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The Week My Case Was (Supposed To Be) Presented a Second Time

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One week before I got the call that my case for heart transplant would be presented for the second time, I said goodbye to my beloved cat. The end came quickly for us. He was old, it is true, but he was also a complete mad man. That was until he woke up from a nap one afternoon and it seemed like he couldn’t use his back legs. Things only got worse from there. It seemed my sweet boy had a stroke.  I will spare you the details of the decline of my fabulous feline. He deserves to be remembered as the majestic beast he was, but it was easily the most heartbreaking week of my life. I understand now what they mean when they say “soul” pets. Gus was certainly mine. I have loved all of my pets, but there was just more with Gus. He was my friend and confidant. He was my nurse and companion through the biggest changes I have ever gone through mentally and physically. I have never met a cat with so much personality, and while we didn’t speak the same language, he always seemed to know when I needed a cuddle or laugh. I can’t see the future, but knowing what I know now, I think maybe he could at least feel it. You see, one of the biggest things I worried about with the possibility of transplant looming was my buddy Gussy. Gus was extremely bonded to me, and exclusively me. He tolerated other adults who would feed him but he was truly only nice to me. I worried about the amount of time that I would be away from him for transplant and recovery and more than that I worried about how to manage after transplant when it is recommended to not be near cats. I believe he took that worry away from me, and knew this next part of my journey I had to go alone. I will miss my Gussy, my Wussy, my baby, my wayby, Fatness Neverlean, Bubs, Bubbers, Chubs McGee, Auggie, Chonk-a-donk, Triple G, and all the other nonsense names I called him daily. 

The Monday before my heart transplant was presented for the second time I woke up with a blue tongue. If you do a cursory Google search for “blue tongue waking”, you will find that the internet believes that you may be suffering from a congenital heart defect (check), heart failure (check), asthma (check), perhaps acid reflux (also check), or the ingestion of a blue food dye. I could not remember eating anything blue, as I do my best to follow the rules and the third rule of CHD club is no blue food. (The first rule is don’t die, the second rule is no faking heart issues for any reason, even if you hate your PE class). Anyway, I didn’t eat any blue food, so mild panic set in. I took a photo and sent it to the team, not my medical team mind you, my home team, my family, it was 7 a.m. someone had to be awake. My sister must have done the same quick Google I did and concluded I had a congenital heart defect. Shocking. What is a girl to do but check her O2 (it was fine), and then try brushing her teeth. Sure enough, the blue started to come off. I swear I didn’t eat anything blue…but I did have Christmas Nerds, red and green Christmas Nerds, the night before and while they aren’t blue and thus not technically against the rules, it’s the only thing that I can think of that would have caused it. All this, before 8 a.m. on the Monday before my case was presented for a second time. 

On the Tuesday before my heart transplant case was presented for the second time, I said “see you later” to the therapist I have been working with for seven years. Like Birdie said in Hope Floats, “Beginnings are scary, endings are usually sad, but it’s the middle that counts the most. Try to remember that when you find yourself at a new beginning. Just give hope a chance to float up.”  Endings are sad, but notice she didn’t say “bad”. Nothing bad here. For the last seven years I have had the best therapist I likely will ever experience. She was who I needed, when I needed her. I showed up in her office broken and without a toolbox. I am leaving knowing who I am, how I roll, and with a toolbox brimming with ways to not only help myself but effectively help others without sacrificing myself (they’re called boundaries have you heard of them?).  I have grown so much as a person it is time for me to test the wings she helped me build. I hear what you’re thinking…now? Yes. Simple as that. It is time. Sometimes you find yourself at a fork in the road in the middle of a journey and you get to choose a new way forward. Our paths don’t go in the same direction anymore, but how cool is it to be able to look back and see just how far that path has taken you. You know me, you know I am like an adorable fungus you cannot get rid of, a see you later is not a good-bye. You’ve seen the photos of me with my childhood cardiologist, even professionals keep me around, just like you they want to see what comes next. I just as much cannot wait to see what is next for her, she has so many new things happening in her life and practice, she changed my life and I can’t wait to see how she changes others. 

Early in the morning, on the Wednesday before my heart transplant case was presented for the second time, I took a small box containing a tiger tipped vial to my local hospital lab. A sweet woman named Loli drew my blood so it could be sent to Nebraska for antibody testing. This is an important part of the heart transplant process, and a vital piece of matching me with a heart in the future. Loli was so sweet and must have been able to tell that I was nervous about this precious vial arriving in time for Friday. She kept telling me how she did this all the time and how they would process the blood and get it on it’s way. She asked if I had a transplant, and I explained I was hopefully getting one. “Kidney?” she asked. I get that a lot, I think it must be more common for a person my age to need a kidney than a heart. I told her it was a heart and that this was my second try. She told me that she knew she probably shouldn’t say this, but it is Christmas time and miracles happen at Christmas. She will pray for me to be listed. I thanked her, and she told me again that she would make sure that this got sent out quickly. Through this whole process I keep having encounters like this one, my family too. I don’t know what I believe about what happens when we die, but I will tell you this, I am shown almost every day that there are people looking out for me on the other side. 

Later that same morning (the day I am writing this), I got a message from my clinic letting me know that my case won’t be presented this week. Unfortunately, they wouldn’t have my antibody testing back in time to discuss my case. I was crushed. I can handle waiting for a heart, and the unknown of when it will happen. I can handle them saying it isn’t time again, they will know when it is time. What is killing me is being told I am going to be put up for consideration again, and being delayed time and again. They knew they would need this test. They knew how long it takes to get results. They knew where I lived. I was just there doing other tests for this presentation, and they didn’t do it then. They didn’t use overnight mail, they didn’t ask me to come back to do the test there. They just told me they were presenting me, and they were sending a kit to collect this blood. I called on Monday to express concern I didn’t have the kit yet and I was told that it would not be a problem, I could be presented without it and to let them know if I didn’t have it by Wednesday. I received it Tuesday night and went immediately to have it drawn in the morning. I triple checked that it would be sent that morning. To have done what they asked and then be told it wasn’t enough within hours of each other was soul crushing. It is my goal to do everything I am asked by my team. If they had told me I needed to come there for them to draw one vial of blood, I would have. We are talking about the literal rest of my life, we aren’t talking about an annual physical, or an ingrown toenail, we are talking about heart transplant, this is something you drop everything for. I understand WHY they need this test first, but I can understand and still be disappointed in the way things went. Trust can be shaken but not broken, so right now, my trust is a little shaken, but not broken. 

