Needing the Dark

Today started early. I had a 9:45 AM appointment in Portland, and if you don’t think that’s early clearly you are not familiar with my 3 AM standard bedtime these days. I tried going to sleep at a sane hour, but my overly active brain had other ideas. In fact, my 4 AM conversation with body and brain almost resulted in its own blog post; I just knew that if I got up to write it I wouldn’t get any sleep at all. And I need sleep. I like sleep. Even before all this nonsense, it was my favorite hobby. ALS just gave my lazy ass an air of legitimacy.

I have recently made a crucial step and actually have started asking my friends for help. I know, I know! I was just as impressed as you are with myself. It was not at all an easy thing, as you can well imagine – especially if you know me. But I have doctors appointments to get to, and J is amazing but cannot be my sole source of transportation – particularly when I own the van and it doesn’t actually need to be him driving it. So I had put out an all call on my friends list for someone to come drive, and my friend Matt stepped up for today. Matt is also the storyteller for my Wednesday games, and as mentioned before is an all around good guy and excellent person to have in your corner. As we were driving to my appointment this morning, talking about video games and commercials and marketing and the abyssmal real estate market, the van’s brake warning light came on. It had done before, and usually came on and went off seemingly randomly, and we had previously resolved the problem by simply topping up the brake fluid. It it started doing this again recently, and despite repeated mental notes to ourselves, we had just failed to get more fluid in it yet. I wasn’t terribly worried. It didn’t seem like that big a deal.

…You can probably see where this post entry is going, yes?

By the time we were done with my appointments, and filled the gas tank, and got home, I’d forgotten all about it. That afternoon was my biweekly therapy appointment, which J was available to drive me for. As we were driving the 20 some odd miles to my therapist, the warning light came on and stayed on. And then, halfway there as we stopped on the freeway for a traffic snarl, there was a God awful smell of burning rubber and when we looked behind us, a bit of smoke. We weren’t entirely sure it was my van? But the presence of the smell and the light made us resolved to put more fluid in the van as soon as humanly possible. For some stupid reason we had taken the brake fluid out of my van and brought it into my apartment, so simply pulling over and adding more fluid wasn’t an option at the moment. Traffic started moving again, then came to a crawl again, and as J put the brakes on, more smoke. Something was obviously not right in a big way.

Fun fact! I have a debilitating phobia of breaking down on the freeway. When I was really little, our car broke down at night on the freeway and I remember vividly my father moving around outside the car trying to figure out what was wrong, while traffic screamed by us in the dark and I just knew in my little kid brain that any second now some car was going to hit him and splatter him up all across our vcar. I shook in terror waiting for my father to die. He did not, of course, but ever since then, any time there is a slight possibility of something going wrong with the vehicle I am in, it creates an instant panic attack. That’s the problem with phobias. There’sno reasoning with them.

Jay was talking, making plans of dropping me off for my appointment and then going to some auto parts place to get more brake fluid and I would make an appointment the next day to take the van in for proper repairs. I didn’t really hear him over the blood pounding in my ears, and my brain was already busy trying to figure out what to do when I vomited any second now. And then we got off the freeway, and I felt safer for a split second until Jay told me that the brakes weren’t responding properly. I just needed to get the van safely somewhere, and then…

… And then, what exactly?

My van is not exactly easily interchangeable with another vehicle. It is a proper medical device. Ever since I got the fucking thing I have been paranoid about getting into an accident because it is not going to be simple and easy to replace it. And if something should happen while I am away from home, I am completely screwed. Stranded. If I were in a manual wheelchair I can get into normal car, but the SS Opportunity weighs 400 pounds without me in it and is a God damn behemoth in her own right. I can’t just get another vehicle. I can’t just call a taxi for a ride home, anymore.

That uneasy feeling turned into outright fear when we parked in the lot of my therapist and the smoke just kept coming. I couldn’t see anything on fire outright, but something was smoking in the rear passenger wheel well and I literally did not know what to do about it. I texted my little brother – because let’s face it – that’s what I always do when I have a car problem because what the fuck even are cars they are magical beasts whose language I do not speak. Not only does my little brother speak cars, he is a professional tow truck driver so even in the worst situation he can bail me out. And has, in fact – when Jay got sideswiped by a probable drunk driver on Christmas in 2017 and the driver took off, it was Justin who went out to get him and help him figure out the next steps. When my brake error light initially came on, it was Justin who told me what to do about it. So when he didn’t immediately respond, and some minutes passed and smoke was still rising from somewhere in my van’s guts, and I wasn’t sure what we would do if we started seeing flames, I called him. He had been taking a nap and listened very patiently while his sister panicked at him over the phone about cars and smoke and I don’t know what to do. He told me to hang tight and he was on his way because he is my hero.

