Sarah Mandel, LITTLE EARTHQUAKES: A Memoir
Zibby is joined by clinical psychologist and author Sarah Mandel to discuss Little Earthquakes, a beautiful, brave, and thought-provoking memoir about her extraordinary journey with Stage Four breast cancer while pregnant with her second baby, and the insights into life, death, trauma, and healing that she gleaned. Sarah talks about the terrifying experience, from finding a lump and being diagnosed hours before giving birth to beating cancer in three months and falling into a dissociated state, traumatized and numb. She also shares the story of her recovery, the experience of putting it all on paper (narrative therapy!) and getting it published, and how all of this affected her marriage, relationships, and profession.
Transcript:
Zibby Owens: Welcome, Sarah. Thanks so much for coming on “Moms Don’t Have Time to Read Books” to discuss Little Earthquakes: A Memoir.
Sarah Mandel: Thank you for having me.
Zibby: Of course. Your story was so powerful. As you know, I’ve been such a fan. My heart goes out to you so much for everything you went through and that you wrote it. There’s just so much here all mixed up. It’s a beautiful story. Thanks.
Sarah: Thank you. Thank you, Zibby. Thank you for coming to my launch last week. That just meant the world to me that you showed up. You became such a supporter of the book. It really is such an honor. When I brought this thing out into the world, I just hoped that it would resonate with people. The fact that it’s resonated with you, wow, it’s been really special for me. Thank you.
Zibby: I was kind of mortified by my kids’ behavior. I love to bring them to book events at night when I know they’re around. It was one of those nights. I was just like, please, both of you, come on.
Sarah: We’ve all been there.
Zibby: I could not stay as long as I wanted to. I’m like, you know what, we’re just not going to do this.
Sarah: That’s okay. We get it. We’re real mothers. We get it.
Zibby: Please tell listeners a little about what your memoir is about and when you decided the journey you had gone through — I shouldn’t use the word journey — the experiences you had gone through, that you would write about it as a memoir. When did it take book shape in your head versus just life shape? All of that.
Sarah: That’s a lot. I’ll try and bring it down. The book is about when I was thirty-six years old. I was working in my practice as a clinical psychologist. I was pregnant with my second child, Siena, who is healthy and spunky and doing great. I found a lump in my breast. Both me and my OBGYN assumed that it was a milk duct that was clogged. I went to the doctor to get it checked out and maybe drained to help reduce any complications with breastfeeding after the birth. Of course, this lump was not related to breastfeeding or a duct issue. It was breast cancer. I found out several hours before giving birth to Siena that this was stage-four metastatic breast cancer. It was in my back. It was an absolutely terrifying, traumatic experience. I was bringing life into the world and didn’t know if I was going to be around to raise this baby and take care of my now nine-year-old. Then after three months of treatment, I got another PET scan. The PET scan came back clean. There was no evidence of disease, which is called NED. I was considered a super responder. This is an almost-unheard-of response to treatment. It was as if I’d been given this new opportunity to live.
Everyone was celebrating around me and crying with joy and relief, and I felt nothing. I felt nothing. I felt guilt because I felt nothing. Here there were so many other women with this disease who would just do anything to get this kind of response. I felt nothing. What a betrayal to these women. I really was so traumatized and in this dissociated state that I was separate from my body. I didn’t feel like I was in the room when I was hearing this news from my oncologist. This kind of state of dissociation stayed with me for months. I didn’t really get insight into this process that was going on for me until, one day, I was lying in bed. I was just staring up at the ceiling for hours and hours and not thinking, not feeling, not sensing anything, feeling like I had completely lost my sense of self. I realized, oh, my god, I’m really traumatized. This was what I did for a living, was working with patients who had significant traumas. I thought, maybe I can apply the treatment that I have worked on with my patients to myself. It’s this type of narrative therapy where you go back. It’s kind of like an archaeological dig. You try to piece together all of the memories of the traumatic event and face the most the gruesome, terrifying details and create a narrative with a beginning, middle, and end. You read it. You read it aloud. You habituate to it. It’s a form of exposure. I thought, okay, maybe I need to do this for myself.
