"You Have Diabetes? Oh... I'm sorry."

Here's a fact that might make you laugh:

I'm still quite afraid of needles. 

It's flu season, and I work at a nursing home, so they encourage we get the flu shot a. to protect our patients and b. to protect ourselves from bugs that patients tend to get this time of year. And of course, health care professionals always recommend us lucky immunocompromised patients get it, because, you know. Poorly-functioning T-cells, and the like.

I was lamenting about this to the nurse who administered it, having cornered me in the office as I was searching for a patient chart and asking me if I was there to get the shot. I laughed to her as I rolled up my sleeve, methodically tapping my foot and staring at the wall, intentionally trying to distract myself. "It's sad I get nervous for these," I said. "Seeing as I give shots 6 times a day or so." 

"You have Diabetes?" She asked. "Type 1," I nodded.

"Oh, man." "I'm sorry."

I never really know what to say to people who tell me they're sorry that I have a disease out of my control. It's such a human reaction, isn't it? To sympathize. I often don't know what to say to patients myself when I see how they're suffering with particularly difficult health conditions. "I'm sorry" is our (perfectly normal and understandable and okay) attempt at empathy. On the receiving end, though, it's hard to process that, sometimes. Which is why I try with my patients to tell them that I'm there to help them function as their best selves despite whatever condition(s) might be in their chart. Back to the fact that we are more than our diagnoses.

I suppose, in my case, it's a hard thing for me to reply to because I didn't...do anything to cause this. It just happened to me, and so it feels more like a divinely intended occurrence or random turn of fate. And yes, I've spent more than my fair share of time being angry over my diagnosis. Feeling sorry for myself. Wondering why I was the one who got it out of the other statistically lucky ones. There's no answer to that question, of course. You don't get to choose. There's many things you have control of in your life - but this was never one of them. I consider it my proverbial cross to bear, in a way, one that I've learned helps me connect with people in difficult times and given me a depth to my life that has humbled me and shown me the fearful feeling of my own fragility and morbidity. So, partly, me not knowing how to reply is because I've already been through the mental leg work of lamenting my loss of former health - coming out on the other end of that, and also reshaping my identity around this disease I call my own.

It never becomes something you're "used" to, I think, and I always try to make that distinction when people tell me that injecting needles each day must be horrible but that I must be used to it by now. I'm never used to it - it will always be a deviation from the normal life I grew up with. Accustomed, yes. Adjusted, yes. Come to terms with, yes. It's a battle I fight daily, and I'm okay with that now. Because I've come out on the other end of that difficult time, accepted it, and become (what I feel) is vastly stronger for it.

Of course, my viewpoints on the acceptance of illness and hardship might be way different than yours -- and that's okay, too. Maybe, "I'm sorry", is just what you need to hear. I know I did, at one point. Especially early on. And sometimes, when I'm going through a particularly tough time, it's what I need to hear, still. This is simply how I feel when people say that to me, which often happens when I tell new people about my condition.

So I just shrug. "No need to be sorry," I say. "It's just how it happens."

Digging Into Lilly's New Patient Assistance Program: Helpful or Another Bandaid?

There are a lot of people who would say that what's happened to me shouldn't be happening. Or couldn't be happening. How can you have so few options for insulin? With patient assistance programs, coupons, copay cards, prescription discount cards, goodRx, Walmart - there's an option out there for me. People that work in pharmacy swear by it. Right?

The point of me being vocal about my journey isn't for you to judge me for how I've gone about surviving. I do understand that there's different ways to handle what has happened to me. My story is my own, though. This is what I've done to live. And the point of me being vocal is to point out the immense flaws in our system. I want to ask the deeper questions of why 3 drug companies raise prices on insulin yearly in conjunction with each other instead of being competitive and making sure that we don't need coupons and programs in the first place to afford our medication. I want to know why they blame rising costs on "research" but then publicly defame researchers searching for affordable cures and laud expensive, technology-driven systems that will keep diabetics coming back to buy more. I want to know why they claim generics are "too hard to make". I want to know why politicians feel like people with pre-existing conditions deserve to not have healthcare coverage or die because they were tossed a bad hand at genetics, in many scenarios. And I want to know why people are so passive about it. So here's a story about how you can end up being someone like me, and how you can fall through the cracks of the system. 

I think that many of you know my story up to this point, and if you don't, much of it can be found on this blog. I was diagnosed at 17 years old, and two months away from moving out of state to college. My parents are divorced and my mother is self employed. We did not have health insurance back then and we were both relatively healthy individuals. I was very fit, not over 100 pounds until I was 15, and a competitive gymnast. We don't have a big family history of major health issues. My diagnosis took us all by surprise, and we were all very unprepared for the reality of life with a chronic illness. Including the $20000 hospital bill. This all slammed me like a train when I was being discharged from the hospital and told that until my medications were purchased, I wasn't allowed to leave.

"Oh." I told the nurse. "My dad will pay for it, I guess." 

I'll never forget what she said next. "Oh, honey," she said, shaking her head. 

"I don't think you realize how expensive this medicine is." 

And she was right. I didn't. Thankfully, though, I did qualify for Medicaid due to my condition and my age. Medicaid covered my bill, pediatric endocrinologists agreed to see me under my health plan, and my insulin was covered without a copay each month. Was it ironic that I spent my life in high school denouncing programs such as Medicaid only to come to have my life rely on it? Yes. But working in healthcare, as well as having a disease of my own, I've certainly developed many new ideals and opinions when it comes to healthcare since then. My doctor prepared me for as long as I was able to keep Medicaid and see them. Until I was 21, I stockpiled insulin and I saved as much as I could. I knew the day was coming, and I wouldn't graduate college until 23, and start working until almost 24. How would I survive until then? I thankfully did - I worked, owning my own business, and I stockpiled more, and I found people - strangers, friends - who were able to give me what they had. In undergrad, I had to lie about my insurance so that I could still get Florida Medicaid as I was required to have health care at school. My Florida Medicaid didn't cut it, but if this was discovered, I'd be forced to by the school insurance since I wasn't a resident and had to live on campus, disqualifying me from residency. The school insurance wouldn't cover my medications. I put my info in every year, saying it was Georgia Medicaid, counting on the fact that Medicaid didn't answer the phone. Nobody bothered to verify the kind of Medicaid I had. So I was able to live like that until I went to graduate school. I lived off of stockpiled insulin, some expired, and was able to keep my Medicaid until that first fall, when I turned 21. The school insurance was so expensive, I'd have had to take out another loan to pay for it. An expensive private one, at that. So to cut costs, I continued to submit my old Medicaid information. This worked until my last year of graduate school, when they found out. They made me get the school insurance, then.

It had been 2 years since I'd seen a doctor at that point. Since I hadn't had insurance, I qualified for patient assistance programs. But to qualify, my doctor had to give me a prescription and fill out an application. I had never had a primary care provider, since my parents didn't have insurance. I didn't have an endocrinologist as I wasn't a pediatric patient anymore. And seeing an endocrinologist - a specialist - involved seeing a primary care provider, paying out of pocket, and then paying additional out of pocket for a specialist who required me to also get labwork - over $500-700, when all was said and done. So I went without, and opted simply for self-managing and paying for spare insulin from other people. When I was forced to get the school insurance, I made an appointment- a 4 month wait - for an endocrinologist. I paid my $250 copay and I saw him and I cried because I knew I hadn't been managing well. I was depressed. I was rationing. My A1C had creeped up since grad school. I was running out of insulin. I was not in a good place. My doctor helped give me the push to get back on track, and he got me samples. I couldn't afford my prescriptions because my school insurance didn't have adequate coverage, but I made it. 

So how did I end up here after I graduated? I felt as though I did everything right. I selected the job with the better insurance. I came to love my job. 2 months in, I learned the company was pulling out of the nursing facility I was in, leaving me the option to stay on with the nursing home under the new company, or transition with the old company, but to an outpatient setting, which I don't like. My heart is in geriatrics. I love geriatric PT, and for a gamut of personal reasons, I do love the building I work in. It is a fast-paced, high admission facility with patients with a wide variety of diagnoses and is unlike a lot of other nursing homes. I love that about it, and I've learned a lot. The company that was taking over also offered me a considerable pay raise, so despite my reservations, I opted to stay on. It was November 1. I chose an Aetna plan for the last 2 months of the year, which covered my scripts with a $40 copay, but my doctor wasn't in network. So for open enrollment for 2018, I took the survey to recommend an insurance plan for me within network with my doctor. A UHC plan came up. Before you make any judgement, please bear in mind that these months were the first in my life that I'd ever had healthcare or selected health care plans. I didn't know much about it. The plan said it covered my prescriptions with a 20% copay, and I thought this sounded reasonable, and the premium was reasonable - my Aetna plan for two people was almost $650 a month. UHC's was closer to $400. So I selected the plan and figured I didn't mind the added expense. It wasn't until January when I went to fill my prescriptions that I learned that this applied after I met my deductible of $4500 for the year. The information about the plan stated it covered my meds, but I didn't realize this was after the deductible. This wasn't going to work. I desperately called and begged HR to let me change my plan. I tried to file an appeal. It didn't work. I was outside of the enrollment period, and this involved government rules. It wasn't HR just being jerks. I understood their hands were tied. I weighed my options. My choices were to find a new job and leave the one I loved, or stick it out. I made the decision to stick it out. Since then, I've been very vocal about the disparities and the underinsured in our system. I always have been - since my diagnosis - but especially now. I interviewed for an article with Bloomberg. I've posted on social media. I've reached out to Senators to laud for witholding the pre-existing condition mandate and holding drug companies accountable for their prices. 

