ago:
"Thank you, Buddha.
Thank you, Sangha.
Thank you to everyone who's been making prayers and offering good thoughts."

Taking and Giving Blood

Thursday I am going to get a blood transfusion to help alleviate my fatigue, which contributed to putting me in bed rather than attending Offering to the Spiritual Guide at the Temple on Sunday.
Today I traded a small vial of my blood, to be "typed and crossed" for the 2  "units" of blood that some kind beings have donated (it's not a set quantity, my phlebotomist explained, because it depends on the concentration of red cells in that particular batch). I send my deep gratitude to all you Bodhisattvas who have given your body in this way.

I had a transfusion before from low hematocrit on chemo, and I felt so much more energy afterward. I am hopeful that this will allow me to enjoy more of US Festival and my family visits next month. My oncologist offered it as a choice, which I gladly accepted. From my experience, I expect I would have gotten more and more fatigued without it.
You may be thinking that what I need is iron supplements, but that is actually not recommended in my case: All of my doctors have told me it's OK to have iron in foods but that supplements would interfere with my treatment (they've also said that if I did take supplements, they wouldn't improve my levels fast enough).
The procedure is considered quite safe - I think it may strike some of you as being more serious than it is. Here's a bit of info to reassure you, from the blood bank associated with my cancer treatment:

The risk of exposure to HIV is estimated to be approximately 1 in 2.5 million or less per unit. Since 1985, no patient has been reported to have contracted HIV from a transfusion provided by Puget Sound Blood Center. The risk of hepatitis C infection is estimated to be approximately 1 in 1 million or less per unit, and the risk of hepatitis B, approximately 1 in 750,000 or less per unit. Bacterial infection and other types of infection from a transfusion are possible, although also unlikely.

Very fine print: Your karma may vary : ) I'll make some prayers that obstacles be removed.

If only I had a stronger mind, I wouldn't identify so closely with my body, but I am happy to say that I'm working on it. When I'm fatigued, my mind feels more vulnerable. This is overly dramatic, I realize, but occasionally it feels like being assailed by soul-sucking Dementors, for those of you familiar with the Harry Potter series, and having to do the Buddhist equivalent of the Patronus charm with all the faith I can muster. (I am actually more of a Lord of the Rings fan - the journey that Frodo makes resonates with me spiritually - but I deeply enjoyed having Richard read both the Potter and Rings books to me at bedtime; he is wonderful at giving voice to all the different characters.)

My faith is my most precious possession, and over the years I have learned the importance of actively protecting it. For example, when my faith is strong, I can listen to someone with doubts about  Buddhism or the New Kadampa Tradition; I have compassion for them. Depending on where they are and what they're wishing for, I can try to help them. I feel my own faith getting stronger, like a workout at the gym.
The Dorje Shugden controversy really deepened my faith. I was very fortunate to be able to attend many of the demonstrations and to meet Tibetan practitioners who had directly experienced persecution. I also researched the issue, reading different points of view, and came to a greater appreciation and understanding of this precious lineage.

However, when I read non-Buddhists make sweeping generalizations about life that contradict what I know and believe, I put up my armor: I protect my heart. Materialists (people who deny there's any spiritual or transcendent dimension to life) seem to pop up when I'm reading book reviews - there are some popular books by atheists and scientists getting a lot of attention in the press. Sometimes writers don't even try to make an argument - they just make a statement as though everyone believes what they do. Mostly I just think it's nonsense. (One of the reasons Americans need Sangha is that Buddhists are swimming upstream in what's mostly a Judeo-Christian culture - there are so many embedded assumptions. But I will save that for another day.)

When my faith is shakier, I will stop myself from reading. If I'm with someone who is denouncing my Spiritual Guide, I will try to excuse myself or at least stop listening to them and listen instead to an inner dialogue, at the very least a mantra. I will "conjure up" (to use the Patronus metaphor) a love for Buddha, Dharma and Sangha - it is refuge in my heart. I go inward, to my heart, with my Guru.