Young Warrior Meets the Great Adalimumab: A Dark Comedy
The beast of polyurethane and springs weighed me down, my spine sinking, my joints aching, my mind shouting in a clamor, "don't let this fluffy piece of furniture get the best of you!" A bead of sweat began to trickle down my forehead, the seams of my shirt digging into my skin, and fire rippling from my metatarsals to my knees. I looked up at the fluorescent white light pulsating like an artificial sun, and then eyed my progress. Thirty minutes into the battle, and the mattress had surrendered only five feet.
My voice rung out, "I need some help!" A beautiful face with deep green eyes and blonde hair appeared in the doorway, an infant at her hip, eyeing me with curiosity while he rubbed his tired eyes with a pudgy hand. "I think you should do this tomorrow," she said.
"But what if I wake up unable to move? I feel good enough, it will have to do," I answered, assessing the joints of my fingers.
"Don't hurt yourself, love. I'll put the baby to sleep, and see if I can lend a hand."
As the moon traced a path high into the sky, the sweet child refused to surrender his mother's breast. The forest outside radiated a peaceful symphony of flowing soft grasses, the rustle of pines, and the shimmer of cool green aspens in the whispering breeze. I decided I needed a break, and paced the streets, the chilly mountain air relaxing my overstrained body.
"Perhaps it is time to give up, to just accept the defeat and surrender," I thought, looking across the valley at the darkly shaded mountains in the distance. Images of my life flipped past: racing and riding endless miles of tarmac and dirt, year after year on my bicycle. Walking slack lines pulled taught across chasms of fear and dread, suspended a thousand feet in the air, and anchored to cliff sides. The familiar sounds of Olympic size trampolines, squeaking out that predictable rhythm as I flew, flipping and spinning, through my adolescence and young adulthood. "It is over. Those days are no more," I said aloud to the trees. As I contemplated the stars above, the vast distances of space and time reinforced my feeling of cosmic insignificance. "Everything is difficult. I can't even move furniture now. How far I have fallen."
A surge of anger simmered within as I reflected on my life, a feeling so familiar when I get close to physical exhaustion. The last attempt to fight, to give all that I have left, always feels like directed rage; a stubborn and angry refusal to yield and be dominated by difficult tasks, competitors, or life. Returning home from my brief walk, I took to the stairs, slowly climbing, feeling my strength begin to build as the resentment I felt towards my condition escalated. Wrath at the deplorable state of my body began to take over my mind. "I won't be defeated by a mattress!" I thought, "I refuse to live like this! I'll rip the springs out of that vile beast!"
I could hear the drums of war pounding a primordial rhythm, pressing me onward, petitioning the gods for protection and strength. The rage within was rising. The ground went flashing by as my arms and legs thrust me forward, compelled by instinctual force. A bookshelf blurred in my periphery, the pictures and trinkets becoming streaks of forgotten memories. A guttural roar escaped my throat and echoed down the hallway, resounding off the ceiling and floor, telling all those that could hear that the hour of war was near.
I made my way into the bedroom, eyeing the criminal, still some ten feet away from its destination. Three massive strides were all that was required to grasp the edges of the scoundrel, locking horns and gritting my teeth. "Get over there where you belong you roguish piece of cloth!" I yelled, the forest outside picking up the intensity of my battle cry, the insects now churning in expectation of the kill. The delinquent fought back relentlessly, using its full weight to intimidate me while I taunted it with vile threats, "I'm not afraid of you, crooked thug! I'll bust your fluffy cotton out!"
My thunderous exhale signaled the fatal blow as I hurtled the villain mattress to its fateful death against the wall. Reduced to a sagging and pitiful bulge, folding over on its side in defeat, the pathetic mattress let out a death wail, the sound of its threads dragging down the wall as it settled into a slouch. "Eat it mattress! I've had enough of you!"
In the same swift movement, I turned and grasped the edge of the queen-sized bedframe. Black stain with elaborate trim, the queen frame stared back at me, daring me to risk it. "Get over there with the mattress you boorish brute! I'll dethrone you!" I roared, the satisfaction of recent victory propelling my hands and legs as I heaved and struggled against the massive creature. Yet, stubborn and unyielding, with its talons sunk in the depths of hell, the bedframe fought back. Inch by inch, we became locked in an eternal struggle of strength and will. Yet I persisted, autoimmune disease ridden human that I am.