Out of desperation to wake myself up from this state of complete numbness and being in a fog, I started to write. The words just tumbled out onto the page. Very soon, I had this trauma narrative that I had written. I realized I wasn’t fully healed yet from the trauma and that I had more to write. I grappled with what to do with that. I remember sitting on my terrace with my husband and saying, “What do I do now? I’m done with the trauma narrative, but I still feel like there’s more for me to do.” I wrote a chapter about that. Then I started writing in the present about the unfolding of living with a chronic illness. Also, it became a story about trauma recovery and about finding my new self again, about finding trust in my body again, things that had been annihilated and had to be rebuilt over time and over new experiences. Now I have this book that was started as a true experiment in self-healing that was not meant to be read by others. Once I got to two hundred pages and read the book, I thought, you know what, this may be a book. This may be a book for other people. I think it really is. At its most basic, it’s a book about how we can manage the inherent uncertainty of being humans and grappling with the unknown and navigating life circumstances that come our way that we had no preparation for that come out of the blue. Does that answer your question?
Zibby: Yes. This is a show for you. There’s no right or wrong answer. It’s just a chance for you to talk about your book and all of that. Yes, it does. It’s funny because it explains some of the more, not self-referential, but the meta chapters where you’re talking about writing. It makes a lot of sense. It’s interesting because in memoir, you still have a protagonist and characters. It’s just yourself and your family. I feel like the character of your husband in particular was so well-drawn. Actually, it brought tears to my eyes in the beginning when you had called him to tell him about your diagnosis. He had been on his way to Arizona. Without even asking, he just got right on another flight and headed right home. Tell me a little bit more about him, about how this has affected both the book — having this be public, in particular, and how this whole thing has affected a marriage. That’s another thing. Not to delve into your complete private life. You don’t have to go into the details, but you know what I mean. He’s a character too. I sort of wanted a PS on him and you two together.
Sarah: I really tried to thank him and also honor him because this book is really our story, so I feel like it’s our book. He’s a lot more private than I am. He really gave me the permission to write about our story. That’s a big deal. There’s some very poignant and romantic and beautiful vignettes of our relationship in the book, but there’s also — there’s some arguments. He can get a little testy. That’s marriage. That’s the reality of being in a relationship. I think he’s been incredibly generous in terms of letting me put our relationship out there for the benefit of other couples and other people who are navigating a trauma in their relationship because it’s really hard. Marriage is hard no matter what. You throw a trauma into a marriage, and it gets that much more difficult. He’s been great. He’s super excited about the book, and giddy. He used to work in publishing way back when, so this is all really fun for him to see that I’m writing a book. For years, he had told me, after I wrote my dissertation in grad school, he’s like, “You’ve got to get this published. You need to write a book.” This is kind of his dream come true that I have a book now that’s out.
Yeah, it is complicated. It is complicated. We’ve talked about, what is it like for people to know these intimate details of our lives? For me as a psychologist, this is a huge shift because with my patients, I was — sometimes I would disclose a little bit more depending on the client. In general, I was really boundaried. I’m not boundaried in this book. You know a lot about me, Zibby. Given what I can do now — I’m not seeing my patients, unfortunately, in my practice anymore. This is my way to really reach people. I think being authentic and letting it all be out there is really a way to connect with people on a human level and validate that what we’re going through is human. You’re not crazy for having these thoughts or feelings or experiences. You’re not alone. This is something we know about. There’s science here. I think that can really help in the healing process.
Zibby: This whole notion of being boundaried — I understand the value as a therapist. That’s part of the contract because it’s not about your sharing all the time. Otherwise, it would just be friendship, honestly. My husband Kyle, he — I used to be very much like, “This is this person’s role. This is my role. No, I’m not supposed to ask so-and-so about their weekend. They’re this.” He was just like, “What are you talking about? Everybody’s just a person.” I’m like, “No, but we’re all in these roles. You’re not supposed to.” He’s like, “I don’t buy that at all.” I’ve actually completely moved over to his interpretation and feeling like a lot of the artificial boundaries don’t serve a purpose. They just keep us not connecting. It sounds obvious.
Sarah: This is what you do. You talk to people. It would not be much fun if there were boundaries because you wouldn’t really get anywhere with people.
Zibby: That’s true. That would be very frustrating. We won’t talk much about this, but there was a PS at the end of the book where things end up going in a slightly different direction than the way we’re expecting as the reader. Did you consider not even adding the afterword? I felt like that must have been a big debate of whether or not to include it.
