Living with Chronic Illness

My heart goes out to all people who live with a chronic, debilitating illness day after day. Those illnesses that keep them from being able to enjoy life as the rest of us who take our health for granted do. And those of us granted with the graces of good health need to learn to have a bit of compassion for those who endure pain and disability day after day.

Shawn has an illness called Cyclic Vomiting Syndrome (CVS). Sometimes I think the diagnosis is just a symptom of something underlying that has yet to be discovered. And unfortunately that leads to thousands of appointments and tests to try to determine what might be causing it. Just in the past 2 months he has seen his primary twice, a rheumatologist, cardiologist a few times, hematologist, psychiatrist twice, and chiropractor about 10 times. They all order tests and new meds to try. And each appointment, each test, each result leads to more appointments and more time and stress. But never any concrete answers. Just more questions. The blood work is always not right. The tests always come back positive for something.  New questions, new meds, new diagnoses. But nothing concrete with concrete treatment that will help him. Just when we think we are figuring things out we end up back at square one. He takes a handful of pills every night and half the time he can barely choke them down. One says he has an iron overload called Hemachromatosis that is attacking his organs. Another says he might have a rare adrenal tumor based on his elevated metanephrines. What are they doing about it? More tests, more appointments or here. . ."try this med and come back in 6 months." This week the psychiatrist (who has never heard of CVS) decided to take him off the one and only stomach med that has helped somewhat and put him on an anti-depressant instead. "Try this" he said. And viola. . .the next day...  he is in the worse episode ever.

CVS has to be one of the worst chronic illnesses someone can have and has to be one of the most harshly judged. Imagine having the worst stomach virus of your life or intense food poisoning. Now imaging having that bug everyday for 10 days straight. And just when it starts to pass and you start to feel better you have the side effects of being sick for 10 days, dislocated and fractured ribs from intense vomiting, extreme pain whenever you sit from the constant diarrhea. Weakness from not eating much of anything for 10 days. Now imagine trying to function normally with employers, friends, family and having them grow annoyed and irritated with you for your seeming irresponsibility or unreliability. But you continue to try to put on your best face as if nothing is wrong and you feel great. Which leads to more judgment because - "he certainly didn't seem sick when I talked to him." Or "It must all be in his head." Or I love this one, "He should take better care of himself."

Then there are the moments when you are episode free for a few days or weeks at a time and you grow optimistic that you have turned a corner with the illness and you have somehow found a formula or medication that is working. You carefully follow whatever seems to be working and you gently step through each day thinking, "Maybe I can lead a functional life. Maybe I can start to make some real income. Maybe I can have a real future with my girlfriend."

This is the time when Shawn took the brave step of starting his own business. We purchased the necessary supplies, advertised on Facebook. Booked several jobs that would get him through the summer. Things were looking up! He was able to do a couple of small jobs and got paid. Although there were a few bumps in the road - it still seemed possible and manageable. Then he booked a big job and a few days in. .  .Wham! Hit with a major episode. And when he is in an episode he does everything he can to fight ("Fight, fight fight" is a frequent text message back and forth between us). He does as much as he can to work, but even at the job he can only work 20 or 30 minutes at a time before he is hit with an attack. Again - imagine your worst stomach bug and then making yourself go to work and work through it. Why does he do it? To make the money to support himself and his son of course, but more than that to not disappoint the customer. To try to remain reliable and to maintain his reputation. He tried his best to finish this job and he was determined. He can sit and imagine exactly what needs to be done and knows that he is the most talented to do it right. And he tries to convince his body that it is going to get better so he can get it done. But the body has it's own ideas.

We reached out to the customer and explained the situation. They had not paid him a deposit so it wasn't as if he was taking the money and not completing the work. And he was communicating daily about what was going on. He kept trying to increase the time frame and at first they were understanding about the illness. I even reached out as I knew them from town and offered the alternative to pay for what was done and hire someone else to finish because it was truly unpredictable when he would be sick and when not. But they kept him on - until they didn't. And then they didn't hesitate to lay into him about promises made, About the amount of excessive time spent on prep (if the prep isn't done right the paint isn't going to last. Anyone that comes in and slaps paint on quickly is not doing the job correctly. He honestly does know what he's doing and if not sick the job would have been done perfectly and had lasted for years and years). But they were frustrated and I get that (so are we!). He had put many hours of work in and bought his own supplies - many of which were not anticipated because of the amount of extra work that cropped up as he went. But this illness does something to your confidence as well because people feel like they can criticize you more openly for some reason and discredit your professional expertise. And instead of arguing he tends to just accept the criticism and it sinks deep into his soul. . .leaves him despondent and hopeless that he can ever do this.

