Recovery

Working as a Transplanted Photographer

I’ve been waiting a long time to write about my career because I haven’t felt like I could say I really have one. I started my own business in late 2015 but had to take a break for several months after my transplant in July 2016.

Developing new strategies

When I first learned all the post-transplant precautions, I was convinced I would never be able to do event photography again. My transplant team didn’t even want me shaking hands at the time, so I couldn’t imagine being back in a room full of people.

Gradually, my immunosuppressant regimen lightened as the risk of organ rejection decreased and I became more confident in public environments. It was a very slow process, but now I am perfectly comfortable photographing a crowded party without a filter mask on.

Instagram story highlight with antibacterial hand wipes pictured. Follow Kathleen Sheffer Photography on Instagram!

My camera bag holds antibacterial wipes, protein bars, antifungal solution, and pill cases, along with my camera bodies, lenses, and speedlights. I bring my own food and water so I don’t risk contamination. I am hyper-aware of any coughing, sneezing, or sniffling, and keep my distance from anyone I think could be sick.

Exposing insecurity

Feeling like it was safe for me to do event photography again was only half the battle. Running my own business, especially in a creative field, still feels like an illegitimate career sometimes.

I imagine my friends who are software engineers aren’t asked if they do it full-time or just as a hobby. My answer to the question, “What do you do?” always requires additional explanation. I often contemplate trading the creative freedom freelance photography gives me for a more widely accepted nine-to-five job.

But I need to be a photographer. I feel happy, confident, and centered behind a camera. It’s therapeutic and fun for me, and I’m pretty good at it! More recently, I’ve enjoyed actually turning a profit. My clients are giving me as much work as I can handle, and paying me for it. This is such an amazing feeling.

Self-portrait of the event photographer.

Focusing on core values

It’s important that we separate our self-worth from our career. While I’m thrilled that I have the ability to work right now, I make sure to keep in mind what actually matters.

When I was hemorrhaging from my lungs and certain I was going to die, all I wanted was to tell the people I care about how much I love them. My portrait and event photography is an expression of my love for people and wish to preserve memories.

Portrait of Serena Lawrence, one month before she passed away.

I want my photos to make people feel special, seen, and cared for. Profitable or not, I believe that’s a worthy endeavor, and I’m sticking to it (full-time!). I will try to be better about writing my columns in my “free time” (at 11 p.m. on Sunday).

P.S. Did you notice my photography puns in the subheadings? Puns are the real reason I chose this career.

P.P.S. Seriously, I need more Instagram followers to boost my self-worth. Click here.


Originally published by Pulmonary Hypertension News.

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Recovery

2018 Update

Looks like I haven’t updated my blog since early November. Oops! I’m still writing weekly my column, Life After PH, for Pulmonary Hypertension News, but even that has been a bit of a hassle to keep up with.

I started this blog when all I thought about and talked about all day long revolved around my health. Recovering from surgery and immunosuppressed, I was physically isolated from society. My mind, still altered by chemicals, was overwhelmed with processing the trauma my body had endured. I needed an outlet and a way to efficiently disseminate information to my supporters at a time when I struggled to hold a conversation.

Now that my health is stable, I really have to force myself to sit down and think about what I have that is useful to share with the pulmonary hypertension and transplant communities. It can mean a deep dive into painful memories and can be emotionally exhausting. That said, I am grateful to have a platform to share my thoughts and experiences on, and writing continues to be a healing activity.

Current preoccupations

Last month, I paid federal taxes! Not only am I happy to have the paperwork done, I am thrilled that my freelance photography business is turning a profit for the first time since establishment in Fall 2015, especially given that I spent most of 2016 and some of 2017 fighting for my life (see: hemoptysis, transplant, and acute rejection).

As much as I love writing, photography is my passion. I’m grateful to friends and family who have encouraged me to pursue this art form, and have supported me financially by referring me to others, or hiring me themselves. Freelancing gives me the flexibility to attend regular appointments and exercise often, which I believe made the most significant contribution to my recovery and my current health.

In addition to hiking, I have been rock climbing regularly, and (humble brag) improving rapidly. Climbing routes are rated for difficulty, giving me a concrete way to track my progress, and to identify goals to (wait for it) reach for. It feels so good to have slightly muscular arms, instead of the noodle-like appendages I grew used to.

Future intentions

I’m not sure who reads this blog and who reads my PH News articles, but analytics suggest there’s a good number of you. Bear with me, faithful readers, as I intermittently repeat my PH News articles here. Maybe I will occasionally generate some blog-only content, but I am putting most of my extra writing energy toward longer form memoir-writing. “Publish a book” remains obtrusive on my post-transplant bucket list.