Now I don’t know when I will actually be presented. Next week being so close to Christmas seems unlikely, the next being the week of Christmas seems less likely. I have felt hopeful the last week, that this would be the time, and I would be listed. Things seemed to be working out. I hope they still will. Right now, I am just sad and angry. I am tired of being tired, and I am tired of waiting to know what comes next. 

You should know I am okay. I really am. I am nothing if not resilient, and my mom has come to be with me while I go through all the emotions. She was coming to be with me when I found out if I was listed and she came early when I was crushed to find out everything would be delayed. I am lucky that either way, when I need my people, they show up. This will get sorted out, and sometimes even the best people in the medical complex forget that there are real people and big emotions behind the test results. 

I share all this because this process is not linear, and because of what is on the line it is incredibly emotional. I share this because you are someone close to me and I want you to know what is on my mind when I seem like I am a little less cheery than usual. It is important to share this because, you might be going through something like this, you might know someone (me) who is or will be, it is important to know that it isn’t a plot against you or me when things don’t flow neatly from point A to B. If you are one of my people thank you for your support and love through this, I continue to be amazed and humbled by the amount of kindness and love I have been shown. If you are on your own journey, I wish you health and ease as you put one foot in front of the other. 

The Beginning

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People often tell me that I need to write a book. Maybe one day when all of this is “over” I can think about that. Right now I have enough seemingly insurmountable tasks ahead of me, I don’t need to add any more, plus, where would I even start? 

I may never write a book, but soon, in a city a few hundred miles away there will sit a group of people I barely know deciding what happens next in my story. I truly believe whatever they decide will be the right thing for me, because since the very start that has been the truth. Somehow even against all the odds, from the very beginning things have just always kind of worked out. My bread has always managed to land jelly side up and leaning heavily on the five-second rule, I have always been able to dust off and move on. 

I guess that if I were to write a book, the beginning is where I would start. I think it is hard for anyone to know with the memories of times before they can personally remember anything, what is true, and what is family lore. Like most things, I would guess the truth is somewhere in the middle of the facts and the fiction. The story I am about to tell is the truth as I know it. I will do my best to tell it free from as much hyperbole as I can manage though you may find parts of it hard to believe, I know there are times I still do. 

June 23, 1982, was a truly beautiful day in Dodge City, Kansas. I didn’t arrive until late morning and even then didn’t make it outside, but thanks to my friend the internet I can see the high temperatures that day barely broke 80. What a lovely reprieve from the scorching late June heat in western Kansas. My mom couldn’t have planned it better, and for the record, my arrival was planned. I didn’t know that until today. I knew I arrived via c-section like my sisters but I didn’t know if the day was planned or would be whenever I started knocking. I have always liked my birthday, the date in particular, not just the fact I get presents. June 23, 1982, 6/23/82, do you have any idea how many times I have had to confirm my date of birth? So many interactions in a hospital require a person, to confirm their date of birth, 6/23/82 rolls off the tongue, and if you’re OCD like me you like that two multiplied by three is six, and eight minus two is six. Brains are weird. What was I talking about? Oh yeah, I was born, well extracted by appointment, the morning of June 23, 1982, at St. Catherine Hospital in Dodge City, Kansas. 

It was obvious pretty quickly that unless Papa Smurf was real and my biological father, there was something not quite right happening with me and my cerulean skin. I don’t fault anyone for the things that transpired over the next 24 hours. It was 1982, we were in a tiny hospital with fewer than 100 beds in southwestern Kansas, and only about 1,100 babies are born with my specific heart disease each year. In such a rural area it is unlikely that they’d ever seen a baby with TGA before. Even if they had, it had only been in the last 10-15 years that doctors had been routinely able to operate on these tiny hearts and increase their life expectancy. So no, I don’t blame anyone for the events that took place over the next 24 hours, because I don’t think my life would be different if things that day had moved any faster, though I do know things could have been devastating if they’d moved slower. 

Obviously, the cobalt cast of my skin was concerning to the doctors. They may not have known the why, but what was pretty obvious, this baby was not getting enough oxygen. My mom was told that some time in an oxygen-rich isolette with some warming lamps should do the trick. It did not, dear reader, do the trick. I’ve spoken to my mom recently about how things went that first day, and it is hard for her to remember all the details. As it stands I was an infant, she was on drugs (prescribed, from a 1980s c-section), and my sisters were only eight and five years old, we don’t have the world’s most reliable witnesses. It went something like this. My mom would come into the nursery to see me, I was quiet, and still, I didn’t open my eyes, and was not “pinking up” as had been promised with the introduction of oxygen. This went on until the next morning, that was when Dr. J made his rounds. He was right out of med school, I happen to know he had only started practicing in 1981, he was much less senior than the doctor who had suggested I needed oxygen and warming lamps. He took one listen to me and knew that there was no amount of heat lamps and oxygen that was going to fix what needed fixing. 

The right thing and the popular thing aren’t always the same as they say, and Dr. J’s suggestion that I needed to be life-flighted to Wichita immediately in order to survive was not a popular call. The more senior doctor had already made the call about my condition, I was just not responding as well as they had hoped. I worry dear reader, that given his way, that doctor would have “wait and see-ed” me right out of this earthly plane. Perhaps that is why I have never enjoyed a wait-and-see approach. Dr. J fought for what he knew was right, he explained it to my mom and my grandparents, and it was decided. My mother had done the first “next right thing” of my life.  I would be flown to Wichita as soon as the life-flight could be arranged. I would “meet” my sisters through a glass window quickly before being shuttled off, and my mother would sign herself out of the hospital AMA so my grandparents could drive her the 3 hours to Wichita to be with me. 

I wrote Dr. J ten years ago, to thank him for what he did for me. What follows is a little excerpt from that letter and his response. It will explain a bit of what happened next. 

“Dear Rev. J, 

My name is Monica Wells, I am 31 years old and your intervention is why I am able to write you today. You don’t know me, in fact, we only met very briefly when I was only a few hours old, but I owe you a debt of gratitude.

On June 23rd, 1982, I was born in Dodge City, Kansas. A blue baby, my mother’s doctor assured her that after a while under a warming lamp and some oxygen, I’d pink right up. It is my understanding that you are the one who examined me and determined this not to be the case. You were the one who made the suggestion/decision that I should be flown by jet to Wichita immediately if I was to survive. You were right. I was diagnosed with transposition of the great arteries upon my arrival in Wichita. My heart stopped for the first time less than 24 hours later and I was having the first of several open heart surgeries within 72 hours of my birth. I don’t know how much if any of this information ever made its way back to Dodge City and to you, but you saved my life. 