Moments after I defeated the ominous and terrifying queen, I heard a deep and booming voice, as if it came from everywhere and nowhere at the same time: "You have proven your strength by conquering the weighty furniture young warrior," the voice echoed, filling the room and nearly crushing me with the intensity of its reverberations. I shook with fear, completely taken aback by the presence of this unseen speaker. "We will help you in your future battles," the voice continued, "but you must make a great journey to the depths of the dark mountains you see in the distance. Come to us!"
"But where are you?" I shouted at the wall and ceiling in fright, my voice quivering and betraying my terror.
"Follow the directions on the map in your pocket young hero, and you will find us," the voice echoed.
"Who are you?" I bellowed, my head turning in every direction.
But minutes passed with no response. Wishing more than anything for help in the tedious battles waged against the mundane, I began shoving my swollen feet into my boots, fumbling at the laces, and crying out in pain.
The journey across the swampy meadow was difficult. I looked down at my hands. The joints just past my knuckles were swollen, cracked, and covered in blood. Knee deep in mud, I had grasped sticks and rocks, and whatever else I could find in my desperate attempt to reach the foothills. "These hands of mine," I thought, "always pestering me, making life a million times harder than it needs to be." Dimly, the forest of my home was visible, some miles away, though dark mist and fog covered the mountainside. I winced in pain as I reached into my pocket and fished out the map, trying to make stubborn joints clench at a thin and wet piece of paper. A big Rx marked the destination, and it seemed I was headed in the right direction.
"How many hours have I been walking?" I thought to myself as I followed the dusty path that lead away from the swampy marshland. "How long must one wait to get some help with this maddening condition?"
A cold and icy wind that swept across the valley roused me from my thoughts. Dark granite cliffs, a few hundred feet high, jutted out of the earth in the distance. A thunderous crack greeted my ears, causing me to jump in surprise. Just above the cliffs, I could make out the luminescent reflection of a glacier, sending a warning signal of its many fractures, crevasses, and potential quakes. Reaching the base of the cliff, I placed my achy palm on a small ledge, and began to climb.
The luminous orb of hydrogen peaked just above the horizon, turning the sky from a murky black to a hazy and purple canvas. Smoke from the fire caused my eyes to burn as I threw on another tree branch, trying eagerly to warm myself. "How many times did I nearly tumble to my death on those cliffs and ice?" I wondered, eyeing the dancing orange and yellow flame as the fresh wood began its process of combustion. Brushing my hands up and down my goose-bumped arm, I began to wonder if the voice in the bedroom the night before was nothing more than exhaustion-induced hallucination.
Just then a dark shadow rapidly flew across the clearing, sending shivers down my spine. I arose hurriedly, stumbling backwards, tripping over rocks and flinging dust in the air until my back was against the cool and solid rocks that surrounded my makeshift campground. "What on earth was that?" I said aloud, my head turning this way and that, frantically searching for the source. Yet, I saw nothing. I struggled to catch my breath, the sound of my breathing bringing fear of discovery. The image of that round and tall shadow, with a thin antenna like extrusion, haunted me to the depths of my being.
"I came all this way, only to be devoured by some strange beast," I thought, wishing I had a means of defending myself. "This is absurd! To wake up one day with fingers so stiff they won't bend, and feet so swollen my shoes won't fit," I continued to think as I hunched down, clenching around at the stones beneath my feet. "There is no justice in this world! My own immune system has been trying to destroy me, and now some abnormal creature haunts me!" I felt my pupils dilate, the green of the grass becoming brighter, the cold chill that had crept in during the night dispelling. "Whatever you are," I yelled at the sky, my mouth twisting and turning as I stood, holding two large rocks in my hand like weapons, "you are no worse than the disease that already ravages my body! I have nothing left to lose! Show yourself!"
Silence reigned in the clearing. I began to wonder if I had imagined the shadow, or if it was some strange illusion like the voice that had propelled me on this ludicrous journey. As I questioned my sanity, I began to see a small glimmer just to the side of the fire, some strange object beginning to materialize from thin air.
A booming and familiar voice accompanied the image, echoing off the rocks as I fell back in surprise. "You are very brave young warrior!"