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Recovery

Bringing Illness Out Into the Open

I bought into the whole, “invisible illness/disability” thing until my condition became visible, but even less recognizable. Outside the clinical environment, few people guess that I am wearing a mask because I recently had a transplant. More common assumptions are that I have allergies, I’m training to exercise at higher elevations, or I am simply making a fashion statement.

We make all sorts of incorrect assumptions when we recognize the presence of a disability. Offer our arm to someone using a white cane. Shout or mouth words to a deaf person. Keep students with wheelchairs in special education classes. When I wore supplemental oxygen in public because of my pulmonary hypertension, strangers would sometimes offer me their seat on the bus, but other times they’d ask me for a cigarette; the level of understanding was inconsistent. I’m unable to think of a so-called visible disability universally understood by the public.

When I think about the times I was bullied as a kid, I tend to think of instances when I was teased for the ways pulmonary hypertension made my physical appearance different from the norm. I’d let comments from my peers slide off, chalking them up to youthful insecurity, or ending the conversation by using big words like “intravenous” and “vasodilator,” the other kids nodding wide-eyed, pretending to understand. But adults teased me too — for wearing a helmet ice skating while on high doses of blood-thinning Coumadin, for carrying so many bags (a backpack for my IV Flolan pump, another for my school books, and a bag for backup medication), and for the rash they assumed was poison oak, but was a side-effect of Flolan.

As an adult, I’m still getting teased for doing what’s necessary for me to stay healthy. Last year, I wore a black face mask every day during the month of October. People stopped me on the street to guess my costume. I wasn’t posing as Hannibal Lecter, Batman’s Bane, or Darth Vader, though passing strangers delighted in rasping, “I am your father.” I wasn’t trying to look like a ninja or a Mortal Kombat character either. Three months post-heart-lung transplant, I had no interest in drawing attention to myself.

Having undergone a life-altering procedure that would remodel my ribcage for several months, I already felt like I didn’t belong in my own body. Now I didn’t belong in the neighborhood I called home. I live in the vibrant Castro district in San Francisco; locals and visitors alike don all sorts of costumes without ever getting a double-take. One man hangs around with nothing but a gold sock covering his genitals, often enough for my Lyft drivers to shrug and say, “Oh, yeah. That guy.” And yet, I had someone shout, “Boo!” at me, a barista roll her eyes telling me a cup of coffee would be “hard to drink with that mask on,” and a homeless woman point toward the Wells Fargo suggesting I would “feel better if you go up there and rob them.”

Though my sister and I laugh about the time a man stumbled when he passed me on a hike, and the time another man tripped down a few stairs when he took a second look at me (Really, men are falling for me all over the place!), wearing a mask adds to my already robust social anxiety. Misconceptions make illness — invisible or otherwise — that much harder to battle.

But I’m not about to let presumptuous comments stop me from living my life fully and safely. And neither should anyone else. I’ve settled on five ways I manage reactions from strangers. My hope is these strategies will work for others who have visible components to their disability. If you have some tips of your own, I’d love to hear from you!

1. Smile.

It makes you feel better and seem more approachable. People can tell from my eyes when I’m smiling behind a mask.

2. Prepare a response.

Have a short explanation for frequently asked questions so you aren’t caught off-gaurd when you get them. For instance, “I have a lung disease that makes me short of breath.”

3. Treat it as an educational opportunity.

If you’re getting stares or questions about your disability, chances are, the person asking has never seen anyone like you. If the goal is to make illness a less taboo subject, we have to be open to sharing with outsiders. This is a chance to raise awareness for your condition. I also like to think that by taking the time to educate someone, I’m saving the next girl in a mask from dirty looks.

4. Simplify your response for children.

Kids will ask the questions adults won’t, but you may need to revise your prepared response so they can understand. “I get sick easily,” works better than, “I had a heart-lung transplant and my immune system is suppressed so I won’t reject the donor organs.”

5. Laugh about it.

Interactions with strangers are worth taking notes on. Whether you blog about them later or share them at cocktail parties, you’ll have stories to tell. No matter how painful the experience, I can always find a friend with whom to laugh about THAT CLUELESS JERK.

Now, if you’re the one staring, don’t feel bad. I know it’s not normal that I’m wearing a mask. But I do see you staring, so let’s discuss!

