Friday, August 30, 2013

A Reality Check…

You might have noticed that I’ve changed the header for the blog. Not only was my listed age no longer accurate, the description had been making me cringe for months.

“trying to maintain a productive and happy life despite being diagnosed with a serious systemic illness with no cure and a poor prognosis”.

That sentence was written over four years ago at a time when, with modifications, I led what might have looked from the outside like a fairly typical suburban life. A quality of life that I had anticipated would gradually change as my health declined.

You’d think that in taking four years to get to where I am now that the changes would have seemed gradual, but that’s far from the way it feels.

In reality, it’s been more like hanging on to a series of ledges leading to the inevitable last one – gripping the edge of each as tightly as I could before having to let myself drop to the next level. 

I wanted to keep believing that instead of steep drops, it would be a staircase on which I could occasionally climb back up a step or two to visit for a short while before a permanent change in status.

It’s just not the way it’s worked out. Talk about some harsh life lessons in accepting realities, the “glass half full” approach I’ve always tried to adopt could only take me so far. There’s a limit to how much shine anyone can put on a tough situation, regardless of how much of an optimist they might be.

There will be no miracle cure for me, there will be no remission. This only gets more difficult until it stops altogether. I no longer utter the words I used to say at the end of a particularly difficult day, “tomorrow will be better”. Those words have become as useless to me as the physical body I inhabit.

It’s not that I’m giving up,  rather it’s acceptance that I’m no longer strong enough to hold on to a particular ledge anymore. Another day, week or month passes – another ledge to let go of.

And with a little  lot of help from my daughter and my friends, finding the strength to look towards that final ledge. Averting my eyes won’t make it disappear.

Friday, August 23, 2013

We Got There…

This post goes out not a minute prior to 9:38 p.m. EDT. I’m afraid to jinx something so very important to me.

For those friends who were quiet on my birthday, my heartfelt thanks for honouring my request. For those who reached out to me with cards, emails, phone calls and other surprises – I dearly thank you as well. I appreciate the thoughtfulness from all in respecting that Suzanna and I were “off the grid” yesterday in not answering the phone, door or checking in on line.

It was our day, and it was amazing. I didn't go any further than the ten feet to the bathroom, yet easily my most fabulous birthday ever thanks to my daughter.

Today it’s her birthday, her twentieth. She’s out celebrating with friends tonight, and hopefully having a wonderful time. I can’t wait to hear the highlights of the evening when she rolls in at, well, whenever she’s ready to roll in.

Turning twenty isn’t typically one of the more celebrated milestones. At eighteen she could vote (and adopt a child apparently!), at nineteen legally drink. She’s looking forward to her champagne birthday when she turns twenty three.

Twenty is an important one to me for a different reason. I just couldn’t bear the thought of leaving behind a daughter while she was in her teens, and if this post goes up tonight – it means that we made it.

In many ways she had to become a responsible adult well before now due to our circumstances (whatever the legal interpretation of adult might be), she’s had many experiences that few her age can relate to. She’s risen to the occasion time and time again.

Yet despite her maturity, the “teen” at the end of her year of age had riddled me with anxiety. I’ve had this hanging over my head for months, would I still be here to see this milestone? What would it take to be here with her today? Would I have failed her if I wasn’t?

Whatever blessings, faith. determination and luck were at play, I’m privileged to be able to wish my beautiful and amazing, no-longer-a-teenager as of 9:38 p.m., grownup daughter a birthday to remember fondly.

Tuesday, August 20, 2013

Thursday…

It’s my birthday in two days. I mention this not because I’m wanting to drop a hint for you to wish me a Happy Birthday on Thursday, I mention it because I’d rather you didn’t.

I’d prefer to ignore the day entirely, and if it weren’t for a loving daughter who insists that the occasion be marked in our own way I would be passing the day as any other.

What complicates things a bit is that Suzanna’s birthday falls on the next day, Friday. That day, her twentieth birthday, is of course  much cause for celebration. The two birthdays have been intertwined for two decades, it’s hard to pull them apart.

