Thursday, May 14, 2020

2 Months of Isolation

We have been social distancing for a full 2 months now. It is amazing to think how much our lives and the world has changed in 2 months time. 

Back in March I went out for a ladies night a few nights before everyone started thinking about avoiding crowds. It was so nice to be out with friend's from Kaylee's school. But I couldn't brush off this nagging feeling that maybe I shouldn't be out in public. The virus seemed to be looming. I had no idea that 2 days later Kaylee's school would have a confirmed case of coronavirus and our whole world was about to shrink very quickly. Kaylee's last day of school was March 13th. My husband's last day of work was around the same time as well so our little family of three (plus 2 cats) have been spending a lot of quality of time together.

At first, everyday felt a bit shocking. I would rush in the morning to check the news. This new normal felt so very foreign and almost unreal. But years of being sick and hospitals stays gave me the wisdom to know that people adapt. We can and will adapt. I have learned to adapt to lower lung function, to being able to do so much less physically, to functioning while ill and feverish, to the flow of hospital life, to existing while dying. I knew soon enough our family would adapt to self isolation. And we have. 

There are moments when the reality of everything hits me and I think, "Holy crap! There is a killer virus traveling around the world killing thousands of people and we have to wear masks, and avoid our friends and stay home as much as possible." But most days we wake up and put one foot in front of another. We do online learning, we mask up before going out, we do grocery pick up. We spend a lot of time in the kitchen cooking, baking and creating. We spend time being thankful we are together and healthy. 

It's not to say that everything is perfect. Online school is definitely not Kaylee's prefered way of schooling. And all that baking/cooking leaves a lot of dishes to be done. We miss our friends and family. We miss hugging those we care about and adventure. I oddly miss the grocery store. 

But humans are strong and we adapt. This surreal existence is starting to feel normal and we are finding our groove in this somewhat lonely, somewhat humdrum life. But we are alive and healthy(ish) and we have one another.

And I know from experience that I can adapt, but I am not naive to the fact that for some may struggle with this new normal and adapting might not come easily. We all have different life stories and we all have different struggles. Just know it is okay to not be okay. And it is always okay to ask for help.

Wednesday, May 6, 2020

New Normal Post Trikafta

I have been wanting to write about my post Trikafta life, but I am finding the words so hard to find. It is so hard to describe how much my life has changed in so many subtle and hugely obvious ways over the past 5 months. I am going to highlight the biggest changes I have felt.

  • PRE: Treatments used to be such an exhausting all consuming part of my day. I needed to be ALONE because I would cough so hard and so violently that it took all of my focus and energy. I would get red in the face, break a sweat, gasp for air, and cough up so much mucus I needed a cup to catch it all. If it was so too soon after eating it would cause me to throw up from coughing too hard!  
  • Post: I can easily play a board game, work on the computer, or hang out with my family while I do treatments because I never ever cough! I don't use up all my energy reserves to do treatments. Instead it feels like maintenance like brushing my teeth or combing my hair. Not particularly fun, but not exhausting, stressful, and painfully time consuming. 

  • PRE: CF dictated everything about my life. I could not get out of bed before taking my inhaler. When I did get up I would cough and cough until I finished my treatments. In the evening if I tried to push off my treatments by a few hours (usually when we were having a fun evening) my body would revolt and I would cough and cough until I relented and did my treatments.
  • POST: I can wake up, eat breakfast, stroll through my garden, and then settle into my treatments late morning if I want. I do not feel like my life revolves around treatments anymore and my body can function without using my inhaler. I went from needing my inhaler within arms reach at all times to feeling secure in knowing I can survive without it. 

  • PRE: If I woke in the night and had to get out of bed (to check on Kaylee, to pee, etc) my lungs would "wake up". My heart would start racing a million miles per hour, I felt breathless and my coughing would begin. It was horrendous. I would often feel afraid that my body would quit after those middle of the night wake ups. 
  • POST: I can wake up, go to the bathroom, come back to bed and fall asleep like everyone else. No racing heart, no panting for air, no coughing!!

  • PRE: Every day was different. Some days I would wake up and my lungs would be okay, sometimes my lungs would be tight and congested. Almost every single day at some point I would feel BAD. Almost every day I felt like I was on the verge of an exacerbation. I felt bad significantly more often than I felt okay.
  • POST: I don't notice my lungs anymore, they feel good every single day! I have days I am more tired than others or some days I feel off, but it is never because of my lungs. 

