On Becoming a New Patient

As the first post here at my my new home, I thought it fitting to return to that seminal moment in the experience of being a patient: finding out you have an illness.

I recently spoke with someone who is newly diagnosed, someone who has otherwise been pretty healthy. Our conversation reminded me of how overwhelming this whole process of being a patient and navigating the health care system can be. As a lifelong patient, I don’t always pay as much attention to this stage in the patient experience as I should, and I started to make a list of all the things that popped into my head as we spoke, ideas both big and small.

What tips or suggestions would you add to this list? What do you know now you wish you’d known when you first received a diagnosis, or, for those who might still be in the process of receiving one, when you first started experiencing symptoms and going to doctors? I’d love to hear your thoughts in the comment section!

  • Don’t feel awkward or guilty about asking for a second opinion.
  • Ask lots of questions—it’s important you understand what’s going on with your health. If you don’t feel comfortable asking your doctor questions, consider meeting with a new doctor or provider to see if there is a better rapport.
  • Some days will be really good. Some days will be awful.  That is okay. Your feelings as you process this are all okay.
  • When it comes to waiting—waiting for appointments, waiting in hospitals, waiting for results, etc., expect the worst and hope for the best. Time works differently in the medical world.  It’s frustrating, it’s not always fair, but it is a reality of the patient experience.
  • A lot of things might seem scary and out of control, but don’t forget—this is your body.  If something doesn’t seem right—a provide doesn’t wash his or her hands; a lab tech sticks you too many times; the test someone is scheduling for you doesn’t sound like the test you know you need—speak up! It might be awkward, but social graces are not worth your health or your sense of comfort.
  • Spend some time getting to know the online patient community. Sometimes, the anecdotal experiences and wisdom there, as well as commiseration and validation, can be enormously helpful.
  • Remember that everyone’s experiences are different, and everyone is at a different point in the process of treatment, acceptance, etc. Not everything you read online will resonate with your experiences, or with what your doctor tells you. Again, ask lots of questions, and don’t be afraid to bring what you find online to your doctor.
  • Drink lots of water and wear layers when you have blood drawn—being dehydrated or cold makes it even harder to draw blood.
  • You won’t get a lot of rest as an inpatient, but there are lots of things you can do to create a better environment and a sense of calm: familiar books, music, and DVDs make a difference, certainly, but you can also inquire about the necessity of overnight vitals to see if you can get uninterrupted sleep, for example.
  • Sometimes you will really want people with you at appointments, or will want to talk about it. Sometimes, you will want to be alone, or want to talk about anything other than illness. These are your boundaries to draw, and it is okay to ask people to respect them.

Also, if you have a moment, definitely let me know if you encounter any issues with the comment system, the subscription service, or anything else that comes up as I fully switch over to this new space.

(And, I am really happy you followed me over here!)

Disappointment: The Intellectual Opposite of Hope?

When my agent was shopping my first book out to publishers, it was an incredibly tense time. I’d done all I could do to set myself up right, and now the decision was out of my hands. For a control freak like me, it was an uncomfortable position.

But what made it harder was how much I felt hinged on getting this book under contract. In my mind, everything else I wanted to do depended on getting this deal for this book at this particular time. The next book I wanted to write, and the book after that, and the book after that? They could only happen if this book happened. The fledgling freelance career I wanted to build out? I would have much better standing with a book under my belt. The more stable academic and research positions my newly-minted MFA hinted at? You know what they say—publish or perish. And my very identity as a writer? Well, writers write things, right? Things that get published.

Of course none of those static boundaries were true, and my life and career would have gone on had things not worked out the same way. It is easy to say that, though, because I did get what I wanted then. The script I wrote for myself, the one so meticulously reliant on each step unfolding just so, went (somewhat) as planned.

But what are so much harder—and, unfortunately, so much more common—are the times when we do plan and work towards something and set up a script for ourselves that does not come to fruition. We want so desperately to accomplish a certain goal that it becomes difficult to see ourselves in any other reality. I see this in my students who are applying for jobs, my consulting clients who are applying to schools or trying to secure agents, and of course I see it so often in the lives of patients. We want a last-ditch medication to do all the things it promises it might; we want the much-anticipated surgery to be 100 percent successful; we want that super-star specialist to give us the answers we need to hear.