He was some minutes away, and so I went ahead and went inside and had my session with my therapist which was now all about my current crisis. J stayed outside to wait for Justin, and would come interrupt the session when my little brother got there. I wasn’t sure what I was going to do. I wasn’t sure what I even could do. Even if he could tow it somewhere, what the fuck was I going to do in my wheelchair and 20 miles from home? Again. You can’t exactly call a taxi.

After my 45 minute session, we went outside to find my little brother arrived in his giant tow truck, lights flashing, working on my van. Because again, hero. J came over and explained what had gone down so far, which is that Justin had pried the tire off the side of my van and had a look inside and formulated some theories. Apparently the brake line was leaking somewhere, as the inside of the tire was coated with fluid, and the passenger side rear brake had had to do all the work by itself and so had heated up red-hot and started smoking and had finally in the 34° weather cooled down to an oxidized white. He was going to tow the van to Les Schwab, and drop off the keys for them to take a look at in the morning, as they were closed by now. He offered to load me up in the van and transport me in it as he transported the van, but that was of course in his own words “illegal as fuck”. And you know, dangerous.

So we had a plan for the van, but I was still effectively stranded in Lake Oswego. My local public transportation service Tri-Met has a wheelchair transport service, but it’s the sort of thing where you have to get a special ID to qualify for it, and you schedule your pickups in advance and allow for a two hour window. The Lyft app on my phone has a wheelchair accessibility feature I had discovered some time ago, but I had literally no idea how that even worked. It was apparently time to find out. I requested a wheelchair lift, and the app cheerfully told me my ride would arrive in 45 minutes. After a moment it updated to 15 minutes. My ride was going to be courtesy of a local ambulance company, please look out for a white medical transport vehicle, license plate blah blahb blah. And just over 15 minutes later, fuck me if a wheelchair transport van didn’t pull up. It had totally worked.

We finalize things with my little brother to drop off my van, and for me to expect a call from the mechanic in the morning with an estimate before any work would be done. The wheelchair transport vehicle was a fucking sweet ride, the driver was completely awesome, and I found out that wheelchair accessible Lyft requests get priority even over his company’s scheduled patients because they are fully aware anyone desperate enough to need a wheelchair ride without a plan beforehand is obviously going through hella circumstances. And so I got a ride quickly, and my ride ended up costing me 10. Fucking. Dollars.

TEN.

Not only that, but my driver was an hourly medical transport driver and so I didn’t even have to tip him. I asked if I could, and he refused.

SOOOOOOOOO in review, my peesashit van broke down today, after standard business hours, in a very dramatic way. And yet, I have an amazing brother who was able to rescue the van and provide me with the next steps, and then I was able to get safely home for a very little amount of money. And I learned that Lyft access is absolutely a viable transport option now. I am home safe and warm with useful information and a solid plan. I have another appointment tomorrow which I’m going to have to cancel, and when I contacted my friend who had offered to drive me for that appointment and told her I needed to cancel and why, she told me her brother is an actual mechanic and as is actually not very far for me. So even after I get the brakes repaired, I have a plan to contact him and get my van checked over thoroughly to make sure I am not going to have any more nasty surprises coming up. Tonight things completely went to shit, and then the universe conspired perfectly to make things as best and as smoothly as possible. Everything could have been so much worse. I could have been completely stranded in Lake Oswego waiting hours and hours in near freezing temperature for a wheelchair transport taxi service to find time to come get me. I have a AAA account so I would have gotten the car towed regardless, but I literally would not have known where to take it. And we could have been waiting for hours for them to have the time to show up also. Instead my brother was there in minutes. With a plan. And a free tow.

Repeating in my head tonight is my favorite quote from painter Bob Ross, who explained light and shadow theory in painting with a profound slice of life advice.

You need the dark, in order to show the light.

My life is as bright as the fucking sun, and it is only these moments of absolute panic and misery that prove it to me. I am fortunate beyond compare. Even when things are chaos around me, the universe conspires to take care of me in a perfect way because of the people I am fortunate enough to be surrounded by. In my most dire circumstances, I am never alone and never without hope.