I hope I have found the right person, and I wonder if you even remember this. I would understand if you have no recollection as  31 years have passed, but my mother remembers it like it was yesterday and the story has always been that you were the one that saved her baby, the one who saved me first.”

His reply. 

“Hi, Monica.

Oh, my!  What a blessing your email is for me!  I do remember you, but I never heard anything more after you were airlifted out. I have wondered of you often, your bright red hair and will to live were impossible to forget. 

…

Thank you for this gift to me.  Most of what we do is like planting a seed…it takes years before that seed bears fruit.  And, rarely do we see or hear of that fruit.  Hearing from you is a privileged glimpse into the fruit of our meeting so many years ago.

All blessings to you and yours, Monica.

Fr. J”

Dr. J now Fr. J left medicine and joined the seminary 10 years after we first met in 1992 and has been a reverend ever since. He and his wife both minister at a church in Texas. He put his brand new career on the line to second-guess those above him, and it saved my life. None of us know or remember the name of the doctor who made the wrong call, we only remember the name of the doctor who made the right call. It has never been about holding a grudge but always about holding gratitude. 

Within 72 hours of arriving in Wichita I had my first corrective surgery, this one to allow me to oxygenate the way my body had cleverly been oxygenating already, by holding open the hole between the two upper chambers of my heart. You see, I even managed to get lucky in that way, by having the right combination of heart defects to temporarily allow me to survive while everyone else figured out a plan. Jelly side up. 

It is hard to have faith in the medical complex. The system is convoluted and seems to be set up to fail. For me, I  just have to trust my gut and do the “next right thing”. Try the new med, or maybe refuse it. Stay with the same team, or be brave enough to say goodbye. Since that first big “next right thing” I have trusted my mother’s gut and learned to trust my own. Presenting my case again is “the next right thing” and if this team, whom I picked because they were also “the next right thing” says it still isn’t time, then I wait, because there is one thing I know for sure, you cannot make “the next right thing” happen. The next right thing just is, and so it will be.

Bad Ass Zone

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I once thought,  if not for my heart disease I would want to be the kind of person who might try to climb Mount Everest. Recently, I have been thinking that I kind of have been climbing my very own Mount Everest for the last 41 years. It seems like I climb for a while, spend a good stretch at a base camp, climb some more, get to another base camp, chill out, wait, and repeat. No one climbs just to hang out at different base camps though, and eventually, you are going to have to push for the summit or decide to go back down. I just realized that if I am going to continue to use this metaphor I would have to refer to this next part of my “climb” as entering “The Death Zone” and that seems a little too dark even for me, so let’s all pretend that the world calls the tippy top of Everest “The Badass Zone”. In fact, perhaps we should encourage all climbers and the Nepali people to start calling it “The Badass Zone”, no need to keep with these self-fulfilling prophecies, in fact perhaps every body still on Everest is a victim of the Pygmalion effect. What was I saying? Oh right. My own Everest, entering the newly named, hopefully to be adopted “Badass Zone” because regardless of how often I roll my eyes at her, I am listening to my therapist and I know our thoughts are important and even if I did think it was funny, we should not call it “The Death Zone”. I digress. 

I hear you, “Monica, what are you prattling on about, would you please get to a point, or even start your update!” I suppose, but I want you to know, you are a buzzkill. 

Yesterday, I had yet another appointment in Omaha for testing with my heart failure (trying it’s best)/transplant team. I underwent a heart cath which at this point is almost, dare I say, run of the mill for me. The worst thing about it is being NPO (Nothing by mouth, I guess in latin it is nil per os, you learn something every day. It means no eating for me.)  for 12-15 hours beforehand. It is minimally invasive, a poke in the neck and then a “lookie loo” with probes in a vein into my heart. I stay awake and communicate with my doctor the whole time. Here is the part where I remind you I love my doctors. I especially love my cath doctor, he is just a fun guy and I bet he would be fun to take to bar trivia. Since I am awake he makes sure I am “included” as much as I can be in the procedure and he isn’t just talking about me right in front of my draped face. I’m rambling again aren’t I? Anyway, I had my “lookie-loo” and honestly things looked a lot the same as they had before. Unfortunately, they didn’t look great before and I am more symptomatic than I have been. 

I shouldn’t have been surprised to see my heart failure (trying it’s best)/transplant doctor, Dr.B after my cath, but there I was, surprised when he popped in unexpectedly to talk to us about what he thought this all means. Have I mentioned how much I love my team? We were not meant to see him, and this conversation could have happened in a MyChart message or through a nurse. When my mom started smiling and saying “Hello!” to someone in the hallway like she knew them I was really confused because we don’t know people in Omaha. We do know Dr. B though and he came in to tell us what he believed to be true. Yes, I am stalling. Basically, things do look the same, however other tests don’t. My cath results don’t agree with my stress test results for example. What he figures is, that while I am chilled out, listening to music, gabbing with Dr. D in the cath lab, my heart pressures are my baseline (I can’t call them normal, these numbers aren’t normal). If I were to do an exercise cath however, (Yes, that is a real thing, and they make you pedal while you’re on the table with a probe in your neck! That is a circus act I would like to see but not perform.) he believes my pressures would shoot up to 3-4 times what they are at baseline, which would make me feel terrible with exertion (accurate) and the other symptoms I am experiencing. He could ask me to perform this circus trick but he doesn’t think he needs to and have I mentioned how much I like him? It is because of this, and the other testing that I have had recently, and in the near future that he is going to present me again in the next couple of weeks for consideration for transplant. He believes it is time to “push me forward” and I have to trust that he knows better than I do when that time will come. I stalled just writing this paragraph. Can you imagine how long I would drag my feet on doing this thing?  

When he left the room, I looked at my mom, a little stunned as I always seem to be when movement on transplant comes back up. It is kind of like a jack-in-the box, I know it is coming but it is a surprise every time. 

“Huh.” I said. “I guess, I really am going to get a new heart.”

She looked at me a little dumbfounded and asked “What did you think we were coming here for?” 

“I’ve been coming for the turkey sandwiches.” I told her. Holding up half of my doughy, white bread turkey and swiss sandwich. I, of course, was joking but those sandwiches are somehow the best food on the planet after being NPO. They stick to the roof of your mouth, and are a choking hazard but they hit the spot. 