Sarah: For sure. I did consider not adding it. I was intending to send out the book before that PS happened in my life. Then it just seemed so important and so in keeping with the message of the book that we can manage these really difficult life circumstances and get through them. I didn’t want to shy away from that. It felt real and important. I wanted to be me. I wanted to be fully me and have the lessons really speak for themselves with that ending piece.
Zibby: The funny thing about memoir — somebody was just saying that, someone far, far wiser than me. I can’t remember who it was. Maybe Tara Westover, who I just saw speak. Anyway, saying that with a memoir, it’s never over. How can you ever really be done when things continue to unspool in front of you all the time? It’s that curation of experience that has all the power in it. Complicated, nonetheless. Did you find you turned to other memoirs of people who’ve gotten through trauma or cancer treatment or other things? Do you eat that type of stuff up, or is that not your genre? How do you feel about it?
Sarah: I didn’t while I was writing because I was worried that I would be influenced. When I was a little girl, I went to the beach with my parents. There was a British family. The little girl was talking about a
Zibby: I keep some books on this little library cart right outside my office here. I had the new Abraham Verghese, The Covenant of Water, and then also John Irving’s The Last Chairlift. Between the two of them, that’s 15,000 pages. Then I was like, you could read six books, or two. How many books could you read? I thought it was funny. There’s something to be said for the deep dive.
Sarah: For sure.
Zibby: At the beginning of the book, by the way, you talked about someone called Hannah who was your model very cool person. In my head, I was wondering because — I’m sure it’s not the same, but I was convinced this was a really good friend of mine who was going through treatment.
Sarah: Who knows? It’s possible. I changed her name. She was absolutely stunning on the outside and on the inside and just beamed positivity. She really represented hope to me. I was just so happy to have a visual of that, something to hold onto, that there was something beyond the crisis days that looked luminous, that looked healthy, that looked happy. In the crisis days, it’s terror. It’s just putting one foot in front of the other. She gave me kind of a guidepost to work towards. I’ve never seen her again. I don’t know where she is or if I’ll ever hear from her. Wow, what a powerful moment to be able to find somebody who can really ground you in how you want to go about this challenging life experience.
Zibby: It’s great to have role models in the weeds, as it were.
Sarah: I couldn’t look as cool as her, but I could smile.
Zibby: Do you have any advice for either people trying to write memoir about a painful thing or — why don’t we do that? I know you wrote it mostly, at first, for yourself. Still, what pieces of advice were
Sarah: As a psychologist, I can’t help but advise being ready. There’s a kind of readiness that’s important when you start to write about your trauma so that it doesn’t overwhelm you and become really triggering and debilitating in itself, the writing. Those are skills that you can learn in therapy. I talk in the final portion of my book about ways to work on learning about your emotion states, learning about trauma and its symptoms so you’re not kind of mystified by what’s going on. You can compassionately say, oh, this is going on for me right now. That’s okay. This is the trauma. I can let it in. I don’t have to fight it. I don’t have to think, oh, my god, I’m really weird, and this has to stop right now. Let it come. Let it pass. You can let it in and then let it go. Once you feel that sense of readiness, and maybe with a therapist on the side or a therapist working with you directly, you can start to write about your past.
How we do it in narrative therapy is you just write down the chapter headings of what were the most salient parts of the trauma. Then you just add a little bit more text underneath, like a paragraph. Then you go into the outline and flush it out. Really look for the sensory, emotional thinking patterns that were going on for you in those moments. Bring it to life. A lot of those experiences have been muted because of that dissociation that is totally adaptive that kicks in when you’re really, really scared, but you can find it. You can find it. When you start writing, it starts to open up that part of the brain that has kind of shut down those memories. You can just get this floodgate of information, of course, out of you, which is what happened with me too. To be gentle with yourself and to know when you need to stop and take breaks and to really lean on a professional if you need help doing this work because it can be a lot. It can be a lot.
Zibby: Sarah, thank you for sharing all of your experience. I’m really rooting for you on so many levels right now. Congratulations. Hang in there. Thank you for your book.
Sarah: Thank you so much, Zibby. Such a pleasure.
Zibby: You too. Buh-bye.
Sarah: Bye.
Sarah Mandel, LITTLE EARTHQUAKES: A Memoir
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