My recent social media post went viral and I received a lot of feedback about (more) use of coupons and patient assistance programs, all of which was greatly appreciated, as anyone seeking to help is always appreciated. Prescription savings cards aren't run with your insurance, so if a savings card saves you $100, but the cost of the drug is $500-600, this is still a great deal of money. I've applied to every coupon and savings program for all of the drugs I'm on, still to encounter this problem. Walmart insulin I wrote a post on a few weeks back which I'll refer you to. But in short, Walmart provides cheap insulin manufactured from the 80's. The Reli On, aka Walmart brand of insulins (novolin or humulin, I know they sometimes switch who they carry) are the older generation of insulins, and so they don’t provide quite the same coverage for blood sugars. They have a shorter half-life than name brand insulins. Their intermediate long acting has to be taken two times a day instead of one. 70/30 is an insulin they don’t even teach most patients to use any longer, because it’s outdated, and it has a high risk of causing increased hypoglycemia because it can be effective up to 24 hours with a peak effect at 2 hours. Not to mention the obvious, they're vials that involve the use of syringes, versus other more technologically advanced methods these days. Will they keep you alive? YES! Are they an awesome, state of the art method of giving you the best glucose control without giving you an increased risk for lows? Do they give you a good quality of life? No. They keep you alive. That is all. And I like being alive, but there is no denying it's harder to control my glucose on these medications, which I have used when I've had nothing else. 

Now let's move on to patient assistance programs. I automatically don't qualify for patient assistance programs because of the fact that I have insurance, but a few people brought it to my attention that Lilly, one of the three insulin companies, changed their program to cater to individuals with high-deductible plans like me. So I promised I would check into it, hopeful again that this might help. It didn't take me long into the application to realize I'm well above the income threshold, posted here: 

In case it's hard to see, here's the link. The income threshold for 2 individuals, as is the case with me, is $47,790 per year. The average salary for a physical therapist is $83,000/year. 

That's plenty to pay for insulin, right? Let's break that down. For the record, I'm being transparent with this because I legitimately want people to understand what it's like to crunch the numbers for yourself. That salary listed above leads to an average of $3000/per 2 week. About $600-800 of that is taxed, and then another $250 goes to health insurance + HSA contribution. Rent is $1600, then there are utilities, insurance, streaming, groceries, has, etc. I pay a larger amount on student loans to avoid compounding interest because I don't want to pay them forever, so I pay about $1100 per month. I then work gigs with my own business to supplement my income with $1000-$2000 per month. 

Now imagine your health insurance pays for... pretty much nothing. Insulin is $800-1100 minimum. Not withstanding other supplies. You do the math, and tell me how much money will get saved every month. I am not below the poverty level by a long shot. I'm well into upper middle class. But I'm in the 22% tax bracket. My insulin + additional diabetes supplies costs almost as much as my rent. Does this make sense to you now? Yes, I get it, get your priorities straight. What's $1100 compared to your life? But imagine going to school for 8 years. Working harder than anything to get there. Weigh my desire for financial stability, starting investments when I'm young, and taking mental health breaks and the occasional vacation to have time to relax from consistently working 5-7 days a week. I had my first day off in 2 months last week. 2 months. Am I wrong to occasionally splurge on myself? Am I wrong to want to save my money instead?

I would argue no. And to those who would say otherwise, I would say: shame on you. I have worked hard my whole life. I have sacrificed more than you will ever know or imagine to survive with a disease I never asked for. I never asked my pancreas to stop working. I also never asked myself to sacrifice my dreams because it stopped working, either. I would never ask that of someone. And neither should you. We as Americans should not have to make choices that sacrifice financial stability or rewards for our hard work for basic life needs. Insulin is not a choice. Insulin is a NEED. If I don't have it, I'll die. Period. If prices keep raising, I'll have to keep finding ways to make do. If insurance premiums continue to be unaffordable, I'll have to continue to make do. I will sacrifice these things if it comes down to it. It will be hard. There is no debate that I will do what it takes. But is that the way I want to live my life forever?

No. I've fought this battle since I was 17 years old, and I will always fight this battle. But it takes its toll on you. The lack of stability in my healthcare journey has been a hard one wrought with anxiety, depression, rationing, eating disorders, and the like. I know I am not wrong in wishing it was not this way. Just like I know I am not wrong when I say, again, that your coupons do not work. Your patient assistance programs do not work. Insulin/Pharmaceutical companies are using these programs as a guise in which to act as though they care about helping people like me without actually doing anything to help people like me. Too "rich" to qualify for help, to "poor" to afford my lifesaving medicines. Here is an idea instead, if coupons are that effective: make the medications cheap enough so that you don't have to use a coupon to pay for them. You'll save money not having to pay people to process the coupons in the first place. And, people like me could then afford them regardless. Until this change happens, though, I will not be silent. I will continue to fight in what I believe is the only sustainable, long term option: holding drug companies accountable for continual rising insulin prices. And I hope that reading this inspires you, too. 

To my Coworker Who Tells me Not to Inject Insulin in Front of Her.

"Ugh! Lacy! You know better than to do that in front of me."

I stare at my coworker from across the office. Our office is more of a closet, really, small and cramped. It fits about 3 or 4 people comfortably. It's where we eat lunch, do notes, or take a break from the crowded and hectic gym. It's where I keep my insulin. It's where I give injections when I eat my meals so that other people don't see me, or so I don't have to do it in the hall or gym, both more considerably open places.
I love my coworkers, but there's one who is very vocal about how she doesn't like needles. At all. I don't really know what to say to her. Do I feel bad and go somewhere else, inconveniencing myself so that she is comfortable, because she is my friend? Do I ignore her? Do I keep turning around into the corner and inject facing the wall when she isn't looking? In public, were it a stranger, I feel that I would act differently. Perhaps I might say something, as I've done in the past. When it's someone I know, I don't know how to tell her that this hurts my feelings and make her hear me. This has gone on for a year. A year of "Ewws!", and "Eek! You didn't tell me you were doing that", and, "You know better than to do that in front of me!", and, "Ugh, even though you're turned around I still know you're doing it, and it makes me shudder."

I flashback to a moment I remember vividly in my undergraduate years. I stood in the middle of the admissions office, where I worked as a work study student. I gave an insulin shot in front of my boss, whom I was relatively close to.
"Why do you always look away when you give insulin shots?" She asked me.
I hadn't realized I did that. I shrugged. "I guess I'm kind of self conscious about what people think. They think it's weird. They don't like it. Some people tell me so."
She looked me in the eyes. "Don't feel like you have to look away," She told me. "This is something you have to do to live. That's nothing to ever be ashamed of."

I remember this moment, and I look back at her, and I say sorry. And then I say, "Wait, why am I apologizing? This is my pancreas."

It's not a huge deal, in the grand scheme of things. My coworker is harmless. She doesn't mean to be hurtful. I find it funny, working in a nursing home with a lot of "gross" things, and this is what grosses her out. My needles. But I think that it makes me sad, still. My Diabetes has always been a wedge of misunderstanding between myself and other people. Waitresses will joke that I don't need diet coke. People will comment that I obsess over carbs too much if I'm discussing it with someone as I'm ordering without realizing why. I'll pay extra at a restaurant to get extra vegetables instead of loads of rice and noodles and people will think I'm picky. Diabetic dietary restrictions are tricky - they're not as clear cut as vegan or gluten free. If you're those things, people seem to understand more. If you're trying to eat low carb, an imprecise art that does help with managing blood sugar levels, people find you, at times, unreasonable and difficult. People tell me they don't know how they could ever be diabetic because they hate needles too much. I guess those people would die, as I would have if I hadn't overcome my severe phobia of needles at the time of my diagnosis.
My Diabetes has always made me someone that people stare at if I inject in a restaurant. I cover my glucose monitor screen as waiters and waitresses will nosily look over my shoulder as I check my levels, curious as to what the machine is. These things feel private, and yet they're also a part of my day to day life that I sometimes don't even stop to think about. Like pulling out a phone or putting on chapstick. But I still feel eyes on me. My husband and I were at a restaurant about a month ago, and I gave insulin while sitting next to a group of two guys and a girl about our age. After giving the first shot, the two guys stared at me while they didn't think I was watching. I saw them out of the corner of my eye. They kept glancing at me, and it made me self conscious. They all whispered amongst themselves. When my food came out, they glanced it up and down, then glanced back at me, as if weighing whether or not I could be eating what I ordered. I wanted to say something, but I also didn't want to start that kind of a conversation when I was trying to enjoy time with my husband.

I feel as though I can't complain about these kind of things, because I don't go give insulin shots in private. But going to the bathroom just to give insulin shots when in public is something I liken a little bit to someone asking you to eat your meals in the bathroom. Something that is a little bit gross and a little bit of an inconvenience. I think that Type 1 is enough to suffer through on its own, without the added stress of judgement from others for what we have to do to survive. I don't blame human nature's need to be curious, and I encourage that. I welcome questions. But I wish that you would see that I'm just trying to stay alive like we all are. I'm just having to do a little extra to achieve that each day. And I wish that you might see my injections through that lens, instead of through one of a gross needle in my skin. I don't like it anymore than you do. I don't want to be an inconvenience to you if you don't like needles. I don't want to make you cringe. The truth is, sometimes it makes me cringe, too. Because it hurts. It hurts me to know that this is what I have to do every day now. It physically hurts because of the fact that needles hurt. It hurts when they bruise. It hurts when the insulin stings. I don't want to make a show, or get your attention. That's not why I'm doing it. I'm just doing what I have to do to survive.

