Love (And Other Serious Side Effects)

In 28 years of dealing with CF, I think I've finally gotten pretty used to the concept of prescription drugs and the interactions they often have with my body. In fact, I would say I'm about one prescription refill away from deserving an honorary advanced degree in pharmacology. My medicine cabinet quite literally runneth over, and I'm not expecting that to change anytime soon. Certainly not with transplant, that's for sure.

Yep, I've dealt with the prednisone munchies and albuterol jitters. I've had sun poisoning because of cipro, vomiting after ceftaz, and fevers when faced with zosyn. I was lucky enough to have my tinnitus resolve after just a few weeks off tobra altogether and my kidney function eventually bounced back after the polymyxin, as did my iron and magnesium levels. I don't have a rash or bruising from the blood thinners anymore, and I'm pretty sure that whole oral thrush incident brought on by general antibiotic use is now a thing of the past. Oh, and that whole raspy (whoops, I mean "sexy") CF voice thing from all the inhaled meds? Yep, got that one too.

I'm kind of a side effect junkie, when you think about it.

When I first started dealing with all my prescriptions and refills as an adult I was always super into reading those little print outs that they put in the bag to tell you about all your drugs. Okay, so maybe not for the obvious meds I had been on forever like Pancrease (which, by the way, lists stomach pain as its most common side effect, making it clearly one of the more ironic meds out there) or even Pulmozyme, but definitely with the "newer" drugs like Prednisone and certain antibiotics. I knew which meds were best taken with food, which meds were likely to cause headaches or blood sugar spikes, and which meds meant I had to stay out of the sun at ALL costs.

Not that any of it really mattered, of course, since I had to take the drugs anyway. That's another great part of having CF -- you can educate yourself all you want on potential side effects, but unless something is causing hemo, bronchospasm, or serious allergic reactions, you're not likely to get the go ahead to cross it off your routine. And this makes sense, because really at the end of the day being able to clear the lung goo is more important than the sound of your voice, reducing inflammation trumps the desire to get to sleep at a reasonable hour, and fighting pseudomonas matters a whole lot more than that perfect summer tan. It's not rocket science or self-torture; it's just that the benefits outweigh the costs.

Recently the CF community has lost a lot of wonderful people, all of whom will be missed dearly. It seems like the past couple of weeks have been particularly tough, and to be frank about it all, it sucks. To find a group of people to connect and share information with about CF is such a gift. To then lose members of that family, their spaces left open like missing pieces of a beautiful jigsaw puzzle, is a heart-wrenching experience, to put it mildly. The passing of a friend, or of multiple friends as is (sadly) the case in this instance, from the same disease you're fighting can send you reeling. The side effects of a million strong drugs put together could hardly come close to matching the feeling of having to say, once again, "breathe easy, my friend."

And yet, none of us seems willing to call it quits. There are plenty of opportunities to do so, to shut down our blogs or erase the forums from our browser's memory, to just sign off with a simple "okay, enough, I'm done. I don't need to know anyone else with CF and I don't need to suffer another loss. Thanks for the laughs and the memories guys, but I'm out." And I can only guess that the reason we don't just throw up our hands is that the friendship, the support, and the strong sense of mutual understanding between CFers is a benefit that quite simply outweighs all the potential for loss, pain, and even fear when someone moves on in his or her journey away from this world. In other words, we stay for one very simple reason:

It's worth it.

Cystics don't come with a warning label or an expiration date. There's no handy little print out given to you when you meet a fellow cyster or fibro that spells it all out in clear and simple English.

Warning: PLEASE USE WITH CAUTION as contains mutated genes and may cause deeper understanding of oneself and one's condition, a tendency to share common concerns or medical issues, empathy, and laughing that lead to coughing fits. Other side effects might include friendship, community, and even love.

A serious side effect indeed, but I for one am definitely not giving up my prescription.

You Can't Hurry Lungs

Nope, you'll just have to wait. And wait. And wait.