But the thing that bothers me the most, is they tried to call him out on taking a day trip, based on seeing posts on my Facebook that we had spend a day on Nantucket together for my birthday. Because I guess if someone feels well enough to go to Nantucket then they must not really be sick? This was a cruel, heartless thing to say. Instead of a "thumbs up" for putting the illness behind him for one day to try to live life a little and to celebrate. To try to not think about the disease for just one day and try to make some memories. Instead of saying "Good for you" they chose to chastise him. And did he feel good in Nantucket? No. He slept on the boat all the way there. We parked him on a bench when we wanted to walk a far distance. He visited just about every public restroom there was. He slept next to me on the beach, holding hands with me. Compassion please. Stop judging.

Judging someone based on what they post on Facebook isn't fair. Most people focus on the positive parts of their life to post. Think of it as a photo album. You go on vacation and take pictures in front of majestic things and everyone has a smile. Do you take pictures when the kids are cranky and hungry? Of when you and your spouse are fighting over directions? Of when the luggage gets lost? No. Why? Because the smiling faces are the memories you want to focus on and remember. Facebook for most is no different. These are the moments to remember and cherish. Don't think of the poster as lying or being untruthful and trying to make their life look golden. If you are close enough to them then you know the real story behind the pictures. Just like I am not going to post about Shawn's illness on Facebook. But if you know me and know us. ..then you know the truth.

If it had been a cancer patient who took a tropical vacation after undergoing their horrible treatment there would have been 500 likes on their Facebook post. There would have been Go Fund Me pages set up and meals made and delivered. Not one person would have said, "Oh he must not really be sick if he can go to the Caribbean." Not one. Why? Because cancer is socially acceptable as awful. Chronic, unexplained illnesses are not.

And please don't think I have any resentment or hard feelings for cancer. I have lost many (too many) family members to cancer. I have many close friends and family members who have fought it and won. I have made many meals, and contributed to many Go Fund Me's for acquaintances who have had to battle this horrible illness. But what I want to hit home is there are so many other people out there that deal with illnesses that there is NO end and no cure. It just goes on and on, day after day, no end in sight. They deserve your compassion and understanding as well.

Yesterday I was riding with my daughter to move her into college and Shawn was following in my car. I was talking to a friend on the phone when Shawn called in on the other line and I said I needed to take the call in case he was sick and needed to pull over. And my friend said, "Oh you are still dealing with that?" There was a pause on my end. "Um, yes. It's chronic. We will always be dealing with it."

And sure enough he did need to pull over. We pulled in next to him and he barely made it, opening the car door and puking on the ground. And this happened repeatedly throughout the rest of the day. After another hour of driving he couldn't do it anymore and we switched spots. He became passenger in Melanie's car (her first time driving such a long distance in the mountains with no cell phone reception wasn't going to be done solo in case we got separated). I drove and led them and he slept, thankfully Melanie didn't need him. She stayed with me and managed the mountains like a pro.

The rest of the day he slept in the back seat of my car with the windows down while Melanie and I moved her in. We went along with the day as needed, but my mind wasn't far from him and his needs. I would check on him frequently and find him sweating and shaking in the back seat, vomit on the ground all around the car. At the end of the day I asked if he wanted to come see the apartment and he did. He dragged himself out, put on a brave, albeit pale face, and went in and took a quick look, met the roommates, used the bathroom and then gave me a pleading look to leave. We were supposed to stop halfway home to visit with friend who had invited us to stay over and then attend their party the next day. But along the way with him still vomiting and looking like death he pulled the cord. He texted them and said we couldn't make it. We came straight home and he went to bed and hasn't moved since. I have checked on him frequently and he is breathing. Still sweating. Still shaking. Vomiting less but hasn't stopped. I check because at some point he will hit the level of dehydration that we can't make up for at home and he will need to go to the hospital. Not there yet. But getting close if it doesn't pass soon.

