Coming Out of the Closet

Susan E. Cohen and her team are competing for the opportunity to create and perform a poignant musical about people living with ME/CFS called “Bathrobe Heroines,” which has reached the semifinals in the Chicago Voices competition. Bathrobe Heroines is competing against seven other groups for three spots to develop the story into an original music theater work with the support of Lyric staff and artists.
Please vote for “Bathrobe Heroines.” Voting takes place daily so cast your vote everyday until April 2.  (Only those with a US zip code can vote.)
I do a pretty good job of passing for normal. I almost always wear gym shoes so people assume I’m some sort of athlete who jogs at dawn or is about to pop on to the nearest treadmill. I actually wear them because, besides being comfortable and supportive and a little more bouncy than a traditional shoe, they save tiny shreds of energy.  I usually leave my purse in the car–my keys in one pocket and my phone in the other with a credit card saves carrying weight–more precious shreds of energy. When I travel with my husband, he will bravely carry my purse for me at times to save my strength. If I am feeling well enough, I take it back from him. I always do as much as I can–he understands that; he knew who I was before I got sick. He is really the only person who has fully witnessed my struggle.
I sit wherever I can–cocktail parties are the worst. People like to stand at parties in America– that way if a few minutes of chitchat is not highly rewarding, you can effortlessly move on to someone else. I know, because I sit at cocktail parties and wait for the courageous soul who will come and take the risk of committing to sit next to someone. I have been known to sit and even lay down sometimes in very unusual places, the floors of airports, the floors of supermarkets; anywhere you end up standing-in-line, you may find me sitting, which is why I usually wear pants.
I have an illness for which there is no cure nor any real treatments, a disease that does not sound like a disease, but is more disabling than most. When I am really ill, no one sees me except my family. You can only find me horizontal, laying on our bed or, if I am too weak to make it upstairs, laying on the couch; in either case my legs angled up against the wall at first to let the pooled blood circulate back. I will lay there for hours feeling like I am cloaked in death, a toxic sensation completely taking over that renders me helplessly weak and powerless to move, the body’s very effective way of telling you that you have overstepped your limits. At that point you don’t get to decide whether you can do more or not. The body cannot go further. Pain in the lymph nodes, lots and lot of pain. This is another feature that people don’t seem to grasp. No matter if I have tried to explain the illness before (which is why I usually don’t bother), any time I mention pain, they invariably comment again, “I never realized you have pain.” Most of the time, because I do not complain and am out of sight when I am severely ill, they do not even remember that I am not well.
Contrary to popular opinion, stress does not make me ill–only using physical energy will do that. Walking too long (and “too long” is not very long indeed) whether on a beach or a garden path or just on the street where I live, will render me hopelessly sick. A short spurt of dancing, my formerly most favorite of all human pursuits whether it be ballroom, modern, disco or folk will make me ill very quickly. Carrying, lifting, hiking, biking, cross-county skiing, tennis – all out of the question. “Face it,” I was told at a medical conference by an exercise physiologist, “Your aerobic system is broken.” I am forced to live like an invalid, while my body yearns to play like an athlete. I cook in the kitchen sitting on a high chair. I make brief “healthy” appearances and then I lay down.
I am a whole lot better than I used to be. For the first five years of the illness, I was bedridden much of the time. I could make it to the bathroom and the table to eat, but not a whole lot more. By experiencing overwhelming weakness, I am now able to understand how people actually die even when they desperately want to live more than anything else. I constantly come to terms with the limits of willpower, something that our culture does not accept.  We battle our diseases in America, we fight the good fight, we overcome, except when we can’t. Until I had this illness, I did not understand how the mind, no matter how strong its willpower, must eventually bow to the body. With this disease, I learn this lesson over and over again.
And yet… every time I start to feel even a trifle better for part of a day, my optimistic side takes over and starts to seduce myself. Maybe I am improving, maybe I can walk a little further, maybe I can keep going. It is hard to believe that someone can keep fooling oneself over and over like a built-in Charlie Brown, but that is exactly how I live. One doctor called me, “The ultimate masker.”  What I really am is a consummate amateur actress, playing the role of a healthy person for the public, playing the role of a not-so-sick person for my physicians, my acquaintances and, ultimately, for myself.
