Advocating … Belatedly

 To whom it may concern:

I apologize in advance for the extremely long email you've received.  The information contained herein is, in my view, essential for a full and robust understanding of the issue I am bringing to your attention today.

I am newer to the Portland Metro area.  My spouse and I moved here in October 2022 for his work.  Initially, we had our care through Kaiser Permanente.  Owing to job change, our health insurance coverage changed on November 1, 2023.  In the process, I needed to establish a new primary care relationship and Tuality is in-network.  I made an appointment for the earliest possible time, which was Tuesday, November 28 at 2:40PM at Tuality Internal Medicine - 368 SE 8th Ave, Suite 301, Hillsboro, OR.  My appointment was with C.O., PA.  C asked me to address him as C and I will refer to him as such throughout this email out of respect for his stated presence in address.

Most recently, my spouse and I were living in St. Paul, Minnesota.  I had healthcare providers of all manner of degree - medical doctors, physician's assistances, nurse practitioners, and medical residents.  I was always treated with care, dignity, and respect.  At every single visit, I felt listened to, heard, acknowledged, and as though my provider was working with me to develop a plan of care that would move me forward in my healthcare goals and were manageable for me personally.  My experiences with C were none of these things.

My primary concerns in getting established with a provider right away were related to medication management of two health issues: PTSD for which I take a low dose SNRI and Hypertension for which I take a low dose calcium blocker.  My most recent prescription had expired and I wanted to new scripts before I ran out of medication at home.  C was asked the relevant questions regarding my history with the medication, side effects, and changes in efficacy.  He then wrote me new scripts and sent them to the pharmacy of my choice.  He performed routine checks (capillary refill, heart and lung sounds, etc.).  C then asked me if there was anything I'd like to discuss.

"Yes," I replied.  "I would like a referral to see a bariatric specialist."

"For weight loss surgery?" C asked.

"I'm open to the possibility of surgery, but my goal is not lose weight.  I enjoy being active and following a soft tissue injury this summer, I've not been able to be active the way I like.  My concern is longevity and quality of life - to have more vitality and be able to move my body in the ways that I enjoy.  I know that weight loss will likely be an important means to achieving that goal, but it is not the goal itself."

"What else have you done to try to lose weight?" C asked me.

I then explained to him that I have a long history of weight-cycling.  Some efforts have been less healthy than others, dating back to 2005 when I lived in New York.  At that point I weighed approximately 365 lbs.  This is my best guess based on body composition as home bathroom scales at that time topped out at 350 lbs and I 'errored' out the scale.  I began to severely restrict my caloric intake.  When I lost enough weight to move more comfortably, I took up running.  I was eating a few hundred calories a day, most days of the week, and fasting 1-2 days per week.  Eventually,  I weighed in at 208 lbs and was officially "overweight" (rather than "obese") for the first time in my entire adult life.  Perhaps unsurprisingly, this was not sustainable and I rebounded to 320 lbs.  I weight cycled another three times in the next eleven years.  By 2016, I came to a full understanding of the ways in which my weight cycling were neither helpful nor healthy and I gave up caring.  My weight remained at 320 lbs and I have never been much heavier than that.  I have never rebounded to, let alone beyond, my starting weight.  I bought a bicyle in 2017 and found that I absolutely LOVE cycling.

During this same time, I began working with an extraordinary trauma therapist.  My goals in life changed (from being thin and pretty to being healthy) and I began to thrive in other ways.

In early 2020, I was able to take a Mindful Eating course and began working with a dietitian (up to the limit my plan allowed which was 3 sessions owing to my lack of co-morbid conditions).  With my dietitian, we determined my resting metabolic rate (RMR) [2,800 calories/day] using the BodyGem, which calculates RMR based on oxygen consumption and energy expenditure.   For Valentine's Day, I purchased an indoor bicycle stand so that I could continue to ride comfortably during the brutally cold and snowy Minnesota winters.  By early May, I was riding 23 miles outdoor with ease.  An accident in late May (in which I sustained tears to my rotator cuff and labrum) was not able to keep me off of my bicylce for long.  My spouse and I were bicycling 20+ miles every weekend and I was bicycling 14-23 miles 2-3 days a week as I commuted to and from work.  By October, I had lost 80 lbs.  I was now down to 240 lbs.  I was also having other concerning side effects.  My hair was falling out by the fistful, I was sustaining pressure injuries on my elbows from resting them on a table, and I had significant hormonal changes.

By the time winter arrived in 2020, I left the acute care setting where I had been working in favor of home-based hospice work.  With the the necessity of driving, the change in weather, the shortening days, I could no longer ride my bike as avidly.  I set up the bike trainer in my basement again and I could not force myself to ride inside again.  My spouse and I continued to take walks regularly in spite of the cold and snow; I was fortunate to be able to walk 10,000+ steps per day in the climate controlled Mall of America 2-3 days a week.  Still, my weight rebounded to 320 lbs.