We carefully construct this eventual outcome, and we cling to the promise of that better reality because that’s what we need to do to push through all the obstacles and hard work necessary to have a shot of getting there.

We hope for the best, because it is not unreasonable to hope for good things.

Because we have hope we can keep sending out submissions while the editors’ rejection letters accumulate, or the job offers don’t appear, or the letters that arrive in the mailbox are too thin. Because we have hope we work through the side effects of medications, or gear ourselves up for the major surgery and lengthy rehabilitation, or undertake medical interventions with high risk and limited chance of success.

I’ve often heard that the opposite of hope is despair. I don’t disagree with that, but I think the situation is far more nuanced. In the immediate moments of bad news, setbacks, and realizations that what we want is not going to happen, despair is real, and it is palpable. It is the moment when hope does not seem possible. It is an innate emotional reaction, one that manifests itself in different ways: tears that come without warning; numbness; a feeling of emptiness. It is encompassing and isolating. It pulls us off our center of gravity.

But there is an intellectual component to an otherwise emotional experience, and I think that is where disappointment comes into play. Disappointment is not as overwhelming as despair, but it makes demands of us. We have invested so much time and energy into one path, and it didn’t work out. Now where we do we channel that energy and momentum?

It’s a question of readjusting our expectations, and re-calibrating our goals. Whether it was getting a certain job, having a successful surgery, or any number of other realities, when we envisioned the “after,” we saw things unfolding a certain way. We have to write ourselves a new script, and in our disappointment, we don’t always want to do that. New deadlines need to be set, new strategies need to be formulated.

Sometimes, if we’re lucky, our re-writing is only temporary. Sometimes, it is life-changing.

I am often amazed at the capacity we have to hold out for the best possible outcome even in the face of very low odds: when early indications and test results don’t look promising, when other people’s envelopes already arrived and we are still waiting, when it has been three months and an editor hasn’t gotten back to us, or deep down we know we’re not really feeling any improvement on a new medication but we resolve to give it more time.

This capacity for hope is wily like that. It is stubborn, sometimes willfully so. But because of that, eventually we are able to envision other possibilities and are willing to pick ourselves up and start again.

Don’t Know What You’ve Got Till It’s Gone

I didn’t realize just how little energy I had as a result of my malfunctioning thyroid until I started taking thyroid medication—it was the kinetic equivalent of putting on a pair of eyeglasses for the first time. Everything was sharper, clearer, more focused.

It was a whole new world. Can you relate?

I didn’t realize just how awful (sluggish, congested, weak) I felt when I ate foods containing gluten until I stopped eating them, and immediately ditched the sinus headaches and malaise. Similarly, I didn’t see just how foggy and gross I felt eating foods with sugar (wine, fruit, vinegar, etc in my world) while on suppressive antibiotics until I eliminated all sugars from my diet and no longer got spacey or clammy or had palpitations.

Five years apart, these experiences opened up “whole new worlds” on their own—not without sacrifice, but totally worth it. Have you been there, too?

And of course, I couldn’t tell just how much the muck festering in my lungs clouded over everything and constantly made me feel awful until I started treatments that actually addressed it—postural drainage, chest physiotherapy, etc—instead of just throwing steroids at it and hoping the infections would subside.

It was a whole new world, one that didn’t automatically include multiple weeks in the hospital every year. Have you experienced that type of profound relief?

Sometimes you just don’t realize how bad things were until you do something to correct it, until things are different. When it comes to medical stuff, this isn’t always a bad thing. After all, if we can look back and compare a “before” and “after” favorably, then we’re doing something right; we’re treating the right thing or implementing the right therapy or making the right lifestyle choices.

And right now, I’m experiencing a related type of gratitude. It has been two months and change since I was acutely ill. That’s right, 10 weeks of relative normalcy, a huge step given that for the past year or two my stretch for bad infections had been about two weeks at the most. The few infections I’ve had have been much more minor than normal, so beyond the daily coughing/wheezing and maintenance, my various conditions have been really stable. Part of it is because my “bad” season is over (September-May), part of it is because I am out in public less during the summer (no commuting to germy college campuses), and I know a huge part of it is because of the very aggressive treatment I’ve almost completed.