  • PRE: Getting sick meant a few months of trying to get "well" again. Even a simple cold or allergy season made every single day a struggle. Even a small cold used to make my lungs react with inflammation so badly that I struggled to breath sitting still and felt like I may suffocate when walking even a few steps.
  • POST: I got 2 bad illnesses since Trikafta. A bad fever followed by a respiratory infection in December and then Influenza A in February. With both sicknesses I felt awful, feverish, miserable. In December I felt so bad I was crying to my husband because I just knew when it hit my lungs I would be in really bad shape. In fact, I genuinely thought I may die. I waited every day for it to hit my lungs and for the inflammation to take over. The inflammation never came. I ended up on oral antibiotics because I was coughing up mucus, but the death grip my inflammation usually puts on my lungs was nowhere to be found. A few months later I had a similar experience with the flu. I truly believe that Trikafta saved my life.

  • Pre: I never expected to live a full life. I mourned so many times the loss of growing old. I used to think about how hard CF was on my 20-30 year old body and wonder how a 60-70 year old body could survive the abuse (if I even made it that long) and it felt completely impossible. 
  • POST: I fully plan to see retirement, my grandchildren (if Kaylee decided to be a mom), and to grow old just like everyone else. 

This is already long, but I feel like it is just the tip of the iceberg in how much my life has changed. I feel grateful every. single. day!! I was given my entire life back and there are no words in the english language to even describe the joy Trikafta has given me!

Tuesday, April 21, 2020

Everything Feels Backwards

I haven't written in a while. For so long CF was taking over every aspect of my life. I didn't want to dedicate more time to CF and talk about it in my blog. A year ago I just finished transplant testing and CF seemed to be at the front of everything. I wanted to push CF to the back of my mind and ignore it's existence. Of course, my failing health wouldn't let me and so I took a break from blogging to get a mental break from thinking too deeply about what was happening in my life.

In November, Trikafta entered my life. Suddenly, I had energy, I had health, I had hope. I was busy living life. So many fears and worries of the future melted away and I didn't want to stop living my life to write about CF in my blog.

Then March arrived and Coronavirus arrived in the US. Schools closed, my husband's work closed, and we were told to hide in isolation from everyone we knew. It is amazing how quickly life can change.

It is strange how my "corona" life has mirrored so much of my late stage CF life. So much fear of germs, wearing masks in public, missing out on fun things in the name of health and safety. It almost feels like life as usual except I am not the only one canceling fun activities, wearing a mask, slathering hand sanitizer whenever I touch anything outside my home. The strangest part is while the world is suffering and struggling I personally feel well. While thousands of people worldwide are gasping for air, suffocating, feeling the exhaustion that comes from the lack of oxygen, I am breathing fine. I no longer wake up coughing, I no longer experience shortness of breath, I can breathe. And I guess I should feel relief...and I do.

But man, my heart breaks for every person suffering right now. I know too intimately what they feel, despite never experiencing coronavirus. I know the fear, the panic, the pain that comes from lungs that are failing you. And I have had 35 years to cope with it, and 35 years of getting through so that I can tell myself (even lie to myself) that I will be fine even when I struggle to breath. But all of these people are experiencing it for the first time and the fear they feel must be extraordinary. My heart breaks for them. My heart breaks for their family.

It feels so weird to feel healthy in a suffering world when for the past few years I felt suffering in what felt like a healthy world.

Sunday, January 12, 2020

The Initial Trikafta Changes

I haven't been blogging in a while and after my transplant evaluation I felt like I needed a break. CF felt like it was taking over my whole life and I just wanted to step away from writing about it in my blog for a little. It has been almost 9 months since my evaluation and my lung function and my quality of life was remaining the same. I was getting sick more often and IVs were still not overly effective, but I didn't have a significant drop or anything that affected my transplant status. I was driving to Stanford every 2-3 months to be monitored, but I was still too healthy to list.

