“Man vs. Self: a literary term that describes a character’s internal conflict, or the psychological battle they face within their own mind.” 

Yup, that’s me, stuck in a literary conflict in the real world. I bet you’re wondering how I got here, all tied up in knots and battling nothing but myself. Allow me to take you back dear reader, to one month ago. I was super stoked to show off my weight loss and health progress to my transplant doctor. He was super stoked at how awesome I am doing. I rode that high for a couple of weeks. Then the undercurrent of that appointment started to nag at me a bit. 

You see, during that appointment we talked about how awesome I am doing. We also discussed how much better I am feeling. We decided together to get some data to back up all of my hard-won progress. This dear reader, is when I kind-of-sort-of allowed my brain to turtle out of the conversation. I had heard what I wanted to hear. There was no need to listen to anything else or absorb it. Right then, into my metaphorical shell I went. 

There is nothing wrong with data, I personally love data. It’s hard to argue with data. Data shows me that what I am feelings is real. I haven’t just convinced myself and others that I’m fine. But am I fine? That is where the test comes into play, and that is why in that moment, into my shell I went. 

One month from today I will repeat the dreaded VO2 max test. I will put on the scuba mask and hop on a stationary bike. I hope to prove to my doctor and myself that I have succeeded. That I have done what they told me I couldn’t. I exercised my way out of needing a transplant. 

My VO2 max has been around 12 for about 3 years. According to my transplant doctor, this is the lowest they like to let people get before listing them. My team first started gathering this data with transplant in mind in 2021. During that year, I did poorly. We called it a scratch because I had just spent the last year inside my house and was “de-conditioned”. In 2022, I did the test again. Once again, I stunk up the room. It was at this appointment we called 12 my baseline and started talking about transplant. 2023, rolled around and the test was kind of the put up or shut up test. If I did not do any better than 2022, then I probably wasn’t just de-conditioned in 2021 but instead have advanced heart failure and we needed to start talking seriously about transplant. Can you guess how I did in 2023? That is right friends. I actually did the worst of the three tests so far. Things were not looking so hot for our hero. That kicked off transplant testing. As we all know from following this story so closely and never forgetting anything, the first time my case was presented to the transplant board, I was denied. In general I was still too healthy to list. This was actually good news. Eight months later, I struggled to work a full day. I was sick pretty much all the time. My case was presented to the board again. Once again, I was denied. They largely considered me too large, my weight was a problem. They did not think I would be a good candidate. They also doubted I could get a good enough heart at that weight. (There is a whole size equation that comes in to play, I’ve explained it before, I can’t want to explain it again.)

It was after that major disappointment that I begged to try something, anything to feel better. The answers were, work fewer hours, and start cardiac rehab. Check and check. I have to admit I was dubious about these solutions. I had been told word for word “you can’t exercise your way out of this.” Looking back I can see this statement was really traumatic for me. In the moment it was just a bit of a gut punch but now, it rings in my head daily in the way that only the most terrible things can. 

So, in March of this year three months after being denied for listing, I started cardiac rehab, and wouldn’t you know it…I started getting stronger. I also started a weight loss program, with help from both calorie restriction and a weight loss drug. Here I am seven months later. I’m inching towards 40 pounds down and feeling better than I have in years. I’m still working out three times a week. My muscles are coming out of retirement. In 30 days time, I will repeat the test that has bested me for the last four years. 

Here’s the rub, and the sentence that caused me to turtle out in my mind at that appointment. If my test is better, that is awesome. It is proof that my hard work paid off. We can delay transplant. If the test is the same, or worse, we have to talk about transplant again. This time my weight isn’t going to exclude me. To be fair that was the goal of cardiac rehab and the weight loss medication. The goal was not to slim me down for vanity’s sake. It wasn’t to get me swole. It wasn’t so I could live happily ever after with no worries of transplant. The goal was to slim me down, get me healthy enough that I could crush a transplant and come out the other side. The goal was to put me in a position where the hearts that I would be offered, were hearts that could go the distance with me. Along the way I found myself leaning into a new goal, delaying transplant, and doing what they said I could not do, exercise my way out of heart failure.

So that’s where I am right now, that is the internal battle I am fighting. I know what the original goal was, but along the way I found a new one. I feel like I am going to crush the VO2 max. My stamina is better than it has been in a very long time. However, data and feelings are two different things. Data talks louder than words. There is a chance that my VO2 max is still 12. There is a chance that when those results come in, we will be once again, having a serious talk about transplant.

I can’t lie. I will be crushed if that is the case. I have worked so hard. Not improving would devastate me. I am “training” really hard at the moment, specifically for the test. My workout at the gym is mainly on the kind of bike I will be tested on. I have to say, it is kind of kicking my butt. I can’t go longer than eight minutes right now. My heart rate gets too high, so I have to pull back. I worry I have tricked myself. I might think I am doing better because I haven’t actually been challenging myself much. It is me against myself right now. I am using all of my therapy tools but sometimes we just have to feel our feelings good, bad, or ugly.

 I have a dream of hitting 20 for my VO2 max, if I hit 20 I have told myself I can get a new cat. I haven’t allowed myself to even think about a new pet since Gus. I knew that if the transplant went forward, it wouldn’t be fair for the animal. A VO2 max of 20 would give me an 8 point buffer between me and transplant. Hopefully, I would be able to maintain it and put off the transplant for at least another 10 years. My doctor also hopes for this outcome.

My reasonable goal for my VO2 max is 15. This goal tickles me for a number of reasons but the biggest one is, that is still lower than the “poor” portion of the VO2 max scale. It isn’t even near hitting “poor” in fact, I’d have to hit 25, to be considered in the “poor” category. Isn’t that funny? It is so true what they say about being grateful for what you have because what you have even if it is not much, could be someone else’s wildest dream. 

I know one thing for sure. No matter what happens with the test this time around, I can honestly say that I have left it all on the field. I have done everything asked of me over the last seven months. If the test isn’t good, there is nothing left to do. I have thrown all I have at avoiding transplant. I have done all I can to make myself stronger. I have actively participated in my care. I have committed to my overall health and wellness. If I don’t improve, it is because something far out of my hands is wrong and I have to accept the next steps. See, just typing all this out has helped, guess writing really is a good tool for me and my mental health. I am not hand writing, however it is still working, guess the ol’ therapist and I will have to agree to disagree on that one.

As always, thanks for hanging out in my brain for a while. I know there is a lot of junk in here, but I hope sharing it with you all leads to a bit of understanding, a bit of reflection, and maybe even some hope? I will update you in a month (unless I get the urge before). In the meantime, cross your fingers. Sprinkle pixie dust, do a naked moon dance, or even pray. Hope that whatever is meant to be on this journey of mine comes to be. I hope to find peace with whatever it is. Thanks.