We’ve come to a compromise, she and I. Suzanna booked both days off of work. Thursday will be just for the two of us. No nurses, no PSWs, no visitors, and this may seem unreasonable – no calls, they’ll be going to voicemail.

Just the two of us. My birthday wish is to spend my day with my very favourite person. Not celebrating, just being. Spending time with my daughter makes me happier than anything else possibly could, and I expect that she and I will have a lovely day – but I just don’t think I have it in me to be wished a Happy Birthday. It’s just not going to be a day I wish to be congratulated on.

I don’t mean to be petulant, unkind, ungrateful or disrespectful towards friends and family who might normally get in touch, it’s just what I need to do for myself and Suzanna. For this last round of birthday togetherness.

Perhaps you might think I’m being pessimistic. What I’m being is realistic. I’m just not going to get to fifty, I’m thoroughly amazed that it looks like I’m even going to get to forty nine after what my body has been doing to me over the last few weeks. Unless of course there’s a nasty turn over the next few days, and I pray for Suzanna’s sake that my body doesn’t betray us. Wouldn’t that just be the ultimate kick in the pants with wanting so badly to be here for her as she leaves her teens?

Suzanna’s birthday is another matter entirely. She and I have the morning together, and then her boyfriend,  her Dad and her friends will be making sure that she makes merry. I wouldn’t have it any other way. I can’t join in but my thoughts will be with her throughout the afternoon and evening.

As much as it has been a fun story to tell over the years about how I went into labour on my birthday, and apparently so determined that she have her own special day that she wasn’t born until 9:38 p.m. the next evening – I wish so much right now that our days weren’t side by side.

If you happen to be thinking of me on Thursday, instead of getting in touch you’d be doing me a great honour by sending a wish into the wind for my daughter. A wish for a wonderful future, a wish that all of her dreams come true. A wish that the person I have loved most of all has plenty of very special birthdays ahead of her.

A wish that life gives back to her what she has given to me. If that happens for her, she’ll indeed be a very lucky woman.

Wednesday, August 14, 2013

A Gift From Holly…

Instead of using my own words tonight, I’ve graciously been given permission to share an article that I came upon a few days ago written by Chaplain Holly Gaudette. It’s entitled "Diagnosis: Meaning Fatigue”, the article has been roaming around in my head for days. Holly has so eloquently put into words the way I’ve been feeling quite often lately.

I’ll reserve personal reflection on her words for another blog post, for now I’ll just say although I wish Holly wasn’t going through her health challenges, I’m grateful that she shared her thoughts.They’ve helped me take comfort in that what I’m feeling is normal, as normal as these feelings can possibly be in a world that’s making little sense at the moment.

Diagnosis: Meaning Fatigue

If I were admitted to the hospital today, and if you were my chaplain, it’s likely that you would find me “difficult to engage.”  Had you stopped by to visit, I would chat politely with you. I would make small talk with you about bike riding, the weather, or the interesting necklace you’re wearing. But when you try (and you will, because the nurses will have called you to address my apparent denial) to engage me, I simply will not go there. 

“How are you, really?” you will ask, filled with compassion for this 31-year-old who is facing her third bout with cancer.   

“I’m hanging in there,” I’ll reply, with a tired smile. “I’m fine.” 

Perhaps you’ll try again; perhaps you’ll leave at that point. Perhaps you’ll decide to try again tomorrow. Chances are good that you’ll feel I’m just “not ready” to have that conversation. Leaving my room, you’ll inform my nurse that you didn’t have much luck, and then you’ll move on. You’ll make your own meaning out of the encounter: at least I know you’re available if I do want to talk.

You might be inclined to agree with my nurses’ suspicions that I am in denial, yet I assure you, I am anything but. If I may self-diagnose, I would like to propose a pastoral diagnosis that would apply to myself and countless other patients facing serious illness: meaning fatigue.