But this update is about Trikafta and not transplant so moving on... When I heard rumors about Vertex providing Trikafta for compassionate use I tried so hard to get on it! Unfortunately, for my mutation getting compassionate use was tricky. I fell into the guidelines and applied, but then the FDA changed the criteria and made everyone reapply. My CF nurse reapplied and said I still fell within their guidelines and we really thought I would be granted compassionate use. The wait felt like it was forever and I kept worrying I would get sick beyond repair while I waited. And then I got the news the FDA approved Trikafta. I was thrilled, of course, but part of me was disappointed that it happened before my compassionate use was granted. Now all compassionate use applications were useless and I was now depending on my insurance. I called and emailed my insurance and pharmacy every day. I was going to make sure I didn't get lost in a stack or pushed to the end of the pile.

I was approved by my insurance and started Trikafta the day after Thanksgiving. What a great reason to be thankful!! So how has it been going?

One of my best friends was visiting from out of town when I took my first dose. I literally popped the first dose and left to spend the day out and about with her. I was distracted and not paying attention to how my body felt except I knew I was coughing a LOT and my coughing felt different. More wet and being productive was so much easier.

I have always been very productive and it caused a lot of issues because I produced so much, it was virtually impossible to feel clear even after treatments. Treatments always felt like a huge workout. I had so much mucus and it was so hard to clear I would often be sweating and red in the face and exhausted after treatments! Within a few days I noticed my production went way down and by day four I was not coughing ANYTHING up at treatments. My cough just disappeared!!

This lack of mucus and coughing both thrilled and terrified me. I have a huge inflammatory response and normally when I get less productive it means my inflammation is out of control and I start getting a lot of plugging which is a nasty cycle that feels impossible to break from. I had a hard time mentally accepting that my lungs were responding to the meds and I didn't need to cough so much. What!? MY heavy producing, never clear, highly sensitive lungs didn't need to cough? It felt unreal and a bit terrifying.

Another massive change I noticed on Trikafta was my inflammation improved so much I can hardly believe it! I usually carry my combivent inhaler everywhere I go. It sits next to my bed at night and it comes in my purse everywhere. If I go for a walk it is in my pocket! I use it several times a day when well and I use it a million times a day when unwell. I now take it before treatments (and not the second I open my eyes) and that is it! I have noticed with my home pft monitor that I still have inflammation because my pfts jump pretty significantly after my combivent, but my lungs are doing so much better I don't feel a difference. Prior to trikafta I would often feel like I was suffocating if I went to long without a bronchodilator.

Within a few days of starting Trikafta I went to cut down a Christmas tree with my family. We drive to a much higher elevation and in the past I really struggled with the elevation and hills. In fact, I wondered if I should go at all this year because I was worried I wouldn't be able to handle it. I did go, but immediately saw the hills and felt dread! We were standing at the top of a steep hill and all the kids decided to run down to look for a tree. I stood at the top and was assessing if I could make it back up the hill if I followed the kids down. I decided I probably couldn't and decided to stay put. But somehow I got distracted and ended up at the bottom of the hill. And before I knew it I was in my car on the way home before it dawned on me, I just spent the entire morning walking up and down hills without realizing it!! No huffing and puffing, no headache from lack of oxygen, not struggle. In fact, I didn't even notice. How AMAZING is that?

The last major improvement I noticed within the first few weeks was that my energy level was INSANE! Within a few weeks of starting I was helping put on a school event. I warned the others on the PTA that I would help if I could, but depending on how I was feeling I may not be able to help at all. When the day arrived, I started working at the school around 11:30am to set up, worked the entire event, and was one of the last to leave when the principal locked up the school on our way out at 9:30pm. When I got home and realized I still had energy I was astounded. Usually, my energy level is so low and if I push myself I pay for it the next several days. But I was acting like a real 35 year old!

This is getting long so this is the last thing I will say. My whole adult life my CF has been a huge rollercoaster ride. So many times I felt like my health turned around and I was so optimistic for the future, but then as soon as it improved it would all crash down. My health history taught me that the highs were temporary and the lows were always right around the corner. Years ago I would celebrate my improvements, but as my health got more complicated I learned to enjoy the highs in my CF, but to brace for the low. It was always right around the corner. And in the past few years my highs lasted a week or two before I would feel the downward slide back to poor health. My brain was so trained that for weeks I couldn't feel overly excited about Trikafta. I felt like I would enjoy better health, but like always, it would be ripped away from me before long. I have been on modifiers before and the results seemed temporary and faded just like everything else health wise. So I talk about these improvements and I noticed them and felt hopeful, but it was clouded with doubt and caution. But I felt hope, cautious hope, but real hope for the first time in years.

