March 10: Reality>>>Sobbing

There really isn't time tonight to be doing this: laundry needs to be done, dishes washed, kitchen table is a mess, pay bills tonight to coincide with Friday payday, need to get my CMEs documented because it's re-credentialing time at Bryn Mawr...you get the picture. But there's a tremendously emotional thing about to happen, I need to vent and seem to do my best writing when slightly depressed.

(Warning: next paragraph is graphic and unpleasant. But my goal is to present the unvarnished truth, to discuss things others won't.)

The last week has been difficult. There must be more of an allergen than usual, because my nose has been filled with nasty crusty things. The capillaries are irritated, so multiple times a day requires blowing my nose and there is blood, clots and huge scabs coming out. It's uncomfortable. But much worse has been my menstrual pain, specifically at ovulation. I was put on birth control pills (BCPs) at 19 because of ovarian cysts, which cause pain mid-cycle, called mittleschmerz syndrome. (Seriously, you can't make that word up!) But BCPs increase your blood's thickness, increasing the risk of clots. So when a mechanical valve was a possibility before the second surgery the pill was stopped and an IUD was put in. This doesn't affect ovulation, but was meant to stop the copious amounts of menstrual blood that was problematic when I was on coumadin briefly after the first surgery. In the past decades of being on the pill I would stop every once in a while, the longest for two years, and the pattern would always resume. Making things worse is that instead of cycling every 28 days mine is every 21, so more frequent pain and problems. It's been three and a half years since going off the pill, and about four months ago the pain started. It's gotten progressively worse and this last round was just awful. Sunday evening through Tuesday evening with serious pain, needing narcotics just to function and get to work. And it's one more damn thing to deal with, of which I'm very tired.

Confession time: I've had to start lasix again. Saw the cardiologist on Friday and got the prescription filled that evening. But I stared at the bottle and just couldn't take one, couldn't accept needing a diuretic again, didn't want to accept a significant step backwards. That lasted until the appointment yesterday with my internist. The office is three long blocks from the house and it's easier to walk then jockey for position in the parking garage. Running my typical couple minutes late necessitated a slightly faster pace than normal, which lead to being out of breath. That's understandable. But I was still clearly short of breath, speaking in half sentences, 20 minutes into the appointment--while sitting. The doctor came over to look at my ankles, which rarely look swollen and didn't then, either. But my socks had been on for only 45 minutes and there were deep ridges, the impression of the individual columns of thread clearly visible in the skin. She looked at me and quietly said what I knew deep down "You have to take the lasix."

Reality is that things will not get better as I get older. Reality is that I can only work 3 days a week. Reality is that I'll never be blessed with another job allowing these hours and get my health insurance totally covered. Reality is that cardiologists are getting slammed with decreased reimbursements from Medicare and are cutting back on everything, including staff. Reality is that 2 people have already been laid off in my office. And no matter how good I am at my job, no matter my years of experience, no matter how well I do my specialty, there is an inescapable fact: I'm the weakest member of the herd in my group. Reality is that this gig will not last forever. Reality is that I'd be stupid to not plan for a probable change in circumstances, decreased income, being on disability.

Reality sucks.

After several hours over several weeks of staring at lots of numbers regarding finances an obvious conclusion is decreasing debt >>> increased long-term security. As with anyone, the highest cost item is my house, which is also the highest source of equity. My suspicion is that it could be sold for what it was bought. Being a rental property should assure good re-sale value, as economists say that after a depression people scale back for at least 10-15 years. Best case scenario would be recouping all the improvements, but I prefer to plan for most probable. If I ended up on disability the most practical decision would be to sell the house and buy a condo free and clear. Right now there isn't enough equity to get a good condo, probably in the Doylestown area near to Mom. There isn't any timeline here, and things may be stable for years. But it's better to plan now than have to scramble if things get worse. Anyone who has ever worked with me knows I always have a plan. That has been one of the ironies of being sick, because you can have all the plans you want, but it doesn't mean that your body, much less life, ever follows them.

All this leads to looking at the mortgage, and there would be a definite advantage to re-financing. That would roll the home equity loan into the mortgage, which is how the Camry was paid for, effectively meaning that it would take the length of the loan (15 yrs) to pay off the car. This lead to the realization that if I sold a car it would increase equity and decrease the monthly payment, a double bonus. Two cars + decreased income does not equate. I'm very aware that most people don't have the luxury of two cars, especially after the financial drain that illness causes. My first thought was to sell the Camry and use my beloved Audi as the primary car for a few months, then do another home equity loan on the new mortgage to buy a good used car with automatic since the chest is bothered by the manual. (And that's before we get into the broken foot and a clutch....) So off the Audi went to the mechanic with the plan of it becoming my primary car. After a $900 bill, including inspection, my wonderful mechanic gave me a totally logical argument: the Audi is 11 years old and will start having more things go wrong, always expensive; and getting a reliable, safe used car would probably not work out to much less than the decreased value of the Camry. I have to have an automatic, no question. And it's easier to plan a regular payment than unexpected large repair bills.