So, that is where I am for now. On the precipice of being recommended to be listed once again, and at the mercy and wisdom of the transplant board, and likely entering the “Bad Ass Zone” of my personal Everest. Whatever they decide will be the right thing. I have full faith in that. Meanwhile, I have a bunch of appointments this month for more tests. Have to keep those bad boys up to date you know. Oh, and…this is fun, in the middle of all of this I have just a touch of skin cancer (nothing serious) that I have to get removed with margins. I dunno all the cancer lingo, I am a heart patient dammit, but I am assured it is nothing to be overly concerned with and I will be getting a good chunk of skin removed and a few stitches in the next couple of weeks and I will be right as rain. It honestly made me laugh when they told me. Of course the weird little spot under my arm was skin cancer, what else would it be! As always, the adventure continues and I will keep you updated as it comes.

One More Time With Feeling

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The thing about roller coasters is, after a steep drop and a straight away, they like to throw in a loop. The drop? My first appointment with the heart failure and transplant team, almost exactly one year ago to the day. The straight away? The holding pattern I have been in since then, where I test and I check-in and re-test and re-check. And now the loop, I am not going to say my last appointment was terrible, but I can’t say that it was the best I have ever had. I know the reality of congenital heart disease and congestive heart failure is more than likely a gradual decline over one’s lifetime. I have never expected to walk into the doctor’s office for them to check the tests and exclaim “You’re cured!”, my brain hasn’t even dared to dream that scenario so I am pretty sure I am on good terms with reality there. However, it is never easy to hear that you seem to be in a bit of decline, and it is even harder when both you and your team know there is very little to be done that we aren’t already. 

As I discussed in my last post, I was going into this appointment ready for reckoning, knowing that I have not been able to keep up with exercise since I have been back at work. I have gained back some weight I lost and am generally not where I had hoped to be at this appointment. I was ready to face the music. The music came I suppose but it wasn’t the tune I was expecting. My doctor is a lovely human who is always as gentle as he is frank. He was not at all shocked that I found it next to impossible to carry on the exercise regime I had been, and work full-time. He reminded me that based on my testing, I am “exercise intolerant” and “disabled from a cardiac standpoint”, he also reminded me that he had played all of his cards already. There are no more medications, I am on them all, and the highest doses. There isn’t another device (well there are a couple but no thank you, trust me) that is better than what I have. There really isn’t any more that the team can do short of transplant and he and I agree that we still want to keep that as far in the future as we can push it. 

Where does that leave me? Well, here comes the loop, the thing I was not at all prepared for – it is time for me to scale back my work load. It was a punch in the gut, almost more than the thought of transplant was. I know I complain about my job, it is true, teenagers are a pain in the behind, but they are also just complete dorks who make me laugh and can be super sweet and innocent, and so funny. I love what I do, I love working with kids who need a little extra love, a little extra help, and watching them learn and grow. Yes, sometimes they challenge me on the dumbest things, and pick weird hills to die on (as a matter of fact they will complain for longer than it takes to actually do the assignment), but dang it if I don’t enjoy the stubborn cusses. 

My doctor went on to explain that while he cannot add more hours for rest, and exercise into my day, he would like to suggest reallocating the hours I do have to best serve where I am currently. He knows I try my hardest with diet and exercise but I am limited. He knows that when I have the time to do what I am “supposed to” I do it religiously. So the proposition was, can I reduce my workday enough to have time to work, exercise and recover all in 24 hours without burning myself down to the wick. If I work five hours a day, instead of seven, can I do cardiac rehab, rest and recharge and repeat? You might be thinking, shouldn’t you use that extra time to JUST rest? Actually, no. For reasons I won’t go into because they kind of feel icky and weird, the size of my body at the time of transplant really matters. It isn’t in a fat shame-y way, it is in the best outcome kind of way. My fitness, and body size have a direct impact on how transplant and recovery will go, so it is also my job. I need to give it the same kind of time I would give a job, it could literally be a matter of life and death. Plus, there is the added benefit that there is still a chance that maybe, just maybe losing some of this pesky weight will make me feel better enough that I can put off transplant for a while longer, maybe even feel well enough to go back full time even before transplant happens. 

I have gone through the full spectrum of emotions this week about this. I did not want this to be the answer. I did not want to take more help than I already have been, from my family, from my friends, from my co-workers. I did not want to admit that the chronic “not feeling good” is actually the advancing of my disease. I have been angry that the systems in place to protect people in times like these are so fully protected by red tape, and that there are so many catch 22’s when it comes to what is best for a person’s care. Catch 22’s about insurance, where to get it, who can get it, who decides what, and why it never seems to be the doctors or patients. I have had a few break downs, deep profound sadness, feeling of loss, and mourning. I know I will be okay and that this is the right choice but it isn’t one I was planning to make and I have never been keen on my circumstances making choices for me. 

All that said, I leaned in. I marched my happy butt into the powers that be and I told them my situation. I asked for their help and they gave it, they will continue to give it. There are still some things to iron out and I found out along the way that I have some more big feelings to work on, but for right now I know that things will be okay. Monday I start my new reduced schedule, and get myself back into my self-led cardiac rehab. Coming out of the loop, I have some curves and hills to get through in the next few weeks. I will do a heart cath in the next couple of weeks, along with repeating some of the heart transplant testing to keep it current. After that I am hoping for another straight away.

Where The Heck Is My Wagon?

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In order to fall off of a wagon, you have to be on it for at least a little while. I call that a win. From June to the end of July I did great. I watched my diet, I worked out, I did all the things, and then…the real world came back, summer ended and school started. Sometimes I feel like a juggler, and I can only handle so many balls in the air at once before I start dropping them. 

Each day, if I did everything I was supposed to do, and did it perfectly, I would:

  • Wake up at 5:30 a.m. in order to work out
  • Shower
  • Exercise 45 minutes 5 days a week 
  • Get ready for work
  • Work 7 hours 
  • Consume  less than 1800 mg of salt 
  • Consume less  than 64 oz of fluid 
  • Consume less than 1500 calories 
  • No dairy (lactose) 
  • Consume foods high in  protein and iron 
  • Have a healthy breakfast (less than 300 calories, and 200 mg of sodium)
  • Protein shake lunch (200 calories) 
  • Cook dinner (less than 1000 calories, and 1200mg salt)
  • Tidy my house 
  • Sleep by 9 pm

The problem is, many days I hit my first wall the moment I wake up. I always say if a healthy person woke up one morning and felt the way I do on a “good” morning they would likely consider calling in to work, much less on a bad day. The mental gymnastics, I have to perform in order to get myself out of bed some days could rival Simone Biles for the gold. Before you ask, yes, showering is on the list. I would like you to think about how aerobic showering actually is, if you are truly cleaning yourself and not just having an existential crisis under running water (been there, do that sometimes). It is a lot of up, and down, reach and lunge, all while maintaining balance and under hot water, ask your other chronically ill or mentally ill friends how hard showering is, and they will back me up.  

