I wanted somewhere quiet. Open enough to just hear myself breathe. Birds. Water. Trees. My dog getting to run through all of it, off leash in her own joy.

So I planned a road trip — slow pace, out east, no real agenda except to just be somewhere for a while.

The top of that mountain turned out to be the apex of the whole trip. I had to stop and just breathe it in — this was what the plan had been leading to all along, what I’d needed the whole time without fully knowing it until I was standing there.

I’m standing on top of a mountain with my arms up and every part of this is joy.

Real, uncomplicated, arms-in-the-air joy — I haven’t gotten to feel that in a long time without something else riding underneath it.

This was the year of the wake-up call. Not the kind that visits once and leaves. The kind that moves in. The one that’s there when you wake up, the one that runs underneath every ordinary hour, where every twinge, every ache, every weird little pull in your body makes you stop and ask: is this something? Is this new? Does this mean anything?

I heard it anyway. Different from all the years I thought I’ll deal with it later, I can keep going. Not this time.

I finished chemo. I got off the wheel I didn’t know I was running on until I stopped and felt how fast it had been spinning. I’m not getting back on.

Here’s the part I didn’t expect to say out loud: I always believed you couldn’t trust people who didn’t trust themselves. I still believe it. I just didn’t see myself in the sentence.

I’ve loved Frost’s Mending Wall for years — the neighbor out there every spring, setting the stones back that winter knocked down, certain that good fences make good neighbours, while the speaker keeps asking him why, keeps wondering what the wall’s actually for. I understood that poem backwards. At work I could build a wall like nobody’s business — this is mine, that’s yours, here’s exactly where this conversation ends. Clean, professional, no apology. I never once carried that same skill home. Not into the men I loved. Not into how I loved my son. I gave away land I should have kept fenced for myself and called the giving away love.

I told myself I was letting my son become who he is. That was true. It was also fear, dressed up as respect, because trusting him meant I had to stop managing the outcome.

I knew the theory. I’d built my whole life on not repeating my parents. Turns out knowing the theory and living it alone, as the only parent in the room, are two different disciplines. I’m still learning the second one.

But I’m also learning what a Tuesday can hold when I’m not extracting a result from it. Coffee. The dog’s weight against my leg. A hike with nowhere to be after. I used to plan five years out and call it vision. I’m learning to plan a Tuesday and call it enough.

Turns out I’m a strategist even here — I just spent fifty years pointing the skill at everything except my own life.

I feel free. First time in my life, actually free.

Free from having to achieve something to justify the day. Free from proving myself to a room that was never really watching that closely. Free from being on, all the time, every version of me pre-approved before I walked in.

Whatever comes next isn’t going to be built on output. It’s going to be built on discernment — knowing what’s actually mine to carry. On joy, on purpose, chosen instead of scheduled. On architecture — the life I actually want, built on purpose this time, and the people I want standing in it with me.

I am so ready to start.

So this climb. It was steep enough that there was rope bolted into the rock, and I used it — fifty and no longer interested in pretending I don’t need help just because I’m capable of it.

Tears for being alive. Tears for being healthy. Tears for the word cancer with free standing right next to it — a sentence no piece of paper has signed yet, no doctor has handed me on official letterhead.

I signed it myself.

Not because the scans are finished saying what they’re going to say. Because I know my own body better than a picture of it, and I am done waiting for someone else’s authority to tell me what I already know is true.

I’ve got fuel left. I can feel it, actual and physical, the way you feel gas in a tank instead of just trusting the gauge.

I came down that mountain the same way I climbed it — on my own two feet, using the rope where the rope was there to use, not performing anything. Just finally, actually, in it.

Transformation isn't linear. I know that now.
It comes in waves, not a straight line up the mountain —
and some days the old feelings, the old habits, show up loud,
like the old defences staging one last fight before they finally stand down.

I’m learning to just sit with that.
Not fix it. Not outrun it. Not turn it into a plan by the end of the day.
Sit with the discomfort and let it be uncomfortable,
without letting it drive.

That’s where I actually live now. In the watching.
In the observing.
In finally, only, fixing my own side of the fence
and letting everyone else tend to theirs.

I think I’m done the climb, actually.
I think what’s left is the walk back down -
not less real, not less mine, just a different kind of work.
Not the hard grind up. The steadier work of staying.

There’s going to be treatment for years. They’re recommending decades.
Scans for decades. Tests for decades.
I’m not going to pretend that part is over,
because pretending is exactly the thing I just spent a year learning not to do.

But today, I know the hardest work is behind me.
What they want for the next ten years is a conversation for when I get home.
Because I’ve got a life to plan around living,
not one hedged against dying, decade by decade, just in case.

That decision isn’t for the top of this mountain.
Today is just for knowing I climbed it.

Our spot was closed.

He didn’t want to go anywhere else. I threw my hands up — actual gesture, actual exasperation — and said fine, that sucks, I guess we’ll just go home. And he said: you can’t be mad at me for having a preference.

I wasn’t mad. I told him so. I’m disappointed. I’m frustrated this isn’t working out. And that’s allowed — I’m going to have moments in my life where I’m disappointed or upset or frustrated, and that’s normal, that’s not evil, and it’s also not about you. You’re not responsible for my feelings. Nobody is responsible for anyone’s feelings but their own. You know that, right?

He didn’t say anything.

Here’s what was actually underneath my frustration, if I’m honest about it: I knew exactly what “we’ll just go home” meant. It meant he’d retreat to his room and close the door. It meant I’d putter around the house pretending I had things to do. It meant the window I’d been waiting three weeks for had just closed over a locked restaurant door, and there wasn’t going to be another one that morning. That’s not disappointment about breakfast. That’s disappointment about arithmetic — I don’t get unlimited chances at connection anymore, I get the ones he’s willing to take, and I have to be strategic about when and how I spend them. Nobody warns you that loving a teenager means treating connection like a resource with a shrinking supply.

I’ve been turning that morning over for days, because it’s such a small thing — a closed restaurant, a shrug — and it’s landed on me like something much bigger. Three weeks of missing him, collapsed into a five-minute exchange where the only thing I actually got right was managing my own face.

I didn’t grow up in a house where feelings had an owner.

I grew up in one where my feelings were mine to manage and everyone else’s feelings were also mine to manage (mine and my sister’s, that is). Where I was told, plainly, that I was the reason things were bad — that I was stupid, that I’d never amount to anything, that whatever was wrong in that house could be traced back to me if you looked hard enough. Children should be seen and not heard. We were told, and we believed it, because if we didn’t, there would be other problems to follow — the kind of problems I’m not going to detail here, but the kind that make a child learn fast to make herself small and quiet. I wasn’t a child there so much as a small adult with none of the authority and all of the blame. I didn’t get told my feelings weren’t my fault. I got told everyone else’s were.

So I know exactly what I was doing, that morning outside a closed restaurant, when I said the sentence out loud instead of making him carry it silently the way I would have had to. You’re not responsible for my feelings. That sentence is the whole inheritance I decided not to pass down. I built it on purpose, the way you build anything you didn’t get handed — deliberately, a little too carefully, checking the fit.

For years, that design held. We were a team. Concerts together. Weekends away at soccer tournaments, hockey tournaments. Drive-ins. Trips. We did things together that were just things, not obligations disguised as bonding — we had great times, plainly, without needing to make a project out of it. There was a trip to Spain with his soccer team when he was sixteen — at the time just a trip, now something closer to a hinge. The last one of its kind, maybe. The marker of a before I didn’t know I was standing in.

And now the same love has to look almost unrecognizable.

Because here’s the part nobody warns you about: the vow I made to myself was never complicated. I never wanted to be the parent who wasn’t there. I built his entire childhood around that one refusal — showing up, being available, watching closely, saying things out loud instead of making him guess. And it worked, for a decade. It is not exactly right anymore. He’s not nine. Now he doesn’t seem interested in the thing I built for him, and some disoriented part of me reads that as the vow failing — like if he’s pulling away, I must be becoming the person who wasn’t there after all. I’m not. Watching closely can tip into something that looks a lot like the thing I swore off, just wearing a different coat. Presence can curdle into pursuit if I’m not careful. Stepping back isn’t breaking the vow. It’s the same vow, further along, just harder to recognize from the inside.

That’s the whiplash. Not that the rules changed. That the same love now requires the opposite gesture, and my nervous system hasn’t caught up to the memo.

Something happened this week that I’m not going to put on this page. As you know, I write here anonymously — this is about my experience, my learning, not the hard moments that people in my life are dealing with. What I can say is that it threw me for a loop, hard, and I’ve spent the days since sitting with it rather than reacting to it — trying to look at it the way a good consultant looks at a client who’s saying one contradictory thing after another: not taking the words at face value, but asking what the behavior underneath them is actually showing me.

Because words don’t always come easy when you’re seventeen and trying to have an adult conversation. They can easily betray a moment of immaturity when you’re dealing with something new and unknown. If I responded to the words, I’d be responding to noise. What I’m trying to track instead is the pattern — what’s consistent underneath the contradictions — the same way I’d read a client who says they’re fine in the meeting and then misses every deadline after it. The words tell you what someone wants you to hear. The behavior tells you what’s true.

That’s harder than it sounds when it’s your child. The person who was, for nine months, literally part of you — carved off, now walking around out in the world making his own choices, choices you can’t undo or absorb for him, some of which are going to hurt him and there’s nothing you can do about it but watch. That’s not a metaphor for me. He is part of me, out there now, separate, and that separateness is the whole point and also the whole ache.

I got through it this week because of my girlfriends — the ones who let me vent without flinching, who gave me their honest read instead of just telling me what I wanted to hear, and who kept nudging me back toward caution instead of protection when my instinct wanted to swing hard the other way. I don’t know how anyone does this without a few people like that on speed dial. I’m grateful, genuinely, for mine.

So here’s what I’m actually doing with all of it: not chasing the disclosure, not narrating my disappointment at him, not making my need to know into his problem to manage. Just staying steady and available through all of it. Not fixing. Not knowing everything. Just steady — so that if he ever does need someone, he already knows exactly who that is and exactly what he’ll get.

I’ve always wanted to be more self-possessed — steady regardless of what’s happening around me, not reactive to every shift in the weather. I’ve built that muscle professionally over decades. What I know about strong reactions is that they’re rarely about what just happened. They’re a trigger — something old getting stepped on by something new. So I do what I always do: acknowledge the feeling first, don’t skip that part, and then break it down and ask why it’s actually there. It’s a lot harder to do that on my own kitchen floor than it is across a boardroom table. But looking back at my parents, and then at my own parenting, I think this might be the actual key to doing this well — underneath the obvious stuff, being engaged, being present. Not managing your reactions by suppressing them. Managing them by understanding them.

If you’ve got any stories to share about raising your own teens, I would love to hear them! feel free to share or message - we all need to help each other do the best we can! It really does take a village!

Here’s the part I didn’t say out loud: I don’t run through a checklist every morning. I’m not standing in my kitchen going movement, check, nervous system, check. That’s not how this works once it’s actually working.

Here’s what my days look like instead. I walk in the morning and I walk again in the evening — not because I’m doubling down on movement, but because that’s when it’s coolest. Ten thousand steps split across two windows I can actually tolerate, instead of one miserable slog fighting the heat in the middle of the day.

Except it isn’t just movement. Notice what else is in that walk without me trying to put it there — sunlight, which resets the clock. Time away from a screen, which is most of the nervous system work right there. Quiet enough to actually think, which is half of what emotional processing even is. One habit, four spokes, no extra hour carved out anywhere.

I need to be honest about something, though. This still costs time, and it costs planning. I don’t book client meetings before ten o’clock, on purpose, because the morning belongs to the walk first. That’s not a luxury I stumbled into — it’s a boundary I built because I decided the walk mattered more than an extra hour of billable time. Summer helps. More daylight in Ontario means it’s easier to get up early and wind down early too, and my body seems to genuinely prefer that rhythm. Winter is a different negotiation, and I’m not going to pretend otherwise.

And it doesn’t look the same every day. During chemo weeks, the walk gets slower, or it gets split into more, shorter stretches instead of two longer ones. I plan for that instead of fighting it. The goal was never ten thousand steps at a certain pace by a certain time. The goal was movement, however it needed to show up that day.

If you’re going to do this, it won’t look like mine. You might not have the option to push meetings past ten. You might not have two cool windows a day. It’ll look like whatever you can actually protect, shaped around your actual life — not an ideal one.

The other thing that’s changed, and it’s bigger than the walk: I used to be someone who ran on get it done. Every day was a list, and the list was the point. Now I ask a different question before I add anything to it — does this actually need to happen? Not “can I do this,” not “should I do this if I had more time.” Does it need to happen, today, by me.

Most of what used to be on that list didn’t survive the question. That’s not laziness. That’s the lifestyle that got me here, quietly rewritten one refusal at a time.

Because here’s the thing I can’t get around: the old lifestyle is exactly what built the terrain this whole series has been describing. The inflammation, the exhaustion mistaken for identity, the body that was ripe for disease before disease ever showed up — that was the output of a life I built on purpose, one “yes” at a time, for years. If I keep living that life, I get that terrain again. That’s not a metaphor. That’s just what happened the first time.

So this isn’t a protocol I’m following. It’s a life I rebuilt, slowly, around a different question. Not what should I add. What do I actually need, and what can I finally put down.

That’s the high-level version. The specifics — what I actually track, what I actually take, what the walk looks like on a chemo week versus a good week — that’s in the workbook, for the people who want to go further than theory.

This series was never about giving you a list to follow. It was about showing you the loop, showing you what breaks it, showing you what feeds it, and now — showing you it’s actually livable. Not perfect. Livable.

That’s the whole point.

That’s not what this is.

Article 3 told you what’s quietly breaking your mitochondria, and most of it isn’t your fault. This one’s the part where you actually do something about it — once you’ve stopped beating yourself up for the terrain you inherited.

Not a protocol. Six areas where you have more say than the exhaustion is currently letting you believe.

Movement

You may be tired from everything else on this list. Chemo tired. Parenting-a-teenager-through-a-crisis tired. Running-two-businesses-while-your-body-does-something-else-entirely tired. Your body still needs you to move.

Not a marathon. Not a gym membership you’ll feel virtuous about for six days and guilty about for the other 359. Small, consistent wins you can actually fit into your life.

Stillness is a decision too. Your body doesn’t know the difference between “resting” and “giving up” — it just reads the lack of signal and downsizes accordingly.

Find the level that energizes rather than depletes. Start there. Show up again tomorrow. That’s the whole strategy. Not sexy. Works anyway.

Sleep as Repair

Everyone tells you sleep matters. It’s right up there with “drink more water” on the list of advice so common it’s stopped meaning anything.

Here’s the part nobody says out loud: rest is what sleep feels like. Repair is what it’s doing. Those aren’t the same thing, and you can tell the difference the morning after — the difference between waking up tired-but-fine and waking up like your body owes you an apology.

I know this one because I track it. My HRV was 17 when I started paying attention. During active chemotherapy, it’s hit 43. Higher HRV mid-treatment is not supposed to happen. That’s not a fluke. That’s terrain doing something.

