On March 21, 1999 I was diagnosed with AIDS after more than 13 years of living with HIV. That was eleven years ago. Every year at this time I recognize this anniversary with a reflection that I share with my friends, family and colleagues.

The 11th Anniversary is the “Steel Anniversary”- less glamorous than silver for 25 or gold for 50, but I cannot think of a more apt metal or metaphor for this anniversary.

On that day in March eleven years ago, I never thought I would be alive today; I never thought I would be working again; I never dreamt I would be planning my 22nd anniversary with Lee or celebrating our 2nd year of marriage; or having our 12th year with our beloved beagle Darwin. Steel- is strong, hard and implacable. It evokes thoughts of determination and strength.

Yes, indeed 2010 is a year where I am relying on my internal steel to face a renewed future of hope. But steel is an alloy that’s structure is dependent on a precise and exact combination of elements to create a strong and durable metal.

In my case that unique combination has come from a synergistic constellation of good fortune, inspiration, colleagues, friends, and family.

I have definitely had good fortune. I have a remarkable doctor and excellent healthcare; something that nearly fifty million Americans do not enjoy. I am not going to turn this reflection into a political treatise- I’ll just say that I have what I believe should be the right of every American- good healthcare where my relationship with my doctor is at the center. Oh yes- I have Medicare- a government run program that puts a premium on the decisions my doctor and I make. I am fortunate that as a disabled person who has been a Medicare beneficiary I can continue accessing Medicare by paying into it now that I have gone back to work. I will not have to rely on the vagaries of the private insurance industry and its intrusion on my relationship with my doctor in order to protect its bottom line.

I have inspiration. The work I did before I retired in 2000 was one of the great joys of my life. Having the opportunity to be a small part of effecting positive change for people living with HIV/AIDS and have it as my career was an amazing privilege. Over the past 10 years I have been fortunate to be continually inspired by the social justice and healthcare access issues that are important to me and to find ways to involve myself in that work while being “retired”. Back in the early ‘00s I had the good fortune to work on Medicare issues for people living with HIV/AIDS and got to know a colleague who helped guide my work on that issue and I count him as one of my mentors. That colleague is Jeff Crowley. Jeff is now President Obama’s Director of the White House’s Office of National AIDS Policy and he is one of the smartest people I have met doing this work and is a down to earth and nice guy on top of it. Jeff is just one of scores of amazing people that I have met. The work has been part of my life’s inspiration but the people doing the work are those that are awe inspiring. My colleagues in the CAEAR Coalition, the National Working Positive Coalition and the Coalition for a National AIDS Strategy have kept my brain nimble and my passion invigorated and they inspire me every day through their passion, their remarkable intelligence, and their generosity of spirit.

Then there are the San Francisco HIV Health Services Planning Council and Shanti. These two entities have woven their way into my life in pretty significant ways for many years.

About eight years ago my friend and former San Francisco AIDS Foundation colleague Laura Thomas encouraged me to think about becoming a member of the Planning Council. At the time, I thought I would rather chew on nails- the politics, the array of strong personalities (yes, I know I am no shrinking violet either) – I wasn’t sure I wanted that stress in my life. I had left work because of stress and didn’t want to dive head first into a situation wrought with tension. But I was appointed to the council and over the years the work drew me in. I recognized the amazing work of this group of people who commit themselves to maintaining the best possible system of care for people living with HIV/AIDS in San Francisco, San Mateo and Marin counties at a time of diminishing resources. A wide array of people with an amazing diversity of experience and backgrounds coming together to make difficult decisions. Community planning- it can be messy, but by God it works and it is a beautiful thing.

It was at Shanti 22 years ago where this then 30 year old newcomer to San Francisco decided to volunteer so I could connect with my new community. It is where my passion around HIV/AIDS began to move outward from my own internal battle with the disease. It is where I found my center in San Francisco. A spark was lit at Shanti 22 years ago that lit the candle that has guided my community work for the past two decades. Another spark was ignited at Shanti 22 years ago as well- that’s where I met Lee and some of the most important people in my life.