The rest of this stuff isn’t so much hard as it is time-consuming and mentally draining. I get tired of thinking about every single thing I consume and how it figures into my restrictions. The amount of time it takes to plan meals, make grocery lists, shop, read labels, and prepare meals (most often from scratch) is a lot when you’re already tired from just existing. 

Anyway, the point is I was actually doing okay when 7 hours of work wasn’t in the mix. I could reliably get 20-45 minutes of exercise each day depending on the day. I had the time to leisurely plan my meals, and cook them, I was able to sleep as much as I needed at night and during the day. I was making progress, and then…summer ended. 

I knew when summer ended that it would be a bad idea for everyone involved to try and do it all right from the start. Trying to do it all and failing would be a hit I couldn’t withstand and perhaps physically would have a hard time recovering from.  I just needed to get through my work days at first, and then hopefully I would be able to add in the exercise. I planned menus in advance, I froze meals, I prepared and within three weeks I was exhausted. I haven’t been sure how I am even going to just do what I am doing much less add more, especially exercise, I get home from work and am exhausted. My legs are swollen, even with my compression socks, and all I really want is to lie down and read.  

It is like I had been juggling tennis balls and suddenly a bowling ball was added to the mix. Needless to say, I started dropping balls, the first ball I dropped was working out. It had to go, it morphed into a hard to juggle football and I just could not do it, and keep the bowling ball going. The problem with that is, that I have a problem with all-or-nothing thinking. It is well documented and something I have spent countless hours working on in therapy but patterns are going to pattern when times get hard and ta-da! I can’t do it perfectly anymore? I already dropped one ball? To heck with the rest of these balls, this is too hard. I am just going to toss this bowling ball around and I’ll pick up another ball here and there. 

That folks, is how I ended up here, looking for my wagon. I know I need to get back on the thing. I have to do what is in my power to do, and I have to will myself through the things that are hard. Man is it easy to get mad, complain, and compare. It isn’t fair that I have to spend double on groceries so they don’t make me sick. It isn’t fair that for me following these specific rules is a matter of overall health daily for me. It isn’t fair when the people close to me, really want me to do these things, yet do not do them themselves because they know it sucks! I think that is one of the hardest things, is it feels very othering to be the only one doing these things. Encouragement is great, but I don’t need a cheerleader, I feel like I need a teammate. There comes a point with cheerleading that it starts to feel patronizing to me, a very do as I say, not as I do kind of situation and I just shut down, (also a thing I am working on in therapy). 

In one month I head back to Nebraska to meet with the heart failure team. I will fess up to my shortfalls, and likely schedule a heart catheterization. I was told that if it felt like I couldn’t both work and work out, a heart cath would be likely, I will tell you, I don’t feel like I can do both. It could be a sign my heart failure is advancing, it could just be a sign that this is going to be a challenge where I am. Either way, I need to do better with my eating and take the extra steps where I can. Sometimes I feel like I am always recommitting myself to this journey, but it is a hard path and there are lots of paths nearby that look more enticing, have fewer obstacles, and are more enticing. This is my path though…steady-on. 

Only Monday

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I woke up at 3:45 this morning and couldn’t go back to sleep. I haven’t been sleeping well the last few days. I also haven’t been feeling my best, it is almost like you don’t get this far in the heart transplant process because you are a healthy person with no reason to feel crummy. In addition to the crumminess I just have been kind of sad. In the period of two weeks, people I have known since they were kids passed away in one way or another from complications of their heart defect. That just never gets easier, especially when they are younger than me. The universe doesn’t do a whole lot of trade in fairness I have learned, but it doesn’t mean I don’t always hold out a little hope that one day that will change. 

So here it was almost 4am and I couldn’t go back to sleep. What is a girl to do besides grab her phone and lull herself back to sleep or at least sweet dissociation by the gentle glow of her smartphone and the promise of an infinite scroll? I round the usual bases, Instagram, and Facebook, and on my way to Tik Tok, I make the mistake of checking my email, it is hard for me to resist the siren song of the red circle indicating new messages. They have to be dealt with (see also; deleted) as soon as possible, the red circle is my mortal enemy and it must be vanquished. This dear reader was a mistake, for the email that awaited me at just after 4am was from my medication subscription service, and they were letting me know about the medications that would not be included in my next order without action. If I wasn’t awake before, I was now.

The first of the year is a real pain in the ass for the chronically ill, especially the chronically ill who take a large number of meds, and even more so if those meds are thousands of dollars without copay cards that have to be obtained, and resubmitted each year. I take 5 medications that cost over a thousand dollars without copay “coupons” that knock the price back to $10 which is great but the series of hoops to get these cards, and register them with the correct places is a pain in the butt. I have been dealing with prescription issues since December, and I would guess I will be until April. 

I immediately begin to dread the phone call I will have to make in the morning but I also know I will have to make it. I absolutely cannot go without my meds, not for one day, let alone a month. I calm myself down (I just get so tired of the hoops) turn on the sounds of gentle rain, and get another hour and a half of sleep before I have to really be awake. 

The moment I have a free second at work I take the chance to make a call to the pharmacy. I plead my case to the woman on the other end of the line. I have a very strict “be nice to the person who answers the phone it isn’t their fault everything is jacked up” policy. Her name was Nona and she was lovely. It took about 10 full minutes of checking this and that and we got things sorted (I think, I will check again in a week to be sure). She also let me know that my request to add the four medications that have been prescribed in the last year but are not in my pill packs could not be added. I would have to contact each provider and ask them to send in a new prescription. Again, it isn’t the person who answers fault. I thanked her and went back to class. 

Thankfully today we watched an episode of Cosmos in science and I had time to message four different doctor’s offices to make my requests. I even heard back from three! Not bad. All of this and it wasn’t even noon yet. 

While sending messages in MyChart I noticed that the appointments for my transplant evaluation were being put in. They were not kidding when they say it is three full days of appointments. It was at this point that I started to feel the anxiety building. Things have been getting real for a while now, but this made it even more so. I reached out to my family text and told them the kind of things I was worried about that they could help with, getting an Airbnb set up, making their travel plans, and generally anything that wasn’t actually doing the testing. They as always came through almost instantly. By the time my third viewing of the Cosmos episode was over I was feeling a bit better.  Thankfully I had a pretty full plate the next hour and was able to concentrate fully on the kids. 

I have to make a slight aside right here. My students have been so good about my absences and understanding my limitations. They are little rascals, don’t get me wrong, but they do have kind hearts. 