Whatever the constellation of factors is, I’ll take it.

I forgot what it was like to be able to accomplish a lot of the things I want to do every day, or to make plans without hesitation or fear I’d just have to cancel, or to go to gym and know my lungs and body will hold up their end of the bargain. I forgot just how great and necessary it is to see friends in person, and be part of family functions, or leave the house and do fun things with my husband on the weekends.

Only now that the vortex of that long, awful winter has finally released me can I say that I didn’t realize what an effort simply getting through the routine of daily life was until it was no longer an effort.

And I love this feeling. It’s a whole new world.

Can you relate?

Keeping it Simple

“Basically, your dog is scared of life,” the vet said.

Great, we thought to ourselves. How exactly do we go about resolving that?

Now I am not one to engage in pet blogging, mainly because I recognize few people will ever find my dog as charming, adorable, or entertaining as I do. But I made an exception in this case, as the vet’s words and her words of instruction lingered in my head all week.

Admittedly, my dog (who is, incidentally, as charming, adorable, and entertaining as they come) does have some issues. She was abandoned twice before we adopted her from a rescue as a puppy, and she has an exorbitant amount of fears: anything with wheels (bikes, strollers, skateboards, scooters, wheelchairs, roller blades, luggage, etc), anything that makes a sudden noise, anything that causes sudden motion, anyone she doesn’t know, etc. The daily hum of anxiety that accompanies her intensifies into sheer panic when we’re not around her, since apparently we’re her ultimate security blanket.

“The best thing you can do for her is to let her experience life. Expose her to as many things as possible and help her learn to see she doesn’t have to be scared of every new thing,” our vet told us. Of course she gave us even more specific instructions, but her overall assessment was powerful in its simplicity.

Just live, just do, and you’ll get to the point where you’re so busy doing and living that there’s no room for fear.

I don’t have an anxiety problem, nor am I besieged with fear by things with wheels, things that move, things that make sound, strangers, or anything I’ve never seen before. By no means am I scared of life. But I do doubt my body sometimes, doubt that it will be up to the task at hand, doubt that it will come through for me when I depend on it.

I had my sweet, scared little girl in mind this week when I did something I haven’t done in years: I rode a bike. Not a stationary bike in a city gym like I’ve ridden for years, but a regular old dusty dirt bike. And I didn’t ride through the suburban developments and sidewalks of my youth, but on an honest-to-goodness trail, a pretty famous trail, even if I only did part of it.

Once I got my license as a teenager, I left my mountain bike in my parents’ garage to collect rust and cobwebs. In the ten years that have elapsed, my body has been through a lot. I was already well accustomed to my lungs preventing me from doing things, (I’d dealt with that since birth), but something in me changed after my adrenal system crashed. I got so used to my body failing me and so used to the small losses that amounted to a significant whole that I forgot how to trust my body again.

It’s been three years since my body came to a standstill (literally) and physically the symptoms of adrenal depletion are so much better, but my mental conditioning hadn’t caught up completely. I put in long hours, I work seven days a week, I go to the gym, but until this week I hadn’t pushed myself out of my comfort zone because it didn’t even occur to me I’d be able to.

The day we set out to ride, the humidity was temporarily gone, my infection was under control, and for once, my lungs were cooperating. Now, would the rest of my body?

It was never the bike that I feared, it was the possibility that I’d get several miles out on the trail and something would happen and I’d get stuck there, or that I’d start the day feeling pretty good and end it in a state of setback.

Instead, I got on the bike and just rode. And rode. And I was too busy moving that I didn’t think about what my body might not be able to do.

Simple advice, really.

Ups…and Downs

I was struggling with a way to tie all the things I wanted to say into a neat little essay-type piece, so I decided to chuck the structure constraints and just go through them.