The Loss of Normal.

As I lay on the ground, staring up at the ceiling, heart pounding, mind unfocused, sweat accumulating on my lower back and forehead, I am tempted to think that this is normal. 

And truly, it is kind of normal. This has been my normal for seven and a half years now. Those seven and a half years feel acute. I have noticed every moment of them, every second of the presence of Type 1 Diabetes in my life. How could you not? Early on, when I was diagnosed, I used to dream of going through a drive through or eating lunch and just eating. Not stuffing my face eating. I mean, eating without thinking about it. No counting carbs, no stopping to check my blood sugar or give insulin. What would it be like to think of food as just food again? What would it be like to not think twice? For my days to not be filled with practical little math equations and calculations in my head?

I don't remember anymore. I don't remember, and that upsets me. I have to think long and hard about those times now, because it has been so long. I have to try to forget that Diabetes happened to me. Because the truth is, the feeling of normal has been erased from my life. I can hardly remember a time now where I don't think of food in the way that I do now. I could try - and have tried - to salvage that. I've tried to ignore the illness that is there, stop caring for myself in some silly protest that accomplishes nothing except for harming myself. I've had burnout, gotten tired of being a full-time pancreas. But it doesn't erase the loss of normal. Nothing does. 

We take for granted the little things in our life that are normal. Working as a physical therapist has taught me that, and so has living with a chronic illness. How many things do you - do I - take for granted each day? Our ability to walk, to talk, to remember, simply to be free to have autonomy over your schedule and when you want to do things that you want to do, or to eat food, or a number of things. I work all day with people who have lost so much autonomy over their lives because of their debility. It makes your heart ache! I cannot be mad at myself or for other people who take these little things for granted that add up to so much. I don't think it's truly possible to fully appreciate them until you miss them. I know that was the case for me. And now that it's happened, I spend every day wishing I could go back to how things were.

That sounds really sad, and it is sad, but it's not supposed to be completely sad. I do appreciate what diabetes has done in my life. I don't mean the stress of paying for it, or the highs and lows, or the needles, the insurance woes. I appreciate that it's changed me, though. Suffering deepens us. I, personally, like the rest of humanity, do not like suffering. But I do know that I am a deeper person for what I have gone through. Someone once close to me told me, "I don't know if I'd know you the same way if I had met you before you were diagnosed with Type 1." This comment upset me a little bit at first. Were they saying they defined me by it? That wasn't the case, though. They had an illness too. Having an illness has helped me to connect with a lot of other people going through their own suffering when it comes to help. Having an illness has helped me to identify with a platform I care deeply about. It's given me a lot of ground to stand on. Do I hate it? Every day. But I am who I am with it. This is my life. I have many things I love about my life, and I'm incredibly blessed, and I have found ways to make peace with the difficulty.

I am reminded as I lay on the floor, feeling too weak to get up, that this isn't normal. I laugh a little bit at that. How many little moments throughout the day do I go through these things and no one sees? I down glucose tabs as I face paint a big gig, not skipping a beat, even when my shaking hand can't keep the paintbrush steady due to a hypoglycemic attack. I'm sweating in between patients, I try to take a quick break in the office, steady my feet, drink some juice to not feel this way. Go back out to treat too soon because I can't let Diabetes get in the way of my job. I lie on the floor of an apartment that isn't mine with friends. They tell me I can eat some of their pizza, but I've already ate to correct the low. If I eat more, my blood sugar will get too high from the over correction. This is hard to explain. It's hard to explain that you don't feel instantly better after eating, either. I just wait until my body cooperates again. Every low is different. How do you explain the difference between a bad low, an okay low, and really bad low? You can't. You can try, but they don't quite understand. And that separates you from people, and you have to learn to be okay with that, and not be bitter about that. 

This isn't normal. It's my normal, but it isn't normal. I was once normal. Once, and it's hard to remember now. I will manage. In a few minutes, I'll be fine. But sometimes, I remember that this is an experience I often carry alone, when it comes to the people around me that I know. That's hard, and that's humbling. But I hope that you, the reader, read this - and take a little less for granted today. I hope you know that I feel for you, in the ways that you may suffer that are invisible to the eye. It is not easy to have invisible problems, or an invisible illness. Let's be kind to each other. Let's try to understand a little better. That way, we bear these burdens feeling a little less alone.

One of the Toughest Things I'm Learning in Adulthood so Far is... Relaxing?

Anxiety is definitely something that has reared an ugly head at me lately, and I suppose that shouldn't come as a surprise seeing as I tend to push myself a little too much. It's funny, though, because my whole life I've always thought I never struggled with anxiety - but really, I think I just didn't have a name for what I felt until recently. In school, I always used to tell myself how much less stressed I would be when I graduated, but now that I'm out of school, it always seems as though there's something else to tackle, to manage, to overcome. Then again, I suppose that could be considered adulthood. But shouldn't adulthood also be seeking a healthy balance between these things?

I've been trying to be more introspective about it lately, and my stress/anxiety certainly has traceable sources. Namely, work. I love my job - there are some days where I find my job very stressful, but if you were to tell me to find a new job, I could give you a dozen reasons why I love being right where I'm at. But, even I have had a hard time lately reconciling the love I have for my job and the stress I feel. Working in a skilled nursing home, I find some days a lot more challenging than others. The patients can be physically demanding, with a large portion of my patients being bariatric, suffering from recent strokes, new amputations, or moderate to severe dementia. Some days, I find the work very rewarding. The day I helped one of my patients with a bilateral amputation stand, I cried with him in joy. I've helped patients get on their feet in time to discharge for their birthdays. I've made special patient relationships and learned a great deal. Other days, it seems like nothing goes right. My 30 minute treat turns into an hour. I get yelled at. I get yelled at again. A patient doesn't want to come to therapy but it's an assessment day so they have to get their therapy minutes. One patient's family member won't stop hanging around the gym asking non stop questions or stopping back in as I'm trying to just take a moment or catch up on the 2 pages of documentation I have. 7 patients will be admitted over the weekend and I'm the only physical therapist currently, leaving me trying to just play catch up the first half of the week. It's a job that, quite frankly, can breed stress, and this is something I've had to be very mindful of, especially over the past month, since I've been the only PT. I am the kind of person that puts my heart and soul into my work, no matter what it is, and I want to try to make a difference in people's lives. But some days, I leave work feeling like I've done no good and my best just isn't good enough. How do you cope with the ups and downs?
To combat these things, as well as to help pay off a bulk of my student loans from early on, I've continued to do gigs in order to make extra money, but also just to give myself a break from health care and get a few hours to feel truly good at my work. I've spent a lot of time reflecting on why I find my work as a children's entertainer at times, more rewarding than my work as a therapist. The conclusion I have come to is that, yes, they are both rewarding in different ways. Therapy is a more hard-earned, disciplined reward, with not always instantly gratifying outcomes. You may work with a patient for works before those small strides add up to something truly celebratory. And what's more - the very nature of therapy, of healthcare, is different. You are assisting people through some of the most difficult times in their lives. Entertainment, on the other hand, is instantly gratifying. I'm a special occasion expense. People hire me for a specific reason and they want me at their events. People review me and praise me for my expertise. Parties are full of laughter, song, and dance. Smiles and joy. I assist people with some of the happiest days of their lives. Entertainment is riding a high - whereas healthcare can be a combination of highs and lows. I believe a balance of the two has certainly been instrumental in combating any early new-grad burnout, as it's important for us as individuals to feel that we are good at things, while being challenged to expand our skill sets and push us on to more.
However, as a result, I know I've certainly asked a lot of myself. I always thought that doing extra work might be easier outside of school, as school was certainly stressful. However, I think I've found the opposite to be the case now that I've graduated. I find work a lot more draining than school was sometimes, as much as I love it. Perhaps it's the extra responsibility, or the standards I put upon myself... or maybe it's just because I'm getting older? But I'll come home from work a lot more tired than I felt after a day in the classroom. With this in mind, I don't feel as energetic as I once was, and I find myself needing a lot more mental health days and rest breaks in between. This is not as easy to execute as it sounds, with high student loan repayment, the rising cost of living, and trying to put away savings. I have been financially stable since I was 17 years old, having built a successful business in Georgia. I opened my first mutual fund at 18, as the financial adviser gawked at me and asked me how I'd managed to save what I had. However, life in this generation is expensive, and trying to save for bigger purchases - a car, maybe a home someday, and just have more financial security than I did when I was 18 (which, I'll readily admit, I had more saved at 18 than I do now, after a wedding and 7 years of college haha) - takes a lot of work. Combine this with the tendency to load too much on to yourself, and I know that it can be a recipe for unwellness, if not executed carefully. I am my own worst enemy, with the standards I hold myself to at times.