Now before I get blasted for being way overdramatic (another special talent of mine, I totally admit), I do want to say that I KNOW I haven't been waiting all that long by transplant standards. A couple of months is nothing compared to one to two year waits so many people experience. I totally get that and I'd like to say that I know my situation is so much better and that I'm top of the list and that I'm lucky enough to still be able to exercise and live life and not just be confined to a hospital bed without my puppy or my home or my couch or good food and I'm not hooked up to a vent or even bipap and sometimes I can go hours or half the day without sticking a cannula up my nose and yesterday I walked my dog and today I'm doing some aerobics/strength training and tomorrow I have gyrotonics and maybe somewhere in there I'll fit in my friend's bday party tonight and be social and put on a smile to look like the generally happy woman that I am and dress up to look like the healthy woman that I am not. I'd like to say all of this and be able to add that I know I'm damn lucky and I'm not complaining.

Except that I am. Complaining, that is.

The past couple of days have brought a new diagnosis for me: pulmonary osteoarthropy. Not such a big deal, I guess, except that it causes severe joint inflammation and pain.

Pain:

Pain is something I've always felt like I could just kind of shrug off. In 28 years I've never once called my doctor because of pain alone, never considered it to be a big problem in the grander scheme of things. I'm "sick" often enough as it is -- if I started calling the clinic every time something hurt, I think my "healthy" days would be cut in half, and I don't want that. I don't want to feel like that. And then this wonderful femme de la vie cystique made an offhanded comment that just kinda sorta maybe changed my entire life. "I used to just grin and bear it through pain, but now I find that I just don't have the energy to live like that." No energy to devote to pretending that pain doesn't exist. No energy to waste on sucking it up when there's so much that can be done about something as simple as pain. At 28 I have mastered the art of genuinely having fun despite pain, but I haven't ever really learned how to help myself live without it. Yeah, I know, just call me a late bloomer.

So I called my doctor, got my diagnosis, and am now back on a high prednisone taper. And you know what? It's working. I no longer cringe to stand up, or hobble around like and 80 year old, or skip my nightly writing/drawing sessions because my wrists and elbows are way too inflammed to help me express myself -- so that my brain remains inflammed as well -- and yesterday I even got down on the floor to play with my puppy for a little while without wincing. Oh yeah, and coughing/CPT/exercise (that holy trinity of CF maintenance)? So. Much. Easier.

Life is all about the little victories right now.

Anyway, I guess I'm complaining. I mean, if I ever were to complain now would probably be a pretty decent time to do it, since I had to repeat an arterial blood gas test yesterday b/c of an administrative error and another friend of mine is having to jump through a million hoops to get relisted because of his chronic rejection and I think someone I've really come to like and admire for her spunk and honesty may have had a dry run yesterday at my center and right now I'm just feeling a little discouraged at the process and at the fact that even on the pred and the azli I seem to be showing signs of an increased cough again, sort of that deep rumble in the pit of your stomach/lungs/soul that tells you the mucus is tasting grosser and the color is just a little off and whoops, was that just a little pleural pain or is that damn left lung collapsing on itself again (because I am, after all, a whole week out of IVs at this point). I guess I'm complaining because I went to get a glass of juice to take my nightly meds yesterday (at 2 am, thank you prednisone) and I actually started crying just a little at the thought of doing this to my body AGAIN -- of adding more chemicals and more side effects and more life-saving everyday miracles that I know I need but that sometimes just make things so damn difficult. I guess I'm complaining given the fact that I've now used no less than three curse words in my normally family-friendly blog.

It might be that all the waiting and the sickness is finally wearing on me just a little bit. It might be that I just need to admit to myself that this has been a REALLY rough year so that I can accept that and move on with it. It might be that I've gotten a little bit worse at sucking it up over the past 12 months or so. Or it might be the fact that two nights ago I messed up and added xopenex to my HTS neb cup, so that my treatment actually went xopenex-DNase-CPT-xopenex-moment of total frustration-HTS-Azli, and then last night I managed to change up the pattern a little by putting NOTHING in my HTS neb cup so that my treatment went more like xopenex-DNase-CPT-3 mins of blissfully unaware nebbing of nothing-more frustration-HTS-Azli. It might be any one or all of those factors, but I guess I am complaining. And maybe, like the lyrics to the old Bird's song (or the Bible) says, there is in fact a time and a purpose to do everything, even complain.

But right now I'm more hung up on a different set of lyrics that just seem oh-so-appropriate. Because how many heartaches must I stand, before I find the lungs to let me live again? And right now the only thing, that keeps me hanging on, when I feel my strength, oh it's almost gone, I remember mama said . . .

You can't hurry love. I mean lungs.

