Several years ago, I interviewed Harvard professor Ellen Langer, who is responsible for some of the most fascinating research to-date about mindfulness and mindset. You’ve likely heard about her counterclockwise study where they put older men back-in-time: These guys spent a week in a camp designed to look like a previous era, where they were concordantly treated like they were much younger, too. The mens’ bloodwork responded to reflect a younger biological age. Or, there’s the study that she did with her student, Alia Crum, where they took a group of hotel maids and told half of them that they were getting a lot of exercise—as much as the surgeon general recommended—simply by doing their jobs. Without changing any other factors, the group started to drop weight and saw other biomarkers improve.

The implications of Langer’s research suggest that what we think about our health has a significant impact not only in how we feel, but how our body responds. It’s the placebo effect, yes, but it’s also bigger than that. (You can find my podcast conversation with her here: “Thinking Our Way to Health.”)

I was thinking about Langer in the context of my recent journey through breast cancer, which is blessedly almost over. (I had my second surgery last week, and now just have a small procedure in the New Year in front of me.) I was specifically thinking about a small point that she made on the podcast, which has had a big effect on how I’ve moved through life: You don’t have to make the right decision. You have to make your decision right.

Breast cancer has been smooth sailing—both because of fantastic pathology reports (my double mastectomy took all the cancer out)—but also because I have pretty much fully surrendered to my (very excellent) medical team. I’ve made very few decisions—really only one or two—and I’ve moved forward with no rumination or regret.

Tactically, here’s what I mean. I picked my wonderful Primary Care Physician (Dr. Daniella Melamed, who is part of UCLA) at random—she had great reviews, she’s not close to retirement age, she still has plenty of availability in her calendar. Earlier this year, she gave me my physical, ordered my MRA which ended up diagnosing my brain aneurysm, and ordered my mammogram (I don’t really need an OBGYN now that I’m finished having kids). Post-biopsy, Dr. Melamed referred me into the Santa Monica Breast Center (also at UCLA), where the first available appointment just happened to be with the very wonderful oncologist Dr. Jennifer Baker. From there, Dr. Baker guided me through my options: lumpectomy with bilateral reconstruction + radiation + possibly Lupron; double mastectomy with bilateral reconstruction + possibly Lupron, etc. (I met with a radiation oncologist and a hematology oncologist in the same visit, though ended up not needing either.) As part of the process, Dr. Baker recommended I go with Dr. Ginger Slack for my reconstruction (also part of UCLA), and the two of them then determined the best plan to see me through. (I ended up with a double mastectomy, to expanders, to implants. You can find all my double mastectomy resources, including some podcast episodes about this process, here.)

In my first appointment with Dr. Baker, I felt at ease and like I could trust her, and so I fully submitted to her experience and wisdom: I made a choice not to interview multiple oncologists (particularly because I had very cut-and-dry cancer), and to go with the plastic surgeon she thought would be the best fit for the outcome I desired (Dr. Slack). I didn’t second-guess them or myself. I decided and moved forward.

In these past few months, I’ve been put in touch with various women who are finding themselves in the process of navigating breast cancer, and that’s been my best advice to them: Find an oncologist you trust who gives you time and answers all of your questions; ask them for their best recommendation on a plastic surgeon who fits your desired aesthetics and gets good and safe results; set a plan with them; go for it. Many of the women I’ve spoken to are stuck in Fredkin’s Paradox, though, where they feel like they are being negligent if they don’t meet everyone. Fredkin’s Paradox postulates that when you have multiple attractive options, deciding between them can be paralyzingly hard. (I get it, there are lots and lots of fantastic doctors, there are many ways to go.)

(Before I move on, one note on finding the right plastic surgeon: I would choose a plastic surgeon who can do all the variations on a reconstruction theme, someone who is comfortable with expanders-to-implants (the classic), who can also do direct-to-implant if you’re a candidate (I wasn’t), and who performs DIEP flap autologous reconstruction, which is the newest and most advanced technique. It’s a bit like choosing a Michelin-starred chef who can do anything, but knows what would be right for you on the menu. You’ll be able to trust their specific recommendation for you because you know they can and will do it all.)

Making a decision, even a complicated one that’s expensive and/or has health implications Is hard, I don’t want to suggest that it’s not. But there are ways to go a lot easier on yourself; the question is what you lose in the process by not checking off every box—and will you actually feel better if you do? (You will not, see below.) It’s a bit like planning a wedding: You can try every caterer and every wedding cake baker, you can assess dozens of variations for florals and place settings, or you can just make some choices and move on. (The best advice from my wedding planner: “Think about the last wedding you went to. Now tell me about the chairs.” Point taken. Also: “You’re the only one who knows the run-of-show; nobody knows what’s supposed to happen, they’ll only know if they’re hungry, hot, cold, thirsty, or can’t find a bathroom.” Point also taken.)

There’s a lot of science that suggests that evaluating options and moving quickly and confidently is the right approach, based on a concept from Carnegie Melon’s Herb Simon, who coined the term satsifice. The goal of satisfice is that your choice is good enough—it doesn’t have to be the perfect choice (perfection doesn’t exist) and it doesn’t even have to be the “best” choice, because after all, who knows. Life is not an A/B test.

Langer writes about the work of psychologist Barry Schwartz in The Mindful Body. Schwartz studied Simon’s concept, explaining that he and his colleagues “found that considering more options and taking in a good deal of information results in a decrease in happiness, self-esteem, satisfaction with one’s life, and optimism. It was also correlated with an increase in depression, perfectionism, and regret.”

In Inside the Box: How Constraints Make Us Better, David Epstein writes about Simon and satisficing as well, expanding: “Maximizers are less satisfied with their decisions and their lives, less optimistic, less happy, more prone to regret, and more likely to endlessly compare themselves to others. It’s not that relative satisficers have low standards; they can have high standards. It’s that they have standards at all other than “best imaginable,” so they create the possibility of satisfaction with their choices.” (You can hear my conversation about constraints with David Epstein here: “The Secret Ingredient to be More Creative”)

At the end of the day, we don’t know how things will work out—we don’t know if there could have, or would have been a better outcome if we’d gone in a different direction (or chosen different chairs for our wedding). The goal of life as Langer and Epstein both underline, is to learn how to move forward—with confidence—despite uncertainty. And then to continue to move forward with life on the other side of the decision, accepting what happens, grounding into gratitude, and taking it all as it comes.

Maybe it’s easy for me to feel this way because I’ve had a great surgical outcome; maybe I would have had an even better outcome if I’d gone in a different direction. But I find that hard to believe, and not really worth the energy of pursuing as even a thought experiment. I’m thrilled to feel well, look good, and have the energetic resources to think more deeply about other things.

See you next week!

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