You don’t need to become a data person to get this. You need to stop treating exhaustion like a personality trait, and start treating sleep like the one appointment on your calendar you’re not allowed to cancel on yourself.

Food

When you’re grocery shopping, think about your week. What healthy snacks can you grab that will actually be there when you need them? The pre-cut fruit bowl and the veggie tray feel expensive — until you price out the drive-thru you’ll hit on Thursday when there’s nothing in the house. At least this way it’s real food.

You’re not going to out-supplement a bad Tuesday. Small swaps planned in advance beat perfection attempted once a week, every time.

If you want to go further, there are mitochondrial cofactors worth knowing about — CoQ10, magnesium, B2, omega-3s. I’m not turning this into a dosage chart. That level of detail belongs in the workbook.

Nervous System Work

This one’s harder than the others, because most of us never grew up thinking or talking about it. Nobody sat us down and explained that our nervous system has an on-switch and an off-switch, or that we’re supposed to know how to work both.

You don’t need a meditation app or a weekend retreat to downshift. A few slow exhales — longer than the inhale — signal safety faster than almost anything else, and it takes under two minutes. A walk without your phone works because it removes the input. Even five minutes of doing nothing, on purpose, is enough to tip the switch.

It’s not about eliminating stress. It’s about proving to your body, regularly, that the emergency is over.

Emotional Processing

Article 3 covered what happens when you suppress this stuff — the cost of sitting on it, the loop it feeds. This one’s the flip side: what doing something about it actually looks like.

I wrote about this already, in more depth than I’m going to repeat here. Public Service Announcement, Part 2 is the one to read if this section resonates. Go read it. I’ll wait.

Circadian Alignment

Your body runs on a clock whether you consult it or not. Light in the morning, dark at night, meals roughly on a schedule — none of this is groundbreaking, and none of it requires an app.

The version of you who scrolls until 1am and then wonders why 6am feels hostile is not a mystery. That’s just physics with extra steps.

Open the blinds. Eat breakfast before noon sometimes. Let your body know what time it is. It’s been asking.

The Bottom Line

You don’t have to do all six of these every day. You have to stop pretending none of them matter.

The mitochondria don’t need perfection. They need you to show up more often than you don’t — move a little, sleep like it matters, eat something real, breathe before you snap, feel the thing instead of burying it, let your body know what time it is. That’s it. That’s the whole engine maintenance plan.

And one more thing, because it’s worth saying out loud:

Little Johnny is still watching. Last time it was what gets sacrificed. This time it’s what gets chosen — on purpose, out loud, even on the hard days. He’s not just learning what falling apart looks like. He’s learning what choosing yourself looks like, too.

Make sure he sees both.

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That’s the loop. Not a one-time event. A feedback cycle that runs quietly in the background, compounding, until the fraction you’re operating on starts to feel like everything you have.

The question is what starts it.

The honest answer is that most of it traces back to the choices we make — not because we’re careless, but because we’re not paying attention to what those choices are actually costing us. There’s no magic supplement that fixes an unconscious lifestyle. But conscious choices, made consistently, change the terrain.

Here’s what’s actually breaking them — and what it looks like to choose differently.

The loop you already know — now with causes

In the last article we looked at the system:

Sleep → Cortisol → Hormones → Immunity → Energy → Sleep

Here’s what’s driving each break in that loop. Not bad luck. Specific, nameable things — most of which are choices, or the downstream cost of choices we’ve stopped questioning.

Chronic stress

Some stress is genuinely non-negotiable. Some of it is a hamster wheel we’ve chosen and don’t want to examine too closely.

Does that next meeting really need to happen today? Can you send someone else? Does little Johnny really need the extra coaching sessions to make the more advanced team — so you can work more hours to pay for the higher level team, to then travel city to city on weekends, to pay for the hotels and the gas and the missed Fridays, to take calls from the road while running on four hours of sleep in a hotel bed?

You see where this goes. The thing that starts as an investment in your kid becomes a self-fulfilling spiral of chronic stress. You’re working harder to fund the thing that’s supposed to be good for your family, while your own system quietly falls apart in the background. Nobody decided that was the plan. It just became the plan.

If the stressful thing is non-negotiable right now, fine. Then what else can you ease up on? Sustained stress keeps cortisol elevated. Elevated cortisol generates oxidative stress inside the mitochondria. The engine runs hot — not for one hard week, but for the years that follow when nobody stops to ask whether this is still the right pace.

Sleep

The mitochondria repair on a schedule. That schedule runs at night, during deep sleep, when cortisol is at its lowest. When the repair window doesn’t open — because of the late night scroll, one more episode, the 6am alarm after a 1am night — the work doesn’t get done.

Nobody is doing this to you.

If you can’t get more hours, protect the quality of the ones you have. Sleep staging matters more than duration. The repair window is the one thing most worth protecting. Hot flashes count as disruption — every one that pulls you out of deep sleep closes the window early. That’s a nightly cost worth knowing about.

Food

The real question isn’t what you eat when you have time and energy to plan. It’s what you reach for when you’re exhausted and there’s nothing prepped and it’s already 7pm.

Ultra-processed food doesn’t just fail to nourish. It demands a response — insulin spikes, inflammation follows, the mitochondria process dirtier fuel through an engine built for something else. Some inputs cost more than they give back.

Sedentary living

Mitochondria are built on demand. Movement is the signal to make more of them. Without it, the body reads the stillness as permission to downsize.

You may be exhausted from everything else on this list. That’s real. And your body still needs you to move. Not a marathon. Not a gym membership you’ll feel guilty about.

Emotional suppression

What you carry costs you. Not as a metaphor — as a physical load on a system that’s already managing everything else.

Unprocessed grief, chronic resentment, the fear that sits in the body as vigilance — these keep the stress response running in the background. The mitochondria† never get a break. Something, eventually, has to give.

This isn’t a prescription for therapy, though therapy helps. It’s an honest accounting of the load. What are you carrying that you’ve never actually put down — not analyzed, not managed, not filed away — actually put down?

I wrote about my own version of this here if it’s useful.

Environmental and pharmaceutical load

Your liver processes everything — medications, pesticide residue, plasticisers, the chemicals in your cleaning products and personal care routine. When the load is high, the lymphatic system gets sluggish and waste backs up into the terrain.

Reduce what you can. Support the system for what you can’t. That’s the whole strategy here — not elimination, just conscious reduction where it’s possible.

Pharmaceutical burden is real and worth naming honestly. Many necessary drugs carry a mitochondrial cost. That’s not an argument against taking them. It’s an argument for knowing what you’re working with and supporting the system accordingly.

The supplement trap

You may be doing everything right on paper and still not getting the benefit.

If your mitochondria are deeply compromised, the system may not have the capacity to break supplements down into a form it can actually use. Right fuel, damaged engine, goes nowhere. Absorption isn’t guaranteed — it’s earned, incrementally, as the system recovers.

Address the terrain first. Then add.

The Bottom Line

You don’t have to fix everything. You have to stop doing everything unconsciously.

The mitochondria are running your energy, your hormones, your immune system, your repair cycle, your clock. They are not miracle workers. Every choice you make either adds to their load or gives them something to work with. Most of us have been adding to the load for so long we’ve lost track of what the baseline actually feels like.

Make the choices deliberately. If the tournament schedule is non-negotiable this season, what else can you protect? If the stress isn’t going anywhere, where can you recover? If you can’t change the inputs, can you support the system that’s processing them?

And one more thing — because it’s worth saying out loud:

Little Johnny is watching. Right now you’re teaching him what’s non-negotiable and what gets sacrificed. What gets protected and what gets run into the ground. What health looks like, what rest looks like, what it means to take care of yourself while taking care of everyone else.

Make sure you’re teaching him what you actually want him to learn.

Next: how to feed the engine — what actually moves the needle, and why the starting point is smaller than you think.

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† Your mitochondria are running every system in your body simultaneously — energy, hormones, immunity, repair, the clock. When chronic stress keeps the alarm bell ringing around the clock, they never get a break. They’re not miracle workers. They’re doing an extraordinary job under impossible conditions. But every system has a limit. Something, eventually, has to give.

The first time, I heard it and sat in shock. It took me a moment to register what the sound even was — someone else’s gong, someone else’s moment, and still my whole body went still, recognizing, before I understood it, that this wasn’t an ending. It was a wakeup call, a rally cry — theirs, and without knowing it yet, mine too.

The second time, I was waiting to see my oncologist, upstairs next to the chemo ward, the day before my last round of chemo. And it felt different this time. I looked at the woman sitting next to me and I just started clapping and cheering. She smiled, and started doing the same. Neither of us knew who it was for. We didn’t need to. The sound was enough to answer for.

The man across from us asked what was going on. We told him: someone’s done their treatment. He lit up like it was his own. For a second, it was — and he joined the celebration.

Sitting there, clapping for a stranger, I decided. I didn’t need this to be a performance. I needed to take those good vibrations and send them back out — pass them on, hand to hand, the way they’d just been passed to me. That’s what my gong would be for.

That’s what I want mine to be, tomorrow — not a gong that says it’s over, but one that says I’m still here, and I’m not done — I’ve got more to do.

I’m ringing it in recognition — for everyone sitting in this chair right now, for everyone who sat in it before me, for everyone who loves someone in it, carrying this alongside them without a chair of their own to sit in.

One gong. Not a battle cry. A wakeup call passed hand to hand, room to room, sent out to anyone who needs to hear that it’s possible to still be here, and still have more to do.

I’m finishing this from the chair of my last chemo treatment and I am grateful beyond words for everyone who lent me their strength to get here. If someone in your life needs this reminder of support right now, send it their way.

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If you’re reading this, know that I’m forever going to be sending a little prayer out to those going through this every time I now hear “Get It On (Bang a Gong)” T. Rex. I invite you to join me. (And if you’re paying attention, the lyrics make zero sense. I'm keeping the gong and leaving the rest of Marc Bolan's word salad exactly where it is.)

Five hours of sleep was fine. Hypervigilant, over-scheduled, always three steps ahead — I thought that was just how I was built. Efficient. I was proud of it. What I didn’t know was that I was causing my own inflammation and calling it productivity. My body was running in permanent low-grade emergency mode and I had mistaken the adrenaline for energy so many times it had become my identity.

I thought I was fine.

I wasn’t anywhere close to fine. I just didn’t have anything to compare it to.

Then I got an eight-hour sleep for the first time in longer than I could account for, and woke up realising the deficit wasn’t from a bad week. It was structural. When I started losing weight, I thought I was losing fat. I wasn’t. I was losing inflammation — the physical residue of years of a system that had too much to process and not enough support to do it. I didn’t know the difference until I could feel it. In how I recovered. In how I thought. In how much I could carry without it costing me everything.

That’s when I started seeing the system. And once I could see it, I couldn’t stop.

Sleep → Cortisol → Hormones → Immunity → Energy → Sleep

One system. Not six separate problems. I spent a year chasing where to start because I’d never looked at it that way before.

And underneath all of it — powering the whole loop — the mitochondria. They also power the lymphatic system, your body’s drainage. When the mitochondria are struggling, the drainage slows. The waste backs up. The garbage piles up in the terrain everything else is trying to run in. That’s why I was inflamed. Not one thing going wrong. A loop, running long enough to become my normal.

Capacity is what depletes us — not in one moment, but through the agreements we make. Yes to this, yes to that, I’ll rest when it’s done. Each one feels manageable. Collectively they rewrite your baseline. And the signal that should tell you the tank is low gets quieter the more you override it. Until the fraction you’re running on feels like everything you have.

What your terrain actually is

Everything your cells are living inside. The sleep, the stress, the food, the movement, the emotional weight, the toxins in your body and your environment. Your mitochondria are running that terrain — producing energy from it, responding to it, being shaped by it. When the terrain is hostile, output degrades. When it starts to clear, things come back online that you didn’t know had gone dark.

Your terrain is not your diagnosis. It’s the environment that preceded it.

Three ways to read your own signals

What you feel is the first layer and the most honest one. Energy on waking — not whether you can get up, but whether you want to. Recovery time after exertion, after a hard conversation, after a hard week. Whether your mood is something you inhabit or something you maintain. These aren’t soft data points. They’re the system reporting.

What you can track is the second layer. HRV is the one I keep coming back to — a direct readout of how well your nervous system is recovering, and it correlates with almost everything else. Sleep staging matters more than sleep hours. Blood pressure tracks vascular load over time. Weight trends tell you something about inflammation. Hot flash frequency, for those navigating hormonal disruption, is a nervous system signal as much as a hormonal one.

My HRV was 17 when I started tracking seriously. During active chemotherapy it has hit 43. That is not what is supposed to happen during treatment. That is terrain doing something. I can see it in the numbers and feel it in my body — and for the first time in my life those two things are saying the same thing.

What needs clinical eyes is the third layer — labs, markers, the things that need someone else’s equipment. Get the numbers. Learn to read the trend. Numbers without context are noise. Numbers over time, in a body you’re starting to understand, are signal.

What gets in the way

Everything, if we’re being honest. And the body doesn’t sort it by category — it carries all of it from the same account.

• Cancer treatment — the diagnosis itself, the mental overhead of managing your own care

• Chemotherapy — a documented mitochondrial cost, on top of everything else

• Disrupted sleep — treatment-induced, compounded by hot flashes pulling you out of deep sleep repeatedly through the night

• Hot flashes — worsened by hormone blocker drugs affecting vascular and autonomic regulation

• Cardiovascular load — blood pressure and vascular resistance changes caused by the blocker drugs themselves, not just the disease

• Lymphatic sluggishness — when drainage slows, waste backs up into the terrain

• Chronic stress — its own section below, because it deserves one

• Emotional weight — fear, grief, uncertainty, the things that don’t show up in labs

• Regular life — work, decisions, logistics, just existing

Look at all of it. Not to feel overwhelmed. To feel accurate.

The stress section — what is yours to carry?

This is the one the wellness industry glosses over, because it doesn’t fit in a supplement protocol.

I am in active cancer treatment. I also have a son — a teenager whose nervous system is genuinely under construction. He’s not being difficult. He’s building himself, and some days he brings me his storm because I’m his safe space, and I’m trying to hold that while simultaneously holding mine together. We’re a great match right now, the two of us.

I also have two parents with illnesses. My mother lives out of town. My sister and I take turns helping her with appointments, coordinating her care, being present across a distance. That’s not a complaint. That’s a Tuesday.

And somewhere in there I’m supposed to be resting, reducing stress, and supporting my mitochondria.

Here’s what I’ve had to learn, slowly and not always gracefully: not all of it is mine to carry. Some of it is mine to hold lightly. Some of it is mine to hand off. Some of it is someone else’s weight that I picked up so long ago I forgot it wasn’t mine.

Your version of this is different. But you have one. The aging parent. The struggling kid. The partner who needs more than you have right now. The job that doesn’t pause for a diagnosis. The friendship that only flows one way. The grief you haven’t had time to feel yet.

Your body is carrying all of it. Whether you acknowledge it or not, the mitochondria are paying the bill.

So before you add another supplement or optimize another protocol — ask yourself honestly: what is mine to carry right now, and what isn’t?

That question alone can change the terrain.

What you can actually do

Find your honest scale. Not the perfect score — the real starting point.