Our move to the Pacific Northwest has been an extraodinary opportunity in terms of year-round outdoor activities.  My spouse and I hike regularly.  We bicycle in fair weather.  We started slowly and worked our way up.  By the end of summer 2023, we were hiking 6-8 miles 1-2 times a week and bicycling 45 miles every other weekend.  My weight remained stable.  I developed plantar fasciitis.  I could not hike for two months.  Bicycling was gentler on my foot, but still extremely painful at times.  We made every effort to continue getting as much movement as possible.

To be clear, I didn't give C this much information.  I explained my history of weight-cycling, in brief; my work with a therapist; my work with a dietitian; my Mindful Eating course; my activity level; and I shared with him what my diet consists of.  My spouse and I eat scrambled eggs with a small amount of lean ham and cheddar cheese (2 eggs for him, 1 egg for me) or scrambled eggs with home-smoked salmon and chevre, and a small tangerine, for breakfast.  I eat greek yogurt, fresh fruit, and a little granola for a mid-morning snack.  I eat a couple ounces of arugula and a well drained can of sardines for lunch.  In the afternoon, I might eat some hummus and tortilla chips for a snack.  Dinner frequently consists of a 3x3" square of homemade lasagne (including homemade sauce) and a big salad using 2 tablespoons of homemade Caesar dressing (no croutons) or 5 ounces of lean meat (skinless chicken thighs, pork loin, or white fish) and a large serving of vegetables.  I would have a serving of dessert (a homemade cookie or a scoop of ice cream) 4-6 days a week.  I routinely weigh my portions and I began to track my caloric intake again in early November.

C's response to me was, "If nothing else worked for you, I don't see why you think surgery will work.  I'd like to try you on a new medication instead."

I expressed my hesitations about medication.  I asked if I would have to remain on medication for life to continue reaping the benefits.  C answered, "There is no reason you shouldn't be able to go off of medication after you've reached your goals so long as you make the necessary lifestyle changes."

When I asked what changes C felt were necessary, he said, "You need to maintain a healthy diet and exercise."

I explained, again, to C what my diet and exercise regimen look like and he said, "You're doing everything right."

When I explained to C the history of hair loss and pressure ulcers, he said, "You probably just need to drink more water."

"I drink between 128 and 164 ounces of water a day.  I'm not clear how much more water I can consume."

C responded, "You're doing everything right with your water intake."

To be clear, I rarely eat out.  I do not eat fast food.  I do not drink soda or other sugar sweetened beverages, though I do like plain seltzer on ocassion.  I consume less than one standard alcoholic drink per week.

Against my stated preferences and with much cajoling from C, I agreed to try the medication.

The impact of the medication has been significant.  As an appetite suppressant, it's very effective.  I now eat less than half of my breakfast.  Most days, I will take the remainder of my breakfast and one corn tortilla for lunch.  Dinner consists of 2 ounces of lean meat and a half a serving of vegetables or a half piece of lasagne and  a salad.  I didn't have a bowel movement the entire first week I was on the medication - and I consider a daily bowel movement an essential factor to quality of life.  I'm now supplementing with 30-40 grams of psyllium husk daily to produce one bowel movement a day.  My average daily caloric intake is now between 900-1,100 calories - of which 120-160 calories are from the psyllium fiber.  I am neither a dietitian nor a food scientist, but it seems many people do not count carbohydrates or calories from fiber and using that measure, my daily caloric intake is closer to 800-950.  

I am exhausted.  I am experiencing nausea all of the time.  I have less energy, less stamina, and less motivation to move my body at all.  I burp dozens of times after every single meal.  Much of the time, I regurgitate food/fluids when I burp.  When I raised these concerns with C at my follow-up appointment on Wednesday, December 27, his response to me was, "Have you lost weight?"

"Well, yes.  I've lost approximately 12 lbs," I told him.

"Excellent.  Then the medication is working," he told me.

"Again," I explained to him, "losing weight is not my goal.  I want to more energy and vitality."

"Do you weigh yourself regularly?" C asked me.

"Yes.  I weigh myself almost daily," I answered.

"And what was your starting weight and what do you weigh now?" C asked me.

"My starting weight in clinic was, if remember correctly, 324 (caveat - I remembered incorrectly; per records, my starting weight in clinic was 322).  That was afternoon and I was fully clothed.  At home, I weigh myself in the morning after voiding my bladder and while naked.  In that context, my starting weight was 318 and my current weight is now 300 or 301."

"Excellent.  So the medication is working.  I'd like to increase your dose.  Don't worry about the side effects.  I'll prescribe Zofran for the nausea and if that doesn't work, let me know.  It might not necessarily be related to the medication and if the Zofran doesn't work, we should rule out other causes.  Also, have you tried eating smaller meals more often?  What do your meals look like?"

I looked up my food log.

"I eat about half an egg, a quarter ounce of lean ham, and a quarter ounce of cheese for breakfast at 6:00am.  I eat the other half of my egg, ham, and cheese on a corn tortilla around noon.  Recently, because of the holiday, our dinners have been a bit richer.  I had 2 ounces of a prime rib and four Brussels sprouts for dinner last night."