Let’s review the events leading up to the pastoral encounter described above.  I was diagnosed, as many patients are, almost by happenstance. As a freshman in college, I had a cough that wouldn’t quit. Hoping for a good night’s sleep, I went to the local ER between classes expecting to be given cough syrup with codeine in it. A few hours later, an oncologist was pointing out the large tumor that had been revealed by my routine chest x-ray. The next time the cancer appeared, I was completely asymptomatic. Then, this time, 10 years later, back pain and slight anemia prompted a doctor to look a little deeper and discover that it had returned for a third time. Listen to patients’ diagnosis stories, and you will hear this theme again and again--who ever would have imagined that a cough was actually cancer?! 

So we begin this journey with an otherwise insignificant physical symptom being discovered actually to be a sign of a very serious condition. And then, from the moment of diagnosis, you are under a microscope. Your body is scanned and tested from all angles in hopes of identifying any renegade malignant cells. Every physical sensation must be evaluated for its significance: waking in a sweat, you wonder did I just have too many blankets on me for this summer night, or am I having a night sweat?? Having been instructed by your physicians to be alert to possible side effects, and to call at the first sign of fever, rashes, chest pain, and a dozen other symptoms, you find yourself staring at a mosquito bite on your forearm, wondering whether it really is a mosquito bite, or whether it’s actually the beginning of an allergic reaction. A pound gained or lost could be the sign of tumor progression. A pain here or there could be indicative of a boost in your white blood cell count. Far from being paranoia, this hypervigilance is encouraged by the medical system as being an engaged patient. Yet for the patient, the experience of being constantly on the alert is exhausting. Nothing can be cast off as insignificant. Not even a mosquito bite.

In this context, patients and families face meaningful conversation followed by meaningful conversation. As the news of the diagnosis is broken to each friend and loved one in turn, the relationships shift. A new weight of meaning settles in.  Meanwhile, priorities have shifted. Bucket lists have been made, and patients have resolved, perhaps, to focus on what’s important. We pour what little remaining emotional energy we have into the relationships most profoundly important in our lives, and pull back from things less meaningful.

In the month since I began chemo treatments for the third time, I have not cracked the cover of a novel. After two weeks of listlessly moving daily newspapers from the driveway directly to the recycling bin, I suspended my subscription. My average response time to friendly emails is about two weeks; I require myself to write one email per day. A month later, I’ve only just opened the cards I received from my coworkers. Meanwhile, I’ve begun playing Candy Crush, an utterly pointless game that involves grouping blobs by shape and color. Diagnosis: meaning fatigue.

So how shall you, the kind chaplain who visits me, make the distinction between meaning fatigue and denial?  And what can you offer me? (Because, believe it or not, there are chaplaincy interventions from which I would benefit.)

Making the distinction is easy: ask me. One of the side effects of meaning fatigue is that we don’t waste our emotional energy on coded messages or beating around the bush. I’ll tell you in very clear terms about the ways that my diagnosis and its ramifications have changed my life. I’ll tell you, too, that I wish I was in denial, as it sounds like a very comfortable coping mechanism. And if you suggest, as chaplains so skillfully do, that “it can be exhausting, constantly having everything in your life carry so much significance,” I will likely endorse that experience. So, you can be fairly confident that I am, indeed, experiencing meaning fatigue. How, then, shall you intervene?

The absolute wrong thing for you to do now is to try desperately to have a meaningful conversation with me. Eventually, you will succeed. You will nudge me to express my feelings of fear and grief, and I will go there with you sooner or later. My defenses are weak, and my emotions are all very close to the surface. Yet all you will have accomplished is to further deplete my emotional stores. What you can do is offer normalcy. Companionship. Friendly conversation. You see, my friends now are all desperately worried. When we talk, they don’t tell me about the mundane matters of their lives; they know I have enough going on. And by the time I give them the update about my treatment and my latest scans, I’m too tired to chat with them about the silly thing my dog did yesterday. But you, chaplain, could offer me a moment’s respite. You could offer me a chance to laugh, to listen, to have a conversation that does not carry any apparent weight or existential meaning. And thanks to the beautifully ironic nature of our work, I will one day write you a thank you note, telling you how meaningful your visits were.