I write this with tears in my eyes. Tears for the grief of living with this illness. I'm not the one vomiting and sick to the point I can't function. But I am watching someone I love very much go through this and even though I do everything I can to help him. THERE IS NOTHING I CAN DO. Nothing. And that feels terrible. Helpless. I am someone who has always been able to step in and fix a situation. Somehow help to make someone's life better and more functional. And even though I have put him on the track to all the medical experts I can find (and we are waiting for an appointment at Mass General with a CVS expert), he is only getting worse. Not better. No matter what I do. And there is a grief and sense of loss as well. Loss for the life we should be living together. The dreams we have of traveling to Ireland, getting married someday, fixing up this house so that we can sell and someday buy our own cute little house with a big backyard for the dogs to run and play. Shoot I just want to be able to buy kayaks someday and spend a day on the peaceful water, just the two of us. We got hints of that early on in our relationship and I want that back. I want him back.  And therefore I will not stop fighting for him and and with him. He will feel better and we will have that life we want. I won't give up because his life depends on it.

And if you see us out living life then applaud him. Give him a thumb's up. Don't assume he must be fine now. He's just trying to enjoy the small, disease free moments and live a normal life. Those are the moments that give fuel to the desire to stay on this earth and not give up.

Update - as I was editing this post I heard moving around upstairs. He comes down with a little more color in his cheeks. I ask, "were you able to keep some water down?" He says yes he had a bottle and it has stayed down. The worst of this one is passed. No hospital. . .this time. He says to me, "Is it pajama day? Because since I've gotten up, knowing there was no Labor Day parties for us today, I spent the morning cleaning, paying bills, writing this and not getting dressed. I say, "Why yes. . .it is pajama day and I reserved the Elton John movie from Redbox." His face lights up. That's it. . .that's all he needs today. Rest, movies, pajamas and unconditional love.

Self Actualization

Psychology 101 - Maslow's Hierarchy of Needs is a concept that I often refer back to in order to see how myself or those around me are handling life's challenges. As a refresher the Hierarchy is based on a pyramid. The bottom tier is your basic needs - food, shelter, clothing. Those who are really struggling just to survive exist primarily in the bottom rung - those who are homeless or have significant mental or medical illness, elderly, developmental delays stay right around here. Their daily life focus is just to exist and survive each day. The next step is being able to make sure their safety needs are met. This includes financial needs. Needing to have bills paid, money management, security for the future. These bottom two rungs are our basic needs to survive. Once we have achieved that successfully and can advance, we worry about meeting out psychological needs - friendships, family. relationships with others, feeling a connection to others. Next up are our accomplishments - being able to succeed at work and in our communities - achieving a certain social status and acceptance. And finally full self-actualization - having complete balance in all the lower levels and being able to realize your own full potential. These people seem to have it all together. They are stable in their work and home lives, stable financially and can go out and share their gifts with the world through volunteerism, activism, pursue goals to achieve more life experience.

So where do you think you fall in this Hierarchy? This conversation came up one time when I was on a date with someone I had been seeing for awhile in between my divorce and meeting Shawn. He asked me where I fell on the spectrum and I was honest. Having just gone through a divorce and dealing with an emotionally difficult teenager at home I thought I functioned around level 3 most of the time. I could see the disappointment on his face. He thought he was fully self-actualized. He saw himself as balanced and able to give back to the world. From an outsider perspective I felt he was trying to "prove" he was self-actualized when he really did not have the psychological needs fully met yet. He had a lot of difficulty managing his day to day conflicts with his family but because he volunteered once a year at a fundraiser his cousin organized, he thought that made him fully self-actualized and giving back to the world. Well, I didn't think he was being fully honest with himself.

I will say there are time I have operated in all of the different tiers. I had full self- actualization at one time in my life. At that time I was a Girl Scout leader, Sunday School teacher, I was able to write 9 novels, maintain my blog, make photo albums of my girls yearly to keep track of their growth, development, all of our memories. I was a loving wife, a good mom. We were financially secure.  Did we have difficulties? Sure but for the most part we were living the dream. So what happened?

Life. Life happened.

I remember the day things started to change. It was 2010. My dad had died the previous year and I had grief from that, but was still able to function pretty highly. Maybe I had slipped down on the hierarchy  (I haven't written another novel since he died) for awhile but for the most part was building my way back up. Tom and I were planning a much needed get away to Jamaica and his parents were in town to watch the girls while we were gone. But that trip to Jamaica never happened. Dean - Tom's step-dad - died suddenly while mowing our yard. The girls and Beach Grammy - Tom's mom - found him in the yard. I was the one who did CPR on him, but it was too late. I held the girls together and helped Janet survive the ordeal. I managed all the arrangements, supported Tom through it (who had been on his way to Jamaica already). It was the first time in my life I felt an anxiety attack coming on- the day of Dean's funeral in North Carolina - where I would be face to face with his family. I didn't want to be in the spotlight or have to talk about the circumstances around his death. But as anxiety usually goes - the thought of is usually worse than the reality and I got through it with no major issues.