Not Your Average (Post) Thanksgiving Challenge

Like most Americans, my family and I spent the better part of last week resting, playing, eating (yes, I did in fact gain 5 lbs in 4 days, and yes, I am happy about it, thank you very much!), and most of all being thankful. We were thankful to be together, thankful for the good food and good company or our wonderful friends, thankful for the (relatively) mild weather in New York, and thankful for an uneventful weekend CF-wise. I was especially grateful to be off IVs and in good enough health to celebrate both Thanksgiving and my birthday in style, and for the chance to do amazing things like go to a Broadway play and see my sister's clothing line on the mannequins at Bergdorf Goodman! To say it was a very thankful Thanksgiving would be a huge understatement.

It's always very cool to do things like go around the table and count our blessings, or see people on the street enjoying themselves and being grateful for all that they have, or (and maybe this is just me) reading all your awesome CF friends' blogs about the many reasons they give thanks during this all-important holiday of celebrating what's right with our lives despite chronic illness or whatever other demons we might be facing. In fact, for me that was one of the many great parts of this year's holiday . . . just reading what all you guys had to say on the subject. Not to say that CFers have a monopoly on being grateful, obviously, but it's clear from the posts that we have more than our share of the stock. Yet another reason to be proud.

Which kind of brings me to my next point, and the start of another official Matter of Life and Breath Blogger Challenge. We all know you guys are grateful, and awesome at counting your blessings, making the most out of life, and eeking every little last drop of pure fabulousness out of each day and each breath. We know that, and we love you for it. Kudos to you all, and a big round of well-deserved applause for the "a rainstorm-makes-your-clothes-clean" positive approach to life.

So here's the challenge: let's see how good you guys are at turning it around and sharing what you're most thankful for about yourselves. Yeah, that's right, I'm asking you all to toot your own horns in a major way, by counting down at least 10 things that are downright awesome and fabulous and amazing about you. Not your life, not your wonderful family, not your fantastic doctors and the wonderful drugs that help you breathe, but just. plain. you.

In case anyone's wondering the inspiration behind this all, check out the recent post on Ronnie's blog about a young woman with CF asking how she could form an identity beyond her disease (title: "How Can I Simply be Abby?"). It really got me thinking about illness and identity, and also (by extension) about the "grateful patient" expectation. You know what I mean -- sometimes as chronic patients with a serious disease (or as caregivers, parents, and partners of patients) we're expected to be, well, grateful. Grateful to the other people in our lives for helping us, grateful to our doctors and surgeons, grateful to the volunteers who help fundraise, grateful to the sun for rising yet another day. And we are grateful -- incredibly and rightly so -- as we all do an amazing job of showing pretty much everyday. But there's a time and a place to be grateful for yourself and all the really cool things you're proud of as well, CF-related or not, and I think it's time we let out a collective roar about just how damn wonderful we really are.

Okay, official "rules" time: 1) you can post in the comments or on your own blog, but please post here and let us know your blog address so we can all share in your awesomeness; 2) anyone is welcome, regardless of your connection (or lack thereof) to CF or any other illness -- coolness may be a shared trait among cystics, but it's certainly not exclusive to us; 3) you have to post at least 10 things you're proud of or think are fabulous about yourself -- and I don't care if it's that you have really cool freckles on your nose, I still want no less than 10; 4) no giving credit to anyone else for your awesomeness -- okay, so we all know that you're not directly responsible for your really cool and unique name (ahem!), but you rock it like a superstar, right? Keep it about all about you, baby; and finally, 5) you don't have to link back to this post, but please challenge your readers to follow suit with their own lists. I know there's more to the blog world than just the people who read mine (although I maintain that my readers are the coolest group out there!), so let's keep the ball rolling as much as possible. Let's face it: after this whole Thanksgiving thing, we all could use a little time to just be grateful for ourselves!

I promise I'll make my own list and post it right here for all to see. In the meantime, happy post-Thanksgiving self love fest!

Live. Love. Create.

After treatments, after exercise, after family and after turkey . . .






. . . you have to take a little time for yourself.

**Note: "Cats" image originally sketched by Andy Warhol, arrangement/colors are my own. "Lotus Blossom" inspired by Turkish folk-art. "Dinner Party" image taken from 1920s cover of "The New Yorker."

They Say It's Your Birthday

It's my birthday too!

