Guilt 101

This image is from gr0wing.comThis is not a post about breast cancer survivor guilt. It’s about good old-fashioned, run-of-the-mill guilt.  I seem to be exceptionally good at it and if you are too, maybe I can serve as a teachable moment.

I had a bit of a health scare last month. I got called back for a mammogram and ultrasound because the radiologist thought she saw something on my regular mammogram. She didn’t, although I have to go back in six months as a precaution.

This is where the guilt comes in. I was trying to brace myself for what would happen if I had to start the cancer treatment cycle all over again (I opted for a single mastectomy for DCIS five years ago). One of the first things that popped into my head was, “Well, if I’m going through treatment again I certainly won’t have time for school.” That’s when I finally bought a clue and realized that I didn’t want to go back to school. Once again, the specter of cancer became a kind of tipping point.

I should pause to explain. Last year I decided I wanted to get serious about getting better at writing poetry, and was accepted into the MFA program at the University of Nebraska. It’s a low-residency program, meaning you attend residency, an intense “boot camp” of lectures and workshops, for 10 days and then study independently with a mentor for the rest of the semester. I loved residency last summer but cramming a 12-hour course load on top of a fairly demanding full-time job last fall was grueling. I decided to skip the spring semester but had every intention of going back next month for this year’s fall semester.

Yet I kept ignoring clues like the stressful dreams I was starting to have again, and other ways my tamped-down feelings started bubbling up. I went to a poetry reading in January, hosted by one of our program mentors. He said he hoped he’d see me in July and I said I would be there. After the reading as the hosts said goodbye at the door, I practically snapped at him, saying again, “I will be there in July!” A little defensive, are we? Who was I trying to convince?

It reminded me of when I was first diagnosed and trying to figure out my treatment options. I was planning a trip back to North Dakota to attend my  dad’s graveside service in May. (I had  attended his funeral in February, and as you might imagine, North Dakota is not big on graveside services at that time of year.) I kept thinking I would just work my trip back home into my suddenly filled appointment book. I was wrong. One oncologist had just recommended a mastectomy, which seemed pretty drastic, and I was trying to get into see a second oncologist. My emotions were churning so much that putting this consult on hold wasn’t the best idea. But because I felt like I had no choice, I kept saying “I’m fine, I’m fine, we have to go.” I was following the iron law of self-induced obligation and guilt.

The tipping point finally came when my husband Bruce and I were having lunch at a restaurant and I burst into tears, seemingly out of nowhere. He just looked at me and said, “You’re not ready for prime time.” And I wasn’t. I cancelled the trip. My brother and the rest of my family understood.

Now it’s deja vu all over again. I went from zero to obligation in 60 seconds, as if once I signed up for my MFA I was on deadline. I finally bought a clue and realized I have a choice. I choose to complete my MFA after I retire, instead of trying to do it in “my spare time” and turning something that is a source of great joy into a source of guilt and stress.

I felt guilty when I wasn’t putting enough time into my work, and I felt equally guilty when I decided to postpone getting my MFA. I dithered before telling my mentor, the program director and the friends I made last summer. But like my family five years ago, they supported and respected my decision.

So this basically proves I have all the self-awareness of a turnip and have learned nothing in five years. Well, I guess I have learned to read the clues a little better. The moral of this story, if there is one, is that if you’re like me and have an overdeveloped sense of guilt, stop for a minute when those guilt feelings start piling up. Read the clues in your own behavior like you would for anyone else. You might find there’s something you’re not admitting to yourself. Admit it, and trust your gut.


Breast Cancer and Disability Benefits

(Editor’s note: This guest post is from Molly Clarke on behalf of the organization Social Security Disability Help. It is not affiliated with the Social Security Administration.) 

Breast cancer and its treatment effects can make it impossible to work. The resulting loss of income and medical insurance can cause a significant financial burden. If you find yourself facing these circumstances, you may be eligible to receive Social Security Disability (SSD) benefits.

The Social Security Administration (SSA) governs two programs that offer financial assistance to people who can no longer work due to an illness or disability.

Social Security Disability Insurance (SSDI) is funded by the FICA taxes that most workers pay into the system. Eligibility is based on an applicant’s work history and the amount of taxes they’ve paid throughout their career. The SSA assigns “work credits” to each quarter an individual works and pays taxes. See if you meet the work credit requirements for SSDI here.

Supplemental Security Income (SSI) is a needs-based program that provides financial assistance to disabled, elderly, or sick individuals who have very little income. Unlike SSDI, SSI is based on financial standing. It is a good option for people who may not have earned enough work credits to qualify for SSDI. Learn more about the financial requirements for SSI here. In some cases, individuals may qualify for both SSI and SSDI.

Breast Cancer Criteria

In addition to the technical requirements listed above, applicants must meet certain medical requirements. The most basic requirement is to meet the SSA’s definition of disability. Essentially this means that you must have a serious health condition that prevents you from working for at least a year.

Although breast cancer can be debilitating at any phase, the SSA has very stringent requirements to qualify for SSD with breast cancer. Unfortunately this can make it very difficult—but not impossible—to qualify with early stage breast cancer.

Typically, applicants’ conditions and symptoms are analyzed by the SSA in accordance with their official guide of disabling conditions known as the blue book. The blue book listing for individuals who have breast cancer requires that your cancer is a carcinoma that has advanced locally, including metastases in your breasts, chest wall, skin, and/or lymph nodes. You may also qualify if your cancer is recurrent and does not go into remission despite receiving appropriate treatment.

Requirements are stringent because cancers that meet these standards are expected to last at least 12 months—satisfying the SSA’s definition of disability. However, if you do not meet these specific requirements, you may still be able to qualify if you can provide medical proof that your cancer and cancer treatments are expected to last at least a year and keep you from working

If it has been determined that your breast cancer is inoperable, unresectable, or has distant metastases, you may qualify for compassionate allowance processing. This program allows individuals with particularly serious conditions to be approved for disability benefits in as little as 10 days. There is no separate application for the compassionate allowance program. The SSA will determine whether or not you qualify and will expedite your claim accordingly.

Starting the Application Process

The SSA requires that applicants provide documentation of their education, employment history, financial history, and most importantly their medical history. You should collect documentation of your diagnosis, laboratory tests, treatments, reaction to treatments, history of hospitalizations, and even personal notes from your doctor and submit them with your application.

It is important to have documents ready prior to beginning the application process so that there are no delays. Once you are ready to begin the application process, you can do so on the SSA’s website or in person at your local Social Security office. If you decide to complete your application in person, schedule an appointment in advance to avoid delays.

The SSD application process can be extremely difficult to navigate. If you find yourself overwhelmed or confused, it may be in your best interest to retain the services of a qualified disability attorney or advocate. He or she will have a thorough understanding of SSD benefits and will be able to guide you through the application process to ensure that you don’t make any mistakes.

Appealing a Denial

Many applications are denied due to lack of medical evidence or small technical errors. If your initial application is denied, do not panic. You are allowed to appeal this decision. It is important to remember that no matter how difficult it may be to be awarded disability benefits, these programs exist to help you. Do not give up. Once you are awarded benefits, you will be able to focus on your health instead of your finances.