Could I have ever imagined ten years ago that the inspiration provided by both the Planning Council and Shanti would converge with my good fortune of good health to open the door to a new chapter in my career? Once again I am able to do the work that I love as a profession. I can do the policy and community planning work that I adore with the support of an agency that it fundamentally tied to my life. The Council has given me the opportunity to have every role possible in its organization- a member, a committee co-chair, a workgroup co-chair, a council co-chair and now director. Shanti has done the same- a volunteer, a board member and now staff.

As I embark on this new chapter of my life and the newest exciting challenge in my career. I am supported by remarkable friends, family and colleagues.

I mentioned earlier that I have had the good fortune to work with people with remarkable intelligence, commitment, passion and generosity. That good fortune continues with my colleagues on the Council, my colleagues on the Mayor’s Hepatitis C Task Force, those that work in government both in San Francisco and in Washington, the federal and local advocacy communities- especially my fellow advocates living with HIV/AIDS and/or Hepatitis C, and my amazing co-workers at Shanti- both agency wide and the Council staff.

Friends are at the cornerstone of my support. Throughout the nation I have met compassionate and loving people because of my advocacy work and because of my beagle Darwin (yes- my beagle has brought me scores of loving and wonderful friends- dogs have a knack of doing that!). I have also reconnected with some amazing people from my years at Cornell and prep school from all corners of the globe. The support of all these friends has sustained me. Some of my friends are gone, taken too early by a disease that I have been fortunate enough to survive. I carry their memory in my heart. For six of these friends from New York I am the sole living caretaker of the flame of our collective friendship- a responsibility I am honored and humbled to have.

My family gave me many of the building blocks of my life. My parents instilled a drive to learn and from the emotional tumult that is part of every family I was fortunate enough to develop a sense of duty, compassion and social justice. My sister Linda is one of the strongest sources of support in my life and I love her dearly.

Last but not least there are Lee and, of course, Darwin.

Darwin, our nearly 12 year old beagle, has not only provided me with calmness, unconditional love and affection but he has brought into my life people who are dear to me and an organization, that touches my heart- PAWS.

Lee is simply the love of my life, my best friend, my confidant and to paraphrase James Joyce, as I oft do, he makes my soul swoon. His battle with prostate cancer this year scared me and completely shifted the paradigm that I had assumed for my life. Like my battle with AIDS and Hepatitis C, Lee’s battle with prostate cancer was another challenge that we have faced together that has strengthened us individually and as a couple while we travel on our lives’ journey together. Lee is my bedrock and he is my joy.

The last eleven years have not been easy. Many of those years were hell and at times I didn’t think I would make it. But now- at this moment- I feel like one of the luckiest people on earth. I know that my good fortune, the steel that I have, is not available for everyone. Many have died, a number of them were good friends who remain in my heart, and some of them were personal heroes. Too many people both in this country and worldwide are not availed of the healthcare and opportunities that have brought me to my current fortunate circumstance. That is unfair and it should not be and none of us should ever accept it.

Nearly a quarter of a century ago I was diagnosed with HIV, eleven years ago I was diagnosed with AIDS, ten years ago I retired for health reason, three years ago I was diagnosed with a long standing case of Hepatitis C and 2 weeks ago I returned to full time employment. What an amazing ride.

On this eleventh anniversary of my AIDS diagnosis- that day I was admitted to the hospital at the brink of death- I have a renewed life and renewed commitment to those that do not have the opportunities that I have had.

Thank you for being part of my journey. None of us can get through life alone. I am blessed with a great abundance of support and love. You are the component parts of my life’s steel. Thank you for the important place you have in my life and for, in your own way, making this world a better place.

One thing that’s really surprised me over the last two years or so is the number of guys we see who are co-infected with Hepatitis C.  When I started working in HIV it was mainly ex or current IV drug injectors who had Hep C.  Now it’s more common to see gay men being diagnosed.  The problem is, once you have HIV, you really want to avoid Hep C as it affects your liver and can be hard to get rid of.

Hepatitis basically means inflammation of the liver, there are lots of different versions of Hepatitis from A-G, all of them transmitted differently, some treatable, some harder to get rid of. You need your liver working well to process any drugs you’re taking. If you’re on anti-retrovirals, your liver has to work hard to process them, so you don’t want the additional burden  it of Hep C on it.