Holly Gaudette received her Masters in Divinity degree from Duke University. She is certified in Thanatology through ADEC. She did her CPE residency in EOL/Palliative Care at Duke.  Holly is currently on medical leave as a staff chaplain at NYU Langone Medical Center in NYC, a HealthCare Chaplaincy partner institution. She is certified as a chaplain by the Association of Professional Chaplains.  You can follow her blog,  Holly's Pan Mass Challenge:  Training. Progress. Defiance. here.

Saturday, August 10, 2013

Lessons From a Friend…

Last year for my birthday, my daughter gave me a gift of the audio book version of “The Five People You Meet in Heaven” by Mitch Albom. I often think about the messages of this book, and on another by Mitch Albom entitled “Tuesdays With Morrie”. If there’s one upside to a slow demise, it’s the opportunity to reflect on one’s life experiences. Where have I found my purpose? Did I find it at all? Did my actions during this lifetime make any difference?

Before I go on, I’d like to make it clear that I’m not looking for answers to these questions from anybody other than from myself. I’m not seeking validation, this post has other reason for being written.

Should I have the privilege of ending up in heaven, there are a few people I’d like to meet up with again. One is a woman I knew many years ago for a relatively short time, I’ll call her Sarah.

When I had just turned twenty (just a few months older than Suzanna is now) I found myself having trouble walking. My legs would buckle from underneath me at the most inopportune times, I was often feeling weak, my balance was off and I was experiencing odd vision problems combined with episodes of vertigo.

I was at the time attending my second year of university. It would have been reasonable to suggest that stress might have been a factor, I’d not had any financial support to attend school from either my family or from student loans (thankfully the rules have since changed, at the time even though I’d already been living on my own for several years and was completely independent, my father’s level of income as reported to Revenue Canada rendered me ineligible for education loans). I was not only attending school full-time, I was also working a minimum of forty hours a week waiting tables at a pizza place to make ends meet. I’m not sure how he even fit into my life, but I was also maintaining a relationship with a boyfriend who’d been an important part of my life for the previous two years.

After a few visits to my doctor, he determined that we were dealing with more than just exhaustion. I was admitted immediately to the hospital for tests and observation. I’ve previously mentioned that I’ve had health issues throughout my adulthood; this is where it all began. Who is to know whether this was the early manifestation of Erdheim-Chester Disease, I suppose an autopsy will offer more information as to the history of this illness in my body.

As is the case now too, hospital beds were scarce and the only spot that could be found was in the pediatric ward. Not having any private insurance, I ended up in a four bed unit. Two of the other patients were in their early teens; the fourth occupant was another adult who’d also landed in the kids’ ward thanks to a bed shortage.

This woman was in her mid twenties, blond and slight, and the day I’d arrived had just come out of major surgery. Obviously in a great deal of pain for several days afterwards, it wasn’t until later in the week that I’d learn more about her. I’ll call her Sarah to honour her privacy.

Sarah had a doting husband who would be at her bedside as often as visiting hours would permit. Other members of his family would often stop by, hoping that they could tempt her appetite with delicious treats.

I’d learn, once her pain had subsided a bit, that Sarah had cancer. She was a DES daughter, the cancer brought on by her mother having been prescribed a drug during pregnancy that had been believed to lessen the chances of miscarriage. It was discovered in the early 70’s that this drug was linked to a high rate of cancer in the daughters of these pregnancies. Sarah was one of the very unlucky ones.

She and I ended up being in that hospital ward together for almost four weeks. It’s not important to this story, but I was diagnosed with probable relapse/remitting type Multiple Sclerosis – a diagnosis that I carried for over twenty years until ECD was confirmed. Those weeks in hospital consisted of multitudes of diagnostic tests with plenty of time in between them waiting for results. During those long hours, Sarah and I shared many long and complicated conversations.

