I want to tell you something I don’t talk about very often.

I am living in heart failure. Right now, today, as I write this. My ejection fraction sits around 38%. I take fifteen pills a day. I struggle to regulate my body temperature in the heat. By the end of most days I am genuinely exhausted in a way that doesn’t fully resolve with sleep. And if you passed me on the street, you would have absolutely no idea.

That invisibility is its own particular grief. But I’m getting ahead of myself.

The Night I Thought It Was Anxiety

I was ten weeks postpartum when I stopped being able to sleep. Not new-baby-not-sleeping. Something different. Two nights in a row where I could feel my entire heartbeat vibrating through my body. I was a psychologist. I knew what anxiety felt like. I told myself that was what this was.

After the second night, I told my partner I needed to go to the ER. Something was off in a way I couldn’t talk myself out of. I still remember sitting in a semi-private curtained area, trying to pump while waiting to find out why breathing had started to feel like work. They ran some tests. They gave me morphine. They sent me home.

I watched the show The Pitt(absolutely obsessed with it), there is a scene near the end of season two, where EMS folks place EKG leads incorrectly because of breast tissue and miss what is actually happening to a woman who is right there in front of them. I watched that scene and felt it in my whole body. Because I have lived that. They ER people sent me home. The morphine let me sleep and made me throw up. The symptoms were still there. “It was probably just postpartum.”

They told me to follow up with an internal medicine doctor.

My partner scheduled that appointment for Thursday. And I want to take a moment to say something about Dr. Rahmen, because she deserves it. She had seen these symptoms before. She looked at my EKG, told me it was abnormal, told me I might be in heart failure, and said I needed an echocardiogram as soon as possible.

I remember sitting in the car in the parking lot of a Jamba Juice after that appointment (because it was the only thing that sounded good) calling to schedule the echo. When the scheduler asked how soon I’d like to come in, I told her, “as soon as you can tell me if I’m dying or not”. She had a cancellation for Saturday at one. I took it.

My partner drove me to the same hospital that had sent me home the weekend before. He had to wait in the car because of COVID. I walked in alone.

My ejection fraction was at 10%. For context, a healthy heart pumps at somewhere between 60 and 65 percent. The echocardiogram technician asked if I was planning to stay to talk to the doctor. Something in his tone made me say yes. The doctor told me I needed to go to the emergency room immediately, that I didn’t have two to four weeks to wait for a cardiology appointment. I asked if I would have to walk or if I could get a wheelchair, because I was so short of breath and I had already walked the entire length of the building to get there because the elevator was broken.

I was admitted for five days. No visitors, again because of COVID. A four year old and an eleven week old at home. I lost twenty pounds of fluid over those five days because my heart had not been able to remove it on its own. I was also in the middle of a thyroid storm. My body was in crisis in almost every measurable way.

And then I was discharged. And thus began my education in what it actually means to live inside a grief that has no name and no finish line.

The Person I Used to Be

I have always been someone who gives everything. One hundred and fifty percent, minimum. I overcommit because for most of my life I genuinely had the capacity to handle it. Multiple projects, multiple groups, multiple responsibilities running simultaneously. I was tired sometimes, stretched thin sometimes, but I could manage it. I always could.

The first time that changed was when my brother died. My brain felt jumbled in a way I hadn’t experienced before. I couldn’t move at the same speed. Things that had always come easily suddenly required more from me than I had. Grief did that. My brother’s death is also the reason I became a psychologist, the reason grief became not just my specialty but my life’s focus, the reason the STAY framework exists at all. Eventually, I found my footing again after his death. I picked the pace back up.

Then came my diagnosis. And this time the change was not temporary.

I had to learn, slowly and against every instinct I had, how to say no to things that previously would have been an automatic yes. I had to learn to ask for help in a way that felt completely foreign to someone who had spent her whole life being hyperindependent. I had a partner and a family who showed up in ways I will be forever grateful for. And I had to let them. Which, for me, was its own kind of loss.

The grief of a chronic illness diagnosis is not a single moment. It is a continuous recalibration. Who am I now that I can’t operate the way I used to? What does it mean that my body has changed the terms on me, not temporarily but permanently? How do I hold the person I was alongside the person I am now, knowing they are not the same and never fully will be again?

I think about this a lot. I live in it every day.

S: Slow Down

This is the pillar I have the hardest relationship with. Personally, professionally, all of it.

I love to go. Movement feels productive. When I am moving I am not sitting with the daily awareness of what is happening inside my body, the reality of a heart that is working harder than it should to do things that used to cost nothing. If I just keep going, I can outpace the discomfort. I can focus on the project, the client, the next thing, the thing after that.

What I have learned, in my body more than anywhere else, is that outpacing the discomfort does not make it go away. It just means it accumulates until my body stops letting me ignore it. And my body has gotten very good at making sure I cannot ignore it.

