I Think That Managing Type 1 Diabetes Should Involve More Than Just Insulin. Here's Why I'm an Advocate of Symlin.

It took me a while to realize that I don't remember having the kind of pressing hunger that I've lived with for the past 12 years before I was diagnosed with Type 1 Diabetes. I ate meals whenever I got around to it, occasionally but rarely needed to snack in between them, and felt full after what I felt like was a normal portion size. 

My hunger crept up on me somewhat gradually, and has waxed and waned throughout my years with Diabetes. In undergrad, I was able to eat massive portions (for me) in the meal hall - a huge plate of salad piled up, chicken, vegetables, and then two or three servings of diet soda just to make my stomach feel more full from the fizz. I had a fridge in my room for snacks after dinner. Thankfully, with access to large portion sizes of relatively healthy dining options, I was able to manage my hunger quite well in college.

In grad school, I would anxiously wait in between classes to eat my between-meal snacks twice a day, barely able to think about anything else until I did. I would eat and then two hours later, feel absolutely ravenous after. I would eat a large lunch, and always try to go straight home to eat. Afternoons have progressively become the worst. 

When I lived alone, I could compensate more easily for it. I'd leave work around 5, and then eat my pre packed dinner before 6:15 yoga class. Then I'd go home and have a huge snack, usually a giant bowl of popcorn (about what you'd get in a big bag at the movies, I always made it myself) and a drink or two until I finally felt full. Life with another human was harder, because I'd have to eat two or three snacks after work just to tide myself over until dinner around 7, or I'd skip my workout all together because I was so hungry, and just choose to make dinner earlier. Having to run an errand before dinner felt nearly impossible, because all I could think about was how hungry I was, and I would feel irritated and have trouble concentrating until I could get home to make dinner, snacking the whole way through cooking until dinner was ready. I'd go back for 2, sometimes 3 portions, and still go to bed feeling hungry from eating early. 

I had read about Amylin back in undergraduate school, raising my eyebrows as I sat at my work study desk in the admissions office, wondering if this was why it felt like I was hungry all of the time. I would rush to the dining hall right at noon for lunch, and then right back at 5, like clockwork, barely able to wait for mealtimes to begin, and it felt like no matter how much I ate, I could always eat more, if I let myself. Funny enough, I actually learned about amylin in an animal physiology class as I was pursuing my Biology major, where I learned that pancreatic beta cells secreted more than just insulin. 

What I learned in a college level science course was something that no medical professional had ever mentioned to me. No one had ever told me about Amylin, or the fact that insulin was not even the only thing that my body was incapable of now producing. Amylin is a second beta-cell hormone. In case you're not familiar with the physiology of Diabetes, Type 1 Diabetics have an autoimmune disease that develops when our T-cells (immune system) attack our own pancreatic beta cells, rendering them unable to produce insulin. However, it also renders our cells unable to produce amylin, too. Amylin is co secreted with insulin, and whereas insulin allows our cells to absorb sugar and carbohydrates, amylin helps to keep glucose from entering our blood stream by suppressing insulin's counterpart, Glucagon. While insulin lowers blood glucose, glucagon raises it, and in a normal person, your body controls these two hormones in sync, allowing for perfectly controlled blood sugar levels. (Note, Amylin is different from Amyloids). 

Our Beta cells also create something called C-peptide, but I won't get into that here.

Amylin does a couple of important things. Firstly, it slows the rate of stomach emptying, meaning that food leaves the stomach slower. This is important for 1.) post meal fullness, but also 2.) Slowing the rate of rising blood sugar after a meal. It's worth noting that blood sugar rises in Diabetics post-meal or drink far faster than in our non-diabetic counterparts (in about 10-15 minutes), simply because food leaves our stomach so much faster. And as such, that means we are also hungrier quicker after meals, so not only is our appetite not well suppressed, but it's also not suppressed for as long... hence my feeling hungry 2 hours after a meal.

Amylin also helps us to feel full during meals. Amylin helps to reduce the amount of glucagon secreted by the liver when we eat. Glucagon is essentially sugar that the liver produces. Glucagon is also one of the reasons diabetics cannot survive without insulin, because your liver will keep releasing glucagon naturally into the bloodstream without insulin to suppress it. (This is why in a Type 1, mealtime insulin isn't enough. We need a "basal", or 24 hour, insulin to help suppress that glucose that enters our bloodstream from the liver. Glucagon also stimulates the appetite. So, as we eat, Amylin suppresses glucagon release, and as such, we are also signaled that we are full. Without Amylin, our brain isn't properly signaled that we are full, and as such, it oftentimes takes the actual feeling of pressure from our stomach to indicate we are full, oftentimes many large helpings and portions later, at least in my case.

Amylin is secreted in equal amounts to insulin in a normal body, and truly, our body cannot properly regulate blood sugar without it. It's a little wild to think that insulin is the sole treatment used to treat Type 1 Diabetics, and that perfect nondiabetic blood sugar is expected when we're only using a third of our beta cell hormones to manage our blood sugar.

It's worth noting that actual Amylin isn't stable enough to be used in drug form, and thus an analog version, Pramlintide, aka Symlin, was created in 2005.

It's also worth noting that lack of Amylin has been attributed to cognitive decline and low bone density in later age in some high quality studies.

Unfortunately, at the time that I learned about Symlin and started to realize that my excessive hunger wasn't normal, was also a time when I had out of state Medicaid that didn't cover anything except the bare minimum - certainly not Symlin. In fact, most insurances to this day either are reluctant to cover Symlin, or don't cover it at all. 

As I went on through graduate school and had no insurance, no access to a medical professional, and no access to consistent insulin supplies, Symlin was out of the question - I just needed to survive. But it always stayed in the back of my mind, and I managed my hunger as best I could, with snacks always packed and eaten frequently. Even when I did have insurance, it was always a struggle to afford copays for my insulin pump, my CGM, and even my insulin - so I didn't even bother to press the topic. 

It wasn't until I switched to my husband's insurance this year that I even considered having the conversation, because finally, I had access to insurance to cover things more affordably than I'd ever had before. Even my last employer's insurance indicated that my close looped insulin pump that I'd fought for 1.5 years to get was going to be a $350 copay per month, and I was so grateful to end up leaving jobs and choosing to switch over to my husband's insurance just for the peace of mind of a reasonable copay for my pump.

My fasting blood and between meal blood sugar has always been good, but I'll be the first to admit that I developed some bad habits as a diabetic who couldn't afford good care, and I struggle with injecting insulin 15 minutes prior to every meal (that's how long it takes to start working), and then continuing to monitor and adjust my insulin levels after. We don't really give enough credit to how hard it is to estimate how many carbs we're eating, consistently give it before meals (especially when you are starving because your body doesn't make amylin), and then to continue to monitor after, especially with the rigors of work and life. It's a huge mental drain. And it's for every meal you'll ever eat for the rest of your life, so hug a Type 1 Diabetic next time you see them. It’s tough out there. Thus, my post meal blood sugar control leaves work to be desired, and after 2 years of going back and forth with my doctor, with little improvement, I think we were both feeling frustrated. My doctor basically told me "I don't know what else to tell you." I had tried a faster acting insulin once, Fiasp, but I just couldn't afford the copay at the time of $190 a month for a single vial, and thus I left that experience feeling a little burned out and sticking with my $35 humalog. 

At my February appointment, I finally mentioned to my doctor that I had been struggling with somewhat insatiable hunger issues for years, and that is was causing me to often overeat, skip exercise so that I could prepare meals sooner, and I believe made it at times harder to control my blood sugar. "I can try to prescribe Ozempic," she stated, "But it's going to get denied, you're not obese or Type 2." I had read recently that GLP-1's like Ozempic could help Type 1 Diabetics, because they helped replace those hormones we don't make, but sure enough, 2 weeks later I got my denial letter. (Note: GLP-1’s differently than Symlin). I was annoyed, but in retrospect rather happy, as the lack of long term use studies of Ozempic concern me, and the side effects are difficult to manage. Symlin is a far safer fit for my body. My endocrinologist went on maternity leave, and then cancelled my August appt, so the next time I could see her was October. In October, I once again mentioned my hunger issues, and this time I pressed for her to try Symlin for me. She was somewhat resistant. "We can try," she said. "If insurance will cover. And do you really want to give a shot at every meal?"
"I want to try," I told her. Besides, what was more needles to a Diabetic, anyways?

It took a frustrating 3 weeks of back and forth to get my doctor's office to even file the prior auth, and even then, once it was approved, I was informed that my copay for a month would be a whopping $289 dollars. I spent 3 combined hours on the phone with insurance begging them to do something. Symlin is off formulary, and as such, I pay tier 4 pricing, meaning I shouldn't pay more than $250, but since a month's supply "is technically 41 days", I pay $289. After being informed that I should either "make more sacrifices to afford it if I want it" and "just ask your doctor to put you on a cheaper alternative" (which there is none, there's literally no other version on the market), and a good cry later, I found a coupon to bring the price down $100. I almost decided against it. It felt exorbitant, and once again I found myself at the pharmacy being asked "Are you aware of the price?". At least this time, I could at least pay my large copay. I told myself I'd try it for a month, and if I didn't notice any improvements, I would stop.

