How My Husband Taught Me To Enjoy Every Sandwich ~ Kathy Chang-Lipsenthal

When my husband was diagnosed in July 2009 with esophageal cancer — a disease with a 25% survival rate beyond 18 months — my initial instinct was to talk about inner strength. “You’re going to beat this,” I told him. “You’re strong. You’re healthy. You’re young.” I think I was trying to convince myself that he would be ok just as much as I was trying to comfort him.

In his serene way (the neurotic guy from NJ I’d married had become a lot more zen after discovering meditation in his early twenties), he immediately said to me, with a smile, that he was fine, that he was going to be okay, and that he was really more worried about us, his family. I was astounded. As physicians, we were taught in medical school about Elizabeth Kubler-Ross’ five stages of grief: Denial, anger, bargaining, depression, and then acceptance.

“You can’t go right to acceptance!” I remember saying to him. “You have to be angry about this! You have to fight this!”

“I don’t feel the need to fight cancer,” he replied calmly. “Fight comes out of fear of dying. And I don’t have that fear.”

Don’t get me wrong. He was not exactly happy about having cancer. Of course, if he had a choice, he would have preferred to live, and not leave his loved ones. But I found it so incredibly amazing how at peace he was with this journey – not sure where it would take him, but going along with the ride anyway. He wasn’t fighting the disease; he wasn’t battling it. He was just living with it. While he was going through chemo and radiation, which were brutal, I felt helpless that I couldn’t help him. In addition to being a physician — a healer by trade — I’m someone who likes to be doing something all the time. It was hard for me to stand by and just hold his hand and love him. It didn’t feel like enough.

Throughout treatment, and in the ensuing months, there was a calm that came over him. He had always taught in his workshops and lectures to physicians, medical students and many others in health care that “today is a good day to die,” an age-old Native American adage. I think he found it curiously satisfying that in the face of death, he could continue to live each day as he had in the past 30 years, loving and appreciating family, friends, and life, and living without fear. As he reflected back over his life, he realized that he was not the same person as that anxious child growing up in New Jersey. Moreover, the lessons and skills he learned throughout the latter half of his life, living fully, with love and gratitude, freed him from feeling fear of the unknown. Asked if he had a bucket list when he was first diagnosed with the cancer, Lee replied without hesitation that he really did not. There was no need to travel to exotic countries, climb mountains, jump out of planes. He had lived his life, having loved and been loved. No regrets. This was the basis for his book.

On Sept. 20th, 2011, my husband Lee Lipsenthal–physician, teacher, healer, devoted father of two–passed away from complications of metastatic lower esophageal cancer. The miracle that I had hoped for did not happen. He was prepared to die, but I was not prepared to let him go. I miss him terribly every day. I have read, and re-read Lee’s book many times. I can hear his clear, strong yet soothing voice recounting our story, and my heart aches for him.

But I also take great comfort in reading Enjoy Every Sandwich. I am grateful for my life with this remarkable man, who loved and adored me unconditionally, and taught me to unconditionally love and adore him. I am reminded of our first dates, when at the end of an evening together, my abdominal muscles were sore from laughing. He continued to make me laugh throughout our married life, and I am grateful that he taught me how to savor every aspect of our life. I will always remember his genuine smile and hearty laugh.

Before he passed away, I promised Lee that I would help him spread his life-affirming message of the importance of practicing gratitude, connecting with our loved ones, and living each day to the fullest, to enjoy every sandwich, every ingredient, be it bitter, sour, spicy, or sweet, layered in that sandwich of life–a guaranteed path to a life well-lived.

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Enjoy Every Sandwich: Living Each Day as If It Were Your Last by Lee Lipsenthal, MD

Ed. Note: Lee Lipsenthal was a longtime IONS board member as well as a gifted integrative medicine physician, who dedicated his life to helping doctors and others find the source of healing within (read our tribute here). He passed away on September 20, 2011, just weeks before his book was published. It is a fitting legacy to a man who touched the hearts of many.

“Being fully alive has nothing to do with the presence or absence of disease.”
—from Enjoy Every Sandwich

In my journey over the last few years, the question of who I really am arose power­fully and profoundly. Am I the physical being I see in the mirror each morning? Am I a soul living in this body that will move from body to body over many lifetimes? Is this life just an illusion?