Pick one signal. Track it for thirty days. Actually look at what it says.

You don’t need perfect conditions to start. You need one domino.

The old me didn’t realize I was dealing with a system in permanent triage. Every function we talked about last time — energy, hormones, stress, the kill switch, immunity, the clock — was running compromised, quietly, for years. The inflammation, the adrenaline that never cleared, the lymphatic system working in dirty water. I thought that was just me.

It wasn’t me. It was my mitochondria doing their best in a terrain that was working against them.

The new me won’t let that happen again. Not because I have it all figured out. Because now I know what to look for.

Next: what’s quietly breaking them — and why most of it isn’t your fault.

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It means what it sounds like. You don’t inherit a secure base. You build one, from nothing, usually while the people who were supposed to give you one are still busy running from their own wreckage. It doesn’t mean you were never hurt. It means the hurt stopped traveling with you.

I didn’t get a secure base. Neither of my parents really knew how to foster connection, and the house I grew up in was a volatile place to be — you never quite knew what you were walking into. I learned early to read the room before I did anything else.

For a long time, I believed I was the source of a lot of what went wrong in that house — that things would have been easier for everyone if I’d simply taken up less space. That belief lived in me for years, underneath everything else. The one thing that ever pushed back against it was my sister, and the plain, consistent way she loved me — a love that didn’t depend on me fixing anything or disappearing. She didn’t argue me out of the belief. She just kept being proof against it. I know she’s reading this, and I know she knows. But it’s still worth saying.

By the time I was a child myself, I’d already found my exit. I lived in my head. If I could understand the system, I didn’t need the people running it to be safe or predictable. I’d predict them myself. I’d need nothing from anyone. I see now that wasn’t peace or self-reliance — it was armor. And for about three decades, I mistook the armor for a personality.

That armor had a very specific logic to it: if I never let myself need anyone, no one could disappoint me by not showing up. Needing someone felt like handing them a weapon. So instead I made myself indispensable — the one who handled things, who didn’t require tending to, who could be counted on precisely because I never counted on anyone back. It felt safer. It also meant I spent a long time being loved for what I did rather than for who I was, without ever really noticing the difference.

I see now that I was lonely. I see now that I isolated myself, always, and that autopilot kept quietly compounding without my noticing. I know I have a real capacity for love. I’m still working out how to let it move in both directions, because I also know not everyone has that same capacity to offer back — and for a long time I couldn’t tell the difference between those two things.

As I think about what I was modeling: I had nothing to model from myself, so I was building it blind, hoping it would be enough, with no way to know until he was old enough for the results to actually show. I wanted to model something that would build a secure child — that was the goal the whole time, even without knowing exactly how. And more than anything, I didn’t want him to grow up thinking love was something you had to earn by being useful or undemanding — the way I did. I think most parents want that for their child, whether they had it themselves or not. I hope, at minimum, I’ve given him that much.

When I look at who he’s becoming, I find something closer to what I never had: someone who can be scared and still stay in the room. It’s a relief to see it — you genuinely don’t know if it worked until they’re grown enough to show you.

He wrote a paper for school about the day I told him about the cancer. I was so happy he wanted to share it with me after he got it back — I will cherish it forever. He described it plainly: he said he could tell something was wrong before I even said a word. That’s the same hypervigilance I grew up with. He has some of my wiring. Of course he does.

Then he wrote that he hugged me as tight as he could. And that he was really just sad, and didn’t want to accept that his life — and mine — was changing.

That’s the part that gets me. He moved toward me. Not away. Not into his head to manage it alone. Toward. At an age where the instinct I’d built for myself would have been to go quiet and handle it solo, his instinct was to close the distance. That’s not the strategy I built. That’s the opposite of it.

He’s finishing high school now, and I’m aware there’s a clock on this — the years where I get to actually guide him through the things I never had guidance on are almost up. So I’m grateful, more than I can really put into words, that this last year forced me to finally do the work of seeing these patterns clearly enough to hand something useful off to him. Just under the wire.

Some of that closeness, I think, is because I made a hard call a while back: I ended a marriage so that he could have a home where he didn’t have to stay alert, where nothing was tense underneath the surface, where he could just be a person without managing anyone else’s mood first. It cost me things. It was still the right call. A child registers whether a house is safe long before he can explain why, and I wanted him to never have to explain it.

These days, as I navigate his attachment style — the teenage I-know-everything moments running right alongside the quieter I-actually-want-to-be-close-to-you-in-this-moment ones — I know our foundation is solid enough to withstand some bumps in the road. That’s not something I take for granted.

I didn’t get a secure base. I built one, badly at first, while running a business and raising my son mostly solo, and later while doing all of that with a tumor added to the pile. The proof it worked isn’t a framework or a diagnosis. It’s a young man who moves toward people instead of away from them, and who wrote, in his own words, that he’s seen — no matter what you’ve had to overcome, you always have more to give. I’ve believed that about myself for a long time — that I’m strong, and that I still have more to give — and it’s a strange, good thing to watch it become true for him too, in his own words, before I ever said it to him directly.

I know there will be ups and downs still ahead for him — that’s just what growing up is. But based on what I can see right now, I feel more and more like he’s a quick learner who will be able to trust himself to get through whatever comes, even if he doesn’t have the language for it yet.

I didn’t teach him that sentence. He watched someone try to live it, badly and then less badly, for years.

That’s the whole inheritance. Not the absence of wounds. Just proof they don’t have to keep moving.

If any of this landed a little too close for comfort — if some line above made your chest tighten before your brain caught up — that’s worth sitting with, not brushing past. Ask yourself what it actually touched. Not the surface story, the thing underneath it. Naming it, even just to yourself, starts to take the charge out of it. That’s most of the work, honestly. Not fixing the old wiring. Just recognizing it for what it is, so it stops running the show without your permission.

Goodbye, chemo. I will not miss you.

Let me be clear about that.

I will not miss the cortisol spikes that woke me at 3am heart hammering for no reason except that my body was doing something enormous and forgot to mention it would feel like this.

I will not miss the hot flashes. The congested nose. Six months of nosebleeds and a runny nose so constant I stopped being able to tell which one it was anymore.

It all just felt the same.

I will not miss my burnt tongue — six months of tasting everything like it had been left out in the rain.

I will not miss the joint pain that arrived without warning and left the same way. The unpredictability of it. The way my body stopped feeling like mine.

I will not miss the swelling — ankles, abdomen, stomach — after working so hard on lymphatic drainage, doing everything right, and still watching my body hold on to what it needed to release.

I am grateful now that I can feel the difference. That I know what inflamed feels like because I’m finally feeling less of it.

I will not miss all the supplements, extracts and mixes — though those aren’t going anywhere, just phasing, just shifting, just becoming a different and more manageable stack.

I will not miss the wondering. The researching. The calculating. The weighing of every option against every other option while trying to also just live a life.

Good riddance.

And to the people who told me — this is going to suck but it’s going to be worth it —thank you.

I needed the honesty more than the reassurance. The permission to say this is hard before anyone told me it was going to be okay.

You were right. On both counts.

Now, about about my hair.

I would never have chosen short hair. Not in a million years. Past my shoulders was my length, my identity, my thing.

And then I didn’t have a choice.

Here is what I will admit: it hasn’t been as bad as I thought.

There is something to be said for how cool it is in the summer. For the simplicity of it. For the way it stopped being something I had to think about.

Hat on. Morning red light therapy. A dose of vitamin D in the early sun before the heat decides to arrive. Morning and evening walks, 10,000 steps at minimum, lymphatic drainage getting what it needs, my body moving the way it was always meant to move.

This is not a temporary protocol. This is the new life.

And the hair I knew: long, past my shoulders, the length I called mine, well that’s years away still.

In the next few weeks the inflammation starts easing. My nose begins to remember what it felt like to just be a nose.

Somewhere around weeks three to six my follicles start waking up. Soft. Fuzzy. Barely there. But there.

By month three something that looks like hair might actually appear.

I am learning to find the beauty in the in-between.

Here is what I want to remember about these six months.

I was not at war with my body.

I was supporting it in the most counterintuitive way it has ever been asked to receive support.

I had to poison it to heal it. I had to break it down to build it back up. I had to introduce something destructive in order to jumpstart something generative.

Chemo. Immunotherapy. The jumpstart my immune system needed — the one that had been quietly devolving for decades until my body finally said loudly and clearly —enough.

And I listened.

And here is where it gets interesting.

Because the same lesson keeps showing up in different rooms of my life.

Loving a teenager is counterintuitive too.

Every instinct says guide them, protect them, catch them before they fall.

But sometimes the most loving thing is to hold back. To watch them stumble without rushing in. To trust that the struggle is the point: that they can’t build what they need to build if I keep building it for them.

Stepping back is not abandonment. Letting them fall is not failure. Loving someone loudly in ways they cannot yet receive is still love.

It just doesn’t look like it from the outside.

The same way chemo didn’t look like healing. The same way poisoning didn’t look like support.

But it was. It all was.

I am learning that the most important things rarely look like what they are while they’re happening.

And now the next phase begins.

The hot flashes aren’t going anywhere — estrogen castration will dictate what my body gets to feel next and apparently hot flashes are staying on the menu.

Weekly IVs continuing. New medications starting. A new set of unknowns. Learning which side effects stay, which ones go, what new ones arrive that I haven’t met yet.

I am gearing up for a different kind of vigilance.

Because here is the truth about cancer that nobody puts on the greeting cards — this is a lifelong thing now.

Monitoring every three months. Scans every six. And every time there’s a twinge, every time a scan is approaching, there is a part of me that wonders: how is this report card going to look?

That wondering doesn’t go away. It just gets quieter. It just becomes part of the background of a life you are choosing to keep living fully anyway.

My naturopath said it clearly: first we deal with this. Then we rebuild.

That’s where I am now. The rebuilding. Not an ending, a threshold.

And I could not have crossed it without the people who showed up and stayed.

The ones who helped me think through the options — who sat with the complexity and didn’t flinch.

The ones who helped me think through the logistics — who saw what needed to happen and quietly made sure it did.

The ones who showed up with meals, who cleaned what I couldn’t, who drove when I shouldn’t.

The ones who pulled me back when I went too deep into the research, into the studies, into the spiral — who said come back to basics, come back to what you know — and were right every time.

The ones who picked up the load with my son when I couldn’t carry all of it.

The ones who kept things moving when my bandwidth was spoken for by something more urgent.

This is a marathon. Not a sprint. And I did not run it alone.

You know who you are. And I hope you know what you gave me.

Not just support. Not just help.

You gave me the conditions to heal.

My body was telling me what it needed for a long time.

I just wasn’t listening.

I’m listening now.

And because I’m finally slowing down enough to pay attention — I’m seeing things I never saw before.

Parallels. Opposites. Connections between my body and my parenting, my healing and my loving, the way I treated myself and the way I treated everyone else.

It’s all the same conversation. I just couldn’t hear it before now.

And soon I am going to the ocean.

East coast. Salt air. Big open spaces. And my dog having the time of his life.

The first real exhale in six months.

That is the prescription no one wrote down but everyone knew I needed.

This is not a victory lap.

This is a woman who spent a year learning to listen to the body she’d been ignoring for decades.

Who is still rebuilding. Who is still learning. Who is figuring out what comes next — one step, one breath, one mitochondria at a time.

And for the first time in a very long time, it’s like watching the sun peek out from the clouds.

And honestly, if you haven’t heard this song, you really need to give it a listen - just a little musical love from me to you: The Last Day of our Acquaintance (It’s the closest to the album release which is really the best version of the song for the use of stress and release with that drum part.) If you aren’t a fan, this song may change your mind.

Not metaphorically. Actually. There is a moment — governed entirely by these tiny structures living inside every cell you have — when a damaged cell receives the instruction to dismantle itself and get out. Clear the space. Stop taking up resources. Move along.

Your mitochondria give that order.

Now. If damaged cells aren’t getting that instruction — if they’re hanging around, accumulating, multiplying when they shouldn’t be — they become like garbage that never gets collected. It piles up. It starts blocking things. The distribution channels, the communication channels, the systems that depend on everything flowing the way it’s supposed to — they start hitting traffic jams. And traffic jams, left long enough, become something much harder to fix.

That’s not a cancer story specifically. That’s a what-happens-when-the-cleanup-crew-doesn’t-show-up story. And it applies to a lot more than one disease.

So. One tiny structure. Six functions. One ring to rule them all — or at least, one address where every major system in your body quietly meets. Here’s what they’re actually running.

Energy. Living costs energy. Everything your body does has a price tag — moving muscles, thinking, fighting off what shouldn’t be there, digesting your lunch, healing a cut. All of it gets billed to the same account. If the supply doesn’t meet the demand, your body starts making quiet decisions about what gets funded and what doesn’t. You don’t get a memo. Things just start working less well. You start working less well.

Hormones. Your hormones are your body’s messaging system — chemical signals telling every part of you what to do and when. The thyroid is the clearest example of what happens when that system goes sideways. Too much thyroid hormone: heart racing, can’t sleep, losing weight without trying, anxiety you can’t explain, heat you can’t escape. Too little: exhausted, gaining weight for no reason, foggy, cold all the time, everything slowing to a crawl. Same gland. Same hormone. Completely opposite experience — and here’s the thing: you cannot regulate your way out of either one from the outside, because the signal is broken at the source. Fix the message all you want. If the system producing it is compromised, the message stays broken.

The stress response. Your body runs on a very old operating system. When it senses a threat — real, imagined, or chronic — it floods you with adrenaline and cortisol to deal with it. That’s useful when the threat is temporary. When it isn’t — when the stress is just the baseline condition of your life — your body stays in emergency mode indefinitely. Sleep suffers. Digestion suffers. Your immune system, which is expensive to run, gets quietly deprioritised. And the system generating all those stress signals? Runs straight through the mitochondria.

The kill switch. Damaged, infected, dangerous cells are supposed to be caught early and removed cleanly. Your mitochondria are the ones doing that catching. Left unchecked, those cells don’t just sit there — they multiply, they grow, they become a bigger problem than the original one. The garbage piles up. The traffic jams start. You already know where this goes.

Immunity. If your mitochondria are already stretched — managing energy shortfalls, sorting out stress signals, trying to keep the hormonal messaging system online — immunity is last in line. You get sick more often. You heal more slowly. Things that should be short linger. Your body is doing its best with what’s left in the budget, which at this point isn’t much.

The clock. Your body runs on a daily repair schedule. Mitochondria follow it precisely — there are times of day when they’re producing, and times when they’re repairing, and those times are wired to your sleep-wake cycle. Disrupt the clock — shift work, screens at midnight, chaotic sleep — and the repair window closes before the work is done. Every night. The clock and the engine are coupled. One suffers, both suffer.

Six functions. All of them running through the same place. This is why every road I’ve walked down this past year — energy, hormones, stress, disease, sleep, recovery — ends at the same address. It’s not a coincidence. It’s architecture.

Here’s what it looks like when that architecture is working, and when it isn’t:

Same body. Completely different experience of being in it.

The variable isn’t willpower. It isn’t age, necessarily. It isn’t even the diagnosis — though you’ll hear that one used to explain a lot.

