Friday, September 26, 2014

Storytelling Medicine: You of All the People in the World

I had decided that you of all the people in the world could be there when I die, and now you cannot be in my life at all.

For about a year, I had felt that I possibly had some terminal illness. Not being inclined to go see a doctor, I had Googled my symptoms for months, and the best guess I could come up with was that it was possibly leukemia or something of that nature.

It would not disappoint me greatly to die alone. But I also acknowledge that we can’t know how we will die and when. There is a reason that I live my life as though I will die any day. It is so that all that needs to be acknowledged, lived and said will be done well in advance of that day. I do not wait to say, “I love you.” When the day comes, there will be no surprises, no unsaid words and no regrets.

I thought long and hard this past year, when I thought I had some disease, about whom I would want with me during the final days of my life. I also knew my biggest health care wishes are to not be in pain and not be kept alive if I were dying naturally. So I picked you, a medical doctor I had never met before, to be there when I died, if needed.

I was so scared to make that first appointment. I dreaded it. I was so sure I would be mistreated and thought of disrespectfully because I don’t want to do health care the way it is done in our society. But you did not treat me disrespectfully. You treated me very well and with high regard and listened as I tried to convey what was important to me.

On the second visit, I told you I was not going to do any tests, and I gave you my health care wishes. I had decided that if I ever had a terminal illness, I would not treat it. My health care of choice in this instance was going to be better nutrition no matter what the test results showed, and I decided I could do that without spending any money on tests. I was, however, very willing to spend the money on the conversations with you about my health care wishes. And I decided I could live with the unknown of what a test might reveal, but I wanted to be assured I had a compassionate doctor available at the end my life should I need it.

So when I told you I would not get any tests done and told you my health care wishes, I could feel the resistance. I could sense that you were thinking that patients don’t do this. I could see the question on your face—Did she just think up these wishes on the spur of the moment? I showed you the date they were written—eight years earlier—and I told you that rereading them eight years later, I would not change a word. I told you that my family and friends—everyone in my life—knows these are my health care wishes. I just needed a doctor, someone who has authority in the system, to know about them as well.

Months went by, and I did change my mind about the tests. Living with the unknown is not always easy. Fortunately, all appears to be fine with my health.

But then, you told me you were taking another job elsewhere for people who need home health care. I know my face dropped, and I was so disappointed. You were the second doctor I would have chosen to be there at the end of my life who told me you were not practicing primary care anymore. I don’t yet need home health care or hospice care, but I know that it will be what I want at some point in time if I need it. However, the system is so compartmentalized that there is no way I could sign up now and keep you as my doctor.

I had decided you could be there when I die. I cannot even begin to describe how angry this health care system makes me for so many reasons, and here is one more. I had decided that you could be there when I die, and now you cannot be in my life at all.

I even went back one last time and asked you to continue to be my doctor and told you that I was willing to pay for your services all on my own, outside of the health care system. Of course, our system does not make that very possible either—although I believe you considered it.

And I told you how much I want the health care system to change and how much I want single payer health care and that this would be part of the story should I ever write what I am wanting to call “storytelling medicine.”

I had decided you of all the people in the world could be there when I die, and now you cannot be in my life at all.

Copyright 2014 by Susan Miranda.
All rights reserved.  No part of this writing may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright holder. For reprint permission, email

Wednesday, May 7, 2014

Pitching, Promoting and Offering: It Is Not What We Do But How We Do It That Matters the Most


I usually write about sexuality related topics. I am taking a little detour in my writing in this article to write about marketing, selling, pitching, promoting and offering our services to the world for money or for free.

If there is one thing I have learned in my marketing class, it is that everyone has to market—businesses, nonprofits, change makers and social justice workers. Marketing is about influencing, persuading and getting people to take action. The marketing professionals I listen to would add: doing all of that with integrity.

Even if we are working for societal change, we need marketing skills to make it happen. Even if we are working in a nonprofit organization and the business model is not based on profits, we need marketing to promote our mission and get funders or donors or clients to take certain actions.