To help, I've certainly tried to incorporate a lot more "self wellness" into my routine lately. Meditation, quiet time, weekends off, hiking, date nights, stepping away from social media, joining a church community group, consistently going to church, yoga, learning dungeons and dragons (nerd alert), picking up a book - wellness is a lot of things. As best as I can... I have a very hard time staying still, and I like to fill every moment of mine with something useful, something worthwhile, something productive. Sitting alone and just sleeping or resting is a largely foreign concept for me, something I've been trying to get better at, especially seeing as my husband is very fond of being at home. But managing stress also certainly has implications with my health, I know, and a lot of what I've been trying to do has centered around trying to manage my health in terms of Diabetes goes. Just trying to change the mindset of "I'm too busy, I'll check my blood sugar later" has been a tough one for me. Or trying to sit down when I get hypoglycemic to eat and let my sugar come back up in between patient care. Taking the time to cook healthy, low-carb meals at home. And... yes, perhaps trying to find an option for work with better health insurance. As much as I love the work that I do, I've spent over 8 years putting my health on the backburner for the mythical "someday" I wouldn't be stressed and had perfect health insurance benefits. As I've gone through adulthood, I have certainly learned, with great disappointment, that the world is not like that. Perfect benefits don't exist, or if they do, they are transient, and life in America with an expensive chronic illness is a volatile, ofttimes emotionally and physically trying journey that beseeches you to fight and advocate for yourself every step of the way. I have had to spend a year coping with this reality, after fighting to be out of school and reach the light at the end of the tunnel for so long, and I've certainly had to build my desire to fight back up after learning how hard things would continue to be. There are days when you do get tired of fighting. There are days when you get angry. Days where you wonder why things couldn't have been different, or why you were chosen to shoulder this burden. But, I think another part of seeking better self wellness for me has been to accept the things I do not have control over, acknowledge what makes me unhappy or upsets me, and focus on what I can do to change these things. As a goal oriented individual, this method has helped me a great deal to focus on what's important, and to help me lead a proactive lifestyle. But on the same coin, taking that same intentionality and turning it into intentionally choosing to relax and sometimes do nothing, and to let go of the things that stress me, has been equally important in learning what I need to function better.

This post wasn't necessarily super exciting, but it's something I've been thinking about for a while, as I enter my second year as a physical therapist, having learned a great deal and having realized how much more I currently have to learn. And it's something I've been thinking about as I approach my 25th birthday, which I'll admit I've been having a hard time reconciling with, as I feel that adulthood is passing me so very quickly. 18 feels like a lifetime ago, while still feeling like a mere year ago. And I still feel somewhere very caught in between a teenager and an adult, waiting to feel as though I belong with other adults, but never quite feeling there. I suppose as a child I never considered that many adults might feel that way, but here we are.
Anyways, I thank you (as always) for reading my blog - stay tuned for more dia-ventures in the near future.

It Wasn't Abuse Because...

It wasn’t abuse because he didn’t hit me.
This was one of the biggest lies I ever believed.

Can I share some personal demons with you? Because I’m going to tell you a story. It’s a story about me, and it's always been hard for me to talk about it. For a long time, in fact, I was rather ashamed to. Things of this nature tend to get to you like that. They make you feel that something is wrong with you, or that you don't deserve to feel better. They make you feel that you deserve all the hurt you bring upon yourself to feel. Even if that isn't true.

The last year has been a really transformative one for me. A lot of counseling, relating behavioural patterns to past trauma, and trying to work through a lot of things I've struggled with in the past - it's been healthy for me, but it's also been hard. I moved to Atlanta in such a bad place, sometimes I look back on my life and I can't even recognize that person who I was anymore. Those long days that felt as though they were dragging on without end are so foreign to me. Don't get me wrong, there were a lot of things to love about those days - life in a new city, living in an amazing townhome with so much sunlight, those white walls decorated with my paintings, finding new coffee shops, and starting PT school. The excitement and adventure of starting life in a new place and discovering new things was so wonderful. But that first year was also harder than you can imagine. I broke down in the hall at school one day during my first semester, crying at my locker. The weight of everything was making me crack, and I couldn't handle it. The intense pressure of physical therapy school was stripping away the careful sense of strength I had built around myself to deal with the difficulty of my personal life. The feeling of loss of control was terrifying. I didn't feel I had any control over anything at all.

This is what happens with abusive relationships, and it has taken me a long time to accept that term as something I have gone through. I never wanted to admit it or was "too nice" to even consider that that was what was happening to me. I told myself it wasn't abuse because of a number of excuses to try and justify the situation in my head through a lens of it being all my fault, because that's what I believed. Abusive relationships leave scars on us even before we're aware of them, you see. And then you start to think that you're the cause of it, because the other person is telling you how it's all your fault. You start to think the other person in justified in how cruel they are to you, because of how you hurt them. So it's okay for them to hurt you.
I cringe now, thinking back on what happened - but back then, I had been so oblivious, so blinded. I was only 17 when I moved to Georgia. I'd just been diagnosed with Type 1 Diabetes. I was so excited to live in the same state as my long time boyfriend. There were signs of trouble long before I ever moved here, but I noticed none of them. This was my first love. I would have hung the moon for him. I thought that he could do no wrong, and me - when I was disappointed because of something that happened, or I upset him - it had to be my fault. This was my first relationship. He knew what he was doing, but I did not. I was just being silly. I was too attached. I was too idealistic. I was too sentimental. I was too emotional. I was too, "too".

One of the signs I should have recognized was was the guilting. This was, perhaps, one of the worst things. How he'd guilt me into paying for things, telling me how selfish and stingy I was if I didn't. He'd remind me of all the things he or his parents paid for. I owed them. He'd tell me his love language was generosity, but me - I was so selfish - I just didn't get it. How could I be so selfish? Why did I look so selfish when I paid for things? Why was money a big deal anyways? "You act like you're so much better than everyone else," he'd tell me. "You have it so easy. It's so easy for you to make money. You don't understand how hard it is for me. It's hard for a man in this city to get a job. You just don't get it." It was little purchases at first. It was dates. And then it turned into traffic tickets. It turned into a suspended license. Bail for a bench warrant for an unpaid ticket. A car. A computer. Rent. It snowballed. But if I ever mentioned how it felt even a little unfair - "You're so selfish. All you care about is work and money." If I ever mentioned being paid back for anything he'd promised to repay me for, he'd bring up all of the times he had done things for me. "I don't keep score like you do. People in relationships shouldn't do that. It's selfish. That's not love"
There was the complete lack of ownership or responsibility over his life - everything was someone else's fault. But I - I was "entitled". I, who had fought for so much in my life - planned life out since middle school, studied endless hours in high school, pushed myself through college before I graduated high school, started a business to support myself in college - all at the bidding of my mother who, God bless her, I thought she was just being pushy at the time but I listened  to her advice growing up - I had obviously been handed everything, as if that was the only way to account for the worth of my merits - not, perhaps, the hard work I had put in to get there. My job, that I had made for myself, was so "easy" - I just slapped on a princess costume and made $200 at a party. Nevermind the years it took to learn the skills I did. Or the money I paid to advertise myself successfully. Or the communication skills I learned to book clients. Or the money I paid for supplies. For a job that many people say they could do, but balk before they even start at how many steps it takes to get there. But I didn't know what it was like to actually work, until I had worked in the service industry. Or retail. Or sales. Like him. How dare I compare my being tired to his! He slaved for minimum wage and had it taxed away, but me - I had everything handed to me so easily. I didn't have the right to complain if I was tired. I didn't know what real tired was.

And my diabetes... how tiring it was, for me to complain about something that wasn't even a real disease. He told me that one time, and it was especially hurtful. He told me I didn't have a real disease, after we dated during a time in which I came close to death when I was first diagnosed because I went into diabetic ketoacidosis and near coma. How small I felt, when he said these things. How he made my troubles seem so worthless compared to his own.

I laugh now, at just how worthless he made me feel without realizing it for so long - in an apartment I paid for, while working 4 jobs my senior year of college to save money and pay bills and have a good standard of living that I felt comfortable with, applying to graduate school and worrying about the certainty of my future. How absurd I should have found it to be ridiculed and berated for working. I found myself crying in a chair in the living room in front of him as he belittled me for this, when he contributed nothing to those bills. He yelled at me and made me feel so bad for running late to a family dinner he didn't tell me we were having after I ran late at a gig, which I often do. My already tired self, felt awful. How selfish I was then, too, to want to make enough to pay bills, and save enough money to not live paycheck to paycheck being anxious. Money has never been about the power, or idolizing it, to me. Do you know what it was about? It was about being incredibly anxious watching friends and families of mine live paycheck to paycheck. It was watching diabetes make me more anxious because I was going to lose my insurance while I was in graduate school and have to find a way to afford insulin. Working and saving money became a natural way for me to relieve the intense anxiety I felt over the uncertainty of my situation, and it worked. It helped me feel responsible and strong and safe in knowing that if I ever ran into trouble, I'd have a little extra to get me through. I tried to tell him that, but all I ever heard - while I paid for the things he asked me to - was the continual belittlement of the man who never once tried to understand this or help me. Only took and belittled me as he did, while I gave willingly, asking myself why I was so horrible to not give more openly, or have the heart to give more. What was wrong with me? I let myself be convinced of by him. Why wasn't I more giving, like him? He was so giving, he'd always say. He just didn't have the means to give. But back when he did - his generosity knew no bounds, he'd say. It would be that way if he had the means currently, too.

Except 4 years passed and it was never that way.