On the bus one morning, a little girl was staring and pointing at me, asking her nanny why I was wearing a mask. “I don’t know why she’s wearing it,” her nanny said. “You should ask.” The woman’s response allowed me to explain, smile, and spread awareness to everyone in earshot. “THIS is how you raise kids without fear of diversity!” I wrote on Facebook that afternoon. My mask comes with a good story, and I’d love to satisfy your curiosity. Though aspects of a condition are sometimes physically visible, there’s always something beneath the surface, or rather, behind the mask.

Originally published by Pulmonary Hypertension News.

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Recovery

Not a Costume: Wearing Masks After Transplant

Last year, I wore a black face mask every day during the month of October. People stopped me on the street to guess my costume. I wasn’t posing as Hannibal Lecter, Batman’s Bane, or Darth Vader, though strangers delighted in rasping, “I am your father,” in passing. I wasn’t trying to look like a ninja or a Mortal Kombat character either. Three months post-heart-lung transplant, I had no interest in drawing attention to myself.

Having undergone a life-altering procedure that would remodel my ribcage for several months, I already felt like I didn’t belong in my own body. Now I didn’t belong in the neighborhood I called home. I live in the vibrant Castro district in San Francisco: locals and visitors alike don all sorts of costumes without ever getting a double-take. One man hangs around with nothing but a gold sock covering his genitals, often enough for my Lyft drivers to shrug and say, “Oh, yeah. That guy.” And yet, I had someone shout, “Boo!” at me, a barista roll her eyes telling me a cup of coffee would be “hard to drink with that mask on,” and a homeless woman point toward the Wells Fargo suggesting I would “feel better if you go up there and rob them.”

I want to be able to write that after all that I went through – all the far more humiliating moments I had while hospitalized, with slowly draining chest tubes and constipation from a slowly emptying stomach – I am unfazed by comments from clueless strangers. But I felt robbed of normalcy each time. I told myself the experience would help me practice empathy, and that every tactless comment was fodder for my memoir.

Though my sister and I laugh about the time a man stumbled when he passed me on a hike, and the time another man tripped down a few stairs when he took a second look at me (Really, men are falling for me all over the place!), wearing a mask adds to my already robust social anxiety. I prefer going to gyms over parties because I don’t have to shout for people to hear me. Some people think I’m wearing an elevation training mask, or sensitive to the loose chalk that permeates rock climbing gyms. My mask may hide my smile at parties, but it also hides the unbecoming facial expressions I make when I’m struggling on a bouldering problem.

Now that my transplanted heart and lungs are a bit older (and a bit more mine), I wear masks less and less. I’m on lower doses of immunosuppressants and therefore less prone to infection, so I mainly wear masks on public transportation, in hospitals, and at the gym. I notice how different I feel leaving my house without fear of people stopping or staring at me, ordering my coffee or interacting with a salesperson without a physical barrier between us.

Last week underscored the reason I wear masks. They are one of few forms of protection I have in a life replete with risk. All the stares in the world are worth the peace of mind that I am protecting my lungs from infection. My P100 and N99 masks filter particles in the air, and have proved an effective way to train me to stop touching my face. With wildfires severely impacting air quality throughout California, and especially the Bay Area where I live, I’ve seen dozens of other people wearing masks around the city. I went from being an outsider to being a paragon of preparedness.

With the holiday falling on a Monday, I was in the thick of the Halloween festivities when I took my dog for a walk in the Castro neighborhood Sunday night. “I like your costume!” someone hooted. I grumbled thanks, but later it occurred to me that I should have said “I like yours, too,” since we were both in street clothes. I wanted so badly to pass for normal and efface myself from public view. My mask made that impossible, and rightfully so, as masks were not the norm.

This October, I’m not the only one wearing a filter mask. I wish deadly fires had not sparked this trend toward normalization, but seeing more education about types of masks and their applications gives me hope for refuting the misconceptions I’ve experienced. Once again, I find silver linings in the midst of disaster: learned empathy and, as always, writing material.


Originally published by Pulmonary Hypertension News.

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Recovery

Saying Thank You: Writing to My Donor Family

For months, I agonized over how to offer my condolences to people I’d never met for a loss about which I had no details. I imagined different scenarios: how different it might be for a parent to receive the letter, compared to a child or a sibling. Because organ donation is an anonymous process, my doctors gave me no information about my donor after my transplant ― not gender, not age and certainly not cause of death. My social worker told me I could write a letter to the family of my organ donor and I might be able to learn more about my donor if someone responded.

After reading a few sample letters other recipients had shared online, I decided all I could do was write about myself. Thinking the letter’s recipient(s) would want to know who I was and how I was doing, I described my life before the transplant, and why I needed a new heart and lungs. I wrote about how my life has changed since my operation, and my goals for the future. I thanked them for saving my life.