I am not a marketing expert. But what I have noticed in my numerous online business groups is that promoting, pitching and making offers have all of a sudden become undesirable. Rules have gotten made to try to control promotion much the way that rules get made around sex and sexuality trying to keep us safe.

In various groups I participate in, there are statements such as “Don’t link to your blog.” In another group no one is supposed to link to their websites. In one group, the rule is it is okay to link to your blog if you want to start a conversation, but otherwise it is not okay.

The conversation is also, fortunately, about being intentional in our online promotions. I fully support people getting intentional, thoughtful and respectful in every area of their lives. I believe building relationships and not pressuring people are important ethical principles in marketing just as they are in sexuality. Those are the same concepts I teach in my sexuality and intimacy workshops.

But I’m also very sure that everything we do is promotion. As I have been saying consistently, it does not matter so much what we do or say as how we do or say it. These arbitrary rules about not promoting our websites or blogs or only posting offerings in a designated marketing group as opposed to the main group or only posting offerings on Thursdays or Fridays or in a specific thread for offerings are not solutions to me.

I believe everything I do is a promotion.

One of the conversations I have listened in on is about not promoting yourself but being helpful to people—and therein you may find your customers. I am coming at this idea from the perspective of being someone who is incredibly giving. I have helped more people move than I can count. I am known for being generous to people by helping take care of their children and in many other ways. Most of my paid work has been in the human services.

We should help someone because we really want to, not because it is the only way to ultimately get noticed for our paid offerings. I place great value on doing something for people unconditionally and not because we secretly are trying to sell something or find clients.

It is hard to guess at someone’s motivation or intent. I like to trust that people have good intentions unless I know otherwise. I also appreciate and feel more comfortable when people are upfront, direct and clear about what they want. If we are proud of our offerings and they truly would help people, there’s no reason to keep quiet or get clever about how we let people know about what we have to offer.

Someone asking my opinion about their website or logo design has started to feel uncomfortable to me. In this marketing environment I am describing, it is really hard to know if the person genuinely wants feedback or they just don’t have any other way to get their website or business in front of me and other potential clients.

We all have individual preferences and tastes. So one person’s style and way of promoting may not be appealing to me but could be appropriate for someone else. Deciding that something is not my cup of tea is very different from deciding that all promoting, selling and marketing are bad.

It is similar to deciding that sex is bad because we don’t share someone else’s preference. It is unrealistic to think that we would like all offers or all ways of promoting. And it is not helpful when someone draws broad generalizations or attempts to control it, especially in the area where they are selling their own expertise, programs or offerings.

I honor the people I know who are identifying marketing that is done ethically and with integrity and marketing that is not. To me that is a much better approach than just deciding that all promoting is unacceptable.

If we don’t like a certain promotional effort, we need to ask what we would change rather than making it impossible to promote. It is the same conversation I would have around sex and sexuality. I have done workshops such as one called “Sex Is Not the Problem; Touch Is Not the Problem” trying to get at this very issue. Yes, there are problems with sex and sexuality, but let’s be specific about those problems rather than draw broad generalizations about sex, touch, intimacy and relationships that make them all “bad.”

Similarly, we should ask what makes quality pitching and selling. Marketing is not going away any more than sexuality is going away. Marketing is the way we get the word out about everything. And, again, it is not what we do but how we do it that matters the most.

Consent and respect are what are most important to me in all areas of our lives. What is consensual and respectful or done with integrity could be talked about fairly endlessly in sexuality and also in regards to marketing. But that is a valuable conversation to have.

I welcome the complex conversation as to how to do it rather than a straight-out attempt to control it. And I also recognize this may not be any easier to do with marketing than with sexuality, given some of the contexts of where it happens. For example, how do you have these conversations online or in a group of thousands? Not easy at all.

However, if we really believe that marketing is good—and we should if we are teaching it or using it in any way—then it is imperative we engage in a way that makes it clear what we want to change. Just like sexuality, it is not something we can turn off at will. Everything we do is promotion in a similar way that sexuality is a life force energy within us at all times. My hope is that we act in both of these areas consciously, intentionally and with as much consent as we can verify in our complex individual and social interactions in person and online.