I brushed off the constant, excessive jealously. I was too much of a flirt. I was too naive. I needed to get myself together. I could not talk to another male without him being a direct threat. One time, I sang in the car with him and his sister's boyfriend at the time. "You never sing in the car with me," he told me later. "Do you like him or something?" It was always me - never, perhaps, his own insecurities, that made him think this. I sought the advice of many friends over the years as I wondered if things were really as bad as they seemed, or if I was just so horrible at this relationship thing, that I was messing everything up, with my selfishness, my immaturity, my not knowing any better. He made me feel so bad about myself, and made me feel that I was singlehandedly responsible for all of our relationship problems. And then he made me feel unwelcome to voice my doubts and concerns to him - because I was scared. I was never in a relationship where I felt open to speak my mind without judgement and persecution. Because he'd belittle me when I did. He'd get angry. He'd stop talking to me. He'd be aggressive. So many times then I'd try to speak, and the words evaporated when I went to open my mouth. Unable to speak because of fear. Unable to speak because I was with someone I was woefully incompatible with - but I'd never been with anyone else to know the difference. I thought this was the norm, and I was taught to think it was all a fault within me because I did not know better. This was all I knew at the time.

When we broke up, I had been agonizing those words I said to him for so long. I was so broken, so torn up, so hurt, so conflicted. I thought so horribly of myself for the times I had wondered, "was this it?" when I evaluated my life with him, trying to push back the well of disappointment and disenchantment I felt in my life. Was I supposed to look at other couples and feel jealously over their happiness? Why did I not feel that sense of happiness or belonging? Why did I evaluate my own relationship and feel... sad? Empty? Begging for answers to the mountain of problems that had grown over the course of years of joyfully happy ups to make me forget the terrifyingly low lows of my relationship, I began to wonder if I'd made a mistake by not dating other people. I wondered if dating other people would have been like this. Was I...missing something? But that was impossible. I was with the love of my life. We were always going to be together. To end that - that wasn't what love was about. You stuck with someone when things got hard. You didn't give up... right? Still, that didn't quell my continual questioning of whether this was what love was supposed to be like. I'd had many people tell me it was not over the years, including other men, and at first I'd respond offended, and then I'd think about it and start to listen to them, but then I'd feel so guilty about entertaining this thought, I'd shut them out, block out these thoughts in my head yet again. It was a cycle. I really listened to one man tell me this once, because he made a very good point of it - and my ex and I broke up because of this when we were in a particularly bad spell. We later got back together, and I pushed the thoughts away still. I had clearly been lied to by this other person - they didn't know what they were talking about. They were biased. They were just trying to tear me away from true love, and I couldn't let that happen.

But years down the road, after being warned that I would regret the decision of us getting back together - I painfully started to wonder if love should not be a girl at 19 supporting a grown man almost 5 years older than her. I burst into tears one day in my senior year of college, telling him how I felt - crushed, and responsible for so much - I was juggling a full courseload of difficult classes, working several jobs, paying bills, applying to graduate school, and I told him I desperately needed help from him. A part time job, anything - to help ease the burden. He looked at me and sincerely told me, "maybe I could help you get some more gigs in my free time." Never once saying, "maybe I can help work to take some of this burden off of you" - but always saying he couldn't. It was just too hard for a man to get a job in that city. It was way easier for me. He was too overqualified. There weren't enough good jobs. He didn't want to work just anywhere. I had already felt incredibly guilty about asking in the first place - how long it had taken to get the courage to ask him for help. How crushed I felt inside when he told me that maybe he could get me more gigs to make more money.

I couldn't do it anymore. I felt like I was at the end of my rope. For years.... I had tried so hard. I had agonized about my many flaws. I had beat myself up, asking God how he could make a human so selfish, so incapable of loving freely and openly, so bad at communicating and speaking her mind, so... me. But I began to think, what if... it wasn't just me? What if this wasn't the true love I had always thought it was?
I got the courage to speak out. I had not been perfect. But I was also starting to realize I wasn't wrong. I had a right to be angry. I had a right to be skeptical of someone who had, certainly, had a lot of misfortune befall him - but 4 years had passed, with every opportunity to better himself, be that college, a better job, anything - all of which I had tried to push him towards - and they all had passed him by, as he lamented at how unfair the world was to him. He blamed me for ruining his life because I had begged him to be close to me. I had done this - I loved him. I was such a child when I loved him, at 14, and later I was a still-blinded, too idealistic woman who loved him. I did, naively, beg him to be close to me. It was hard, in my youth, to imagine anything worse than him deploying overseas or moving across the country, because we had already done long distance so long. And he listened to me, and he stayed - to both our faults. I was too shortsighted to see how this might make him bitter, and he to realize that he was perhaps passing up good opportunities. It was both our faults, and I owned this in the end. I still did what I could. I encouraged college. I paid for him to go to a bartending course, hopeful that this could help. He managed to get little on-off bartending jobs in the last few months of our relationship. He worked part time at a nursing home. He made a few hundred dollars a month, and he'd pay for his new computer, games, and a utility bill. Things didn't get better. By then, I was in a deep well of depression, questioning the mistakes I'd made that had gotten me to a place where I felt hopelessly stuck. By then, I think I'd realized that I was unhappy, and I didn't want this. But I didn't know how to get out of it. I'd made too many commitments and I'd hurt him too much, I told myself. Over the years, I'd become codependent. He needed me. I couldn't give up on this. But I hurt both of us in the months I agonized over this realization that had taken years to dawn on me. I reached back out to the man who told me I'd regret my choice and I told him he was right. I wrote in my journal about this to try and work through it. I still felt guilty about it, so I cut him out of my life again, and suffered in silence. I talked to someone else who made me feel, for a brief period of time, a little better. Who made me feel like relationships didn't have to be like the one I was in now. That was wrong of me. But having people just to talk to made me feel a little less alone in this world made of my mistakes.

And that's what ultimately led me to finally break things off one night. It was one of the darkest nights of my life. I had worked all day, driven home in my new car following my bad car accident that winter, and my engine failed. I was going to have to get another car. I got towed home. My mom was upset at the situation I was in, and gave me a rather stern reprimanding as I cried on the phone to her. I cried the whole way. The words weighed like lead on my tongue, but I told him those deep dark feelings on my heart because I couldn't take the loneliness anymore. I couldn't live a life in which I was so unhappy that every day I cringed at all the happy people around me. Oh, how there were a lot of questions I had at 19, 20, that I needed answers to, and I was just trying to find them, through any avenues I could. Starting with freeing myself. He screamed at me. He was upset. Understandably. A few days went by and things were quiet. Then, he tried to convince me to get back together with him.

It seemed sweet at first.

He showed up unwanted, let himself in before I had changed the locks, and gave me the second bouquet of flowers I'd ever received from him in 5 years, and a teapot. It was nice.
He took me to the cemetery we loved to walk around and I let him, part because I feared him, and part because I felt so bad about how upset I had made him (part of the struggle of codependency), and part because I feared who I would be without him. "Give me another chance," he asked, when we got back to the apartment, after he gave me the nice things and took me to the graveyard and we'd taken nice pictures. It was nice. Wouldn't it be easier to just... say yes? Undo all the hurt? Surely I didn't want this? It was hard enough to speak my heart once, but here I was, having to do it twice, and my will was crumbling under my codependency.
And I wanted to say yes... kind of. Rather, I was more afraid of what he would do if I said no. Most of my communication issues stem from simply hating to let people down. I always have to fight to not tell them what they want to hear simply because I'll feel bad if I don't. I am painfully aware of this reality, but it is hard for me to change, and it was even harder then that it is for me now. I was torn between wanting to do what I knew would make him happy, and the fact that I'd be killing my own happiness in the process. I could not bear the thought of doing this again, because I had let this guilt and emotional codependency take control of so much of my life for so long.
So I told him no.
And that's when he got so angry. As if he were just putting on a facade and I had stripped it off. "I spent the last of my money on these gifts for you," he said. "I'll have nowhere to go if we're not together." I almost broke again then. I felt so guilty.
But I had come so far. It had taken me so long to have the strength to say those words to tell him to leave in the first place. It hurt so bad, what was happening. But letting all that be for nothing - that would hurt worse.

The next couple of months passed, and things got worse. He took those photos he'd taken at the graveyard and kept posting them on my profile. When I tried to delete them, he'd keep posting them. He posted about me on social media and told this story about how he got his heart broken and broke up with me when I cheated on him the day he was going to propose. He was right, I had been texting someone else, the same person who made me feel a little better through my depression clouded mind. And that was one hundred percent wrong of me, which I will readily admit. But that's not what happened. We had gone to Savannah, and it was Valentine's day weekend. I was sad because he didn't get me a card or anything for Valentine's day, but he told me I must have accidentally thrown away the card, because he had definitely gotten me one. This vacation was a last ditch attempt on my part to fix things between us, and I became so overwhelmed with depression that night, I begged him to take us back to the hotel, not hungry for dinner or in the mood to do anything. We spent the night in silence and drove home the next morning. Two weeks later, I broke up with him.

