On Waiting

Well hello again, beautiful people.

So as most of you probably know by now, I received a very special gift this Christmas -- December 25, 2013 -- in the form of sparkling new lungs from my newest partner in crime, Donor Nick. And despite my declaration at age 11 that I would never ever love a Christmas gift as much as I loved my new pink Huffy bicycle, I'm pretty sure this one takes the cake for the best.Christmas.present.EVER. To be honest all I really remember is the vague sound of the telephone ringing, the bumps in the early morning darkness as my boyfriend sprang up to get it, the thumbs up he gave me from the bedroom doorway, and then an overwhelming sense of peace that this was it, this was right, this was going to happen. True to his saintly name, my newest donor had arrived just in the "nick" of time.

He arrived in the nick of time because I was dying, literally. I had been placed on bipap for high CO2 and plummeting O2 saturations, but even that was barely working anymore, and I knew the next step was a ventilator. I was struggling just to keep my head above water in rehab, much less gain any real ground toward my strength or weight goals pre-tx, and my family had taken to staying up in shifts throughout the night to watch me breathe -- a brutal exercise in unconditional, heartbreaking love that I think any CF or lung disease family can relate to on some level or another. I knew deep down that there wasn't much time left, and they knew with me, and yet we all still hoped, wished, and prayed for a miracle.

And then it happened.

We had been teasing and joking about new lungs for Christmas for a couple of weeks -- who wouldn't have? It was the perfect image -- Santa packing a living, breathing set into his bag and stuffing them down the hospital's chimney on that not-so-white Carolina Christmas morning. And yet the reality is that it wasn't a jolly fat man from the North Pole who saved my life that day. It was a beautiful stranger and his amazing family who suffered the ultimate tragedy of losing a loved one and a family member on that holiest of holidays, on the day of birth and celebration, and who chose to turn around and change that grief into hope, into love, into a gift from one human to another that is beyond all measure -- the Gift of Life. It is to them, not to some dude in a red suit, that I will always be thankful. It is to the miracle of organ donation, that brings life from death and rebirth out of worry and tears and so much hardship, that I will forever owe my life. And I promise to use this gift as it was offered: in faith, in compassion for others, and most of all in love. I promise to celebrate the life inside of me every single day.

Which, so far, means a whole lot of hospital celebrations. I'm coming up on week 4 in here, which is not exactly rare for retransplants as they are "messier" jobs than the first. That seems to be the case with me as the only thing keeping me here is a single chest tube which 1) refuses to stop draining fluid, and 2) is now also necessary to drain some small air leaks that have caused what is known as "subcutaneous air pockets" underneath my skin and primarily in my face. Yes, it makes me look funny (think "Fat Albert" on steroids), but at least the chest tube seems o be doing its job in bringing it down.

So now, ironically, I wait. I received my gift, and I'm happy to say that everything went wonderfully during the surgery (though they had to cut poor Donor Bob -- gone but never forgotten -- out of my chest piece by piece given the sorry state of my lungs this time around). Donor Nick looks great and my first bronchi came back completely clear of infection and rejection, indicating that he is happy and healthy in his new home. For all of that I am grateful. For the tubes and suction and the solutions to the "bumps in the road" both big and small, I am grateful (if sometimes a little impatient). And for the chance to experience all of this -- for the moments, for the lifetime, for the breath -- I am forever indebted and forever grateful beyond measure.

And that, beautiful people, is worth the wait.

An Introduction

Dear Readers, Followers, Lurkers, Commentors, Visitors, and All-Around Beautiful People:

First of all, on behalf of Piper, Sampson Bear the Dog, Piper's Family, and everyone else who makes this blog possible, we want to apologize for the recent lack of postings. Please rest assured that, despite the gap, our current mission remains the same as always: to bring you the most up-to-date anecdotes, randomly charming musings, and (strangest of all) true stories of life with CF and lung transplant -- and everything in between! Please also know that the vote is in on blogs with the most amazing, loyal, and forgiving reader base and we are delighted to announce that you all have won the prize, hands down. Congratulations from Piper and all of us!

