Practicing gratitude can relieve stress, decrease depression and allow us to sleep better. In Wake Up Grateful, Kristi Nelson gives us the tools to truly live gratefully. Read an excerpt below. 

Diagnosis of Unknown Origin

It was a warm night in New York City, but not even a second down comforter could stop my whole body from shaking. Shivering chills and blazing heat had sent my internal thermostat climbing and falling like a roller coaster for days. By the third day of fevers over 102 degrees, it was time to get help. It was May 30, 1992. I was 32 years old.

I had moved to Manhattan for a job the year before and had friends nearby who drove me to a hospital in New Jersey. I was admitted for observation. I was observed, rigorously tested, and observed some more. But the fevers did not abate.

By mid-June, I was moved to a Manhattan hospital, where I was admitted with little more than “fevers of unknown origin,” or FUO in diagnostic shorthand. This diagnosis was unusual in that it required me to remain an inpatient; it also made me particularly interesting to residents and physicians across a range of specialties. FUO is meant to be a temporary stop on the way to someplace more solid, someplace with a classification and protocols. Diagnosed but undiagnosed, I was presented at grand rounds and became the problem to solve, the case to crack.

Having a diagnosis that included the word unknown made me feel like my life had been reduced to one big paradox. FUO was something the doctors could scrawl on the clipboard hanging at the bottom of my bed and tuck into the folder outside my door. FUO gave me a private room and made my visitors don masks before entering. FUO satisfied the insurance company’s need to justify weeks of hospitalization and expensive testing. And FUO allowed my employer to grant me an extended medical leave. But FUO answered nothing.

Unknown wedded me to uncertainty. To live inside a body about which I could offer no reassurance to my loved ones was confounding and painful. Their questions were an anxious and relentless chorus: What is wrong? What do you have? Why don’t they know more? What are they doing for you? When can you get out?

We hung our hopes on every new possibility and I joined my doctors in promising everyone that the next test would provide an answer. Meanwhile, they questioned, tested, imaged, and biopsied. They attempted treatments for a variety of infectious diseases: malaria, tuberculosis, histoplasmosis. But the fevers came back while the misdiagnoses, negative tests, side effects, and ineffective treatment trials continued to mount. Increasingly, the only honest answer I was able to muster was, “They do not know. I do not know.”

Every moment of not knowing was a source of suffering, often more so than the physical suffering of spiking fevers. I joined the medical professionals in being driven by the belief that just around the bend was the answer waiting to be discovered. If only we could determine the right test, we could finally find the solution. The promise of that end justified any and all means. I signed every consent form, agreeing to risks that I would have previously thought unimaginable — internal bleeding, paralysis, death. All in the hopes of knowing what was happening in my body and how to make it stop.

Everything changed with the mediastinoscopy — a last-ditch diagnostic intervention. The surgery for which the renowned specialist was on his summer sailing vacation in Switzerland, so we went with the available surgeon. The surgery after which the nurse told my family that I had almost bled to death. The one after which I developed a raging staph infection. The one in which they took out lymph tissue from around my heart that suggested cancer, but then the exact type of cancer fell into question. The pathology reports from four leading cancer institutions all came back with different results. Probable diagnosis: cancer. Exact diagnosis: inconclusive. Treatment plan: more diagnostic exploration.

Three months had passed and I was no wiser about what was wrong with me. I had no answer from doctors or the medical system. I did know, however, what I was experiencing, feeling, and coming to understand. I felt a strong desire to let go of pursuing a definitive answer. I felt a call to let go of an inherited, internalized belief that everything could be known, would be known, and should be known. The typical path of “if only we could get the right information from the right authority in the right way at the right moment, we would know something for sure,” was not working. What I was coming to understand was that the physical and psychological costs, losses, and harms resulting from the quest for data were throwing the benefits out of balance. I suspected that I could be part of the solution by trusting my sense that perhaps we already knew enough, and that time would tell us more than any immediate diagnostic information.

Surrendering the drive for certainty was both terrifying and empowering. I learned to see hope as an unconditional orientation to life that called on me to bow to the one truth of which I had become certain: there is a mystery to life that is more vast and promising than what is knowable. And even though I had no idea what that mystery held, I knew it could hold me — and I was getting better at holding it. Within the embrace of all that was unknown and uncertain, I felt an unlimited aliveness well up in me that was greater than any aliveness the medical system was promising. In that spaciousness of my heart, I felt that every moment of my life mattered, and I wanted to live it — no matter what I knew or did not know, no matter how long I might or might not live.

Excerpted from Wake Up Grateful by (c) Kristi Nelson. Used with permission from Storey Publishing