It’s what’s happening inside the cell. And if you want to understand what’s happening inside the cell, you have to understand what’s breaking it down in the first place.

(If you want more background on how metabolism, sleep and stress connect to all of this, I wrote about it here — it’s a good place to start.)

Next: how to know if yours are working — and what your body’s already been trying to tell you.

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What I never did was sit in the feeling underneath the understanding. The grief. The loss. The sadness of not having gotten what I needed when I needed it. Sitting in that seemed impractical — useless, even. What was I supposed to do with it? Understanding was the useful part. Feeling was just... feeling.

I didn’t see what holding onto it, unfelt, would actually cost. Somewhere in there, it built a nervous system that runs hypervigilant by default — always scanning, always three steps ahead, always braced for whatever’s coming. That hypervigilance built a career. It also quietly took everything it built with. You can’t run on high alert for decades and call it free.

A year of nervous system work, of actually trying to let things go instead of just understanding them intellectually, has shown me something I wish I’d known decades ago: you can’t skip the feeling and get to the letting go. The only way out is through it. I’m learning to trust my own competence instead of my own vigilance — to actually believe I’m safe, instead of staying ready in case I’m not.

And now, watching my son get closer to leaving for school, I’m sitting with a harder version of the same question. How do you let go of something you love that much? Not manage it. Not control it from a safe distance the way I’ve controlled everything else. Actually let it go.

This is something I’m only realizing now, at fifty. I wrote it for my son, and I gave it to him. I’m not sure how it landed yet. But it needed to be said, so I’m sharing it here too.

(An ode to my son)

It took me a year.

Not a metaphorical year. An actual one. Three hundred and sixty five days of sitting in things I had spent a lifetime learning how to avoid.

Nausea. Confusion. Frustration. Grief I couldn’t name because I hadn’t let myself feel it long enough to know what it was.

That’s what excavation costs. That’s the price of finally going in.

Here’s what I found when I got there.

A little girl who didn’t get held enough. Who learned early that love was not guaranteed. Who decided somewhere deep and wordless and small that if she just worked hard enough, was good enough, needed little enough, she could earn her way into feeling safe.

She never quite got there.

So she carried it. For decades. Buried under achieving and doing and building and pushing through.

Unfelt. Unnamed. Waiting.

And then you came.

And I loved you with everything I had — including everything I hadn’t healed.

I held on tight because the little girl in me knew what it felt like to not be held at all.

I mothered you hard because somewhere underneath it I was trying to mother her too.

I didn’t see it then.

I see it now.

Here’s the lesson I needed fifty years and a cancer diagnosis and a year of feeling everything to finally learn —

When we bury things they don’t disappear. They just go underground and keep growing in the dark until they find a way out whether we’re ready or not.

The excavation is harder the longer you wait.

The price of not feeling is always paid eventually — with interest.

You don’t have to wait until you’re fifty. You don’t have to wait for a crisis to make you stop and finally go in.

You can start now. Messy and young and uncertain and not knowing what you’ll find.

That’s okay. That’s actually the whole point.

Feel the things while they’re small before they become the things that run your life without your permission.

I’m not telling you this because I have it figured out.

I’m telling you this because I’m still in it.

Still excavating. Still finding things I didn’t know were there. Still learning at fifty what I wish I’d known at seventeen.

But I’m in it.

Finally. Fully. Without the armour.

And that’s what brave looks like from where I’m standing.

Not fearless. Not certain. Not having all the answers before you begin.

Just willing.

Willing to feel it. Willing to name it. Willing to go in even when everything in you says to stay on the surface where it’s safe.

I just want to see you be brave.

Not for me.

For you.

So you don’t have to spend the next thirty years excavating what you could have felt right now.

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If any of this landed for you, here’s a place to start: pick one thing you’ve understood for years but never actually felt. Not analyzed. Not explained away. Just sit with it — five minutes, no fixing, no agenda — and see what’s actually been waiting under the explanation.

You don’t need a diagnosis to start the excavation. You just need to be willing to stop being so damn practical about your own feelings.

And if you are interested in the inspiration behind this one - check out the song, here.

I’ve been writing this series for over a year now. Through diagnosis, through chemo, through the appointments that frustrated me and the ones that didn’t, through the research rabbit holes and the 2am wake-ups and the walks I took anyway because the data said to.

You’ve been reading it. Some of you have been here since the beginning. Some of you found your way here recently and went back to read everything. Some of you have written to me — about your own bodies, your own appointments, your own version of the loop I keep describing.

I built this for you.

The Mighty, Mighty Mitochondria series wasn’t just a science explainer. It was everything I’ve learned, distilled into something I wish someone had handed me before I needed it. The workbook attached to this post is the companion — not more reading, but something you actually use. Fill it in. Come back to it and see what moved.

Read more

That is the understatement of your entire education.

Read on.

I have spent the better part of the last year inside one of the most clarifying and disorienting experiences a human body can go through — active cancer treatment, with all the pharmacological weight that comes with it. And somewhere in the middle of chemotherapy, cardiovascular monitoring, integrative naturopathic care, HRV tracking, sleep staging, and a supplement protocol that would make most pharmacists blink twice, I kept arriving at the same address.

The mitochondria.

Every single time.

Ask me about cortisol. Mitochondria. Hormonal disruption from treatment. Mitochondria. Why the morning walk matters more than almost anything else I do, why TM isn’t just meditation but something measurably cellular, why melatonin at therapeutic doses is doing something entirely different than helping you sleep.

Mitochondria. Always the mitochondria.

They are not the powerhouse of the cell. They are the command centre, the hormone factory, the stress sensor, the immune coordinator, the circadian timekeeper, and the final arbiter of whether a cell lives or dies. Calling them a powerhouse is like calling the conductor of an orchestra “the person who waves the stick.”

You know the Cadbury secret? The one guarded so closely only a handful of people alive are allowed to know the recipe? The mitochondria have one too. Except this one is guarded much, much more.

Every time I think I’ve finally understood them, there’s another layer underneath. That’s what this series is. A year of going deeper, and a honest account of what I found.

Two scenarios. One of them probably sounds like you.

The first person wakes up before their alarm. Not jolted — surfaced. There’s a moment before full consciousness where the body feels settled. Energy isn’t something they’re performing. They actually have it.

The morning doesn’t require negotiating. The walk happens because the body wants it. Somewhere around the twenty-minute mark something shifts — a biochemical ease, a loosening of whatever the night held. Thinking is clear. Not caffeinated-clear, which is borrowed clarity with a bill attached — actually clear. Problems that felt large yesterday have edges today.

Here’s what thriving mitochondria don’t look like, because the wellness world gets this almost universally wrong: they don’t look like stillness. They don’t look like slow.

In the last sixty seconds while writing this, I moved through a business idea, a science question, an editorial decision, a travel logistics problem, and a calendar issue — and landed on each one cleanly before moving to the next. That’s not scattered. That’s executive function running at capacity. The five things felt like options. I’m also practicing havening as I write — a technique that induces a delta brainwave state through specific touch sequences, almost certainly doing something mitochondrial via cortisol suppression. That’s the fifth thing happening in the same minute. Not zen. Capacious.

Recovery from the walk is fast. By the time they’ve showered they’re not tired from the exertion — they’re energized by it. Not a personality trait. Mitochondrial biogenesis — the body creating more engines in response to the demand you placed on it. Mood is stable without maintenance. Sleep comes easily that night, deep sleep follows, and the cycle begins again.

The second person wakes to the alarm after what technically counts as eight hours and doesn’t feel like it. There’s a specific kind of fatigue that has nothing to do with sleep quantity. Cellular flatness. The body is present but not available.

The morning is a negotiation. Coffee first, obviously. Then maybe movement — or maybe not, because when you actually run the numbers, they don’t resolve in movement’s favour. You tell yourself you’ll do it later. You know you probably won’t.

Thinking is wading. Ordinary decisions cost more than they should. The same five things that felt like options for the first person feel like a pile-on — not because there are more of them, but because each one costs more to hold.

Recovery doesn’t come. If they pushed through the walk, they’re paying for it hours later, maybe into tomorrow. The exertion didn’t build anything. It drew down a reserve that wasn’t full. Mood needs managing all day. Sleep comes late or comes broken. The alarm goes off again the next morning, and the cycle continues — pointing the other direction.

Same person. Same morning. Same life.

The only variable is what’s happening inside the cell.

That’s not a metaphor. That’s the mechanism. And once you see it, you can’t unsee it — in yourself, in the people around you, in every conversation about energy and health that spends all its time talking about everything except the thing actually doing the work.

So this is where we start. There’s another layer. There’s always another layer.

Next: what these things actually do — and why “powerhouse” was the understatement.

This is the first part of a six part series - the intent is to help explain what we should actually be focused on if we want to be healthy - not skinny, not strong, not nutritionally disciplined by our diets, but healthy from the inside out. I’ve also built an assessment tool for my paid subscribers as a thank you for your support, so please watch your inbox for that.

And thank you all for your support, I hope this helps you on your health journeys!

The Highlights Reel

Let me give you the highlights reel, because I’ve been living this for just over a year and I think it’s time to lay it out in one breath.

Cancer verified. Naturopathic marathon — sleep, food, metabolism, supplements, forty pounds gone, a body rebuilt from the inside out. Gearing up for chemo. Chemo. Side effects from chemo that I will not romanticize. New naturopathic therapies layered in — hyperthermia, IV vitamin C, mistletoe, fasting protocols. Remarkable scan results: two tumours gone, third cut in half. Then: they want to talk about five years of estrogen blockers WHILE ongoing HER2 blockers continue for a full year. AND I fought for a referral to a heart specialist because my blood pressure has been flagging Stage 2 since March and my mitral valve has progressed from trace to mild regurgitation on the HER2 blockers. Recommendation: Continue chemo anyway. Continue HER2 blockers. Have the short and long-term cardiac conversation. And deal with heart issues as they come.

Fourteen months of that. And the ask is: sign up for five more.

I’m going to need someone to explain the logic. Again.

Remarkable. By Any Measure.

You already know the scan results — I wrote about them in The Finish Line Moved. Two tumours gone. The third half its original size — I believe it’s scar tissue, my body’s monument to where the fight used to be. We won’t be doing any more scans on it. The reason given: the results won’t change protocol. (Read that again. We don’t care what’s actually happening in your body. Just stay on the chemo train.) The nodes that confirmed spread: fully resolved. The bone lesion my oncologist had been calling metastasis: now sclerotic and stable, radiologist’s read likely treatment response.

Remarkable. By any measure.

So I was more than a little deflated when the recommendation was to stay the course. Maintain the current chemo schedule for as long as I can stand it, alongside HER2 blockers for at least the full year. That’s where they lost me.

The Three Questions

Because I have questions. Specific ones.

1. Is there still active cancer in my body?

2. If so — what is its actual receptor makeup right now?

3. And if I was ER+ but those tumours are gone — what am I now?

The medical system is here to treat my disease. But if they won’t do the scans, won’t biopsy the one remaining unknown, and won’t retest receptor status after fourteen months of treatment that demonstrably changed my biology — how do they know what they’re treating?

This isn’t a fringe concern. A 2026 study of 508 breast cancer patients found HER2 status changed after chemotherapy in 43.7% of cases — nearly half.1 Not a rare edge case. A coin flip.

So I did what I always do. I went and read the actual science.

The Protocol

Here’s the recommendation: aromatase inhibitors — estrogen blockers — for five years minimum. The guideline is explicit. It applies, and I am quoting directly, irrespective of pathological findings.

Irrespective of pathological findings.

It does not matter what actually happened in your body. The protocol is the protocol.

Because my pathological findings are: two tumours gone, nodes gone, bone lesion resolving. And the protocol’s response to that is identical to what it would have been if nothing had worked.

That’s not medicine. That’s a flowchart — except even that gives it too much credit, because a real flowchart has decision points. It assesses results. It weighs intervention impact. It asks: given what we’re seeing, which path makes sense now?

What I’m looking at is simpler than that. Phase 1: treat cancer — chemo and blockers. Phase 2: finishing cancer — more chemo and blockers. Phase 3: cancer gone. Phase 4: continued blockers, new blockers, blockers for the next five years. No forks. No recalibration. No moment where the results get to change the answer. Just the next pre-loaded step, waiting.

The outcomes are an input the system was never designed to receive.

The Evidence They’re Working From

The ER+ result driving this recommendation came from a biopsy taken in March 2025. From tumours that no longer exist. (ER+ means estrogen receptor positive — the original tumour tissue had receptors that responded to estrogen, which is why estrogen-blocking drugs are part of the standard protocol. But that designation came from cells we can no longer find.) Receptor status changes during chemotherapy — multiple large studies confirm it, including one published this year showing that nearly half of HER2 patients had different receptor results after treatment than before. The researchers’ conclusion: retest after chemo.

No one has offered to retest mine.

The one tumour that might still be present has never been biopsied. We don’t know its receptor status. We don’t know if it’s tumour tissue at all. And the protocol doesn’t ask — because it was designed for patients who had surgery and came out the other side with tissue in a jar and a pathology report in hand.

I haven’t had surgery. The framework being applied to me was never built for a patient like me.

One more thing worth saying plainly: the drugs they want to add — estrogen blockers — were studied mostly in women whose cancer was not HER2-positive. My cancer is. The two subtypes behave differently, respond differently, and the evidence for adding estrogen blockers on top of HER2 treatment is, at best, thin. That’s not me rejecting science. That’s me reading it.

The Standard of Care Is an Average, Not a Gospel

It isn’t wrong. It’s an average. A guideline built from trial data, designed to give clinicians a defensible starting point across a population. That’s legitimate and useful.

The problem is when the average gets mistaken for the gospel. Every theory — medical, scientific, strategic, doesn’t matter — lives or dies in its application. Applied thoughtfully to the right patient with the right context: good medicine. Applied automatically to every patient regardless of what’s actually in their file: something else entirely.

I am not a walking, breathing average. I am one person — not a culmination of trial populations, not a data point to be smoothed into a curve. The theory didn’t save me. The application did. But it was my application — of naturopathic medicine, integrative therapies, adjunctive options I hunted down myself, data I trended on my own body month over month — that actually moved this. And now I’m being handed back a theory designed for someone else.

And Then There’s My Heart

My father had a quadruple bypass at forty. I watched cardiac disease move through my paternal line my entire life and I flagged it on day one. I went into this knowing I would not trade cancer for heart disease. That was never a negotiation.

The research on breast cancer survivors is clear: the top two causes of death are heart disease and cancer recurrence. My spidey senses were tingling from the beginning. To their credit, the cardiac risk of HER2 blockers is on the brochure — it’s why I get an echocardiogram every three months. They know.

But I’ve been documenting the degradation of my cardiovascular system for three months now. Bringing data trends to appointments. Flagging patterns. Asking questions. And what shows up in my clinical notes is that I’m “worried about blood pressure.” Not that there’s a trend worth investigating. Not that the trajectory means something. Just: patient is worried.

Probably because it won’t change protocol anyway. So we’ll cross that bridge when we come to it.

That’s the medical equivalent of watching your brake pads degrade and saying don’t worry about it — they’re still working. They are. Until they aren’t. And by then you’re not having a conversation about prevention anymore. You’re managing a crisis.