I see the light, because of the dark.

A Rad Update

Step 1. Gather the required materials.

One box of Radicava, which contains two 100ml bags. Two saline flush syringes. One package of IV tubing. At least two alcohol prep pads. One IV pole.

If we were taking labs, or redressing the PICC line, there would be so many more components. This, though, is the minimum. There will come a time when this is routine and second nature, but for now, everything is still double and triple checked. We lay things out like we’re preparing for surgery. It’s not far from the truth.

Step 2. Wash your hands.

There’s hand sanitizer, which also gets liberal use, but there’s no substitute for scrubbing your hands with soap and hot water. I find it almost impossible to wash my hands well these days, and drying is a nightmare, so I typically opt for the sanitizer only. If your hands work, though, go wash them.

Step 3. Open all the packaging.

The box of Radicava contains two trays of 100 ml bags of medicine, each with a silica bag and a little pink oxygen indicator. We peel back the lids on the bags, which each have a plastic seal over the input valve. We leave those intact until the last minute. We unwrap the two saline syringes, but leave the caps on. We open the first alcohol prep pad and set it aside. We unwrap the IV line and hang it over the IV pole. OK. I think we’re ready.

I’m appalled every day at how much waste this generates.

Step 4. Prep the line and bag.

We close the IV line, either through the clamp or dial, depending on the tubing style. Removing the bag’s seal and uncapping the IV line’s spike, we push the spike into the gray seal on the bag as straight as possible so as not to split the bag. It takes a surprising amount of force to do this. Because the line is clamped, nothing happens yet. We squeeze the tube’s chamber to fill it about half full of medicine. Carefully, slowly, we unclamp the line and allow the medicine to flow through the tube, stopping it just before it spills out of the end. We clamp it off and set it aside, dangling harmlessly from the IV pole for now.

Step 5. Sanitize the input valve on the PICC line.

The alcohol pad is scrubbed over the PICC’s blue input valve for 15 seconds. It doesn’t have a cap, so it’s out in the open all the time, well, tucked up under the sock against my skin, and must be cleaned carefully. We let it air dry.

Step 6. Saline Flush to clear the line.

Uncapping the saline syringe, the plunger is pushed juuuuuuust a little bit to push the air out. Or, you know, accidentally create a beautiful arc of saline in the air if you push too hard. The syringe is then coupled to the blue port on my PICC, twisted in place to secure it, and the saline injected a push at a time, to the rhythm of a heartbeat. Bublump. Bublump. On the second push, I feel the cold liquid in my vein, and a moment later, I smell and taste the saline in the back of my throat. It’s a hospital smell. The rest of the syringe is injected, decoupled, and disposed of in the biohazard bin.

Step 7. Insert tubing into PICC and begin infusion.

The IV tube is pushed into the blue PICC port, the little plastic collar screwed tight to secure the connection. The tube is unclamped or undialed, and the Radicava begins to flow into my vein. It feels like nothing. It’s not cold, like the saline, it has no taste, no burning like some antiseptics and anisthetics. There is no sensation at all, and the only reason I know I’m getting medicine is to watch the IV chamber steadily drip drip drip drip…

Step 8. Swap bags when the first one is empty.

The tricky part to this is allowing all of the medicine to drain out of the bag without letting the chamber empty, which will allow air down the line. Air in the line is bad. I have remedy available, if that should happen; it’s easy enough to use a saline syringe at the bottom of the line to force liquid back up into the chamber and clear air out. But it’s best to not let that happen. We swap the bags and sit back to wait some more. This is supposed to be a 1 hour infusion, but it’s taking closer to 2. A lot of the reason for this is an extension of the PICC line we added so that I can reach the ports myself, which bottlenecks the flow AND adds extra distance for the medicine to have to travel.

I can do a lot of this myself, except the coupling of the IV line to the PICC. Both ends are very floppy and you can’t touch the ends without having to start over and resterilize. Doing all these things, though, cause my hands to cramp up a lot and then be completely useless for the rest of the day, so I happily leave it to others when I can. J’s been doing it the last couple days, which is marvelously helpful.

Step 9. Bleed the line carefully.