Wow, so okay 28 years. 27 years and 46 weeks after I was diagnosed and a full 10 years longer than the projected life expectancy for CFers at that time. 17 years after I got my first horse for Christmas, 15 years after the first time someone I had a crush on kissed me (eep!), and 12 years after I first got my driver's license and started tearing up the streets of Colorado. 10 years after my senior prom and the year I left home to move across the country, and 7 years after my 21st birthday, which we won't even begin to discuss here (although I can't resist noting that it spanned two major US cities). 6 years since I graduated and left Atlanta for "The Big Apple" and 3 years since I graduated again and left law school for "The Real World." Nearly two years since I first heard the word "transplant" applied to my lungs and 1 year and 1 month since Sampson joined my family. In other words, 28 years full of crazy, chaotic, amazing, memorable, and sometimes just a little bit over-the-top experiences. And the only thing I have to say to all that is what I've already said: wow.

Birthdays are always amazing things, and while I don't mean to steal anyone else's thunder, I think they're even more special when you live with a chronic illness. It's such a cool tradition to celebrate life and the day that we came into this world, and of course this year I feel like it's even more significant somehow. The truth is, though, that it's not just the 27th of November that's worth celebrating -- all those plain old regular days that make up the rest of life are pretty damn amazing too, when you stop to think about it.

Hopefully at some point during this 28th year (most likely on one of those plain days that happens to fall in between the birthdays) I'll get a call for a kind of "rebirthday" that I know will change my life in some new and surprising and hopefully wonderful ways. I'm so grateful for the past, but I'm also really looking forward to the many things I plan to add to that list of "lifetime milestones" with my new lungs. Every day of every year, for hopefully a long time to come.

So happy birthday to my awesome body for sticking with me through all the nonsense, and happy birthday to my mind for not giving up and going wholly crazy through the madness. Most of all happy birthday to my spirit, for proving itself this year to be just about the most resilient thing since the Timex watch ("takes a licking . . . "). I can't wait to push the envelope even further and see what new ways we can come up with to get into trouble together -- and with 365 opportunities a year, I expect some pretty amazing things.

Okay so how many days is it until your birthday, and how are you going to celebrate?

And Every Breath We Drew Was Hallelujah

I feel like for the last week or so, ever since getting news that "we're number 1!" (sorry, I just can't resist the urge to make that into a little cheer every time I type it), I've been having these kind of slow-motion moments when I suddenly look around and think "wow, this could be the final time I do ____ with my 'old' CF lungs." I know that sounds kind of weird, but to be totally and completely honest the prospect of removing one of my most vital organs and replacing them with the lungs of another is a pretty weird concept, so bear with me if I get a little sentimental.

Yep, sentimental. Or maybe nostalgic is the word I'm looking for here. Because the thing is, I love my lungs. I don't particularly love the whole CF part, obviously, but I love that these amazing bags of tissue have managed to fight this hard for so long. I love that they're still breathing, still giving me enough rich oxygen to enjoy the holidays and my birthday. And if they need a little help every now and then, well, who can hold that against them really? Because these are the lungs I was born with, the lungs that saw me through so many horse-show summers and ski-weekend winters, the lungs that held their breath in that crucial moment before my first kiss and the lungs that fueled my celebratory cheers when I graduated. These lungs have been my heroes, my sometimes silent companions, and the bane of my existence at various times, but the point is that they're my original lungs, and it's hard for me to fathom sometimes letting them go.

Last night I stopped IVs. I was scheduled to stop this morning, but the peripheral infiltrated and it wasn't worth calling out a homecare nurse and starting another for one dose, so instead I simply called the game and pronounced myself (and my lungs) the winners yet again. A little over three weeks of hardcore antibiotics (our 7th course this year, but who's counting?) and we're back on top of our game -- able to do most resting activities without supplemental O2 and hitting the gym/gyrotonics like nobody's business. So it was time to stop the drugs, and as usual I couldn't have been more thrilled about it all. My mom and I carefully washed our hands with sterile soap, peeled back the tegaderm, and with a quick deep breath, pulled out the peripheral catheter and voila -- my arm was IV free. It's a ritual I've repeated over and over throughout the years, and it never stops feeling pretty darn amazing, as I'm sure you all know.