Sarah had had a radical hysterectomy in hopes of removing all the cancerous cells. Her time spent in the hospital was in recovery from the surgery with no further treatment plans, ultimately she wanted to go back home to the tiny apartment she shared with her husband.

To ease Sarah’s discomfort, the nurses would draw a bath for her and Sarah would invite me to keep her company at the side of the tub. She in the bathwater telling me all about her life, having a few years on me I thought her worldly and wise and was honoured that she trusted me with the details of her life. Looking back, there were so many similarities in our life experiences that it feels as if we had been destined to meet.

Back in our room things were different. We were kitty corner across from each other, communicating with the other patients in the room was difficult. Between facial expressions, hand gestures, and occasionally with hand written notes passed between us courtesy of the nurses our friendship strengthened. This is of course well before the time of texting and emails, I can only imagine how furiously rapid the communication would have been had today’s technology available at the time.

Once we were both released from the hospital, we kept up our relationship. In the first few months, I would visit her and her husband often. Sarah loved to knit, and would always have her hands busy with her latest creation as we caught up. She, her husband and his family were a welcoming clan; I was often invited to family events with his parents and siblings.

A few months later I raised the white flag on my education. I’d fallen too far behind in my classes after a month away, and realized that there was no possible way to maintain both full time school and full time work. I left university, and with what was remaining in my stash of accumulated education funds I set off to backpack by myself across Europe.

My first destination was Paris. A city I wish I’d had the opportunity to get to know as well as I came to know Toronto, but I’m grateful I got there at all. Three times in fact, the second trip being important to this story. On my European adventure I also visited my mother and her boyfriend who were living in Italy at the time, and stopped in to spend time with relatives in Germany too. The rest of the time I spent getting the best possible value from my Eurailpass (do they still have those?)

After some months I returned, only to find that my boyfriend of close to three years wanted to end our relationship. Absence doesn’t always make the heart grow fonder, and in hindsight I can’t blame him, we were on very different paths. His well defined, mine uncertain.

For awhile I felt afloat, not knowing what road to follow. Wallowing in my uncertain future, I abandoned many friendships. Including the one with Sarah. There would be the occasional phone call and she’d often invite me to visit. I rarely did. Sarah was not doing well and I was afraid to see her, afraid that I’d say the wrong thing. Confident that her loving husband and his wonderful family would be looking after all her needs, my excuse was that my visits would exhaust her.

Jump forward another year. By this time I’d taken a course to be certified as a travel consultant, was working for an agency and in a relationship with the man that would become my first husband, and Suzanna’s father.

Professionally I was doing well. The pay was lousy but at the time the travel benefits for agents were fantastic and I was taking full advantage. Through an incentive offer at work, I’d earned two weekend trips away, one to London, England and the second to Paris. The fact that they were separated by only three days back in Canada in between seems in hindsight ridiculous, to my early twenties self – it was adventurous and beyond exciting.

After crossing the Atlantic four times in the space of eleven days, I came back from Paris giddy, but thoroughly exhausted. Yet as soon as the plane touched the ground I felt something nagging at me, I couldn’t put a finger on the reason for the uneasiness.

I made my way back to my apartment, and for reasons I’ll never understand yet am so grateful for, I opened up that day’s Toronto Star and was drawn to the Death Notices. There was Sarah’s name; the second night of visitation at the funeral home would be drawing to a close in less than an hour and a half. I quickly changed my clothes, splashed water on my face and headed to midtown from my northwest Toronto apartment.

The look on Sarah’s husband’s face as I entered the room is still as clear as can be in my mind to this day. He rushed over and hugged me so tightly, and told me that he’d been trying to reach me for over a week, but didn’t have the correct phone number. Sarah had wanted to tell me herself that her death was likely to occur within a few weeks, that she’d wanted to see me before she died.