That’s the pattern. Different organ. Same system.

Weighing the benefits and drawbacks of a treatment that carries documented cardiac consequences is not being difficult. That’s what informed consent actually looks like.

But don’t get me started on that one.

Where I Am

I’m still in the middle of this. The decisions aren’t final and I won’t pretend I have answers I don’t have yet.

What I know is that I came into this as an informed participant and I’m staying one. I did fourteen months of the hardest work of my life. My body responded in ways that surprised everyone. And the system’s answer is a five-year protocol built on tissue that’s gone, for a subtype it wasn’t optimized for, without asking a single new question about what’s changed.

Two out of three tumours gone. The recommendation didn’t move an inch.

I didn’t come this far to stop reading.

Next: the biology of what’s actually been driving this — and why the mitochondria your oncologist never mentions might be the most important variable nobody put in the protocol.

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A note on liquid biopsy — and why I’m raising it here

If you’ve been following along, you know I’ve written about liquid biopsy before — I think it should replace the mammogram as the standard screening tool at forty (link to “What If We Looked at Forty?” once live). But it’s relevant here for a different reason.

A liquid biopsy is a blood draw — no needle in the tumour, no surgery, no recovery — that detects DNA fragments shed by cancer cells into the bloodstream. It can read receptor status, identify mutations, and detect residual disease at a level imaging can’t reach. It’s the closest thing available to knowing what’s actually happening in my body right now, without tissue that no longer exists.

It isn’t publicly funded for breast cancer in Ontario. Of course it isn’t. But the POWER Study at Western University launched ctDNA testing in December 2025 specifically for patients who don’t qualify through standard-of-care pathways. I’ve already reached out. I’d pay out of pocket if I had to — and I’d encourage anyone in a similar position to ask about it.

I am the patient. I would like to know what is actually happening in my body before someone prescribes me five more years of treatment based on a diagnosis from tissue that’s gone.

That should not be a radical position.

(Ontario patients hitting walls on molecular testing: the POWER Study contact is at vcgc.lhscri.ca. Select “Oncology – Research.” Worth a call!!.)

As always, I’m just hoping to help others on this journey, so if this info is useful to you - or helps you understand what people dealing with cancer are living with, please let me know!

Here are the best punchlines from my experience over the last year. Feel free to add your own if you have some.

#10 — At my first meeting with my oncologist, right after being diagnosed, I asked him if I should focus on sleep, exercise, keto diet, avoiding sugar, vitamin C, vitamin D...

“You don’t need any of that, you have aggressive cancer. You just need to start chemotherapy in two weeks.”
(At diagnosis, April 2025.)

#9 — When I told my doctor I wanted to explore immunotherapy in Mexico — treatment I couldn’t get here in Canada — he wasn’t interested in hearing about it.
“You are making a dangerous choice here. I don’t need to see what the program is about. All I need to know is that it’s in Mexico.”

#8 — When I asked what monitoring I’d get if I declined chemo and surgery, this came from the head nurse.
“There’s no point in doing any imaging. There’s no monitoring necessary. We know the cancer is going to grow and spread. We’d just put you on palliative care.”
(He called back 20 minutes later to say they weren’t just waiting for me to die — there’d be other things we could do.)

#7 — Six months after diagnosis, with no spread, I finally asked what “aggressive cancer” actually meant.
“It means it’s likely to spread and grow very quickly.” (and yes, that was said with a straight face) - not acknowledging the you needed to start this months ago typical messaging from this Oncologist.

#6 — After supplying a full year of blood pressure data — ten months normal, two months hypertensive, coinciding exactly with starting chemo:
“This isn’t high blood pressure. It’s fine. It doesn’t change anything we’re doing.”

#5 — I’d had a headache for five days straight — throbbing, worse when I coughed or sneezed. I’d been trying to medicate it myself the whole time, and nothing was working. I showed up for chemo and told the nurse all of it.
“No,” she said. “We need to pause chemo right now. I need to talk to the doctor.”
She brought it straight to him. His answer:
“No, the headache’s fine. Continue with chemo. If you still have it in two more days, come back to the emergency centre.”

#4 — The actual clinical note, I read after I brought in a year of documented blood pressure data:
“The patient is worried and concerned about her blood pressure.”
No comment on the data. Just the worry.

#3 — After learning every known tumour had shrunk or healed except one, now at half size — I asked how they’d tell active cancer from scar tissue.
“We won’t monitor it or image it. We don’t need to. It’s irrelevant now. We know you have cancer, so imaging won’t change our protocol.”

#2 — Eight months into declining chemo and surgery:
“I would strap you to this table and give you chemo right now if I could. If that sounds like I’m trying to scare you, I am. You’re making dangerous choices.”

#1 — After finally getting to a Radiation Oncologist (who was very happy to tell me he was the HEAD of Oncology at the Cancer Centre).
“New treatments are coming out all the time, and we want to work with you as a partner in your care.”

I had to stifle my laugh at this one. I almost asked if that was the mantra of the whole oncology department — because it certainly wasn’t anything I’d experienced in my past year…

So there you have it, 10 different conversations, but just one version of care. And that’s the ‘team’ I have in my corner. Thanks Canadian Medical System!

And in case you thought a terminal diagnosis was stressful enough on its own — good news: turns out stress has nothing to do with disease. So don’t worry, conversations like these aren’t making anything worse.

As always, I’d love to know if I’m the lucky one out there or if I’m the norm. Please feel free to share any of your top 10 moments!

I was sixteen when I knew something was seriously wrong. By the time the medical team started working through possibilities, I’d already landed on appendicitis. Not a guess. A knowing. They confirmed it.

I felt the same way when the cancer diagnosis came.

The doctors were alarmed that I waited nine months before starting treatment. Some were openly shocked I was still standing. But I wasn’t operating on denial or bravado. I was operating on something I couldn’t fully articulate at the time — a deep, settled certainty that this wasn’t going to be the thing that ended me.

It took me a while to understand where that certainty came from. The nervous system work, the therapy, the forced stillness of the last year — all of it kept pulling the same thread. And the thread kept leading back to the same place.

Not to me. To them.

I wrote earlier about Generational Scarcity — about survival wiring that outlives the emergency and becomes identity. That piece was the beginning of pulling the thread. This one is about where the thread leads.

My Dziadz Short for Dziadzuś — Grandfather in Polish

My maternal grandfather was fourteen years old when Russian soldiers came to the door and took everything. His family ran. They ended up in a work camp. He lost a sibling there.

He was old enough to understand exactly what was happening and too young to stop any of it.

Somehow, he kept going. He joined the Polish army at sixteen, made his way eventually to England, didn’t like it, and came to Canada, where he built a quiet life and never spoke about any of what came before it.

What I remember is the garage. He loved working with wood — armoires, bookcases, chairs, birdhouses — and he loved that I loved it too. He made pieces for me that I still have and will always keep. Measure twice, cut once. I carry that in my bones. He was there when my son was christened. That matters more to me now than I had words for then.

He was calm and steady and content to let my Babcia carry the conversation. My lady, he’d say, she talks for both of us. Always with a smile. He found his peace in faith, in the Knights of Columbus, in showing up and being useful without making noise about it.

What he lived through would have broken most people. Survival at that cost doesn’t come free — it seeps out in ways that outlast the emergency, and he knew that better than anyone. I think the most honorable thing he believed he could do was try to bear as much of that weight alone as possible. To spare the people around him from what he couldn’t fully put down. He didn’t always manage it. But he tried. And the trying was its own kind of love.

I have nothing but fond memories of him as my grandfather. And I am forever grateful he got to see my son christened.

My Mother’s Gap

My Babcia (Polish for Grandmother) raised eight children while working full time and helping her own parents farm on weekends. She had moments of real joy — the bouzouki on the radio, the house lit up at Christmas — but between the children and the work and the exhaustion, there wasn’t much room for those moments to breathe. My mother was the eldest. She was expected to do most of the child management because someone had to and she was the one standing there.

By the time she had us, she was already spent. She didn’t withhold love by design. She was so depleted that what she had to give was a fraction of what any of us needed — including her. She stayed anyway. Through everything, she stayed. That’s hers. I claim loyalty from her because she modeled it with her whole exhausted life, even when staying cost her everything she had left.

I’ve been thinking lately about what her life might have looked like if she’d had permission to imagine something different. If someone had handed her the language for what she was carrying, or a model of what else was possible. She didn’t get that. What she got was responsibility, and she carried it.

What I got, with enough distance and enough time and enough hard work, was the chance to finally put some of it down.

Gram My paternal grandmother (English background)

My paternal grandmother was a different kind of force entirely.

She was one of the first women in the Canadian army. She met the King of England. At some point she showed up to a men’s track and field day — because she wanted to, because she saw no reason why she shouldn’t — picked up a discus while the men jeered, and threw it. Got angrier with every turn. Threw it further each time. A reporter happened to be there. For a time, her name was in the Guinness Book of World Records.

She raised three sons alone after her husband died when my father was nine. Each son was born in a different part of Canada. She became a professor, taught Spanish, wintered in Mexico for decades — teaching women there about options, about birth control, about not having to start a family before they were ready. She never stopped moving toward whatever was in front of her.

She kept a scrapbook. Clippings — the King, the record, moments that reporters recognized as worth documenting in real time. I have that scrapbook. I have her watercolours too. I got them when she passed, after sitting with her and holding her hand while she went — she waited for me, I know she did — and they are among the most cherished things I own. I will have them always.

She tried to pass the painting skill on to me directly and it didn’t take. But everything else did.

When I was young, she’d take me to work sometimes - I saw children who had disabilities and with Indigenous communities in the area. I got to see different kinds of homes, different social structures, different ways of living — and she let me ask why. She answered honestly. So instead of learning that difference is something to fear, I learned that difference has context. That there are reasons things are the way they are. That understanding is the beginning of help.

She gave me my first systems lens before I had language for what a system was.

She was a kindred spirit. The only person in my family when I was young who I could truly identify with. We had the same spirit. That meant more to me than I could articulate at the time, because I was always the black sheep — and she never made me feel like that was something to fix.

My Father’s Gap

My father wanted roots where his mother sought adventure. He was twenty-two when he became a father — young, without a consistent male role model beyond his brothers, and carrying his own unexamined inheritance from a woman who was extraordinary and largely absent.

What he gave me that I’m grateful for: he used to come talk to me at night about politics. Parties, policies, how to argue a position, how to think about systems and the people who build them. I loved those conversations. They gave me something I’ve never stopped using.

And he gave me music. The Beatles. Genesis. Chris de Burgh. Alan Parsons. He handed me the greats like they were a birthright, and in a way they were. Music became one of the most important languages I have.

Those late night conversations and those records installed something real in me. The curiosity. The habit of asking why. The refusal to take a system at face value.

He gave me my first political education and my first musical one, and didn’t know he was also giving me the tools I’d one day use to understand everything, including him.

The Ones I Didn’t Get to Know

On my Babcia’s side, my great-grandparents immigrated to this country and built a life here. I knew them. I was lucky enough to have that time. But I didn’t know, until after they were both gone, that they spoke English.

They were too embarrassed to speak it with me. That was a generational thing — the shame of the accent, the fear of getting it wrong, the sense that their English wasn’t good enough to offer. So they didn’t. And I lost whatever conversations we might have had about where they came from and what they carried and what it cost them to start over somewhere new.

I think about that sometimes. What they would have said. What I would have asked.

If they can hear any of this — I want them to know that I care about them. That I love them. That I understand, now more than I ever could have then, what it takes to leave everything familiar and build something from nothing in an unfamiliar place. I understand it because I’m about to do it myself.

And I hope they know that what they started is still going. That it made it all the way to me.

What I Am Because of This

From my Dziadz I learned sacrifice. He carried the cost of survival quietly, trying to bear as much of it alone as he could so the people around him wouldn’t have to feel the full weight. I learned what it looks like to endure without performance.

From my Babcia I learned that joy is not frivolous. She was the only one in that family I ever saw light up — the bouzouki on the radio, the house glowing at Christmas, laughing at something that caught her off guard. She knew how to enjoy herself. That mattered more than I understood at the time.

From my mother I learned loyalty. She had nothing left and she stayed anyway. Whatever else was complicated between us, that is hers and I claim it as mine.

From Gram I learned that the rules written for other people don’t necessarily apply. I learned to walk into unfamiliar rooms and be completely fine. I learned to pick up the discus. I learned that the world is something to move toward, not something to be managed from a safe distance. And I learned — through her work with the different communities and the questions she let me ask — that when something looks broken, the right response is curiosity, not fear.

From my father I learned to ask why. The late night conversations about politics, about policy, about how to argue a position and think clearly — those were real, whatever else was complicated behind them. And the music. The Beatles. Genesis. Chris de Burgh. Alan Parsons. He handed me the greats like a birthright. Music became one of the most important languages I have.

What’s interesting, looking back, is what got lost in the middle.

My mother inherited my Dziadz’s steadiness — the responsibility, the accountability, the showing up. But the joy didn’t make it through. My father absorbed something of Gram’s systems orientation — unconsciously, imperfectly — but not quite the wisdom to know what to do with it.

I got all of it. The endurance and the curiosity. The steadiness and the capacity for joy. The systems lens and, eventually, the understanding of how to apply it. I wrote about what that inheritance cost — the survival wiring that outlives the emergency — in Generational Scarcity.

And I am only now, in my late forties, in the middle of the hardest thing I’ve faced, learning how to actually integrate those things. How to be steady without sacrificing joy. How to think clearly without losing the ability to feel. How to build — businesses, arguments, protocols, a life — without white-knuckling through every moment of it.

When I think about moving to another country, I don’t think about what I’m leaving. I think about what I’m going to build there. I wrote about that recently — the moment in a coffee shop when that shift became clear — in When Does It Become My Life. That’s not bravado. That’s not denial. That’s just who I am.

And now I know exactly where it came from.

The Cardinals

I’ve never been one for gardening or bird watching. But as I’ve spent more time at home this past year, looking for quieter ways to be in the world, I’ve found myself drawn to both.

I have feeders now — front yard and back. And there is a family of cardinals that comes to visit.

Every time I see the male, I think of my Dziadz. I say hello. I thank him for stopping by. I tell him I miss him and that I still think of him. And when I see the female, I do the same for my Gram — just another adventure, I tell her, but this time she gets to watch from somewhere quieter.

The first time I saw them after I put the feeders up, three cardinals arrived together. One male. Two females.

I sat there for a moment and just watched them.

I didn’t have words for what I felt. I still don’t, not entirely. Just gratitude. Full, quiet, uncomplicated gratitude for where I come from and who got me here.

Some things don’t need more than that.

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Every one of us inherited something — steadiness or joy or curiosity or loyalty or the capacity to endure. Sometimes we got it clean. Sometimes it came wrapped in damage and took decades to unwrap.

What got through in your lineage? What got lost in the middle? What are you choosing to carry forward?

I’d love to know what you’re comfortable sharing.

Because here’s what I’ve come to believe, after a year of pulling this thread:

Into every generation, one person is born who decides to do things differently. Not because they’re the strongest. Not because they’re fearless. But because they’re willing to become aware. (bonus points if you get this shout out!)