Hep C is blood borne, hence the link to injecting drug use.  As the numbers of gay men being diagnosed with it started to climb, there was some confusion.  Was it now being passed through sex as well as blood?  In fact what’s happening is that we’re mainly seeing it in guys who like rougher sex, such as fisting.  Hep C, unlike the HIV virus, can live in a tiny speck of dried blood for weeks.  If  you have sex with someone there only has to be a miniscule amount of bleeding to pass the virus on.

Some guys I know go to sex parties where all the men are HIV+.  The assumption is that it’s OK to bareback as everyone is aware of each other’s HIV status.  As it’s so easy to pass on, it’s spreading through the HIV+ gay community in London rapidly from what I’ve seen.  You don’t need to have sex to pass it to someone, the smallest trace of blood can be passed on really easily by touching and even through a shared lube pot.

Once you have the Hepatitis C  virus, it’s possible your body will clear it on its own.  If not, there is a treatment, Interferon, which works for some people but not for others.  It can be a very unpleasant treatment and generally lasts six months to a year.  You have a weekly injection and many people feel very unwell and fluey in the days afterwards.  It can also cause depression.  But lots of guys report they’re not too badly affected by it and are able to carry on as normal.

It’s best to have the treatment as soon after infection or diagnosis as possible.  Hep C, like HIV has a Viral Load and having the treatment as soon as possible can get the Viral Load down quicker and you’ll stand a better chance of clearing it.

If you’re HIV+ and your clinic hasn’t offered you one already, please make sure to ask for a Hepatitis C screen.  It might be a scary thought, but it’s much better to know if you’ve got it and the earlier you’re diagnosed, the higher your chance of clearing it.

There have been numerous points in my life where there has been a substantial change, something stamped permanently in my make-up.

I’ve just spent an exquisitely wonderful day doing things that even I had begun to suspect I was not going to do again. Apart from a couple of fiddly little projects I’ve been toying with, it’s a long time since all my machinery got to have a play.

Simple things – an improvement in economic outlook, a reminder of how much I love the night skies, a clear assertion of who I am and what I believe.

Being a parent to a late-teen who’s having all the experiences of that age is a reminder to me that pain is pain, and it’s unbelievable how many shades of pain there are. All distinct, arrived at by different formulae. My boy is getting to learn from things that I’ve never had to deal with. I can’t imagine how the Universe looks from his perspective, but I recognise his pain as each of the rites of passage takes place in its own time and in its own way.

I’m a pretty hide-away kind of guy. I spend most of my time way down the back of the yard in my caravan, where I can make strange AVS sounds night and day without anyone complaining. But times like this I really make sure the boy knows I’m right here any time he wants me. I don’t want to fuss and crowd, or overwhelm with sage advise. I don’t think he wants that either. He knows I know and he knows I know he knows.

Something a little strange about today’s project. I didn’t have to rush out and buy a heap of stuff before I started. It was actually a very good day of recycling. The project is a mount for a bino-telescope that’s on it’s way. After picking through all the carcases of projects past, I identified the base of a pier with three flat legs with levellers, and a lazy susan bearing type Dobsonian mount that I had briefly used for the 14″ f7 Newt. As it happened, the slots for the alt bearings of the scope just happen to be at the exact right height for the centre of altitude rotation of the human head. The logical conclusion is a sit-in mount, where you paddle your way around with this pair of perfectly counterbalanced 100mm semi-apo binoculars between you and the stars.

Thus far the pier and the mount have been cleaned up and prepared to be assembled. The pivot arm on which the scope and counterweights will mount has been cut and welded. The 90mm diameter aluminium pivot bearings have been cut and machined.