But as I stared down at my naked wrist, still red and a little raw from the infiltration and the dressing, it suddenly dawned on me that this might very well have been the final "tune-up" for my CF lungs. Kind of a heady realization, when you think about the fact that I've been enduring these pokes and lines and "wow, did I just get hit by a truck?" side effects for no less than 28 years. And yes, of course I realize that I'll be back on IVs off and on after transplant (hopefully more off than on), but the knowledge that these lungs (my lungs) might never again have to endure a course of Merrem or Tobra. Well, it was just kind of a "wow" moment, to put it lightly. Kind of like the other day when I realized after clinic that, unless I come back there earlier than my usual 3-4 weeks or so after IVs, I might also have had my final visit to the CF clinic as I know it. And again, of course I'll be back there occasionally after transplant. I'll still have CF -- I know that -- but my lungs won't have it, my CF doctor will no longer be my primary care pulmonolgist, and therefore it will all be different in some ways, even if parts of it will stay more or less the same.

I guess change always brings with it some sense of loss and nostalgia, even the most positive ones. Graduating law school is a great example -- I was so ready to be out of there, and yet at the same time I couldn't help looking around during those final moments on the Columbia quad and thinking "I may very well never see some of these all-too-familiar faces again." And I realized that, sure, there were parts of law school that I wouldn't miss much at all (Socratic Method, anyone?), but there were also parts that I would be kind of sad to let go. Little things, even, like just the simple routine of having familiar faces in the hallway and knowing how to find my way around the building. All those known, understood, and comfortable daily rituals that, however annoying they seemed at the time, made life just a little more predictable, a little bit safer. And I knew, of course, that I would make new friends and learn my way around new hallways at work. That was never a question, but it was still a change. And it was still a little scary.

I don't preach on this blog because it's not my calling and it's not my style, but I think I've been open enough at this point to say that I do believe in a higher plan. I believe that all of us are made from the same amazing universal light, and guided by a divine hand. Because of this belief, I know that there are perfect lungs out there for me. I feel strongly that they will come at the right time, and that they will be a blessing beyond measure -- a perfect gift from one child of God and the universe to another. But this doesn't mean that I expect my new lungs to replace my current ones. No lungs, no matter how perfect, could ever in my mind replace my CF lungs, because no lungs can go back with me and relive all those wonderful (and maybe even not-so-wonderful) moments of my life thus far. My new lungs and I will have new experiences, no doubt some of them amazing and wonderful and beyond my wildest dreams, but they will be new, framed by a different backdrop, and maybe sometimes slightly confusing. And that's okay, honestly. I've faced change before, and I've come out on the other side stronger and still myself. I fully expect to do it again.

So as I glance once again at my recovering IV site this morning, I'm still awash with feelings of awe and, yes, a little nostalgia for the CF lungs I might soon be giving up. But I also can't silence that other little voice in my head, the one that's been growing stronger and louder lately, and that simply seems to say over and over again: "This is okay. I'm ready. When the time is right, I'll be willing to let go of what's known and embrace the new. I'm ready."

And that is, by far, the biggest change of all.

Love Among the Lotus Flowers

5 months ago, I fell in love. I didn't expect it to happen, in fact it was probably the last thing I would have anticipated as I stood in the center of that large, hot, and dusty pottery factory somewhere in Cappadocia, Turkey, watching my mother, father, and sister haggle over some large jugs and decorative bowls. The owner of the factory, a kindly looking older man with an impish smile, seemed all too happy to discuss the various deals he could make, and cup after cup of the region's famous apple tea was brought out as the bargaining continued. Having reached my personal limit for hot beverages served despite the 100+ degree heat, and knowing that I was of little use in figuring out the best price for my mother's new living room decorations, I wandered from the group and made my way over to a smaller, shadier, and (I hoped) cooler room off to the side of the main showroom. At the very least, I figured my exit would allow me to avoid having to "politely decline" any more steaming cups of liquid heat, especially since, when it comes to tea, I was fast learning that the Turks don't really take no for an answer.

I stepped into the dimly lit room and immediately noticed that it was filled, floor to ceiling, with decorative plates hanging on the walls. These plates were in stark contrast to the larger platters displayed out in the main room -- all were vividly painted in rich colors, measuring about 12 inches across, and designed using a concentric circle motif. Intrigued (and relieved by the blessedly cool air in the room), I moved forward and stared up at one of the covered walls. Immediately I noticed that many of the plates appeared to be telling a story, which radiated out from the center of the plate and followed the circles until the outside edge. I also noticed that several of the plates seemed to have the same pattern painted on them (all by hand, I knew, since we had toured the factory prior to entering the showroom), albeit each in a different set of bright, carefully chosen colors. And then, halfway up the second wall and a little to the right, I saw it. And it was an instant, deep, and totally true love.


