Monday, January 22, 2007

The Envelope, Please...

This entry is not about what you probably think it's about. More on my feelings about Volver and Babel at another time...

For weeks I'd been holding onto an unopened envelope that was waiting with my two weeks' worth of mail when I returned from my holiday trip to the east coast. I didn't want to open it as soon as I got home on New Year's Eve, then I didn't want to open it on New Year's Day.

'Why go there if it's something even remotely unpleasant' was the way I thought about it. It's no way to start the new year... with "bad vibes" and all that ridiculous stuff. I wanted to set a different tone for kicking off the new year. Not that I set a good tone for the year, but still...

So the envelope sat there and sat there, getting shuffled around every time I rearranged the growing stack of mail that always gets out of control within a week or so. From the desktop to the box of bills. On top of the Pottery Barn catalog, then under the magazines.

It was getting silly. Last Friday I had resolved to open the envelope this weekend, so that I had a couple days alone — or at least not distracted by work — to mull over what was inside and let it sink in. Last night came around and it was still sitting there. I managed to fall asleep without opening it, then saw it there again this morning while I was starting to make breakfast.

Enough was enough.

But this was really no ordinary envelope: with the return address from Dr. JDK, M.D., I knew it was a transcribed summary of the results of the tests on the blood samples I had drawn from me before leaving town in mid-December.

The blood tests: a predictable necessity three or four times a year now; usually a good five or six vials worth. Luckily, nothing about phlebotomy bothers me at all, and I always tell the staff at the lab that; I figure they need a break from people hating or fearing them all day. Really, they could take all they want and it wouldn't bother me. Three vials, six vials, ten vials, what's the difference?

Except in December it was different. In my last round of tests, back sometime in early summer, things weren't looking awful, but they weren't looking too great. My viral load had creeped back up to where it was somewhat detectable, though my CD4 count was fairly stable.

I didn't like the idea of detectable virus at all. Detectable = Drug Resistance, and the idea of drug resistance freaks me out, especially since I just started this new four-drug/five-pill cocktail in the summer of 2005, just about a year before the detectable test. Having the new regimen be effective for just one year bothered me a lot, especially since I switched to that drug combo as a result of developing resistance to an NNRTI-category drug, which was borne out by phenotypic resistance testing.

I wanted my current drug regimen to be effective for several years. I get angry, dejected, and also afraid of how this virus hijacks one's life and plans. I resent other positive people who stay healthy and symptom free for years or decades without needing pharmaceuticals. I resent people who've been on the same regimen for ten years with no ill effects and textbook-ideal results. I don't begrudge them their luck; I just can't help feeling fucked because maybe I don't have, or won't have, or haven't had the same luck. Then I feel guilty about the self-pity and think how happy I am that I'm not living in a village or shantytown in Kenya or Transvaal or West Bengal or some other place where getting drugs is pretty much impossible.

I try not to dwell on the negative possibilities of what another round of resistance might mean. Switching to a different protease inhibitor that might really screw up my liver enzymes, or kidney function, or blood lipids. Another round of phenotypic testing to see which drug options have become "all black" on the bar chart, and thus no longer good possibilities.

How many years might I have? How many years might I have? How many years might I have?

We can all ask that question even in the best of times, in the best of health, in the prime of youth or the prime of middle-age or whatever, and not know the answer. The answer can always be ten, fifteen, three, less than one... But I know that I ask the question far more often than I ever did a few years ago, and that it's something that I'll always be asking, in the back of my mind. Someone described that kind of nagging voice like a radio playing at low volume in the other room: sometimes you're engrossed in life or some project and don't even notice the sound, other times it's more still and the sound is more noticeable. But the sound is always there: "How many years...?"

Even worse than the question of time is the question of quality: "What will it be like, later on... down the road?"

Still, I'm lucky. And today, now, I feel even luckier. I open the envelope and unfold the single sheet:
kidney function-normal, blood glucose-normal, blood count-normal (WBC slight elevation), liver enzyme-slight elevation, cholesterol-normal, ldl-normal, hdl-normal, triglycerides-high....

PCR RNA (viral load): <50
CD4: 376
CD4%: 36%

Less than 50. Statistically undetectable.

I'm safe for now. I'm really happy. Relieved. Reprieved. Whatever you wanna call it.

The triglycerides still being high are a little worrisome; they might indicate increased risk for diabetes, though the other indicators are fine. It just means that the issues now are: Start Running! Join a Gym! Eat Better! Eat Less! Cut the Sugar!

Shit, this is my life. But I guess it's really... ok.


copperred said...

Emotional rollercoaster: worry, anger, disappointment, guilt, worry. To do it, not just once, but regularly, must sap you. To keep on going is an accomplishment in and of itself. Good to know you won't be going anywhere, unless planned.

Huntington said...

I'm happy to hear that right now, things are looking good. As you know, "right now" is all we can count on, and that radio-voice in the other room is a fucker who needs to have its FCC license revoked. Good news!