Defining the self by bodily limits comes into question in a very simple experiment often performed in Psych 101 classes around the country. A person is asked to sit at a table with one hand above the table and one hand below it. On the table is a rubber hand, placed where the person’s real hand would have been. The subject’s hand under the table is stroked with a feather while the rubber hand above is being stroked. The subjects are confused about which hand is real. They feel the tickle of the feather in the rubber hand and sometimes try to pull it away, perceiving the rubber hand as the real hand. When the fingers of the rubber hand are bent backward, these individuals fear pain and withdraw the real hand.

The substitution in the subject’s mind of the rubber hand for the real hand occurs because the brain creates an internal imaginary construct of what the body is and where its boundaries lie. To keep us from hurting our­selves, the brain needs to know where the body is at all times, and to do this, it relies especially on the senses of touch and vision. You need to know how far to extend your arm or withdraw it in any task or emergency, but this construct, created by the brain, can be fooled by a rubber hand. Our definition of the self can get recreated rapidly by the brain, so that even the brain doesn’t know who we are all the time. How can we define ourselves by our physical bodies when this definition is flexible even to our own brains?

In addition, our bodies change over time. Our cells are being replaced constantly as new cells grow and old cells die off; none of the cells in your body are the exact same cells they were a few years ago. You can tell this by looking at an old photograph of yourself. You look different now than you did when you were younger, yet you would say that you are still you. We change, we grow, we gain weight, we lose weight, we get injured, we heal. Our bodies are in flux. Clearly, the body alone can’t define the self.

Can we define ourselves by our thoughts and emotions? Ask yourself if you think about and see the world the same way you did twenty years ago. Have your per­ceptions changed? Have your beliefs changed? Have your motivations changed? Has your knowledge changed? Your thoughts, beliefs, and emotions change from moment to moment, year to year, and decade to decade, yet you are still you. We can’t therefore say that the true self is defined by our thoughts, beliefs, or emotions.

I love the following exercise. Close your eyes and say the following to yourself, repeating each statement three times:

I have a body, but I am not my body.
I have feelings, but I am not my feelings.
I have desires, but I am not my desires.
I have thoughts, but I am not my thoughts.
I am the self, the center of consciousness.

When I am too wrapped up in a thought, an emotion, or a desire, I do this for about a minute, and it helps distance me from the thought or emotion. During my radiation treatment, I often repeat, “I have pain, but I am not my pain.” It is a simple yet effective way of lessening any experience of pain.

There must be a broader definition of the self that transcends the body, emotions, and thoughts. I like to think of this as the spiritual self, the transpersonal self in psychological language, or the one self—a self some­how beyond the physical, beyond the body or mind. This one self is connected to our sense of spirituality, our sense of connection with others and the universe as a whole. It is to some degree selfless. You might get a sense of the one self while walking in nature, listening to music, praying, or meditating. In that moment, you lose your mundane definition of yourself. You may experience this as a connection with a higher power. You may even have a sense of this one self when feeling love toward another or holding your child in your arms. The usual boundaries drop away, and for a moment you be­come one, or as Bob Marley sang, “one love, one heart.”

I believe that we evolve naturally toward this one­ self if we allow it to happen. We begin our lives vulner­able and depend on our parents to feed us, clean us, and comfort us. When we need these things, we cry to get our needs met. Survival is our primary concern; we are always surveying for danger and seeking safety as we age.

In our early childhood we are also social beings. We learn that when we smile, our parents smile. This gives us a sense of protection and safety. Soon we learn to expand this interaction to others, and our community grows. We learn to adopt behaviors that we see in others, allowing us to fit in and feel safe within our community. This gives us a greater sense of safety and enhances our likelihood of survival.

At some time in your life, you begin to realize that you are not made up of just the component parts of your personality. You also realize that you are not satisfied with the life that was prescribed for you by family and community. You realize that something else is needed to satisfy your soul; your one self is calling out to you for something more, something vague, something unknown, something different. You wake up to the feeling that this life may not be enough.

I believe that this restlessness, this pressure to change, moves us to evolve naturally toward this one self if we allow it. Our human capacity to change and grow over time opens a new door of possibility: a more fluid definition of the self. Like a tree that can bend with the wind, we become more able to deal with life’s changes as they arise. As you continue to push and grow, you have more one -self or selfless experiences, connections with nature, with God, with a sense of spirituality, with unconditional love, compassion, and service. You can begin to move beyond simple survival. You are no longer attached to the you of the moment. You become open to all possibilities. For me, it is this one self that is not identified with cancer, pain, or fear. Cancer is just a physical event of the moment—it just is what it is.