I knew I had to have the plate right away. The prices were marked on the back of the objects, but of course I knew from my parents' ongoing discussion with the owner in the next room that such things were wholly negotiable. Never mind that, though, I was determined to make this plate my own. As I reached for it and carefully removed it from its place amongst the others, I wasn't even sure why I was so drawn to this particular piece. The simple answer, of course, is that I've always had what my friends in college used to jokingly call an "inner raccoon", meaning that I tend to gravitate strongly towards things that are bright, shiny, and most of all colorful. The plate, of course, was all three of these things, and absolutely gorgeous to boot (trust me, the above picture doesn't even do it justice), but then again so were half the other things in that room, and none of them had made me whip out my credit card yet. I couldn't really articulate why I loved the thing, in other words, but I knew that I did, and that was enough reason for me to take the plate, turn, and rejoin the main room, the empty spot on the wall behind me a glaring testament to my refusal to separate myself from my plate for even a second longer.

As I re-entered the main room, my parents and the shopkeeper were just finishing their final cups of tea, having successfully arranged the purchase of not only their own jugs, but also a large serving platter for my sister (although in all fairness, I believe it was my sister who got the deal pushed through in the end -- the shopkeeper was very much interested in making sure the "lovely young lady" left happy). The old man, having secured his sale, turned towards me and his face lit up as he noticed the plate still clutched protectively to my chest. "Ah, the family print," he sighed, a reference to the fact that this particular plate held the concentric circle markings of his own family, the founders of the pottery mill and craftsmen for several generations. It was this pattern that I had seen repeated so often on other plates hanging in the room, though not in the brilliant reds, golds, and blues that made my plate so special. He scurried over to me and took the plate from my fingers, carefully tracing its textured surface with his own. "See here," he explained, "the central flower in the middle of the plate is the lotus blossom. A sign, in our tradition, of creation and perseverance, as this flower grows out of the mud from the bottom of the pond and emerges into the light above the water as a full and beautiful bloom." He paused and seemed to think for a moment before he added, "also, we say, it is a symbol of rebirth and new starts. The lotus folds itself away each night, disappearing beneath the surface to emerge again with the dawn." He broke out into a wide grin as I breathlessly whispered "perfect."


I didn't get much of a bargain for my lotus flower, especially when compared to the amazing deal orchestrated by the rest of my family in my absence. Maybe it was my refusal to sit down and drink another pot worth of scalding-hot tea, or the whiteness of my knuckles around the plate as I emerged from the dark room, or maybe it was something as simple as the way I held my breath as he described the plate's symbolism and the life-cycle of the lotus flower. Most likely it was my simple response, "perfect", that really did me in, although to be honest it really doesn't matter. I would have paid more for the plate, if I'd had to, and as it was the folded bills of Turkish Lira that I handed over seemed a weak offering for such a beautiful thing. It's amazing how money pales in the face of true love, after all.

5 months later I still look at the plate almost daily. I haven't yet hung it in my apartment, in fact, because I never could decide on the best place for something I love that much. Instead it sits on my kitchen counter, sometimes holding a couple pieces of fruit or some other object, but mostly just sitting there -- its open blossom a visible reminder of life, perseverance, and rebirth. And crazy as it sounds, there are moments when I just stand and stare at it, letting its color wash over me, and returning to the intense feeling of joy and rightness that I felt that first time I spotted the plate on a poorly-lit wall in a side room of a tiny pottery factory.


Today I tried my hand at recreating the bloom that I love so much on paper. It is, obviously, imperfect, but I wanted to try in honor of my friend (and many of yours also) who is living her last days in joy and peace right now down in Texas. She is, to me, an amazing example of rising up from the mud, growing through that dense water, and emerging above the surface as the most beautiful of blossoms. And although she might disappear again beneath the waters soon, I know she will continue to bloom in so many ways. So I'm dedicating this very humble effort to Courtney and her family, and to everyone awaiting a rebirth or transformation, as a reminder that what comes from mud can be beautiful, and that what at first seems delicate might be, in fact, the very picture of strength and what it means to persevere.