"Okay, so you're eating small portions.  That's perfect.  Keep doing what you're doing.  I'll write that prescription for the dosage increase.  Make an appointment in three months to check back in."

C also ordered labs, as appropriate, and the orders appeared in MyChart.  It was in this context that I learned that there were multiple errors entered into my medical chart.

When I had my last Fasting Glucose Test, it was 2017.  Because of a slight elevation, my physician ordered an HbA1c, noting that the high fasting glucose result could be indicative of pre-diabetes OR a result of stress.  My HbA1c came back at 5.6.  While this is just under the line for pre-diabetes, it was within the normal range.  I was NOT pre-diabetic when I last had my fasting glucose checked more than six years ago.

Though I had regular annual exams between 2017 and 2022, this was not rechecked as no other health marker indicated it needed to be completed more frequently.  In 2022, having just moved to the Portland Metro area, the physician resident I saw at Kaiser-Permanente when establishing care ordered an HbA1C.  The result was 6.0.  I began to prioritize movement and changed some of my eating habits (more fish for lunch vs leftovers) and I attended a "Managing Pre-Diabetes" health seminar.  I began to prioritize movement in my work day (routinely adding long walks on my lunch and eating my lunch while driving between locations) and, as noted above, my spouse and I were able to be more active outdoors over the winter than when we lived in the Midwest.  In May 2023, I asked my physician to re-check my HbA1c.  The result was 5.9.  Still pre-diabetic, but trending down.

In my chart, C added two new diagnoses:  Diabetes Mellitus Type 2 and Impaired Fasting Glucose.  When I asked him how he came to the determination that I had both an impaired fasting glucose and T2DM, seeing as he never ordered a fasting plasma glucose test and my two most recent HbA1c levels were nowhere near diabetic ranges and trending down, he did note that he'd made a mistake and updated my records to indicate Pre-Diabetes.  I also asked several questions related to my diet and exercise regimen.

In each of my visits with C to date, he has stated that so long as I make "the necessary lifestyle changes," I should be able to stop taking the new medication and maintain my weight loss.  When I again shared with C what my diet and exercise includes and asked what lifestyle changes he believes are necessary in my efforts to achieve my goals of greater vitality, quality of life, and longevity, C noted "I usually recommend healthy diet and increase in physical activity."  I quite literally cannot conceive of any way I can improve my diet in healthy and sustainable ways beyond what I am already doing.  I quite literally cannot conceive of having time in life to do anything apart from working full time and working out if I'm going to reasonably get more exercise than I was getting prior to my injury.  He then offered to refer me to a dietitian to develop a plan for maintenance of caloric balance, noting that this is not his area of expertise.

I am frustrated.  I am angry.  More than angry, I am livid with the way I've been treated.  I am deeply disturbed by the experiences I have had with C.  C focused on his goal of decreasing my weight while ignoring my goal of increased vitality, manageable activity, and longevity.  When I noted the profound extent to which the medication he prescribed is impacting my ability to engage in exercise and the nausea, regurgitation, weakness, lightheadedness with exercise, and exhaustion, he declared that were "nothing severe" and stated his intention to increase my dose.  The extent to which these are impacting my quality of life is something I experience as quite severe and at direct odds with my health goals of more physical activity - in the safest possible way.  The fact that I have lost weight was the clearest proof that the medication was working to achieve C's goals for my health - which frankly seems to be a matter of making me a less-fat fat person.

My goals have been ignored, brushed aside, or dismissed.  I have been humiliated and degraded.  I have been told to "make lifestyle changes" and when I explain what my lifestyle entails, I've been told that I'm doing the right things.  When I have then pointed out that this has not been successful and I am concerned that the medication being prescribed would only work if I remained on it for the rest of my life (which could be several decades), I was told, "You shouldn't experience a weight rebound so long as you make the necessary lifestyle changes."  When I then follow-up and once again explain exactly what my lifestyle entails and ask specifically what changes to make, I'm told, "healthy diet and increase in physical exercise."  This circular conversation is absolutely mind-bobbling and infuriating.

I do not know what the root of this communication barrier is - and I have a number of theories that range from frank and explicit anti-fat bias, to a broken medical system that allots fifteen minutes for face-to-face medical appointments, to working in a system that treats individual human beings as population-level trends while plugging their data into a statistical model and prescribing a one-size-fits-all plan of care that delivers anything but actual care.  What I do know is that regardless of the root cause, how C presents himself to and treated me as a patient is completely unacceptable and I very sincerely hope that he's provided appropriate feedback and coaching so he does not treat any other patient with such callous disregard in the future.

Thank you so much for your time.

Sincerely,

Me

Chase Joy

Chase joy.  

And when you've caught it, feast upon it.

Gobble it up like an ice cream cone on the hottest day of the year.

