One Year Down….

One year ago I posted my first blog entry. Compelled by the sense that there had to be people out there like me—young and living with multiple chronic illnesses—and that if only I started to write about it I might connect with them, I started slowly and hesitantly. Would anyone read what I’d written, and more importantly, would anyone care about what I had to say?

The first couple of months I only posted once or twice—between graduate thesis work and my goal of posting essay-type pieces that offered some sort of insight and could hopefully stand alone, it took me a little while to find my rhythm. I began to notice a pattern—people started commenting, and their insights helped me think of things in new ways and pointed me towards all sorts of blogs and perspectives. I am deeply grateful to those of you who have found something that resonates with your own experiences enough to keep on reading.

When you live with rare diseases or multiple diseases, it’s easy to feel isolated, both in terms of day to day to experiences and also in terms of a writing community. Not many people write about PCD or bronchiectasis. I knew I wouldn’t have the huge, thriving audience that a well-known disease like diabetes would, and that while a lot of my experiences with things like infertility and chronic fatigue or celiac disease and thyroid problems related to things other people have or write about, I wondered if the fact that this wasn’t a disease-specific blog would somehow isolate me.

My hope was that the overall experience of living with chronic illness—the ups, the downs, the minutiae of daily life, the relationship moments—were universal enough to apply to anyone who clicked on my blog, that issues of identity, acceptance, setbacks, and hope transcend any one disease or condition, and, of course, that there is humor in all of this craziness.

That’s still my hope.

One year later, I think I’ve found a rhythm, one that wouldn’t exist without the people reading it on the other end.

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Thinking Blogger Award

To my surprise and appreciation, Elizabeth at fluent gave me a Thinking Blogger Award. Unwittingly, she has made my job of selecting five blogs that make me think, make me question, and challenge me a little bit harder because hers would be right at the top! Thanks, Elizabeth, and your musings on writing, writers, and life in general always give me something to ponder.

With no further ado, then, here are five of the many blogs that make me think:

Musings of a Distractible Mind: This doc’s curiosity is matched by his intelligence and wide range of interests. A great read.

Managing the Sweetness Within: If there’s one thing Lyrehca likes to do, it’s ask questions. She’s asked a lot of terrific ones as she juggles Type 1 diabetes and pregnancy, and she is as insightful as she is hilarious.

Swimming Upstream: I first found this blog through Elizabeth’s site and have been engrossed by this writer/MFA student’s honest, thoughtful prose.

Tundra Medicine Dreams: The thoughts about medicine are as striking as the amazing photography and descriptions of Tundra life–an intellectual and visual treat.

Emergiblog: Kim’s blog is informative, interesting, and always satisfying.

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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.

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A Healthy Narrative

In Illness and Culture in the Postmodern Age, David B. Morris highlights this distinction between disease and illness: “The power to make us sick or well inheres not only in microbes or medications but in images and stories…the main assumption underlying the distinction between between disease and illness is that knowledge falls into two broad categories, objective and subjective” (36-37).

While many things within this quote (and, in fact, his entire book) interest me, for the sake of this particular entry, I’m intrigued the idea of stories and their relation to this division of knowledge into subjective and objective…basically, I am interested in the role of the narrator and storyteller.

As a patient, the role of storyteller is so important. We bring our subjective experiences with illness—the actual process of living with conditions—to our doctors, who hope to match up what we tell them with a different type of knowledge, science. So the details we choose to disclose, how we disclose them, and the narrative we establish about our illnesses often shape our diagnostic journeys. Certainly there are countless tests out there whose results can confirm, refute, or re-cast our stories, but what we describe to our physicians sets the whole process in motion. If I say I generally have pain and fatigue or I say I have pain in my trunk accompanied by muscle weakness and tenderness that worsens after exertion, then I am giving my doctor two different avenues to explore that might share some similarities but can lead to very different destinations.