At the very end of class just as we had finished our work my phone started to ring. Normally when I have students I don’t answer but I saw that it was the Children’s Hospital in Omaha calling, I had a feeling they were trying to get something scheduled. I asked the kids to give me a moment and took the call. It was indeed a scheduler wanting to see if I could schedule my next heart cath…for tomorrow! Apparently, my team decided they wanted a heart cath before all of my other appointments and in order to give me my usual doctor the only day they could do it was tomorrow. That was not going to happen. I know the whole transplant process is hurry up and wait. I just didn’t know they would do all the hurry-up part while I did all the waiting. I asked for a different day with a different doctor and got it scheduled for two weeks from now. The stress level was hitting critical levels. It was time to call my mom. I sent my students to lunch and did just that, have I mentioned that all of this has happened and it was barely past noon? Mom talked me down and I was able to function the rest of the day without incident. 

It is now 7pm and I am exhausted. I have a feeling I will finish writing and posting this and be tucked away in bed before 9pm. This was just a Monday after a Friday when I was so tired I could not get out of my bed. Tomorrow is a Tuesday, and I will message my former doctors for records that my new doctors will need as I move forward, and maybe I’ll even get that dentist appointment scheduled too. Did you know you can’t get a heart if you have crappy teeth? Gotta get those pearly whites checked out. Thursday I get to go to the CPAP store because my old supplier couldn’t understand that I got a new machine and messed up my orders all the time. I did the right thing when I fired them but then I found out that in order to get my supplies from a new provider, I have to have an appointment to be taught to use a device I have been using for five years. It isn’t the person who answered the phone’s fault. The red tape is everywhere, and it makes me tired. I am very tired and it is only Monday.

It’s not tomorrow.

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“It’s not tomorrow.” 

That is the phrase I have been telling myself and my mother at the end of each conversation we have had since Ashley, the nurse coordinator and my self-proclaimed “newest cheerleader” handed us “The Packet”. Perhaps not THE packet but definitely a packet, a packet that indicates we have taken another step in this transplant process – a packet outlining a whole lot of scary scenarios and less than favorable outcomes. “The Packet” includes a whole lot of places to sign acknowledging understanding of all kinds of things, I would tell you what but if I am honest, I have only skimmed “The Packet” I am not quite ready to read it in full. I am going to take it to work, scan it in, send it out to my team and hopefully soon we can talk about it together. I don’t want it to live in my head with just myself to absorb it, I want to look at it with MY team ready to help me interpret, dissect, and digest its contents. 

Until now I have only been monitored by the Advanced Heart Failure and Transplant clinic, with the knowledge that transplant is in my future. During my appointment this week, on the suggestion of my doctor we have taken one more small step and I will be doing the actual evaluations for heart transplant. Please understand, this is still the very base of the mountain. There are many hoops here as well, many approvals to get, and then many tests to schedule. 

THIS DOES NOT MEAN I AM OR WILL BE LISTED ANY TIME SOON. 

Read that again. I am not listed. I may not get listed at this point. If I am listed after this, I likely have a very long wait ahead. This is all just the evaluation process. I am super stoked to have found out during this appointment and testing that there are no concerns about my liver currently, which can often be the case in people with congenital heart issues. We can all celebrate that. As Bruce Bryan would say “Put that in the W column.”

There is still a lot of time in this process. There are still a lot of unknowns in this process. There are a lot of big feelings in this process. The only thing I know for sure right now is, it’s not tomorrow. My family and I have time to absorb and digest this information, and as always I promise to update when the situation changes. I appreciate all the love and support from my people. You all have made your presence known in ways I did not expect and am not entirely certain I deserve, but I am grateful. 

Until next time.

Ease

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When my therapist first suggested the idea of group therapy for me, I was skeptical to say the least. I had a hard enough time in my own company, with my own issues, I wasn’t sure how I was going to enjoy or interact with others and theirs. Much like with the other aspects of trauma recovery I have been through I rolled my eyes, but agreed to try. Skeptical resignation is my thing, my therapist understands, she is less concerned about how I start and more concerned about where I finish. I came to her office because I was ready to try someone elses ideas of how to cope, that didn’t mean I was going to do so with a smile on my face and a spring in my step. Old habits die hard. 

It has now been two years since I started group. Last week, I attended my last meeting. Over the last two years I went from group therapy skeptic to true believer. Much like a summer camp full of people with hearts like mine, a room full of people who were all on the same path of healing – even if the place of origin and destinations were different, created a space for rapid healing and leaps that I am not sure could have happened in a one-on-one. 

As our therapist began our last meeting with a short catch-up something struck me, it seemed that all of us, even our leader, had spent the last few weeks decluttering, down-sizing, donating, and throwing out things that we no longer wanted or needed. Turns out that along with letting go of the habits, behaviors, people and relationships that no longer served us, we were doing the same with tangible things. There had been no homework to do so, no prior plan for this to be a group cleanse. It seems that the connection between feeling stuck and having stuff is real and as we were all becoming unstuck, the stuff was also falling away. 

For me the impetus for purging came down to one word. Ease. There has been a trend over the last few years to choose a word that you want to describe the upcoming year. A goal of sorts, a resolution in a way, a word to work towards and make a reality in your life. While I am not one to follow the pack, it became apparent in the latter part of 2022 and the beginning of 2023 that my word is ease. I didn’t even really pick it. It picked me. At the intersection of healing and progress was one desire, ease. I am tired of fighting against myself and against my life. My therapist loves to remind me that “what you resist persists” and through years of progress I grudgingly (I didn’t say ease came natural) can admit that tends to be the case. 

As I prepare to move forward down the road of transplant I don’t want to be or create my own obstacles. In my summation, the more ready I become now, the better off I will be when the time comes. The last thing I want is to get the call and go for the biggest moment of my life, and have more layers of stress because the state of my apartment, or the amount of absolute junk and nonsense I am leaving for other people to handle while I recover. Ease now, is an investment in peace of mind then.

Sideways

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Sometimes, even with the best doctors, and the best teams things go sideways. As far as I can tell the reason for this? We are all humans, and as my nephew once said when he was three or four “We are just made of meat.” Sometimes the truest words come out of the mouths of children. At the end of the day, we are all just sentient meat sacks doing the best we can. The hard part, when you are dealing with matters like your health and life, is deciding how human you are willing to let the people charged with taking care of your needs be. The even harder part for me is not letting a bad day make me lose trust in the process irrevocably. 

