#17  Missing the Brightening Air

It is unfortunate that fatigue and tiredness are listed as synonyms in dictionaries, because fatigue, as a medical condition experienced by people with post-viral illnesses, is a different beast than the daily tiredness brought on by work and play. I’ve tried often to capture the distinction. I want to try again.

            You wake at eleven a.m. on the day your daughter and husband are sightseeing in London without you, because you knew you’d be in no shape to join them. But . . . eleven o’clock? Last night you set your alarm for ten o’clock, so either it didn’t go off, or more likely, you turned it off and don’t remember. Your dreams are still with you: people crowding onto a bus to run away from something; gunshots; forced to choose what and who to leave behind.

            In the here and now of this very late, rainy morning in London, however, you just need to run to the bathroom to pee. And you’re aware, if you’re going to join your husband and daughter for a show at the Old Vic tonight, you need to do so and get going tout de suite. To be on time for that show, you will need to catch a bus at six o’clock, and if you’re going to catch a bus at six o’clock, you must, in the next seven hours, get up out of bed, pee, bathe, put in your contacts, apply some makeup, decide what to wear, put it on, cook something to eat in the vrbo kitchen or venture out for food, download the transportation app, and figure out the bus or tube route to get you to the theater.

            And this is the part that you think healthy people do not experience: You want to pee. You want to bathe and dress. You want to go to the show. These activities are important and valuable to you. What you are feeling as you lie in bed is not depression, in which nothing seems important and nothing has value. On the contrary, you can picture yourself in the bathroom, you can picture yourself dressing in the bedroom, you can see yourself riding the bus to the Old Vic, greeting your daughter and husband and laughing at the sheer joy of being together at a famous theater about to sit and watch a lauded performance.

            Yet you continue to lie in bed. An assessment is happening. In the same way that someone with cracked ribs would reckon how much it’s going to hurt to roll over, stand up, and walk to the bathroom, you’re assessing how many invisible units of energy you’ve got in you to do those simple movements. Do you have enough?

            Momentarily, you lie to yourself. Of course you’ve got enough! This is easy! The path ahead is clear and doable! You’re just about to swing your legs over the bedside when reality spreads through your body like a swift, unwelcome invasion of some kind of parasite that devours energy and chews through your hopes. Your legs remain still under the covers. In a moment of truth, a moment you don’t intend to last, you close your eyes.

            When you open them, it is one o’clock. Two hours have passed. You now have five hours to get on board a bus to the Old Vic.

            The blinds in the bedroom of the vrbo are still closed, but you can tell by the sound that it’s stopped raining. You think of your daughter and husband. You know their plans were to sightsee in the city center. You wonder what landmarks they’ve seen today, what they’re seeing now, what you have missed and are missing. You wonder if they’ve managed to stay dry.

            Thinking about their sightseeing leads back again to the question of the show at the Old Vic. Can you pee and bathe and dress and eat and plan a route and catch a bus in time? A simple question for a healthy person, but for you it’s another, and now more urgent, calculus. So many pieces. So many variables. The strength in your legs, the level of your energy, the extent of your brain fog (can you in fact figure out the bus and tube route?), the time it might take to dress, the effort it might take to get something to eat, how close is the nearest restaurant or take-out, how far will you have to walk to a bus. And the really remarkable thing is that while you’re lying with your head on a pillow making these calculations, an entire hour goes by. Just like that. It’s now after two o’clock. Your window for actually stepping onto a bus has shrunk again. And you still haven’t gotten up to pee.

            You have an image of the Old Vic in your mind, though you’ve never been there. You see yourself sitting in a velvet seat between your daughter and your husband, poring over the program and taking in the set, full of promise, on the stage. You have a sense of the excitement you’d feel as the curtain rises, a sense of the nostalgia you’d feel for the evenings forty years ago when you were a student in England seeing plays with performers whose names now draw top billing. You know what the evening could be, and all that it could bring.

            But in spite of all the pictures in your mind and the desires of your heart, as though your body has decided of its own accord, out of its own knowingness and practicality, your fingers, as though they are independent of your brain, text a message to your husband: Can you return my ticket for tonight?

            And that’s it. You’re not going. With more than four hours to go, you’re not going. You didn’t decide. Your brain, your heart, your love, your desire; they had nothing to do with it. Your body decided. Your wasted, heavy, burdened legs and arms and cells and blood vessels and mitochondria—and whatever else is involved in chronic fatigue syndrome—made this wretched decision. Your heart sinks and you feel an irredeemable longing. Your mind is rehearsing apologies to your daughter and husband. But your body—you can’t deny it—is stunningly relieved. Every muscle, for hours now having been tensed in preparation for a Great Journey, lets go and sinks into the mattress.  

And it is that letting go you can’t forgive.

