Sharing gratitude to be alive. Multiple musings from simple to complex w/ people, family, music, poetry, pet love, scenic nature, spirituality, health, motivation, & more. Also, find the book at ahouseinsideofme.com and in print, on Kindle, and iBook titled A House Inside of Me: Poetry by Marian Elsie Blake (2013) by Mary Blake Huer
Pip: A book that began with a mother's poem, grew through a cancer diagnosis, and ended up exploring what remains alive underneath biological change — Gratitude Squared has been busy.
Mara: This episode covers the publication of that book and the decades-long creative journey behind it — from a childhood metaphor about a House to the biology of repair, disability, and what it means to keep living.
Pip: Let's start with the announcement itself.
The House Is Open
Mara: The book is called Life Beneath Uncertainty: Misfires, and the post announcing its publication frames it this way: "This book is not a promise that uncertainty disappears. It is an invitation to look more closely at the abundance of life that exists alongside it."
Pip: So not a survival manual — more like a guided wander through everything that keeps going even when something has gone wrong.
Mara: Available as an illustrated paperback and a digital PDF through the Blurb Bookstore. The House, as the post puts it, is open.
Pip: And the origins of that House go back much further than the publication date.
Before the Book, a Mother's Poem
Mara: The post "Before Misfires, There Was a House" traces how the book's central metaphor began — not with biology, but with a poem written by a mother.
Pip: A poem that sat quietly for years before illness gave it a second life.
Mara: The post puts it plainly: "Cancer made me curious about biology." That one sentence carries a lot — curiosity as a response to diagnosis, not just fear.
Pip: Which reframes the whole project. This isn't a book about what went wrong.
Mara: Exactly the opposite. The post describes a growing astonishment at how much goes right — repair, communication, adaptation — happening constantly, unnoticed. And a distinction that became central: a cell may misfire, but the person is not the misfire.
Pip: That's the line that does the real work, isn't it.
Mara: It is. And from there the House expands — back through decades of work with people living with disabilities, through personal experiences with treatment and uncertainty, into a question the post names directly: "What remains alive underneath biological change?"
Pip: Memory, curiosity, humor, faith — the post lists them out, one per line, like rooms you might still find intact.
Mara: The book grew from that inventory. And the post ends with the observation that perhaps it didn't begin with cancer at all — perhaps it began when a mother quietly left a House, and a daughter had to live long enough to find out what was inside.
Pip: A poem becomes a metaphor, a metaphor survives a diagnosis, and a diagnosis becomes a book. That's a long arc.
Mara: And the question underneath it — what remains alive when something changes — doesn't really have a final answer. Which is probably why there's more to come.
After years of writing, researching, reflecting, illustrating, and revising, my new book, Life Beneath Uncertainty: Misfires, is now published and available through the Blurb Bookstore.
Many of you who have visited Gratitude Squared over the years will recognize some of the ideas that found their way into this book.
There is biology, of course. There are the unexpected misfires of living systems, and the remarkable processes of repair that continue quietly within us. There are personal stories, reflections on disability and illness, poetry, and questions that do not always have easy answers.
And there is a House.
My mother, Marian E. Blake, gave me that House through her poetry many years ago. I have wandered through it in my imagination ever since. In this book, the House has grown into a place readers can visit, with a Winding Stream to follow and rooms in which to pause, wonder, reflect, and sometimes simply rest.
This book is not a promise that uncertainty disappears. It is an invitation to look more closely at the abundance of life that exists alongside it.
I am grateful to everyone who has encouraged my writing and followed these reflections over the years.
The book is available as an illustrated paperback and a digital PDF. You can explore it here:
Life Beneath Uncertainty: Misfires — Mary Blake Huer
Note: Blurb frequently has sales for new customers. There is a 30% off sale now.
Here is a potential podcast to announce the book as well:
Pip and Mara: The House Has Opened Its Doors
Pip: Mara, have you heard the news? The House is finally open.
Mara: The House? You mean the one we’ve been talking about—the House that began with a mother’s poem?
Pip: That very one. Only now it has 260 pages, illustrations, a Winding Stream, and places where visitors can stop along the way.
Mara: And a name, I understand. Life Beneath Uncertainty: Misfires.
Pip: Yes. Although I suspect the title might make some people think it’s a book about everything going wrong.
Mara: Which would be rather unfortunate, because so much of the book is about everything that continues going right.
Pip: That’s what I’ve been thinking. Our bodies are doing remarkable things every moment, even when we’re worried about the things that aren’t working.
Mara: And the House reminds us that a person is always more than a diagnosis, a disability, or a difficult chapter of life.
Pip: So what does a visitor do when they arrive?
Mara: They can follow the Winding Stream, explore the rooms, read some poetry, consider the science, or simply pause.
Pip: No mandatory tour?
Mara: None that I know of.
Pip: Good. I’ve never been particularly fond of mandatory tours.
Mara: Then perhaps we should open the door and let readers discover the House for themselves.