I was pleased to find that my aptitude hasn’t changed through the period of disuse. I still suck at welding and I still have no idea why my bandsaw won’t cut an accurate angle (umm, something about tools and blaming thereof?) Nonetheless, I have a very high hit rate on ending up with something that does what I intended it to. Quite often I look at it once I have it and realise that I’m never going to do the thing that this thing is meant to do. Actually I’ve done most things that I’ve done at least twice – once to do it and the second time to prove I wasn’t scared. On this occasion I have a very reasonable expectation of getting the pleasure I anticipate. There’s just been a very strange confluence of events that make it clear that this is just one of those thing’s that’s meant to be. A master of self-justification? Yes. Always on first impulse, but I’ve got a pretty good eye for it now, and this project scans clean. Astronomy and engineering have resurfaced often enough over the years for it to appear that they’re a stable part of my cycle. They’re things I can only enjoy doing when I’m pretty relaxed, feeling good and have a little kick of excitement going on.

A few more brand-name commercial entrainment sessions have come my way for consideration. I think I’m going to stand by my earlier statement that this kind of content doesn’t invite critique beyond technical competence. The particular sessions I’ve listen to claim a 3-point entrainment system which they describe in substantial detail in their product manual. The three entrainment techniques disclosed are used very cleverly in the sessions. I consider them to be well constructed examples of the meditation program sub-genre.  I love hearing other designer’s work. I consider it a real look into the present nature of the artist.

Oh, yeah! The whole household is enjoying one major upper – Lori got the required “Negative” in her last blood tests – she no longer has Hep C – the Pegasys Interferon treatment has worked! Another sixteen weeks of treatment to finish off the job and the bad days will have been all worth it. I don’t know how Lori fared compared to anyone else, there were some pretty rough patches, and I think my Lori is one tough chick, but we both agree that it’s obviously not always as bad as the many tales of woe and suffering that are posted around the net. Once piece of advise we were given, and that we’re now very glad she took, was to start on antidepressants a few weeks before starting the Interferon. There’s no doubt that the treatment makes a pretty hard hit on mood and outlook. Prophylactic antidepressants made a big difference. I think she’s got an awesome family too – I just marvel at the love all her kids have for her. I’m so proud of them all. I’m proud of all my kids, even the ones who I have seen so little of. All meeting the challenges of life with flare, and oh, what a spectacular range of experiences they’re finding for themselves.

Cheers,
Craig

Yesterday, February 23, 2010,  the New York Senate Codes Committee voted to pass through a bill (Senate Bill 5620) that would prevent new HIV and Hepatitis C infections by stopping police harassment of program participants. Our thanks to everyone who called committee members and sent memos; your support was crucial to the moving forward of this bill.

The next step will be to get the legislation passed through the senate. LAC and our partners will continue to monitor the  bill and keep you up to date as the process moves forward.

Wednesday, March 3, 2010 is Status C Unknown’s Hepatitis C Advocacy Day. If anyone from your agency is interested in attending,  please contact Jeremy Saunders, lead organizer for NYC AIDS Housing Network / V.O.C.A.L. NY-Users Union, at 917-676-8041 or jeremy [at] nycahn [dot ]org.

Abnormals I like to see

Thyroids, B12s and Vitamin D

            I view with compunction       

            High liver functions.

I just hate hepatitis C.

One of my medical school classmates said, in 1978, that he didn’t want to go into primary care because he didn’t want to just take care of sore throats and runny noses.

Just before bed last night I logged onto the lab queue.  Six patients blinked in red from the icon at the lower right corner.  A seventh blinked in black.

 Vitamin D deficiency is rampant, and of the six patients with abnormal results, five had low Vitamin D levels, one critically low at 7.5, the lower limit of normal being 33.  One set of lab values gave a new diagnosis of rheumatoid arthritis, another a case of hepatitis C.

I see so many people who just don’t feel good that twelve years ago I specified a group of lab tests: CBC, sedimentation rate, B12/folate, thyroid, Chemistry 14, and hepatitis C; I named the panel the GFMP (Gordon’s fatigue and malaise profile).  I put it together right after I’d gotten a lot of propaganda from the Hepatitis C Foundation.  Three years ago I started checking Vitamin D levels.  In all that time I picked up exactly two cases of hepatitis C, and both of them were found by sleuthing down abnormal liver function tests.  In this new case, the liver functions were normal, along with the rest of the panel.

Of historical note is that hepatitis C didn’t even get identified till after I’d finished residency.  There was nothing to do about it for years; now we’re running a 50% cure rate, cutting into the number of people needing transplants.