1. It’s officially springtime. Not that you’d know it from the snow on the ground and the fact that I’m wearing gloves today, but it’s a start. It occurred to me as I walked my dog this morning that I made it through a winter without being in the hospital. It has been at least a decade since I’ve said that. True, I’ve suffered from various plague-like infections since October, I haven’t been able to hear out my left ear for a couple of months now, and my peak flows have been horrid, but no matter. No steroids, no hospitalizations. Now, if my immune system and my antibiotics can hold out for a few more weeks, I think I’m in the clear.

2. When I am not jealous of Dr. Jerome Groopman (a famous doctor! A staff writer for the New Yorker! A widely-published book author! The man has that whole left and right brain strength thing going on that I can only imagine) I am wholly appreciative of and fascinated with what he writes. His newest book, How Doctors Think, tackles a subject near and dear to my heart, misdiagnosis. He argues that misdiagnosis results from mistakes in thinking, “cognitive pitfalls” that occur when doctors assume certain things based on a patient’s history or complaints and “anchor” themselves to one idea/diagnosis instead of considering broader possibilities. (See a great article taken from the book here ). Having been involved in this exact scenario for years, I really appreciate the clarity and insight Groopman brings to this discussion, and am looking forward to reading the whole book. (Plus, it makes me feel a little less crazy after all those years of answers that didn’t match my problems and a little more understanding of the physicians behind those diagnoses.)

3. There are days when I seriously question what I do and how long I can do it. There are also those wonderful, uplifting, soul-buttressing days, though, when I have no need to question. I have some amazing students. Thoughtful, inquisitive, and intellectual students whose projects and interests truly excite me, whose questions about science and public health and society make me want to read more and whose research reassures me just a bit about the future of our country’s health care system.*

4. Three people in my personal life are pregnant right now; two just made the announcement recently. Wonderful, exciting news, the kind of news you need when it’s cold and miserable out and you just want spring to start, when you just need to reminded that everything is a cycle and there is always the chance to start anew, when you can feel yourself getting happier just by virtue of their happiness reaching out to you. **

5. I had an amazing conversation with an incredibly wise and insightful CF patient the other night, one that left me with so many questions and so many things to think about. It was the kind of talk that left me humming with energy, my mind going in so many different directions. ***

*Sometimes I still question the choices I’ve made. Just when I think I’ve set up a schedule that is conducive to my health and my writing, I am plagued with doubt. Am I being lazy? Wouldn’t things like medical bills be so much easier to stomach if I took on more classes? In theory I am making an investment in the future by proceeding this way now, but that lag between theory and practice can be difficult sometimes.

**Apparently this spate of fertility has prompted well-meaning people to approach my mother and ask when we’re going to have kids. Not surprising, since people have been asking us that since we were engaged, but since that’s a complicated question with an even more complicated answer, this unsettles me. Right now there isn’t much to say about it, and I find myself not wanting to discuss what is there to discuss. I suppose I just wish the good news—the pregnancies—could remain all about the pregnancies and the people involved in them. I mean, I know it’s human nature and an inevitable (and innocent) question, but I’d rather just focus on the three babies, not what anyone else may or may not be doing in the near future.

***At one point, I was asked “Do you know anyone like you?” I answered that no, I didn’t personally know anyone with PCD but that in the past couple years, I’d found groups online. I read from time to time, but rarely post. This segued into a really interesting discussion about the nature of community at different points in illness—for example, how if you’ve been sick all your life you might not need the same community you did as a child but if you’re sick for the first time as an adult, you might really need to seek out people with the same condition. I said that no doubt it would be valuable to know someone with PCD face to face, but that I know enough people with significant illnesses that I can extrapolate what I need to. Since I’ve never known anyone like me (except my parents, to an extent), this hasn’t bothered me.

I got home that night still thinking about community. In my inbox was an e-mail saying someone from the PCD Web group had died at 42. It was not anyone whose posts I had ever read, but I felt really down. It hit me that with community comes the burden of reality.

Type A by nature or by illness?

So here’s the truth about me: I’m a bit…obsessive. I wake up in the middle of the night with a jolt, knowing suddenly that I have a typo on a certain page of a document. I can’t go to bed without making a To Do list for the next day, nor can I feel relieved or productive unless I am able to cross every item off that list.