What Bucket List?

An event that changed my view of so-called bucket lists occurred in the middle of my treatment. My friend Mark, his wife, Anna, and their family came to visit us from Pittsburgh on one of my chemo breaks. Knowing that my life might be shorter than expected and knowing my love of rock ’n’ roll, Mark asked me one day what band I would most like to see before I died. Laughing, I said The Beatles (I knew I might have to wait until after I died for that one!).

When I was a seven-year-old sitting on the floor, two feet from a round, black-and-white TV, watching the Beatles on The Ed Sullivan Show, my life changed. The energy, vibrancy, and passion coming out of the tiny TV speaker resonated through my little body, creating a passion for rock ’n’ roll that still lives.

Mark said, “Would you like to meet Paul McCartney?” I said, “Sure,” knowing that this was an impossible task for a guy who is not in the music industry and a difficult one even for those who are connected. He called me a month later to tell me that he was working on it and had a plan. He had gotten in touch with Paul’s pilot, whom he knew from Pittsburgh, and was trying to make it happen.

I was laughing my head off with delight. Although meeting Sir Paul would have been on my bucket list, I had something better: a friend who would go well out of his way to do something to make me happy. Just knowing this was a huge petal in my pocket.

I no longer have a bucket list. I have love in my life. This is far greater than seeing the Pyramids, climbing mountains, eating Thai food in Thailand, or any other physical activity that might be fun to experience. I am loved, and I have loved. My bucket list is complete.

I believe we are all born with the capacity for gratitude, but many times we get in our own way. Two common examples of this are pessimism and perfectionism. Pessimists and perfectionists may have things to be grateful for in life, but they will rapidly find a reason why something is not right or perfect or how it could have been better. Their imaginal minds search for mistakes or flaws. In doing so, they immediately jump to the negative without enjoying even a brief moment of gratitude. “Yes, but . . .” is their language. They can’t enjoy a sandwich because it has too much mayonnaise or too little lettuce or the bread is too hard or too soft.

On the other end of the spectrum are those who ignore difficulty until their lives fall apart. I often see this in people with significant spiritual lives and practices. They blind themselves to life’s realities by diving deeper into their practices: “If I just meditate and do my yoga, this will all go away.” I have seen many people who are not aware of themselves or the harm they do to others and use spiritual practice to avoid their real lives.

My friend Nita and I refer to this as spiritual bypass. People use spiritual practices and beliefs to excuse the harmful things they do to others and avoid or bypass who they truly are. Gurus and priests do this unconsciously to avoid the dark aspects of their personalities. This is how child abuse and sexual affairs can occur among religious leaders. They have not dared to look at their shadows. They can enjoy their sandwiches, but while they eat, the ceiling falls down on them. Ignorance is not always bliss.

Gratitude practice means facing reality and gaining awareness of the many aspects of yourself: your inner self, your one self, your subpersonalities, and those of the people around you. It means understanding and embracing your shadow. It means letting go of a need to control yourself and others, it means growing compassion for those who have hurt you, it means being aware of the difficult parts of your life and still being able to reach into your pocket on a dark, snowy night just before you leap from a bridge to find that small, innocent petal. Gratitude is the ultimate expression of hope.

A healthy practice of gratitude is simple. You don’t need to whitewash the bad; just remind yourself of the good now and then. Remember, what you look for is what you find.

Reprinted from Enjoy Every Sandwich: Living Each Day as If It Were Your Last by Lee Lipsenthal, MD, © 2011 by Lee Lipsenthal, MD. Used with permission of the publisher, Crown Archetype, a division of Random House.

As medical director of the famed Preventive Medicine Research Institute, Lee Lipsenthal helped thousands of patients struggling with disease to overcome their fears of pain and death and to embrace a more joyful way of living. This is his story.

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Life, Death, and What Really Matters by Karen Wyatt, MD

Throughout my career as a family physician, I have been a student of human suffering. I have had the opportunity through the lens of medical practice to observe and participate in various crisis points in my patients’ lives, and as a result, I have learned about the many ways in which we humans cope with the tragedies of our existence. In addition, my education in suffering was abruptly accelerated several years ago when my father took his own life, leaving me in an uncharted abyss of grief, guilt, and loss. I began working with hospice patients as a means of healing my devastation over his suicide, immersing myself in death and grief in order to find a way out of my pain. While I expected to encounter even more sadness and despair as I sat at the bedside of the dying, I discovered that some of those patients were actually more fully alive during their final moments than most people I knew.