I sent emails to the phone nurse pool, to be opened up in the morning; get viral load and viral type on the Hepatitis C, send the rheumatoid patients’ lab work to the rheumatologist, and start all those Vitamin D deficieny patients on bold doses of the sunshine vitamin. 

I get a call at about 9:30 AM from a hunting buddy who is connected to me at least three ways.  A friend of his has bad migraines and isn’t getting very far with the other docs and would I be willing to work the friend in?

I ignore the fact that I have had bad consequences because I don’t say No well, and I say yes.

I find a hole in my schedule at 11:30, and I tell my nurse.

Three other holes that don’t exist get filled before 11:30 and I don’t start with the new patient till 12:20.

Ninety percent of my migraine patients get successfully managed with life style modification.  For all you migraine sufferers out there, here goes:  Eliminate nicotine, caffeine, alcohol, Nutrasweet, cheese, and hotdogs.  Get into a rigid, effective sleep pattern.  By the time I individualize details for this migraine patient (for example, move the TV out of the bedroom, quit smoking with Chantix, and taper down the caffeine) it is ten minutes to one, when the afternoon patients start up, and my documentation is 12 charts behind.

Oh, yeah, and I arrange an MRI for her because she’d never had one and her headaches are getting worse.

I bolt my lunch in five minutes and I’m hacking away at my computer, putting in documentation.

Eventually I hope to get control of my schedule, but I know that it won’t happen till I start saying No.

I’ve gotten better.  Four times today when patients tried to put more than four problems on their list I gently made them put together a realistic agenda, and encouraged them to come back at a later time.  I didn’t tell them how trying to pour gallons into teacups strains me, puts me behind so the other patients get mad.  I just said boy, that’s too much for one day, but it’s really important, can you come back Tuesday?

I still fall into unrealistic time management thinking more than once a day. 

I still finish with a joke.

Los Angeles Times     (02.17.10)

In San Francisco Friday at the 17th Conference on Retroviruses and Opportunistic Infections, Yale University School of Medicine researchers will present a study, reportedly the first of its kind, of the viability of hepatitis C virus (HCV) in used syringes. When shared among injecting drug users, syringes with detachable needles are more likely to transfer HCV from one person to another, the results show.

In their experiment, Dr. Elijah Paintsil and colleagues loaded HCV-infected blood into syringes, depressed the plunger, and measured the amount of HCV in the residual blood at that time and again nine weeks later. In detachable-needle syringes, HCV persisted at nine weeks in most temperatures. In syringes with attached needles, much less viable HCV was noted.

Paintsil said prevention specialists operating needle-exchange programs should be aware of the study’s results, though he noted that detachable-needle syringes are used much more commonly by drug injectors outside the United States.

Proceedings of the National Academy of Sciences February 16, 2010  V.107  N.7

Alexander Plossa,b,1, Salman R. Khetanic,1,2, Christopher T. Jonesa,b, Andrew J. Sydera,b,3, Kartik Trehanc, Valeriya A. Gaysinskayaa,b, Kathy Mua,b, Kimberly Ritolaa,b, Charles M. Ricea,b,4, and Sangeeta N. Bhatiac,d,e,4

aCenter for the Study of Hepatitis C and bLaboratory of Virology and Infectious Diseases, The Rockefeller University, New York, NY 10065; cDivision of Health Sciences and Technology, Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139; dHoward Hughes Medical Institute, Cambridge, MA 02139; and eDivision of Medicine, Brigham and Women’s Hospital, Boston, MA 02115

Hepatitis C virus (HCV) remains a major public health problem, affecting approximately 130 million people worldwide. HCV infection can lead to cirrhosis, hepatocellular carcinoma, and end-stage liver disease, as well as extrahepatic complications such as cryoglobulinemia and lymphoma. Preventative and therapeutic options are severely limited; there is no HCV vaccine available, and nonspecific, IFN-based treatments are frequently ineffective. Development of targeted antivirals has been hampered by the lack of robust HCV cell culture systems that reliably predict human responses. Here, we show the entire HCV life cycle recapitulated in  micropatterned cocultures (MPCCs) of primary human hepatocytes and supportive stroma in a multiwell format. MPCCs form polarized cell layers expressing all known HCV entry factors and sustain viral replication for several weeks. When coupled with highly sensitive fluorescence- and luminescence-based reporter systems, MPCCs have potential as a high-throughput platform for simultaneous assessment of in vitro efficacy and toxicity profiles of anti-HCV therapeutics.