Then Janet got sick. Less than 2 years later, I would find myself moving to Florida for the summer to take care of her in the end stages of her illness. I took time off from my job.took the girls with me and helped take care of her in her final days.  Then after she passed I helped arrange the celebration of life and worked on getting her house in order to be eventually rented out.

We were all very sad with the loss of these three people in just a few short years. But we were strong. The girls were strong. What I didn't realize at the time, despite his outward appearance as managing the details and expertly handling the financials of the estates, Tom was NOT strong. He did not take time to grieve for the deaths. Instead he threw himself full time into doing what he was good at. Managing. He had not dealt with his emotional needs. He just tried to stay fully self-actualized without taking care of his more basic needs. And secretly he was following a dangerous path of self-destructive behavior. He hid this from everyone for awhile, but it was becoming more evident as our marriage started to disintegrate. He was pulling away from our relationship and becoming more and more unhappy with me, not understanding that we all were grieving in our own ways. But he didn't want to talk about it. He didn't want to address it. He just became more disoriented and confused until finally we split. I knew there was a mental component to his distraction and unhappiness, but you couldn't tell him anything at that time. He was convinced getting out of the marriage would be what would make him happy again. I prayed to God to send him a lightning bolt to make him realize the path he was on was self destructive and he needed his family to help him through instead of pushing us away. I tried to get him to go to church or counseling or to watch certain movies with me that addressed a lot of what he was going through. He did do counseling, but wasn't fully honest with the therapist with what was truly happening in his life, so it was pointless.

Fast forward a few years and that lightning bolt did strike him. He was arrested for solicitation of a minor. His obsession, addiction to on line pornography caught up to him and he was caught talking to someone who said they were 14 years old when in actuality it was a police officer trapping him into a sting operation. So that "pretend" self-actualization came crashing down around him because he never took the time to understand his emotional needs, instead just trying to maintain the full life balance he thought he had and was entitled to. He thought the pornography helped him maintain his homeostasis, without realizing how unhealthy it was and how it had truly taken over his life. I don't necessarily agree that the punishment he received was fair. Four years in prison for talking to someone on line that wasn't even really a minor, seems excessive. But it happened in Florida, which is known to be very strict on it's "child predators." I get irritated when I see others who had actual physical contact with a real teenager get less time or no time at all. But the good thing is that lightning bolt almost immediately had the desired effect. Tom started counseling. He started actually being honest about his addictions and realized how unhealthy they were. He realized that he had never dealt fully with the deaths in his family and he needed to take a step back to take care of his own mental health. While awaiting trial he became very active in a church and began volunteering with Meals on Wheels. He started counseling others who were going though similar issues and he joined sex addicts groups. He actually achieved true self-actualization before he went to prison. He has been there for a year and while there he has gone through the steps of the hierarchy again. At first he just needed to find out how to survive there and now a year later he has formed relationships, friendships and has obtained a job in the chapel. He leads bible study and counsels others. He says he is there for a reason and that reason must be to help others get through their current situations. So in a year's time he has managed to climb the tiers again.

In my job as and Occupational Therapist, a simple way to think about what I do is to help people achieve their highest functional level on the hierarchy. When I evaluate someone I am assessing their current functional level and the level they used to function at before their illness. Someone who comes right out of the hospital and is fully dependent on family or private aides to care for them is functioning in the first tier, maybe even below it if they can't manage any of their basic needs themselves. If they used to be fully independent and functioning at the top tiers, then they need my services. But if they have been functioning at that level for quite some time - those who are terminally ill or advanced dementia - then there is not much I can do except make sure the caregivers know how to address their basic needs. If someone comes out of the hospital and is already independent with their basic needs and is planning to go back to volunteer at the library and attend their church council meetings, they also do not need me. It's those in the middle that need me the most and often those with chronic illnesses who don't know how to manage their illness well enough to achieve a higher sense of self also can benefit from OT services. (managing their pain in order to be able to enjoy a dinner out with family, or manage their energy level to be able to go to church again).