Despite Symlin being around since 2005, only 5% of Type 1's are on Symlin. Even my pharmacist at a busy metro Atlantra grocery store pharmacy in the Southeast told me that she had never had anyone order Symlin before, and they had to special order it. There are several reasons for this, some of which I've addressed.

1. Many insurances don't cover or it's off formulary. My insurance is some of the best there is, and even with that, it's classified as tier 4 off formulary.

2. As such, even if insurances do cover, it's oftentimes very expensive

3. It's needed for proper blood glucose control in combination with insulin, but since we can live without it, unlike insulin, it is rarely discussed

4. It involves administering a shot with every meal, which is yet another cumbersome medication to keep up with for already needle fatigued and generally fatigued diabetics 

5. It doesn't save our lives, so again, maybe it's easy not to care about it

6. It's not taught to Diabetics

7. (Opinion) Health care providers are uncomfortable prescribing it. Even my pharmacist did not know how to administer it without reading the instructions in front of me, and told me the wrong info. I had to look it up later. My doctor didn't tell me how to prescribe it at all. I just had to sort of figure it out. I was also the one who had to research Symlin, advocate for myself to be put on it, and fight every step of the way for it. And even then, my insurance makes it difficult for me, despite it being a hormone my body doesn't make. 

Symlin unfortunately also is more acidic than insulin, therefore it cannot be mixed with insulin at this time. I do honestly believe that if Symlin's importance were to be better promoted, that more studies could focus on combining the two. A few studies have tried, but unsuccessfully so far, but studies do indicate that this should be a focus for the future. 

Despite it being somewhat of a nuisance with an extra three shots every day, and despite the price, I have noticed such a drastic improvement in my hunger levels, as well as improving glucose levels in just two weeks, that I am motivated to be an advocate for Symlin. I want to raise awareness for this hormone so that other Type 1 Diabetics realize that just prescribing insulin should not be the only focus in our care. We deserve better. And for the first time in years, I finally have normal hunger levels. I wake up, have my coffee, can leisurely enjoy a light breakfast, and I don't count down the clock until lunch. I have a normal portion, feel full after, and don't have to rely on constant snacks to get through the day. I may have a light snack here or there, but I generally feel pleasantly full. My portion sizes have shrunk to normal helpings, and I feel satisfied and full while I eat, which is something I haven't experienced in years. I don't have to arrange my day around wanting to be home right at 5 to cook dinner, that extra errand before meals doesn't leave me hangry and reeling, and I actually feel in control of my meals, instead of them controlling me. It has really so drastically improved my life, and I'm hoping more discussion around it can help make it more affordable and more accessible for Type 1 Diabetics.

Many people have said that insulin makes you gain weight, but I actually think it may be more attributable to the lack of amylin. (It's natural to gain weight when starting insulin, as your body has effectively been starving without it. Insulin in studies hasn't directly been linked to weight gain).

Side effects are minimal - some light nausea in the beginning (I did have one wave of nausea the first week that almost made me throw up one time, but nothing so severe since then), and for me, a tiny bit of dizziness the first two weeks. It stings a little to inject due to its higher acidity, but it's not bad. My weight has been stable, and Symlin generally leads to just a small loss of weight (5-6 pounds), and more importantly, better A1C levels. 

I'll definitely update on my journey in a few more months. In the meantime, I feel really privileged to be able to afford to try treatments such as Symlin, and I think it highlights the important of advocating for yourself as a patient if you feel you could be doing more to improve your health and your care. 

Why I Left My Career as a Physical Therapist

A few months ago, I announced that I was leaving my career as a physical therapist. This came as a surprise to some people I knew, and others, had been expecting it as I’d been talking about my disgruntlement with the career for a few years.

I spent years, over $100,000 in student loans, and sacrificed an immense amount of time and effort while exposing myself to dangerous insulin rationing during school all for this career that I thought would be my forever job. I’d climbed the ladder to regional management, and still, found myself finally unable to settle for continuing in this career. Why?

I’ve been meaning to write about it for a while, and while I have many more thoughts I could probably share, here is the story of what led me to leave my PT career. 

A year ago, I sat at my computer desk, nervous and sweating as I got on a teams meeting with my boss and her supervisor. It was two days before Thanksgiving. She had told me on Friday that we were going to have a meeting, and I spent the entire weekend stressing about it, feeling deep down that it wouldn’t be good.  

They let me know that due to the impending and Medicare cuts that I would be forced to take a demotion back to a Rehab Director. The building that I would be demoted back to had just been sold to a real estate developer, leading residents to move out in droves, with an uncertain future ahead. I would be losing my salaried job where I managed several buildings, to go back to this one building, where with the uncertainty and move outs, I would not be able to maintain a caseload, and would be paid hourly based on how many patients I saw. I saw the writing on the wall, swallowed my beating heart, and told them that I would be looking for other jobs. My boss called me so we could talk after the meeting. “I’m sorry”, she offered. “I didn’t want it to be like this, two days before Thanksgiving on a teams call. I wanted to tell you in person. I’m sure we can work something out. I’ll ask for the highest level pay I can get for you.”

My mid year review had been excellent, and while I had inherited some struggling buildings, we were turning things around. I had a great, loyal team that I loved, and I appreciated the ability to focus more on team building and employee empowerment and less on constant direct patient care. I had never aspired to management at this job, preferring to wait before I pursued the role with more experience, but my boss had pushed me to apply for the role twice, before I finally did and was offered the job. Ironically, I didn’t even get paid much more for this role. I was honestly so speechless, and I had little to say. “I’m going to do what’s best for me,” I told her. “And when I figure out what that is, I’ll let you know.” We awkwardly hung up. I went to Thanksgiving in a funk that entire week because the job I had spent three years being dedicated to was now gone. I was still naive and idealistic about jobs, thinking that the amount of effort I poured into them was tantamount to how highly they valued me as an employee. It was especially hard for me because I had given what I felt like was everything to this job, creating a successful rehab program with the highest grossing profit in my area (impressive for all independent living), all the while establishing a new clinic at the height of Covid as a new Rehab Director with no experience. I had been a good choice for the new area rehab manager role that absorbed my multi site manager role, and I knew it, even if my region had had a higher level of independent livings, which traditionally didn’t drive as much profit as assisted livings. I had shown up, through pandemics and divorce, and driven to Newnan 50 minutes away daily for 5 months without travel pay during the pandemic (“but at least it would give me hours”). However, the choice had been made to give the job to my coworker who had been with the company for three months. I was originally told that everybody with six buildings or less would be losing their job. But I found out on a teams call a week later. No opportunity to interview for it, and no one had taken the time to tell me. That’s when my disillusionment really sunk in, though to be honest, it had started along time ago. Being a therapist drained me. I had become disenchanted early on, as a new therapist in a nursing home, between being asked to come in to complete paperwork at 11 o’clock at night, to be called back in at 6 PM for late night Friday evaluations, to being completely and utterly disrespected when I tried to put in any PTO, because we had no one to cover me. Frankly, that was not my problem, and I was more than willing to be a team player that stayed late at night to accommodate when I was there. Holidays were worked, overtime logged. My PTO would get lost mysteriously, there was black mold in the office that management brushed off, and when the Medicare payer system changed, we were told that we would now be expected to work weekends, but at least we still had a job. The black mold? I ended up purchasing a mold testing kit after seeing my fellow employees coughing in the office for MONTHS. We had insisted that as the office had flooded at least 3 times before due to poor drainage in the area outside, that we really needed new carpet. Management refused. So we swabbed the vents, under the wallpaper, and the carpets, and when it tested positive for black mold, we presented it to our boss. Suddenly, we weren’t brushed off, and corporate flew all the way in from California next day to apologize and let us know that they were renovating the gym. Once it was renovated, I put in my notice and left that setting in the nursing home for a new opportunity in independent living and found it to be a breath of fresh air. However, after three years in this new role, it was dawning on me that the same problems that I experienced in subacute rehab were also becoming problems in the outpatient world. This was hard for me to reckon with because I thought that I had found my work home, however, the burn out still crept up on me, regardless of the satisfaction that I got from my job. I felt exhausted after long days, frustrated by the lack of flexibility, and frustrated by the lack of financial growth. The office chair patients sat in was peeling horrendously, and I asked for 4 months it be replaced, assured that it would but it never was. I bought black leather tape on Amazon to patch it. 

