The last time...

I once found myself in a discussion about how or if we know, when we do something for the last time, that it is our last time. For example, a group of friends had gathered in Donald’s home to celebrate his life and to mourn his death. All around us were signs of his presence, and what appeared to be signs of his intention to return soon. Did he know when he walked out of his house that last time that he would never again set foot in it?

Today I received word that my kidneys are not functioning properly, most likely because of drug interactions. I had been feeling listless and tired for several weeks and I just thought that it was normal for this stage of my HIV infection. I had not made the connection that I had just started a new medication for lowering my cholesterol. I learned that this drug should never have been prescribed with another drug that I am taking to lower my triglycerides. The triglycerides are elevated because of other meds that I am taking and have been hovering around 1000 mg/dl (a value greater than 150 mg/dl will send a cardiologist into a frenzy). So, if I had not taken the latter drug, I would likely have suffered a stroke or heart attack by now anyway. I am feeling like a clown’s balloon, that when squeezed at one end, blows out at the other.

Additionally, because my kidneys are now functioning poorly, I have to stop one of my HIV meds. The impact on my health of this last step is unclear. I could experience viral rebound, meaning that my HIV can come bounding back, reproducing very rapidly and potentially developing resistance to my other meds. It is possible that if my kidneys begin to work properly again from removing the contraindicated drugs, then I can start the old HIV med again and all will be well. It is also possible that I will have to start a completely different regimen of HIV meds because of the combination of side effects (extreme elevation of cholesterol and triglycerides) and drug failure (rebound). The problem with this scenario is that I may not be able to tolerate the new combination of treatments if the old treatment fails. I have already developed significant resistance to multiple drugs across multiple drug classes and have already lived miserably with diarrhea for months on end just to keep my HIV at bay by taking a med that worked but that made the quality of my life miserably bad. My options are running out.

So, I found myself asking today, will I know when I have said "I love you" for the last time? Will I know when I have embraced someone with a passionate kiss for the last time? Has that already happened? When will I have sex for the last time? When will I walk in the sun for the last time? When will I learn my last lesson? When will I travel to a foreign land for the last time? When will I breathe in for the last time or caress a lover’s face for the last time? Will I know it when I hold the puppy that thinks I am her rock of safety for the last time? When will I see my friend’s faces for the last time?

When will I leave my home for the last time or clean my house for the last time? Is that already signaled by the quarter inch of dust on my furniture? When will I look upon the light of the setting sun and smell the beauty of honeysuckle and think that life is good…for the last time. When will I listen to my favorite music, or watch my favorite film for the last time? When will I speak to my best friends for the last time?

The truth is, we have to live each day as if we know it is our last and mindfully observe the love and beauty in our lives as if we will never see it again. Even in moments of extreme self-pity, we have to learn to acknowledge the good that has benefited us and how we are so much more fortunate that so many people in this world who deserve to have the lives we have lived. I tried hard tonight to remember this as the sadness of having to say goodbye became a real possibility for me once again.

Categories: HIV/AIDS medication side-effects kidney+disease