Let its sticky sweetness dribble down your chin and arm,

the remnant is evidence of the thing now in you - 

filling your belly and becoming a part of you.

And in times of desolation,

when your limbs are too tired for the chase

and your belly is full of sorrow,

sit quietly and let joy come to you,

presenting itself in shyness and timidity,

but no less potent in consolation.

Know that she is yours and she will sustain you in all things,

if you permit her.

Please Use Caution When Opening

Please Use Caution When Opening the Overhead Bin 

            as Things May Have Shifted During Flight

The great blue heron stands in the shallow life-giving waters, 

Where fish move and swim and have their being –

Before sustaining the heron in the form of lunch.

 

When the sun burns long for days uninterrupted

And the shallows begin to dry,

When the fish die off for lack of relief

 

And the pond recedes to stagnant algal blooms

Before cracking in thick sheets formed by the unrelenting heat

The great blue heron rises in flight.

 

 

Please use caution when opening the overhead bins

As things may have shifted during flight.

 

 

I took flight several times and found myself

Always returning to the same pond.

The familiarity of the slime and the stench were inescapable.

 

A silent promise, hanging in the air, that things would change

That people could grow and learn as if by accident,

That one day we simply cease to be whom we’ve always been.

 

I searched for new places to find sustenance

In the form of things that moved in harmony with my Self

Rising from the clear and shallow life-giving waters.

 

 

Please use caution when opening the overhead bins

As things may have shifted during flight.

 

 

“Baby, I love you.  I have big plans for us.  You are a queen.

Drink the cool, clear waters of my love as they wash over you

Unmooring you from your own life.”

 

“He beat me.  He broke my nose.  He took my shoes and my car keys from me.  

I walked ten miles home barefoot at one o’clock in the morning.

He pulled me out of a chair by my hair; he threw me off the bed.”

 

 

Please use caution when opening the overhead bins

As things may have shifted during flight.

 

 

“I’m very disappointed she didn’t walk away the first time.

     I thought she was stronger than that.”

Children learn what they live and grow to live what they’ve learned.

 

What did you teach her about walking away, as you stood at the stove

The next morning, the shadows of his handprints wrapping around your neck,

Unhidden, undiminished by the fragrance of blueberry pancakes cooking on the griddle?

 

What did you teach her every day before and since? Forty-four years

Of standing at that stove, interrupted only when he walked away,

But always, always, always welcoming him back?

 

 

Please use caution when opening the overhead bins

As things may have shifted during flight.

 

 

The great blue heron found new shallows of life-giving waters,

Where fish move and swim and have their being – 

Before sustaining the heron in the form of lunch.

 

The sun warms the air and waters

As its reflection dances across the surface

Shimmering like so much glitter when the wind moves.

 

The rains come to refresh the waters

Filling the banks, feeding the reeds, sustaining life anew.

The great blue heron does not rise to flight.

 

 

Please use caution when opening the overhead bins

As things may have shifted during flight.

 

 

The greatest gift he ever gave me was the courage

And confidence, the self-assurance to leave if I choose.

The second is like it: to be a home I will never want to leave.

An Open Letter to My Church

Dear [Church]:

I am sending this letter to the Church Council, by way of the moderator (hi, [moderator]!), though the contents actually address the whole church.

 

I realized this past Monday that it had been a year since our first (very fateful) 2020 Annual Meeting. Evidently, I was not alone in this remembrance as later in the week I received an email from the Communications account at [Church] with the news that the report for this year’s Annual Meeting was ready to go.  I read it with the usual degree of interest (which is not insignificant) and a great deal of sadness.

 

There was no sadness for the contents of the report – in fact, there was much joy at God’s provision in the past year.  There were also a lot of losses and change in the church, which is mostly how life goes.  In times of loss and pain, I have always turned to the church for a bit of shoring up.  An hour in the pews on a Sunday morning is often sufficient to keep the structural integrity of my faith life intact.  This is a funny thing to me, given how little attention I actively pay to the service, fidgeting as I do with my phone through most of any meeting in order to sit more still, listening to the goings on and shouting answers to rhetorical questions asked in the middle of a sermon because I’ve forgotten I’m in the hallowed sanctuary of church and not at the Pub Quiz of the local beer hall.

 

This past year was quite eventful for me as well.  Some of it was unexpected and joyous – as when I started a new job doing the work I love, a full time hospice chaplain; some of it was joyous and long overdue – such as finishing my ordination process at my Ecclesiastical Council and being deemed “Ordination Ready, Pending Call.”  Between the two (the new job and the readiness), I can be ordained at any time – I haven’t done so yet because it’s important to me that it be in person.  Some of this past year was quite painful as well.  And that is where my sadness bubbled up in reading the Annual Report.

 

[Church] is the only church I have known in my four and a half years of living in Minnesota.  It’s where I married Hot Husband on July 6, 2018.  Some of you were in attendance!  It’s where I had my first art exhibit from October – December that same year.  Many of you attended that as well.  [Church] has been my church since I first tried it out – Mother’s Day, May 8, 2016 – when Hot Husband (then Hot Partner) and I came to the cities to buy our house.  I knew on that day that I had found what would be my home church when we moved up later that summer.