I have to sell the Audi. It's the most practical solution financially, the best longer-term decision. I mentioned this to Chrissy on Monday and she said her son-in-law's old Audi's engine just blew. He called me tonight and wants to buy mine, sight unseen, could even do so tomorrow if the loan comes through in the morning. He's somewhat mechanical, has a place he gets parts cheap and a friend who moonlights from his full-time job as a mechanic for one of the Audi dealerships, so repairs don't scare him as much. A buyer found with no advertising, no pesky phone calls and lots of test drives to endure. The Universe is taking care of me, it's working out, all falling perfectly into place.

I went up to the garage to clean her out, get the worst of the collected stuff removed so it could be properly detailed today. There were a few surprises of things found, congratulations on having two working flashlights, the mystery of three tire gauges. I opened up the center console and started removing the little things in there: pens, note pads, mints, bobby pins, business cards. In the back, out of sight, was something I'd forgotten was even in there: my medic keys from 139. The key to the building door, the key to my locker and the distinct barrel key that opens Bucks County drug boxes, which all on-status paramedics carry. A key that I will never, ever, be able to use again. A huge part of my life that was abruptly ended, will not be reclaimed. A loss of identity, a sense of my place in this world. In the car that was paid for by my paramedic shifts (being 'extra' income after my PA salary), the car that took me to hundreds of wonderful places, holding the key that represented the loss of a major chunk of my life, I started sobbing. Great huge, hacking, hiccuping sobs. Sitting in my beloved little car, my first symbol of success after the difficulty of school and beginning a career, a car that has been a consistent joy in my life, regardless of what was happening. I sat in my little car, in the dark garage, and cried.

I cried for what I've lost, what will never be again. I cried for all the dreams that will never be realized. I cried for the plans for my future that crashed to a halt the second the images of my heart came on that echo screen. I cried for all the things that were accomplished despite the diseased heart, and all the things that I'll never get to do because of that diseased heart. I cried for the changes in my life, the helplessness, the loss of control over so many things large and small. I cried for the innocence of ignorance all those years before being sick. And I cried for the knowledge of what life now holds. I cried for the longing of the past and fear of the future. I cried while struggling to breath, continued even as the tissues became more and more bloody, my allergy-consumed, already irritated nose unable to contain the flow of coumadin-thinned blood mixed with copious amounts of mucus.

A montage of memories flickered through: the first night I picked her up, my elation surprising the salesman. Showing off, people from work coming out to admire. Roaring into the parking lot at Morrisville and listening to the satisfying spray of gravel. Road trips of hundreds of miles up to New Hampshire, NY, Virginia, cranking up the awesome sound system. The joy I've always had whenever getting behind the wheel. That car is just so much fun to drive: zipping around corners, flying up hills, sailing along on rivers of highways. When I get into the Camry it's an instant reminder that the reason for it's purchase was necessity, the results of my illness and chronic problems. But in the Audi I can pretend, even for a short time, that the last six years haven't happened; that car allows me to be the more carefree person I was 'before sick'. It's an escape from my reality.

It isn't just selling a combination of metal and parts and leather. It's giving up the last fragment, the last piece of what life was, what it could have been. It's submitting to the constantness of my illness, sacrificing the last major material representation of the life I used to have. It's giving up something that has brought me such joy over the years, such satisfaction of accomplishment. There will be many other things that will be sold or given away in the next couple years, but none will be as difficult or represent as much personally as selling this car. Nothing else sold will have as much triumph of ownership attached.

The silver lining is that since this will be the most difficult thing to let go, it will make the other possessions easier to release.

One of the ways I've coped with the last six (!) years is by allowing myself to wallow in self-pity when necessary, and this is one of those times. It is an exercise in futility as nothing can change what has happened. Everyone's life changes in some way and no one knows what the future holds. A favorite bumpersticker says "Change is Inevitable, Growth is Optional". It is good to remember that I still have control over my reactions and actions to what happens. I am convinced that something wonderful WILL happen because of all of everything that's happened to me. There is something more for me to accomplish, different ways I can make a difference, other people to help, new directions to grow. There will be other goals met, other things to celebrate, events and people that I would have missed out on if my life hadn't taken these twists and turns.

But I'm really, really, really going to miss that little car.

Thanks for following along with my journey, Laurie