The New Normal, Again.

ruleI have been a out of commission lately. Upon Justin’s discharge from the hospital my role as his caregiver increased significantly before he was admitted back into the hospital through the ER late Sunday evening. To say the last week has been overwhelming and a rollercoaster of emotions would be an understatement. To read about how Justin’s doing, feel free to check out my latest update on Project: Transplant.

I learned a lesson in self-care this week. For weeks I have had people ask me: “Are you taking care of yourself?” – with rolled eyes, I said “yes, of course.” I felt fine, a little overwhelmed at times and tired, but I was okay. Coming home from the hospital was a shock to my system. I was excited, my husband was finally coming home after 21 straight days in the hospital, our puppy would finally have his human back, and I could finally take a breather from my constant commute back and forth.

No sooner did we walk in the door of our house did I realize how wrong I was. Being home, while slightly comforting, was completely overwhelming. There was no medical team, no routine, no doctors walking the halls – it was just me, a bag full of medications, some instructions, and our animals. What the hell had we gotten ourselves into?

Having not arrived home until after 9pm, we were both exhausted and decided that going to bed was probably the best choice for both of us. After a crappy night’s sleep our first official day home had started. Justin wasn’t feeling well, but pushed through, even showering before falling back asleep. The visiting nurse came by to show me how to operate his IV pump, clean his port lumens (lines), and take his vitals. So. Much. Information. Just thinking about disconnecting his IV, by myself, at midnight when his drip would be done gave me a whole new level of anxiety. Trying to hold it together, I found myself sitting in the garage, crying to my mom on the phone. I felt unprepared and inadequate to do all of this. I went to bed that night exhausted, but ready to do my part with disconnecting his IV meds. And, quite frankly, I kicked ass. I was quick, confident, and precise as I cleaned, flushed, and heparinized his lumen in under 10 minutes so he could get back to sleep.

Despite my midnight confidence it took less than half a day at home for both of us to feel overwhelmed. We made the best of it, but we knew we had a lot to figure out. By Sunday afternoon, as we were catching our groove, Justin spiked a fever of 100.8, warranting a call to the BMT unit. After being directed to go to the ER for admission, I packed up some of our things and felt a twinge of relief mixed with anxiety. It was scary that we had to head back so soon, but comforting to know he would soon be back in the BMT unit with his medical team. I made the decision, from the ER room, to take the week off of work. I had been working remotely while Justin was in the hospital, but just couldn’t find it in my power to focus on anything but what was right in front of us. It felt like a small self-care win.

I spent the night with Justin both Sunday and Monday, only going home briefly to shower and grab some additional things. When Tuesday morning came I felt panicky, I had a stomach ache, was convinced I had a urinary tract infection, was exhausted, and couldn’t do anything for my husband to help him recover. I was dreading talking to his doctor, assuming that my physical symptoms would mean they wouldn’t allow me to stay with him. I couldn’t stand the thought of being kept away right now. His doctor walked in the room, gave us an update and asked if we had any questions. Justin pointed at me and said “She doesn’t feel good.” I started bawling. She convinced me to go home, see a doctor, and get some rest. I did exactly as she said.

After lunch with my mom, seeing a doctor, doing a quick shopping trip, and picking up an antibiotic for myself, I was home. I sat in the sunroom with the windows open, ate dinner, and just took a breather. Around 6:30pm I shut the house up for the night and went into the bedroom, I was asleep within 20 minutes. Despite the felines waking me up a few times I slept until 8:30am on Wednesday morning, I couldn’t believe it. 13 hours of sleep in one night and I was convinced I could keep going. I forced myself out of bed, made some breakfast, took a shower, and prepared enough food to keep me satisfied for a couple of days at the hospital – something I had never taken the time to do before. I felt ready to get back to Justin.

I had convinced myself, over the last month, that I had been taking care of myself. I didn’t feel any more exhausted than I should, I made excuses for all of the signs of burn out I was experiencing. Of course I felt like this – my husband just had a bone marrow transplant.

That is no excuse. I didn’t adjust my self-care plan based on our new day to day life. I wasn’t increasing my water intake to compensate for the dryness of the hospital, I wasn’t being proactive with my food preparations because it was easier not to, I wasn’t napping when Justin was because I thought that was my time to “get things done”, I was lying to myself and to everyone else about my self-care and right when my role changed, it bottomed out on me. I had to, yet again, create a new normal. One that was focused on our physical and mental health FIRST. Everything else can wait for us.