And awareness is where every generation changes.

This is the finale of the series. It follows “The People Who Can’t Afford to See It.” That piece was about why the system can’t reform itself from within. This one is about the future it’s quietly refusing.

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We have, finally, decided that forty is the right age to start looking.

In October 2024, Ontario lowered the starting age for publicly funded mammograms from fifty to forty.¹ We agreed, as a province, that somewhere around forty it’s worth spending money to go looking for cancer in women who feel perfectly fine.

I want to sit on that date for a second, because it’s personal. For almost all of my forties, the system was not going to look at me until I turned fifty. I found my own tumour at forty-nine — by hand, a year before the program would have so much as mailed me an invitation. The one kind of cancer we actually screen for, in the one body I have, and I still beat the system to it by a year.

And even now that we look at forty, we look for almost nothing. There are screening programs for exactly four cancers: breast, cervical, colorectal, and lung. That’s it. Fifty-some other kinds have no recommended screening test at all. Only about one in seven cancers is actually caught by a screening program²— and the cancers we don’t look for account for roughly seventy percent of cancer deaths.³ We screen for the few we know how to screen for, and we let the rest announce themselves whenever they’re ready. Usually late.

The blood draw we don’t fund

Here’s the part that turns this from a complaint into a question.

There is now a blood test — a “liquid biopsy,” or multi-cancer early detection test — that screens for a signal shed by more than fifty kinds of cancer, over forty-five of which have no other screening at all.⁴ It is extraordinarily specific: in the large studies, its false-positive rate is about 0.4%.⁵ Added on top of standard screening, it found cancers at roughly seven times the rate of standard screening alone.⁶

Set that 0.4% against the test we already rely on. Over a decade of mammograms, forty to sixty percent of women get at least one false alarm — a callback, often a biopsy, for something that turns out to be nothing.²⁰ And in dense breasts, where about half of us live, the mammogram can miss up to half the cancers that are actually there.²¹ A signal flagged before there is even a tumour to image, with a false-alarm rate near zero, is more reliable on the very axis screening is meant to deliver — and catching a whisper is far cheaper than waiting for the lump that rings up the surgery, the chemo, and the decades of follow-up. That is the case for looking early. It is not a case for trading away the mammogram.

I want to be honest about what it can’t do, because the honesty is the point. It is not a miracle and it is not finished. It misses many early cancers — its sensitivity at Stage I is low — and it’s weaker on some common cancers, including breast, which is exactly why you’d never trade your mammogram for it. The largest trial to date, the NHS-Galleri study of 140,000 people, lowered the number of cancers caught at Stage IV but missed its main goal of significantly cutting late-stage cancer overall.⁷ The mortality verdict isn’t in. Anyone selling it as a sure thing is selling something.

But that’s not the argument. The argument is about direction, and about money. A blood draw like this costs around thirteen hundred dollars,⁸ and the system won’t fund it. So hold that number next to the ones on the other side of the ledger.

What late costs — using me as the example

I was diagnosed at forty-nine. Three tumours, an aggressive type, caught the way most cancers are caught: once they were big enough to find by hand.

What came next is the expensive part, and almost none of it shows up when people picture “the cost of cancer.” Chemotherapy. HER2-blocking drugs my team expects me to stay on indefinitely. The heart damage those drugs and that pressure are doing, which now needs its own specialist, its own medication, its own monitoring. And then the part that never ends: the surveillance. Echocardiograms. Bloodwork. Scans. Appointments. For years — possibly for the rest of my life. Cancer survivors carry a tail of follow-up that runs for decades, and routinely into debt.⁹

And then there’s the surgery — the part I haven’t reached yet. My case wasn’t tidy: Paget’s disease of the nipple, invasive ductal carcinoma, and a spread of calcified tissue. The plan was never just to lift out three small tumours (the biggest barely over a centimetre). It was to take everything abnormal with clean margins — an estimated third of the breast — then operate on the healthy breast too, to make the two match, with reconstruction on top. The nipple was coming off as a matter of course: Paget’s, I was told, is usually just removed. They didn’t actually know whether it would resolve on its own.

Here’s where I am now: the masses are mostly gone, and the nipple looks fine. So I keep asking the question no one seems to want on the table — if the response did this much, all that cutting would have been for what?

And I’m not the first to ask. There are documented cases of Paget’s disease of the nipple disappearing completely after exactly the kind of neoadjuvant therapy I’m on — a taxane with the two HER2 blockers — the nipple returning clear, no residual disease.¹⁷ Surgical de-escalation after a strong response isn’t fringe, either: HER2-positive cancer reaches a complete pathological response in well over half of cases, and there are active trials testing whether those patients can safely have less surgery, or skip it.¹⁸ It is not standard yet, and I won’t pretend it’s a sure thing. But the plan to remove a third of one breast and reshape the other was written before anyone knew how I would respond — and now that they do, no one has offered to revisit it.

It’s the same logic I had to use on my heart. In “What Economics Taught Me About My Body“ I called it prevent, not repair — don’t pay for damage you can’t take back before you even know it’s needed. A third of one breast for “cancer removal,” a third of the other, healthy breast for “parity,” and reconstruction on both — that is exactly that kind of cost.

The math: three roads from one diagnosis

So follow one diagnosis — mine, at forty-nine — down three different roads, all the way to the end, not just to the moment of diagnosis but through everything that comes after. These are rough, order-of-magnitude figures, most Canadian, a few American, all sourced below; round them however you like, the shape doesn’t change.

(**My apologies Substack doesn’t do well with table imports)

Same woman. Same cancer. The only variable is when, and how hard, we looked — and the distance between that first column and the other two is a whole life’s worth of treatment, monitoring, and money. The prevention column stays small. The treatment columns never close: they keep charging through remission, and, if the dice fall the other way, all the way to the end. For a survivor, the bill barely stops at all.

One honest caveat, because it matters: you screen a lot of healthy people to catch the few. The blood draw isn’t $1,300 instead of a hundred thousand on the same person — it’s $1,300 on many people to find the one early. But that’s the trade every screening program already makes, and it still comes out ahead: catching cancers earlier across a population has been estimated to save the system trillions.¹³ Early is cheaper even after you pay to look.

One thing this accounting leaves out on purpose. Every scan in it carries a cost that isn’t money. A CT is a dose of radiation, and four a year, year after year, is a real cumulative load — on a body already fighting cancer, which is its own quiet irony. A nuclear-medicine bone scan leaves me radioactive enough that I carry a letter from the hospital so I don’t trip detectors at the border. I’m keeping all of that — the radiation, the toll, the wear — out of this piece deliberately, because the moment you try to add it the accounting turns into a mess, and the dollars are damning enough on their own. Just know the real bill is heavier than the one I’m totalling. The money is only the part that’s easy to count.

And then there’s the column no ledger keeps. Prevention doesn’t only save money — it saves the life the money was trying to buy back. A cancer caught as a signal instead of a tumour is a person who never loses the year, never loses the heart, maybe never loses the life. Saving money and saving lives are not competing goals here. They are the same arrow, pointing at the same door — the one we won’t fund.

Because prevention shrinks the system

This is where the incentives I traced in Follow the Incentive come back around — the system that protects itself before it protects you.

A system funded by treatment grows by treating. Every late diagnosis justifies another oncologist, another chair, another wing, another line in next year’s budget. The metrics that get an administrator promoted are patients seen, treatments delivered, centres built. There is no line item for the cancer that never happened. Nobody gets a parade, or a budget increase, for the tumour they prevented — because a prevented tumour is invisible. On a spreadsheet, it looks exactly like nothing.

Prevention does the one thing an institution is never built to want: it makes the institution smaller. A blood test at forty that kept people out of the chairs would, over time, mean fewer chairs. Fewer scans. Fewer follow-ups. Less to fund, less to staff, less to point to when the budget is debated.

So the spending isn’t careless — that’s the comforting version, and it’s wrong. The spending is directed. It flows, reliably, toward whatever grows the machine, and away from whatever would let people not need it. They will spend sixty-five thousand dollars treating me late and a fortune watching me for decades — but not thirteen hundred a year looking, or five hundred helping me not get here. The farm runs exactly as designed.

What actual health care would look like

Picture the other version. A blood draw at forty, every year, looking not for one cancer but for fifty. And with that blood test doing the broad work, the mammogram itself could be used the way the evidence actually supports — later, every other year, or matched to a woman’s real risk — instead of annually, for everyone, forever. That saves money, and it spares women the harms that heavier screening brings: a false-positive rate that reaches sixty percent over a decade of annual mammograms, and overdiagnosis estimated as high as thirty percent — women cut and irradiated for cancers that would never have harmed them.²³ Looking smarter is not looking less; it is looking better. A rising signal routed straight to confirmation and the smallest possible intervention. Nutrition, sleep, and metabolic health treated as the frontline tools the evidence already says they are, not as things to wave off on the way to chemo. The whole apparatus pointed at keeping people out of the system instead of processing them efficiently once they’re in it.

That is what the words “health” and “care” would look like, put back into the name.

We have the beginning of the tools. We have the math — early is cheaper and kinder, by orders of magnitude. What we don’t have is a system with any reason to want it, because the version where I never needed it is the version where it earns less.

When I began this series, in “The Syllogism of Cancer Treatment,” I promised I’d follow the money on prevention — that the real question was why we wait for a tumour we could have caught as a whisper. This is where that thread ends up. Not on a better drug. On a different question.

I am one example. One woman, one late catch I made myself, one heart now paying for it, one decades-long tail of scans I’ll be tracking on my own. Multiply me by everyone whose cancer was never on the list.

Then ask who benefits from us being found late.

This is where the whole series has been heading. It started with an uncomfortable idea — that the average a doctor reads you was never really about you. It kept going from there: that the system is built around the tumour, not the patient; that no one inside it has to be greedy or cruel for it to fail you, only to follow the protocol that feeds them; that the good people in it cannot afford to see it clearly; and that, in the end, it will spend freely to treat you late and almost nothing to keep you well — because treating you is how it grows. Piece after piece, the same shape: a machine that has quietly stopped being about health, or care.

These are public dollars — yours. The system has already chosen how to spend them. It chose treatment. It chose itself. The only question left is what you will do now that you can see it.

So I’ll leave you with the questions it took me a diagnosis to learn. When a doctor hands you an average, will you ask whose it is? When the plan is set before the evidence is in, will you ask for the evidence anyway? Where do you want your money going — toward the cancer caught late, or the one never grown at all? And the one I can’t stop asking myself: now that you can see the farm, which animal are you going to be?

I can’t change any of this from a chemotherapy chair. But I can refuse to be found late without a fight — and I can hand you the questions. What you do with them is yours.

Have the conversations — at your kitchen table, with your doctor and your nurse, with the politician who wants your vote. Ask the questions out loud, and make someone answer them. A system only protects itself for as long as the people paying for it stay quiet; it changes the moment enough of us refuse to. So don't just sit with these questions. Say them. Share them. Vote them. I was found late — but the farm only stays a farm while we keep our heads down, and you don't have to keep yours down a second longer.

¹ Ontario Health, “Ontario Increases Access to Breast Cancer Screening by Lowering Starting Age” (OBSP eligibility lowered from 50 to 40, effective October 8, 2024). https://www.ontariohealth.ca/about-us/our-work/our-stories/ontario-increases-access-breast-cancer-screening-lowering-starting-age

² NORC at the University of Chicago, “Just One in Seven Diagnosed Cancers Found by a Recommended Screening Test.” https://www.norc.org/research/library/new-research-highlights-just-one-in-seven-diagnosed-cancers-foun.html

³ University of Michigan / IHPI: cancers without a validated screening test account for roughly 70% of cancer deaths. https://ihpi.umich.edu/news/cancer-screenings-have-saved-us-least-65-trillion-study-estimates

⁴ GRAIL, “Galleri multi-cancer early detection test” (signal across 50+ cancers, 45+ of which lack recommended screening). https://grail.com/galleri-test/the-test/

⁵ Galleri test performance (specificity ~99.5–99.6%; false-positive rate ~0.4%). https://www.galleri.com/hcp/galleri-test-performance

⁶ GRAIL, “PATHFINDER 2 … Increased Cancer Detection More Than Seven-Fold When Added to Recommended Screenings.” https://grail.com/press-releases/grail-pathfinder-2-results-show-galleri-multi-cancer-early-detection-blood-test-increased-cancer-detection-more-than-seven-fold-when-added-to-uspstf-a-and-b-recommended-screenings/

⁷ NHS-Galleri trial: a reduction in Stage IV diagnoses and higher early-stage detection, but the trial did not meet its primary endpoint of significantly reducing late-stage (Stage III–IV) cancer. See coverage, e.g. Pharmaphorum, “Grail’s multi-cancer test fluffs its lines in UK trial.” https://pharmaphorum.com/news/grails-multi-cancer-test-fluffs-its-lines-uk-trial

⁸ Galleri list price ≈ $949 USD (≈ $1,300 CAD), generally not covered.

https://www.galleri.com/

⁹ American Cancer Society Cancer Action Network, “The Costs of Cancer Survivorship” (decades of follow-up tests, monitoring, and medical debt). https://www.fightcancer.org/policy-resources/costs-cancer-survivorship-2022

¹⁰ Cost of a structured lifestyle (diet + exercise) program, using the Diabetes Prevention Program as a real-world analog: ≈ $553 per participant per year, and highly cost-effective. “Cost-effectiveness of the National Diabetes Prevention Program,” Diabetes Care (2025). https://diabetesjournals.org/care/article/48/7/1180/157485/Cost-effectiveness-of-the-National-Diabetes

¹¹ Mean anti-HER2 drug cost ≈ $65,150 CAD for neoadjuvant pertuzumab + trastuzumab. “A population-based comparison of treatment, resource utilization, and costs by cancer stage for Ontario patients with HER2-positive breast cancer,” PMC7921035. https://pmc.ncbi.nlm.nih.gov/articles/PMC7921035/

¹² Mean cost per patient on first-line pertuzumab + trastuzumab for HER2+ metastatic disease ≈ $267,282 (systemic therapy + clinic visits), Ontario data. https://pubmed.ncbi.nlm.nih.gov/38127177/

¹³ University of Michigan estimate that cancer screening has saved the U.S. at least $6.5 trillion. https://ihpi.umich.edu/news/cancer-screenings-have-saved-us-least-65-trillion-study-estimates

¹⁴ Ontario screening mammograms are publicly funded (no cost to the patient); the system cost is roughly $100 per screen, with private 3D mammograms running ≈ $140–360. See CMAJ Open, “Cost-effectiveness of mammography from a publicly funded health care system perspective,” https://www.cmajopen.ca/content/6/1/E77; private pricing per Valence Medical Imaging, https://valencemedicalimaging.com/what-is-the-cost-of-a-mammogram-in-brampton-understanding-screening-expenses/.