Unfortunately, as we begin this new year of blogging and being, we do so without the help of one of our crucial team members thus far. As some of you may know, our beloved Donor Bob, whose breath and spirit proved invaluable not just to this blog but to all the experiences, moments, and people behind it, has moved on to greener pastures. Donor Bob graced us with his presence for 3 1/2 years, during which time he enabled Piper to do "Amazing Things" such as return to school for a master's degree, watch some of her closest friends begin families, celebrate her parents' 40th anniversary, turn 30, and meet the love of her life. Now if that's not a gentleman, I don't know what is. Sadly, Donor Bob fell ill early in 2013 and simply never recovered, despite aggressive treatment, to the point where we finally said our goodbyes on Christmas, December 25, 2013. May we always remember him with love and gratitude.

And now for our happy news: Welcome Donor Nick!

We are excited to welcome Donor Nick to the team after his miraculous and perfectly timed entrance into our lives this Christmas Day. (Piper's side note: I actually went into surgery on Christmas around 6:30pm and got out about 12:30am on the 26th, which also happened to be my parents' 43rd wedding anniversary.) Donor Nick has bestowed upon our girl two beautiful new lungs that apparently were so large they had to be "stuffed" in there like a couple of Christmas hams. We'll take it. Donor Nick, thank you for joining our wonderful, chaotic, crazy, beautiful lives. We are, as we remain with your predecessor, eternally grateful for the gift of Life you brought us through your Christmas Day miracle.

It goes without saying that we are blessed beyond measure by this new addition -- and it shows. Piper is recovering well, though still in the hospital in a pulmonary "step down" unit that affords more personalized nursing care. The doctors say the only thing keeping her inpatient are the chest tubes, which are taking a longer time to "dry up" than they did after her first surgery. Much of this is par for the course on second transplants, which tend to be messier business because of scar tissue and other complications. Thankfully our faith in the medical team never waivers -- we know we are getting some of the best care in the world and feel very much at peace with where we are today. Although Piper reports that she would really like to be reunited with that shaggy little mutt of hers one of these days. In good time, Piper. In good time.

So there you have it, friends and loved ones: all the news that's fit to print. And As we gear up for a big year in 2014, please know that we would be honored and delighted if you would continue to share the ride.

Sincerely,

Piper, Sampson, and All of Us

'Tis the Season

I originally posted this as a status update on my personal Facebook page as a way to respectfully chime in to one of my favorite seasonal traditions: the great flu shot debate. Two hours, 22 shares, and 16 comments later, I realized this was an issue that people need to be talking about, and so I decided to take it to some of the coolest and smartest folks I know -- all of you. Please be aware, of course, that this is my own highly personal perspective as a person, as a CFer, as a transplant recipient, and as a a strong believer in community health. Because what we do matters. I promise.

Every year around this time I watch for the first flurries. I sit in wait for those swirling flakes of debate that go hand in hand with the coldest season of the year and the inevitable question that, sooner or later, we all have to face. Should I get a flu shot?

Honestly, I can't answer that question for you. No one can, except maybe your doctor or your child's school depending on its vaccination rules. I can't tell you whether it's worth the so-called risks of the shot itself, or playing the bad guy and bundling your kids off to the doctor again. I haven't read every piece of medical literature out there on the subject, nor could I even if I made it my full-time job. I'm not here to discuss conspiracies or WHO statistics or the devastating spread of preventable disease in countries where vaccinations are not available. I'm not here to police your decision at all, in fact. I'm here to share mine.

I don't have a choice in the whole vaccine thing because when I got my lung transplant they made me sign a paper promising that I would stay current on all vaccines for the rest of my life (except live vaccines, which are dangerous for me). So every year, while other folks debate, I simply trudge out to my doctor's office, endure the poke, and keep my promise to myself, my healthcare team, and my donor. That said, even my doc admits that vaccines might not work on me very well simply because I don't have much of an immune system to react to the dead virus and produce the necessary antibodies. Because of this, everyone who lives with me or shares close contact with me on a regular basis is also required to get their shot to help keep me (and my precious lungs) safe. That means my boyfriend is getting his shot for pretty much the first time ever this year. Bear in mind that he's not so super into needles, that one, but he's doing it for me anyway. Love is never having to say "I'm sorry my genetic disease requires me to purposefully destroy my immune system so that you have to get a shot."