 

The New Normal: Caregiver Guilt

the-new-normal_caregiver-guiltThere are so many layers to caring for a loved one that has an illness or medical issue. I thought I had experienced all of them, figured out and mastered, this role once and for all. It has been five and a half years since Justin’s original diagnosis, in that time he has participated in countless clinical and research trials, went through traditional chemotherapy, and has now spent a year of his life fighting this disease

I thought I was prepared. I thought I had figured out how to deal with the emotional aspect of being the caregiver to someone with cancer. The truth is, I wasn’t dealing with the emotional aspect of my role at all. I was avoiding it.

There is a part of me that shuts down when my husband is gearing up for, going through, or coming down from a treatment process. I become an all-business freight train. Every single thing that happens in my daily life is measured to what Justin is going through, not by him, but by me. I have less patience for nonsense, including my own.

There’s no crying in baseball.

Sometimes being a caregiver means you don’t get the time to deal with your own emotions, because, let’s face it, it’s easier not to. We all know it’s not healthy to ignore your own emotional and physical needs, but I’m here to tell you, as someone who avoided dealing with my own emotional well-being, it catches up to you.

There is this heavy guilt that comes along with taking time for yourself when you are also caring for someone else. It seems selfish to stop, to yell, to cry, to be still – there are so many other things that you could be doing – that you should be doing.

But just like the Delta Flight Attendants tell you: “Put your oxygen mask on first before assisting other passengers.”

Easier said than done.

Going into Justin’s admission I knew that I would stay the first night with him at the hospital but would head home the following night to spend some time with Bruno, our cats, and just get a good night’s sleep in our bed. As soon as, and I’m talking the minute, we walked onto the BMT unit the guilt set in. It was a pit in my stomach, a swarm of butterflies, all erupting at the thought of leaving him here to go back home the following night. The swarming caused this kneejerk reactionary crying that was unstoppable. I tried to hide it, to just swallow it and be present. It didn’t work.

I spent a good portion of our first night in the hospital and most definitely the second day crying about leaving Justin to go home. I asked him repeatedly if he would be okay on his own, knowing that he would say yes, and most likely needed me to get away from him for a few hours. He always said yes. Always.

As the hours ticked by the guilt was crushing me. How could I leave him here? Why am I reacting like this? Why am I not stronger about this? I felt so incredibly sad about him being in the room alone, and me in the car driving away from the hospital.

It’s strange being in the hospital for an extended amount of time. You lose your bearings and grasp on the real world, you forget about everything outside, the hospital campus, the hospital itself, and ultimately live life on a single floor. You forget what is going on around you. The realization of what’s going on out there while you’re stuck inside is paralyzing and overwhelming. I didn’t want to become part of the outside world while Justin was still stuck inside.

After several text message exchanges with my mother, a good friend, and conversations with Justin, I packed up my things for the night. I procrastinated on actually standing up to walk out the door. Started random conversations, putzed around on my phone, smiled at Justin with tears in my eyes. I was a mess.

Finally, I got up the courage to just go. I kissed Justin goodbye, asked him one final time if he would be alright and made him promise to call me, text me, and Facetime me. The waterworks started, he laughed at me, and pushed me out the door. I managed to make it to the car without having a nervous breakdown, drove the 20 miles back home, pulled into the garage, walked into the house, greeted my puppy, and collapsed on the bed crying uncontrollably. Bruno licked my face, laid down next to me, and once I felt like I had sufficiently gotten my emotions out, I set out to make some dinner and get ready for bed.

It wasn’t until the next morning, after getting a full eight hours of sleep, having the luxury of making my own coffee and breakfast, and being able to spend a few hours at home better preparing for my next trip to the unit, that I realized just how necessary that time was. I felt so much more refreshed and prepared to spend another night at the hospital. You see, I wasn’t doing anyone any favors by feeling guilty about needing to take time to recharge. I was nothing but a crying mess for 36 hours, and I’ll tell you what: crying messes are not useful in the bone marrow transplant unit.