 

I needed [Church] to be my church this past year.  The church imploded on January 26, 2020 and not one person from the current Council reached out to me.  Only one person from the entire church initiated contact.  When I finally met with them for coffee just a week before the pandemic shut everything down, I asked why I had been left in the dark about the issues at Olivet and the plans to bring it all to light at the Annual Meeting.  “It was felt that you’re too close to [Former Pastor],” was the answer.  

When asked by another person why I stayed, I answered honestly, “I made a covenant (sacred commitment to the community) in joining [Church].  Though many have violated their part of the covenant, I haven’t been released from mine.”  I have been treated with open suspicion and mistrust - bordering on hostility - ever since.  I continued to show up to the extent my abilities permitted me because I wanted [Church] to be my church.

 

I left one job and started another – I needed my church to celebrate with me.  I had my Ecclesiastical Council and passed – I needed my community to cheer me on and dance with me.  (To your credit, many of you did attend, but no one offered connection or celebration at any point following).  I had three family members (all of whom have been married for less time than Hot Husband and I) enter a time of estrangement from their own spouses – one of whom is now divorced, two of whom have very young children in the middle – and I needed my church to grieve with me.  When one of those same family members attempted suicide because of a mental health condition that is refractory to care, I needed my church to comfort me.  When another of those same family members became entangled with Child Protective Services because of a long history of substance abuse and mental illness, I needed my church to surround me with love and encourage me to continue making healthy choices and reaffirming my boundaries.

 

I am sure there are ways in which all of these pericopes seem disjointed and unconnected to one another. When Olivet hosted my art exhibit, [Well-known Church Artist] approached me after and said, “I’m so glad you’re no longer suffering.”  It was the first time that I felt seen by [Church Artist] – seen in the kinds of ways that matter and let you know that you aren’t alone in the world and that people can know the parts of your heart that make you incredible and different and that aren’t always available to be seen because they mostly like to burst forth in the middle of celebrations – like a bikini-clad stripper from a giant birthday cake or maybe candy from a piñata or confetti from helium balloons floating above a parade.

 

The important thing about my art exhibit is that it was left unfinished.  By design.  On purpose.  Because as the hobbits sing in their walking song, “The road goes ever on.”  From earliest childhood to 2020, I knew two things: 1) I wanted to be a mother more than anything and 2) I would have to create a radically different life from the one I had been given if I was going to do the first well.  The next part of my exhibit, the next stop on the journey, then next turn in the road of my life was the hope of bearing children.

 

In early 2020, Hot Husband and I learned that our marriage is infertile.  The cause of this infertility is insurmountable– no medical interventions are available to bring the next part of my art exhibit, the next stop on my journey, the next turn in the road of my life to fruition.  I learned this the same day that I learned one of my aforementioned family members was 1) getting divorced and 2) pregnant with her and her now ex-husband’s second child.  This same child was two weeks old when CPS took custody of them and their 1 year old sibling; the same week their mother relapsed and left inpatient drug treatment; the same week my other family member became estranged from their family and attempted suicide; the same week my third family member began the process of separating from their spouse.  The same week I left my previous job and started my current job.  The same week I had my Ecclesiastical Council and was unanimously determined to be Ordination Ready, Pending Call.

 

In the midst of all of this, I received the occasional e-mail from the [Interim Pastor] about what I would need in order to experience healing with the congregation of [Church] following the 2020 Annual Meeting.  When I responded that what I need is accountability, for people to simply be honest with me about their secret planning for the Annual Meeting – I was met with radio silence.  I didn’t hear from the [Interim Pastor] for six weeks – and only then because I initiated to tell him that I didn’t know what to make of his silence since making my needs known.

 

I don’t know, [Church].  There are all sorts of ways this could have gone differently.  All sorts of ways I could have asked you to be my church this last year.  But who could I have asked?  The folks at the table who looked me in the eye and lied to me, insisting that there was no planning for the Annual Meeting, that it was all a big surprise to them as well?  The folks who told me that I was too close to the former pastor to be worthy of consideration?  The folks who expressed pleasure at my decision to remain a part of the church and then treated me with a cold shoulder and inherent distrust when they learned why I have remained?  The new pastor who failed to even acknowledge that I had stated a need – even if it couldn’t be met?

 

Who could I ask to sit with me and drink tea together – if only over Zoom – while I shed tears at the death of a long-held dream?  Who could I ask to reassure me that I am not my family and I can be sad for them and still celebrate my own life?  Who could I ask to help me see that the life I created for long hoped-for children was now a life I would have (GET!) to live for myself?  Who could I ask to mourn and celebrate with me the millions of little griefs and the billions of enormous joys that we encounter in a year?