It gets worse. I still remember the questions I got wrong on standardized tests from several years ago and can write them out, and it is with equal queasiness that I can play back every word of a fight or disagreement or awkward situation verbatim, wishing I’d have said this or cringing that I’ve said that.

Not surprisingly, such tendencies also mean I like to be in control. I never liked group projects because I figured I could do a better job on my own, and when I served in editorial positions of power, I had to constantly remind myself that delegating the work out to the staff was a positive thing, not a necessary evil. My dog got lost last year when someone was watching her, and since then I have become a total helicopter mom. At dog parks, I can’t relax and instead, stand guard at the gates lest anyone leave them open for even a second. When my parents watch her, I plaster their back door with signs reminding everyone not to leave the door open.

Too much hubris? Probably. Too much energy wasted on wishing things were perfect and making sure everything unfolds just so? Definitely. Qualities I’m proud of in myself? Not really. But at the same time, they are qualities that are partly responsible for the things I have achieved, and I can’t help but feel that our biggest weaknesses are also often our strengths—it just depends on the degree to which we allow them to dominate.

I’ve always chalked a lot of this perfectionist/control stuff up to the fact that I have always been so sick: I can’t control so much about my life, so what I can control, I try to do in full force. I take the large issues, the life-threatening ones, in stride, so it’s sometimes the smaller stuff that frustrates me. It makes sense, and it’s certainly a convenient rationalization on days where I wish I could just escape myself a little bit.

But lately I’m wondering about how much of my personality is defined by illness—or, more accurately, a reaction to the presence of illness—and how much is just my personality. Would I be this way I was healthy? Since I’ve never been healthy, I just don’t know. I know that in various ways I am a lot like my parents, but then again for as long as I have memories, they have been sick, so that doesn’t help me tease it out much. I could have inherited these traits from them, or I just inherited a lot of medical problems and the three of us happen to respond the same way to illness.

I guess since I have no “before” and “after” when it comes to illness I will never know where illness leaves off and plain old Laurie begins when it comes to these qualities, but in the end that doesn’t really matter. What’s more important is maintaining that balance between strength and weakness that keeps me going without making me go a little crazy.

A Bumpy Trip Down Memory Lane: Illness and Accuracy

Lately I’ve been playing an annoying and ultimately counterproductive game of “What If?” You’ve all played this in some way or another, so you know as well as I do that it never ends anywhere good, does it?

Specifically, I have been asking myself “What if I had energy?” When I get frustrated over my current lack of it, I can’t help speculating: What would it feel like to make plans and be able to keep them? What would it be like to not need an entire pot of coffee (gross, I know!!!!) in order to function? What would it feel like to come home at the end of the day and accomplish something other than collapsing on the couch? What would I do if I woke up in the morning without feeling foggy in the brain and achy in the muscles? Most of all, what would I say if I didn’t have to say “I’m too tired” so much?

Really helpful, right? To make it worse, I’ve been looking back to my college days, when I was what I considered really busy—I took five classes, worked on the campus newspaper, interned at a national newspaper, volunteered at the hospital, etc. “I wish you knew me when I had energy, when I could do everything I wanted to,” I say to my husband every now and again. Suddenly, the old me seems so much more productive and engaged than the person I know now. I still juggle a lot of projects, but I’m not pulling 18 and 20-hour days at a stretch like I used to; I can’t even contemplate being out and about that long anymore.

But memories can be deceptive, and when we look back at them, there’s often a reason, an agenda or subconscious motive, that skews how we see ourselves. We can re-write past romantic relationships as either wonderful or terrible, depending on what we need them to be to feel good in the present, or we can reconfigure academic or professional failures to be someone else’s fault when it hurts too much to accept them for what they are in the here and now. The list could go on and on. When I look back at the “busy” me and see this stage as something to strive for once again, I think it’s really because of two things: 1. It is hard to admit how much has changed in terms of my health and 2. I have a hard time scaling back and doing this is a way to thwart my own progress in doing so.

When I really look at the facts, I can see how misleading my own nostalgia really is. First of all, I did have more energy back then because my adrenal system hadn’t failed yet (that would happen two years out of college), I wasn’t dealing with steroid withdrawal (I was still on them full-throttle), and my chronic fatigue wasn’t exacerbated by these two other complications like it is now.