With my 24th birthday in mind as a soft deadline for my letter, I delivered a hand-painted watercolor card filled with my best condensed handwriting to my social worker near the end of April. A weight lifted when I had finished, as if I’d just turned in a final paper. Now, when people asked if I knew anything about my donor, I could say I had taken steps toward knowing more.
In July, after celebrating a full year with transplanted organs, my thoughts returned to the letter. I’d heard I would be notified if and when the letter was delivered to my donor family. On a whim, I emailed Donor Network West, the organ procurement organization involved in my case, to check for an update. A call the next morning informed me the organization had not received any correspondence from me. To my dismay, the letter was lost, adding another item to my list of disappointments in my transplant team. I wrote again, this time in an email, promising future handmade cards. Still nothing.

I believe it’s important that my donor family knows how often I think about them and my donor, and how hard I work to care for their gift. As I return to a routine that isn’t entirely dictated by my health, I can see more friends, some of whom I lost touch with while in the throes of medical drama. At coffee with a friend from college, I was taken aback when she asked if I feel better now than I did before my transplant. Admittedly, she doesn’t know much about pulmonary hypertension, and I was pretty good at hiding my symptoms when we lived together.

When my team was listing me and I was forcing myself to picture best-case outcomes, I didn’t imagine the life I have now. My transplant changed my life in truly unimaginable ways. Not only can I breathe easier, but my whole circulatory system is healthy now! I’m thriving, and I want my donor family, in addition to my family and friends, to grasp just how transformative this has been.

With the holidays approaching, I am writing again. I delight in celebrating birthdays and other occasions with my family, but recognize the inherent unfairness. My donor family spends their holidays without the person who saved my life. I know that I didn’t cause or hasten my organ donor’s death, and that putting their gift to use is the one thing I can do to help some good come out of their loss. Still, I understand that their family might not be ready to rejoice with mine.

It was surprisingly painful for me to write my first thank-you letter, and I went through several drafts. I had to reflect on my life with PH and how close to death it brought me, in addition to empathizing with my donor family’s grief. I cried a lot more than I ever expected I’d cry while writing a thank-you card. Everyone has to go at their own pace, but I encourage other recipients to start writing as soon as possible.

Even though my donor family has not responded, writing to them has brought me closer to closure. The act of describing one’s life before and after transplant is an important step in processing the amorphous mass of emotions involved.

Some of the resources that helped me write my donor family include guidelines from Gift of Life and from UNOS. Sample thank you letters worth consulting include ones published by Los Angeles TimesSharlie’s Angels Blog and Bob’s New Heart Blog.


This post was originally published by Pulmonary Hypertension News.

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Recovery

Redefining Self-Image

The best product of my teenage angst was a series of abstract paintings entitled, Attached to a Machine I through IV. During my junior year of high school, I was particularly upset that my doctors had switched me from a tiny pump that fit into my pocket (CADD-MS™3) to a tiny pump that fit in my pocket (Crono Five) with a syringe that stuck out a bit. Truly catastrophic.

The new pump meant that I could receive medication at a lower concentration and faster rate, putting an end to a series of hospital stays caused by clots that formed when my medication was accidentally stopped for too long. Each time my Broviac catheter clotted, surgeons had to replace it. The operation required general anesthesia and often came with additional complications, like blood infections I spent weeks fighting, with caustic medication tearing through my peripheral veins.

Attached to a Machine IV

Oil on canvas.

Foolishly, I fought hard to keep my cute, pager-sized pump, only recently freed from the brick-sized pump (CADD-Legacy™1) I started on in first grade. Introduced to the market by an Italian manufacturer, the Crono Five pump came in a snazzy green color. At the time, I had a Samsung flip phone with a megapixel or two, and I started taking close-up pictures of my pump, printing them out, and then painting them. The results made me more comfortable with my latest attachment and earned me an A in my high school art class.

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Acrylic on canvas.

My pump—whether it was the CADD-Legacy™1, CADD-MS™3, or Crono Five—gave me life. Or rather, kept me from death. Any interruption to the medication brought on nauseating symptoms of withdrawal, even in the few moments I discontinued the delivery to change out the pump, syringe, and tubing. In my more dramatic moments, I thought I shouldn’t be alive—that only a series of tubes and beeps sustained me, and that a machine defined me. Painting was a physical outlet for my rage, the brush strokes therapeutic. Abstracting the machines that administered my treatment gave me control over the image of my illness.

KronoFive I

Chalk and graphite on mat board.