These companies would always blame reimbursement for the lack of raises and supplies, which I understand, especially after several roles in management. However, it doesn’t erase the fact that many of us have high student loans and are just struggling to make it by. With my demotion pending, I started looking for a new job, and within a week I stumbled upon one that I thought ended up being perfect for me. It was an area rehab manager job in Georgia, and I would manage all their Georgia clinics. It was a non-clinical role, which was a breath of fresh air, as previously I had been expected to manage five buildings while still treating 50% of the time. For reference, I expected most of my rehab directors to have productivity close to 65%. This company that I moved onto definitely had its issues. The tech issues were utterly obnoxious, and there were obvious instances of clinics not up to compliance standards or having made dubious financial choices.  However, I was more than thrilled to hand in my resignation at my previous company, and try my hand at helping these clinics to grow. 

Before I left my old job, I was told that I was required to give four weeks notice, not two, otherwise I’d be disqualified from working there again. Christmas was two weeks away, and I shrugged. “You didn’t even wait to hear about my offer,” my boss said. 

“I assumed you’d reach out to me about it,” I told her, figuring the onus should have been on the employer trying to convince me to stay. But she didn’t, and I told her that it would have been disingenuous to hear her out when I knew I wouldn’t accept anyways. I asked for feedback about why an internal interview process wasn’t given, and was told that “geographically this just made the most sense.” I gave them the courtesy of staying an extra days to help with coverage, but refused to be guilted by my boss, who told me “I just feel bad for all of those patients who won’t get their therapy.” I asked about severance - they didn’t offer any because they “technically weren’t laying me off”, even though the demotion they were offering wasn’t viable. I had to fight for my PTO payout and only received it after sending a scathing letter to HR stating I wouldn’t be leaving if it wasn’t for their decision to demote and and leave me in a position where I would have unstable pay and struggle to afford health insurance. I did also call to light their lack of an internal interview process…and my suspicions about discrimination. 

While settled into my new role, in February, I learned that my new company had been taken off the public market by a private investor. One day at the end of March, an unexpected teams call was added to my calendar. I had a sense of dread about it, because nothing good comes of unexpected teams meetings. I was also still reeling from the unexpected loss of my previous job. I could feel my hands tingling in the all too familiar tell of my anxiety and nerves as I heard that several clinics would be closed over the next three months and all new growth halted. I recall thinking to myself, which clinics am I going to lose? What pay cut am I going to take? However, I did not expect the unannounced teams call 20 minutes after the meeting ended where I learned that I was being laid off once more. I was in such a state of shock, especially considering that four months prior I had been essentially laid off at my previous job. While I hated what happened, and I was definitely frustrated about it, I did have three months at full pay, a severance package, and an incentive bonus to stay, so I appreciated at the bare minimum that I got that, at least, as it was generous for a relatively new employee. However, it was then that the disenchantment finally returned full force. I realized that operations was wearing at me, and that it was hard for what I had to do to sit in my conscience. It’s taken me a long time to realize that I really likely belong, long term, in the public service sector, and I butt heads with corporations. My personality is well suited for public servitude, and my passion for helping the underserved too strong for me to care about profits the way I should. The irony is that my second job - the one I was demoted at - was a not for profit company, although you’d never have guessed it. I have always valued people over profit, even when it has not made me the best friend of fellow operations directors. I stick up for my team, one of my golden rules is that when somebody asks for PTO, I allow them to take it, and I treat my employees with respect and dignity as should be the expectation. I level with them, I explain why certain decisions have to be made, but I am not there to make their life to be any more demoralizing or more difficult than it already is. If they needed a PT to cover because we were short staffed, I would step in. Low caseload? I’ll go screen door to door with you. Our job as a leader SHOULD be to sacrifice for our employees so that they have the best quality of life in their job possible. Yes, minding the business is why we have jobs in operations. But the business is nothing without its workers. Finding the nuance in that is what makes mid to high level management difficult sometimes, however, I felt a lot of reward in my responsibility as a manager. 

I felt in my heart that this was it. There was a finality to leaving my career this time. I couldn’t go back to a non-operations level job, where I was a therapist driving productivity, and having absolutely nobody and no one care about what quality level of care I was providing. It is demoralizing to work in fields where it doesn’t matter what continuing education you have, what empathy you provide to your patients, that you go the extra mile. It’s an afterthought to the one thing that does matter to so many therapy companies: productivity and contribution margin.

At the end of the day I was a number on a spreadsheet and I knew exactly what the numbers were because of my roles. 

In April, I received another little surprise in a cease and desist letter emailed to me by my previous employer stating I was violating my non compete by poaching patients and employees. I had had two employees from my old company I’d hired, one who was already PRN with my current company, apply for a full time position with us and leave her previous role, and another I had met once at a building I didn’t manage coincidentally apply to one of our open roles. I had written evidence of encouraging patients to stay with my old company because I was not practicing clinically, even though they contacted me. I wrote them back a scathing letter in response, never picked up the physical letter mailed to me from the post office, and never heard from them again. The clinic that they had offered me a demotion in ultimately closed that fall. 

I began the arduous role of trying to tailor my résumé once more for non clinical jobs. I had tried back in November when I went on an application binge after I learned about my first layoff. I did not hear back from a single one of them. I knew how hard this was going to be, and I put it off for a while, because I had time, to be honest. I struggled with knowing what I really wanted to do. And I played around with the thought of going back to school, if anything, because I just couldn’t stomach the idea of going back to rehab. I was burned out and felt that everything that I’d gone to school for was for nothing. No one cared that I had a doctorate, and it felt like no one saw past my clinical experience. But I used AI to help tailor my résumé, and I applied to job after job after job, hoping that I would hear back from something. Finally, after weeks of this, I had the idea to apply to a role that I had seen at work in my previous role. I liked the idea of account management, as my favorite part of my job was the connections I made with people, but I just couldn’t seem to break into it because I didn’t have any sales experience. However, I did have experience in therapy, and therefore I applied for an account executive position for a home health therapy company. The argument for why I would be a strong candidate was an easy one given my regional level experience. I sold therapy, in a sense, every day to stakeholders within my role. Within two days after the interview, I had a job offer. I took a day to ponder it, and then I accepted it. 

Four months later, I have not looked back. My quality of life has changed drastically, and while I still have days where I feel like I am on a steep learning curve, days I work late and stress, and I beat myself up feeling like I have to do better, I have learned so much in the past several months, and I know that I will continue to learn and become stronger in my role. The job flexibility has been absolutely incredible, and I can’t imagine going back to my previous clinical or even clinical operations life. 

My experience unfortunately gave me a lot to think about when it comes to the world of therapy. It’s probably obvious to many that I’ve become very bitter towards therapy. And I probably should’ve known more as a young adult about the career field I was getting into. I found myself feeling restless because I had very few job prospects for growth, and I was already getting paid at a level where I couldn’t expect to see further pay raises. Many of us are lucky if we get a .5% increase for cost of living and merit once a year all rolled into one. Many of us get nothing. And even that is at the discretion of companies who lately have been slashing rates and pay due to declining reimbursement.

After working in operations I feel very strongly that there are a lot of things wrong with healthcare. It’s no secret that workers are burning out. The for profit system is quite frankly burning all of us out, and workers are tired of being treated like a commodity with no humanity applied to the work that we do. Too few managers or corporations care about the value or the empathy we provide, but rather the profits we drive. Too many leaders are too far removed from clinical work and it reflects in the poor morale they create within their teams. And yes, I understand that businesses to an extent have to operate like this, but they deny time off for holidays, don’t pay for advanced ceu’s, give you $10 as a thank you for Christmas, slash your 401k match for the year, and freeze your pay while expecting more and more from us each year. Every second of down time in our day is criticized and counts against us. Employees are written up if they have to take the day off for sick kids. We’re treated as though client cancellations are our fault. Some companies expect 95 percent productivity or higher with no built in time to review a case before a new evaluation or assessment or to do the very specific and arduous level of documentation required for therapists to justify why insurance should even pay us in the first place. 

When therapists ask for new equipment, such as a Sara Walker in a SNF because we have nothing to assist us in walking high acuity patients, we’re told there is no money for it. When we needed new wheelchairs whose brakes worked, there was no money for that, either, even when these facilities were marketed as rehab facilities, and even when they spent a week training us on their proprietary “wheelchair management” and fitting program with the design of bringing more long term patients on caseload.

Broken equipment goes unfixed for months, you’re questioned for ordering more than one box of gloves, often forcing us to have to go to the store to buy our own if we run out, and we’re asked to market programs that companies won’t spend money on to ensure we have the proper materials to implement. 