Here's the point, though: if he didn't know me, he would most likely be just fine without the flu shot. True, over 40% of the children who died of the flu in recent years were apparently not high risk patients, but even so -- most normal, healthy folks will be just fine, even if they do get the virus. But the fact is that he does know me, and chances are good that you, too, know someone who is deathly afraid of catching the flu for a really good reason. Chances are you know someone, even if you aren't aware of it, who has a lower immune system capability, or an underlying disease, or is elderly, or is pregnant, or . . . well, the list is pretty extensive, actually. These people are afraid of the flu because, to us, this virus is way more than an inconvenience or a few missed days at the office. And we care about the flu shot -- yes, even your choice to get the flu shot -- not because we want your arm to be sore or because we get a kick out of watching healthy folks facing their fear of needles. We care about it because this issue, for us, is about more than your right to build up your 7-year-old's immune system "the natural way." It's about our right to go outside of our houses between the months of October-April without risking our very lives because that 7-year-old (or his parent, classmate, teacher, or someone else who caught the flu after him) is in front of us in the grocery line.

Vaccination is a personal choice, right? But spreading germs once you catch them is not. Even with great hygiene and the best of intentions, those pesky little things have a way of making themselves at home on classmates, coworkers, friends, loved ones, public surfaces, and all sorts of other shared spaces. And maybe that's not a huge problem for you or for your child. In fact, maybe it's a risk you are willing, able, and even happy to take. That's fair. But before we make these so-called personal choices about preventative healthcare, maybe we should all look to our right and look to our left and then ask ourselves honestly: are we truly willing to risk the health of our neighbors (friends, family, strangers on the street) for the sake of this one "individual" decision?

Because that's the kicker with community health, guys. It's never as personal as we think it is.

So if you choose not to get your flu shot this year, please also consider staying home if you or a close family member is ill. Please consider the fact that most people shed virus for at least a day before they even show symptoms of a virus like influenza, and please consider educating your children about proper hygiene habits like coughing into their upper arm, washing their hands frequently, and sneezing into a tissue whenever possible. Most of all, please consider how your choices may impact the people around you and their overall health and well being as well, and once you've considered all of that, please make your personal, individual choices wisely.

Our health depends on it.

The S Word

I believe in the power of words.

To me -- as a lawyer, as a blogger, as a speaker, certainly as an empowered patient, and even just as a person -- words have always been important. How we choose to express ourselves colors our perceptions and those of everyone around us, just as the words others choose impact our own understandings. As a kid I remember hearing that the Inuit and other American Eskimo tribes have something like 50 words for "snow" (FYI: read this article from The Washington Post if you're interested in learning a little more) and being fascinated by the idea. Mostly I remember thinking that, as a Colorado girl, I should probably have at least 25 of my own words for snow, and also that clearly this language thing was more complex than I thought it was. More specifically, I was intrigued by the notion of having multiple words to describe a single phenomenon, and the way that choosing one word over another might change the whole darn thing. And then I went back to coloring or multiplication tables or whatever it was that I happened to be doing at that time. Because, you know, I was a kid.

Fast forward to last week somewhere in a major research hospital in the Southern United States.

I was sitting in yet another waiting room awaiting yet another exam for yet another lung transplant and feeling an extreme sense of been there, done that syndrome. After all, I have been "here" (as in the physical state of end-stage lung disease) before, and I have done that insofar as I've already come through this entire process once. I was wearing what might as well have been the same hospital gown and lugging what might as well have been the same O2 tank and sitting in what might as well have been the same uncomfortable chair thinking what might as well have been the same slightly scattered thoughts while trying to push aside what might as well have been the same ugly fears and series of "what ifs..." from my brain. In short, I was frustrated and I was tired and I was ready for the test to be done, so I decided to distract myself by looking through my "transplant folder" at some of test summaries and other medical documents I had either brought with me for  or accumulated during the evaluation. I opened it up, grabbed one at random, and began reading the "notes" section.

"Ms. Beatty is a 31-year-old female who suffers from cystic fibrosis and advanced rejection of transplanted lung..."

And that's as far as I got.

I've seen the words "suffers from cystic fibrosis" so many times that the phrase has almost lost its meaning. Almost. But seeing it there, in black and white on a piece of paper by a very well meaning physician not-so-almost took my (very limited) breath away. Sitting there in that waiting room in the scratchy gown and the uncomfortable chair, I sucked my oxygen and gave a furtive glance around me at the nurses, doctors, other patients, and support people nearby. Then I asked myself honestly: were we suffering? Or, more to the point, I guess, was I suffering? One minute ago I had just been "bored" and maybe "tired" or "annoyed." Was I now supposed to suffer on top of all that?

Did they get it wrong? Or does the medical community just have 50 different words for snow...er, make that "suffering"?