Pip: With pleasure. And I hear the book is now available at Blurb.
Long before I began wondering about biology, my mother had already given me a place in which to wonder.
She gave me a House.
My mother, Marian E. Blake, wrote poetry throughout much of her life. Her poems grew from faith, family, hardship, humor, observation, and the ordinary experiences of being human. Years ago, I published a collection of her poetry because I wanted her words to continue living beyond the pages on which she first wrote them.
One of her poems imagined a house inside of us.
At the time, I loved the image for what it was: a spiritual and personal metaphor. I did not know that many years later, after illness entered my own life, I would return to that House and begin looking at it quite differently.
Cancer made me curious about biology.
I began asking questions I had never thought very much about before. What actually happens when cells change? What happens when something in the body does not work as expected? Why do some biological changes disappear while others persist?
Eventually I began using a simple phrase for some of these events:
biological misfires.
I did not mean that a person had misfired.
That distinction became increasingly important to me.
A cell may change. A repair process may fail. A biological event may unfold in an unexpected way.
But the person is not the misfire.
The more biology I studied, the more another realization surprised me. I had begun by looking for what went wrong. Instead, I became increasingly astonished by how much goes right.
Every day our bodies carry out enormous numbers of successful biological activities without our ever noticing them.
Repair happens.
Communication happens.
Adaptation happens.
Life continues.
Disease is memorable partly because health is so abundant.
And somewhere along the way, my mother’s House returned.
I began imagining that perhaps illness changes something within the House without necessarily destroying everything that lives there.
There may still be memory.
Curiosity.
Love.
Humor.
Faith.
Relationships.
Choices.
Wonder.
The ability to participate in life.
The House gradually became more than one metaphor. It became a place from which I could ask a much larger question:
What remains alive underneath biological change?
That question eventually carried me far beyond cells and repair mechanisms.
It led me back through decades of work with people living with disabilities. It led me to people whose abilities were sometimes hidden beneath what others immediately saw. It led me into my own experiences with cancer, treatment, uncertainty, gratitude, and the unexpected business of continuing to live.
And eventually those ideas became a new illustrated book I have been working on called Life Beneath Uncertainty.
The book has now reached the physical-proof stage.
That still feels rather astonishing to write.
But perhaps the book did not truly begin with cancer, biology, or even Misfires.
Perhaps it began many years earlier when my mother quietly left me a House.
I simply had to live long enough to discover what was inside.
Pip: Gratitude Squared has been quietly doing something unusual — writing about hope, healing, and what it actually means to wait for something you can't yet see.
Mara: That's the territory today: what distinguishes hope from joy and peace, and how healing engages the soul differently than it does the body. Let's start with hope itself — what it is, where it comes from, and why it asks more of us than we might expect.
Hope, Joy, and Peace — What Sets Hope Apart
Mara: The question this segment opens with is deceptively simple: what makes hope different from joy and peace, and why does that difference matter when someone is afraid?
Pip: The post "Hope, Joy, and Peace" draws on a piece by Shauna W. to frame the answer, and the quote lands squarely: "no one hopes for what they already have. It's the time between realizing what we need, and our receiving of it, that we must confidently expect. Hope sits between."
Mara: So the upshot is that joy and peace are available now — in a sunset, a piece of music, a calm moment — but hope is structurally future-facing. It requires waiting, and that waiting is the point, not a flaw.
Pip: Which explains why the post argues that when fear is immediate, joy and peace are the tools you reach for first. Hope follows — it's the deeper current running underneath. That's not a small distinction when someone is genuinely frightened.
Mara: "Grateful for Hope" extends this by treating hope as its own kind of practice. It describes hope as positivity, optimism, possibility — and notes that it can attach to something small, like passing a test, or something deeply spiritual through prayer and meditation.
Pip: Hope is a four-letter word doing a lot of heavy lifting.
Mara: And both posts arrive at the same place: hope requires patience, but when it arrives, the post says, "hope overflows." That's the reward for the waiting. The healing segment takes that idea somewhere more urgent.
When Healing Reaches the Soul
Pip: This segment sits at the intersection of serious illness and spiritual life — specifically, the question of what medicine can and cannot promise, and where assurance actually comes from.
Mara: "How Does The Actual Healing Process Interact With the Body Versus How it Engages With the Soul?" puts it directly: "Healing outcomes when engaged through the SOUL are based on ASSURANCE, and FAITH."
Pip: That's a real distinction. Doctors, by training and by regulation, offer probabilities — "probably," "we hope," "we never know." The post documents asking for certainty and being told it isn't available. Assurance, it turns out, lives somewhere else entirely.
Mara: What makes this concrete is the moment with the hymn "Blessed Assurance" — hearing it on the radio and recognizing that the soul offers what western medicine structurally cannot. The post notes the writer asked their doctor to record this in the official medical file, and the doctor agreed.
Pip: That detail is doing a lot of quiet work. It isn't a rejection of medicine — it's a parallel track.