We are expected to work holidays and take no time off around the holidays with no extra incentive or pay except for the goodness of our hearts (and we wonder why no one else is willing to cover the holidays when we offer no incentive to do so). When we do ask for PTO, we are asked by our managers if we have someone to cover us, even though it’s their job to ensure that workers have coverage so that they can take their hard earned PTO. For many of us, no N95 masks were provided until well after the pandemic wasn’t as life threatening, even though we had to get up close to patients daily. We don’t provide adequate rest periods or time off for healthcare workers who work in extremely draining and people forward jobs, and for the record, a lot of us don’t even get so much as a pizza party for employee appreciation. I was once given a $100 budget to allocate between 15 employees and 5 buildings for Christmas gifts. 

Is it really any wonder why therapists don’t want to be therapists anymore? Yes, there are still plenty who do, and I think some people were just born to be therapists. We need those people. And I’m not implying that my experience with my employers is indicative of all employers.

But then there are some people like me that wanted more, and just got burned out by this constant cycle of being gaslit by my employer for needing a raise or asking them how I can document point of care while grouping several patients or doing a hands on, manual therapy heavy evaluation and giving patients the face to face time they need to build rapport with them as opposed to having my head behind a screen. It doesn’t sit right with me to even continue to work my way up the management ladder when I know that I’m just perpetuating unrealistic standards for my employees that I’m somewhat powerless to change. Yes, I can and have advocated for my employees, but I am one person and will not change an entire company. 

Our reimbursement continues to be slashed, and with it, our pay, while tuition for schools increases. I make now what I made my first year as a new PT in a role that expects no more than a bachelors degree, with the potential for bonuses that many of my established coworkers enjoy, indicating that they are quite feasible.

Our lobbying companies lobby for us poorly and charge hundreds a year for a membership. 

Stability is few and far between as companies often pass hands, leading us to rocky stability in our health insurance coverage, 401ks, and quality of life.

We’re pushed to see people in “groups” in rehab facilities, leading to sub par care, and high patient volume and insurance dictating reimbursement has led to treatment times being cut short for certain insurance types, meaning you often can’t provide the care that you want to to patients. The high patient volume we are expected to see is exhausting and further perpetuates burnout.

Once you’ve reached your max pay, there is little to no room for pay growth, leaving you in a position where cost of living consistently erodes away at your ability to afford to live.

Insurance companies don’t see the value in therapy, and it’s frankly hard because of our model of requiring several visits from patients who many times have high copays. This has left many people to go to cash based, which if it’s for you, I think can be great, but is also difficult for those who cannot afford it, especially the geriatric population, whom I have a special place in my heart for. Technology has a real ability to transform therapy for the better, but few practices will take the time to invest in it or equipment proven to help maximize outcomes, leading to insurances still expecting more results in fewer visits, and many places unable to deliver, resulting in a model that many patients may feel is ineffective. 

So? I decided to walk away. It just wasn’t for me anymore. I crave growth, the ability for my time to be valued, and more possibilities than what the therapy world could offer me. 

I still keep up with some of my old patients and I’ve absolutely loved seeing the magic that therapy can do, but I find myself so much happier having removed myself from that world now. Am I letting my license lapse? Certainly not. But I also won’t be back any time soon. 

29.

 

My older patients call me melodramatic for mourning the final outpost of my twenties, and I guess they're right. It's really nothing to mourn, not in the grand scheme of life. 

29 years is not a long time to live.

But still, the saying that youth is wasted on the young is true, and even at the young age of 29, I can't help but reflect on the years I wasted not for what I haven't accomplished, but rather for how much I underestimated how quickly they would pass. 

It's a funny thing to go from always being the youngest in the room, to slowly aging and becoming "that" adult. The slightly too-worn out, stressed one, who has seen a thing or two and occasionally mutters little cryptic, vaguely jaded words of advice. Trust me, I've learned the hard way, but now I'll actually have been around long enough to mean it, because young or no, I really have seen a thing or two. 

I'm old enough now to also temper the chips on my shoulder. The price you pay for surviving hardship is that childlike, carefree sort of innocence, and the prize you win is strength and fortitude, if you let it be so. But still, try as you might you'll feel a little jaded, hearing people say, look how much you've overcome while you feel like those too-hard edges and the sensation of keeping your back to a door that's about to fall open with life stuff while you desperately try to keep it pushed shut to hold it all together is too hard a price to pay sometimes. 

But I ramble a little bit. Surveying my life, I'm actually quite pleased. I feel like I've tempered many of my experiences into meaningful stories, and my advocacy efforts have landed me a couple of news stories and articles, some small time fame. I feel more plugged into the human experience, able to better listen with compassion and manage my emotional edges in a more productive manner. Financially stable, good job, a home, a marriage, even. This is a beautiful life I've had the pleasure of creating in my late 20's, and at least, I feel I've shaped the life I wish I'd had in my early 20's. I'm grateful for my hardships, too. How much it's given me to think about, and how much it's inspired me to be candid and share my stories for catharsis and perhaps, as a bright side, to be a little beacon of hope to someone out there. 

If I could go back and tell myself things at 21, or at 26, I'd whisper, don't you know? It's actually all going to turn out good. Really, really good. Hang in there. And I probably wouldn't believe it, but it would wriggle in the back of my mind a little bit, at least, and I'd think of it throughout the years. 

There is, all in all, plenty to reflect on in this beautiful year of my life - my engagement, the pain of losing my beloved childhood cat and truly, my best animal friend - our beautiful trip to Scotland and our elopement. Sifting through all of this, in honor of my birthday, I'll share a little story that truly represents the metamorphosis my life has endured in the last 2-3 years. How it's become full circle: balance restored, for what it feels at last, in many tangible and intangible ways.

It started this April, when I went to church with an old friend of mine named Hannah. We took a walk after the sermon, strolling the shaded sidewalks of Oakhurst, aptly named for all of the trees, sipping iced tea as we walked, Hannah eating a bag of coffee store trail mix. Hannah was telling me about her small group.

Have you met this person? She asked as she described her. I told her no, but I had a feeling that I knew who it was. My friends had talked, over the years. Even my mom had. It's the funniest thing, Hannah went on. She told me about how this girl had had a really hard time in her relationship in the last year. Then finally, a few months ago, she had decided to exit the relationship. Hannah recounts feeling so elated for her, at her growth and her strength - at making the right choice. 

So I asked her who she was in a relationship with, Hannah told me. 

It was my ex husband. 

I became really quiet.

Are you okay? Hannah asked. I nodded my head. "I am..." I said. "I'm glad you told me. It's just hard. I really thought he would change." 

I went home to get ready for my gig and I texted my exes ex-fiancée, who had ended up messaging me back when I first started writing about what happened, and thus began several conversations on and off throughout the year after everything in 2020. I had found so much comfort in hearing her stories. They made me feel sane - like I hadn't made everything that had happened all up. 

I feel really sad, and weird, I told her. I hate hearing about someone else he's done this to. I hate hearing about how he hasn't changed. 

Still, for my wistful sadness I laughed at the sheer chance of it - that somehow all of our paths had started to cross in this strange way. Her and I sharing stories of the person we thought we knew. My friend happening to cross paths with my exes ex-girlfriend. For being such a big city, Atlanta is small, in some ways.

It was about 2 months later when I got the message at work.

She messaged me and said, I think we dated the same person. I was wondering if you'd maybe like to talk. My heart raced. I never expected her to reach out to me. If anything, these people are the kind of people you never get along with. But I have always loved candidness, deep conversations full of meaning, same as I've never really known how to do small talk all too well when I've met a stranger. I'd much rather jump into the serious things, and I've never shied away from telling a story. So I messaged back. Yes, I was married to them for 4 years. And yes, I'd be open to talking.

I was so nervous having coffee a few days later I embarrassingly had to take one of my leftover 2020 Klonopin, even though I didn't like how tired they made me. We had a lot of commonalities. We both embroidered. We both liked poetry. Homeschooled. Quite enjoyed Grimes, even post Elon Musk. We both wrote. It felt incredibly special, to be able to meet this person. It felt incredibly special to be able to share our experiences. She told me about how she'd read my blog. How she hadn't believed it at first. But then the same things started happening to her, and she started to believe it was true. The amount of stories we shared were staggering, each one helping me realize more and more what an empowering thing exiting this relationship was. It helped me recognize the patterns I had missed, how they simply repeated themselves, over and over. 

Listen - although it can be hard to talk about, I think this is an important thing to say. For all of your healing, there are still going to be things you might have still wished you could change. There will still be things you might question. And it can be hard to watch someone move on and wonder, what if there was just something wrong with me? I have lumped a lot of blame on myself over the years. Despite telling myself it wasn’t true, I have hurt in having been told that I caused someone’s addiction. I have hurt in being told I made it all up. You’re a liar. Just a negative liar. I knew it wasn’t true. I never shared my story to gain power over someone, but rather, to reclaim my own. But still, those words had an impact. I think I settled on just realizing there were two flawed individuals. But after hearing how so much of the same blame and deflection happened to someone after me - after hearing about how the tall tales of recovery that would happen in spite of me never came to fruition once it was all said and done - well, I started to feel a shift.