Monday, October 21, 2019


The FDA approved Vertex's triple!!!

I realize I have been mia recently, but I am still alive and well!

Friday, May 10, 2019

Transplant Evaluation Day 4

I have been putting this entry off for a while. Partly because I have been busier with the nicer weather, but also because I just wanted to move on. When I first got back from my evaluation I was wanting to process what I had gone through (we actually went on a little getaway right after which was why my blog posts were delayed). I wrote the 2 entries right away, but then I felt my feelings switch and I just wanted to tuck it away in a quiet spot in my mind and move on. But I know how much I wanted to hear about the evaluation process when I was waiting and so here I am writing about my final day even though so much of me wants to shut the computer off and forget that piece of my life. I clearly, have bad coping skills!

Thursday was the day I had scheduled for my heart Cath. We had to leave our air BnB by 11 and my appointment was for 12:30. We packed up all our food (bringing food and staying in an air bnb was such a money saver btw) our clothing and then went to find gas knowing it would be a long day and we had a long drive when it was over. We got to Stanford early and checked in around noon. The heart cath area was so busy. They had screens with case numbers (which we were given when we signed in) and everything was color coded so while family waited in the waiting room they could watch the progress of the procedure via the colors on the screen. If your loved one's case number was glowing green you were getting prepped, if you were orange you were in the procedure, etc. It reminded me of an airport! It also made me feel a little less nervous seeing how many people were undergoing some variation of the heart cath. They clearly do a ton of them at Stanford!!

I needed to be fasting and I was surprisingly hungry. The various fasting requirements and the schedule made me feel like I was in a calorie deficit and I was starting to feel it by the 4th day. The average age in the waiting room was probably 70+ so I felt my husband and I looked very much out of place. There was an elderly couple that were sitting across from me and I couldn't help, but hope that my husband and I can still be alive and well when we get to their age. Unfortunately, the heart cath was very behind. I was finally called back after waiting for what felt like forever. I had to go alone and they told my husband that after I was prepped they would come get him. They then asked a million questions before the procedure. She asked a few questions about my husband and I and then commented that we must have married very young. I got married at 26 which is relatively young in todays standards (and even more so for our area). The nurse acted surprised and then asked how old I was. She was shocked I was 35. CF patients are notorious for looking young and I did during my whole malnourished underdeveloped stage. But being fair skinned in a sunny climate hasn't been kind to me and I think I look my age so I instantly loved this nurse. Of course, like I said the average age in the heart cath was 70+ so I doubt my nurse had a good gauge on how old 35 year olds are supposed to look. She also told me about a friend of hers whose daughter had CF and had a lung transplant.

During my intake a nurse came to access my port. This was the first time at Stanford that I felt like the nurse was unsure of how to access a port. My intake nurse was trying to tell me a story about how they are using something from a squid to do CF research. I am sure (like many nurses over the week) she was trying to distract me from the port access. However, I can NOT be distracted during a port access because I am super controlling about it. I felt rude, but basically ignored the intake nurse and was focusing and giving advice to the nurse working on my port. She explained she used to access them all the time, but it October was her last access after changing departments and she was having trouble feeling the 3 dots on my power port. The second she poked me I told her she missed (I was right), but she got it the second time and it was fine. After they brought my husband back and Ii figured the procedure would begin soon after, but we had no idea just how long our wait would end up.

The nurses seemed to switch around and it seemed like person after person was being called back and we were left to wait. We tried to ask what was going on, but it seemed everyone we asked said they weren't on my case anymore. I am still not sure which nurse was mine towards the end (I had so many switch to different patients). The woman across the way (we were all lined up in a big room separated by curtains) was someone that was in my lung transplant class. We exchanged thumbs up as she was wheeled to her procedure . I tried to nap and watch videos on my phone but the hunger and thirst (the worst!) and the nerves were getting to me a bit. I guess while I was napping the elderly man from the waiting room (his wife was having the procedure) popped in to check in on our progress. It was so very kind for him to show concern for us when he clearly  had big concerns of his own. Later, when he was leaving he walked by our waiting area and waved and wished us the best of luck. Writing this is bring tears to my eyes. It was such an emotional week and this particular day was hard because we waited so very long and I was so nervous. To have a stranger reach out and show some support when he had his own concerns and struggles reminded me how kind hearted people can be and it meant so much to the both of us.