Now I have life because of another human being. My tissue stitched to my donor’s and not to a tube, my life has new meaning. When I’m flying down a hill on a bike, sweaty and exhausted from the climb, I exalt for both of us. I take this healthy heart and lungs where my organ donor cannot go in death, and where I was never able to go in life with PH. In December, I traveled to the south rim of the Grand Canyon, at an elevation above 7,000 feet—my first trip post-transplant, after a lifetime limited to altitudes below 4,000 feet.

Painting allowed me to create beauty from the trials of my disease. My organ donor created beauty through the trails I’ve hiked, walls I’ve scaled, photos I’ve taken, hugs I’ve given, jokes I’ve told (they’re wildly funny), and the life I’ve lived because of their gift. Every impact I make builds on the impact my donor made in their selfless decision. Owing my life to another human being, rather than a pump, is a responsibility I am increasingly honored to have.

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Hiking at altitude in Sedona, Arizona, with my family.

Author and hospice chaplain Kerry Egan observes that the hard things we go through define us, but that we decide how they define us. She writes in “On Living” about finding a way to let her hard thing be kind to her. My ugly syringe led me to paint, and my transplanted heart and lungs led me to write and climb rocks. I never wanted a pump, or a disease, for that matter, and I never wanted a transplant. I often wish I had a normal childhood or could hope for a normal future, whatever that means. But at the same time, I wouldn’t want to miss out on the (sometimes fuzzy and abstract) beauty that defines my abnormal life.

Originally published by Pulmonary Hypertension News.

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Recovery

Life with More Spoons

My sweet friend Teresa has stopped asking me if I have enough spoons to hang out with her. With my health stabilizing, appointments fewer and farther between, and my oxygen saturation at a steady 100 percent, I have a lot more spoons to work with. If you’re sitting there wondering whether heart-lung transplants come with a surplus of cutlery, let me explain The Spoon Theory.

Christine Miserandino originally coined the metaphor to explain what it felt like to live with lupus. At a diner with a friend, she used spoons to quantify the total supply of energy she had between rests, and the amount of energy (number of spoons) needed to perform daily tasks like getting out of bed and taking a shower. Borrowing from nearby tables, Christine gave her friend a bouquet of spoons and had her friend list the activities she did in a day, taking one or two spoons away for each. To her friend’s dismay, her bouquet quickly dwindled.

Spoons were a useful symbol for me to explain my limitations to friends and family. When I had pulmonary arterial hypertension (PH), I was tired from the moment I rolled out of bed at 10 a.m., tearing my oxygen cannula from my nose, and heading to the bathroom for my first round of diarrhea for the day. I almost never made my bed because all the reaching and tugging involved was exceptionally depleting. After cooking a meal, I would struggle to clean the dishes I had used, creating tension with roommates. Thinking about each activity in terms of the number of spoons it required helped me budget my energy with more intention.

Since my transplant, I’ve gained an appreciation for how hard my life was with PH. Everything is easier now, and I feel kind of guilty because many of my friends (and readers) continue to battle health issues. It’s impossible as a healthy person to fully understand life with PH, but I battled the disease for 23 years, and now I’m learning what life is like with a healthy heart and lungs — what it feels like not to use all my spoons in a day.

The cashiers at my local supermarket tease me because I come in a few times a day to purchase one or two items. I can go to the store as many times as I like without experiencing fatigue. It’s a privilege not to have to plan as much of my life in advance.

More than a year with my new heart and lungs, I still budget an inordinate amount of time for certain activities, like showering, which used to take at least half an hour with a sterile bandage change. My mind has not quite caught up with my healthy body, and I surprise myself when I’m able to exercise, do household chores, and work on my photography business all in one day.

Experiencing life with more spoons, if you will continue to indulge this metaphor, has made me fearful I will lose them again. I’m protective of my newfound health to the point of paranoia. I feel I cannot delay any of my goals, and that I owe my energy to those who have less.

In high school, Teresa waited patiently for me to catch my breath every few minutes while I attempted to hike with a group of friends. After college, she’d understand when I didn’t have enough spoons to meet her at a bar. Last month, we went hiking after I had spent the morning rock climbing. This time she didn’t have to wait for me — I even carried her water bottle. With ample spoons left, we went to dinner, and I drove her home. My therapist tries to tell me that just because I can do more now, doesn’t mean I have to or can do everything. I’ll let you know when I figure out how to slow down.

Though I’m afraid my health might decline again, and transplantation comes with myriad risks and unknowns, every day I accomplish more than I ever imagined doing when I had PH, and even find myself with extra spoons to spend doing silly things like brushing my dog’s teeth before bed!


Originally published by Pulmonary Hypertension News.