Mara: Exactly, and "Arousing Joyful Hope: Footbridges to Healing" makes that parallel visible in physical space. The City of Hope campus in Orange County is described as a holistic model — drumming classes, a Pacific Symphony Fourth of July event, a survivorship blue carpet walk where staff lined the walkway ringing bells and applauding patients.
Pip: The post draws a pointed comparison: Disneyland makes you happy for a day. The City of Hope keeps you joyfully alive for many.
Mara: Both posts land in the same place the hope segment did — gratitude as something practiced outward, toward others, even from inside difficulty.
Pip: Hope that waits, healing that reaches the soul — these aren't abstract ideas in this material. They're being lived.
Mara: And that's what makes them worth returning to. More from Gratitude Squared next time.
Pip: Water — it sustains life, powers cities, and occasionally reminds Florida that it is very much in charge. Gratitude Squared has been sitting with that full range of what water means.
Mara: This episode covers water's many roles — sacred, practical, recreational, and dangerous — and then pulls back to look at what a serious gratitude practice actually asks of us. Let's start with water itself.
Water's Many Roles
Pip: Water shows up everywhere in human life — in ritual, in sport, in survival — and the question these posts are really asking is whether we ever stop to notice the full weight of that.
Mara: The post "Focus on the Complexity of Water – Multiple Dimensions" sets the context directly: "Its beauty, but power is never ending. IAN reminds us that water should not be taken for granted as it may surge, rise, suck one under, drown, bury, and destroy."
Pip: That list lands hard. The same element you're grateful for at the beach is the one dismantling houses in a hurricane. The range isn't poetic — it's literal.
Mara: The post organizes that range carefully — water as sacred, water as biological necessity, water as utility, water as recreation. Baptisms and surfing and cooling systems all share the same source. And the molecular note is striking: blessed water, the post says, is changed at the angle at which molecules connect.
Pip: So even the chemistry is in on it.
Mara: The earlier piece, "Gratitude For Water," comes at this more personally. It invites readers into the soothing sounds of ocean waves as a gratitude moment, and it points toward Lourdes, France — where people travel specifically for sacred, healing water. The post describes the sounds of streams, rain, and the ocean as aids to quiet reflection.
Pip: There's a thread running through both posts: water as something you experience with your whole body, not just something you manage or consume. The waterfall that "ripples or roars" — Niagara Falls gets a name-check — is doing something different from water in a glass.
Mara: Right, and "Gratitude For Water" asks readers directly about their own experience — what water means to them personally. It's less a catalog and more an invitation to pay attention.
Pip: Which is exactly where the next piece picks up — what it looks like to really sit with gratitude rather than just note it.
Gratitude Practice
Mara: "A Deep Gratitude Soak" starts as a meditation on water imagery and becomes something wider — a case for gratitude as a state you can study and inhabit.
Pip: The post puts it plainly: "I believe it is a state that we can study and adopt in our everyday lives."
Mara: The searching-through-photos exercise that structures the post ends up surfacing the gap between people who soak for leisure and those for whom water access is survival. That pivot — from bliss to hard reality — is the point. Gratitude that doesn't reckon with that divide stays shallow.
Pip: Water as ritual, water as wreckage, water as the thing you soak in until reality surfaces — there's a lot of ground in a single element.
Mara: And the practice of noticing it seriously seems to be the throughline. More of that next time.
Pip: Some questions answer themselves just by being asked — and Gratitude Squared asks one this week that stops you mid-scroll.
Mara: The post takes on love in its most complicated form: what it looks like when it costs something, and what gratitude means when life is genuinely hard.
Pip: Let’s start with the story at the center of all of it.
How May I Capture “Love” In One Post?
Pip: The post opens with a question it never quite resolves — and that’s the point. How do you write about love when the story involves cancer, a goodbye, and a six-pound Yorkie named Mickey?
Mara: The setup matters here. Sherry has been hit by aggressive breast cancer a second time, and in the middle of navigating a double mastectomy and treatment decisions, she also has to decide what happens to Mickey, her dog of thirteen years. The post puts it plainly: “After cancer seemingly has taken everything that is meaningful to one’s life, should it also take one’s best friend?”
Pip: That question lands hard because it isn’t rhetorical. Sherry actually had to answer it — and her answer was to find Mickey a new home rather than let him go without one.
Mara: The logistics are specific and worth sitting with. Sherry and friends located a Yorkie rescue group, found an adoptive family, and arranged a volunteer caravan to carry Mickey north to new parents and Yorkie siblings. The new family, reached by phone, promised to try to love Mickey as much as Sherry does.
Pip: Promised to try. That’s the kind of detail that makes a story real rather than tidy.
Mara: The post is careful not to let the rescue story soften what’s actually happening. It names the cancer directly as the “evil” that doesn’t just damage a body but, as the post says, “literally tears out the heart of the cancer recipient that certainly has done nothing to deserve such a fate.”