Yes, I wish I had changed things sooner. I am sad I didn’t reclaim my life years prior. I am sad that I allowed myself to be used and lied to, as two other people were. But striking up this strange and unusual friendship with this person helped free me from so many old thoughts and helped me finally be proud of how strong I was to have come out of this on the other side and thrived. It helped me to further see the past with greater clarity for what it was: I was caught in the sad spiral of someone with an addiction who would do anything to lay the blame on anyone but themselves. And while I will never change their narrative, I feel powerful in knowing that my lack of silence has helped me find peace and helped someone else to find peace, too. I will never be a woman silenced. I have never regretted sharing my story, and you shouldn’t, either.

The catharsis of knowing this person has been life changing, and they've become a friend I never thought I'd have. It has felt like redemption, honestly. I had made my peace long ago. I had moved on into the most profoundly wonderful relationship I'd ever known. But embarking on this friendship was and has been power. It's been a thing of beauty. Women looking out for each other. We have all been - all three of us - through not only hardship, but a shared hardship, and we'd come out of the other side of it. We'd helped each other process the difficult things. We'd laughed over each other’s stories. We'd created a Spotify playlist. I have been so grateful. Yes, that chapter where that relationship held power over me has closed in my life - the dust has settled, the book set back on the shelf. But I am reminded that words are power. What we say carries weight. 

It has the ability to change and shift your life. It did for me, for the better. And if you’re looking for that sign to share your tough story, maybe this is the sign that you needed. For some of us, your story is just the push we needed. To get there or keep going. When I wrote my story those two and a half years ago, I knew people would read it simply because, yes, hardship is an interesting thing to read about. But I never imagined who would read my blog, or what it could do. I didn’t think I would ever see the full impact of sharing my story the way that I did. The validation of our shared experiences gives us strength. Let us all strive to make ourselves more vulnerable.

One Year Later.

One year ago, I steeled myself as I opened up my laptop and clicked the zoom link sent to me. I felt robot-like. Emotionless, guarded. I nodded my head and provided a curt "yes" as it was required of me. Yes, I wanted to keep my name the way that it was. It made no sense to me to return to a name that belonged to a father I didn't speak to. Yes, I was sure. No, I had nothing else to add. What would have been the point? It wouldn't have changed things. I just wanted it to be over.

As the judge ruled from across a computer screen that the divorce was final, I took a long exhale and shook as I opened up my blog. I had a long cry, and then I wrote about it. Then, I went to work. It didn't seem worth it to make the day any more than what it was. It was both monumental in what I had left behind, and a new page from which I was finally free, after many years of hurt. A symbol of moving on for which the real groundwork had already been done over many hard months. There was nothing left to mourn, nothing left to say goodbye to. Every bridge had already been burned, and with it a cloud over those old memories settled, permeating how I saw those last 5 years of my life. Things would always be different from that day. But that was a closing part of moving on past what I had already grieved for in the months previous. So it didn't make sense to stay home and mope, it made more sense to just step outside and keep going. After all, Covid had robbed me even of a final encounter, of the satisfactory feeling of watching a book close on an old chapter. A zoom call to settle things felt merely like a pantomime that failed to assign any real relevance to such a large event. At any rate, truth be told, I'd had enough of that over the summer. Afternoon after afternoon of sitting on the sofa, staring at the ceiling and wondering how coming home to an empty home would ever feel normal. I forced myself to observe solitude for many months. I needed to: needed to know I could be alone. Needed time to read the books my counselor told me to. Needed time to process both sides of what happened. Needed time to be okay to accept that there was no going back. Needed time to remember how happy I could be outside of a relationship that was wrong for me, but that I clung to out of fear. 

I had spent a long time deciding whether this was what I wanted even after the choice was no longer mine to make. It took a long time to accept that it was happening, and that was hard, too. It's one thing to decide that something is right, but another to follow the steps that make it more and more real. It's hard to step over to the other side of what was once an idea, to the final result, the one that cannot be undone. It's sort of like thinking about having surgery for a while. You know it needs to be done. You accept that. You schedule the appointment. But sitting on the operating table waiting to be put under, you are fearful. There's a realness, a sense that you cannot any longer go back. You know that when you wake up, there is no changing your mind: what's done is done. Deep down though, I knew that this is what I’d wanted for a long, long time. It had actually never even been a question of that, not really. It was a question of whether I was strong enough to come out on the other side of what I needed to do intact. Did I have the strength to follow through? For years I had decided that I didn’t. So I decided it was better to try to be happy in a bad situation than to risk it with the unknown. 

Spoilers: the unknown is usually not as bad as we make it out to be. I wish I hadn’t let it scare me the way it had. 

That isn’t to say it wasn’t the hardest thing I’ve ever done. I’ve had an overall very fortunate life with some very hard things sprinkled throughout. More than anything, I’m just proud of the strength I’ve cultivated to survive the hard things. Even if to no one but myself, I feel I’ve proven I have what it takes to get through the downs, especially the really, really low ones. Even with that, this almost broke me. There was a time I thought I would never recover. Everything felt grey, my joy evaporated like the water I used to water my plants in the summer. There was pain that hurt my heart so immensely I thought I would sink under it. I don’t know how I made it. But overused as the saying might be, what they say about it being darkest before the dawn is very true. The dark was darker than I’d ever experienced. But even that small sliver of sunrise that came after gave me just enough to hold on. 

It was hard, but ever since that day, and now standing on the other side, I've never felt so free. I remember a night about a year and a half back, before COVID, out with friends at the time. They asked how I was doing and over the pounding music, the throngs of people at the bar of our favorite mexican restaurant, I leaned over and said, "I'm so anxious. All the time. I don't know what's wrong with me. Maybe I should see someone? I'm just so unsatisfied, no matter what. I'm always trying to find the next thing to distract me." 

I never made any secret of my anxiety to my friends, but truthfully, I struggled with the weight of it more and more as time passed. I really started to wonder about what could be wrong with me. One day as I was taking a shower I realized I'd just woken up with the feeling that I was tiptoeing over glass and it never fully went away. Sometimes, it was a dull ache. Other times, it felt like a shard of it was lodged in my heart, hurting with every beating motion, and I couldn't figure why. I found myself loathing quiet moments to myself, my mind taking them as an opportunity to wonder deeper about why I couldn't avoid the worries growing ever louder in my mind. 

I've actually had quite a few friends go through divorce now, especially this year, and I shake my head and wonder if it's really true that young relationships don't last. I don't think that's always the case, but without even realizing, I changed and realized I didn't like the things I thought I did, I wasn't the person I thought I was, my priorities were very different than I had ascertained them to be at 22. Without a guidebook, I felt the parts of me that I wanted to nurture sat in the shadows, unable to realize fully what I wanted to be. What was harder still was perhaps having an idea of what those parts of me could have been, had I chosen differently.  

Do I regret how things happened? A little. I wish I had been a better communicator. I wish it had been a cleaner break. I wish I hadn't waited so long, hadn’t changed my mind the first time. I had sat on the steps outside my apartment, largely quiet as my mom spoke on the other side, years ago, back when I was a new bride and had been sideswiped by the drinking episodes. "Ask for an annulment," she'd urged me. "You didn't know about this before. That's grounds for an annulment." I did look into it. In the state I was in, it was hard to get one, hard to prove. People online said your request would get denied. But part of me held me back from searching deeper. I even applied for my physical therapy license in Florida, knowing that if I didn't make some monumental point of leaving, I might never be able to extricate myself. But when it came time to take the Jurisprudence test, I never followed through, letting the link to sign up sit untouched in my inbox. 

All of this taught me a few things.

I've learned that letting yourself truly and deeply suffer to spare someone's feelings is almost never worth it, no matter how noble you might be trying to be. The suffering has to have somewhere to go, and inevitably it falls back to both parties. 

I've learned that being alone isn't half as bad as being with someone not right for you. It might not feel okay at first, but I promise you, it gets better. Hobbies, trips, friends, counseling will save you. It doesn’t get better all at once, but little by little. 

I've learned that anxiety can be a manifestation of buried feelings, of grief, and a sign that you should listen to. If you’re uncomfortable in the quiet of your mind, you need to lean closer. Ask why. It’s uncomfortable. You may not even like the answers. But it never gets better if you don’t. 

There was a time just a little over 8 years ago now; a September night I’d finished a gig. It was my senior year of college, and Jordan came up for the weekend to DJ a gig in downtown Macon. We were going through one of our phases of talking, and it was bad. It wasn’t actually bad. But I’d realized a few weeks earlier again that I still had the same feelings I’d always had for him. I still felt the immense pull I inevitably always did to talk to him, and sitting next to him always felt like there was a magnet drawing us closer. It was bad because I was aware of how much I loved him, despite trying to push those feelings aside, but I was still in a relationship I felt I couldn’t get out of. The situation felt doomed once more to spiral out of control until I shut it down out of fear and the feeling of hitting a wall in being unable to do anything about it. 