Copyright 2014 by Susan Miranda.  All rights reserved.  No part of this writing may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright holder. For reprint permission, email

Monday, April 14, 2014

Death Work, the New Sex Work

Twenty-five years ago, when I began to educate people about unlearning homophobia, biphobia and sexphobia, I always acknowledged the complexity of sexuality, intimacy, relationships and orientations of all kinds. And I decided that the three topics I would address because they are not talked about enough are sex, money and death and dying.

As I educate people about sexuality and write about all the topics I can think of—abortion, STIs/AIDS, monogamy, polyamory, sex toys, pleasure, orgasm, self-pleasuring, sex work and more—I emphasize consent, respect and our intentions, whether it involves sex, money, death and dying or any other area of intimacy.

Death is a taboo topic in the United States—possibly more taboo than sex. Yet it is another form of intimacy, involving interactions with people like doctors, nurses and hospice care providers. But I am suggesting something beyond what is the norm today when I use the term “death work.”

How many of us talk about and plan for our death and dying? Not as though we can’t wait for it to happen, but as though we know it will happen. The quality of all parts of my living and dying has always been important to me—so important that it is worth considering carefully today how I would like things to go at the end of my life.

It is strange to me that it is okay to pay for numerous services—from doctors, massage therapists, chiropractors, talk therapists, coaches, mentors, trainers, yoga instructors—but when it’s in the realm of sexuality, it becomes not okay. Well, what about in the realm of death and dying?

Intimacy is everywhere, even where we may not be comfortable with it. It is at our day jobs and our professional work, in classes, in social media, in bars and pubs. It is in the events and conferences we attend, in our conversations, in our touch, in our eye contact and in our hustle and bustle. It is in our transit: in cars and on the buses and trains I take on an almost daily basis. And it is in sex work or paid sex as well as almost every other service offered out there. Intimacy is also part of death and dying. And all that really matters to me is consent, respect and our intentions.

I recently wrote an article called “Obligation Is Not Love.” For me, that includes any obligation to show up or any sense of “I have to” when someone is sick or dying. I am not planning on people just showing up when I am dying.

Money gets exchanged all the time. It is not good or bad; it all depends. And there are other kinds of exchanges whose value depends on whether we feel good about the exchange. The value is not usually dependent on society’s rules or norms.

As intentional as I am with my intimate interactions in every other part of my life, I want to work at doing the same with death and dying and maybe even more so. For years I have let friends and family know my health care wishes. But more recently I have started having conversations with people I would like to be there with me when I am dying. That is, I have started the conversations with individuals as I take into consideration the fact that I may need to pay money to be able to choose the people I want near me when I am dying.

I am not a fan of a health care system that focuses more on life-saving events than dying gracefully. I know what kind of health care I want and what kind of dying I want. And it is with full intention that I move toward the taboo topic of death and dying as though I were hiring someone for business coaching or yoga instruction.

Copyright 2014 by Susan Miranda.  All rights reserved.  No part of this writing may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright holder. For reprint permission, email

Saturday, February 1, 2014

Friendship Is Just as Important as Any Other Relationship We Could Ever Have

The title for this article could have been “Friendship Is Just as Important as Any Sexual Relationship We Could Ever Have.” But then I realized that some of us have sex with our friends.

My only rule for all relationships is that there are no rules other than that they be healthy. But then, the question always follows, what does that mean?

I honor however people do relationships as long as it works for them. There is no one right way to do anything, and the complexity of how we all do intimacy and sexuality in our lives is fascinating to me.

Nothing is more important than how we do love, and sometimes that can include affection or sensuality or sexuality—and sometimes not. Whether we call the person we have a relationship with a “friend,” “partner,” “significant other,” “spouse,” “husband,” “wife” or any other label does not matter to me. Labels don’t tell us much of anything. If we really want to know, we still have to ask the person what they mean when they use that label and what their relationship entails. What’s important is how we do love—how we love ourselves and how we love our work, where we live, and all the people in our lives.

Sex is not more important than other forms of physical or emotional intimacy. Sexual love is not more important than non-sexual love. Romantic and sexual relationships are not more important than non-sexual relationships and friendships.