¹⁵ Cancer survivors face years of follow-up surveillance (labs, imaging, scans, specialist visits). Routine radiographic surveillance has been estimated at roughly $9,000 per life-year, with individual CT/bone scans running to ≈ $6,000. “Surveillance Imaging After Curative-Intent Treatment for Cancer,” Journal of Clinical Oncology (2024). https://ascopubs.org/doi/10.1200/JCO.23.02475

¹⁶ End-of-life / palliative care for an Ontario cancer patient averaged ≈ $25,000 (2002–03 data; higher today), and the cost of dying with a terminal illness like cancer is commonly estimated at $30,000–$40,000. “Resource use and costs of end-of-life/palliative care: Ontario adult cancer patients,” https://pubmed.ncbi.nlm.nih.gov/21805942/.

¹⁷ Documented cases of mammary Paget’s disease achieving a complete pathological response after neoadjuvant chemotherapy (including a taxane with pertuzumab + trastuzumab in HER2-positive disease), with the nipple clear of residual disease. “Pathological Complete Response following Neoadjuvant Chemotherapy in Invasive Ductal Carcinoma with Mammary Paget’s Disease,” PMC8460882, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8460882/; and “An unusual case of complete pathological response to Paget’s disease of the breast,” https://academic.oup.com/jscr/article/2022/4/rjac106/6566189.

¹⁸ HER2-positive breast cancer reaches a pathologic complete response in a majority of cases, and surgical de-escalation after a strong neoadjuvant response is an active research area (image-guided de-escalation and surgery-omission trials such as TRAIN-3 and CompassHER2-pCR). “A prospective trial of treatment de-escalation following neoadjuvant paclitaxel/trastuzumab/pertuzumab in HER2-positive breast cancer,” npj Breast Cancer (2022), https://www.nature.com/articles/s41523-022-00429-7; “De-escalating Surgery Among Patients with HER2+ and Triple Negative Breast Cancer,” https://link.springer.com/article/10.1007/s12609-022-00453-3.

¹⁹ Canadian breast-surgery costs range from ≈ $8,225 for breast-conserving surgery to ≈ $26,026 for mastectomy with reconstruction (British Columbia data); bilateral / symmetry procedures add further. See also stage-specific per-case costing, Current Oncology (MDPI, 2023), https://www.mdpi.com/1718-7729/30/9/571.

²⁰ Over ten years of screening mammography, the cumulative probability of at least one false-positive result is roughly 42–61% (about half of women), and about 11% face a false-positive biopsy. NEJM, “Ten-Year Risk of False Positive Screening Mammograms,” https://www.nejm.org/doi/full/10.1056/NEJM199804163381601; JAMA Network Open, false positives with tomosynthesis vs digital mammography, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790521; American Cancer Society, “Limitations of Mammograms,” https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/mammograms/limitations-of-mammograms.html.

²¹ Mammographic sensitivity falls as breast density rises (from ≈75% to ≈51%, and lower in some trials), and roughly half of women have dense breasts. “Breast density effect on the sensitivity of digital screening mammography,” PMC11631811, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631811/.

²² My own totals are estimates. The documented mean anti-HER2 drug cost for a course of dual blockade (trastuzumab + pertuzumab) is ≈ $65,000 CAD (footnote 11); I am slated for roughly two years of blockers, which pushes the drug cost past $100,000 before chemotherapy delivery, scans, heart medication, or surgery. Scan costs use Ontario system figures — echocardiogram ≈ $209 (OHIP Schedule of Benefits), CT ≈ $450, and nuclear-medicine bone scan ≈ $500 (the latter two estimated). At my schedule — a CT and an echocardiogram every three months, a bone scan every six — monitoring runs ≈ $3,600 a year during active treatment, with the echocardiograms continuing indefinitely for cardiac surveillance. OHIP echocardiography fee per Ontario Schedule of Benefits, https://www.ontario.ca/page/ohip-schedule-benefits-and-fees.

²³ Mammography reduces breast-cancer mortality (by roughly 13–25%), but carries real harms: the cumulative false-positive rate reaches ≈ 61% over a decade of annual screening (≈ 42% biennial), and estimates of overdiagnosis range widely, with recent U.S. figures around 31%. Biennial and risk-based screening are widely viewed as offering a better balance of benefit to harm. “Benefits and harms of mammography screening,” PMC4415291, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415291/; “Current Issues in the Overdiagnosis and Overtreatment of Breast Cancer,” AJR, https://www.ajronline.org/doi/10.2214/AJR.17.18629.

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The systems that fail us are not, mostly, run by villains. They are run by good people — people who would never have built the thing themselves, who are certain they are helping, and who cannot afford to look too hard at whether that is still true.

That last part is the one I can’t stop turning over. I want to be careful with it — not because I am afraid to say it, but because I want to say it accurately. So here is the question: how many people inside these systems are there not because they believe in them, but because they need them?

It starts with school. A nurse spends about four years in training before she can practice. A family doctor, closer to ten — an undergraduate degree, medical school, residency. A specialist like my oncologist, thirteen to fifteen. Years of tuition and debt and exams and sleepless residencies, all spent earning the right to belong before you are ever allowed to practice on your own.

That is an enormous down payment — in time, in money, in identity — made before you have treated a single patient unsupervised. And nobody makes a down payment that size on a thing they intend to question. The length of the training is itself a measure of the commitment: by the time you are finally inside, the system is not a job you took. It is a decade of your life you have already spent. So of course you need it. The only question is how.

Financial need is the obvious one. These are often stable jobs — good benefits, predictable hours, pensions you would be crazy to walk away from. I understand the pull better than most, because I walked the other way. I am an entrepreneur. I traded that security for autonomy, and I know exactly what I gave up to do it — which is precisely why I would never wave it off as a small thing. Not everyone has the appetite, or the cushion, to choose meaning over security. Most people, sensibly, do not.

But there is another kind of need that is harder to name and, I think, more powerful in keeping broken systems intact.

Identity need.

When you have spent twenty or thirty years inside an institution — when your credentials, your title, your professional network, your daily purpose, and your sense of competence are all housed inside that structure — the system is not just where you work. It is who you are. Questioning whether the system works is not an intellectual exercise. It is an existential threat.

And so people do not question it. Not because they are stupid or malicious. Because the cost of seeing it clearly is too high. If the system is broken and you have given it thirty years, what does that mean about those thirty years? The mind protects itself from that conclusion with remarkable efficiency.

This is not unique to government or unions. I have watched it in corporations too — people defending strategies they privately know are failing because their identity is too tangled up in having championed them. But in systems without accountability mechanisms, without the market eventually forcing a reckoning, that defense can last indefinitely. There is nothing to break the spell.

I watched a version of this on the news last week, and it stopped me cold: nurses marching against the privatization of health care.

Sit with the economics for a second. In a public system, the government is very nearly the only employer in town — and when there is one buyer for your labour, that buyer sets the price. Economists call it monopsony, and it reliably holds wages and conditions below what real competition would pay. I know it from the other side. When I worked in the private sector, I had friends in government jobs who envied our wages, because private employers had to compete to keep good people. More employers bidding for your work is one of the most reliable raises there is.

So the thing those nurses were marching against — a world with more than one employer competing for them — is, on paper, the world that would have to lure them with better pay and better conditions just to stay staffed. They were rallying to protect the very arrangement that caps their own bargaining power. I am not saying privatization is simple, or that their concerns about patient care and access are not real — they are, and they deserve a serious hearing. But look at the reflex underneath the signs. It was not “what serves me and my patients best?” It was “protect the system.” Because the system is not only where they work. It is their security, their pension, their thirty years. You do not march to dismantle the thing your whole life is standing on — even when the economics says a little competition for you might be the best raise you would ever get.

So the system fills itself with people whose stability depends on its continuation. And then it is shocked — shocked — when reform never comes from within.

The system is not broken despite good people working inside it. The system perpetuates itself through good people working inside it. That is the design. And most of them will never see it, because seeing it costs too much.

Bring it home to the room I actually sit in. Ask why an oncologist — a smart, decent man who I believe genuinely wants me well — will not fight the protocol, will not question the standard of care, will not step outside the lines even when the patient in front of him is asking him to.

Because the protocol is the hand that feeds him. His license is granted on the condition that he works within it. His income runs through it. His standing among colleagues depends on staying inside it. His legal protection — the one thing between him and a lawsuit when a case goes wrong — is his adherence to it. And his sense of himself as a good doctor is measured by how faithfully he follows it. Protocol is not a guideline he consults. It is the ground he stands on.

So when I ask him to deviate, I am not asking him to change his mind about a treatment. I am asking him to step off everything that holds him up at once — livelihood, license, reputation, legal cover, identity. No wonder the answer is no. The wonder would be if it were ever yes.

That is the quiet engine under this whole series. Not bad doctors. Not greed. People who cannot afford to see the thing clearly, because seeing it would cost them the ground they stand on. You do not bite the hand that feeds you — you do not even let yourself notice it is a hand.

I don’t say this with contempt. I say it with the specific grief of someone who spent thirty years watching it happen — and a political science degree that told her exactly what it was called.

Next: if this is why the system can’t reform itself from within, the final piece is about the future it’s quietly refusing — What actual health care could look like if we looked at forty.

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Not about the drugs. Not about the side effects. About systems. About how they’re built, who builds them, and what happens when the people inside them stop being able to see them clearly.

Somewhere around cycle three I started thinking about Animal Farm.

Because Orwell wrote the most precise description I’ve ever read of how a system that was built to protect people quietly becomes something else — and how good people end up carrying it forward without ever meaning to.

That’s what this piece is about.

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I debated calling this piece What Animal Farm Taught Me About the Hippocratic Oath, but that never felt quite right. The oath matters, and we’ll get there, but it’s not really what this piece is about.

This piece is about systems.

More specifically, it’s about what happens when a system drifts so gradually that the people inside it stop noticing the drift. When good people inherit rules they didn’t write, enforce standards they didn’t create, and become part of something they genuinely believe is helping—even as the outcomes begin to tell a different story.

Animal Farm isn’t really a story about pigs. It’s a story about institutions. About how promises survive long after their meaning changes. About how ordinary people become participants in systems they would never have built themselves.

That’s why I kept thinking about it in the chemotherapy chair.

In George Orwell’s Animal Farm, the animals overthrow the farmer and build a system founded on one golden rule: all animals are equal. If you haven’t read it, here’s what you need to know: it’s a warning about how systems built to serve can be subtly eroded over time to serve the few who build and manage them. The promise stays on the wall. The reality underneath it quietly becomes something else.

Boxer the horse believed the promise completely. He worked harder than anyone, believed more than anyone, and when resources were scarce he rationed his own meals so others could eat.

He trusted that the system he was serving was serving him back.

He was wrong.

Then there’s Benjamin. The donkey. The oldest and wisest animal on the farm. He could read. He saw exactly what the pigs were doing from the beginning. He watched the rules get rewritten one by one. He watched Boxer work himself toward the slaughterhouse and said almost nothing. Not because he didn’t care. Because he’d decided long ago that knowing the truth and being able to act on it are completely different things.

He was right. And he was also a tragedy.

I don’t want to be Boxer.

But I can’t be Benjamin either.

The Oath

First, do no harm.

I used to think I knew what that meant. Sitting in the chemotherapy chair, watching the IV drip, I thought the oath was the one thing I could hold onto. The promise underneath everything. The line nobody crosses.

Then I started asking questions.

Harm to what, exactly? My tumour? My heart? My liver? My quality of life on the other side of this? The life I’m actually fighting to get to? Because those aren’t the same answer. Not even close.

My oncologist isn’t violating the oath. By his definition he’s honouring it completely. The tumour is responding. The protocol is working. In his framework that’s the opposite of harm.

The cardiovascular damage? An acceptable trade-off.

The liver strain? Expected and documented.

The life waiting on the other side of treatment being quietly mortgaged to pay for today’s win? Not his department.

The oath says do no harm. It doesn’t specify which part of the patient. The system inserted that clause without telling anyone.

Do no harm.

To the thing I’m treating.

Everything else is someone else’s problem.

We treat the Hippocratic oath the way the animals treated their golden rule. Universal. Absolute. One law for everyone regardless of where they stood in the hierarchy.

But universal principles have a way of bending toward whoever holds the power to interpret them.

The pigs

Nobody rewrote the oath in a single meeting. There was no room where powerful people decided patients would matter less than protocol. That would be a conspiracy and this isn’t a conspiracy.

It’s something slower and harder to fight than that.

I kept thinking about this in the chair. Who built the framework my oncologist operates inside so completely he doesn’t even see it as a framework? Who decided what counts as evidence, what gets approved, what becomes protocol?

Pharmaceutical companies fund research to find treatments that work for their CUSTOMERS. The problem is that what gets funded gets studied. What gets studied gets published. What gets published becomes evidence. What becomes evidence becomes protocol. The pipeline looks scientific because it is scientific. It just has a starting point nobody names out loud; Pharma is a business, not a charity.

Follow the money back far enough and you’ll find the pigs.

Medical schools don’t train doctors to ignore their patients. They train doctors to practice ‘evidence-based medicine’, which sounds unimpeachable until you ask who generated the evidence and why. By the time my oncologist sat across from me he had been trained, tested, licensed, and credentialed entirely within a framework he had no hand in building and every professional incentive to maintain.

He didn’t choose the rules. He learned them so thoroughly he stopped seeing them as rules.

That’s how the pigs stay in power. Not through force. Through education. Through a system that produces the same practitioners decade after decade who train the next generation the same way.

The farm keeps running. The oath stays on the wall.

The dogs

If the pigs built the framework, the dogs make sure nobody steps outside it.

Licensing bodies. Professional colleges. Residency programs. Hospital credentialing committees. They don’t think of themselves as enforcers. They think of themselves as protectors of standards. And they’re right, up to a point.

But standards have edges. And the dogs patrol those edges with remarkable consistency.

Step outside the approved protocol and you risk your license. Question the evidence base too loudly and you risk your reputation. Collaborate openly with a naturopath, (even one with eighteen years of integrative oncology experience and a fellowship from the American Board of Naturopathic Oncology), and you risk your colleagues’ respect.

The dogs don’t have to bark often. The threat is enough.

And then there’s the next generation. My oncologist didn’t choose to be an enforcer. I assume he went to medical school to heal people. He genuinely believes he’s doing that. But everything he does, every protocol he follows without question, every alternative he dismisses without consideration, every conversation he redirects back to standard of care reinforces the party line.

The dogs don’t need to be in the room anymore.

They trained him so well he does it for them.

That’s how systems perpetuate themselves. Not through force. Through formation. Train enough next generation dogs and eventually the fence becomes invisible. Not because it isn’t there. Because nobody inside it has ever needed to look for it.

Boxer never questioned the dogs either.

He just kept working.

The goats

Every farm has them.

The ones who ask inconvenient questions. Who look at the posted rules and notice when they’ve been quietly amended. Who say out loud what everyone else is thinking but has learned not to say.

In medicine the goats are the integrative practitioners, the naturopaths, the researchers publishing outside the mainstream pipeline. Not fringe. Not anti-science. Practitioners who looked at the whole patient and decided that mattered more than staying inside the approved framework.

They pay for it.

Not dramatically. Not with their lives. But with their credibility, their referral relationships, their seat at the table. The conventional system doesn’t persecute them, it simply doesn’t recognize them. Their outcomes don’t count. Their observations don’t enter the room. Eighteen years of integrative oncology experience, fellowship credentials, documented results, foreign currency. Real value, wrong denomination.