That night, I lied. I told my boyfriend I’d be working at a gig late, but I went to watch Jordan at his show instead. I guess you could say I first realized I had really strong feelings for him the first weekend we ever spent time together a few years before when I watched him play a show. Even back then, when he looked up at me, it felt like I was the only one in the room he was playing to. It felt the same way that night. He looked up at me and smiled, and I couldn’t tear my eyes away as I smiled back. I lost myself in that moment, until a girl came over, drink in hand. She tapped her foot to the music for a while, and then turned to me. “Is that your boyfriend?” She asked. 

“Oh…” I said, caught off guard. My cheeks turned pink. “…no.” 

“Oh,” she said. “It’s just, the way you were looking at him. It looks like he’s your boyfriend.”

He finished his set, and we mingled for a while outside until it got late. One of us suggested we take a walk through downtown. We turned the corner, and as our hands brushed we grabbed each other, walking hand in hand down the street. It was such a simple thing. I’d held hands with him before, in private. But I’ve never forgotten how it felt, that outward show of my feelings, holding hands as people passed us and wondering how we looked to them: like we were together. We sat on a park bench holding each other as long as we could until I had to go home, unable to make excuses for how late I was out any longer. 

Eventually I grew tired of those goodbyes. Watching the clock. Never having enough time. 

In that quiet of the morning a year ago as I contemplated what to write, I realized this had never been a story about my ex husband and I at all, but rather a story about finally trusting myself enough to take the leap of faith to be with Jordan, a contemplation always riddled with self doubt for me. Even before we dated I second guessed myself with him. 

“What if we give dating a try and it doesn’t work out after all? What will that mean after years of believing we should have been together?”

“We’re really different, we’ll argue all the time.” 

“What if you get tired of me?”

You spend long enough losing at relationships that you get jaded. And yet, for all of my years of doubts and talking myself out of it, they never did come true. It’s been a full year now, and I still spend large portions of the day wondering if my life is real. How could I still be so happy? How could I still get butterflies every time I see him? How could I have lived so many years saying goodbye over and over again to the one person that I’ve never been able to be without?

I’d written to him, just as COVID was starting to get bad.

"I only want to be true to myself... accept these feelings in my heart, make peace with them. Letting myself have the space to feel makes me feel free, in a circumstantial way, through having the peace to know simply that it's okay to be. I close my eyes and exhale, allowing those feelings the space to exist. They live in a garden in my mind, and in so many rooms in my heart. Just this one small connection of writing to tell you this is a solace, this connection one I treasure always." 

Yes, if I could have changed things, I would have listened to myself sooner, instead of spending so long bargaining with myself, convincing myself that eventually things would be better when I learned how to quell my feelings and be more devoted. 

But I’m so proud of breaking the cycle. I have never felt one iota of self doubt in this year. I wake up and I’m at peace. It was long overdue. 

Recovering from divorce is hard. Some view it as a mark against you: a thing to be judged by. A failure. As a child of divorce, I remember growing up being very resolved that I would never get one. That was my life goal: have a relationship that lasted forever. I may have grown up in a broken family, but my own family wouldn’t be. I’d make it so. I believe I fought the concept for a long time in part because of this. But as you get older, things aren’t as black and white as you think they are growing up. I realized that just because you might still be together doesn’t mean things aren’t broken. In fact, sometimes staying in something that isn’t right is the thing that makes you broken, each of you chipping away at each other until there’s less and less of both of you to give. Sometimes, you come around the circle far enough to realize, sickly, that you were broken before you ever entered that relationship. That your past perhaps made you more prone to choose things that weren’t good for you. 

Perhaps I’m only putting a positive spin on it because I lived through it and I’m trying to be kind to myself. But if you’re going through it or you’ve been through it before, there is strength to be found through it. You’ve experienced the splintering of your entire life, lost friends, belongings, perhaps lost a home… and you’ve come out on the other side. Get the counseling, if you haven’t. It’s worth it if you can. If your counselor isn’t helping, find another.

And don’t let it harden you. Stay soft. I think the strongest people remember that that’s where true strength lies: in our ability to not let our hurts accumulate into chips on our back, but scars that we let others see to show them that we were strong enough to survive them.

Now I’m one year into the best year of my life. I’m excited to see where it goes from here. 

This is the Hardest and Most Vulnerable Story I'll Ever Tell You.

The paramedics called during the summer of 2016, two weeks after our wedding.

They had found him on a sidewalk, bloodied and unable to remember how he had gotten there. “Your husband is intoxicated,” they’d told me. “We’re taking him to the hospital.”

I didn’t know I had married an alcoholic.

What a foolish thing that sounds like when you write it. When I was 21, everything about our romance had felt like a fairytale. Two weeks into meeting him, he said I was the girl he was going to marry. 5 months later, he proposed. We didn’t spend a single day apart until our wedding, a year after we met.

Despite all of that, this is not even a story about my ex husband. It’s about the man I’ve been in love with for almost a decade. It’s taken me a very long time to be ready to share this story.

I had met Jordan 4 years earlier, when I was 17. Later, he’d tell me he saw me from across the room and thought,

“That girl is special. I need to go and talk with her.”

The briefest of conversations was the most pivotal moment in my life up to that point. That night set so many events into place, the effects rippling for years onward. We learned we were both from the same place in Orlando, and we shared many of the same circles there, in fact. When we spoke later after that night, I learned that we shared the connection of chronic illness. Mine with Diabetes, his with a kidney transplant. I learned he was a DJ and passionate about music. We shared a love of literature and intellectual conversation.

I felt a real connection with him, but I had a long term boyfriend I’d been dating for a few years when we met. Ironically, he was the reason I’d ended up in Macon…of all places. Then, he’d ironically also moved across the state after I moved there to start college. I had hoped to close our long distance gap.

It wasn’t until a year later, on the brink of a breakup, that we reconnected.

Jordan had moved back home from college, but was visiting friends back in Macon for the weekend. He invited me to coffee. We’d had a phone call just a few weeks prior, but aside from that, I’d met him only twice. When I accepted the invitation for that evening, I wasn’t sure what to expect.

I didn’t return home to my dorm until he dropped me off at 4 in the morning. Neither of us wanted to end the night. The evening had passed and the coffee shop closed. We spent the entire night wandering the Mercer University campus, exchanging the entireties of details about our lives, who we were, who we wanted the other to know. Many of us can’t notice the inexplicable shifts that occur in our lives until we see them in hindsight, marking the point where we become changed people. But that night, I felt the shift. I discovered a kind of intimacy I’d never before felt in my life. It touched me inexplicably within my soul, in a way that has never changed, not once, since I felt this shift 10 years ago. If we’d never had any interaction after that night, I still would say I’d never felt closer to another human being.

I felt giddy the next day, full of butterflies and nervous jitters, disappointed to have to spend the day working, unable to think about anything but how immensely, unbelievably enjoyable spending the night talking had been. We texted each other the whole day, and we met up that night for a show he was playing. A pull that felt magnetic coursed through me that entire day. The kind that makes you feel like you’ve only ever read about love but never felt it before. Even now, ten years later, that feeling still remains. I remember seeing him as I walked in the room and lighting up. I was so aware of everything that night: the way our gazes lingered on each other, the way our legs brushed under the table after he’d finished playing his set. His friends had driven me there, but he volunteered to drive me back, just the two of us. Every moment just sitting next to him felt like it set my heart on fire. We stayed up the entire night talking again, and no matter how many hours passed, the conversation and the company never grew old: something I still feel even today. He felt like my closest friend even after just that weekend.

The next few months were filled with mountains of consequential moments for me. Jordan told me he liked me. I invited him to my college homecoming dance, and then I got so nervous, I almost didn’t go through with it. Over Thanksgiving we met up in Orlando, spending a sunlit day in my hometown of Winter Park, somewhere I’ve always found to be an idyllic place paved with brick streets, and shadowed by canopies of trees overhead. We played chess, I saw his family’s home for the first time, we held hands in his car, I cried on a swing over something my mom had said. We shared a moment on his dock at the lake and I felt like I could have kissed him then, but my fears of moving on from my first love held me back.

When I started second guessing myself, and got back together with ex boyfriend, Jordan insisted I was making a mistake.

“If you’re so angry at me, why are you still talking to me?” I asked.

“You know why,” he replied.

“Tell me,” I pushed him.

“Because I love you.”

We reconnected my senior year, after cycles of speaking, and my ghosting, him. Each time we talked, I couldn’t remember why I had chosen not to be with him. It was always the same story: I’d reach back out. We’d start talking until well into the morning, night after night. All of my feelings would flood back. We spent so many evenings walking around downtown Macon, braving cold nights, getting coffee at Jittery Joe’s, me thinking I was finally ready to act on my feelings: always second guessing myself. I couldn’t understand what was wrong with me. I hurt Jordan with my actions, but he never held it over my head. He was always the level headed one, imploring me to see things for what they were.