In all the joy I can find in the complexity of my relationships—in my attractions, desires and levels of intimacy and ways of doing emotional and physical intimacy and sexuality—the highest compliment I can pay to anyone is to call them a friend.

I prioritize the traits and qualities that go into my friendships, like trust, care, loyalty, authenticity, honesty and love. I protect them in my relationships regardless of all the other unique characteristics or arrangements possible in a particular relationship.

Having care and intention in how we do everything in our lives matters. Being conscious and intentional in each moment of relating is my only goal, knowing I may or may not do even better in the next precious moment I have with someone I love.

Copyright 2014 by Susan Miranda.  All rights reserved.  No part of this writing may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright holder. For reprint permission, email

Thursday, October 31, 2013

Obligation Is Not Love

I wish I knew who first said, “Obligation is not love,” so I could give them credit. I first heard it from a therapist in a scream therapy process I chose many years ago as a part of my healing journey.

I grew up on a family farm in a community where if someone needed a barn built, everyone came to help. But I also grew up in a family in which it was not okay to say no.

I learned a certain loyalty that I treasure. I can be a good friend. I say “can” because it is with some misgivings that I also embrace the concept that obligation is not love. So I will not be an obliged friend. I don’t have rules for any of my relationships; I only care that they are healthy. But what does “healthy” mean? Only I can answer that question for myself in any moment. And only you can answer it for yourself.

The problem or the gift is that the answer may change from one moment to the next. So it may feel right to be friends or in a sexual relationship with someone in this moment. However, I am always attentive in each moment to when a shift needs to happen in relation to the connections that I value and love. If I think there needs to be a change of any kind, I will try to have a conversation with the person I am in relationship with to sort through what feels right for the relationship in this moment and into the future. I am also attentive to when words of appreciation and love need to be spoken and all the ways my actions speak louder than my words. I consider those words of appreciation and love some of the most meaningful and important actions I can take in my life.

Friendship, relationships and connections to other people are gifts. But none of them is a gift unless it is freely given, not out of guilt, expectation, routine or habit. That does not mean that I am not committed or loyal. But it does mean that I look for a level of choice and intentionality in every moment. And I strive to create connections in which the people I am connected to have the freedom to be authentic and honest.

I don’t want anyone to interact, relate or be in friendship or relationship with me unless they truly desire it. I don’t want conversation, dinner, touch or superficial or deep connection with another person unless intentionally chosen.

Living this value to its fullest means I think twice about just about everything. If I send a card to someone for their birthday, when their next birthday comes around, I ask myself if I want to send a card again and make sure I am not doing it only because I have done it previously. It means that I think twice about how I mark holidays, weddings, funerals and every other occasion that may have expectations interwoven in it.

And it means that I don’t always make the most typical decisions. I did not go to my own mother’s funeral, for example. It was the right decision. I have no doubt that my family knows I loved her very much based on my choices and actions leading up to that event, which were just as intentionally chosen as my decision not to go to her funeral.

I allow each of my friendships and intimate connections to have its uniqueness, and I work hard to not assume that it needs to be the same the next day or the next year.

I don’t have rules. I only constantly ask myself what is healthy and what needs to happen in this moment with this person I love. It does not have to look traditional. It does have to be intentional. I only want love and friendship freely given and freely chosen in every precious moment I have with someone.

Copyright 2013 by Susan Miranda.  All rights reserved.  No part of this writing may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright holder. For reprint permission, email


Sunday, June 30, 2013

I Love Food Too Much

I am told this is one reason people give for why they cannot lose weight. I use the word “love” frequently, and I mean it every single time I say it or write it—except this time. I don’t think we can love anything too much. If we do, then I don’t think we are using the word correctly or loving in the way loving is meant to be done.

I am a sexuality educator and consultant. For the past twenty years, I have talked about the importance of self-pleasure, self-love and our relationship with ourselves. I consider eating one form of pleasure that is neither less nor more important than other forms of pleasure.

I have challenged the cultural norms as best I can about just about everything. Much of my work has been trying to increase awareness and acceptance of gay, lesbian and bi sexualities. I advocate for all sexual expressions and activities as being acceptable as long as they are consensual.