Secondly, I was my own worst enemy in those days—I’d run myself to the ground, get an infection, and then spend several weeks a semester in the hospital as a result. Sure, I had energy for a couple weeks at a time, but I pushed too hard and wound up paying for it. It is convenient to overlook that fact when I wax nostalgic about how over-extended I used to be, but the reality is that the way I acted didn’t give my body a fighting chance to establish any sort of control or stability.

So I may not run around in a million different directions and I may not define myself by the number of activities I do, but I have more balance. Yes, I wish I had more energy and yes, I miss being able to do things I want to do, but regressing to my former way of living certainly isn’t going to improve that scenario.

Now, if only I could remember that more when I start to play “What if…” Nostalgia is inevitable, but it isn’t always accurate.

Mourning Thoughts

I found out last night that the father of a friend of mine died suddenly the other night. Obviously all death is tragic, but there is something especially unsettling about unexpected death—the lack of warning, of preparation, the inability to say all the things we’d say if we had the chance.

Naturally, this terribly sad news made me think of my own father, currently in the midst of a flare-up of his polymyositis and still trying to improve his renal function. He has flirted with death more times than I care to elaborate, and when I consider the many life-threatening conditions he’s battled for so many years, I can’t help but wonder just how much more his body can take.

For people whose lives are dominated by chronic illness, sudden death is so disconcerting because it flies in the face of all the things we do each day for our health. I’ve watched my father test his blood sugar, inject himself with insulin, endure the nausea and ill effects of chemotherapy, and work against the pain and fatigue of muscle disease for years. I’ve picked up his blood pressure, gout, and cholesterol medications from the drug store, and I’ve visited him in the cardiac unit after his catheterizations, angioplasties, and stent insertions. All the things he does to stay alive could wind up becoming his entire life, if he let them.

And all the things he does for his health reassure me that he, that we, have some control over what happens, that if we plan and dose and medicate and recuperate, we can keep death at bay and our bodies can keep bouncing back. Sudden illness and death is so scary for that exact reason, because it defies planning or preparation or proactive approaches. But perhaps the day to day grind of chronic illness, the whispers and tuggings that our conditions bring into our lives, can also combat that most sober of reminders.

No matter how short or trivial the conversation may be, I never hang up with my father (or my mother, husband, or brothers) without saying “I love you”. I do this not because I am thinking catastrophically that it could be the last time we speak, but because I have learned not to take anything for granted—illness as well as health.

As Good as It Gets? Thank You Very Much

The Wedneday night before Thanksgiving, I collapsed on the couch just in time to watch “Top Chef” with my husband. I had the day off and spent most of it preparing appetizers for the next day’s feast—in between bouts of coughing, wheezing, and assorted aches and pains. For weeks now I’ve been battling what I refer to as a “high-functioning plague,” a respiratory infection that has lodged itself in my lungs and won’t let go. While it makes breathing difficult and congestion constant, I am usually still able to go about my daily activities and am not confined to bed. I feel sick, but it is a functional sick, so it is okay.

During the commercial breaks, my husband and I chatted a bit about our upcoming few weeks. I mentioned needing to schedule a test I’d had to cancel earlier this fall, and the conversation eventually drifted towards an inevitable topic with us these days: maintaining stability. It’s been 10 months since I’ve had a seriously acute respiratory event and needed to be hospitalized, the longest stretch I’ve had in over a decade. I am so conditioned to expect critical illness that sometimes I can’t even believe it. I’ve had to juggle several other conditions, but they are more life-altering than life-threatening.

Three years ago, I spent the entire week of Thanksgiving in the hospital. I spent Christmas Eve of that year being transported by ambulance from my parents’ hometown hospital to my Boston hospital, one Christmas out of the past five I have spent in the hospital in recent years. Holidays haven’t always been especially festive for me.

But here it was, the night before Thanksgiving. My appetizers were finally ready, my condo was scrubbed clean, one of my favorite shows was on, and I wasn’t anywhere near the hospital. The holidays were indeed making a comeback.

