The body is fragile—it’s a wonder anything ever goes right—and so are the systems that, however imperfectly, sustain it.
SUMMARY
I write summaries for people who need to carefully marshal their time and attention.
My friend had breast cancer surgery with a relatively new procedure that depended on a lot of skills, people, and systems
Climate change impacts all our systems of care—structures, logistics, relationships—and we need to fill these systems with flexibility, redundancy, generosity and justice
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The waiting room on the surgery floor of UT Southwestern Medical Center is huge, all along one side with floor-to-ceiling windows. I spent the week in Dallas as part of a four-person support crew for my friend Marie, during and after her double mastectomy—specifically, a robot-assisted nipple-sparing mastectomy. Outside the waiting room, long-tailed grackles and white egrets flew back and forth. I pointed them out to the rest of the team—her brother, partner, and 17-year-old son—to give us something else to think about. The sun beat on the grass and concrete, driving the outdoor temperature up into the 90s.
When you’re dealing with the US health care system, every fork in the road could lead to somewhere impassible, or at least terrible; every moment you luck out, here comes the next moment. If you’re a woman of color, as Marie is, can you count on good care and consideration? Understaffing plagues hospitals across the country: will the right provider be there at the right time? Will the insurance company go back on their promise to cover an experimental procedure?
The surgery itself is a fork in the road. For years, all breast cancer patients had to choose between increasing their chances of survival and retaining sensation in their breasts, the loss of which makes many people feel estranged from their bodies and their being. Most people with breast cancer still have to make this choice, often accompanied by years of medical debt either way. The procedure is still being assessed by the FDA as a standard of care. Marie is part of the study that will shape that standard, but she had to navigate a lot of obstacles to get in.
And so many other things had to be possible: time off work for her and her care crew, the ability to travel (she’s not from Dallas), research skills that allowed her to identify and evaluate the efficacy of the procedure. There’s also the electricity that powers the robot; trucks and planes that carry the anesthetic; the computer system that tracks her records. The roads the medical team drove on to get to work.
What if the road to the care you need is not just figuratively but literally blocked, buckling in the heat or flooded out? I think often of a home health care aide in the climate anxiety counseling booth’s early years, who spoke with me about the flash flood that cut her off from an elderly client. The body itself is fragile—it’s a wonder anything ever goes right—and so are the systems that, however imperfectly, sustain it.
Social scientists call climate change a threat multiplier, meaning that it augments and Frankensteins the strains on our lives. That includes the induced strains of capitalism and the logistical strains of large systems involving many complex elements. It also includes the relationships on which we interdepend. Within this hot-ass summer, Marie is recovering in an air-conditioned rented house, and the care crew is staying there too. Cool indoor air and multiple bathrooms with working plumbing are a privilege, but not an extravagance. They’re making it easier to deal with the parts of this that are unavoidable, like pain and lack of sleep. They’re helping us be kinder to each other as well as to her.
Trust is also a privilege, in the sense that it should be available to all but isn’t always. Marie can cry out when her drains hurt, interrupt any of us to fetch her a drink or help her stand, and share her fears about whether some sensation or symptom is simply painful (as if pain were ever simple) or A Bad Sign. She’s probably holding back some, and she’s also worried about how we’re doing. But she isn’t fully dependent on someone she has to placate or impress. She can tell at least parts of the truth about how she’s feeling and what she needs, and we’re mainly rested enough to respond with equanimity and kindness. This is vanishingly rare. And climate impacts are endangering it as surely as they endanger the tiny frogs in the pond outside the house, especially as they combine with other kinds of violence.
We need both functional relationships and livable systems. A person with no available friends and no trustworthy family should be able to get reliable medical treatment and support—including a safe place to stay—regardless of their personality, their hygiene, their wealth, or where they live. Relationships help us demand the best from the systems that we need and that also, currently, harm us, as well as weathering those systems’ deficiencies. The CNA who spoke to me at the climate booth was able to switch clients with a trusted colleague on the other side of the swollen river.
Relationships also let us know we’re alive: cooking and sous-chefing and providing color commentary, laughing on the phone with a sibling, breathing together through pain. In the long stretch of time that it took Marie to come out from under anesthesia, her brother and partner went to be with her, leaving me and her teenage son staring out the waiting room window, not knowing much about what was happening. “Do you see any birds out there?” he asked, with a generosity that makes me cry as I remember it.
And on the morning after her surgery, Marie and I stepped onto the back patio before the heat got too bad. She was still feeling shooting pains near the drain sites, but had a better sense now of what to expect. We walked around to reduce the risk of blood clots in her legs, talking about the areas where our work overlaps and gazing at the plant life that perennially delights us. “Is that mint?” we said at the same moment, and started laughing. It was.
None of the things we were afraid of have happened so far. The surgery went well, as surgeries go, and Marie is relieved and impressed by both the professional and the relational care she’s receiving. This should not depend on money, luck, or even skilled research and self-advocacy. It should not sustain or snap according to the whims of profit, and it should be resilient to the systemic and relational strains that we know are increasing. The route to care should be less like a brittle highway and more like a river delta, rich and wide and branching, carrying us all to where we need to be; like what you’d see and smell under the leaf litter of a healthy forest; like the nerves that map our bodies.
PRACTICE: Be part of the care delta for climate, disability, and gun safety activist Daphne Frias, whose current living conditions are hostile to her recovery from cancer. You can read more from Daphne here.
SHORT READING: Courtney Martin, “The body keeps the sunshine: reflections on caring for people we love in ways they may never remember.” In addition to the deep relevance and truthfulness of this for all the relational care we may give and receive, this essay seems tied in with questions that I often hear and ask at the counseling booth: Is there any point to doing anything now? Can anything I do matter? Remember that every atom of care we give, we give to someone or something who will die eventually. If anything matters, it’s going to have to matter before then.
LONG READING: Zoe Schlanger, The Light Eaters. I read this in Dallas on Marie’s recommendation, and it slaps.
UPCOMING EVENTS:
July 23, 12pm ET, online: Join Green Builder Media and me to talk about “Confronting Climate Anxiety” (sign up at that link)! We’ll try a couple of small exercises together and explore climate anxiety as a community issue with community solutions. You can win a free copy of my book this way!
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I wrote a book, LESSONS FROM THE CLIMATE ANXIETY COUNSELING BOOTH: HOW TO LIVE WITH CARE AND PURPOSE IN AN ENDANGERED WORLD (Hachette Go, 2024). This newsletter holds the ways that what's in it has branched out: new reflections, events and workshops, unresolved questions, further reading, ways to connect and act. I'm glad to be here on earth with you.