Every year on my birthday, since the first evening we’d had coffee together, he’d send me a beautiful mix of songs he created, telling a story through lyrics, song titles, and concepts, about us. The very first one was titled “ideal day”, inspired by a question he asked me as we were our getting to know each other: what my ideal day looked like. They grew more intimate as the years passed, exploring the nuances of our complicated relationship.

“The only walls we’ve got are the ones we build ourselves,” one of the songs in his mixes mused that year.

By the time my relationship finally ended, my senior year of college, Jordan and I again weren’t speaking. I still had yet to realize the cause to my poor dating choices. That was in order to feel needed, I looked for men I could try to fix. These relationships were unhealthy, but they felt normal. Safe. I struggled with codependency, having grown up with a complicated relationship with a father rarely in my life, and a cold family. I would later read books that write about how codependents will push away healthy relationships for this reason: they were uncomfortable, and this is exactly how Jordan made me feel. Uncomfortable. Unsure of the feelings I was having. He knew me better than anyone, but I couldn’t explain why that also made me feel like I wanted to run away and shut him out. I don’t think I wanted to face many of the things he implored me to confront within myself. Still, my feelings were so strong, so unlike anything I’d ever felt. They ran deeper than anything I’d experienced, which was what I knew always led me back to reaching out to him. I’d always wake up one day and out of the blue miss him so much I couldn’t stand it anymore.

The summer before I moved to Atlanta, Jordan came to visit. I was so nervous. It was a tumultuous time: my ex was stalking me, his post-breakup interactions having turned very abusive, and it made me paranoid and fixated on him, worried he would show up at any moment. The weekend wasn’t at all what I’d hoped it would be: an opportunity to solidify our relationship. Instead, it became a weekend of my paranoia intensifying with Jordan's presence, leading me to shut down almost the entire time, barely sharing my feelings, and certainly not moving our relationship forward in any meaningful way. I wanted to get out of Macon, to have a fresh start in the city and wash away old memories and hurt. I came to the conclusion that I just wasn’t ready for a relationship, and might not ever be, with him. For what I thought was the last time, I said goodbye to him after that weekend and again pushed him away. I’ll always remember that weekend: how hurt I knew I made him feel. “I worry,” he told me. “That there will be a day where you’ll wake up and regret that you made this choice. Where you’ll remember this moment, and wish you could have changed it. By then, it might be too late.”

I chose not to let myself think of this.

---

I managed to forget him for two years. I well and truly moved on in my life. Then, I found that I really did wake up one morning and was struck by the overwhelming need to talk to him. Jordan had been right about this.

He’d also been right about the other part: It was too late.

Because I realized it once I was already married.

That first summer after my marriage, I had struggled, in complete isolation, with the gut punch of realizing I’d married someone who had lied to me about who they were. Two incidences with paramedics, and nights of disappearing and not remembering where he went the next day. Hidden bottles found behind the trash can. I found I grew paranoid as I second guessed every action, every smell of what I thought might be alcohol on his breath. It felt like it had come from nowhere: surely it hadn’t, but I hadn't noticed any of these signs before. And then, one day, I got that call, and it was like a switch had flipped. I went to sleep in a fairytale one day, and the next I woke up in a story I didn't recognize.

But I felt I could tell no one. How could I? The shame I’d feel admitting I married someone too soon, and only a few months after our wedding … I was too proud to tell anyone. So I buried these thoughts, as deeply as I could, as long as I could.

Deeply troubled, I spent two weeks barely sleeping after I woke up that morning. But my thoughts felt deafening, and no matter how I tried to bury them, they kept resurfacing. Finally, I did the only thing that gave me peace: I sent Jordan a message.

I felt panicked. Lonely. I felt shame and guilt. Here was the truth: if I had known that the man I’d chosen to be with was an alcoholic, if he had been fully honest with me… I wouldn’t have gone through with the marriage. I felt pain and hatred towards myself for this realization. I grew up as a child of divorce, wanting desperately for my first marriage to be my only one. I felt a strong sense of Christianly duty to honor the vow I made through thick and thin. Imagine how I felt when almost literally all of a sudden, I couldn’t rid my head of these deafening and troubling feelings for someone else.

I realized I would therefore very likely live my life in love with a man I could never be with at the same time I came to the realization that I wasn’t strong enough to leave my marriage.

I didn’t want these feelings, or the questions they left me with. I didn’t want the solution: a complete upheaval of not just my life, but my husband’s. Unthinkable pain. I wanted to be a good person.

But the pain of his addiction, and hiding it from me, cut deeply. So did the realization that we were simply a bad match. Caught up in mutual codependency and naive romanticism, we had failed to stop and ask ourselves whether we operated in compliment, or opposition, to each other, prior to marriage.

I felt truly lost: like God had forgotten me. I went to church. I prayed to God and I asked him over and over why I felt the way I did. I wanted to cry out in church, "Here I am. Why can't I stop these feelings? Why is trying my hardest not enough to silence my doubts? Why can't you silence my thoughts?" I questioned my life. I mourned from the pain of mistakes I felt were permanent.

“You’re going to have to make a choice,” Jordan told me. “I’m not saying that for me. I’m saying it because you making a decision that prolongs and perpetuates your sadness will only prolong this negative cycle.” I knew he was right: I had to choose whether I wanted to move forward or remain in this cycle. I again chose the cycle.

Two weeks later, my husband found emails we'd exchanged while we were on our delayed honeymoon in Europe. I had felt both elated and sad on that trip. Elated to be overseas for the first time in my life. This, overshadowed in that I felt sad at how angry I was about what had been hidden from me. I felt bitterly heartbroken at how many doubts I had about my marriage. When he found those emails, though, I felt numb, and ashamed. As he cried at me, I knew I was in the wrong. I knew what a shock and betrayal this was to him, to see that I struggled with these emotions towards another person, that I hid them from him, and for him to read about how much I struggled to justify staying in our marriage. Emotionally cheating is a heavy thing to carry. But I was angry, too, and I snapped. “If you didn’t drink too much, this wouldn’t have happened,” I told him. Was that really true? I honestly didn’t know.

When he convinced us to go to counseling, things got better. I was relieved: I wanted to do anything to avoid facing the hard questions my dilemma posed. I so badly wanted us to mend things so that my life could be stable. The questions still loomed. What did it mean that still, no matter how hard I prayed in church, I could stop neither my questioning over whether I should be with someone else, nor ease the pain in my heart?

I wanted to dedicate myself to fixing my marriage. After losing his job from a drinking incident, I encouraged my husband to go to college. I threw myself into supporting his dream of going to medical school. I knew it would keep me busy, being in graduate school and working nearly 30 hours a week myself. I preferred this to allowing myself to stop and think about things.

If I thought this would change me, I was disappointed in how depressed and unsatisfied I still felt. I caught myself hoping that my husband would slip up, to give me a reason to leave. But what would it say about me, to leave a man struggling to become sober? I think it was wrong to both of us to wait for him to make a mistake first to leave. I was giving control of my life to someone else.

But I was too fearful to end things, worried about the pain I would cause, worried about the shame I would feel. Worried about what people would think, and filled with guilt: I felt I could never hurt someone I care about that badly. I promised myself I’d stop giving into my feelings, stop all communication with Jordan, and I did. It hurt me immensely to do so, and I wrote about my unhappiness and pain in my journal, which my husband picked up and read one day without telling me, then later confronted me on. I didn’t know how to make things better.

When the accident did happen, it shocked and shattered me. He showed up to swing dancing, drunk, a little over a year later. I remember laughing about that day in morbid humor: the day of the solar eclipse, the day people thought the world would end. It didn’t, but my world felt like it did.

He’d told me he would meet me there since he was late getting back from seeing the eclipse. I’d just started my first job, and had had to work. He drove my car there, and ran up and violently shoved off the partner I was dancing with, screaming in the middle of the crowded floor. My mind felt like it shut down. I sobbed, running out of the dance. Dancing had been my “place” for years. My happy place, my safe place. It’s where my husband and I had met. I felt violated and ashamed at the scene caused. I drove across town alone to a parking lot and sat there, after calling my husband’s mom, letting her know what had happened and crying over the incident.

It had been months since we'd talked, but I called Jordan. Instead of admonishing me, Jordan told me gently, “This can be the last time you hurt like this, if you want it to be.”

For almost year now, I’d tried denying my feelings. What if everything was all in my head? Was this merely something I clinged to for escape from my unhappiness? Would I feel this way if my husband didn’t drink so much?