The caregivers of these patients are often overlooked. We pile on the responsibilities to the family members who are taking care of their loved ones and insurance dictates that if they have a reliable caregiver then they need less of our services. But the caregiver has a hierarchy to maintain as well in order to successfully take care of the loved one. Just like a new mom has to be have a emotional balance in order to adequately care for their newborn. Much of my focus is making sure the caregiver is also taking care of themselves and is maintaining a balance. They might need to get some support from other family members or private aides so they can focus on their own needs. I had a patient recently who had a life long diagnosis of schizophrenia. She had been in the hospital for pneumonia but had a mental episode because of getting off her meds while she was sick. Her primary caregiver was her sister. But the sister was also caring for her husband who was recently diagnosed with cancer and needed frequent transport to Boston for treatment as well as being taken care of during treatment. She also had a 97 year old mother who lived alone, but had recently been failing and needing more attention. So this one woman would accompany all three of these people to their doctor's appointments and the doctor would turn to her to give her the instructions on what the patient needed, not understanding that she was caring for three dependent people - in three different homes- at the same time. When I would talk to her she always seemed upbeat and positive. I would be amazed at her strength but at the same time worry she was actually pretending to function at the top tier when in actuality she was barely meeting her own basic needs. She would utter under her breath, "I have to find a way to get back to work. I am the only one generating an income right now." I am not a social worker, but in order for my patient to have her basic needs met, the caregiver needed to be able to function. We would talk about who else could step in and help out (not really anyone except occasionally a niece) or what social resources there were to help. We were able to get my patient into a adult day health program which gave the sister 6-7 hours a day to be able to focus on caring for her husband. She hired a private aide to make sure her mom had dinner and was taking her meds at night. By the time I discharged I felt like the family was operating at a better balance and the caregiver would be able to eventually return to work, but wished she didn't have to. But that's what our society dictates in order to survive.

So where I am functioning right now? Well, I'm writing for the first time in five years or so? So that's something. But I have to admit I have been at level three for a long time. I make sure mine, my kids and Shawn's basic needs are met. I make sure they stay up to date on their appointments, work full time, manage all the finances, take care of the house, yard and pets. But I am not going above and beyond for anything else. The landscaping stays basic. The work that needs to be done to the house can wait. The deep cleaning is not important. The requests to attend fundraisers with friends go unanswered. The political diatribe of the country gets a quick daily skim without too much overt worry. On a side note that probably inspired this blog post, I recently watched interactions on-line over a recent protest in town in regards to the conditions of border detention facilities and thought, "Wow. These people must be fully self-actualized to be able to have that much passion for people thousands of miles away that they have never met and have absolutely zero impact on their lives." I admire that their lives are in such great balance that they can devote themselves to such important social matters. But sometimes I wonder how things really are in their internal lives. Are there people closer to them that might need their attention or help? Are they overlooking someone like my recent patient's sister who is struggling to care for everyone by herself, medically, emotionally and financially? Should maybe some of these people seek out those that might need more of their attention instead of them holding protests and arguing on-line endlessly with other people they don't know and with probably never know.

Off my soap box and back to why I am only at a three and actually happy to stay here for awhile. I have my responsibilities and in order to be fully present and devote myself to what is important I will continue to say no to unimportant things (unimportant to MY life, survival and the survival of my family, but important to those who can devote their time), continue to meet only the basic needs and just keep things SIMPLE in order to not eventually self-implode. Yes that means saying no to yoga classes or spin classes as they are not something that has ever been emotionally helpful to me. To meet my emotional needs I like to read, write (again! yay!), play Words with Friends and watch movies and cuddle on the couch. I might say no whatever takes me away from this things that keep my life in balance right now.

And what is important right now? Keeping the emotional well being of my daughters forever in the forefront of my mind. Are their basic needs being met, are they happy, balanced, self-actualized? Are they able to achieve their hierarchy without me? Working on that. Teaching Kylie to drive has been put on the back burner because it is a huge stressor that I can't focus on now. I just wish a fairy driving instructor would show up and take over.

But the one who needs me the most right now is Shawn. He is battling with a very serious chronic illness and I am doing all I can to help him get the best care possible and find a way to manage the illness so he can have somewhat of a functional life. The illness he has, Cyclic Vomiting Syndrome (CVS), has to be probably one of the worst chronic illnesses that is not immediately terminal that anyone could endure. Imagine vomiting 6 hours a day, several days per week. Imagine when you are not vomiting you are having other severe intestinal discomfort and running to the bathroom every 30 minutes. Also imagine severe joint pain that sometimes leaves you unable to stand or to walk, needing crutches at time just to rush to the bathroom.Now also imagine trying to work and make some sort of income while going through all that. And no one outside of the house really understands the reality or full scope of what's going on with you so their expectations of you are to fully participate in what they need/want of you. And imagine doctors just kind of shrugging, ordering more tests and pushing a new med on you without really any idea if it will help.