 

A few of you did send Get Well Soon cards following my bicycle accident(s) and I appreciated the kindness of this gesture.  And the pain of a torn rotator cuff and bruised femur are but a breath when measured against the weight of injury to the soul from infertility.

 

My life didn’t stop being BIG, rich, juicy, beautiful and full of JOY when the change in pastoral leadership occurred.  Terrible things didn’t stop happening in my life and the lives of my loved ones.  Instead, life continued on, just at the road goes ever on.  I just no longer had a church community with me on that journey.  I no longer had wise pastoral counsel.  I no longer had church friends I could turn to for a cup of tea and conversation.

 

My life will keep on being BIG, rich, juicy, beautiful and full of JOY.  Terrible things will continue to happen in my life and in the lives of my loved ones.  Life will continue on, just as the road goes ever on.  I need a church community that is willing to journey with me.  The fact that you choose not to be a community deeply grieves my heart and I feel sad.  I know that church can be SO MUCH MORE.  I know that [Church] can be community.  [Church], you have demonstrated that you do not want to be a part of my community and you do not genuinely want me to be a part of your community.

 

Thus, I formally request that you release me from the covenant I made to [Church] and remove me from your membership rolls.  If you have questions, please don’t hesitate to reach out.  Text first and let me know who you are.  I’m more likely to answer an incoming call if I know who to expect.

Sincerely,

Me

I'm Going to Die Today

"I'm going to die today.  How do I NOT die today?"

That was the first thought I had on my commute home Thursday night.  After three months of using my indoor training stand, I had finally gotten the rear tire on my bike swapped out for a road tire, the weather was clear and warm, the winds low.  I rode my bike to work that morning for the first time in nine months.

It was a beautiful ride.  All that indoor training had worked wonders as my first commute of the season was a full 10 minutes shorter than my final commute last autumn.  I felt good - that "exercise high" people talk about when you've moved enough with enough intensity to get the endorphins moving.

Then, I had a perfectly normal day at work, finishing my shift with a two hour stint managing the flow of people into the hospital, checking temperatures, verifying their lack of symptoms, feeling grateful that no visitors came to be turned away.

I returned to my office, shut down my work station, put on my bike shorts, strapped on my helmet and headed to the bike cage.  I retrieved my bicyle, loaded my pannier on the back, and headed out.  I was a mile into my commute, had just crossed the Martin Olav Sabo Bridge, with nothing in my mind except the cadence of my legs, "One, two.  One, two.  One two....."  And on it went.

I turned the curve, began shifting up, reached the highest gear halfway down the east side descent, and felt my body relax into the joy of accomplishment.  "I can do this again tomorrow," I thought, as the ease of my commute infused me with confidence.

I was nearing the end of the descent, I looked ahead on the path, the sharp turn to the left so much closer than I had known, my lane covered in loose sand, a clump of bikers in the oncoming lane.  I'm traveling at least 16mph and I know that I cannot navigate the turn, on sand, at that speed; I cannot cross into the oncoming lane.

"I'm going to die today.  How do I NOT die today?"

I aim for the grass and find myself heading straight at two light poles, firmly planted on either side of a utility box, without clearance between the obstacles.  Aiming to go wide, around these items, I find myself barreling headlong toward a small tree.  I veer left to clear it - there's enough space between it and the next tree immediately to my left - and I am airborne, flying over my handlebars, and I know, "I am not going to survive this."

I hit the ground.  Hard.  My right shoulder makes impact along with my head.  My head bounces and my face makes contact.  The right half of my body is stationary and I feel the left half continuing to slide forward in the hard earth.  My neck, back, and hips shift and move in ways I am confident they are not really built to move.  I feel dirt and grit in my teeth.  My right shoulder hurts.  My upper lip got caugt between my top and bottom teeth on impact - I can feel the swelling.  My teeth are undamaged.

"Are you okay?" a passing cyclists asks.

"Yes," I say.

"Are you sure you're okay?" he asks again, slowing down.  "That was bad."

"I'm fine.  I'm going to call my husband," I respond, pushing up, noting that this is probably the last time in awhile I'm going to be able to move my arm like this.

"That looked really bad," he says, watching me sit up and begin fumbling for my pannier, which has dislodged from my rack.  I look around for my bicyle and see it lying several feet beyond me.  The passing cyclist, perhaps assured by the fact that I'm moving about, continues on his ride.  Several more cyclists pass on the trail.

My arms are shaking so bad I can barely manage to hold my phone.  I cannot move my right arm at all.  I begin texting with my left hand - repeatedly deleting mistyped letters. 

"Crashed.  Need ride."  "Hiawatha and 28th"

"Ok.  I'm coming.  Are you ok?"

"Probably."  "I can't really tell."  "No blood."  "My right arm is useless.  Bad headache.  Road rash on my mouth."

"Ow.  Which corner?"

"South west."  I know that if I gather my things, I can walk my bike over to opposite side of the road and sit in a bus bench while I wait.

When Husband arrives, he pulls the bike rack out of the trunk and begins affixing it.  "Can you open my door?" I ask him.