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The Waiting Rooms That Give Me Community

When my alarm goes off at 9am in clinic and I pull out my bright green pill organizer, others around me start to do the same. “I’m glad she did that because it reminded me,” I hear one woman say as I leave the room to find a space where I feel safer taking off my mask for the five seconds I will breathe unfiltered air and drink sips of water.

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One week’s worth of the medications I take.

Lung transplant clinic days begin when I take a seat in a line of patients waiting for the Pulmonary Function Lab to open at 7:30am. Next, we race to complete chest x-rays and blood work before we can get our name on the list to see a physician. Some days I spend five hours at the hospital leading up to a five-minute meeting with my doctor. This isn’t unique to transplant clinics. Hospice physician, Ira Byock, recalls his father saying twenty minutes into a wait at a cancer center, “They give you only six months to live, and then, little by little, they take it back from you.”

Masks make it easy to recognize my compatriots so I try to use time in waiting rooms to meet other transplant recipients. I carry business cards with a link to my blog to make it easier to stay in touch. I’ve met patients ten, fifteen, and even twenty years post-transplant, heard stories about overcoming rejection, and traveling internationally. Sometimes it’s just nice to not be the only person in the room taking Prednisolone, a drug that makes me pretty much constantly on edge, and that has lived up to my pharmacist’s initial advertisement: more side-effects than letters in its name.

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Fellow pulmonary hypertension status post-double-lung-transplant patients Mark Simpson and Mari Matsumura share stories in a waiting room at Stanford Medical Center.

The drug that kept me alive before my transplant was so uncommon I had to fly or drive long distances to find other patients (and doctors) who understood it. My mom and I attended a pulmonary hypertension (PH) Conference in 2000, a week after my diagnosis. A fire alarm went off in our hotel the first morning. Standing outside in our pajamas, we met other families attending Conference, who, unlike us, had thought to grab backup supplies for their pumps that, like mine, administered intravenous Flolan, a medication with a worrisome 6-minute half-life. Forever after, I had a dedicated “backup bag” that went everywhere I did. Biennial PH Conferences were one of few forums in which I met other patients and learned critical information, like how to conceal my pump under a dress. Now I have a built-in community I can recognize based on the time they have their labs drawn.

Barring a few exceptions, all transplant recipients take an immunosuppressant with the brand name Prograf (also known as Tacrolimus and formerly FK506) every twelve hours. Transplant teams have a target level for the Tacrolimus concentration in the blood based on type of organ transplant, time since transplant, and so on. You don’t want the level to be too low or you might reject your transplanted organ(s), but you don’t want it so high that you risk infection and toxicity. Since the level can fluctuate a lot while trying to find the right dose with a handful (literally) of other drugs, labs must be drawn frequently–twelve hours after the last dose and immediately before the next. For me, that means at 9am or 9pm.

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Two-time heart transplant survivor Corie Crowe models in a surgical mask alongside her medication.

Sometimes I’m just not in the mood to deal with needles in my veins right after breakfast. Luckily, a friend I met in a waiting room taught me the secret of the after-hours lab. When a father and son line up with me at 8:30pm, I’m certain they’re checking Prograf so I introduce myself and ask what the boy had transplanted. Forever a perfectionist, I have them check in ahead of me so I can wait to have my labs drawn a little closer to 9pm. Out in the hallway, I overhear the phlebotomist praising the boy’s bravery. I smile, transported to bittersweet childhood memories.

As a child with PH, phlebotomists told jokes in vain attempts to distract me from the needle piercing my skin, my parents had me squeeze their hands, and rewarded me with bags of chips after my blood was drawn. As an adult with a heart-lung transplant, I calmly pull down the arm rest, squeeze my fist, and take a deep breath. In a few moments hundreds of thousands of other transplant recipients will be silencing alarms and swallowing pills. I am not alone.


Originally published by Pulmonary Hypertension News.

Photos © Kathleen Sheffer Photography

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How My Cosmetic Products Changed with My Chronic Illness

“What’s with the nail file?” my sister asked, her eyes failing to conceal her amusement. Still grinding my nails down, and with two backup emery boards in my purse, I explained my new habit, one of many recent changes she bore witness to.

Nail files

My nurses gave me a present when I was discharged after my heart-lung transplant. They included a set of nail files, explaining that filing my nails down was safer than using clippers, which could lead to open wounds and infection. I think this applies more to infants who could lose an entire toe to adult nail clippers. I’ve had no issue caring for the cuts I get while rock climbing (this makes me sound way more hardcore than I am). Still, I latched onto the idea and started bringing nail files everywhere. Filing helped pass time in waiting rooms and gave me something to do instead of building anxiety.