A little before 5 (!!!) the surgeon finally came too talk to me! This was 5 hours after getting to Stanford and after fasting for way too long. The first thing the surgeon said was, "where is your IV?" When I told him my  port was accessed he said the port was great for anything they will give me during the procedure, but he needed an IV as a guide for the catheter. I seriously wanted to scream. I was so dehydrated I felt like I was a raisin after fasting (both liquids and food) for so many hours and they wanted to start an IV. That should have been done at 12:30 when I had only been fasting 6 hours or so. Of course, the first IV failed and the nurse called someone else. They started getting stressed because the nurse failed in the spot that needed an IV. They ended up putting it in more to the right and thank goodness the second one worked (although this ended up backfiring later).

Finally, a nurse came out and started to get me ready for the procedure. I told her the intake nurse told me I would get a valium, but since I was delayed I never got it. This nurse acted like a valium was overkill, but agreed to give me one since I requested. I have never had a valium before so I am not sure what it is supposed to feel like, but I think they gave me a sugar pill or such a low dose it was useless because it had zero effect on me. As I was being wheeled out of the heart cath a family was sitting in the last curtain waiting for their own procedure. As I was being wheeled by they all gave me a thumbs up and wished me luck. There are so many kind people in this world!!

When I got the procedure room they prepped my arm, hooked me up to heart monitors and put oxygen on my nose (although they said it was a precaution and there was no oxygen in it at the time). They used lidocaine to numb my arm. The whole thing reminded me a bit of getting a PICC line in radiology with a bit more set up and many more nurses and respiratory therapists around.

When I am having medical procedures done I have this control issue that I have to know what is going on. I think having people doing things TO YOU can make you feel out of control and the only way I don't stress is if I know step by step what is happening. So I kept asking a bunch of annoying questions. Did the catheter go in? Is it stringing okay? I bet they wish I was put to sleep. And my stress level/anxiety clearly wasn't soothed with the valium they gave me. And then I knew that something wasn't going well because with PICC lines the line is put in until it hits right above your heart. With a heart cath it goes into your heart. In distance, this isn't a big difference, but I could tell it was taking too long. So I started questioning again. The nurse was kind and turned the screen so I could watch the wire. He actually didn't need to show me because I knew what was happening. It was the same thing happened so many times in the past with PICC lines. The wire was curling back on itself because something was blocking its path. They said it may have been my port among other things. I knew it wasn't my port because this was an awful dejavu that I had been through a dozen times before. It was some weird anatomy of my veins. The next thing I knew some woman came out of a back room and said that my arm wasn't working so they were going to try through my neck. I groaned. They decided to try one more time on my arm. I protested a bit because of my history with PICC lines. Considering my last PICC line took 9 attempts I was more concerned about getting it right than going through my arm.

It is interesting because I haven't had a PICC line in over 6 years. It was amazing how quickly I was thrown back into all the feelings and stress that came with all the failed attempts. The heart cath procedure wasn't bad, but it brought back a lot of old feelings that I had forgotten and somehow felt so much heavier and uglier when they resurfaced.

So they tried the second time. I asked them to tell me when the catheter was placed, but heard the distinctive POP that comes when a vein is accessed so I told them before they even had a chance to tell me that it worked. I have a feeling they hated me and my nonstop commentary. When I asked if the wire was able to thread they assured me it had. I felt so much relief until the nurses started rushing around my bed and the mood of the room changed. I looked around for someone to tell me what was going on, but everyone was clearly very occupied. I finally said, "Is everything alright? Am I alright?" Apparently, my heart monitors stopped showing clear readings. They assured me that it was nothing to do with ME, but the monitors were acting funny. At this point I was really wishing the valium had helped, but instead I watched the clock on the wall trying to pretend it was 10 minutes later when the whole thing would be finished.

Soon enough the doctor assured me that my results were good and that my CF had not negatively effected my heart and I was off to recovery. Unfortunately, because I had two catheters in I had to go to a step down recovery where my husband could not join me. They needed a nurse to remove my catheters and hold pressure on them for 15 minutes and so I needed too be in a step down where a nurse could give me the needed attention. The nurse that did remove my catheters was actually my favorite nurse of my stay in Stanford.