I learned a valuable lesson with this new chapter over the weekend: taking care of yourself is imperative, and giving into the guilt is not an option. No one can be “on” all the time, it’s not a realistic expectation and chances are, no one expects you to fill quota anyway. Take time, be still, breath, recharge, and go back in the ring.

The New Normal: Five Years Later

EJFP ChaptersYesterday was five years since Justin’s original diagnosis of lymphoma. Five years. 1,825 days. It seems crazy to think about what has happened since August 10, 2011. I remember that day, vividly. We woke up from our sixth overnight in the hospital. Justin was two days post-op for his mysterious artery entrapment syndrome. My parents had cut their vacation short to come home to help me take care of things while Justin was in the hospital. I was focused on getting home. We were happy because we knew it was Justin’s release date, but irritable through the hours of waiting to walk out the door.

The medical assistant finally arrived, he was one of our favorites. There was one final scan Justin needed to do before they literally pushed him out the door. I wish I could remember his name. As he was getting Justin ready to take downstairs for his final test a young doctor walked in. He was the hematologist that had been referred to us after they discovered the enlarged lymph node in Justin’s abdomen. A biopsy was just a precaution.

“Justin is thin and I’m sure his lymph node just LOOKS bigger on a scan.”

I honestly hadn’t even thought about the biopsy results, no one made it seem like a big deal. Our focus was his leg and rehabilitation toward walking again. But here he was, this doctor I can’t describe as anything other than an awkward hipster looking man that looked no older than I was at the time. I was 27.

“So I’ve spoken with the lab and it looks like we have an “unofficial” diagnosis of non-hodgkin’s follicular lymphoma. It’s not confirmed yet, but that’s what it looks like. This is what we consider a watch and wait situation so my office will call you in October to set up an appointment.”

He handed me a stack of papers that looked like they had been printed from the internet. I looked down and the third word on the page was “cancer”.

“Do you have any questions?”

I was dumbfounded. Frozen. This can’t be real life. I looked up at him from my little make-shift bed and smiled, with panic in my voice I said “um…I….well…no, I guess not”

“Okay, well if you think of anything let me know. Good luck with physical therapy.”

And he was gone. Never to be seen or heard from again.

The medical assistant continued to help Justin transition to the wheelchair to take him to his final test. Realizing he was still in the room, I looked up at him and took in the look of shock on his face. He was just as shocked as I was. We made eye contact for a moment and he snapped out of it. This man that I can’t remember the name of witnessed one of the biggest moments of our lives. The moment that everything changed and I can’t remember his name. I think of him every once and awhile. I wonder how he is and if he thinks about that moment too.

That was the day that I learned to hold in my emotions and control my tears. To think through things and hold off on exploding until I was in an appropriate space. It was the first time I understood what people meant when they said they felt “numb”. It’s a very accurate description. I was numb, tackling what I could, one day at a time.

August 10, 2011 was a lifetime ago. I am a completely different person than I was when I woke up that morning. I have watched Justin go through two additional occurrences of lymphoma since then. Five treatment plans. Two anaphylactic reactions. Countless blood tests and CT scans. Hours of of sitting in waiting rooms. Days, Weeks, Months of being numb in order to make it through the day. Thawing in the comfort of people that are trusted and allow you to melt just long enough to relax and move forward. One day at a time.

Somewhere along the process of getting through Justin’s original diagnosis, I started this blog. It took some time, but eventually I wrote The Last Normal Day. The story of everything leading up to our first night in the hospital. I was so exhausted that I never really finished the story. I wrote The Last Normal Day Part Two but I was so sick of telling the story at that point that I couldn’t form the words. Five years later, I found a way to form the words. I thawed a little bit this morning writing this. It felt good and was much needed.

Thank you for letting me share my story.

The New Normal: The Waiting Game

I suspect that you don’t have to be going through treatment for cancer in order to have to master the game of waiting. 

There is a systematic process to everything in the University of Michigan Cancer Center. For us, lately, and most certainly today, a large part of our process has been waiting. We are closing in on our tenth hour for the day. Day one of “lead in” treatment has been relatively uneventful, but we’ve struggled to keep ourselves entertained. I’ve buried myself in a book I’ve been reading and Justin has burned down his iPhone battery twice playing videos and obsessively figuring out jigsaw puzzles. Everyone around us seems to be moving at this higher speed. Other patients have come and gone with their families, staff have ended their shifts and packed up for the day and here we sit waiting out the rest of our time. There is one family that remains behind their privacy curtain that has some more time under their belt today. They came prepared as I have been listening to their epic Yahtzee game from across the room. 