Through my work with the dying, I was gradually transformed into a student of life, which ultimately led me to write my book, What Really Matters: 7 Lessons for Living from the Stories of the Dying. It is both a call to awaken to the spiritual aspect of this life on earth and a guidebook for navigating tragedy.

Without a doubt there has never in our history been a greater need for guidance than there is today. We are facing an unprecedented global economic crisis, degradation of our natural environment, widespread war and societal conflict, and human suffering that includes poverty, sickness, starvation, and exploitation. The threat of extinction looms large in this final year of the Mayan calendar. We have come face to face with the unknown and must focus our attention and energy on what really matters because time may be running short. Each moment is of great importance.

Yet the lessons learned from the dying have illustrated that all of life should be lived as if it could end at any moment. The true value and meaning of life are found when it is viewed from the perspective of its final days. So this precarious moment in time, when destruction hovers nearby, is a true gift. It is an opportunity to find our way back to what is most essential, to rediscover joy, and to rise to our highest potential. Because the dying have already navigated their difficult last days and found abundant life in the midst of decline, they are perfect teachers for us now as we face our uncertain future.

Embrace Your Difficulties

The first concept to learn from the dying is that suffering is a universal and necessary component of existence. In fact, every living thing suffers in its own way, and every living thing eventually dies. The reason suffering must be embraced is so that it can be used as a vehicle for learning the deeper lessons of life. To reject and resist pain is to prevent the growth suffering offers and actually results in more misery in the end. Yet our society teaches us that we are entitled to a life free of difficulty and struggle.

We expect to have things go our way and are deeply offended when that doesn’t happen, as evidenced by the plethora of personal injury lawsuits in this country. Some of the wasteful spending in healthcare occurs for the same reason, as costly diagnostic tests and unnecessary treatments are utilized in a futile attempt to eliminate all suffering and to forestall death.

Of course we should work to improve conditions for all of humanity—and for our own situation as well—whenever possible, but that work must be done from the perspective that life’s suffering is a teacher and that learning from it is the most important thing we can do. This is a tricky balance, requiring energy and focus to see the difference between embracing suffering and becoming apathetic to suffering. We must be open to feel the pain of our difficulties while we remain actively engaged to rise above them. On a practical level, we can utilize the following recommendations to embrace our difficulties:

Eliminate self-pity. Watch for responses such as “It’s not fair!” or “Why me?” when things don’t go well. Those reactions often reflect an attitude of entitlement that is common in our society. Consider instead that some of these situations are a gift, not a punishment.

Cultivate patience. During challenging times, allow circumstances to unfold before making judgments. The passage of time can bring about many changes. Use journaling, contemplation, meditation, or prayer to learn the virtues of patience and endurance.

Manage fear. Use deep breathing, yoga, guided imagery, or bodywork practices to decrease anxiety and pain. Uncontrolled fear can cause regression to unhealthy behaviors and worsen the experience of pain.

Let Your Heart Be Broken

This lesson taught by the dying is an admonition to experience true, deep, and heartbreaking love. In our society the word love is used in many superficial ways—such as to express our preference for one kind of hamburger over another or our devotion to a sports team—that do not represent the meaning of true love. From the perspective of the dying, love is the force that connects us deeply and vitally with other living things. Love breaks our hearts because inevitably we always lose those we genuinely love. But the essence of love is choosing to open ourselves to the pain and willingly becoming vulnerable to loss.

This is an important lesson because it pushes us to expand our capacity to give to others and to take risks in that giving, which is the source of our spiritual growth. So to let our hearts be broken by expressing true love to others exposes us to the possibility of more suffering and more learning. Step into the practice of genuine love in the coming year by adopting the following guidelines:

Give first. Focus your attention on what you can give to others rather than on what you are receiving from them. Journal about ways in which you can show love to those around you.

Be of service. Find volunteer work in an area that interests you in order to practice bringing love to every situation.

Join a group. Learn to work with others by participating in a shared process such as a support or therapy group or a spiritual or social organization. Strive to be authentic and fully committed to any projects you pursue.

