Last week people in the United States gathered for Thanksgiving dinner.
For many, unemployment, the threat of lay-offs. or impending foreclosure gave them less than usual for which to be thankful.
As they looked across the dining table, they found reasons for gratitude.
"At least we have our family; at least we have our health.
As long as we have those, we'll be OK," they said.
But what about the homes with an empty chair?
What about those who spent Thanksgiving worrying about the next step in their cancer treatments?
What happens to gratitude when we don't have our family or our health?
Elisabeth Kubler-Ross was one of the first researchers to look at what happens emotionally to people who are dying.
She found that the patients she worked with went through five stages that she called denial, anger, bargaining, depression, and acceptance.
Since then other researchers have come up with other ways of naming the stages and have pointed out that people do not go through these stages in a linear fashion, but may go in and out of the different responses to grief.
Although Kubler-Ross did her research when a cancer diagnosis almost always meant death, psychologists now realize that we often experience these responses to other crises in life like illness, divorce, or job loss.
Thankfully, most breast cancer patients today will not die prematurely, but they still have some mourning to do.
The most fortunate will have a lumpectomy scar and some time lost to radiation as well as the nagging fear that their cancer may pop up again, perhaps in a more dangerous place.
Others may lose a breast and experience more rigorous treatments that leave them with debilitating side effects.
After they sort through the denial, anger, bargaining, and depression that often accompanies a serious illness, most will eventually come to an acceptance of their "new normal."
As I've talked to breast cancer patients over the last eleven years and watched my own emotions swing back and forth, it seems to me that a major component of reaching acceptance is gratitude.
I volunteered with a breast cancer support group in the town where I used to live.
I was struck by the number of times women in every new group used the word "fortunate."
"I'm so fortunate to have breast cancer," one woman said.
"My brother-in-law had a stroke, and he can't communicate.
I've just lost a breast."
Others were grateful for early detection, for successful chemo treatments.
The ones whose cancers were killing them talked about gratitude for a supportive family or caring nurses.
Reaching this stage of acceptance is not a process that can be hurried.
Anger and depression are often part of the journey.
This year an empty chair at our Thanksgiving table gave me some difficult moments.
But I'm mainly grateful for the blessing of my father's life.
Remembering the parts of our life that bring us joy can start healing our spirits.
A true spirit of gratitude can help us travel the rough places on the cancer road.