"I am not sick. I don't belong here."

Each week I go to Mayo Clinic for physical therapy. Maybe it’s a little excessive to be there of all places for PT, but my surgeon and medical team are also there. Eighteen months after my hysterectomy, I am finally rehabbing with some extra help.

The physical therapy clinic is in Building 3 on the Phoenix campus, known as the “cancer building.” (Mayo’s proton beam is in the basement.) Every time I walk through the door, the thought enters my mind, “You are not sick. You don’t belong here.” I see patients around me who have lost their hair from chemotherapy, patients being transported by wheelchairs, people who are fighting for their lives. And I wonder “What am I doing here?”

I feel out of place among these patients, most of whom are trying to survive. I know people who currently have cancer and whispers of grief catch my breath. I am reminded that I walk through the doors with some physical privilege. When I leave after the physical therapy session is done, my brain again says - “I don’t belong here. I AM NOT SICK!”

The “what am I doing here” sensation reflects the image I have of myself. I see myself as not ill and yet I also know good health is ambiguous. My self-concept has been sustained by some level of denial and avoidance. But in the cancer building, there is no denial.

There is some distinction between health and sickness in my mind, some clear definition that has developed over time about what sickness looks like and what health looks like. But what about the in-between?  Can we be neither healthy nor sick and still need treatment?

I mentioned this to Pauline, my physical therapist, about the mental dissonance taking place every time I walk through the doors. Am I sick? And if so, how sick am I? Do I deserve to be here? These thoughts create a disoriented feeling in my body.

What is health and what is illness? Is there a place in between? A third option? Does health exist on a continuum and not a destination like “Healthy Land” or “Sickville?”

And what about invisible illness? When we look okay on the outside and the health problems and chronic disease aren’t easily identifiable. What then?

Can both exist at the same time - health AND illness? In DBT, we call this the dialectic. Two seemingly opposing positions. We don’t choose one or the other. We hold both in tension with each other. We can be healthy and sick.

For most of my life, the conditions I have managed have been largely invisible. You can’t see my thyroid disease. You can’t see the pain I have endured with endometriosis and the way adenomyosis wrecked me. You can’t see the fatigue and exhaustion, the food sensitivities or the migraines, or the episodes of diverticulitis. Most of what I experience and contend with is on the inside and not visible if you look at me.

The way I see myself is being challenged, the image I have of myself is confronted by  external factors and objective feedback. Walking through the hospital doors challenges the view I hold of myself. When I agreed to PT, I didn’t know that I was signing up to confront my self-concept.

I meet my own fear at the door. Fear of aging. Fear of decline. Fear of some health catastrophe befalling my husband and I as we age. We are at that point in life where there are less years ahead of us than behind. And I really want to be the 80 year old woman exploring the world, walking on cobblestone streets, taking in the view of French villages yet unseen. I want to be on the yoga mat and to not be limited. More than anything I want my husband with me, in one piece.

Walking through the doors reminds me of how unfair disease is. How we can do the “right” things and still we get sick. I confront the reality that my body is not under my control and that illness may develop despite my best efforts.

Driving home from the PT appointment last week, I realized that movement is at the bottom of my life. My priorities are work - writing and creativity - cooking and household tasks - hobbies, but movement and my health are at the bottom. I get to them if there’s time left over in my day.

In my twenties I could get away with it more, ignoring my body and living in denial. Aging and decline seemed like far off possibilities. But now as I approach 50, that mindset isn’t really working. And it seems more pressing to move my body higher on the list. To make it a top priority, not an after thought. To find ways each day to nurture my body. To attend more to this body I am housed in and not put everything else before it.

So yesterday I stretched on my yoga mat at the end of my work day. I moved my body over the weekend and soaked my sore back in an epsom salt bath. I started each day with a sunrise walk and aimed for more consistency.

I keep coming back to the fact that my body needs to be higher on my priority list, not an afterthought.

What about you? Where does your body rank on the list?

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