Pip: And then it pivots — not away from the grief, but through it — into gratitude. Three times the post repeats the phrase “you are so blessed if you do not,” stacking the ordinary things most of us never think to count.
Mara: There’s a detail at the end that reframes the whole story. Sherry got Mickey thirteen years ago, during her first cancer diagnosis, because caring for him gave her direction and hope. The post’s words: “Mickey fulfilled his job and must now move on.”
Pip: Thirteen years of a dog doing exactly what he was supposed to do. That’s not a small thing to name.
Mara: The post closes by asking readers to send love to both of them as they say goodbye — and to notice, today, whatever blessings their own life holds.
Pip: Gratitude as a practice is easy to talk about in the abstract. Sherry’s story is what it looks like when it’s not abstract at all.
Mara: That tension — between the difficulty of a situation and the choice to stay thankful anyway — is exactly the territory worth returning to.
Pip: Gratitude Squared has been quietly building something unusual — a framework for thinking about illness that starts not with disease, but with everything your body is getting right this very second.
Mara: That’s exactly the territory we’re covering today — from the biology of repair and what happens when misfires persist, to what it means to keep living inside uncertainty, and how the series lands on something that looks a lot like hope.
Pip: Let’s start with the biology itself — the misfires, the repair crews, and the question of what fear actually does to us.
Biological Repair And Misfires
Mara: The central argument across this series is that disease is the exception, not the norm — and that understanding that distinction changes how a patient feels, not just what they know.
Pip: And the series opens with a reframe that earns its ambition: “Disease is memorable because health is so abundant. A misfire matters only because your biological success is so overwhelmingly common.”
Mara: That’s the spine of the whole project. The introductory post on intermittent biological misfires defines the concept directly — your body makes small biological errors constantly, and most are repaired automatically. Disease develops only when some escape that repair and accumulate.
Pip: So the word “misfire” is doing real work. It’s not softening the science — it’s relocating where the story begins.
Mara: Right. The introduction is explicit that this is a companion metaphor, not a replacement for clinical language. The point is that calling cells “misfires” acknowledges malfunction without implying the whole person is broken.
Pip: Which is a meaningful distinction when the alternative vocabulary includes “enemy,” “invader,” and “battle.”
Mara: Parts Three and Four move into the mechanics — DNA repair, immune surveillance, protein assembly, quality control systems working in parallel. When those internal crews are overwhelmed, medicine steps in. The framing there is direct: “Medicine is not fighting the body. Medicine is helping the body.”
Mara: Part Five pushes the framework further by introducing time as the main character. Aging, genetics, inflammation, environment — none of these act independently. They interact continuously, and persistence of a misfire is the result of that ongoing interaction, not a verdict on the body’s failure.
Pip: The body doesn’t reset. It adapts. Which is either reassuring or a little humbling, depending on the day.
Mara: The practical upshot is that the three-pillar model built across the series — repair, time, accumulation — gives patients a way to ask “how does a living system carry its history?” instead of “why did my body betray me?”
Pip: That’s a question worth sitting with before we get to what living inside that uncertainty actually looks like.
Healing, Trust, And Living Systems
Mara: Part Six takes the framework into lived experience — specifically, what happens when the repair crews, both biological and medical, are working on an entire living system under stress, not a single isolated problem.
Pip: The post is candid that this gets complicated fast. A sepsis episode during ongoing chemotherapy meant the treatment itself had become part of the biology every physician had to weigh.
Mara: The conclusion drawn from that is precise: “Living systems keep repairing, adapting, healing, and sometimes surprising us. Healing is a process inside of uncertainty.”
Mara: Part Seven, the series finale, closes on a gardening metaphor — immune cells as gardeners pulling weeds, sleep as nighttime cultivation, medicine as tools. The invitation is to ask not “why aren’t you perfect?” but “what does my body need today?”
Pip: Wonder and uncertainty, it turns out, can occupy the same space. That’s the series’ quietest and most durable claim.
Mara: What stays with me is that the framework keeps expanding to meet real experience — it says “Come with me.” You don’t have to face uncertainty alone.
Pip: Biology inside time, with a repair crew and a garden metaphor. Before we finish, I keep thinking about one sentence from this series. “Wonder begins when we finally see where we are.” Maybe that’s the real invitation here. Not to ignore illness. Not to pretend uncertainty disappears. But to see that even in uncertainty, your body is still repairing… still adapting… still trying.
Mara: Perhaps that’s where hope begins – not in certainty, but in understanding.
Pip: Thanks for joining us for this journey through Biological Misfires and Hidden Healing. The author notes: “When I began this journey through illness, I thought I was learning about disease. Instead, I found myself learning about life.” It is so fascinating……..Until next time… keep looking forward with wonder.
As you traveled through these six conversations, what question has been quietly growing within you?
Can I still trust my own body?
What is really happening within my body?
How do I live with uncertainty?
An experienced Gardener knows:
Growth happens when nothing is visible.
Every garden has weeds.
It’s important to spend more time cultivating than worrying.
This knowledge is similar in biology.