One night, I woke up with him standing at my bedside, as he set his phone down next to me, begging me to take him back as he lamented at how hurt he was. That phone was playing Moon River, a song I still can't listen to to this day without it evoking a genuinely visceral reaction in me that nearly makes me throw up. In tears, I begged him to leave, crying until he finally did, as if those tears would block out his presence.
When being nice didn't work, he hacked my internet so he could tell who was at my apartment. He cloned my phone so he could read all of my text messages. Months back, I had let him buy a computer that went on my credit - foolishly - and he then refused to pay for it, holding my desire to not damage my credit over my head. So I finished paying for it, even while months later he'd brag about how much money he made as a new bartender. He would leave notes on my car around town. He'd say he saw me places, referencing things that I'd done that no one could have known without doing so. I finished working at school one day, and he was waiting outside for me - refusing to leave until I talked to him. My boss let me hide in the office and locked me in, for hours, until he agreed to leave.

It got worse. He got violent. Before I changed my locks, he showed up again - my journals in his hands. Photos, frames, cards. Journal entries referencing other people during our breakup a few years ago. The more recent entries dealing with my doubt over my relationship and conflict. He tore these things up and threw them at me. Took the journals and posted photos of the entries to Facebook. Screamed at me as I curled up in a ball on the floor, crying, wishing it would stop. "I'm going to torture you," He told me. "Worse than what I went through in basic training." He threw photos, smashing glass everywhere. He threw a vase of the roses he'd given me when trying to get me back, and it smashed into pieces. I tried to run for the door. He grabbed me and held me down. "I bet you're going to say I hit you," He'd scream. "But I'm not. This isn't abuse. You need to get over it. This is nothing compared to the pain I feel," He'd scream again, physically holding me down, blocking the door.
Finally he left. A guy offered to come over to help me clean up the mess he had made when he had thrown things everywhere - I was feeling particularly unsafe the next night - and then he showed up with a gun, telling him to leave. This was before I realized that he could tell when other people were at my apartment.
I'll never forget the night I found out I was accepted into Mercer. It was the last night before I finally changed my locks. I came home from work and he had cooked dinner. He hadn't told me he would be there. My mouth felt like cardboard as I tried to eat with no appetite. I told him the news of my acceptance to Mercer. He talked with me like old times. "Take me back," he said. "I'm proud of you," he told me. "We can explore Atlanta together. Like we used to."
I looked at him, swallowing the cardboard food.
"We... won't be exploring Atlanta together. We aren't getting back together." He got so angry again. I was so fearful. He yelled. He screamed. He threw more pictures. He smashed things. I tried to leave and he blocked the door again.And then he cried and he collapsed. Terrified, I seized the opportunity I had. I grabbed my purse with my insulin and my car keys and I ran. I ran out the door and I started my car and I drove to Wesleyan and I stayed the night with a friend. I didn't call the cops because I didn't want to make his life difficult. How naive I was. But I did call my mother. I told her what happened and she called his family and she threatened the cops. My stepdad came up the next weekend and helped me get my locks changed and made sure he got back all of his stuff and I didn't have to be there. I was so relieved, even as I slept on the floor in an empty room alone that night, because all of my furniture in the apartment had been his. I was sad, and I had paid a high price for this freedom. But I was free. Or so I thought - but I wasn't out of the woods yet. Because this is how abuse works. You still think it's your fault. And I was so codependent that I was afraid to fully let him go. His hurt made me feel so guilty. I couldn't just cut things off.
So I would still go over and see him occasionally, when he'd gotten his own place. Because in those moments I didn't feel so afraid of what my life would look like once he was really and truly gone, and I was alone. I was terrified of being alone, even though I had been so lonely - and terrified of saying goodbye forever. But the longer I went without doing it, the harder it got. We'd try to hang out like old times, but then there was one night he asked me if I was talking to other people, and I told him yes. While on one hand, I felt incapable of moving on, I was still trying to. He got so angry that he locked me in a dark room as he took my phone and texted anyone else I was talking to that I didn't want to talk to them. I banged on that door, scared, begging him to let me out. I was so scared and desperate that I slammed my body against that stupid door and I splintered it. I ran, I grabbed my phone out of his hands, and got out the door, crying hysterically as I stumbled down the street in the middle of the night. I ran but he caught me and I collapsed, crying, begging him to let me go. But he wouldn't. He finally agreed to let me go when we drove to the house of one of the people I was talking to - so he could bang on his door and tell him I didn't want to see him anymore. I was afraid to talk to other people because at this point, I knew he was reading all of my text messages, because he had told me, although I didn't know how.

I reached out to one of his good friends in an attempt to try and make him the middle man in making things better between us. He had always been nice to me, and I thought he would help me. His friend attempted to sexually assault me, and when I refused his advances, he spread rumors behind my back and told my ex that I had pursued him. I tried to tell my ex that this wasn't what happened, but he fully believed it was my fault. It was further fuel on the fire for how I was unloyal, untrustworthy. Unable to get close to anyone because my ex always seemed to know where I was and who I was with, I felt more alone than ever. He would then harass me until I agreed to see him, with hundreds of texts, with phone calls. I couldn't change my phone number because it was also my business number, and I didn't want to lose business. If I blocked his number, he'd just use a google number. He was a constant presence in my life, and I was too afraid to let go, even though him being in my life made me so scared. My grandmother and my mother didn't know how bad it was, but they told me it was abuse. I brushed it off. "He's just hurt," I'd say, refusing to acknowledge all the signs before me. "He didn't hit me." They begged me to listen, before it got even worse. I was so naive. I kick myself for not listening.

I thought I'd escaped when I got to Atlanta. I was so careful. I had wiped my phone. But somehow, he still found me, and he stalked me. He moved to Atlanta, too. And then he began leaving more notes on my car... in my gated community. With an address I had been careful to not disclose. It got worse - he'd leave items on the doorstep. He'd stand outside my window in the middle of the night. I couldn't go home one night after school. because he was waiting outside the gate to my apartment, waiting to confront me. I started dating someone else, and he called them, trying to sway them from dating me. He took advantage of the fact that I was still hurting and used it as fuel to harass me further, while badmouthing me to everyone he had the chance to, privately as well as on social media. He'd post photos of the cash he'd made on social media and personally belittle me in long, drawn out statuses about how I hadn't had the insight to realize all that he was worth. Brag and brag he would about how much money he made bartending - ask if he was "good enough" now, say that he could have done this all along, but I simply took him for granted - perhaps forgetting that I had been the one behind him to help him get there. Over time, I became paranoid, afraid to go home, afraid to walk down the stairs at night, afraid to open my window blinds. I was afraid to go places away from home, afraid he'd find me. Afraid to check social media, because he'd post horrible things about me.

I didn't even know where to start in trying to get help, or even to share how bad it was. Being depressed took away my desire to want to reach out to others to accept what was happening to me. And I felt very alone. Thankfully, I did have a few close friends in PT school who were able to help me make it through. And it's important to say that this wasn't all his fault. I let it happen to me, too. I wanted it to stop, but I was also afraid of the unknown. He used the fact that I felt conflicted over this situation as fuel on the fire to do what he did. It was when I started letting go of the fear of a life without him that I started regaining some power over my life again. And somehow, I made it.
And then one day - 11 months after we had broken up - the stalking and the harassment stopped. And you know what's so funny? I had been so fearful of letting go, so scared of what it meant to be alone, and felt so broken inside the last day I saw him. But I said goodbye for good in my heart that night, and I met the love of my life only two days later in a tiny cabin in the Buckhead woods in the water fountain line. And the rest is history.

I have healed so much in these three years. I have also realized that I have much more healing still to do. I deserved better, but I didn't think so at the time. But I do now. There's so much I wish I could have gone back and said - so much I didn't have the courage to say back then. That's another thing I felt like I'd lost control of - my ability, my right, to speak up. I never felt like I could talk with him. The words just got choked in my throat. They felt unwelcome - they'd be met with hostile ears. So I put them away for so long. I let my loss of confidence, my belief that everything was my fault, make me feel like nothing, and make me feel powerless to try and seek help.

My heart pounds as I have written this and gotten it off my chest. Even all of these years later, this story is so hard to share with people. So much hurt is folded up into those painful memories, too many of which there are for me to share in a single post. And what if no one cares? What if no one reads this? What if he sends me a threatening email again, like he did the last time, telling me how I need to get over it and again claiming that what he did wasn't abuse? His and my stories are so different. We are both biased through the lens of our own hurt, but it doesn't take away everything that happened. To him - his actions may have seemed rational. Even if they caused me the incredible hurt I've shared with you. But I'd always have to laugh a little sadly at how he'd threaten me if I didn't take down anything I said about him, never even mentioning a name - but those photos he posted of my journal on facebook are still there, years later. He'd tell me he deserved to share what I did to him because I hurt him. All while he thought it okay to threaten and try to silence me. But, you know what? I will not be silenced.

Our demons can be very hard to share. And I'm sharing them with you, not as some way to get back at someone that hurt me so long ago - but to help myself, who is very much still healing from things that happened to me, long ago. It's been all these years, and I'm still fighting them, even when I don't want to or don't think I am. They haunt me when my walls go up. When I get into conflicts and I just want to run away and shut down, like I tried to all those years ago, not knowing what else to do. These things have caused me a lot of pain, but someday, I don't want them to. Healing happens for years, and years. I'm better now, but I'm still healing. And that's something that I'm completely okay with.

But Have You Tried Any of the Coupons?