Over the last few weeks, the subject of my upcoming appointment with my ACHD (adult congenital heart disease) doc has been ever-present. Due to my struggles with PTSD related to medical situations, I spend copious amounts of time with my therapist preparing for appointments. I do my best to work through any feelings I may have leading up to the appointment, any apprehension, doubts, worries, fears, or frustrations. We work together to get to the bottom of what I am feeling and try our best to prevent problems before they arise. The enemy of anxiety is preparation. 

The biggest hiccup for this appointment? I would be going alone. This was by my own design, I had many offers for the company of my family. All they need is a little forewarning and planning and any one of them could have been present, but I was certain I wanted to do this alone. I had things I wanted to discuss one on one with my doctor and now that the hard part of hearing out the transplant doctor was over, I felt like I could manage a measly ACHD appointment with ease. More than that, there was a not insignificant part of myself that needed to know I COULD do this on my own, that I wasn’t so stunned by recent revelations that all the progress I had made in becoming a mature, informed, self-advocate who could stay present, even in the face of troubling news hadn’t been undone. I was bound and determined that this visit would be just me and I was excited about it. 

My plan was pretty simple. I had a few mundane things to talk about in reference to making myself feel better in the short term. Additionally, I wanted to have a frank discussion about where I stood as far as transplant was concerned. I expected to tell him how I have spent the three months since I was, in many ways, blindsided by his revelation that it was time to start the discussion about transplant and had been preparing myself mentally for the prospect. I wanted to let him know how far I had come in that process and how confident I felt that this is the right path at the right time, and I am in the right state of mind. I was going to discuss how I was feeling tired of trying one more thing that likely would not work, how I have been bone tired all the time, and that I have not been able to do the things I was able to do even a year ago, and how the simplest things like laundry have the ability to wear me out. Lastly, I wanted to have what to me was the hardest part of the conversation, a discussion about what kind of outcomes he had seen in those with anatomy like mine, post-transplant. All this and I was ready to do it all myself, as a grown, capable adult human. 

My plan went sideways almost instantly. When meeting with the fellow before I saw my doctor, I could tell that he was having a hard day. The man who has always come into my appointments well put together and with a pep in his step was disheveled, obviously tired and stressed, with the messed up mane of a man who had been gripping his hair in frustration. As I answered his questions, he seemed unaffected, and even uninterested. I felt myself starting to drift from confident to triggered. There have been many times in my life where I have felt, justified or not, that doctor’s interest is dependent on the emergent severity of my symptoms. So it was pretty triggering to feel as though my mundane complaints were not interesting to a member of the same team that had told me that in situations like mine decline and decision to list a patient isn’t usually emergent or extremely symptomatic, rather it is a slow decline in quality of life and abilities. I did my best to stay present. I decided to swing at the low-hanging fruit, wondering out loud if once again tackling my iron deficiency was worth a shot for short-term energy. I was concerned about some chest pains I had been experiencing, “likely musculoskeletal” was the answer I received with no follow-up. I expected that as it often is, I have a condition similar to arthritis that affects my chest wall. Finally, I told him that I wanted to talk to my doctor about my decreased endurance and tolerance for exertion, and how even with the new med, it was not improving. 

When my doctor entered the room he was as kind as usual, though he did seem tired. I don’t know where these two men had been before they were in this room with me but I had the distinct feeling wherever it was, they had been there a long, stressful time. The appointment started as expected, my doctor asked how I had been. I once again explained how I was feeling tired and while the new medication my other doctor had started did seem to help a bit, it was not life-changing. I expressed how I had made some changes to my diet as well in an effort to lose weight and restrict my sodium even more, but I was still feeling as though I was ready to start moving in the direction of heart transplant testing. It was here where things began to go sideways.

At my previous appointment my doctor made it abundantly clear that I could not diet or exercise my way out of the heart failure I was faced with, go back to the blog entry, I talked about it there too. Of course, those things were important as always, but they were not going to “fix” the issue at hand, nor was the issue my fault because I was overweight and out of shape. This conversation was immensely appreciated because as much as I might know that deep down, it is a hard thing to remember when you feel like perhaps your heart is fine and the only issue here is being completely out of shape. Today, when addressing my tiredness he went right to my excess weight and the need to change my diet. Did he not hear what I had just said about eating tasteless, high protein overnight oatmeal for breakfast every day, and changing from lunches of leftovers or at worst vending machine food to a vegan, plant protein shake? Did he not remember telling me to do what I could, when I could? I was telling him that at the end of my day of work where I usually walk almost 3 miles, I had nothing more in the tank. I could barely make myself dinner before crawling into bed and trying again the next day, much less taking a walk or jumping on my bike. I felt like I was spinning out, and that despite my efforts I had failed. At that moment my PTSD brain started reaching for survival mechanisms. 

He went on to address my question about the potential of moving forward with testing for transplant. I wish, dear reader, that I could tell you what was said here. I wish that more than anything, however, my amygdala finally overpowered me. That lizard part of my brain completely shut off any part of my brain that could absorb information. The lizard was off the leash and I was out of the driver’s seat, and by the time I caught the lizard’s tail and clawed my way into the passenger seat, the conversation was all but over and the parts that I could recollect were not at all what I was expecting. Under better circumstances, I would have asked questions, gotten clarification, asked what had changed, and why his opinion was different from that of my other doctor. I would have done a lot of things differently if but at this point I had been triggered so badly that I was unable to recover. I had dissociated so completely I felt foolish, small, and incompetent, I didn’t want to make it worse by asking questions that were born out of fear, and convoluted by a stressed-out brain. 

Sitting in my car I messaged my family and informed them of what had happened. I felt like I had failed myself, that all my work was for nothing, and that as much as I tried I may never be able to mentally handle the twists and turns of this process. Over the next 24 hours, I spiraled in almost every way I had to spiral. I won’t get into all the lies that my brain told me, but there were many and some of them were quite creative. I knew I was out of reach of my tools, I wanted to feel better and I knew I could, so I reached out. I reached out to my family, I reached out to my therapist, and I talked about what happened and how I was feeling. Once I was more clear on why I was feeling how I was feeling, I could use my tools to cope with what had happened and why it was affecting me so greatly. And after processing, I was able to write a group of follow-up questions to send to my doctor for a second chance to better communicate with each other. 

