As my evaluation dates grow closer, I keep thinking about being sick enough, and whether I even know what that means. Medically, it isn’t my choice whether I’m sick enough; that decision is above my pay grade. It is however, my choice whether I feel sick enough to agree to being listed, and to accept everything that comes with that.
This has been a very hard thing for me my whole life.
When you live within the paradigm of a person with a chronic illness, or a progressive disease, whatever you want to call it, your definition of feeling healthy is often leagues apart from the average person’s definition of feeling well. That discrepancy has reared its head more than once in my life, much to the confusion of people who live within the paradigm of health and wellness.
Imagine my surprise when, at 13, I discovered that most people don’t experience sudden racing heartbeats that make them feel ill. Or the time I found out that it isn’t, in fact, normal to wake up from a dead sleep gasping for air, or feeling like someone just punched you in the center of your chest. Whoops.
How was I supposed to know? I’d never known anything different. And the doctors weren’t asking those specific questions, so I wasn’t answering them.
“How are you feeling?”
“Fine.”
“Are you having any heart issues?”
“No.”
“Have you had any issues with dizziness or fainting?”
“No and no.”
They never asked, “Are you waking up gasping for air?” or “Do you feel sick to your stomach after exertion?” So I assumed that was A-okay. Upon reflection that was probably a giant dose of disassociation/denial but I have enough to unpack in therapy already so, moving on.
I wasn’t stupid. I understood that the other kids could play in PE class much longer than I could, but I could still play. And because our PE teacher was a bit of a taskmaster with no time for whiners, I often pushed myself beyond what I felt my limits were, just to avoid being singled out by her.
But it’s not like my friends and I sat on the swings at recess and debriefed about how we felt after gym class. There wasn’t really anywhere for a kid, especially one who’s always been pretty literal, to gain context for what I was feeling.
And in a lot of ways, that’s still true.
Am I sick enough?
Is the life I have right now so hard, and so distant from where I want to be, that it’s worth pushing all my chips in and hoping to come out the big winner?
If I am sick enough, what does that mean about me and about the “little heart that could” that still beats in my chest? The heart I’ve been betting on my entire life to defy the odds and prove people wrong. And what about the life that I have made purely out of spite and determination? What happens to all that stuff if I give up now? Is it giving up, or is it moving up?
In therapy I’ve talked a lot about the way I personify my literal heart as a character in my life; both friend and adversary, hero and villain.
What does it mean if I agree to exchange it for one of those fancy, normal hearts? A heart that hasn’t known what it is to struggle for each bit of oxygen it provides. A heart with no scars, no history, no quirks.
What part of me do I lose when I lose it?
I’ve talked about this exact thing so much in fact, that my therapist has suggested he could write a letter to the transplant team explaining why he thinks I would benefit from seeing my old heart once it is out of my chest. He knows how important this relationship (and it is a relationship), is to me and thinks it might be best to allow me a moment to say a true and final goodbye. I tend to agree. It feels a lot like I will have to redefine who I am without this other part of me that shaped me and my life in so many innumerable ways.
Then again, Dr. B talks about “the window” all the time at my appointments, wanting to list me while I’m in the window. That Goldilocks zone between sick enough to need a transplant, but not so sick that I can’t endure it. I trust him. I trust his team. Why is it so hard to trust the process?
I don’t want to miss my best chance. I’ve had a front row seat to watching someone I love make the stubborn choice, the wrong choice, every single time they were offered a choice and killing themselves in the process. I refuse to be that way. I have been a fighter my whole life.
Plus, there are still so many things I would like to be around for in the future. So many things I haven’t done, or seen, or experienced. I don’t want to get to a place where the choice is out of my hands, or worse, where there is no longer a choice at all because I missed that window.
My whole life has been a lesson in endurance, physically and mentally. Every day has been a test of how far I could go, pushing boundaries, pushing limits.
Agreeing to a transplant isn’t endurance. It’s acceptance.
It’s saying, “Okay. I’m willing to put the cudgels down and stop fighting this fight. I’m ready to embrace whatever comes next.”
That’s a big pill to swallow, and I know a thing or two about swallowing big pills.
Maybe agreeing to a transplant isn’t betraying my heart. Maybe it’s the last thing my stubborn little Franken-heart and I will do together, one final act of defiance against the disease that has been trying to end this story for decades.
I don’t know.
I truly don’t.
This is where I’m supposed to wrap things up neatly in a little bow and tell you that I’ve found my resolve one way or the other. But this isn’t that kind of story. The choices are too big, the consequences too permanent, and the questions too complicated to tie up that cleanly.
Right now, I’m still sitting with the question.
Am I sick enough?
Maybe the truth is that I won’t ever feel like I am. When your baseline has always been “make the best of it” and “push through,” the idea of being sick enough for something this enormous feels almost impossible to measure from the inside. Enough implies a limit, and limits are not something I have ever been very good at accepting.
I do know this: I don’t want the choice to disappear because I waited too long. I don’t want the window to close while I’m still standing here trying to decide whether I’m brave enough to walk through it.
So for now, I’m doing the only thing I know how to do. I’m showing up. I’m asking the questions. I’m listening to the people who know more than I do. I’m putting my trust in the people who deserve it, and I’m taking each step as it comes.
Or at least I’m aspiring to do. In reality, I’m already worrying about several steps down the line. I need you to work with me here; I’m trying to keep us all optimistic.
And, in the middle of all that trust, hope and aspiration, I’m trying to figure out what my stubborn little heart and I are going to do next.
Perhaps, the bravest thing we have left to do together is let go.