Look, cystic fibrosis isn't pretty. Chronic rejection isn't pretty either. Neither of them are afflictions I would wish on, well, frankly I wouldn't wish them on my worst enemy to tell you the truth. Most people I know with CF feel this way, even those who claim it as a blessing in their lives because they feel it's made them stronger, more grateful, or whatever other moral high ground illness might give us a right to claim. I don't disagree with their perspective (who am I to do so anyway?), but for me having cystic fibrosis has never been about the blessing or the curse. It's something I have, plain and simple. It's something I fight. It's something I'd like to see eradicated and cured altogether so that no one else ever has to go through it, because I don't believe you need to experience CF to have a happy life. And I believe that given the choice, most of us would choose not to have it in our lives or in our children's lives. Because it is painful, it is frustrating, it is hard, and it can be deadly. It can be just about the most despicable little monster on the planet.

So does that mean I suffer?

Sitting there in that waiting room, I had the overwhelming urge to grab my pen, cross out that line, and rewrite the sentence to read "Ms. Beatty struggles with cystic fibrosis and advanced rejection of the transplanted lung." Because you know what? I do struggle with it. Every single day. I struggle to breathe now, but even before that I struggled to find time to do all my treatments with CF lungs, to find balance between life and an illness that just wouldn't go away. Sometimes I struggle with my doctors, or with myself, or with my care-partners (my preferred word for support people), or I struggle to deal with some of the side effects from medications. Sometimes I just struggle to keep it together in a crowded waiting room, and hey, who hasn't been there before? I struggle against cystic fibrosis every time I go out with the mission to raise money for a cure. I struggle against it when I watch other people fighting this fight, or watch my family watch me. I struggle against it because I don't want to surrender and I refuse to suffer. So, yes, I struggle sometimes with cystic fibrosis/lung disease, and you know what? I'm okay with admitting that.

Cystic fibrosis is not optional. I was born with it, I have it, and I have to figure out how to live with it every day. In a similar vein, I know that "rejection of the transplanted lung" in my case was not anything that I (or my body) did "wrong." Because believe me, if there were some huge, looming mistake that I made I would have found it by now -- God knows I've been searching. So I also know that being where I am right now was not optional either. Neither of these were choices. But I know that, for me at least, and at this stage of my disease, suffering would be.

Maybe that's just the linguistics nerd in me again. Maybe it's because no matter how much I struggle with CF or chronic rejection or SVT or any of the other ridiculous health issues that seem to rear their ugly heads at inopportune moments, I still consider the rest of my life to be pretty effing amazing when you really stop and think about it. Maybe it's because I have a multitude of different words to describe how people deal with the pains and realities of chronic illness, and to me suffering seems like a last resort. Maybe that's because I've been lucky -- and believe me, don't I know it. Maybe it's just because I'm too darn stubborn to admit I'm wrong. And maybe, just maybe, that little bit of stubbornness is enough to keep me alive.

Or maybe it's all just semantics anyway. But I, for one, still struggle with it.

Just Breathe

A few years ago I had a minor, unsedated procedure to remove an infected port-a-cath. At the time I remember lying on an elevated platform in my vascular surgeon's office with a bunch of sterile dressing draped over my head and neck area, with a bunch of men hunched over my pretty much naked chest. And yes, it was every bit as much fun as that sounds. But I digress.

At some point during the process, my surgeon needed to numb up the area enough to cut my skin and vein open and pull the evil cath-of-death out. This involved sticking me repeatedly with lidocaine, in my neck and chest, while I lay there sick, semi-undressed, basically blind, and breathing through sterile sheeting. And because he was a good surgeon and recognized that I might not be entirely comfortable with the situation as it was, he instructed me carefully that the numbing step was about to happen, that it would hurt, and that he wanted me to try and breathe through the discomfort -- physical and mental -- because it would only be temporary and the result was important. Breathe through it, he said. Interesting choice of words, doc.

Breathe through it. 

Later on, when my lungs failed, a pulmonary rehab trainer told me that during times or activities of high stress, most people tend to breathe erratically. Or, to put it another way, to stop breathing altogether. When lifting heavy objects, for example, the natural tendency is often to hold our breath until the burden is removed. When faced with a scary situation we breathe in rapidly -- and then we hold it until we believe the danger has passed. Heck, according to my trainer many of us go so far as to exhale completely before attempting even unremarkable tasks like climbing a staircase, which means we do so without the full use of our breath. And she must be right, because to this day I can remember hearing my mom's Jazzercize instructor crying out "don't forget to BREATHE" to an entire class full of women with tightly wound perms and colored leotards. In fact, to hear how often we as humans subconsciously choose to stop or just stunt our breathing, one might get the ridiculous idea that oxygen is an optional life source.