Once the bag is empty, we play a game of chicken with the medicine, allowing it to drain down the line until the air is allllllllllllllmost to the PICC line. We don’t want air in my line, obviously, but we also want every last drop of the insanely expensive medicine in my veins and not in the trash. Once the line’s drained as far as we dare, the line is clamped, decoupled, and the entire bag and IV line is discarded. More trash.

Step 10. Saline flush.

Hands are washed and sanitized again. After another scrub of the port, the second saline syringe is rid of air pockets, attached to the blue port, and screwed in. More heartbeat push, more cold, more hospital smell and taste. Yummy. The syringe goes in the biohazard bin, even though it never really touched my fluids. Quite the opposite.

Step 11. Redress and cleanup.

We’re done! Everything is thrown out, the IV pole is collapsed and stowed, and the PICC line is coiled up and tucked under the itchy fishnet sock around my arm keeping everything covered.

*****************************************

Today will be day 5. Fortunately, it is not time sensitive in application like an antibiotic might be, so as long as I do it sometime on that day, it’s fine, it doesn’t need strict scheduling. Last night’s dose began around 8; tonight will be closer to 10 or 11, my first ever dose was 9 AM. For the second round, I have to do 10 infusions over 14 days, and I can also pick and choose dates and times. If I want to do Monday through Friday and skip weekends, I can. If I want to do all 10 days up front and get it done, I can. It’s up to me.

The main problem I’ve had so far has been dealing with the PICC, in that it’s inconvenient as hell (I miss showering – I can only shower if I take these huge complicated precautions to wrap it all up watertight and I just can’t pull it off on my own) and itchy AF. The bandage tape is itchy, the sock is itchy, the lines are tickly and like to snake their way out of the sock and say hi to the world from under my sleeve. It’s convenient as hell for not having to have an IV poked in every single time, but everything else about it sucks. I’ve already decided to get the port-a-cath installed once I’m done with this round.

I’m tolerating the drug just fine. I *think* it’s exacerbating my headaches, but nothing unbearable, and it may be causing night sweats, but I have to research that to find out if it’s even a thing that might happen. Otherwise I’m doing good. We’ll find out in March if it’s affected my decline in the least bit.

So that’s everything so far about radicava, darlings. It’s going well. I’m still terribly excited about all of this.










Liste du Bucquette

I have a complicated relationship with the idea of a bucket list.

Okay, so, first? The name ‘bucket list’ kind of bugs me. I can’t really pinpoint why. It feels a little disrespectful, I think, but that doesn’t make sense as I am PERFECTLY willing to make all kinds of jokes about my condition and I’m notorious for not taking it as seriously as some people might like. Maybe it just feels a bit…man, I don’t know. Whatever.

Everyone seems to assume that the moment you are told you’re terminal, the first thing you do (after you cry a lot) is run out and make a list of things you want to do before that happens and start working to check things off. I’ve had a LOT of questions about the sort of things on my bucket list. But here’s the thing – I DID NOT HAVE ONE. I did not immediately start figuring out what life experiences I wanted to have before I died, I was FAR too busy figuring out how I’m going to LIVE. I have a lot of plans to make, and I’m still dealing with that whole “my life is suddenly very finite” idea. Figuring out grand adventures was honestly the absolute last thing on my mind. I had research to do, and people to tell, and disability to work on, and medical appointments to go to, and a house full of chaos besides. I have no time at work to think about these things. The idea of setting aside some time specifically to think about “what would I like to do before I die” is bizarre to me, and I’m not the sort of person who thinks about that as a matter of course. A lot of people have some vague idea, or have that one thing they want to accomplish – my main babe Danielle wants to see Australia, badly. I didn’t ever really have things like that. There’s been a lot of “this would be really cool to see” but there’s never been a primal PULL to accomplish anything before I die. Nothing I need to have done so I can consider mine a life well-lived.

The idea of a bucket list has brought up another major point: I really suck at accepting nice things. Whether it’s a compliment or an extravagant gift, I am easily overwhelmed and hesitant to accept. It’s likely a combination of growing up extraordinarily poor and having crushingly low self-esteem for most of my life (and still, to a large extent). There’s a large dose of “I don’t feel like I deserve this”. There’s a large part of “there are other people who definitely deserve this more than I do.” So when people have asked to help make some bucket list items come true, I’m like a deer in headlights. One friend has offered to fly me to Maryland to see her and then daytrip to New York for an honest to God Broadway show and fancy dinner. Another was asking how I’d feel about an international trip, because she is totally willing to take me on one, do I have a passport? And I’m overwhelmed. Because that’s a lot of money. A lot. More than I would probably ever justify spending on myself, even if I had it. So I’m very tempted – it is in my NATURE – to politely decline.