So what does it means to be the storyteller? It should be pretty easy, right? But that’s not always the case. I know from firsthand experience that assumptions, fears, and self-consciousness can really affect what I say and how I say it: I don’t want to sound like a complainer if I list too many symptoms, I don’t want to seem like I’m making a big deal out of nothing, I don’t want to deal with more tests so I might not mention certain problems I’ve noticed. In addition, despite my best intentions and the short lists I’ve made in preparation, sometimes I get so wrapped up in a particular conversation with a doctor that I forget to touch on other details…we’re threading a different narrative line and I’m unable to shift its focus.

My incomplete narrative may be authentic to my subjective experience in many places, but it is not whole. But can it ever be?

As a writer, the role of the narrator and storyteller is inherent in every step of the writing process. In order to create atmosphere, emotion, or a factually accurate account that is concise enough, we’re constantly choosing certain details and facts over others: what does my reader need to know about the background of a situation to understand a current dilemma? If I’m trying to illustrate a particular aspect of a relationship or make a specific point, what other information about the dynamic do I need to cover? If I’m writing about a scene where something good happens, is it disingenuous to leave out negative moments that were also part of the back story if they interfere with the true (but incomplete) moment I am describing?

And of course this process is filled with the same types of obstacles that occur when we’re asked to be narrators of our illnesses: how do I come across to my reader? Does the situation I have described make sense or does the reader need more information? Will I hurt or offend anyone I have portrayed? Will anyone care about what I have to say? I am the one deciding which facts to include, so even if my finished product yields a cohesive storyline, I know it might not be a complete one.

This tension is not unique to the position of patient or writer, but since I exist within both modes, it’s interesting to look at how they intersect. I think there will always be that push and pull between the subjective (our experiences) and the objective (science, facts, historical record), but that’s what makes both medicine and writing so dynamic.

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An Addendum to “Why I’m Not a Numbers Girl”

You may remember that I don’t typically care much for numbers—how they can define us, how they can limit us, how I can’t escape them even when I wish I could. (Here’s the post all about that.)

I humbly submit an addendum to “Why I’m Not a Numbers Girl.” Don’t get me wrong, in most instances, I still feel that percents and ratios and variables and risk assessments too often fail to quantify what’s most important. I still don’t like that as patients, too often we’re reduced down to a list of stats and numbers (vitals, meds, dosages, surgeries, lab results).

But I recently (re) discovered that sometimes, numbers can actually better our understanding of ourselves. Not exactly earth-shattering news, I realize, and certainly all you diabetics who test blood sugar daily or patients who monitor blood pressure and other routine activities like that must be rolling your eyes at the obviousness of that statement, but it’s an important realization for me.

When I was acutely ill (in and out of the hospital for weeks at a time), the doctors trying to figure out what was wrong with me asked me to keep track of my peak flow meter readings. For those of you blessed with hearty lungs, a peak flow meter is basically a tube you breathe into that measures how much you can exhale. The lower the number, the more constricted your airways, so peak flows are a good way to predict respiratory trouble. I stuck with it for several weeks, filling in the little boxes in a notebook a doctor gave me…and then I went into the ICU again and everything got thrown upside down. When I came out of this hospital, I had a new team of doctors and a million other new things to consider and somewhere along the way, my little notebook disappeared.

And then last week, in the midst of spring cleaning my medications (so long, empty pill bottles! See you later, empty inhaler canisters!) I stumbled across my humble little peak flow meter. A desire for more order and predictability in my life coupled with an increasing interest in Microsoft Excel prompted me to re-instate the daily peak flow charting, this time with nifty little grids and columns.

The result? I’ve noticed a pattern: the days where my morning readings are especially low (they are never spectacular, even on my best days) correlate with the days where I wheeze more, cough more, and in general experience more fatigue. The days where my early morning readings are higher? I am able to go to the gym, I don’t spend half the day coughing, and I can get a lot more done.

Duh. I know you’re thinking it. I am, too. Somehow charting peak flows just slipped to the bottom of my priority list, far below all the other more time-consuming things I do to maintain my health. No, knowing my peak flow readings will not prevent my bad days altogether, but it will help me prepare for them and predict them. I understand my body and my symptoms so much better once I stopped long enough to pay attention to my internal warning signs.