My naturopath sits at my table. He can see every hand. He knows exactly what should be played and when.

The system won’t let him touch the cards.

Benjamin saw everything too. The difference is the goats haven’t stopped talking. They just haven’t been given a microphone.

The close

I’m sitting in the chemotherapy chair remembering Animal Farm and thinking about Boxer and Benjamin and the oath on the wall; the pigs who rewrote it so gradually nobody noticed until it already meant something different.

And I’m thinking about the patients in the chairs around me.

Some of them know they’re on the farm. Most of them don’t. Most of them arrived as Boxer; compliant, grateful, willing to ration their own concerns so as not to be difficult. Trusting that the system treating them was built for them.

I was Boxer once. Not for long. But long enough to know exactly how he got there.

The difference between me and Boxer isn’t intelligence. It isn’t strength. It’s that somewhere between the diagnosis and the chair I looked up and saw the farm for what it was. And I decided I couldn’t afford his faith or Benjamin’s silence.

All animals are equal. But some animals are more equal than others.

The oath is still on the wall. It just doesn’t mean what it used to.

I’m not going to be Boxer. I can’t afford to be Benjamin.

I’m going to keep asking the question nobody expects me to ask. Keep finding the cards nobody dealt me. Keep looking around this farm and naming what I see, not because I think I can change it from a chemotherapy chair, but because Boxer never knew he had a choice.

I do.

And so do you.

Naming the farm doesn’t change it. But it changes you — once you’ve seen who built the table and why it stays, you can’t sit at it the same way again.

Except it leaves one question I can't put down. The pigs, the dogs, the farm running itself — none of it works without good people inside it who never see it. So why don't they? That's where I go next: The People Who Can't Afford to See It — why the system fills itself with people whose stability depends on never questioning it, and why reform so rarely comes from within.

Before you go, I’d love to know where you see yourself in this story. Boxer? Benjamin? One of the goats? Also a fan of Orwell? Tell me in the comments — the more of us who name what we see, the harder it becomes to unsee.

U

In my last post, I raised a simple question: I may still have active cancer in my body — or I may not. So the obvious next step, at least to me, was to find out. A scan would clarify what comes next.

Instead, I was told it wouldn’t change the plan.

Here’s the frame I want you to hold for the rest of this. You go to a doctor because you’re worried about your health. I did. But my health is not the first thing being optimized in that room — and not because my oncologist is a bad man. Because the system he works inside is pointed at something else, and he is doing exactly what it trained him, paid him, and protects him to do. The distance between why I walked in and what’s actually being protected — that’s the whole story.

When the system would rather spend fifty thousand dollars treating me than fifteen hundred finding out whether I need the treatment at all, the natural question is: what exactly is being optimized? And who benefits from that math?

I started with the money, because money is the easiest place to see incentives clearly.

In the United States, I’d have found it. Oncologists there mostly work on a “buy and bill” model — the practice purchases the chemotherapy, gives it to the patient, and bills the insurer for the drug plus a markup, often around six percent. More drug, more margin. A single six-doctor practice can buy roughly eight million dollars of chemotherapy a year and sell it for about ten. The incentive to keep treating is built right into the business.¹

That isn’t my system.

In Ontario, the expensive HER2 drugs I’m on are funded centrally and reimbursed to the cancer centre at cost — there’s no markup to capture. The delivery itself is paid through a bundled hospital payment priced to cover cost, not to turn a profit. And my oncologist isn’t a small-business owner buying and reselling my chemo; Ontario oncologists are paid through a mix of salaried plans and modest per-visit fees.² ³ As one Canadian oncologist put it plainly: here, no one makes money giving more expensive drugs.²

So the honest answer is: nobody is getting rich on my cycle count. I want to say that clearly, because the easy version of this story — the doctor profiting from the poison — is the American version, and it isn’t mine.

But “no profit on the drug” is not the same as “no incentive.” Push past the money and the incentives are still there. They’re just quieter, and most of them aren’t financial.

The protocol is the safe ground

Start with the one sliver that is financial. Oncologists who bill per visit are paid for each encounter. On chemo, I see mine every three weeks. In follow-up, I’d see him every three months. Active treatment is simply more billable visits than a healthy patient in surveillance. Any single fee is small, and a salaried doctor doesn’t even have that — so this is the weakest thread. But notice its shape: the system meters my contact with it by how much it is doing to me.

The stronger pulls never show up on an invoice.

“Standard of care” isn’t a medical phrase. It’s a legal one — the yardstick a court uses to measure a doctor against his reasonably prudent peers.⁴ Clinical guidelines get used in malpractice both ways: following them is a shield, departing from them is a sword.⁵

Here’s what that standard is being applied to. There are over 200 distinct cancer types, 800+ named subtypes, and fewer than 200 approved drugs to treat all of it. In Canada alone, 1.5 million people are living with cancer — 53 million worldwide — each one a different body, a different genome, a different ecosystem of metabolism, immunity, stress, and history. And the system’s answer to all of that variation is a single protocol per cancer type. I’ve looked at that logic directly — it doesn’t hold⁶.

So when I ask my oncologist to stop early, to refer me out, to treat my response status instead of the calendar, I’m asking him to step off the legally defensible ground onto the one spot where, if anything goes wrong, he is the one who broke protocol. Doing the standard thing protects him whether or not it’s the right thing for me. When he told me I didn’t need a cardiologist, that wasn’t necessarily indifference. It was the protocol answering: a referral isn’t in the script, and the script is what holds up in a courtroom.

The protocol confirms itself

Then the quietest pull of all. The twelve-month treatment standard for HER2-targeted therapy — established before any trial directly compared it to a shorter course, and later shown to be no better than six months for most patients⁷ — is the thing every oncologist was trained on, tested on, and credentialed inside. Following it validates the framework that produced them. Questioning it questions the framework. It is far easier, and far better rewarded, to be the doctor who delivered the standard than the one who improvised and has to explain why.

This is the part that should unsettle you more than greed would. Greed you can follow and expose. This you can’t — there’s no one to catch. Just a system in which the protected choice and the prescribed choice are the same choice, taught the same way, decade after decade, until the rule stops looking like a rule and starts looking like reality.

So the patient becomes the watchman

Here’s where the cost lands. When the people deciding your care are pointed — for reasons none of them chose — at a target that isn’t quite you, somebody has to watch the rest. That somebody turns out to be the patient.

I’m the one reading the studies. Getting the second opinions. Laying my own scans side by side. Writing the letters. Sending faxes to have my clinical notes updated with data. Tracking the slope no one else is tracking. That work is real, it’s exhausting, and it should not be mine. And it’s worse than unfair — it’s unequal. I can do this. Plenty of people in those same chairs cannot, and the system gives them no reason to think they need to.

The damage to my body never appears on the ledger the system is actually optimizing. It’s pushed off the books and onto my future — the one place no incentive in the room is pointing.

The referral the system didn’t make

I’d been raising my blood pressure numbers with my oncologist for months. The cardiac data was there — echo results, diastolic trends, the mitral regurgitation progressing from trace to mild. I wasn’t asking him to panic. I was asking him to refer me to a cardiologist so someone qualified could look at the slope and tell me what it meant.

The answer, each time, was some version of not yet.

What made this harder to accept is that none of it was surprising — not medically. The drugs I’m on carry known cardiac side effects. Left valve regurgitation issues and elevated blood pressure aren’t rare developments. They appear in the literature. They appear in the consent forms. They happen to a meaningful number of people on this exact protocol. Which means the system already knows this territory exists. It just hasn’t built anything to navigate it.

It was my naturopath who finally moved it forward. I was telling him about the ongoing standoff — the data I was bringing, the referrals that weren’t happening, the specific frustration of watching numbers trend in a direction no one seemed authorized to address — and he mentioned a name. An oncologist about an hour away who had left her local cancer centre because she found the approach too formulaic, too protocol-driven, not focused enough on the person in the chair.

He gave me her information. All I needed was a referral from my GP — which I got — and I could see her. No special access, no out-of-pocket cost, no permission required from the system that hadn’t been listening. She operates as a tax-subsidized resource and we meet virtually. The barrier was lower than I expected. I’m sharing that because most patients don’t know it’s possible.

The first thing she asked me, before anything clinical, was what I wanted. What was important to me in this treatment.

I wasn’t expecting that question. But I was very ready to finally answer.

The space between “you’re fine” and “you’re broken”

She also gave me a frame for something I’d been struggling to name.

The problem with the medical approach, she explained, is that it’s designed to fix a problem — as the system has defined it. There’s no mechanism for what comes before the threshold. So when I bring my blood pressure readings, my echo results, the visible slope of my cardiac function over time, everyone in the room can see the direction. But until a number crosses the line the system has agreed to act on, the answer is: not yet.

For a patient who doesn’t fully understand what the short and long-term effects of these drugs will be — who is already managing treatment, side effects, fear, and uncertainty — “not really that bad” offers nothing. No timeline. No plan. No explanation of what crossing that threshold will actually mean or what comes after. Just a waiting room with no clock and no one at the desk.

That conversation crystallised something I’d understood instinctively for years but never had the language for. A naturopath — or most integrative practitioners — treats the whole body system. Medicine treats an ailment. They are not different approaches to the same goal. They are different goals.

Integrative practitioners ask: what is happening across this entire person, and why? They look at the whole system, try to determine root cause, and work to prevent the problem from developing further. Physicians ask: what is the problem, and how do we stop it? They arrive after the fact and work to eradicate what’s already there. Prevention isn’t in the mandate. The soil that grew the problem in the first place isn’t the question being asked.

This is why I had always gravitated toward integrative care. It wasn’t ideology. It just made more sense to me. This is how I approach consulting; I don’t just look at one factor (as NOTHING exists in a vacuum.) A system that looks at sleep, stress, metabolism, immune function, and emotional state alongside the thing being treated is looking at more of the picture. The medical system, by design, is not — and that’s not an accident or an oversight. It’s the direct consequence of treating the ailment as the unit of analysis rather than the person.

And here’s what I keep coming back to: the cardiac side effects of the drugs I’m on aren’t a mystery. They’re known, documented, and predictable enough to appear on the consent form. We are not in unknown territory. Which means the question isn’t whether some patients will develop problems — it’s which ones, and how soon. That sounds exactly like the kind of question worth asking before something goes wrong, not after.

Why would anyone want to wait for a major problem when there’s a possibility of avoiding it altogether?

That experience — real concern, visible evidence, documented risk, no action — is how patients end up feeling gaslit inside a system that is technically functioning exactly as designed. The data is real. The trend is visible. You bring the numbers in good faith and leave having been heard by no one.

Patients can live in that space for years.

I’ve spent a long time as a business consultant. If I sat across from a client and said: I can see you’re losing customers, I can see the revenue declining, I can see the trend — but let’s wait until you’ve lost two thirds of them before we do anything about it. No client would accept that. No consultant would propose it. It would be a professional failure by any standard.

That’s the logic being applied here. Except in the business example, we’re ONLY talking about revenue. In this one, we’re talking about a human body that cannot be restructured after the fact.

Why I’ve stopped calling it ‘health care’

I stopped calling it the Canadian health care system. I call it the Canadian medical system now — because that is what it is. It is focused on medicine, not health.

I tell my clients: if you’re plotting a course on a ship and you’re one degree off at the start, that’s the difference between hitting Africa and Australia. That’s what this feels like. The system can remove the cancer and create a boatload of other problems I now have to manage — or it could get me to a healthy state. Medicine doesn’t seem to offer that option.

Think about what we accept from every other professional we hire. A financial advisor who watches your portfolio decline and says not yet. A mechanic who sees the warning signs and says come back when it breaks. A consultant who watches you lose clients and waits until two thirds of them are gone before picking up the phone. We wouldn’t tolerate it. We’d fire them. We’d leave reviews. We’d tell everyone we know.

But when a medical system does the same thing — when it watches documented, predictable, known-side-effect damage trend in the wrong direction and says not yet — we call it standard of care. We thank the doctor on the way out. We make the next appointment.

When you take out health and care, what’s left is the third thing every large institution eventually gets good at: protecting itself.

Once you see that, you can’t unsee it. And once you can’t unsee it, the question stops being why isn’t the system doing more — because you already know the answer. The question becomes: what do you do when the system won’t move?

You move.

You find the GP referral nobody told you was available. You ask the question the appointment wasn’t designed for. You find the practitioner who left the cancer centre because she wanted to know what mattered to you. You track the slope yourself, bring the numbers, and refuse to leave without a record that you brought them.

That isn’t cynicism — it’s just the incentives, added up. A doctor protected by following the protocol. A protocol protected by being the standard. A standard protected by the people it trained. Each part shielding the next, around and around, while the patient — the one the whole thing was supposedly built for — is left holding the parts no one else is paid, trained, or protected to hold.

This one just happens to have my heart on the table.

Nobody has to profit from the farm for the farm to keep running exactly as designed. But you don’t have to keep waiting for permission to protect yourself.

This is what the system looks like when no one is doing anything wrong — and still something is going wrong by design. The harder part is what it does to the people who see it clearly: not agreement, not outrage — just a kind of quiet disorientation with what you’re now expected to participate in.

The next piece goes there. That’s where it starts to get uncomfortable — and that’s where I’m going next.

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¹ On the U.S. “buy and bill” model and its incentives, e.g. KevinMD, “Do oncologists have an incentive to prescribe expensive treatments?” https://kevinmd.com/2012/07/oncologists-incentive-prescribe-expensive-treatments.html.

² Cancer Care Ontario, “New Drug Funding Program,” https://www.cancercareontario.ca/en/Funding/New_Drug_Funding_Program. On the absence of a Canadian profit incentive, see “In support of Canada’s health care system: an oncologist’s perspective,” PMC2913838, https://pmc.ncbi.nlm.nih.gov/articles/PMC2913838/.

³ Cancer Care Ontario, “Systemic Treatment – Quality-Based Procedure (ST-QBP),” https://www.cancercareontario.ca/en/cancer-treatments/chemotherapy/funding-reimbursement/systemic-treatment-quality-based-procedure; and on physician compensation models, Ontario Physicians Recruitment Alliance, “Physician Compensation,” https://opra.ca/resources/physician-compensation/.

⁴ “The Role of Practice Guidelines in Medical Malpractice Litigation,” AMA Journal of Ethics, https://journalofethics.ama-assn.org/article/role-practice-guidelines-medical-malpractice-litigation/2011-01.

⁵ “Medicolegal Sidebar: Clinical Practice Guidelines — Do They Reduce Professional Liability Risk?” PMC7000047, https://pmc.ncbi.nlm.nih.gov/articles/PMC7000047/.

⁶ “The Syllogism of Cancer Treatment,” https://really654643.substack.com/p/the-syllogism-of-cancer-treatment.

⁷ Earl et al., “6 versus 12 months of adjuvant trastuzumab for HER2-positive early breast cancer (PERSEPHONE): 4-year disease-free survival results of a randomised phase 3 non-inferiority trial,” The Lancet, 2019. DOI: 10.1016/S0140-6736(19)30650-6. PMC6615016.