We are all just cogs in the systematic process of April 12th in the University of Michigan Cancer Center. 

  I am grateful, after his severe allergic reaction three weeks ago, that Justin is sitting in that same chair mostly symptom free on his new treatment protocol. He has been goofy, happy, upbeat, and strong throughout this entire day. His strength has eased my anxiety. 

We have figured out how to push through the idle waiting time, we work together. We depend on each other, we laugh until we notice how loud we are, we roll our eyes, we chit chat with the staff, we eat snacks, and we take it one step at a time. 

My advice to anyone stuck in what seems as idle day of waiting: find low maintence ways to keep your mind engaged, without requiring solid focus. Years, and even weeks ago, I assumed I could use this time to work. I lugged laptops and books around with me during 12 hour hospital days to never even unzip the bag. It’s just not feasible to expect that kind of focus from your brain. My phone, a good book, a pillow, and some snacks are all we needed to make it through the waiting. 

The funny thing is, a boring day of waiting is what you shoot for. No one comes into this room expecting or wanting to have an exciting day. You aim for boring and hope that you can keep yourself distracted enough to make it to the end without becoming bitter and cranky. 

I think we were successful today. Knocking on wood the next 45 minutes remain just as boring as the last 600. 

The New Normal: Pause 

It’s a quiet Sunday at the Paff household. It’s a chilly, rainy, gray day outside and we all seem incredibly content to remain in cozy positions easing in and out of naps. I have a snoozing puppy wedged between myself and the back of the couch, a husband next to us snoozing in the lazy boy, and two cats snoozing close by. The front window is cracked just enough to bring in some fresh air and noise from the outside world. It’s like the universe put us on pause for the day. 

  
There is a long list of things that I should be doing today. I should be getting the laundry started, I should be making a grocery list for tomorrow, let’s be honest, I should be grocery shopping today, I should be bringing in all of the boxes in my car so we can start packing for our move in six weeks. Chances are I might get to a couple of those things later today but for now I’m going to enjoy the stillness in my house. I am going to enjoy quiet moments of calm amongst the chaos that has been swirling around our lives lately. We are on pause. 

Justin had ten appointments at the hospital last week. Ten appointments packed within four trips to Ann Arbor for the week. It quickly became overwhelming for both of us. They have told us that the next two to three weeks will be the craziest for us in terms of coming and going, and afterward things will become more regular as he starts treatment. I think they managed to pack those two to three weeks into one week, as the next seven days are seemingly empty in comparison, with only one appointment on the books. This will be the first time I will be working a full week since the end of January. I will have five whole days to focus on work and gearing up for the two big things that are just around the corner: clinical trial treatment starting and moving. Justin will be able to rest, play video games, and focus on conserving his energy for the first two days of his treatment starting. 

We are on pause. 

Yesterday, I spent the day with my mom, we had breakfast and then spent the rest of the day preparing my grandmother’s house for moving and an upcoming estate sale. While we were eating breakfast I was telling her about what our week was like and in the middle of talking I looked up from my plate and just said: 

“I’m not dealing with this as well as I have before.” 

“No, you’re not.” 

We smiled and kept on talking. It was that moment that gave me some clarity. 

No, I wasn’t dealing with it in the same way I have before. It’s harder this time, it’s different, bigger, more difficult, and the third time. The first time we just powered through, the second time we were more angry but we knew how to cope, we were more prepared. This time is kind of like Charlie Brown kicking Lucy’s football. Eventually we will get the football on the other side of the field but in the meantime we are taking everything as it comes. I’ve accepted the fact that I won’t be able to control everything, that I will have to ask for help from people I trust, I will cry at inopportune times, and I will have to stop feeling guilty for having to ask for time off and for being not my usual self. I will use the moments when we can pause to recharge and gear up for when I feel like I’m not “dealing” well. Life isn’t convenient and I can’t control everything. My job is to support Justin. End of story. That, I can do. 

Today is a pause day. Puppy snores and cuddles are calling me. 