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Lenten Resolutions: Caffeine, Clarity, and Contrition

I am sitting in a Starbucks right now, ostensibly preparing for my next class, but in reality I am distracted by the wonderful, luring aroma of espresso. Its scent lingers on my clothes and I can almost taste it. It is my Siren calling for me, tempting me with promises of pleasure and joy.

I am drinking tea. And I’m clearly not that psyched about it.

Before I totally martyr myself, I should probably mention that I gave up espresso-based drinks for Lent and cut down on relgular coffee, but I didn’t give up caffeine altogether (that would be a kamikaze mission for me; I tried it once a few years ago and within two days, my boss politely wondered if I might think of something else to give up since my productivity had taken a noticeable nosedive and my headaches were blinding). But since I do waste a sizable amount of money on sugar-free, nonfat latte concoctions at least six days a week and haven’t attempted to teach a late class without an espresso infusion in three years, it is something.

I’ve already acknowledged the absolutely disgusting amount of caffeine I drink in previous posts—a pot of coffee on my own in the morning, and the life-saving latte in the afternoon, at least. At this point, I’m beginning to see it as more than just a conversation piece (you think that’s gross? Listen to how much coffee I drink!) and as some sort of personal failing—how in hell did I get to this point? And to top it all off, it doesn’t even help. I’m still brain-foggy and slow-tongued by late afternoon.

Combined with my other Lenten resolutions, I hope the caffeine-cutback makes me less disgusted with myself. I’ve also cut out eating in between meals (my equally night-owl husband and I have been known revert to college behavior and run out to 7-Eleven to buy frozen yogurt at midnight or throw a bag of popcorn in the microwave in time to watch the Daily Show, not really the best way to eat).

Over the past few years, though, I’ve started to see the merit in not just giving things up for Lent but in making changes/improvements and adding positive behaviors to my life. My theme for this Lent is balance, not just in terms of maintaining health conditions (that’s a given) but in terms of setting aside time to reflect and also in terms of clearing my mind of negative or hurtful things: not getting so buried in student papers and revisions on Sundays that I don’t make it to church; not backing out of weekend plans with friends or my husband because I’d rather use those five four hours for work; not getting bogged down by passive-aggressive anger when calm confrontation would cause much less pain, etc.

So that’s where I stand. As my good friend said yesterday, you can do things for Lent for faith-based reasons or because you like the personal challenge (I subscribe to both), but either way, it is a chance to let go of some of the obsessions, indulgences, and pettiness that we’re better off without.

So here’s to less caffeine, less workaholic tendencies, more introspection and reflection, and more mature ways of handling problems. (But I’m not going to lie, I’m already salivating for my Easter Sunday sugar-free, nonfat cinnamon dulce latte!)

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Emergency Surgery

The instruments were sub-par, the lighting wasn’t ideal, and the surgeon was plying his technical trade for the first time, but against all odds, the surgery was a rousing success.

In the grueling pre-operative moments, I went through many emotional states. There was disbelief: I can’t believe this is happening (again). There was sorrow: I can’t imagine what I will do if I have to suffer this loss. There was anger and denial: But I’ve done everything I can, I’ve taken all the precautions and safety measures, I’ve performed all the maintenance and follow-up. This can’t be happening to me.

In the end, though, an eyeglass repair kit hastily purchased at 7-Eleven and the two sturdy hands of my intrepid husband proved enough to perform a delicate operation on my sickly little Powerbook G4.

The bizarre DOS language that took over the screen, the incessant kernel panic message that froze and crashed the computer every 10 seconds, the horrible shrieking sound it omitted whenever I tried to run a disk repair, the terrifying hieroglyphics that appeared where a lovely Microsoft Word document had flourished only moments earlier—in the end, all these malignant forces were no match for the two of us, battle-weary and used to the wily ways of the shifting internal network card whose movement wreaked havoc for my hard drive.

We’d experienced cataclysmic moments with it before, we’d tasted fear and considered the worse-case scenario, so we thought we were veterans by now. Nothing could have prepared us for the full onslaught of last night’s carnage and disease, the symptoms of which first appeared at the corner coffee shop around 8pm and whose groans and machinations did not end until this morning. For the first time, I really thought all hope of salvaging my beloved little titanium wonder was gone.