I spent that evening alone. I eventually did get out of bed, stayed in my pajamas, and cooked some eggs for my dinner. Since I had slept so late, I was awake when my daughter and husband burst in the door at eleven p.m., brimming with news of their sightseeing and reviews of the play, which they both deemed marvelous. After my daughter left and my husband went to bed, I lay awake on a couch in the living room reading the script they had bought me. The play was The Brightening Air, by Conor McPherson. Someday, I hope to see a production of it. When I’m not so tired.

Image: Photo by uriel on Unsplash

#14 What Do I Need?

            The light from a gray day in northwest Wisconsin is fading. Through the window in the cabin bedroom, the color is deepening from one adjacent Pantone shade to another, like someone is flipping through a color wheel. Soon I’ll see the reflection of what’s in the room rather than the trunks of the trees outside it.

            I’ve been in bed all day. My energy bank account is at zero. Actually, it’s less than zero. I’m in debt. I’ve been reminding myself to take deep, slow breaths, and with each breath imagining a shiny quarter dropping with a plink into a piggy bank.

            Earlier this afternoon, my husband stopped in the bedroom doorway and asked if I needed anything. After a moment, I shook my head, only because I couldn’t process his question quickly enough to give him an answer before he turned away.

            If I had been able to think more quickly, what would I have answered?

            Do I need anything?

            Yes. I need someone to bring me a bowl of warm food that’s easy to swallow.

Do I need anything?

            Yes. I need a friend or a family member or someone to ask me, how was today?

            Do I need anything?

            Yes. I need scientists to figure out the cause of this illness and discover a foolproof cure. I need them to have done that twenty years ago. I need all the doctors everywhere to be as educated about ME/CFS as they are about heart disease. Until they find a cure, I need all the doctors everywhere to have good ideas about how to manage this illness.

            Do I need anything?

            Yes. I need my friends to invite me to parties even if they’re probably right that I won’t be able to go. I need people to ring me up and tell me the latest news so I don’t feel so embarrassingly insignificant and out of the loop. I need my community to remember that I’m here and that I’m ill, even though they hardly ever see me and when they do I look fine.

            Do I need anything?

            Yes. I need the people from whom I’m asking these things to know that it’s truly okay that they don’t know what I need, because this illness is dismally uncharted territory for all of us. There’s no way they could know, and I do, truly, understand and accept that. But I need us to figure out what I need together, with no guilt, no blame, no recrimination, no apologies.

            In short, I need what every human being on the planet—ill or well—needs: to be cherished as part of a loving community, and to be accompanied all our days.

Photo by zengxiao lin on Unsplash

# 3 What’s the Plan for Today?

This morning, my husband asked me my plan for today.

My reply: I have no idea.

It’s been a long time since I made plans for a day. Instead, I have hopes. Today, I hoped to do some grocery shopping and cooking, tidy up the kitchen, and plant the impatiens I bought yesterday. I truly thought it was a realistic list.

I was out of bed just before ten, had a cup of tea, blended my breakfast protein smoothie, and talked for a while on the phone with my sister and my mom. After I hung up, I thought a brief lie-down would be a good idea. Pacing is so important when you have fatigue. If you take the breaks you need, you can last longer.

I laid down at 11:30 a.m. thinking I’d need just twenty minutes of rest, but I fell asleep. When I woke, I was the opposite of refreshed and ready to go. Fatigue lay on top of me like fathoms of water. I turned just my head to look at the clock and felt the slump of disappointment that is so familiar these days. It was four o’clock in the afternoon.

I thought about the grocery store and the cooking and the kitchen and the impatiens. I kept thinking about them while I laid in bed, under the weight of an ocean, until about five o’clock when thirst and hunger pushed me down the stairs. I thought about them again when I’d had something to drink and eat. I could still get to the store. I could still plant flowers. Plenty of daylight left. But my arms and legs were weak strangers to me. They carried me up the stairs back to my bed, and that’s where I have remained.

Discouragement is the constant companion to chronic fatigue. It can pull you under and anchor you to depths you hadn’t known existed.

As much as I can, on days like today, I surface toward encouragements. In Pema Chodron’s When Things Fall Apart: Heart Advice for Difficult Times (Shambala, 1997), she writes, “We don’t know anything. We call something bad; we call it good. But really we just don’t know” (9).

I want to label the disassembling of today’s hope list bad. Negative. Disappointing. HopeLESS. Seems to me that it is all of those things. But Chodron may be right. I possibly don’t know anything. I possibly don’t know that there is some purpose to illness, some undiscovered sea creature of energy in the drowning of fatigue. So I don’t plan. I hope.

Hoping seems more in keeping with not knowing than planning does. So tomorrow, I’ll have a new hope list.

Julie

Photo by Julie Blake Edison on Unsplash

#2 What Is Mast Cell Activation Syndrome?