Makeup

Expired products can harbor bacteria, so I trashed lots of cosmetics after my transplant. A drug-aided identity crisis contributed to my desire to dispose of relics of my life before transplant. With the promise of three months living near the hospital, away from my friends and career, I struggled to imagine a future resembling my past. A year later, I still don’t own makeup. It doesn’t make sense to apply concealer right before I put on an N99 mask.

I welcome any stranger to point out my lack of eyeliner instead of the far more obvious feature distinguishing me from my peers. Applying makeup can be fun and make me feel good, but newfound confidence and an appreciation for naturally pink lips, cheeks, and fingernails makes me less interested.

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N99 respirator mask worn to protect against infections.

Mupirocin Ointment

I didn’t trash Mupirocin, an ointment prescribed by an otorhinolaryngologist — a specialist concerned with diseases of the ear, nose, and throat — to prevent nosebleeds caused by drying supplemental oxygen and high doses of blood-thinning Coumadin. One New Year’s Eve, I spent six hours bleeding into a trash can of tissues until it finally stopped. Other nights I went to an emergency room. I haven’t had a nosebleed since my transplant, but I still apply Mupirocin when dry environments like airplanes irritate my nose.

Deodorant

When my body was fighting pulmonary hypertension (PH), I hardly ever broke a sweat. In fact, I felt colder with exertion. In the middle of an exercise class last week, I looked down to see my entire arm shiny with moisture. Disgusting. I’m regularly horrified by how much sweat my body can produce. It’s as if I’m going through puberty all over again, and it’s just as startling at 23 as it was at 13.

Acne Treatment

Thanks to prednisone, I have acne for the first time in my life. I’ve changed up my body wash and apply ointments prescribed by my dermatologist. I’m grateful to have the time and energy to wash my face every night. When I had PH, I was overwhelmed by the steps I had to take before I could get in bed: mixing intravenous medicine, changing pumps, taking pills, applying Mupirocin, and setting up oxygen, to name a few.

Hair Removal Cream

Many patients experience rapid hair loss or hair growth with large doses of prednisone after transplant. I gained a mustache and sideburns. Not ideal for a 23-year-old woman. A nurse practitioner told me patients “just deal with it,” but luckily, members of Facebook groups and my dermatologist suggested other options. Hair removal cream became my go-to fix once I moved past the nasty smell.

Sunscreen

Due to immunosuppressive medications, transplant patients are up to 100 times higher risk of developing skin cancer. I wear clothing with long sleeves, sport dorky hats, and embrace applying sunscreen before leaving the house, even in foggy San Francisco.

Antibiotic Ointment

When I hike or rock climb, I bring fresh Neosporin (it expires quickly) and bandages — an easy way to maintain peace of mind and an active lifestyle.

Cocoa Butter

A friend recommended dabbing Palmer’s cocoa butter with vitamin E on my chest tube scars after they started to heal. I can’t know for sure that this had an impact, but it gave me a sense of control over my healing process. I apply it to all my scars (including scars from Broviac catheter replacements) and wish I had done so before my transplant. Applying the cream forces me to touch my scars and become more comfortable with them.

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Scars healing eight months after surgery.

I’m fascinated by how the change from life with PH to life after transplant with chronic immunosuppression manifests in my life every day. What I lost, kept, and gained in the transition was more tangible and far-reaching than I anticipated.


Originally published by Pulmonary Hypertension News.

Photos © Kathleen Sheffer Photography

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Recovery

Valuing My Life With PH

I found a four-leaf clover, at last. I haven’t found one since my heart-lung transplant and I have been worried four-leaf-clover-finding was another part of Kathleen that did not carry over from pre- to post-transplant life. My memories of spotting four-leaf clovers go as far back as first grade when I would spend recess sitting in the field scanning the grass for those extra-special shamrocks. One summer day I collected 26 four-leaf clovers from the lawn in Verna’s backyard while my sister swam in the pool. To have gone more than a year without finding one seemed like a bad omen, since hunting four-leaf clovers became second-nature, continuing through college and long after I let go of the collection pressed between the cardboard backing and glass of an elegant frame Verna had on hand.