I needed time alone back home. I saw him after 3 years that fall. When I did, I couldn’t breathe. My heart raced. Everything I’d denied myself came rushing back: just from literally seeing him. The most wild and long-burning love I’d ever known. In that moment, I knew it was never just in my head. I’d been waiting for years to allow myself to accept that this was who I should be with.

I planned to end things and move back to Florida. But when I returned home, the pain I anticipated leaving would cause outweighed the truth that I had lost the ability to be happy in my relationship. When he implored me to, I told him I would try again. I shoved away the future I hoped for. The words Jordan had once told me rang in my ears.

“When sacrifices cause us deep unhappiness, in the long run, we aren’t even doing the right thing anymore. The sadness will come back around to ruin the original sacrifice. The cycle will continue.”

He promised to stop drinking this time. A year passed. Jordan moved to Atlanta for work. I told him I still couldn’t be with him. I pushed myself to stay away.

“I made a promise,” I said. A hundred social ties still bound me to a marriage I felt trapped in.

“So did I,” he told me. “I told you I’m going always going to be here for you.”

We didn’t talk for another year. I told myself that I had to put my all into focusing on my life in the moment, if I was going to fix things. I didn’t expect a birthday mix that October, but it arrived. It came with a message.

“I tried to move on,” he wrote. “But I always wake up one day, and my feelings pull me right back. The biggest thing I regret is choosing not to remain friends with you. I’d do anything to take that back.”

I knew that if we began to talk again, I wouldn’t be able to ignore my feelings. As long as he was in my life, in any capacity: everything in me pulled me to him closer. I knew I would inevitably have to make a choice. Otherwise, this cycle would continue.

I fantasized about what my life would look like if I could stop letting my fear paralyze me and see the truth for what it was: I’d gotten married too young to someone who had lied about who they were. I’d married someone during a time in which I’d buried my feelings for someone else as an attempt to run away from processing old hurt and emotions in my life. But I felt I was doing right by putting every effort into my marriage to fix it. Was I truly willing to sacrifice everything to end things? I didn’t think so. That’s the nice thing about a holding pattern: all of the possibilities are present, with none of the consequences. There were a lot of consequences. I didn’t think I would be strong enough to bear them.

Nearly another year passed, and my husband promised me it would be okay if he could start drinking again. I never thought to push him to finish AA. My mom always asked me how his meetings were going. I lied and said they were going well. I didn’t know how to properly support someone recovering from addiction. I didn’t realize it was significant that he didn’t finish. I figured it was like counseling: you felt better, so you could stop going. (Later I learned this isn’t necessarily the case either). Sober, he was angry, so it was almost a relief. Then, one beer turned into two drinks. A bottle overnight. It always did. I cleaned drinks hidden behind the nightstand in the morning.

I knew this wasn’t happiness. I might have been Christian, but I had a hard time believing that this was what any God could want for me. I didn’t want to feel like I was losing myself anymore. I didn’t want to feel like a hollow shell struggling to find happiness. I didn’t want to feel like I had to drown myself in half a dozen activities just to stave off depression daily.

But I told myself this was merely my own selfishness talking. If I tried harder, I could find happiness. If I went to church more, I’d stop feeling things I shouldn’t. I ignored the next birthday mix.

In 2020, 15 months since we’d last talked, I suddenly couldn’t get it out of my mind. I decided to listen to the mix on the way home one day. I felt I was in a stable place at the time, and able to listen with impartiality. He’d sent a second mix with the first. “One I’m very fond of,” he’d noted. Titled, ISLY.

ISLY. I still love you.

I listened. The mix devastated me: it felt like every track implored me to see the truth for what it was. I wept in my car as I listened to a track with lyrics that sang,

“I have unfinished business in this life/Not ready to go to the other side/Your immortal lover.”

It made me so depressed. I wanted my heart to do something other than cause me pain. I started getting anxiety attacks. I cried during my commutes for days. I sat in my car once I got to the parking lot of work, listening to the tracks I’d heard in the mix on repeat.

Something was wrong in my life. I’d done everything the right way as much as I could. I had followed all the steps. Church. Counseling when I had doubts, or started to end things again (Even if I went begrudgingly at first). Small group. Friends who encouraged me. Not perfectly. I failed many times. But I truly gave it my all. I prayed. I journaled. I focused and worked hard to love my husband. Years passed. It felt like I tore out my heart to not talk to Jordan, over and over again. My heart felt like it beat at half capacity in the life I continued to live.

I think I had done everything the best right way I could.

And still I couldn’t escape the fact that I loved another man. What do you do when you realize that? Do you hate yourself for years, like I did? Fight it with all of your might? Push it away as desperately as you are able?

I suppose if I could tell you that I finally got my act together - that ceasing all forms of communication, doing counseling, and continuing to tell myself that I was happy fixed things for me - this would truly be a redemptive story. But the fact is, I tried all of that, and it failed. Lines became blurred in my life that I never thought could. I became a person young me would have villainized. I think it was hard for me to see the good in myself for a long time. And maybe the fact that nothing I tried to amend this situation worked made me weak: I’m not sure. But I did learn this, and it’s made me very sympathetic to stories of difficult love: ignoring the heart is something you can only do for so long. Something will give: you’ll have to find a place for the sadness to go. You don’t get to try to decide what the heart feels. I don’t know why that is. But I never could tell mine what to feel for a prolonged time. It never lasted. It always went back to telling its truth.

Eventually, if you cannot rid yourself of these feelings you have to accept that it is all real. Then, you can either choose to continue in darkness, smothering your heart, or step into the light. I’d lived in darkness for a very long time now.

So I wrote him a letter. I hurt so much that it was all I could do. When you hurt, you’ll do anything to make it stop.

I posted it in the Dropbox we’d shared for 8 years, making no grand statements or declarations, simply telling him that it was enough just to have found what we shared in this lifetime: that this gave me happiness when my days got hard.

Truthfully, though, I think I took for granted that Jordan would still be there. I think I knew that, deep down, he’d also never fully shake the very clear fact that whatever we had, we seemed to be made for each other. He knew I felt the same.

In his reply, Jordan told me he’d again woken up and couldn’t shake the feeling that he had to talk to me. He’d found my letter by accident, three weeks after I’d written it.

Just a few weeks after, when I came home and my husband was still drunk from the day before, I finally sunk with the realization that the cycle had merely continued. Pain, dissatisfaction on both ends. Deep down, I believe I had always known that no matter how hard I still tried, this wasn’t right, even if I didn’t want to. My body knew: the depression, anxiety I had developed. We’d lived separately under the same roof for a long time. I had struggled greatly for never letting myself believe that choosing Jordan was the right thing, never truly able to shut out my feelings for him. Instead, I had spent 4 rather lonely years unable to give my husband the wholehearted support he needed for a truly devoted wife. I had distanced us. I had given myself an anxiety disorder. I won’t abscond him: he continued to abuse my trust by spiraling back into addiction. He blamed me for not finishing AA. In the end, he told me that my toxicity drove him to develop a drinking problem, even though it had existed long before me. Two of us were at fault. And almost every night for 4 years, I had questioned if anything I ever did would make me feel satisfied.

Then, the pandemic felt like it had stripped everything from me that I thought was too important to leave behind.

Church. Friends. Travel. Work.

With nothing left to bury my unhappiness in, I took a long walk and then I finally told my husband what I should have said years ago.

“I can’t do it anymore. I hope that you know what your drinking has cost you.”

The week of what would have been our 4th anniversary, he left. I wanted to undo what I had done. I asked him to stay. I couldn't eat, I couldn't sleep. I begged him to reconsider. It all felt like a mistake: I didn’t feel the grand sense of freedom I thought I would. I felt pain, and disgust, with myself. Had I flippantly villianized one man to ease my conscious about being in love with another? Was this the greatest mistake of my life?

I told Jordan I needed space. I didn’t know when, or if, I could talk to him again.

Alone, I went to the darkest places imaginable. As I considered going to the hospital for my panic attacks, I sought treatment for my codependency. I went to the counselor I’d gone to for years, who had counseled me through my marriage and now counseled me through divorce. I got a psychiatrist. I still went to church online. I did a lot of talking to God. It took months of healing, months of being alone and learning how to not cry when coming home to an empty home. Months to think about what I wanted, and what the past ten years had meant. I began to see things clearly, very slowly, in the midst of that copacetic summer, I finally found, after all those years, healing.

I texted Jordan, months later. It had been 9 years. I felt as though we had fought a war. We’d tried moving on. I’d pushed him away, multiple times. Back in Macon, all those years ago, Jordan made me a promise that he would always be there for me and would care about me. Even after all the years that passed and all I put him through he never broke that promise.

Finally, it was time to bring the cycle to a close.

So I wrote to him.

“I’m finally healed enough to talk again. Do you want to come over?”

Listen to ISLY here: https://m.mixcloud.com/jordan-mcgee2/isly-mixed-by-mcgee-me/