If people were trees, I’d guess that one sapling in every forest has heard of mast cell activation syndrome. That’s most likely because fewer than one sapling in every forest has been diagnosed with the illness. But, according to the handful of medical researchers working on understanding the condition, there might be a pretty hefty stand of trees surrounding that one sapling that all have a mast cell disorder; they just don’t know it.  MCAS manifests as such a strange variety of symptoms that it is usually misdiagnosed as two or three or even ten other concurrent illnesses. The limited number of patients who have been diagnosed might be the tip of a very unpleasant iceberg.

I was diagnosed first with chronic fatigue syndrome and then with MCAS. That makes sense, because it now appears that MCAS may be chronic fatigue’s daddy.* In fact, MCAS may have an entire brood of distressing progeny: fibromyalgia, multiple chemical sensitivities, POTS, irritable bowel syndrome, and much more. The common thread here is that all these conditions are of unknown origin and were first dismissed by medical science as hooey. It’s possible—and I stress possible, because a LOT more research is needed—that MCAS is the root (or a root) of all these branches. If science can figure out what causes MCAS and how to cure it, we may be on our way to curing a whole tree of suffering.

So, what is mast cell activation syndrome? Here’s the Sesame Street explanation (keeping in mind that I am myself a student of MCAS, not an expert):

Mast cells were our bodies’ first defense against cellular invaders. Apparently, for a time, they were our only defense. They were the army before we had the air force, navy, and marines. As such, they had to do all the work of defending our bodies. Eventually, our bodies developed a more sophisticated defense, or immune, system, with lots of players doing the work the mast cells had once done on their own. But the mast cells haven’t been put out to pasture—oh no. They’re still around and playing an important part in our bodies’ defense system. Unfortunately, in some people, the mast cells are working way too hard. Maybe they didn’t get the message that they’ve got plenty of help now? They are not standing down at all, ever, and are firing on the very things they are meant to protect. They are overly activated, hence the name mast cell activation syndrome.

Mast cells originate in the bone marrow and then spread throughout every type of tissue in the body. They’re not numerous, but they do tend to concentrate where the body interacts with its environment—the skin, the digestive system, and the respiratory system. So symptoms of mast cell activation can include itching, flushing, rashes, hives, wheezing, sneezing, difficulty breathing, anxiety, panic attacks, low blood pressure, rapid or racing heart rate, gastrointestinal distresses of all types, sleep disturbances, and . . . yep . . . debilitating fatigue.

There’s so much to explain about MCAS. As I learn more, I’ll try to pass it along.

Julie

My primary sources for this post are both from Lawrence B. Afrin, M.D. One of his presentations is available on YouTube as Mast Cell 101, and his book, Never Bet Against Occam: Mast Cell Disease and the Modern Epidemics of Chronic Illness and Medical Complexity (Sisters Media, 2016) is widely available.

*When I originally wrote this post, I was under the impression that ME/CFS is caused by Mast Cell Activation Syndrome (MCAS). I have since learned that MCAS may more likely be a comorbid condition with ME/CFS. Or not. At this point, nobody really knows.

# 1 Introduction

No one expects to become ill. Well, okay, I know lots of us harbor anxieties that we will end up with the diseases and conditions that seem to run in our families. Both my grandmothers had breast cancer, so in the back of my mind, wiggling about like a little worm, is a subcutaneous worry that I might end up with breast cancer too. But I’m guessing that most of us, if we’ve enjoyed nominally good health in the past, go about our days thinking that we’ll have decent health tomorrow too.

 And then suddenly, perhaps because of an infection, or gradually, like the diminishing daylight in November, we find ourselves with a diagnosis. Even if a friend has warned us—Julie, if you keep going this way, you’re not going to see your kids through high school—we’re still shocked when a doctor tells us that we have a chronic illness that is difficult to diagnose and has no known cure. And then, six months later, we’re even more distraught when she tells us that, based on our blood work, that chronic condition is actually caused by another, underlying chronic condition with no known cure and about which little research is being done.* So we’ll just have to experiment with symptom relief for as long as it takes. Meanwhile, rest. Stop working (not that we’ve been able, for some time, to work at all). Accept help from others (but we are Midwestern! And German/Norwegian!).

And so, without any preparation, mental or physical, we find ourselves in the ranks of the chronically ill, and the world as we have known it, indeed our own bodies as we have known them, are whisked away into a past that suddenly seems more golden than it did when it was the present.

The disorders I’m dealing with are complicated and almost entirely unknown by the general public. Trying to explain them to family and friends is exhausting and discouraging. So, since writing, for me, requires less effort and brings greater satisfaction than talking, I’ve decided to share what I hope will be a healing journey here in this blog.

If you’ve happened upon this page, feel free to read future entries, or not read them. We live in a busy world; following a blog is a big ask, and it’s just not many people’s cup of tea. All I do ask is that if you respond in the Comments section, please be kind. Kindness is healing for all of us.

Good night, and joy be with you all.

Julie

*When I originally wrote this post, I was under the impression that ME/CFS is caused by Mast Cell Activation Syndrome (MCAS). I have since learned that MCAS is more likely a comorbid condition with ME/CFS.