Gardeners do not expect perfection:
Flowers bloom and fade.
Branches break.
Bugs arrive.
Weeds appear overnight.
Yet every spring, gardeners begin again.
Our bodies are not so different from a garden.
DNA repair is pruning.
Immune cells are gardeners pulling weeds.
Stem cells are new seedlings.
Scars become new pathways.
Sleep becomes nighttime cultivation.
Exercise becomes tending.
Nutrition becomes soil.
Medicine becomes tools.
Our metaphors begin organizing our conversation.
Not explaining. Organizing.
They organize the way we think.
Once we see biology differently, we begin living differently.
Another metaphor might be a lighthouse! Think of the beauty from the light shining in the distance, guiding you to safety, security, perhaps to your home. The lighthouse provides orientation for us. This is a remarkable vision from which we continue our discussion on hope and health.
People facing illness desperately want resolution. It may not always be possible. Orientation is.
This framework offers something more immediately attainable.
Orientation.
Knowing where you are.
Knowing what your body is attempting.
Knowing who the repair crews are, coming to help you.
Knowing that uncertainty does not mean abandonment.
That is a profound distinction.
You are probably reading this now because you are experiencing uncertainty at this time in your life.
So, I ask one favor of you. When you are finished reading, I invite you to come with me into our gardens as you continue your life. Within these six blogs we have discussed possibilities for your reflection:
The biology is important.
The science is important.
The repair crews are important.
But underneath all of these blogs in the series is my quieter message:
You don’t have to face uncertainty alone.
These conversations within will accompany you through one of the hardest experiences of your lives without pretending to have all the answers, if you are willing to walk alongside me.
Choices
There are differences between owning a garden… and loving one.
Many people stand in their garden saying,
Why aren’t you perfect?
Gardeners don’t.
They ask,
What does this plant need today?
That question changes everything.
Similarly, the body is not an enemy. Sometimes we need to ask what does my body need today?
It is entrusted to us. There are many variations but it is really a miracle and functions constantly even though you are not often aware of such. When your body has a misfire, you also may choose what you wish to do next to protect and facilitate your overall health.
Always remember that you typically have choices in life that move you toward healing.
During my years as a rehabilitation professional, I learned that healing is rarely a straight line. Sometimes the greatest victories were measured in inches…
or one more spoken word…
or one spoon lifted independently… To someone else, it was only a spoon.
To us, it was independence returning.
or one smile after months of discouragement.
Gardeners understand this.
Tiny growth matters. Tiny accomplishments matter.
Revisiting Biology in the New Framework
Our discussions have assisted you in considering that biology is doing what you may never have seen before.
Consider that you are now visualizing misfires, and the work by various repair crews healing your body. As a part of something unimaginably larger than yourself,
Wonder begins when we finally see where we are.
Not just geographically.
Biologically.
Emotionally.
Spiritually.
In the universe.
Expanding Your Choices in the Presence of Illness
I hope you are now considering the expansion of choices you might have now that you have learned more about your biology.
You, as the reader decides:
Will I continue living in fear?
Will I become more curious?
Will I ask different questions?
Will I become an active participant?
The responsibility shifts now, very naturally to you.
Humanistic Biology
The vision of biology described within this framework includes – repair crews to fix misfires, accumulation of changes, and partnerships with medicine. Our multi-condition model of lived biology has layers:
Normal repair
Persistent misfires
Long-term adaptation
High-intensity medical intervention
Biological Misfires and Hidden Healing
As I recovered during the past decade, I remember thinking: I had no idea my body was accomplishing so much without my awareness. I purposefully began to focus on what was around me and within me. I thought about the words AWE, NOVEL, and WONDER.
I listed a few relevant statements as I recovered and continued to live:
Most biological misfires are repaired silently.
Our bodies employ remarkable repair crews every day.
Medicine joins and becomes an extension of the body’s own repair crew.
Fear is natural, but it does not have to guide our decisions.
You are encouraged to move away from an initial fear response to one that is more hopeful.
Remember: Living is your end goal.
Discovering Hope in Your Garden Within
When I began this journey through illness, I thought I was learning about disease. Instead, I found myself learning about life.
I discovered repair crews I never knew existed.
I discovered resilience that had been quietly working long before I noticed it.
Most of all, I discovered that wonder can exist in the same place as uncertainty. That is the journey I hoped to share with you.
Listen to the message: Come With Me…
This is an invitation to continue living, your best life!
The garden is a companion image in which you have control over the flowers you plant and tend. The choice to plant wonder is yours, just as it is in your garden,
I hope you find peace and joy in your journey toward healing.
Pip: Gratitude Squared has been building a framework for understanding biology, medicine, and what it means to live inside a body that keeps surprising you — and this episode sits right at the center of that project.
Mara: The territory today is what the series calls living with uncertainty — how healing works when it isn't clean, how treatment becomes part of the biology itself, and what it looks like to stay a participant in your own care.
Pip: Let's start with what that actually means when the stakes are real.