Finally, I was moved to a regular recovery area and I was finally able to see my husband. And thank goodness for him because one of the first things he said was, "when can she eat?" The nurse got me a snack kit with brie, crackers and grapes. It was one of the best tasting things I have ever eaten. I was so happy to have food and water again! At this point it was just about 7:00 and I was so ready to say goodbye to Stanford and get back home to my kiddo. Unfortunately, (I am using that word a lot), the worst was yet to come...

Friday, May 3, 2019

Transplant Evaluation Day 3

To start with Day 1 go here.

I woke up Wednesday and turned to my husband and said, "I am over it. It was fun, but now I want to go home." I had a lot of adrenalin the first day and some of that carried into Tuesday, but by Wednesday it had warn off and I was ready to go home. But we were half way done and had no choice, but to continue on! So I put on my big girl panties and went to my first test.

Echocardiogram with Bubble Study: I checked into the echo lab around 8:45. I went back into the medical room where they had me change into a gown with the opening in the front (opposite of the norm). The nurse came to start an IV. I asked if she knew how to access ports and she said she was more than happy to use my port instead of a peripheral line. I was so happy! My port was coming in so handy! She left to get port supplies while the tech (Dr? Sorry, I had so many tests I wasn't sure who was a Dr and who was a tech) started the sonogram. It was very reminiscent of when I was pregnant, but instead of looking at a beautiful baby growing inside of me they were looking at my beautiful heart. Again, I was watching the screen, but it was a lot less fun than looking at baby feet and baby hands. All the pictures looked the same so I was only half paying attention. The tech was so warm and kind though which seemed to be a trend at Stanford!

When the nurse came back she accessed my port and we started the bubble portion of the test. They push saline with bubbles in through your IV and watch how they pass through the heart. Apparently, they are looking to see if any bubbles find their way to the left side of your heart. If they do, it means you have a small hole in your heart which apparently is somewhat common. When the nurse pushed the bubble saline into my port it traveled through so quickly they actually missed it! The combination of using a port which is much closer to the heart than a peripheral in the arm and my very fast heart beat made the bubbles travel faster than they anticipated. They repeated the test and then did it one more time while I clenched my stomach (like I was going to the bathroom) which apparently puts more pressure on the right side of your heart. I am 99% sure I failed this test, meaning I have a small hole in my heart. Nobody ever told me what this actually means as far as transplant or life in general. Hopefully, it isn't a huge deal since nobody mentioned it, but I will be asking my CF doctor about it next clinic.

During the test the nurse in the room started asking about my schedule for the day. When I mentioned I had blood work she told me that I should get the labs taken from my port. I wasn't sure the regular outpatient lab would do that so she started making calls to see if someone could take blood from my port. Finally, she told me she would walk me down to the lab, wait with me and then ask the phlebotomist if she could do the draw instead. You guys, that was so insanely nice and was the overall feel at Stanford! Everyone went so above and beyond what was expected of them and they just all genuinely wanted to make my life as easy as possible. So we went to the lab together and she drew 8(?) more vials of blood and then took out my port needle.

Lung Transplant Clinic:

After my labs were done we went over to transplant clinic. I was surprised to find other people with CF (pre-transplant) in the waiting area. In recent years my current clinic usually brings us back pretty quickly (where we still wait forever) to avoid having too many CF patients in the waiting room at the same time. Just like my current clinic we waited forever to be seen. Also, like my current clinic we saw a team of people. I had to give an overview of my medical history and any family history of diseases. I was glad my dad was there because outside of my immediate family I wasn't sure on family history as far as health issues. The social worker stopped in and said I was a good candidate from his end. I was able to skip the nutritionist because my weight is fine which saved us a bit of time.

I was told pretty quickly that I was not ready for transplant. My 6 minute walk was good, my lung function numbers are not good, but not at transplant level yet and I am not on oxygen. We went in anticipating this result, but I felt so much relief knowing that I could put transplant off a little bit longer. It does scare me a little bit though because I was told without hesitation that it is not time. I think about how low my energy is and how often I feel sick and I can't help, but feel a sense of dread for what things must be like when it is time. It is one of those times that it is better to just not think about the future and try to stay in the moment because no good will come from thinking about your inevitable decline.

Clinic was the last appointment of the day. I was hoping to feel relieved that I was almost done with my week at Stanford, but I was absolutely dreading my right heart catherization and finishing day 3 meant that I was one day closer to the heart cath.