Hold No Resentments

This is the lesson of forgiveness, which teaches us that it is necessary to let go of old resentments and bitterness in order to grow and face the challenges of life. The dying spend a great deal of time in their final days working on forgiveness and overcoming the negativity of past wounds. When we harbor anger toward others in our hearts, we are not truly free to move forward in our lives. We can become stuck and stagnant as our energy is consumed by negative thoughts and emotions. During difficult times, such as those our world is currently facing, it is necessary to make available as much energy as possible for creativity and problem solving. Forgiveness is the means for releasing the life force that has been bound up internally, keeping old anger and animosity alive. To jump-start the practice of forgiveness this year, try the following practices:

Acknowledge mistakes. One of the initial steps toward releasing others from your anger and blame is to focus first on your own behavior and take responsibility for your mistakes. Forgive yourself and recognize that everything that happens can be used as a source of growth.

Create a ritual. Sometimes performing a tangible act that signifies forgiveness can help you to accomplish this emotional task. Plant a forgiveness garden, write a poem, light a candle, build a small shrine, or draw a picture to symbolize the act of letting go of old negativity.

Clean the slate. Use meditation, journaling, guided imagery, or prayer to imagine wiping clean the tally sheet where you keep track of wrongs that have been done to you. Try each day to clear away any new resentments, while you also continue to work on the old wounds.

Dwell in the Present Moment

One of the gifts those who are dying experience is an enhanced ability to live in the present moment. Because the future does not exist for them, each moment is significant and every breath is precious. Many spiritual teachers have emphasized the importance of remaining in the present moment, for growth occurs only in the present. But this is an extremely difficult task because our minds are accustomed either to dwelling in the past, conjuring up old memories, or to projecting into the future, dreaming or worrying about possibilities.

We must learn to bring our energy and focus into the here and now, for creative solutions to our problems can only emerge in the present moment. Of all spiritual practices, those that help us remain in present time are likely to be the most productive toward our growth and awareness. Though it is a challenging lesson, any progress at all toward residing in the here and now is significant and helpful. Here are some suggestions for improving your ability to dwell in the present moment:

Heal grief.
Our old memories of loss and pain can keep us trapped in the past, so it is important to work actively to heal those wounds and free up the energy they store. Use journaling, counseling, group therapy, or a letting-go ritual to help release old grief.

Practice mindfulness. Use meditation to practice bringing your awareness over and over again to the present moment. While performing everyday tasks, such as washing dishes, doing laundry, or eating a meal, bring your full attention to the activity and notice every detail to improve your ability to remain in the present.

Spend time in nature. The rhythm of life constantly unfolds in the present moment, so spend time in the natural world, where you can tune out distractions and join with the flow of the present. Practice gardening, walking mindfully in the woods or a park, or simply meditating outdoors in the elements to find a connection with the energy of life.

Living from Within

These four core lessons—embrace your difficulties, let your heart be broken, hold no resentments, and dwell in the present moment—represent just some of the wisdom conveyed to us by those who are facing the end of life. When viewed together, these lessons actually describe for us a way of being in the world, a perspective on life that propels us toward wholeness, integrity, creativity, and awareness.

At a time when we stand at the edge of disaster, uncertain of our future, it is imperative that we listen to the teachers who have gone before us to brave the unknown. Their message is actually simple: focus only on the things that are most important while there is still time to make a difference. The solutions to the problems we face are already within us. We have only to bring our energy and attention to them. Let the lessons from the dying become our guidebook, our map for the uncharted territory that lies ahead.

Finally, these lessons have directed me on my own journey out of the abyss of grief and guilt over my father’s suicide. While I found no answers for his death, I did find the inner resources to live peacefully with my questions. I found the beautiful light that shines through my heart, broken open with love. I found the exhilaration of releasing every strand of tangled resentment I carried within me. I found the rhythm of a single breath and the stillness of this one and only present moment, and I found the deep meaning of our shared suffering, as it was transformed, word by word, into a tribute to life and death and what really matters.

Dr. Wyatt is a family physician who has spent much of her twenty-five-year career as a hospice medical director. The author of What Really Matters: 7 Lessons for Living from the Stories of the Dying (Select Books, 2012), Dr. Wyatt has lectured and written extensively on end-of-life issues with an emphasis on the spiritual aspect of illness and dying. To learn more, go to

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