Living with Uncertainty: When the Body Becomes the Whole System
Mara: The central question in "Part Six: Living" is not whether healing happens, but how you orient yourself when it can't be guaranteed — when repair is probabilistic, not perfect, and you are living inside that gap.
Pip: The post names that gap directly. Here's the framing: "We don't promise to remove uncertainty, rather we are hoping to give people moments of clarity, perspective, and perhaps even wonder while they're living with it."
Mara: That's the anchor of the whole piece. Not resolution — orientation. The goal is not to eliminate fear but to replace enough of it with knowledge that you can participate in what happens next.
Pip: And participation turns out to be load-bearing here. The post argues that understanding your biology changes your emotional experience — that when you're a member of the intervention team, informed consent becomes something you actually inhabit rather than just sign.
Mara: The model the post builds is four concentric circles: biology at the center, then medicine, then human experience, then meaning at the outer ring. Each layer depends on the one inside it, and meaning only becomes available once you understand what the inner layers are doing.
Pip: Which sounds tidy until lived experience breaks the diagram open entirely.
Mara: That's exactly what the post does next. It introduces a fourth response to the existing three — repair, persistence, response — and that fourth is simply experience. The model has to expand because real lives are more complex than any framework drawn in advance.
Pip: The sepsis story in the post is where that complexity stops being theoretical. A Friday text to a physician's assistant becomes a hospital admission, then a sepsis diagnosis, then a surgical team pushing for immediate intervention, then an oncologist arriving on a Sunday morning to stop it.
Mara: And the detail that lands hardest is this: the chemotherapy keeping the cancer in check was the same reason surgery was dangerous. The treatment had become part of the biology every physician now had to consider.
Pip: Two sets of doctors, different hospitals, a weekend, a port in the chest that ruled out standard home IV care — every proposed solution was contraindicated by something else in the system.
Mara: The post walks through those conditions methodically, asking the reader to identify the repair crews, the conflicting interventions, the conditions of significant medical risk. It's structured as a teaching case, but the stakes in it are entirely personal.
Pip: What comes out the other side isn't a cleaner model — it's a more honest one. The post lists the emotional responses that tend to follow serious illness: fear, grief, frustration, uncertainty, and hope coexisting. And then it offers this: "another perspective may become available — one grounded in curiosity, collaboration, gratitude, and wonder at the extraordinary work still taking place within us."
Mara: The post closes by widening the frame beyond cancer — heart disease, autoimmune disease, neurologic disease, serious infection, unexpected diagnosis. The biology differs, the post says, but the uncertainty does not. This framework is for anyone whose confidence in their own body has been shaken.
Pip: And the final note is that the series isn't finished — a closing piece is coming, framed around the invitation to "Come With Me," with the reader choosing an image that helps them continue living.
Mara: The body, the post keeps insisting, is always working for you. Even when the repair is complicated, even when the crews are arguing — it's still working.
Pip: Living inside uncertainty, staying curious about the biology, keeping yourself in the room where decisions are made — that's the thread running through all of this.
Mara: And the next piece in the series promises to take that somewhere new. Worth staying close to what comes next.
Living systems keep repairing, adapting, healing, and sometimes surprising us. Healing is a process inside of uncertainty.
Medicine supplements the body’s own response when the need for repair becomes urgent. But biologic and medical repairs typically strive for continued living, without certainty.
Therefore, biologic and medical repairs are probabilistic rather than perfect, at times. So how do people learn to live in biologic partnerships with uncertainty?
Living With Uncertainty
We don’t promise to remove uncertainty, rather we are hoping to give people moments of clarity, perspective, and perhaps even wonder while they’re living with it. We want individuals to identify their fears and settle into something beautiful, encouraging positive choices even while living with uncertainty.
Scientific Understanding of the Various Repair Processes Changes The Human Experience.
What happens when your lived experience becomes more complex than you expected? That is, when your misfires of particular biological cells are long-term, and continuous what happens? When your diseased cells don’t stop misfiring or multiplying what do you do?
When do your repair crews (biologic-internal and medical-external) change their intervention plans? When the complexity of your treatment is introduced and explained further to you, how/who identifies the need for a repair? How do you determine when the medical repair crews are more necessary than your biologic repair crew for your survival?
Now that you understand biology differently, how will you live differently? Understanding does change your emotional experience.
Imagine four concentric circles.
Center:
Biology
Next:
Medicine
Next:
Human Experience
Outer ring:
Meaning
Given the above model, when/where does meaning for an action plan for intervention come from? From where does your understanding of your various treatment options come?
Greater understanding often helps people participate more fully in their treatment decisions and may reduce fear by replacing uncertainty with knowledge. Why? Because when you participate in your treatment decisions, as a member of the team, you enrich your human experience and make informed decisions beginning with consent.
Moving Away from a Simple Explanation of Biology: Expanding the Model
Given real human lives, living under real conditions with disease, changes our view of biological repairs. Our model has to expand again.