PDF

http://www.pnas.org/content/107/7/3141.full.pdf+html

Guelph Mercury     (02.11.10)

A recently published study found high rates of hepatitis C infection among aboriginal illicit drug users ages 14-30 in British Columbia. One of the significant risk factors linked to infection was historical: injecting drug users who had at least one parent forced to attend a residential school.

Funded by the Canadian Institutes of Health Research, the Cedar Project is a long-term study of HIV and hepatitis rates among young drug-using aborigines in British Columbia. The project’s Patricia Spittal, of the University of British Columbia, and colleagues surveyed 512 youths from Vancouver’s Downtown Eastside and the northern city Prince George. Of participants, 34.8 percent were positive for hepatitis C virus infection, and among the 268 reporting injection drug use (IDU), 59.4 percent were HCV-positive. HCV prevalence among participants was 34.5 percent in Prince George and 35.0 percent in Vancouver.

“Given that Vancouver has consistently been described as an epicenter of the HIV and [hepatitis C] epidemics in British Columbia and Canada since the early 1980s, these findings indicate that the faces of these epidemics are changing,” said Spittal. “Harm-reduction programming [and] trauma-driven addiction care must be resourced for the north because we often just presume that everything happens just in the Downtown Eastside, but it’s just not the case because there are little Downtown Eastsides all over the province.”

Among injecting drug users, risk factors significantly associated with HCV infection included daily opiate injection (adjusted odds ratio 2.7, 95 percent confidence interval 1.0-7.4), reuse of syringes (AOR 2.4, 95 percent CI 1.3-4.4), having at least one parent who attended residential school (AOR 1.9, 95 percent CI 1.1-3.4), female sex (AOR 1.9, 95 percent CI 1.1-3.4), and duration of drug use (per year) (AOR 1.4, 95 percent CI 1.3-1.5).

“The crude incidence rate of HCV infection was 10.6 percent and the incidence density estimate was 9.9 per 100 person-years in this cohort,” the researchers reported. The full report, “Prevalence and Incidence of Hepatitis C Virus Infection Among Aboriginal Young People Who Use Drugs: Results from the Cedar Project,” was published in Open Medicine (2009;3(4):e220-227).

San Francisco Chronicle     (02.17.10)

A bill introduced in the state Senate on Tuesday would allow any pharmacist in California to sell sterile syringes without a prescription. Supporters say SB 1029 could help reduce rates of blood-borne diseases like HIV, hepatitis B and hepatitis C.

California, New Jersey, and Delaware are the only states that prohibit over-the-counter sale of syringes. Sen. Leland Yee (D-San Francisco) said his bill builds on a pilot program, approved by Gov. Arnold Schwarzenegger in 2004, that requires approval from local governments. The program, set to expire at the end of the year, allows an adult to purchase up to 10 syringes in one pharmacy visit. Yee’s legislation would increase the number to 30.

Under current rules, 15 counties and four cities have approved syringe sales. Adam Keigwin, Yee’s chief of staff, said many municipalities decline to participate, fearing the perception they are making it easier for addicts to abuse drugs. But studies show syringe sales do not contribute to drug use, crime or unsafe disposal of needles, he said.

“Study after study show it’s good public policy,” said Keigwin, adding that Yee’s bill allows pharmacists to choose whether or not to sell syringes without a prescription. Any costs associated with the measure would be offset by savings from reduced infection rates.

Each year in California, syringe sharing results in some 3,000 hepatitis C transmissions and 750 HIV infections, according to Yee’s office.

“This is an effective public health measure which is proven to reduce health care costs to taxpayers,” said Yee. “It’s a moral as well as fiscal imperative.”