"It should be open," he says, pausing to pull his key fob from his pocket and hitting the unlock button.  "There you go."

I start to tear up.  "I mean, literally," I say to him, "can you literally open my door for me?"

"Oh, shit.  Yes," he says, pausing to open the back passenger door.  I drop my pannier and helmet on the back seat.  He opens the front door and I climb in, using my left hand to pull the door closed behind me and put my seatbelt on, cradling my right forearm against my belly, trying to keep my should from moving.  It hurts all the time, but every slight move causes the pain to skyrocket.

Husband insists on medical care.  He mentions the emergency department.  I have no compound fractures and only a slight amount of blood pooling in my nostrils.  I bargain for the urgent care.  We swing by the house, as it's on our way, and secure my beautiful bicycle in the garage.

After a brief wait with an ice pack, I am seen by the nurse practioner who evaluates me for a concussion, orders a shot of Toradol and X-rays.  I cry through the entire process of having films taken, grateful that I have to hold my breath when the technician takes the images, as it is the only time my ribs are not moving and less of me hurts just slightly less, despite the fact that my shoulder hurts infinitely more.

I have no concussion.  Nothing is broken.  I am given a sling to help keep my shoulder immobile and ordered to take ibuprofen on schedule - 800mg every 8 hours OR 600mg every 6 hours.  When we get home, I realize that my house keys are NOT in the front pocket of my pannier where they ought to be.

Husband and I eat dinner and then head back out to look for them in the grassy area where I crashed my bike.  I start to notice the scraped on my elbows, knees, and face.  I have a scrape above my right eyebrow where the visor of my helmet slid down and cut into my head upon impact.  We see my tire tracks in the dirt where I left the path.  The bent grass is just barely discernible in my path to the crash. 

"Oh, my god," I keep saying over and over and over again.  "I can't believe I didn't die."

"I know," Husband says.  "I'm really glad you're still here and it's incredible that you have so few injuries, considering."

I look down.  "Hey, look!  There's my keys!"  I gingerly bend down to pick them up, tuck them in my pocket, and we begin walking back to the car.  I'm confident that I will not be riding my bike in the next couple of days, but maybe next week, I think.  If my shoulder starts feelings better.

We climb into the car and again, I get my door closed and seat belt buckled using only my left hand and arm.  "You should stay off your bike until your tune-up," Husband says.  My tune up is in 13 days.  "And, you need to replace your helmet."

He is right, of course.

"I'm glad you're alive.  I hope this will remind you to be more careful on future rides," he says, squeezing my leg.

Future rides.  Yes.  I love my bicyle.  I love riding.  I want to climb into the saddle again.  I managed to not die that day.  For that, I am grateful.

Tomorrow is My Birthday

Content Warning:  Lots of self-pity ahead....

*****

For the past several years (since 2009 in fact), I have veered a little toward depression on my birthday.  Feelings of failure have plagued me.  Back in 2009, the downward spiral was begun by the fact that I was on a two-year medical leave from grad school (initiated by a bout of depression, which included a suicide attempts) and though I knew that I would returning that autumn, in that moment, on that birthday, I felt like everything I had wanted in life was simply out of reach and would never be achievable.

This year, it seems, isn't much different.  I don't know if the dead-end, unfulfilling, way-too-easy job I'm working with no prospects for advancement or even lateral movement into a different role with a more interesting set of expectations or if the infertility thing or the fact there's a pandemic raging out my front door and I'm being furloughed from work (which honestly doesn't bother me all that much; it's the fact that my employer has dictated that all furloughed employees who have paid time off available to them are OBLIGATED to use that paid time off to cover their furlough, and I'd take the furlough unpaid because I'm saving that PTO for a vacation, to Budapest, that isn't going to happen this year either, because, you know, there's a pandemic raging outside my front door - and yours, too!).

You know, as I think about, I didn't go through the whole, "Woe is me, I'm a failure, my life has not followed the plans I set at the age of five and I'll never accomplish anything or be good enough" last year.  I actually had a great birthday.  I celebrated at work with friends.  Then, after, I celebrated again at church with other friends.

All of my friends have left my work place.  I've made new friends and I'll be celebrating with them tomorrow, but I miss the folks I celebrated with last year - with a trio of cupcakes that I named after volcanoes.  Three different flavors.  Three different volcanoes.

With work that is not at all taxing and which does not, generally (at least until this morning), spark massive amounts of impotent rage and resentment, I have had a reasonable bit of brain space emptied of anything other than creative ideas.

So, this year, I'm making cupcakes again.  This year, I'm making one flavor of cupcakes.  I'm only sharing with people at work (my often willing culinary guinea pigs) because I won't be anywhere near the people at my church and because the people from church I want to share my cupcakes with are no longer a part of the church I serve as an at-large member of the council.