Medicine is practiced under uncertainty. Every treatment represents a careful balance between anticipated benefit and known risk. Patients consent to treatment because they and their physicians hope the expected benefit outweighs those risks. When unintended consequences occur, a deeper understanding of the diagnosis, and recognizing the complexity of caring for your living body is necessary.
Some examples for the repair crews facing high-stakes during biologic repairs include a patient who experiences acute system stress (high-intensity intervention+ biological fragility+ unsuccessful treatments).
This situation may cause an emotional response to their biology.
The emotions accompanying serious illness are real and deserve respect. Fear, grief, frustration, uncertainty, and hope often coexist. This framework does not ask us to deny those emotions. It simply suggests that, over time, another perspective may become available—one grounded in curiosity, collaboration, gratitude, and wonder at the extraordinary work still taking place within us.
There are other issues linked to uncertainty. Medical intervention is not a purely physical science. It is based on hypotheses and outcomes from clinical trials. The human body does not always respond similarly to each treatment as human beings are not identical. They are not clones. Humans are not carbon copies of each other. Human beings, presenting various physical conditions, health status at the time of treatment, age, diets, exposure to toxicity over their lifetimes, and so forth introduce variables which may not always be controlled during treatment, and may then link to uncertainty.
The very name “clinical trial” implies an understanding of clinical variability. The patient signs a permission form acknowledging such in hopes of success for their particular illness.
A Multi-Condition Model of Lived Biology: Intervention Becomes Complex
The currently proposed model has three responses: repair, persistence, and response. Lived experience is introduced, and so expands the model to include a fourth – experience.
Responses may be layered (body + medicine+interacting under stress).
There are times when treatment and disease together create conditions of significant medical risk. During my decade of survival, there have been unintended consequences from treatment, what I term collateral issues. Specifically, consequences having a history with sepsis, bacteria, a macular hole, dehydration, and potential blindness, to name a few, led me to propose a multi-condition model for intervention.
Let me provide one example of an application for the Multi-Condition Model:
Review the facts within the story, and then answer proposed questions:
On a Friday afternoon I was not feeling well. I texted my PA and asked for an antibiotic. She told me to go to the emergency room. I went, was examined and ended up being admitted to the hospital. I had never been in an emergency room in my life, nor admitted to a hospital. Suddenly, I was alone and called my son in another State. My little dog was left home alone.
I texted my PA and explained that I was admitted to the hospital. The hospital physicians went into swift action, administering three antibiotics through IV. I was told I had sepsis! They sent a physician in who said I needed immediate surgery. I texted my PA again who told my doctor. My doctor phoned me to say “Do not let them do surgery, and he needed to speak with them.” I explained I felt I had no control. He set up a group chat on the phone with the medical team in the hospital. He did not have doctor’s affiliation with that hospital group. I continued to wait, with a medical flurry around me. I must admit that, at that point, I felt fear.
On Saturday they were planning the surgery. My oncologist had spoken with the on-call surgeon explaining that I was under treatment with infusions (chemotherapy) and I would not heal from surgery because of the Avastin. They continued to be in and out of my room. A different physician set up home health care minimally for one month with IV antibiotics ongoing. I waited. My son arrived. I was less fearful now, and learning.
Early Sunday morning I was surprised to see my oncologist walk into my hospital room smiling. He examined me and left to meet my doctors in the hospital. After their meeting, he stopped by and said I was being dismissed from the hospital and on Monday I would go to another one of my physicians for examination and continued care. Immediately, thereafter the doctor from the hospital in which I was admitted stopped in and said, “You sent your gyno doc in after us! We will discharge you today”. I thanked everyone. I was now in awe and wonder, and I felt joyful.
During this two day ordeal, I reflected on my situation. I now had sepsis. My mother had died from sepsis just before her appointment to see her cardiologist. My sepsis was advanced, and my health placed me at significant medical risk. I felt confused as I had always expected I would die from my multiple cancers, yet now I could die from sepsis, a collateral condition, unintended from my treatment. I also had just learned that my chemotherapy, while saving my life on the one hand from the persistent accumulating biological cells, was prohibiting my body if and when I needed a surgical, medical repair crew, because of the way in which the chemo impacted the growth of blood vessels. I learned something new.
I continued with various doctors’ orders, engaged in multiple ongoing conversations, developed a new action plan, continued to receive multiple antibiotics for weeks, and continued to live. I never forgot that for a day I had a choice to be treated for sepsis and/or cancer. How might I die?
Looking back, I realized something that had never occurred to me before. My cancer was no longer the only medical problem being treated. The treatment itself had become part of the biology that every physician now had to consider. My repair crews were no longer working on one problem. They were working on an entire living system.
Sit with the details shared within this story for a moment before answering several important questions from the evidence:
Why did intervention become complex?
Consider the urgent that had to be made about treatment(s).
What physical findings warranted the rapid response?
Who were the medical providers interacting under stress?
What were the conditions of significant medical risk?
What might have been the unintended consequences from treatment?