Guys, trust me on this one: it's not.

So where does that leave me now? Well, recently my lung function has taken a bit of a nosedive, leaving me with a whopping 22% FEV1 (the amount of air one can exhale in one second). And this is, sadly, what we might call NOT a great number. All of which means that after much consideration, time, and effort on the part of my amazing team(s) of doctors and specialists, I have decided to actively pursue a second lung transplant. At this point in the game with chronic rejection, it's become clear to all of us that retransplant is the next step if I am going to try for that long and heathy life I truly believe is possible. My days with Donor Bob, amazing as they have been, are coming to an end one way or another.

And I will breathe through it.

I will breathe through the discomfort and remind myself that this is only temporary. All of it. I will breathe into the hard stuff, remember to breathe when it gets scary, remember that there is no box so heavy that it can't be moved. I will breathe, and I will not forget. And I will take that 22% and use it for all it's worth -- I promise you that, beautiful people -- because that choice is and will always be mine alone. Not CF's, not chronic rejection, not any of the other little monsters hanging out in the shadows. I will breathe, because that is MY breath.

And there will be discomfort.

I hate this disease more than anything for what it does to my family. I hate having to go through this again because I feel like the rest of my body is so beholden to this one very temperamental part. And I hate watching as life gets smaller and smaller traveling down the medical rabbit hole -- again. I want my loved ones and myself to have more time to enjoy the things that make up our lives when we're not overwhelmed with this "sick stuff", want to go back to the days when my health was A factor in my day-to-day plans and not THE factor. I want all of you to be able to read this blog and smile and know I'm okay (I AM okay, by the way). But then again, I know the reality is that this discomfort, is only temporary -- and the result is important.

So I'm asking my loved ones, my family, and all of you to do me one huge favor:

Please breathe through it with me.

And together, we can blow them all away. 

An Honest Reflection

Well hello there friends, loved ones, and beautiful strangers:

I am writing this post because I looked in a mirror today. Okay, to be honest, I look in the mirror every day (fine, sometimes several times -- I'm a girl, after all), but today was a little bit different. Today was different because today I was caught off guard. And again, to be fair, I probably should have expected to run into a mirror or two when I walked into Bed, Bath, and Beyond. It seems like the kind of store where mirrors would be plentiful -- bedroom mirrors, bathroom mirrors, and, well, beyond. So, yeah, I probably should have been expecting to turn a corner and get hit with a random mirror attack, but I wasn't. I was surprised.

The first thing I noticed when I saw myself today, besides the fact that my jeans were somewhat dirty (to be expected after a day of trying to help unpack my new apartment), was my new scar -- the one from my melanoma removal last week, which also happens to be the one that currently is full of stitches until tomorrow afternoon. And this was probably noticeable at least in part because this 2.5 inch beauty is, in fact, on my face. Or, rather, on my chin to be exact. Oh, yeah, and did I mention it still has stitches? Also, that said stitches are surrounded by a bruise that makes it look like I slammed my chin repeatedly into some immovable object? Because yeah, that would all be true.

And this might also be the time to mention that I'm recovering from a cold, and that my lung function is such right now that walking to the store without O2 is enough to make me breathless. Because that's all the truth also -- for right now, at least -- and that's what I came face-to-face with this afternoon on aisle 4, right next to the rotating fan I was planning to purchase.

One word, guys: Ouch.

So, dear friends and strangers, let me say one thing in response to the mirror in aisle 4. Let me be the first to tell you that even when I'm standing there tired and breathless and sporting war wounds on my face, there is one thing I want more than anything else in the world.

Please look past all that. Please see me, instead.