As the night progressed, my symptoms worsened. I turned pale, got clammy and sweaty, and the exhaustion in my arms and legs was overwhelming. This was a nightly occurrence, as was the coughing jag that followed. We barely noticed it, only pausing to turn the volume on the television up more so we could still hear it above all my racket.

“It’s not great, but it’s a lot better than the past few years. I’m not healthy, but I am stable,” I said to John.

“It might just be as good as it gets. And you know what? I’ll take it.”

“Me too,” he said. “It’s more than good enough for me.

And when we sat down to dinner the next day with our family—including my father, who only a few months ago underwent heart surgery, my mother, whose joints would pay for her meal preparations for days to come but whose smile didn’t show that, and my niece, a healthy and happy two-year-old—we knew that while stable never means perfect, we’ll gratefully and thankfully take it for all of us.

Invincibility and Illness

One evening last week, I noticed a girl doing something I would never do on that particular stretch of urban street: walking alone in the dark. Granted, it wasn’t extremely late and there were lots of cars and buses on the street. But it was a poorly lit section of road in a pretty tough area—one where a gang of children (children!), ages 10-14, had nearly stabbed a man to death around 9pm just a few weeks ago—and with lots of dark alleys and shadowy hills, it wasn’t exactly a welcoming area once the sun went down.

I could tell she was a college student: she looked about 18, she was wearing a sweatshirt with the insignia of a university just a few blocks away, she had a backpack slung over one shoulder, and like many of the students I see on my campus, she had iPod headphones in her ears and Ugg boots on her feet.

Beyond these telling details, there was something else that told me she was in college: her air of invincibility. She strolled down that dodgy, dangerous street confidently. I admired her for this, but I also worried about her on account of this.

I think it’s an almost universal experience, that sense of invincibility and fearlessness so common during the college years. We’re insistent that we can work hard and play hard; we take challenging courses as we balance campus parties and social events. We stagger home from bars late at night, usually without worrying about if this is safe. We pull all-nighters to cram for finals without considering what this does to our bodies. We eat unbalanced meals at ungodly hours, we think coffee is an equal substitute for rest, and we think because we are young, we can get away with it.

In college, I may just have been foolish enough to walk alone in a city at night. In fact, I know I did this on more than one occasion, buoyed by the false notion that because I was in a “good” area that guaranteed nothing bad could happen. But for me, this air of invincibility was even more pronounced when it came to my health. In addition to the typical age-related tendency towards taking risks, I had to contend with my innate response to the interruptions of chronic illness—the harder it pushed me, the harder I pushed back.

I over-extended myself largely to prove that I could do whatever I wanted despite being sick. I took on too many extra-curricular activities, I spent far too many nights at the newspaper till 6 am, I hated to turn down plans with friends. Each time I went into the hospital, I came out of it with an even more relentless attitude towards taking on too much. Did I ever really think taking such risks with my health would work out favorably for me? Did I ever really believe that none of this would catch up with me in the end?

Of course I didn’t. But that didn’t stop me in those days.

My belief in my own invincibility is much more muted these days. Now I am the one reminding my young students not to roam the city streets alone. Between my vigilant attention to local news and surging violence and my evolving realization that none of us are untouchable when it comes to taking risks, I’d sooner spend my last few dollars on a cab then put myself in a potentially dangerous situation that is both completely predictable and avoidable. I am not ruled by fear, but I think about safety much more than I did when I was in college.

In terms of my health, the gradual progression of my conditions has forced me to abandon the notion that the choices I make don’t have consequences. I spend far more time and energy trying to prevent symptoms from worsening and trying to maintain a balance between what I want and what my body needs than I do in trying to “strike back” at illness or prove that it can’t stop me.

Part of this transformation is simply the maturation process all young adults go through, and part of it can be attributed to the fact that at some point, we get too sick to be able to pretend we’re otherwise any longer. For me, this all happened at the same time.

I watched the young girl disappear into the shadows as my bus pulled away from her somewhat wistfully. Sometimes I miss that invincibility, that ability to take such risks without worrying about the consequences—but such nostalgia is fleeting. I may not take the same kind of risks, but I don’t pay the same consequences either.