What do you notice about how the treatment and disease together created conditions of significant medical risk?
Do you recognize the various factors we have been discussing throughout this series?
multiple repair crews
conflicting interventions
uncertainty
collaboration
informed consent
changing treatment plans
biological complexity
Consider the urgent decisions that had to be made about the treatment(s).
The treatments included multiple rounds of IV antibiotics and ongoing chemotherapy. One urgent treatment would have been surgery.
What physical findings warranted the rapid response?
The physical findings included blood tests that indicated sepsis in the blood stream. The physical findings also discovered the development of a fistula that needed immediate surgery to prevent further spread of infection throughout my body.
Who were the medical providers interacting under stress?
The medical providers were two sets of physicians within two different hospital settings. The medical providers had different backgrounds, training, and practices in their specialities: oncology, infectious disease control, general surgery, emergency care. Their stress was exaggerated by the occurrence over a weekend, when the doctors were on-call or not available.
What were the conditions of significant medical risk?
The conditions of significant medical risk included possible death from the infection throughout my body (sepsis), and the possibility of my body not healing and therefore blood loss after surgery. Without the surgery one group argued possible death. With the surgery one group argued possible death.
What might have been the unintended consequences from treatment?
The unintended consequences from any of the treatments might have been continued infection and/or death. The infectious diseases team plan was further complicated by the present of a port in my chest. Home health care teams typically administer IV meds through a vein. That was not possible in my case, I would have had an at-home care team without proper training to meet my particular medical treatment need.
What do you notice about how the treatment and disease together created conditions of significant medical risk?
All proposed treatments: surgery, IV infusions or treatments, medications to treat infection were contraindicated. Fortunately, my oncologist persuaded the surgeon and other physicians to stop moving towards surgery, to discharge me, and I was sent on Monday (next day) to yet another medical setting where a plan was developed to continue to treat the sepsis and cancer.
Through this example, one should see that the repair crews moved away from a simple explanation of biology. The balance between an anticipated benefit and known risk was lost, but an new alternative plan was developed and “living” continued.
This experience is an example of a moment when biological misfires and their treatment become urgent, so the system was forced into rapid, high-intensity response.
This is one example of a collateral issue during which a complex intervention plan was necessary, and the previous repair crews’ plans were modified. Misfires, persistence, rapid accumulation, and both the biologic repairs and medical repairs were not successful, thus a high-intensity medical intervention was rapidly developed. All medical teams discussed each option with me and each other, and we selected the presumed best option together. Our action plan was effective.
This example is applicable beyond discussions of the disease of cancer.
The framework proposed in this series is offered for anyone who has ever had their confidence in their own body shaken.
Cancer.
Heart disease.
Autoimmune disease.
Major surgery.
Neurologic disease.
Serious infection.
Unexpected diagnosis.
While the biology may differ, the uncertainty does not.
This multi-condition model of lived biology has layers:
Normal repair
Persistent misfires
Long-term adaptation
High-intensity medical intervention
The model has three responses…
repair
persistence
response
lived experience becomes the fourth.
Up to this point, we’ve been asking readers to expand their thinking regarding biology. Here, we are beginning to ask them to rethink their relationship to biology. This discussion makes interventions with “live biology” more complex.
Structurally, the framework is beginning to move through an understanding of four different stages:
What is a biological misfire?
How does the body repair itself?
What happens when repair is overwhelmed?
How should we live when biology remains uncertain?
I would offer another layer: mindfulness, or mindful interpretive responses.
Earlier in the series, we discussed “being aware”, “looking around”, “taking notice”, “paying attention” and “taking action”. Biologic repairs, and medical repairs are positive actions on the patient.
The emotional and interpretive responses, part of the human condition, from the patient typically will be positive as well, after the initial fear, grief, and frustration noted when a patient first learns of their diagnosis of disease. Responses like wonder, understanding, collaboration, sincerity, and thankfulness are frequently observed responses within the multi-condition model of lived biology as intervention becomes more complex.
Summary
What do we discover along the way from disease to health? We understand that “We must go on Living!”
We live through uncertainty, but we continually expand our model basing the expansion on:
real-life experiences,
participation in your own treatment, and
increased knowledge regarding available treatment options, as a
member of your intervention team.
Reflections
If you were to summarize your thoughts after reading this discussion on Living how would you describe your real Living Biology?
What are the various layers/available treatment options you have experienced, if any?
Did you review several different treatment options?
Do you see that treatments are not lost, they keep building on each other?
Has the process of decision making , even under uncertainty become a bit clearer?
Remember Living is your end goal. Your body is always working for you!
As always, I hope you may view your life with wonder and find peace.
Note: The final part of this series will focus on your future.
The proposed ending is changing, just as our framework has changed, has extended.
The essay will suggest “Come With Me”. Several possible visual images will be presented, with the message:
“Choose the image that helps you continue living. Choose one, or keep all. They have become companions for me.”
Soon… it is coming…..
#gratitudeultra
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