Please see a woman who is smart, adventurous, playful, and even, on occasion, kind of funny. Please see the person who is stronger than facial scars and damaged lungs -- the kind of gal who pushes boundaries, who fights back as hard as she knows how, who just in the past year has come through some pretty tough stuff and has done it with as much patience and humor as she knows how. Please see someone, if you can muster the imagination, who has completed road races and raised literally hundreds of thousands for charities, who has a randomly silly laugh and a puppy who still thinks she hung the moon (shhh, don't disillusion the poor guy!). See someone who is loved, who is happy, who is not afraid of the future (not really, anyway) because she has faith in herself and in God and in all the wonderful people who surround her -- like you, for example. See someone who is a lot like you, actually, because she laughs and cries and gets overly excited about little details and votes and likes ice cream and she, too, wishes she could be on a beach somewhere instead of standing by the mirror in aisle 4. See a woman who could tell you all about living life for 3 years with breath and energy and health, because she had that and she knows deep down that she will have it again soon.

And how much of a gift that truly, truly is.

She could tell you about living your dreams and making a difference, about medical miracles and the selfless gift of organ donation. She could tell you about loving someone and feeling loved back, and why we should never take that for granted. She could take your hand and put them on her other scars -- the ones you can't see, the ones on her chest -- and let you feel what it's like to feel the breath of a beautiful stranger giving life to another. She could tell you about speaking in front of crowds of hundreds for a cause you believe in or she could make up stories and rhymes to make you smile, because that's what she's best at in the whole wide world. And she would ask you about your life, too, because hearing the stories of others is one of her favorite pastimes. She could make you believe in something, anything really, because we all have the power to share that with each other.

Or, if all of that is too messy (and believe me, it can get messy) then please just see a person, any person, who is trying to make the best of whatever life throws at them, and who is grateful, even for her scars. 

That would be enough, I promise. 

And mirror, mirror, on the shelf

Shine past our scars, and show our selves.

With love and light, beautiful people. 

Piper 

The 10 Commandments of Life with CF (or Anything Else)

Well, this was quite a week. Beyond flying to NYC for transplant clinic and a meeting with my surgeon (both went well, by the way) and having the small and thankfully superficial melanoma removed from my face tmw (thank you, immunosuppression drugs!), I've been pushing myself pretty hard. Thankfully the push has not been without rewards -- getting to see my sister, for example, and learning that I am not yet at the stage where my transplant clinic wants to relist me immediately for transplant. And, of course, another reward that I think is always a hard won achievement in the world of CF and lung disease: a little insight into who I am personally and who I would like to be as I continue progressing through this crazy, beautiful journey we call living. 

In particular this weekend, I was inspired by the grace and style of some of the fabulous people I'm lucky enough to have in my life. People like my friend Ali, for example, who recently lost a beloved family member to illness after herself battling through a rough summer. Ali, you are the classic example of someone who always thinks of others, even when you have every right to be selfish or tired. Or my sister, Erin, who held steady through a truly crazy week and never once lost her confidence or grace under pressure. Erin, you remind me how important it is to be confident and proud. My boyfriend who encourages me to go with the flow and let it unfold, my folks who remind me of the importance of family, or any number of all of you, who never fail to set the bar for how much complete strangers can love and support each other through absolutely anything. And so, it is in honor of all of these people, and everyone else, that I offer my own insights into the amazing lessons you all have taught me. Or, in other words, "The 10 Commandments of Life with Cystic Fibrosis (or anything else)."

Thanks for the inspiration, beautiful people.

10. Thou shalt not compare thy life, thy coping skills, or thy appearance in the hospital to others, or to what thou hast witnessed on TV or on the Internet. Grey's anatomy is just a sitcom, and no one's hair or makeup looks like that in the ER. Honest.

9. Thou shalt not measure the day's success solely by activities completed, but also by smiles shared, quiet moments of reflection, and small kindnesses given and received. Some triumphs, after all, are small. 

8. Thou shalt honor thy mind as thy body; and thou shalt remember to appreciate both for what they can do, not to disparage them for what they cannot.

7. Thou shalt be kind to thyself and others whenever possible.

6. Thou shalt forgive thy mistakes and the mistakes of others, even if it takes a little time. This stuff is hard, and no one is perfect.

5. Thou shalt feel, even the hard stuff. No, really. That's okay. 

4. Thou shalt allow others to feel. Also okay.

3. Thou shalt strive for perspective. Thou shalt also know it's not always easy to keep. 

2. Thou shalt remember that thou wast made as thou wast made -- it is not thy job to apologize for thy thyself or thy body. It is a gift, not an inconvenience. I promise.

And finally...

1. Thou shalt love others as thyself, and thyself as others. Really.

And now, the age old question: what would you add? 

With love, light, and learning,

Piper