"What are you?" I yelled back, squinting to discern the shape that was taking solid form.
"I am the great inhibitor of tumor necrosis factor, and the first of monoclonal antibodies!" The voice thundered. "My name is Adalimumab, though many call me Humira!"
Cylindrical, with a violet colored plunger jutting out of one end, and a long silver needle on the other, Adalimumab was a human sized syringe! As it spoke, a small air bubble bounced up and down inside a chamber that was filled with clear liquid.
"My name is Michael," I responded, stepping forward, lifting my chest and standing tall, "conqueror of mundane tasks despite endless pain, and the one who smiles though every step is agony. I seek the valley of Rx." I held out my map, hoping the giant syringe could direct me.
"This is the valley of Rx that you seek," came the reply. "You have arrived. We have been expecting you."
"We?" I asked.
No sooner than I had spoken than two other objects began to materialize. The first was a brown pill bottle with a white cap. The second a glass vial filled with a yellow liquid.
"I am the great Prednisone," said the pill bottle, "Suppressor of immunity, reducer of inflammation, and king of the glucocorticoids!"
"And I am the glorious Methotrexate," said the small vial, "Ruler of antimetabolites, suppressor of intercellular adhesion molecules, and inhibitor of T cell activation!"
"We are here to help you young warrior," the great Adalimumab said as the three mysterious deities approached me, bouncing along the terrain as they came near.
"I'm so glad" I uttered, the rocks falling from my hands. "Every day I wonder how I will survive."
"Your fate is to struggle," Methotrexate responded. "Your immune system has declared mutiny, and is trying to overthrow you."
"But we can slow down the attack," the great Adalimumab continued, turning its plunger towards Methotrexate. "If you inject us, together we can fend off your rogue immune system."
"And if you swallow me, I can reduce that pesky swelling that cripples you daily!" Announced the great Prednisone.
It sounded too good to be true. I ran my hand through my hair as my skeptical mind jumped into action, red flags appearing everywhere. "I'm not so sure I am ready to inject mysterious substances, or swallow pills I've never seen before. How will you fight this disease?" I asked, the seeds of doubt spreading.
"We will have to disable much of your immune system," Adalimumab said. "You will not be as strong at defending outside attacks. Your risk of infection and lymphoma will be greatly increased. There are also side effects and a chance we will be ineffective."
The feeling of hope dissipated as my shoulders slumped towards my chest. I looked at them with a raised eyebrow, and chuckled to myself, "The irony of it all!"
Looking over my shoulder I surveyed the great distance I had traveled. My home lay somewhere in the shadowy and dim vastness beyond. I turned and looked down at my youthful body, once so full of enthusiasm and energy. I thought of my family, my wife and children who needed me. I thought of my future, those yet to be seen adventures with the people I love. And I thought of my past, that life filled with constant striving and passion. Holding up my swollen and stiff hands to demonstrate my sincerity, I addressed the three deities. "Because I am desperate, I will I give it a try," I said, exhaling both courage and fear at the same time.
"Great!" Adalimumab nearly shouted, the air bubble fluttering in excitement. "All you have to do now is petition the gods Anthem/Blue Cross. Should you make many sacrifices, paying a large portion of your income to them monthly, they may decide to cover most of the cost of treatment."
My head hung in defeat. "This is the price of uncertain help at the risk of serious harm or even death?" I asked incredulously.
The ceramic of the coffee mug was warm in my hands, the murky brown fluid restoring my energy as I contemplated the morning. My wife sat across from me, the little baby in her arms, the mischievous look of childhood curiosity illuminating his bright and inquisitive blue eyes.
"You look exhausted," my wife said, looking me up and down. "How did moving the furniture go?"
"Awful," I responded, slowly reaching out with my hand and brushing the soft blonde hair of my little boy's head. "I can hardly move from stiffness and fatigue. I'm so tired my mind is completely blank. It feels like I've walked hundreds of miles in my sleep."
"I worry about you," she responded, spooning up some oatmeal for the little guy, "do you think the new drugs are working?"
"I'm not sure," I answered, bringing the mug to my lips, "I was told it takes a few weeks, so we will have to wait and see."
Have you managed RA fatigue better than you used to?