My boyfriend called me a couple days ago. While in treatment he finally got tested for Hepatitis C. I know I have it, hospital visit in July confirmed my worst fear. And because of our using together, how we use together, we were both pretty sure he had it. And his test was positive. They went on to do more blood tests to narrow down the strain and things like that. So, he calls me to tell me that the doctor found out his Hep C was “gone,” or inactive is the better term.

For some reason, some people are able to fight it off without treatment. It’s never truly gone but the viral load becomes undetectable. And at that point it doesn’t have any impact on your health, on your life. Of course I’m happy for him. I’m glad that he doesn’t have to endure any kind of suffering… unless of course he further damages his liver by using again or taking Tylenol, etc. For someone with Hep C I wish I knew more than I know, but I have very basic knowledge. I need to find a specialist to narrow down the strain for myself and maybe be treated. However, I was told when I was diagnosed that I would probably never be able to be treated because the treatment can cause depression. With a history of bipolar disorder, severe anxiety and panic disorders there aren’t many doctors that will take the chance of worsening any or all of those preexisting conditions. Whatever.

So for the past couple days I keep telling myself I can’t hold it against him that his body, his immune system is stronger and better off than mine. I can’t be mad at him for being healthy just because I’m not. And I can’t hold it completely against him that I have Hep C… he did not personally give it to me. But his friends, his… “posse” of people…. probably did. I wouldn’t have been around them, using with them, if he really was looking out for me like he should have been.

But at the same time, can’t I at least be annoyed, angry even that he got off easy? Leaving me to suffer, as always? I seem to get all of our consequences. Like the ravenous debt he racked up in my name. The truck he registered in my name, that he held over my head for months because I crashed “his” truck — “his” truck!! He ripped me apart from my family, who meant the world to me. Feeding me propaganda and ultimatums if I even talked about missing my family. In July, he got to go to jail – which is not a nice place to be, I understand – while I was left alone with his really pissed off and vengeful family. Alone, homeless, strung out. And all the while him threatening that if I went back to my family he was through with me. And what was I supposed to do? Wait in the woods until he got out of jail? No, my father brought me to detox. I got sectioned from detox to a mental institution. Then my father took me to another mental institution because I was so afraid that my boyfriend would be mad at me if I wasn’t in court for his court date that I was willing to wait in the woods across from the court house so “we could be together.” I was justifiably out of my right mind and belonged in a mental hospital. Then when I went home to my family for a couple weeks to do a partial hospitalization program after being released from the nut house — he threatened to leave me then too — for betraying him. All the while he had been stealing from me, making me feel less then and unworthy, making me feel less then human. Making me feel like I didn’t deserve to have him in my life. In reality, I deserve better. And I realize that now.

The problem is, I love him. And I care for him, and worst of all I believe in him. I believe that he is better than he even believes he is. The other problem is, I am having an extremely hard time with forgiveness. And this is just one more thing, one more consequence that I have to bear and he skates out of… and it’s hard. It’s not easy being the only one who has to deal with the wreckage, wreckage that isn’t completely mine.

So I am mad that he gets to be better. Because I am sick everyday. And as I said in my previous post – I have to remind myself most days that Hepatitis C is not a death sentence. Because when I wake up feeling like shit everyday, and I am ready to go back to bed after I take a shower, a shower! — it feels like a pretty big freakin’ deal in my book. I just want to scream sometimes — “have I not suffered enough?”, “what else do I have to go through because I making a freakin’ mistake, I freakin’ relapsed!”, “am I just meant to be absolutely freakin’ miserable for the rest of my life!?”. I mean, seriously… seriously! When will my pain be enough to suffice the gods? Is there any end to this ocean of regret for the things I have done? I’m freakin’ sorry! I hope that whoever is looking for it accepts my apology before I end up back in the freakin’ looney bin. Or worse.

Trust me. I don’t want either of those to happen. I want to be happy. I want to have a good life. I just want my suffering to end, because enough is freakin’ enough. And I am irrationally mad at my boyfriend because he’s healthy and I’m not. And that’s not fair to him. He’s trying to improve himself, he’s trying to recover and have a good life — a good life, with me. And I want that so bad. I just don’t want to be sick, sad, and tired through that entire life. Maybe that’s too much to ask?