Which is why people occasionally still invite me to travel with them. I am an adventurer at heart, but these good meaning people have no idea of how I would hold them back. I can’t go to the market place in the early morning and then through the museum and then on to the palace, the temple, the ruins. Only in my fantasy. I imagine that if I am in a different, exotic country, I will inhabit a different body, my real body, the body I was born with, the body that had limitless energy the first 24 years of my life, the real me.
Obviously, I still have not integrated the sick person I am with my self-concept. In my heart, I aspire to be an adventurer. In my brain, I am a popcorn popper of plans and temptations. In reality, I can do one activity and, on a good day, maybe two, but not day-after-day in a row. On a bad day I have to be still. I have to wait for the temporary reprieve that recovery mode will eventually bring. Have I ever been well for a whole week in the last four decades? I would have to say no. How about a few days in a row? You mean, the whole day, all of those few days? No. One whole day? In the first thirty years, never. Now, once in a great while, it happens. This is an illness that never leaves you. It inhabits you, it stands ready to consume you, it shadows you in the rare moments you appear to live normal.
Do I describe this to you now because I seek pity or sympathy–unequivocally, no. I describe it only so you have a chance of understanding how I live, that I inhabit a completely different world, that I function in a very unstable universe of illness, where things change every few hours and, therefore, for which I must make constant accommodations. That to my consternation, I find myself a delicate flower who cannot abide the cold, who can get a sore throat followed by bronchitis from a brief chill. I am someone who once canoed down the Allagash River, who camped outside in the winter, who worked as one of the first female mailmen, a person who ran along the beach for the sheer joy of movement. I remember myself going out to dance in the rain…
When I first became ill, I was diagnosed with Leukemia, then Hodgkin’s disease, then “nothing” because the disease I suffered from had not been named or even discovered yet. Our physicians knew they could not cure everything, but they thought they could, at least, render a diagnosis. If your complaints did not fit into one of the medical sorting boxes, you simply could not be ill. “You must have more symptoms,” I was told. “You must have fewer.” “You should get married,” the infectious disease specialist counseled.” “You should work on your brilliant doctoral dissertation,” the Mayo Clinic advised. I was told time and time again, “If you were a man, this would not bother you,” and, “If you got married, this would probably all go away.”
The disease I have was originally called CFS for “Chronic Fatigue Syndrome,” in this country, then briefly referred to as CFIDS for “Chronic Fatigue Immune Deficiency Syndrome.” There was a quick flirtation with “Neuroendrocrine Immune Disorder,” while Myalgic Encephalomyelitis or ME has been the title for a long time in most other countries. At the moment the medical choice of our national experts is a combo platter name of ME/CFS. The reference to “chronic fatigue” makes the illness sound like people are tired. Let’s face it, everyone in America is tired. Tired is nothing. We have all been tired. Tired is something you push through. You have a cup of coffee, you shake yourself out of it, you soldier on. Tired is not Chronic Fatigue Syndrome. Profound debilitating weakness—now that is ME/CFS.
A new IOM committee, supposedly validating the illness as a real disease, just recently proposed “SEID” for “Systemic Exertional Intolerance Disease,” which unfortunately conjures up the image of a “couch potato” or perhaps aged people propped up in wheel chairs in the halls of a nursing home.
Last weekend I attempted a walk in the Botanic Garden with a good friend. “Are you sure this isn’t too much for you?” she, who knows me well, asked. “No, I love it,” I answered bravely. “The fresh air feels so good, the walking really lifts my spirits.” By the time she dropped me off at my car, I was beginning the descent. This phenomenon—a severe reaction to even relatively mild physical exertion—is a hallmark of the illness called Post Exertional Malaise or PEM. I barely managed to drive home and get into the house as I felt the illness gathering momentum and then completely taking over. I cancelled our Saturday night plans; I stayed home Sunday waiting for the siege to pass. I was still in pain and enveloped with weakness at bedtime.
I had a lot of time to think. I thought about how nobody, except those who are stricken or their close family members who live with them on a daily basis, really understands this illness. I thought about how I hide it most of the time. And, as I lay there, feeling like I was dying, I decided that perhaps it was time to come out of the closet.