Slowing down for me is an act of surrender that I have to choose over and over again. It is closing the laptop when I have more in me to give because I know what tomorrow will cost if I don’t. It is canceling something I wanted to do because my body needs rest more than I need to show up. It is letting the discomfort of being slower, less productive, less present than I want to be actually land instead of running past it.

It is also an invitation I try to extend to the people around me. When someone shares something hard, a diagnosis, a loss, a thing they are carrying, we do not have to rush to fix it for them. We can slow down, be in the discomfort together, and let that be enough. Most of the time it is more than enough.

T: Track the Loss

The secondary losses of a chronic illness diagnosis are enormous and they accumulate quietly and daily.

There is the stamina I don’t have anymore. The projects I have to pace differently than I want to. The relationships I cannot maintain at the frequency I would choose because I simply do not have enough energy left at the end of a day that has already taken everything. There are the pit stops my family has learned to build into every outing because of my medications and their side effects, a small logistics adjustment that is also a constant, quiet reminder that things are different now.

And then there is the thing I don’t say out loud very much. I know I will need a heart transplant at some point. I have done the research. I have sat with the question of whether I will be there for my kids’ graduations and I have had to find a way to live inside that uncertainty without letting it swallow everything else.

Tracking the loss means naming all of it. Not just the diagnosis but everything it has reorganized, everything it has taken, everything it asks of me and the people I love every single day. When I actually look at the full weight of what I am carrying, two things happen. It feels heavier for a moment. And then I stop wondering why I am tired.

You are not carrying too much. You are carrying a lot. And you have probably never counted all of it.

A: Allow Complexity

This is the pillar I feel most at home in, maybe because chronic illness has forced me to live there whether I wanted to or not.

I am angry about this diagnosis and I am grateful they eventually figured out what was wrong. I have good days and hard days and sometimes both within the same hour. I have this strange, specific window into what it means to live with invisible suffering, and I would not trade the insight it has given me for my work, and I would also give it back in a heartbeat if I could.

I have a cousin who also lives with a chronic illness. We have a running text thread and sometimes, out of nowhere, one of us will send the other just two words: “tits up”. It means today is a rough symptom day. It means I’m in it. It means you don’t have to explain anything. And every single time it makes me smile and reminds me that I am not alone in something that can feel profoundly isolating.

The complexity I sit with most, if I’m being honest, is the invisibility of it. Because my symptoms are not loud, because I look fine, it is easy for the people around me to forget that this is happening inside me all the time. And so when I have a hard day after a stretch of good days, there is this pull to apologize for it, to feel like I am being a bother, to minimize what is real because the contrast is confusing to others.

I am working on that. Reminding myself, the same way I remind my clients, that complexity does not require an explanation. Both things can be true. The good days and the hard days. The gratitude and the grief. You do not have to choose one to justify the other.

Y: Yield to the Moment

This is the muscle I feel most confident in and I think it came directly from loss.

When grief shows up, in a session, in a conversation, in my own body on a day when I have a full calendar and zero capacity, I have learned to throw the agenda out the window. Not reluctantly. Genuinely. Because I have sat with enough grief, my own and other people’s, to know that the moment in front of you is almost always more important than the plan you made for it.

When someone starts to cry in the middle of a conversation that was supposed to be about something else, I want to be the person who says, we have time, this matters, you don’t have to apologize. Because we spend so much of our lives moving through to-do lists that we forget to be human together. Connection over pain is not a detour from the real work. It is the real work.

Yielding to the moment also looks like listening to my body when it tells me that what I planned is not what today can hold. That is still hard. But it has become one of the most important things I know how to do.

What I Want You to Know

I am telling you all of this not because my story is the point. It isn’t. The point is that grief shows up in all kinds of bodies and all kinds of lives in ways that are invisible to almost everyone around us and sometimes even to ourselves.

I built the STAY framework because I believed, and still believe, that we need a different way of being with grief. One that does not rush toward resolution or demand that loss make sense on a timeline. One that makes room for the full, complicated, nonlinear reality of what it means to carry something hard and keep living anyway.

I also built it because I needed it. I still need it. Every single day.

There is grief and embarrassment in admitting that things don’t get done at the same speed and frequency and consistency that they used to. I worry sometimes that people think I am a flake, inconsistent, unreliable. When the reality is that I am living in heart failure. It takes everything I have, every day. And some days I have to prioritize rest because my body tells me in no uncertain terms that there is no other option.

If you are living with something invisible, something that costs you more than people can see, something that has changed the terms of your life in ways you are still grieving, I want you to know that I see it. Even from here. Especially from here.

You are not a flake. You are not inconsistent or lazy or difficult. You are living in something real. And that deserves to be named.

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