So I have no hesitation to also challenge assumptions that we need to be of a certain weight, body type, skin color or age or to be able bodied in order to be considered healthy or beautiful.

While I don’t define health and beauty by pounds or outer appearance, there is no doubt that we live in a physically unhealthy society here in the United States. However, we also live in a mentally, emotionally, sexually unhealthy society, and it is just as important to address these aspects of our lives and health as it is to address physical health.

So I don’t underestimate the need for more exercise and healthy choices around food and other parts of our lives. But I will advocate for healthy choices that come from true empowerment within and not from pressure or arbitrary standards of beauty from a partner, peers or society.

I believe the only way we change anything is to fully accept where we are right now. We don’t get anywhere by beating ourselves up or not having compassion for ourselves and other people, whether we are talking about making good choices around sex, food or any other area of our lives.

So can we love food too much? To answer that question, we need to answer these questions: Is our love for food unconsciously similar to what happens in some unfulfilling relationships, or is it a love of the most authentic, meaningful and healthy kind? When we eat, are we really experiencing the pleasure of the food, or do we not even taste what we are eating? Are we intentional with our food, or do we go for what is convenient? Do we rush, or do we take time preparing and eating the food? Do we have regrets?

I believe it is important to be intentional in all parts of our lives, including what we eat. But our bodies and our lives do not have to look one way or like someone else’s.

First published on   June 27, 2013

Copyright 2013 by Susan Miranda.  All rights reserved.  No part of this writing may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright holder. For reprint permission, email

Thursday, May 16, 2013

The Children

For the past five years until nine months ago, when my beautiful neighbors moved four hours away, this is what happened.

Every day on my way to my day job, I would walk past my neighbors’ house while the two children and one or both of their parents were having breakfast in their dining room. I’m not sure how it started, but it became a game: I would do something silly outside their window, like throw snow or my hat up in the air, dance, do whatever crossed my mind to make them laugh and smile and give me a little joy to start my day. Then, when I came home, I would see them, and knowing that life is short, I would not hesitate to play with them if it were summer time or give them a hug or chase them (kids love to be chased) or play tag or play games that Kai, the five-year-old, usually made up.

I have felt so grateful that their parents could share them and not be afraid that they could love another adult, one not related by blood. I think this culture has a lot to learn about dealing with insecurities and not feeling threatened or jealous in all of our loves and friendships.

Have I told you I don’t do anything typical? I don’t think of family, parenting, children or any way of my being in a typical way. Since the parents were so loving and open to me and not threatened that their children loved me, I took the time to be there and help if they asked. Even if they did not ask, if I saw the children in the backyard on the weekend, I would run over there and let the parents do something else while I played with them.

I love both of the children very much, and Ruby June, who is two and a half, and I have a very special connection. I swear I was waiting for her before she was born. I tell people that I think she and I knew each other in a past life. She would say “my Susan,” and I would reassure her that I will always be hers. Right before they moved, she would want me to do everything—change her diaper (if she had one on) or give her a bath at bedtime. She asked one Saturday to come to my house and eat lunch and take a nap. The mother told me no one could get Ruby to nap so easily—not Grandma, Dad or her. Ruby and I would go to the nearby park and take our time coming home, talking about all we were seeing as we walked home (or I carried her and whatever she chose to bring with us to the park).

I used to joke that I wanted to marry the family—the entire family—and I don’t mean that in any sexual way. Have I told you I don’t do anything in a typical way? I do it in the way that feels best and most authentic to me. Loving those children and that family feels really right to me.

There was a time in my life I thought I was not capable of love and that I would only feel hate. So it is actually very beautiful that I will love and risk losing and do it again and again in each moment. I would never undo or change what I had with those little ones.

I joked with one person at my day job (when she was having a hard day) that maybe if she played Ring Around the Rosy every day the way I did, she would have a better time at work.

I miss the daily presence of those two children very much.

Copyright 2013 by Susan Miranda.  All rights reserved.  No part of this writing may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright holder. For reprint permission, email