8 thoughts on “Coming Out of the Closet”

  1. This Is a mirror image of my life before a graded exercise programme enabled real I improvement . Now I have better days and can enjoy some activities. The M.E has not gone but I can manage it a little better….thankfully. A really honest account of the callenges we face every day. Thank you.

  2. Love, love, love it. This matches my experience of the illness so well, and my experience of attempting to soldier through at first.
    I’m at the place where I can tentatively make strides forward, and it feels great while simultaneously feeling very deceptive. I’ve been able to do more, recently, but the spectre of a backslide is always hovering nearby.

  3. Dear Susan,
    I felt it was me writing my own story!
    Your descriptions are telling how exactly my life looks like for the past 4 years, including Fibromyalgia and SIBO.
    You’re very lucky having someone who supports you. It’s about a terrible situation that makes you feel so lonely in this planet!

  4. Thanks for this excellent inside view of the illness we share. I know what it took to write it!

  5. Thank you so much for writing this. I am 27, and was an active person in college, lots of friends, was always able to balance school with a social life and still get good grades (in engineering too). Right before I started grad school, in a very good time in my life, I just started to change. In 3 months I went from being that active person to feeling utterly ill by the end of the day. I lost contact with all but 1 of my friends, she was the only one willing to reach out to me and understand. Grad school was absolutely hell, my mother and father literally drove me to campus for nearly 2 years because I was so sick. It was shear will that got me through those first 3 years. I told my mom that I felt like I understood what patients undergoing chemo felt like. There were times when after intense activity (my brother’s wedding, lots of family visiting and doing things etc.) I would literally wake up moaning in pain in the middle of the night.
    I have now dedicated my life as a geneticist to solving diseases, and this is one that is in desperate need of attention. People at work don’t understand how hard it is to hold a job, it’s like you said, I put on my “social” mask of health, but inside I feel foggy headed, exhausted, stiff, and never goes away. I tell my boyfriend, sometimes there are good days, and sometimes there are bad days. Sometimes I do a lot with the knowledge that I will have to crash the next day.
    Thank you so much for writing this….the concept of putting on your “healthy” mask to outside world is very hard for others to understand. People with this disease are the strongest willed of all! I hope to one day soon contribute to the research on this, we will find a cure within my lifetime I feel!
    Stay strong!!!!!

  6. Lovely piece and yes I can so relate. I got sick in the mid 80s as a young mom of two. The illness has waxed and waned over the years mixing it up at times with other invisible chronic illnesses. It is a lonely illness and you captured much of how many of us feel.

  7. Thank you for so eloquently sharing the truth behind what I, along with millions of other ME/CFS suffers, experience daily. I had always enjoyed an extremely, active lifestyle and worked full-time as an RN prior to being struck down by ME on 12/24/09. I was bicycling 200 miles a week, but then following an extremely, severe bout of the flu with primarily upper respiratory symptoms, I was never able to become well again! I descended down a dark hole with a laundry list of symptoms that didn’t fit into any neatly, organized diagnostic box. I was diagnosed with post viral syndrome after leukemia and lupus had been ruled out. Then when I failed to get better after six months I was told I had CFS. I asked what the hell is that? I’ve never heard of anyone being this sick unless they were dying! I had feared things contracting things such as AIDS as an occupational hazard!. Note that being an RN I had been vaccinated against both H1N1 and the seasonal flu that year, all to no avail and even possibly resulting in my demise! On the days I could, I would try to take my dogs out to walk them around the block, but no one knew that the remaining 23 hours of the day were spent lying in unimaginable pain with extremities that felt too heavy to lift. I comprehend your dilemma of trying to merge the athletic, woman I see in my mind, with the woman trapped in pajamas and lying in the recliner trying to summon the strength to bathe! God bless you and all of the others who have had their lives stolen by this disease!

  8. Thank you so much for this essay. It captures so many feelings that I also have, and captures them so beautifully. On bad days, I come back and read this essay to reassure myself that I’m not alone in this, and to reassure myself that I’m not actually dying, even though sometimes it feels like I must be. How can a body this depleted and in this much pain not be dying?
    Also that Charlie Brown kidding yourself really resonated with me. If I have a good day, or even two in a row, I feel like I’ve won the lottery, and somehow convince myself that “maybe this time it won’t come back…” But so far it always comes back. I guess the Charlie Brown is some kind of mental game to try to stay hopeful.
    It’s discouraging and isolating. It seems it would be easier if we could just tell people we had MS or something without the stigma that CFS/ME has, though I’ve come to realize that you have to experience failing health to truly understand how it changes your life. Doctors who want to blame us for our own illness or call it psychosomatic would do well to really listen to their patients… What was your life like before this? What are your hopes and dreams? We don’t choose this illness anymore than others choose cancer or MS, but it has this stigma that only adds to our feeling of isolation.
    Thank you for coming out of the closet and writing this essay!

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