In gaining a healthy heart and pair of lungs, energy, and circulation, I’ve lost parts of my identity. Beyond spending less time sitting on lawns, I no longer have a Congenital Heart Defect or Pulmonary Arterial Hypertension (PH). During an O2 Breathe Walk, a fundraiser for the Pulmonary Hypertension Association, I was given a T-shirt that says “PH Survivor.” I debated whether I could still wear it. For a long time I thought that transplant meant I had given up the fight against PH; that I had failed to last as long as I needed to for researchers to find “The Cure.” Honestly, I didn’t wear the shirt outside even when I had PH, and it took some doing to take a photo that showed more than “URVIV.” When I reframed transplantation as a treatment for PH, I decided I am still a PH survivor because I was born with PH and fought it. I wore the shirt to bed last night (it makes a great pajama top)! 

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Like others I tried over the years, this treatment option comes with major side-effects. When I tell someone I had a heart-lung transplant, I’m usually greeted with “congratulations,” unless they are particularly clueless and say, “Get well soon.” When I was dealing with intense postoperative pain and brain fog, it upset me to be congratulated on my “new life.” With multiple blood draws, tests, and appointments each week, it didn’t feel like much of a life in the beginning. Now when I meet recent transplant recipients, I have the urge to say the same, knowing how difficult and rare it is to survive the wait for a donor and the operation itself.

“Congratulations on your new life” does not acknowledge the value of the life before the transplant. I had 23 years of that “old life,” and I had grown fond of it. PH sucks (this super cool enamel pin by artist and PH survivor, Jenny Janzer, agrees with me). Life with chronic illness is not easy, but like most challenges, it can be an experience rich with unique opportunities. Everyone’s interests evolve with age, but many of mine developed because of my illness and the limited choices it gave me.

While my cabin-mates at summer camp swam in the pool, I did crafts. While I was at home with pneumonia, tethered to an oxygen tank, I did jigsaw puzzles and played board games. While my sister went to soccer camp, I took a web design course. Now that I need to exercise my new organs daily to maintain their function (and my sanity), I spend less time on art projects and board games. As frustrating as it was to be slowed by shortness of breath, I noticed more things when I moved through the world with PH, and would take photos on walks with groups, while surreptitiously catching my breath.

“Congratulations” does not acknowledge the spectrum of grief and celebration inherent to transplantation. It’s a continuous grief process that began with the loss of my organ donor. “The Call” offering me a heart and lungs en bloc, brought the knowledge that someone with A+ blood had died, that I might die in surgery, and that I might live to experience life without PH. Sixteen hours after my call, I lost the heart and lungs I was born with, and my pump, a machine that delivered life-prolonging medication to my heart for 17 years.

Recently I worried that, without refresher training, I could not perform the procedures I did while on the pump. Then I decided it’s OK for a 24-year-old with a liberal arts degree not to know how to mix intravenous medicine. Still, I miss having saline, gauze, and sterile bandages on hand, especially since my active post-transplant lifestyle seems to make me more prone to injury.

One night, while hospitalized after my transplant, I went for a walk with my dad and my IV pole. Stiff, cranky, and swollen from steroids, I was furious when dad said, “I am just so happy for you.” Like “congratulations,” his statement was an insufficient summary of complex emotions. What I’d prefer to hear as a transplant recipient, and say to others in my situation, is difficult to summarize in a few words. The closest I’ve gotten is this: “I am so happy you are alive, and I know it isn’t easy.” Those of us living with chronic illness often see ourselves as a burden to others and don’t want our complaints to make us appear ungrateful. We need to be reminded that our lives are valuable. We need others to know that the fight is not over after an operation; it is ongoing, never easy, but full of opportunity.

I love having the ability to chase after my dog, go on 9-mile hikes with my friends, and photograph 10-hour weddings with heavy equipment in tow. My post-transplant life is very much informed by my PH life, empowering me to appreciate falling asleep without an oxygen cannula, and changing clothes after showering, instead of sterile bandages. Last month, my sister and I took our bikes to ride along the same path we rode so often as children, and later as teenagers. The slopes I previously perceived to be mountains are now gradual hills, and the ride that drained a full day’s energy barely ranks as a workout for my new organs. When I catch my breath with ease, I cry for the little girl with blue lips who had to learn before other kids to shift gears on a bike to make it up hills. I cheer for the transplanted woman who now can race her younger sister up those hills (and win fairly, sometimes), even if it’s 20 years late. I cry for my donor, because my new life is only possible because they lost theirs.

clover 4

Relief washed over me when I saw it. As if it might run away from me, I hastily snapped the delicate stem and examined the stunted fourth leaf crowded by the others. I’m comforted to know there will be time in my new life to sit in the grass disentangling shamrocks until I find the elusive extra leaves that make me feel as special as they are. Now it will happen because I make the time to sit and look, and not because I’m too tired to stand.


Portions of this post originally published by Pulmonary Hypertension News.

All photos © Kathleen Sheffer Photography.

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