I'd put off going to the pharmacy for about 3 months now. It's come to my realization that when I think about going there, I immediately become anxious. I find myself avoiding the pharmacy when I just go grocery shopping. Oftentimes, I avoid that Kroger all together, because just being there has me feeling as though I can literally feel the excess Cortisol entering my bloodstream. This is the result of years of leaving the pharmacy, disheartened and, often, in tears, without any medication in hand to even amend for the trouble. Every time I go, it feels like a game of Russian Roulette to see how much my medications cost.
But I needed to go, so I inwardly groaned, and I drove to Kroger. I placed my best attempt at a steel face on, and I walked up to the pharmacy. I told them what I needed: I needed Tresiba, one of my new long acting insulins, and I needed the new birth control that my OB prescribed to me. I did not ask to get anything else filled. There's no point - I wouldn't be able to afford it. I walked around the store to pick up some groceries while I waited. My phone pinged: I grabbed it from my purse.

Text message from the pharmacy.
"Your Rx is ready. Estimated total is $962.73."

This number is staggering, but I hardly blink anymore. This is how it goes - it's American health care. I can't say it doesn't disturb me, though. Even I've noticed the dollar amount ever creeping up when I ask how much my insulin will be. $250 used to get me a pack of insulin pens - a pack of 5.
Now it gets me a little less than one vial that lasts half month that I have to draw out with a syringe, or $500+ for a month's supply of Levemir, in vials, which is a long acting insulin. A "cheaper" long acting insulin, mind you.

I breathe. I steel myself again. You don't understand. So many times I've gone to that pharmacy, and I've broke down in tears. I've cried at pharmacists and begged them to see if there was any other coupon, anything I might be missing to let me get my medications any cheaper. I ask them what the price is of a cheaper brand. But they won't tell me, because evidently, they need a prescription to tell me that.
So I walk up to the pharmacy, and I keep my face blank. They bring me my basket of those medications. I tell them I have coupons - oh, coupons, the lauded saviour of the chronically ill everywhere. Can't afford your medication? Look for a coupon. Have you tried Good Rx? They're great. I heard if you ask the pharmacist, they'll give you discounts. Whatever my medication woes are, everyone tells me to find some goddamn coupons.

Your coupons don't work.

I've had a coupon in hand every time I have gone to the pharmacy since my insurance plan with my employer switched. I've clutched those coupons, in paper or via my phone as a screenshot. I've applied for all of the savings plans for the 3 companies that sell insulin in the U.S. I've called foundations that are supposed to help people like me. They don't have anything available for the lucky ones with high deductible plans. To be one of the cracks - too "rich" to qualify for coupons, for programs, because I have insurance, or because I make too much.
Too poor to afford the medication I need to keep me alive.

The last 4 coupons I tried? Didn't work. They took $100 off of each of my insulins. They were $465.00 each before. That brought them to $365.00 apiece, for a months supply. That doesn't take into account the other supplies, but I don't try to refill those anymore, because there's no point. I'll get the test strips for cheaper. I have enough pen caps and lancets to last a lifetime. I never use my Glucagon anyways. I have some old expired Ondansetron in my cabinet for the sick days, so I can keep food down and won't get low in case of nausea.

I was very hopeful about these coupons. The first one I clutched was from my OB because she said my insurance might not cover the new birth control, which I wanted to try because I was having some bad side effects from the other ones I had tried. The second was for Tresiba - "pay no more than $15 for 12 refills," it promised. A nondiabetic may look at this coupon and think all of your problems are solved.
I look at that coupon with skepticism, because there's always a reason why they don't work.

But I hand them the coupons when I'm told my insurance covers neither of the medications. I try to keep my face blank again, but inside my mind is racing, and inside my heart is sinking, wondering if there will ever be a time in my life where I'm not consumed by the worry of how much the bill at the pharmacy is going to cost. People don't even stop to ask themselves what kind of toll that alone exacts on a Type 1 Diabetic. They tell you to get Coupons, to go to Walmart (we'll get to that later), but they never stop to think, "Isn't it stressful to constantly worry about how it's going to work out month to month? Or a year from now? Or two decades from now?"
The answer is, yes. It's a waste of my very brain space, but that worry is a seed, and that seed has grown into a tree, and it's forever lodged inside of my mind, planting doubt and anxiety and worry atop anything else stressful that may be occurring in my life at the time. These are the kind of thoughts that make you tired. They make you want to stop trying to fight so hard and devote your energy to this same old fight, month after month. They make you bitter. They make you angry. They make you defensive, like a little kid that's been bullied too much, except the bully is big pharma, and big pharma is telling you that their bottom line is more important than your life, but have you tried some coupons?

So... by now you're probably realizing that I'm very sick of being told to get coupons. I have goodRx the app downloaded on my phone. I've applied to EVERY program out there. If there's a coupon out there -- trust me, I know it. I hold my breath almost. The woman hands the coupons back to me. "They need to be activated," she says.
So I sit down. I call the number on the Tresiba coupon. It doesn't work. It tells me the number has changed.
So I call that number. I answer the prompts to see if I'm even eligible for the coupon. I get hung up when it asks me if I have insurance that covers it. Kind of? With the deductible it doesn't.... but I guess without the deductible it technically would...
I hit the number for no. "We're sorry, but you're ineligible. Goodbye."
So I guess that was the wrong answer. I call back. I go through the prompt again. I answer yes this time. Then it tells me to wait for the next available rep.
The coupon for the birth control is easier. I can text to activate. I put my headphones in and start this while I wait. I go through the prompts. When I get to the one about agreeing to receive information about the drug, I hit no. I don't want spam email.
"Sorry, you're ineligible." It texts back. I sigh. I try to type yes and send. Doesn't work. I start the prompt over this time. I answer yes to the question. My card is activated. One down, one to go. The phone rings, a person answers. I give him the card number. I wait for another 5 minutes.
"The card isn't valid anymore." He tells me.
"But I just got it from my doctor," I reply.
"Sorry." He says. "Check the website for a new card."
I sigh. I thank him, feeling empty inside. I go to the manufacturer website. I go through the same prompt of questions again. I download a different card. It's just a Novo Nordisk savings card. There's no promise of $15 per fill, or anything like that. I've been at the pharmacy about 50 minutes now. I've come after work, and I'm hungry. It's almost 7. I hand her the first coupon, tell her it's activated.
It works. It's not as cheap as I think it will be from what the coupon said (pay no more than $35 for a 3 month supply!), but it takes $337.00 for 3 months and turns it into $100. I give her my phone.

"Wow, this is only the second time I've held an iPhone X!" She says. I look at her blankly. She types in the coupon. I put my iPhone X into my expensive purse. I can afford these things. They are pennies in comparison to the medication I need daily, for a hormone my body has cheated me out of making in a bad draw of genetics. My insulin is so expensive, I don't even want to try to worry about affording it.
"It's cheaper than insulin," I tell her, and she looks at me and appears confused. She's a tech, and she looks a couple years younger than me.
"That was a joke," I said, trying to be more lighthearted.
"Oh..." she laughed. "I thought you were for real."
"Well, it was a joke. But I mean, that is for real. This phone is cheaper than the medications I'm trying to get filled."
She looks a little shocked at that. Surely she's filled insulin before?
But she goes back to typing. I go back to trying not to lose my shit at the pharmacy for the dozen and a half time. I breathe calmly. I think nice thoughts. I tell myself it's okay either way.

"Well, looks like the coupon doesn't work. Your insurance doesn't cover this kind of insulin. We'll try to get a prior auth and call you in a few days. Maybe it will work then."
She pauses. "You have insulin to last you until then?" she asks.
I shrug. It doesn't matter how I answer this. They can't help you even if you do.
"I'll figure it out."

I swallow. I told myself to expect this. The coupons rarely work. I tell her that would be great. I pay for the birth control with my HSA card. I tell her I have no questions. I leave. I swallow back the tears, stuck in the back of my throat. I want to sit in my car and cry again, like I've done every time I leave the pharmacy. I don't even want to buy the groceries I picked up. But I do this, and I get into my car, and I don't cry. I just think of this blog post I want to write, instead, because it keeps me from crying sometimes. But I already cried as I wrote it, because my mind flashes to this stupid conversation I had on Facebook a few days back, where I liked a post one of my old friends posted about how insulin is unaffordable (he isn't diabetic, and I'm always happy to see non diabetics spreading information  on the current insulin crisis).
And some lady just replies, "you can buy insulin at Walmart for $25. A lot of people just don't know this."

I try to explain to this woman why this is not a solution, but, as Facebook debates often go, they don't. This woman had gestational diabetes and knows everything she wants to know about the current state of insulin in the United States. She still has blood sugar problems. She had to use insulin and just got it from Walmart and was just fine when she was pregnant. 6 long months of blood sugar woes, and you know everything. Evidently. It's been 8 years for me. I've heard of Walmart insulin. A lot. Because, of course I had. I've always looked for every possible solution for me. For a long time, I tried to put off vial and syringe insulin, because syringe injections are more time consuming, less precise, messier, and more inconvenience than insulin pen useage. And the syringes are bigger. After doing both, I can say they mostly feel the same, but the needles are thicker and I am still quite afraid of needles, but I do it anyways, because I like to live. I've used almost every insulin I can get my hand on - Novolog, Humalog, Humulin R, Novolin R. Lantus, Levemir, Tresiba. Anything. Because anything beats dying. I've bought this insulin. I've accepted it from strangers. I've accepted it from friends. I've gotten samples from doctor's offices.