But with a flick of his wrist, the turn of impossibly tiny screws, and the re-alignment of one pesky, wriggling network card, John brought my computer back to life. Since my G4 is almost an appendage at this point—I use it easily 14 hours a day during the week and only a little less on weekends, and practically twitch if it isn’t in my vicinity at all times—the prospect of losing it was inconceivable.

Luckily, my computer is again whirring and clicking away as it should, the picture of health…and life for me can go back to normal. You gotta love it when acute triage solves the problem.

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Food is Love

I met John exactly two weeks after I was diagnosed with celiac disease. At the time, I was just as apprehensive about the whole situation as he was, though we manifested it in different ways. Our first date—while wonderful—included several renditions of the following:

“Are you sure you don’t mind if I have some bread? I don’t have to…I can even ask the waitress to take it away if it’s bothering you.”

“No, it’s fine. I don’t mind. Just because I can’t eat it doesn’t mean you shouldn’t.”

And back and forth we went, both trying to make the other one comfortable and not exactly sure how to do that.

He told me later that of all my health problems, celiac disease was the only one that scared him initially—he loved eating out so much and wondered if we’d have enough in common. Naturally, the irony of that statement is that it turned out to be food that brought us together, and food that helped him bring me back to myself.

That night I ordered a salad. I didn’t want to be the “that girl,” the one who only eats salad, especially on a first date, but I was too nervous to try anything else on the menu. Grilled chicken over greens? Now that was a dish I knew was gluten-free.

We both have a lot more confidence now.

Going gluten-free was certainly life-altering, but I had so much other stuff on at that point in my life—I was in and out of the hospital several weeks a month with respiratory infections, and had also just gotten officially diagnosed with PCD and bronchiectasis, which were pretty serious and life-changing events on their own. I was adjusting to new medications, dealing with a lot of lung-related complications, and had only recently started having chest PT twice a day, a huge transition all on its own.

With so many substantial changes and serious illness all at once, eating salad for lunch and dinner and yogurt for breakfast was an easy way to stick to the GF diet without investing too much time and energy that I didn’t have. Plus, as a single girl living in an apartment the size of a large suitcase, less groceries and cookery meant more space to live.

And then we had our second date, and our third, and suddenly I was going to Italian and Malaysian and Mediterranean restaurants, and ordering a garden salad wasn’t cutting it anymore. John loves trying new things, and I wanted to enjoy dining as much as he did—and, obviously, I wanted him to enjoy dining with me. I started asking questions about meals and learning the best way to approach servers with my allergy concerns.

And something else happened—we began cooking meals together. John would print out GF recipes he’d found online and we’d go to the huge grocery store near his apartment. Left to my own devices, my shopping cart still consisted of lots of lettuce and some organic soup, but we branched out together: gluten-free flours for apple pies, cornmeal for polenta pizza, spices for homemade Indian food and fresh vegetables for stir-fry. I began to look forward to cooking the way I had when I was younger; John’s creativity was contagious.

Before I knew it, I was eating hot food again on a regular basis. I was also finally starting to feel better—my energy was improved from the GF diet, and my lung infections were less severe and my time in the hospital decreased as a result of my new treatments. Soon, I noticed another change, something I hadn’t seen during all those long months of being in the hospital and being preoccupied with all the adjustments I had to make: I was happy.

We’ve been married a year and a half now, and we’ve done even more adjusting. John no longer eats exclusively gluten-free meals in our home—he no longer worries he should, and I no longer worry that he’s worrying. Some nights, he has ravioli and I make brown rice pasta; other nights we have naturally gluten-free risotto or roasted chicken or tuna steaks.

For this Valentine’s Day, John made our plans a few weeks ago. He selected a restaurant we’d always wanted to try that had a special pre-set menu for the occasion. He shot me an e-mail:

“There are a bunch of options for you that are safe, I checked. The menu is attached. What do you think, do you want to go out to dinner?”