Just this month Shawn has appointments with his primary care physician, a rheumatologist, hematologist, cardiologist and psychiatrist. Also I am working on getting him to a CVS specialist at Mass General, hoping they can help more than the other two GI doctors he has been to. All of these appointments need a ton of paperwork filled out and phone calls to be made and test results to be sent. It is a full time job being the caregiver of someone who has such a significant illness. He can't manage this stuff himself. He can barely manage his own self care. Also we have done the long arduous process of applying for disability which we just found out this week that he was denied for because apparently he can stand and lift 10 pounds. Yes- his 10 pound puke bucket. Seriously. Ugh. I would like any of those people who made that decision to try to work on a day that they are wracked with a horrible stomach bug. Yes, you are puking and having diarrhea every 10 minutes but you must still get on a roof and paint without falling off or passing out or puking on the person's roof. And he has done that. And in the bushes, and in his car, and on the side of the road. We can appeal and plan to, but will wait until this latest round of appointments because if a new diagnosis comes out of it that will be helpful in the plight.

One new diagnosis that may be causing some of the issues is genetic hemochromatosis or an iron overload in the body. This was found recently on bloodwork conducted by his PCP, showing a genetic mutation as well as excessive iron stores.  If your body has an iron overload then your organs cannot function and can become damaged. It makes sense for many of his symptoms and is the reason he is seeing a hematologist this week. My hope is that the hematologist will offer a treatment that can actually help him to feel better, but as I know in healthcare, you tend to put your full optimism and hope into that one specialist that will make it all better, only to leave with extreme disappointment that they can't do anything either. So I have learned to not get my hopes up too high or have expectations that someone will actually listen at how debilitated he is and actually help.

I am trying to help Shawn try to stay on the hierarchy. Right now honestly he is barely at the first tier, but he tries to be at 2 or 3. He tries to balance work and the illness and insists he can do it. I actually want him to just quit trying to work altogether and focus on that first level of basic health, but he insists he can't do that. Six months ago he was so bad he could never make it to work in Chatham. He was constantly having to call in sick and his boss, although compassionate, was frustrated at not being able to rely on him when she is having to make promises to her customers. He felt the stress of constantly disappointing her and with my advice I suggested he quit and focus on his health. He did and for awhile he seemed to get a little better. He was on a new med at the time that seemed to be helping. So we cautiously took some steps to start his own business because it would be easier for him to set his own hours and not make any specific promises. But now, that new med is no longer working and his illness has taken full hold of him again. I think it's time to back off of trying to work and focus again on health, but he is too proud to fully rely on me financially, but I try to convince him that if he can rest and care for himself then the GOAL is to have better health and eventually be able to work his way back up the ladder. But right now he is trying to do more than he is capable. Trying to pretend at a higher level than reality - which as we have seen before tends to backfire.

So that same God that sent a lightning bolt to Tom is somehow testing me. Is He trying to teach me extreme patience? Compassion? Empathy? Or has He just put me into this role because he knows I might be good at it. I might be the only person who will help Shawn through this and get him the treatment and help he needs because no one else would care enough. It is very difficult to see someone you love suffer so much.

 I pray daily that Shawn will feel better and promise God that I have learned my lesson. I am more patient, compassionate and empathetic than ever. I understand unconditional love. I am good now. We can move back into that life where I felt I could be fully self-actualized. And I promise I won't ever take it for granted again.

And those of you reading this? Where do you fall? Are you at the highest tier? Are you feeling balanced and fully self-actualized? I hope so and if you are hold on tight to it. Don't take it for granted. And look around to your close circle and see who might be struggling and need some assistance from you.And don't just ask "is there anything I can do?" Because they will say no. Actually show up and do it. Bring a meal, get some groceries, take their loved one they are caring for out for errands, something. And if you are pretending to function higher than you should, it's ok to back off and make life a little more simple. Say no to those things that aren't going to benefit you to stay balanced and stop feeling guilty for saying no to those volunteer requests when you need to be helping yourself and those close to you first. Because pretending to function better than you are only hurts you in the long run. And if you are one that's struggling, find some help to pull yourself up. Don't be afraid to ask. DON'T say no to those offering. And don't forget to ask for God's help as well. He really is listening.