Here's the thing. The insulin that Walmart sells, has been around for a very long time. It was used quite a while ago. And it does work. It doesn't work as well, but it works. But here's a little diabetes education for you:
They have rapid acting insulin now that takes effect immediately. They have rapid acting that takes effect in 15 minutes. You have to take insulin prior to any meal with carbohydrates.
Walmart insulin? It's short, not rapid acting. Walmart insulin takes about one hour to kick into effect. This means you have to inject one hour before you eat. Do you always know if you're going to eat in an hour? What if you go to a restaurant? Or you're out with friends? On a date? What if you work in healthcare (like me) and you run late with a patient? What if you just want to eat a snack? Do you guess, and risk being low, or do you risk being high because you didn't give it in time? What you have is an insulin that works,  but it drastically changes your quality of life.
And NPH. Don't even get me started on NPH. NPH is so old, I was never even educated on using it because it was phased out before even I was diagnosed. NPH is a type of long acting, but since it is very different from the long acting insulin of today, it severely restricts your ability to eat with relative freedom. Mealtimes have to be meticulously planned, and you have to meticulously count your carbs. I bolus through a method called sliding scale - I count (or try to) the amount of carbs I eat based on nutritional information or best guess available. I give insulin based upon an insulin to carb ratio to control my blood sugar. With NPH, you have to restrict your meals to a specific amount of carbs - 30 grams, 45 grams, etc. It gives you a lot less freedom to eat meals if you can only eat within a certain parameter. It gives you very little freedom to eat spontaneously or go out to eat. Today, there are long acting insulins that let you use sliding scale, and they work 24 hours. There's a new one that works up to 48 hours. But these are made by a mere 3 companies in the U.S., and there's no generic, because they claim insulin is too "complicated" to make one - a drug that has existed for 100 years, and was once sold for $3 a vial, by a man who didn't patent it, so as to make it affordable for others.
So what do you get when you go to Walmart? You get the bare minimum of care. You get vials and syringes, insulin that is outdated in type, and you get a drastically reduced quality of life. And what you often get as a result, is poorer blood sugar control.
And what you get from that, is higher A1C's. You get eventual complications. You get judgement from health care providers about why your A1C isn't better, when you're just trying to make it by enough to get any kind of insulin that keeps you alive. You read about a diabetic koala bear who got the latest and greatest continual glucose monitor at the zoo, but you can hardly afford a month's supply of vials for you - and meanwhile, the surgeon general is making comments about how diabetics ate too many cheeseburgers which is why they are in their predicament, and senators say we don't deserve to be covered by a pre-existing mandate when we are at fault for having this disease. You read about incredible new technology, the birth of closed loop systems and pumps and continual glucose monitors and instant acting insulin. But you cannot have them, because your insurance isn't good enough, and it's too expensive to pay cash.

And if you're me, you suffered from depression in the last 2 years, shelled out a $225 copay to go to the endocrinologist, didn't hear the end of how bad my A1C was after 3 years of not having insurance and just trying to survive, and finally got things back on track with a pretty remarkable new insulin called Tresiba.

But the coupon didn't work today.

And so I'll go back to using the doctor's samples, the Walmart insulin, the anything's-I-can-get. I'll try to keep my sugar under control and I'll keep reminding my doctor that I can't get a pump this year because my deductible is $4500. And I'll keep making do. Yes, I will survive. I'm not going to die.

But when is it my time? When is it my time to stop ceasing to merely...not die? When do I get to thrive, to have the latest diabetes tech, to have the best new insulins, to get my A1C under 7.0 or 7.5 or, hell, let's throw it out there - under nine, or ten, for the first time in I can't remember when? Did I not work hard enough? Is Diabetes not a sensational enough issue for people to care about? Because we've been crying out for years, and no one has answered.
They've told us that there are coupons, while at the same time, prices have almost doubled for the insulin I could never afford even when it was cheaper.

But I get tired of telling people this, because part of me knows that the people around me get tired of hearing these same cries for help, or cries of trying to raise awareness for this issue, and they don't want to hear it anymore. How many times can you say something until it's a broken record to someone else? Even when it can't ever be a broken record to you, because it effects you daily?

And I'm discouraged. I can't have the care I want or need. I have the care that keeps me alive by the kindness of strangers. I go by Doctor, but I still can't afford insulin. If my problem is a problem caused by my lack of effort, please tell me where along the line I fell short. But today? I'm just tired of this same old problem. Tired of the anxiety, the worry. Tired of the constant fight that I used to think would be better after I graduated - but I'm still trying to figure out how to fix it. And I'm tired of people who think they know the solutions, but know nothing of what walking in my shoes is like - try to brush my concerns, my problems to the wayside, with recommendations to use coupons or try the Keto diet or fast to boost my immune system or go to Walmart.
You do not understand.

But I hope this post helps you to.

Be Kind: What (Almost) One Year Working in a Therapist Has Taught Me.

I'm walking down the hall of the main wing at work, and the sound of a man playing guitar and singing reaches my ears. This is not a sound I hear often in this place. I peer into the room - it's a younger man, and I'm slightly caught off guard, as he has a strikingly beautiful singing voice. He is sitting next to the bed of a woman I have never treated, but have ofttimes seen sitting in her gerichair in the same wing I'm at now. This woman cannot speak. She cannot move her arms or her legs, and she appears to be in pain all of the time, because her face is locked into an almost permanent grimace. My heart goes out to her every day I see her, and I always make sure to make eye contact with her as I walk past her when she's out, and smile. I do this not to be pitying, but because it's a fact I've found, that a lot of people in places like where I work, just need to be seen. Need to be heard. We strip our elderly of so much in these places - to the point where I feel that they can almost lost a part of their identity. All of us in these settings should practice kindness, treating others like individuals, like humans with rich backgrounds, sick or not. This woman is on hospice. She has looked progressively worse over the past few weeks. Her roommate used to be so sweet to her. She'd sit out and hold hands with the lady, but her family moved her somewhere else, so now she doesn't have anyone to sit with her and quietly hold her hand throughout the days. I walked past that room and it almost made me tear up, to hear the man with the sweet voice singing her beautiful songs. I hope it brought some beauty to her life.

I'm treating a man yesterday. We are sitting outside, as he gets cold in the gym. "I've been here before," he says. "Twice. But I can't remember. I know I forget things, but sometimes I even forget that, too."

A woman called me over to her bedside while I was treating her roommate. She has been on hospice for a while now. A lot of times, she seems to speak jibberish, or yells, or doesn't make sense. But she looked at me today and in the clearest voice said, "What am I going to do once my roommate goes home?"
"I don't know," I replied. "I'm certain you'll get a new one."
"But we get along so well."
"I'm glad to hear it.", I responded.
"No, you don't understand. What am I going to do? Who am I going to talk to? You don't understand what it's like to be me. I'm just a dying woman who wants to be recognized. Don't you understand that? I just want someone to talk to me. I just want someone to be here. I'm so lonely."

Isn't it hard not to keep your heart from breaking when you hear these things?

Days like this make me think: what fragile senses of control we have over our lives. Just when we think we've got it, something out of our control always seems to happen, stealing away that carefully sought after sense of security. This was diabetes for me, and I'm sure as you read this, you can easily think of something that's been that for you. Working where I do always seems to solidify this for me, because here it's the things out of people's control that seem to steal away everything - even their recollection of the fact that anything is gone at all. It's easy to mourn for these things. If I stored away all of the sadness from my own life and the lives of the people I treat in my heart, it would be too much to bear. These things are designed to make us stronger, I suppose, but really, some days I just get tired. Where does the suffering of humankind end? Or does it? There's an answer to this if you're Christian - we certainly aren't promised easy lives, or lives where we won't suffer. This world is full of suffering and pain, just as much as it is matched with unspeakable joy, love, and goodness. This is what it is to be human in a nutshell, and as much as this can be hard to see face to face each day sometimes, it's a powerful reminder, that through our suffering, we must savor the little moments with beauty and peace, and build ourselves up to be strong, to face these times of hardship.

I can't even begin to express to you how much I have learned over the course of one year practicing as a physical therapist. And the crazy thing is, the important things I've learned aren't even about my clinical skills (although I've learned a lot of those). They're about working with people. They're about caring about people. This month marks one year of officially being employed, and August one year of working at my skilled nursing facility. My job is hard, and many would not consider it ideal or enjoyable. My office is a closet, the place where I work smells like, well, a nursing home, the gym could stand to be updated, the rehab department is currently a little bit of a hot mess, and I have days where patients yell at me, have hit me, and have projectile vomited across the room. We work holidays. A patient asked me the other day what I wanted to do, and when I told him I'm doing it, he seemed very surprised. There is little recognition. The paperwork is intense. Our stories of victories often go unsung. But, in my heart there is still a really big love for it. We must dive headfirst into often what seems like dark places to truly understand other people and why we are here. It is through the unpraised hard work, the little things that you know you can do, that you learn what is is to help other people, or if nothing else, why they need help so bad. I'm not saying go work at a nursing home, by any means. That's not for everyone nor does it need to be. But what I'm saying is, take a little extra time today to listen and open your eyes and ears to humanity. Ask yourself if there's something you can do. If an opportunity presents itself to help someone, consider doing it. And be kind. Above all, be kind. I try to remind myself of this daily, especially when I'm not feeling particularly kind, and not acting like it. But you'll be surprised at how far it can go, and how much it's sorely needed, by all of us.