Rarely a week goes by that I don’t think of Sarah. After more than twenty five years it still rips at my heart that I’d let our friendship lapse, that I wasn’t there for her.

I pray that I do get to see her again. That’ll I’ll have the chance to tell her what she’d meant to me, that I loved her. That I was scared of losing her and avoiding her was the only way I could handle my sadness at the time.

I pray that if I get the chance to see Sarah again, that she won’t be holding resentment against me for not being there for her at the end. That she’ll allow me to tell her that she mattered, and that she taught me lessons that continue to slowly sink in to this day.

Although I never knew Sarah as a “healthy” person, I remember her for her dignity, inner strength and wonderful sense of dry humour. I’m also grateful that I had the opportunity to see her stubbornness, to learn what sorts of things annoyed her (including me at times!), and to hear stories of her childhood that helped her become the Sarah I only came to know in her last years.

She was so much more than just her cancer. The reality is that I’d never have met her if it hadn’t been for her illness, but she let me see beyond that.

I’ve wanted to write about Sarah ever since I started this blog, I’m not sure why now seemed to be the right time.

I tell this story not because I want to make anyone feel guilty if they’ve been uncomfortable about getting in touch or visiting, I tell this story because I’ve stood in the shoes of being overwhelmed by the reality of an illness relentlessly attacking someone I cared about.

I can’t predict with any certainty how I’d react if someone else I cared about was diagnosed with terminal illness. I’d like to believe I’d go about things differently, but even being in the position I am now - I just don’t know. That’s as honest as I can possibly be on the matter.

Tuesday, August 6, 2013

Sleepy Time, Sort Of…

I've been reminded a few times today that there’s been a longer than usual break since my last post, I’m still here!

There’s been quite a bit going on around here, though nothing that I felt particularly moved to write about. The IV pole and pump that had been delivered were taken away again just a few days later (funding was not approved for full-time residency of the equipment in our apartment – where oh where will I now hang the cured salami?)

Tomorrow morning more medical supplies arrive – catheter kits to be implemented as needed. Probably more than you really needed to know, but that’s my reality. This isn’t pretty and certainly isn’t much fun. It gets less enjoyable with every week that passes.

In preferring to avoid getting into the unsettling details of my physical health tonight, I thought I’d dive into my “blog notes”, emails that I’ve sent to myself when a blog post idea occurs to me but I’m not in a position to write it up at that moment. Usually because it’s in the middle of the night and I’m trying hard to enforce a no-technology rule between 3 am – 9 am. I may be wide awake, but it makes my friends feel better if they believe I’ve had a decent night of sleep. Mind you, in emailing myself I did utilize technology so I’m obviously not doing a great job of sticking to my guns.

Note from July 16th, time stamp of 4:34 a.m.. “Not finishing bubbl witch” (sic). I read this over a few times wondering what I might have meant (I never said that I was coherent in the middle of the night). I finally remembered, but it’s an irrelevant point to me at this moment.

I do get a few hours of sleep each night, yet even then it appears that my mind is keeping quite busy. I remember vivid dreams, but I also talk in my sleep. I have conversations with Suzanna, hearing her end and replying with no recollection the next morning of what we discussed. We’ve started recording my sleeping hours, here’s a gem from the other night.

Suz at 3:22 a.m. heard “Are you trying to wake me?”

“No, why?” she asks.

“It sounded like a thumb trying to wake a finger”.

If anyone knows what a restless thumb might sound like, do let me know. We’re days later still laughing when we think about where that exchange might have gone had I kept talking. There’s plenty more where that came from, I’m sorry to admit. Conversations about fried chicken (surprising coming from me, I have an anaphylactic allergy to poultry and haven’t eaten it on purpose in about twenty five years), about potential death brought on by my arm that fell asleep, asking Suz if she’s cooking Chinese food (she wasn’t, apparently I misinterpreted the stink of skunk wafting in from outside) and then telling her I was too tired to chew any food anyway.

Tonight? Talk of travel would be a nice change. And so would remembering it.