Social distancing, physical distancing, COVID containment....  Whatever you call it, there will be few opportunities to celebrate much of anything tomorrow.  Not a terrible thing - I don't like big parties and I'd rather celebrate with 47 smaller parties (tea with a friend, lunch with another, cupcakes with colleagues, dinner with hot hot Husband, an accidental encounter with someone I love), but even that is limited this year.

Maybe I did it wrong.  Life.  Maybe I shouldn't have planned.  Maybe I shouldn't have tried to make something of my life.  Maybe I shouldn't have tried to have a meaningful existence.  Maybe....  Maybe I should stop wanting to make a difference, stop wanting to matter.  I'm halfway through my life - maybe more.  And all I have to show for that ridiculous master's degree and the years of therapy is another idea for a cupcake.

So, I cry about the whole no babies thing and I fantasize about quitting my job for ... something more (as if that's even a possibility) ... and I fry sage in butter until the butter is browned and the sage is crispy which I will turn it into cupcakes, with a blackberry cream filling, lime buttercream icing, and blackberry and crispy sage accent on top.  I will take those cupcakes to my new friends who are work colleagues.  And I will ask them to celebrate with me - from at least six feet away - because, after all, tomorrow is my birthday.

On Dying Dreams

Last night I dreamt that I was lying in bed, curled in a fetal position, crying inconsolably.

This is not an uncommon dream these days.  I've had it about six times since January 15, 2020.

We had just returned from vacation the day before and our only real task that morning was a visit to the urologist.  (In fairness, Husband had a LOT of tasks on his list in preparation for the coming semester and I had laundry and cooking on my list, but the only really IMPORTANT thing, so far as I was concerned, was that visit to the urologist).

It's strange, sitting or standing in the exam room of a urology clinic, looking at charts and models of male and female urogenital anatomy and reading little blurbs and numbers about things like how many couples face infertility and whose body contributes at what rates, while my husband produces a sample for the doctor and I try to offer him privacy, knowing that I want to peak through the microscope at what's on the slide and that this happens in such short order I can't exactly wait in the lobby and hope to be called back when things are prepared.

The slide looks empty at first, and then I see one and then another - sperm that are wiggling with all their might, going nowhere.

This isn't right.  The last time we went through this, there were sperm everywhere and they were swimming across that slide like champions - our own little storehouse of Michael Phelpses.  "So, your numbers and motility are both down substantially in the last three months," the urologist says.

We return to the exam room and all take seats.  "I mean, we got back from vacation yesterday," I say, holding onto anything that might offer a glimmer of hope.  "Between the hot tubs, cases of wine, and blackberry gummy edibles...."

"It's possible," says the urologist.  "What's probable when we see unproductive motility is the presence of Anti-Sperm Antibodies (ASAs).  They grab onto the tails and prevent them from propelling forward."

I'm a married to a guy who does statistical modeling for a living because he finds it fun.  Okay, fun is an overstatement.  I don't get it and when I ask, he tells me, "It's really, really interesting and when something works, it's really, really cool."  When the urologist says, "probable," I know what that means.

The glimmer of hope I had been holding onto is extinguished.

"So," I ask, already anticipating an answer in the negative, "would that mean IUI?"

"No," the urologist says.  "That means IVF would be your only option.  If that's something you're open to exploring, I can give you a referral for more testing, but at this point, if you're not considering IVF, there's not much point."

We headed home with a referral for more testing, though I had already drawn my line in the sand.  I knew that IVF would not be an option for me.

Still, we did more testing and by the end of January learned that, yes, ASAs were the culprit.  Yes, IVF would be our only option for a biological child.  For me to become pregnant, to generate life, to carry and birth a new human.

I don't actually know anything about the experience of IVF.  I have a general knowledge of how it works, but I don't actually know the nitty-gritty details.  So, reconsidering my line in the sand and wanting to have all the information before making a decision, I registered Husband and myself for a "Demystifying IVF" seminar.  February 13, 2020, we had the sexiest, most depressing Valentine's date in the history of the multiverse.

As it turns out, IVF is even more horrifying than I had imagined.  On top of that, with ASA factor infertility, standard IVF is not an option.  We would be looking at ICSI and IVF - where they pick the single best sperm available and inject that single sperm in the the single best egg available and hope for the best - with significantly increased risk to the resulting embryo.  Fortunately, I do not have to even consider this.  We are ruled out of IVF for other medical reasons.

So, that's it.  The end of the options.

I have spent my entire life doing the necessary internal healing work with one goal in mind - to create a life that was conducive to generating life, to raising children in a safe and health home.

Now, I know.  It took too long, the obstacles were too many, and the amount of trauma that needed to be transformed was just too much.

It appears that in building a life for children I will never have, I managed to build an extraordinary life for myself.  And I am not a hedonist.  I do not want to live exclusively for my own pleasure and comfort.

Whenever I stop to think about these things, something like hope and joy come bubbling up to the surface.  "Grace abounds," is the refrain filling my entire being.  "Even in this, grace abounds."

Still, when I sleep and the world falls away and my mind has space to feel the loss and grief, I dream about the grief of dying dreams.  And I weep.