My friends know me very well though, and I was preemptively asked to consider their position. They have a friend who is dying, they want to make one good memory with her before that happens. And they have the means to make it an extravagant memory. So that, when she dies, they have no regrets over time lost and opportunities wasted. Do I really want to deny them that? Won’t I consider how they feel, and realize this is as much about them as it is about me?

…And I can’t fault that. If it were anyone but me, I’d totally be on board, I get it. But being on the receiving end of that feels strange.

I certainly don’t feel like I deserve magical golden presents. And though I’d love to see Italy and Japan and New York, it’s not likely that I’d travel there, even if I had the rest of my natural lifespan. So why do I suddenly get the option to do these things just because I’m going to die sooner? Why does ALS equal a ticket to New York when there wasn’t going to be a ticket to New York in my future otherwise? How does THAT work? Consolation prize? SORRY ABOUT THE SLOW DEATH, HAVE SOME PASTA IN ITALY.

There’s also a battle within me of pragmatism. Part of me wants grand adventures, yes, but there’s a large part of me that just kinda…wants to continue to live life normally. Take a vacation occasionally, sure. But nothing so extravagant. And otherwise stay the course. Go to work. Be as normal as possible for as long as possible. Maybe that’s a form of denial, but ALS has already completely disrupted my life and I feel like I need to mitigate that disruption. So, suddenly becoming a jetsetter is weird for that reason, too.

So no, I didn’t really have a bucket list. I was given that as a homework assignment Wednesday, and whaddyaknow, there’s a website for it. So I made one, and I’m continuing to add to it. I was told specifically to only include fun things. “sell the house” and “work out disability benefits” do not go on that list; there’s a separate ‘shit I gotta get done’ list for that stuff. This was to be a list of everything I can think of that would be awesome to see/do/make/have before shuffling off this mortal coil, no matter how unlikely. So, here it is so far:

http://bucketlist.org/list/tragerstreit/

I’ll keep adding to it as I think of things. It’s a work in progress; it’s hard to think about this for too long without spiraling down, for one, and there’s so so so much cool stuff to do, how do I figure out what should be on this list? The next step will be to figure out what’s actually feasible, and then sort that smaller list in order of physical demand so I can do that shit first, before it becomes too problematic. I was told I should make that list public, so that friends of mine could sign up to be buddies for adventures – like, “You want to go to Yellowstone? Awesome! I do, too! I’ll go with you and that way it’s definitely going to happen!” And they can choose the events that would be most meaningful to them to participate in. Not everyone gives a shit about being there when I get a tattoo, but for other people that might be a meaningful moment to share with me. Maybe one of my friends has also always wanted to learn how to pin insects.

Annnnnnnnnd then there’s the idea that’s been floated by me by a few friends of putting up some kind of donation thing, so that friends can outright sponsor a bucket list item, or donate towards one. And that also feels weird. Again, there’s the “I’m not worthy” part, and there’s a chunk of “your money could be spent making YOUR life more awesome, you should do that” or “ALS research needs the money more than I need a new tattoo”. But it’s not about ALS research, or potential vacations, or any of that. It’s about the crushing sense of helplessness they feel, and this is one thing they can do. Something solid. Something concrete. Something that makes their friend’s life a little brighter for as long as she continues to have it.

Mehhhhhhhhhhhhhh if I keep talking maybe I’ll convince myself. I’m still not buying it. I’m hardwired not to. I’m trying to be more gracious about accepting help when I need it. I’m trying to teach myself to see that accepting these happy things will make me better at accepting help for the not happy things. If I can get over myself and accept a trip to NYC, I can get over myself and accept a hand taking a shower later.

But overall, I am grateful. So, so grateful, that I have friends who want to do these things for me. I’m grateful to the universe that they’re in a position to be able to. They’re lovely people, and I’m glad they’re doing well. I’m grateful that these people were put in my reality and that they remained in my orbit. And I’m overwhelmed with the love and support everyone’s shown me in their enthusiasm to make this list happen.

I know the best, most awesome, most generous, most loving people. And I adore them. I am a lucky girl.