The New Normal: We’re Not in Kansas Anymore

I always get excited about a new month. Nothing really changes between the 31st (or the 30th, 28th or 29th) and the 1st, but the transition from one month to the next is usually pretty refreshing. It’s a chance to start fresh, and there’s nothing wrong with that.

February was rough. For a short month it was packed with, what seemed like, more than 29 days worth of stress, worry, and questions. Some questions got answers and some were added to a list to be figured out at a later date. As if February wasn’t hard enough, it was leap year and we were “lucky” enough have one extra day. Our extra day was spent meeting with the bone marrow transplant doctor that we had been referred to as part of Justin’s latest treatment plan. Here we were again, listening to a man we had just met, explain what was happening in Justin’s body and what our next steps are.

There’s no flexibility with a bone marrow transplant. You are essentially being told that the next year of your life is being put on hold. We were shocked.

We’re not in Kansas anymore ToTo. 

This was no longer the treatment process we knew and had gotten used to.

The night before his appointment, I spent some time putting together a binder to organize all of the paperwork that we had been given recently. I was getting overwhelmed with all of the information being packed in my brain and I knew eventually I wouldn’t remember the simplest of details. I felt prepared and like I was, finally, ahead of the game. As the doctor and transplant coordinator kept talking and handing me folders, packets, study information, and things to fill out I just kept thinking…

“Damn, I’m going to need a bigger binder.”

It felt like we had fallen into another universe, and again, had left with just as many unknowns as we did answers. As we walked through the maze of the main hospital and parking garage I felt extremely thankful that Justin’s dad had come with us that day. I just wanted to shut my eyes and turn my brain off for a few minutes. I was asleep before we hit the expressway.

When Justin and I got home we didn’t really talk about the details. There was no use trying to control things now. A bone marrow transplant won’t happen for at least four months, and if we learned anything from the short month of February, it’s that we have to take this one step at a time. Stupid extra leap day.

The next morning I got to work early to make up some time I had missed the day before, eventually I realized that it was no longer February. It was a relief. It made processing the year ahead of us a little less daunting to think about. I felt like a new month gave me the motivation to leave the shock behind me, with February. A new month and a new mission.

I can’t help but think that the bone marrow transplant appointment being on the last day of that awful month was more than a coincidence. I’m not usually one to believe that things happen for a reason, especially lately, but whatever made it happen, I’m thankful for it. Justin and I have a fight in front of us and we are as ready as we can be. It will be different, more difficult, and scarier than any other battle we have seen. We’ll get through it, one month at a time.

The New Normal: Waiting. 

“We are going to have you wait here, ma’am.”

It’s not very often when I am asked to stay behind in a waiting room while Justin goes in for a test or procedure. However, when it happens, I hate it. 

I’m not sure if it’s a control thing, which let’s face it, is entirely possible but I know it’s most certainly a selfish thing. 

I want to be in the room.

I want to hear what the doctors say. 

I want to keep and eye on my husband. 

I want to know what’s going on. 

One of the things I love about the University of Michigan’s Cancer Center is that it takes into account that most patients come with a person. The hematologist talks to both of us and specifically asks me if I have any questions. I am comfortable in the Cancer Center. When we branch out into the rest of the hospital is when I start to get anxious. I’m just an extra body beyond the Cancer Center doors. I have very few complaints about the University Health System, I am very confident in their ability to provide excellent care for Justin. Over the years I have just come to realize the vast differences between being a Cancer Center patient and being a hospital patient. It makes me sad. Not sad for me or even for Justin, but for the people that only know that side of healthcare. 

I am getting dangerously close to promoting people getting cancer just to get the exceptional care that is provided. Don’t misinterpret that, the Cancer Center is full enough. 

So, here I sit in the packed radiology waiting room, about a football field away from the Cancer Center. Somewhere beyond those doors is my husband, I guess I’ll just have to wait for our 40 minute ride home to hear about what his morning was like. Either way, I will be thankful that we are here and we have experts doing what they do best. 

A little blog housekeeping: I have tried very hard in the past to not make all of my writing about cancer but it still remains a huge part of our lives on a day to day basis. I have found that writing about my experience is helpful to me. I, however, will not use this platform to tell Justin’s story. All posts about my life as a caregiver will be tagged with The New Normal. I will continue to try and maintain a variety of topics on this blog and hope you enjoy reading either way.