This Valentine’s Day I think just might try the grilled ostrich skewers…you’ve got to live a little, right?

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Waiting to Exhale

It still hasn’t sunk in yet. On Friday, I accepted an offer to publish my first book. Normally I find it impossible not to betray how I am feeling—the high lilt or slow lull in my voice says it all—but this time, my tone reflected little emotion.

“Give me a second. I am really excited, I swear…it just doesn’t seem real yet. You know, when you think about something for so long and want it and work towards it, and then you actually get it, it doesn’t seem real, like this isn’t happening to you,” I said to my agent.

In a sense, it all happened pretty fast: five months ago, I found an agent, three weeks ago my submissions package went out to publishers, and three days ago my book found a home.

But as all of you writers out there know, none of this happened quickly. It’s been a lifetime of writing—of needing to, wanting to, having to write…A lifetime of journals and diary entries, of stories and articles, of high school competitions and college op-eds, of high-intensity internships and relaxed writing workshops, of literary criticisms and news articles…A lifetime of sojourns to coffee shops and libraries, of late nights and early mornings, of days spent alone at my computer, of revising and reworking and refining, of knowing that the times when I feel most alive, when things connect and spark and I have energy, are when I am writing.

As clichéd as it may sound, I’ve wanted to “be a writer” for as long as I can remember. I didn’t know what that meant in those days, beyond that it was the standard prediction all my grammar school English teachers made for me, and that I couldn’t help thinking of Jo in Little Women whenever they made such comments.

Twenty years later, I’m still trying to figure out what exactly “being a writer” means.

What I did know then (and recognize still) is that words made sense to me then when so many other things in my life didn’t, and words defined me in ways I desperately needed. When I was growing up, my classmates had sports banquets and track meets and health; I had writing awards and journalism conferences and scribbled entries into all the journals I kept. I had writing, so my illnesses could never totally overwhelm how I thought of myself, even during the really difficult times.

For all the projects and roles and jobs I now have, for however complicated I might be tempted to think my life is, my true ambition, my deep down desire and hope, the thing that drives me, terrifies me, and humbles me, is quite simple: I want to write books.

It is the easiest statement I can write, and yet it is the one I am so hesitant to vocalize, half-believing if I show how much I want it, it will remain elusive.

I often stumble when people ask me what I do: “I teach writing classes” or “I freelance” or “I’m working on several projects” or “I do editorial work.” Only once have I replied “I am a writer,” and even though I spoke the words, I didn’t own them. I feigned confidence but felt fraudulent.

So what does it take to embrace that identity, at what point is it possible to say “I am a writer” and believe that the elusive dream is a genuine reality?

I know that I am taking a first step towards that scary, powerful, humbling thing I want. I know that in a life filled with compromises, accommodations, and complications, this feeling, this exhilaration, is pure and unfettered. I know that I have much work left to do, that this place is the only the beginning, but I also know it is where I need to be.

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Media Controversy and Rare Diseases (PCD and EDS in the News)

I have lots to post about–it’s been an exciting week–but until I do, here’s some reading for thought, especially for all of you out there who belong to the Rare Diseases Club. By now, I’m sure you’ve read or heard a lot about the backlash from ABC’s “Medical Mysteries” show and the effect such portrayals of rare diseases have on the people who live with them, but here are two thoughtful and informative posts:

MickeyMusing’s blog takes aim at “freak show” tendencies in the media and specifically touches on PCD (primary ciliary dykinesia). I must admit, it’s not often I see my near and dear PCD in the news, and this article underscores the reality for the millions of people living with rare diseases: the burden is on our shoulders to educate, inform, and enlighten.

(On that note, see my sidebar to get to the PCD Foundation!)

Yanub’s “Moblizing Against Misrepresentation” is a constructive answer to the current debate over how patients with EDS were cast on a recent episode of “Medical Mysteries.”

I show Tod Browning’s “Freaks” to students in my class (Constructions of Health in Contemporary Literature) in an effort to explore how image and language influence perceptions of “normal”–perhaps we’re not as enlightened in 2007 as we’d like to believe..??

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