In the end, there are a few things that are true about this appointment. The appointment didn’t go as I had planned. My doctors, as humans, were very likely in the middle of an off day, or a tough situation. While this shouldn’t have been an issue in my appointment, humans are going to humans and it ended up that way. Additionally, I learned a big lesson, this process is enormous and taxing, it is emotional and it is going to be triggering from time to time, it will be in my best interest to not attend appointments alone for this reason. This fact isn’t a comment on my character, it is just a fact about the situation. Finally, when a human having an off day, meets a human who is stretching her emotional limits, there will likely be misunderstandings and friction. One less-than-stellar appointment isn’t going to change the way I proceed. I still feel more comfortable here, with these doctors than I have felt with other doctors in the recent past. I believe that I am in the right place, to get the care I need, whatever that involves moving forward. While this was not my favorite appointment it is because it is so far from what I have come to expect from them. I have been in situations where this type of appointment was the norm, which is why I have been so thrilled with these doctors and this team. 

On a separate note, I would like to say this, your support and care dear reader are appreciated beyond measure. I want to share this process with you because in sharing with you, I am able to work through the process for myself, share with others in my same position, and record forever how this process felt. This said I need to make it very clear, no one, not one person on this earth is more invested in my health and well-being than me. I am and will continue to do whatever it takes to give myself the longest and most full life possible. This is not a post telling you I have doubts about my team. If I doubted my team, this post would be about ME looking for a new one. All of this is to say, please don’t tell me I need to change doctors, teams, and locations. That is a decision for me to make, and extra input from others, though I know meant well, only causes me more conflict than is needed. Should the moment ever come that I feel that a change is needed, I will do the research, and find the place that is most suited to my needs. I have done it before and if needed I will do it again.  I am after all a grown, capable human.

Surprise! You’re sad.

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Lately my feelings have been a jack-in-the-box. Life just keeps turning the crank, and I think I am keeping it all together until suddenly, when I least expect it, pop-goes-my feelings. Usually this happens in the quiet moments before sleep. You know that time, if you’re like me, is some of the only time in the day where you give your brain a moment to get quiet and wander. Wandering minds can be a dangerous thing for people who are trying really hard to keep their thoughts and feelings in check. Even more dangerous are sleeping minds, minds that are beyond our control completely, minds that do whatever they need to do to draw our attention to the issue that we are ignoring. 

Let’s start with Monday. Monday of this week I woke up with a thud, a jerk of my head and body that was so extreme I thought for sure I had just experienced a shock from my ICD. I was absolutely certain of it. It is not a fun way to wake up, but it also was not the first time I have been awoken like this. I did a body scan. My chest didn’t hurt. My heart rate felt normal. I grabbed the blood pressure cuff I keep on my bedside table (doesn’t everyone?) and took my pressure, low but in the normal range. My head hurt pretty badly, but other than that, everything felt normal. I text my sister. She was present the last time this happened. We talked it through and decided that I should probably be very sure before I attempted to go to work. I messaged my work, it was 5 a.m. the doctors wouldn’t be in for hours still and I was exhausted, a little freaked out, and did I mention my head hurt? 

When I woke up and only my head hurt I was pretty certain I had a phantom shock. A real shock would leave my body feeling much worse for the wear. I slowly get myself going, I took a long shower, ate breakfast, and got dressed. I waited, did another body scan (when I say this I just mean I spend a moment or two in silence really feeling how my body feels by concentrating my attention on different areas) I felt okay. No shock detected. Why do phantom shocks happen? “They found that the phenomenon primarily occurred in patients with a history of traumatic device shocks, depression, anxiety and PTSD. They conclude that memory reactivation of traumatic events seems to contribute in the pathogenesis of phantom shock.” Clin Cardiol, 1999, vol. 22 (pg. 481-9) Basically, I have PTSD and somewhere squirreled away in my subconscious is the memory of the shock I received so many years ago and that I didn’t even earn but scared the life out of me just the same. Now, sometimes when I’m “fine” but not so secretly carrying around stress, that memory finds its way into my unconscious mind and rears its head forcefully, and convincingly. 

I mentioned this incident to my therapist I said “They say these phantom shocks are brought on by stress and anxiety. I thought I was doing okay, but maybe I’m not.” Her response? “Maybe parts of you are okay, and parts of you aren’t.” Shh. I’m fine, remember? She followed up, “My take is that you are feeling understandably vulnerable”. Ugh. I reminded her that to me that is the worst of all the feelings and quickly changed the subject. It is much easier to duck and weave from your therapist when you aren’t actually in their office where they can play defense or maybe it is offense…more directly. Also, she was right and I was in the mood to hate that. I feel like I spend a lot of time dealing with my feelings, I’m just not the greatest at truly feeling them. I have good intentions, and I mean to but when it comes down to it most often feelings have to catch me off guard and attack. 

Case and point an understandable but odd bit of sadness that struck me last night as I was falling asleep (I told you it is always sleeping or bedtime). I have a heart cath coming early next week and I was thinking of the things that I need to get in order beforehand. Suddenly I was completely overwhelmed with sadness. If things move the way my cardiologist predicted this is very likely the last heart cath this heart will have done. I am not particularly keen on heart caths or anything, they certainly don’t hold a lot of happy memories. Though there is that one time that Charlotte got to be my nurse and my femoral artery wouldn’t clot so we got to spend quality time with her applying direct pressure to my groin, that was kind of funny. That same visit Julie was the last nurse standing and we got to hang out until way past her shift ended because they wanted me to have a bed for overnight but one never came so Charlotte vouched for me that this wasn’t my first rodeo and I would return if I started to bleed out, (I did not in fact bleed out). So while I don’t have any particularly fond memories of heart caths it was just the thought of this being the first “last” for this heart. It struck me harder than I would have imagined. Lasts are hard, even if they are for the best.

It doesn’t help that you are talking to the person who personified everything in her youth (and maybe still has that habit). No stuffy slept on the floor for fear that I would hurt their feelings, when my mom got me a “pet net” for the corner above my bed deciding who went up there and who stayed on the bed might as well have been deciding who lived and who died. I guess in a not so subtle way I still feel like that now, this heart has been loyal, it has been through hell and back and done everything that was asked of it and more, replacing it feels like a bit of a betrayal and facing this first, “last” just really drove that thought home. So, the jack-in-the-box popped open and the feelings jumped out. It wasn’t so much the feelings, but the when and why that surprised me. I knew more feelings would come, I think it will continue to be a mystery what causes them and why I react to them. I will meet them as they come, and I will deal with them as they do. I have a target to work with, I have to start looking at the hard thing a bit more, so I can come to terms with what it means to say goodbye to the heart that has carried me when so many said it couldn’t. I have been given the gift of time to grieve and thank my spiteful, spitfire of a friend while it still beats in my chest. Perhaps, like most grief it won’t be something I completely get over, but something that dulls as time passes and acceptance sets in.