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Chronic Illness Essays

Getting My Life Back After Open Heart Surgery

James Beard- and Julia Child-award-winning author Linda West Eckhardt lives for food, family, and dogs. But what happens after the cookbook writer gets her chest carved open?

When my old sweet dog, Tex, died from diabetes at the age of fourteen, I went into mourning.  Nothing seemed to help me get out of it. But when I helped a friend find a rescue pup for herself, the answer jumped out at me: I should get another dog.

Surprisingly, and seemingly easily, I found a half-grown white pup with one brown eye at the shelter who reminded me of my old friend, Tex.  I took him home immediately and began to walk him along with my trio of sleepy ten year old dachi-si cross dogs.

Several things became immediately clear.  He never spoke. He fixed me with his eye and kept me in his gaze at all times.  My friend, the dog trainer had the answer for that. This dog is deaf.

It seems white dogs are often deaf but make great pets because they bond so closely.  The pup and I became inseparable almost immediately. We did a lot of walking. His big old long legs and his insatiable energy made him a great walking partner.

The pup and I became inseparable almost immediately… In fact, by the early part of March, he had about walked me to death.

In fact, by the early part of March, he had about walked me to death.  One day, I felt a tightness in my chest and a shortness of breath that cut our walk out for that day.

Dogwalking Towards Death

I called my beloved Dr. Byrd, my primary care doc, who advised I should come in ASAP. So, cutting to the chase, after two days of tests, Doc said I should go to St. Barnabas Hospital.  They’ll be waiting for you, he said noncommittally.

Eternal optimist that I am, I drove to the hospital with my friend, Rose, thinking there would be more tests. But within about 3 hours, they were wheeling me into the operating room, and before I could even digest this bit of news, they had whacked open my chest, laid my heart out on a table, stripped veins out of my leg to make the repairs to the three choked-up coronary arteries and borrowed a cow’s valve to replace that one which had been wheezing in my chest for years.

Can I even begin to convey to you the shock I felt learning that while I was under an almost 6-hour anesthesia, there had been a long vertical incision carved down the front of my body from the throat to the waist? Staring at myself in a mirror in the hospital I could barely register the fact that they had sawed through the breast bone to get at my poor pitiful heart.

Staring at myself in a mirror in the hospital I could barely register the fact that they had sawed through the breast bone to get at my poor pitiful heart.

But the strange thing was, I felt no pain.  Not then, and not later. I did take care when lying down not to put pressure on my heart.  I did train the new pup not to lie on my body. After all, he was the fourth dog in that king-sized bed, and if I could keep all those dogs from doing more than snuggle, all would be well.

Well, they were little dogs – up until I got the big white Galoot.  But who could resist that smile? And he was so quiet. He would put his head on the pillow next to mine and just stare at me with pure love in his eyes.

The Slow Slog Towards Wellness

Taylor, the cute deaf dog Linda adopted just before her surgery.

And so began a long recovery that called for lots of naps, great restrictions, and warnings about lifting heavy things.  But before you knew it, I was given permission to drive and so began the long slow slog to wellness.

At one of my appointments, I asked the doc how long it would take for me to feel normal.  He smiled ruefully and answered, “About a year.”

“Are you kidding me?” I answered.  “I don’t have a year to give this. No way.”

By then, I had seen a virtual army of doctors:  cardiologists, internists, blood pressure specialists, surgeons, so many doctors and doctors’ appointments,  I couldn’t even keep them straight. I had a line of prescription bottles lined up over the kitchen sink and did my best to take them as prescribed.  And I was focused. I wanted to get well.

Heart disease was no surprise in my family.  My mother and both grandmothers had all died from heart disease, usually at the beginning of their seventh decade. The fact that I had lived almost a decade longer and now was on the mend from a triple bypass surgery was a testament to modern medicine.

Sliding Out Of Depression

But, while I should have been steadily improving, I had to note that I was sliding into a serious depression. I began to fight with my daughter.  I could hardly stand to watch the news. I didn’t want to even throw the ball for the dogs in the back yard. I would get up at 6 to walk the dogs then go right back to bed for the first of a series of naps I took until bed time.  I had quite simply quit cooking. And considering that I am a cookbook writer this was really unheard of.

I bought books to study up on this cardiac recovery.  More than one book said the most common side effect was depression.  I can attest to that, I muttered under my breath.

I bought books to study up on this cardiac recovery.  More than one book said the most common side effect was depression.

Normally, my days are filled with cooking and writing and testing recipes and feeding people and dogs.  My friends and I hold what we call the Maplewood Dining Club about once a week where we sit down to enjoy a meal together.  Since all of us are women of a certain age who live alone, it makes for a great family activity and a bonding that we couldn’t do without.  And I even wrote a book dedicated to my dogs: The Dog Ate It.

When it was time for my follow up with my doc, I bundled up all those scrips and took them in a paper bag with me to the appointment. I complained to him about the depression.  Doctor Byrd lined all those little bottles up and studied them. “I think you can cut this one out,” he commented about one. “It’s for cardiac patients who haven’t had bypass surgery.  Why don’t you stop taking that and see if you feel better. But don’t expect miracles.”

Getting My Life Back

So, I went home with really low expectations.  I mean, hey, that’s a marker for depression. You don’t expect much. But I put away the scrip he’d said I didn’t need.

And on the third day, which happened to fall on the Ides of March, the 15th, a miracle happened.  I woke up and jumped out of bed, ready to play with the dogs. I called up a couple friends and invited them to dinner.  I hadn’t cooked in 3 months.

I suddenly knew I was going to get well. The miasma of illness had fallen away.

Just like THAT, the depression lifted.  I got my life back. I suddenly knew I was going to get well. The miasma of illness had fallen away.

So what’s my take away from all this?  Follow doctor’s orders, but don’t be afraid to ask questions.  You never can tell. You might get your life back too. And with fewer meds, not more.

Chronic Illness The Good Fight

How Climate Change Is Hurting Our Health

More heart attacks. Worse asthma attacks. Year round allergies. And tropical diseases everywhere. That's just a taste of what climate change is doing to our health.

Climate change can seem like a problem so much bigger than an individual person. But even outside of flooding coasts, hotter summers, and freakier storms, climate change is deeply impacting our health on an individual level. But just how much? Enviromedics: The Impact of Climate Change on Human Health, a new book from two experts on emergency medicine, addresses just that million dollar question.

“If things are going bonkers weather-wise in our neighborhoods and regions it doesn’t take much imagination to understand that it affects our health,” explains Enviromedics co-author Dr. Jay Lemery, an associate professor of emergency medicine at The University Of Colorado, who wrote his book alongside his mentor Dr. Paul Auerbach, a professor in the Department Of Emergency Medicine at Stanford.

And those effects, which Lemery has seen first-hand as part of his own practice, can be severe, such as pre-existing conditions like asthma exacerbated by extreme heat, or allergic reactions that last for whole seasons.

The book takes readers “bedside” to a mixture of scenarios extrapolated from the authors’ own practices: patients with preexisting conditions exacerbated by extreme heat; allergies previously bad for short periods lasting whole seasons; heat-induced asthma attacks.

In myriad ways, some discreet, others overt, climate change imperils global health. “Ecosystems are suffering and we are inextricably linked to the places we live,” says Lemery. We spoke to him to learn more.

How did you go from emergency medicine to climate change science?

A man with a beard wearing a knitted cap and a blue sweat shirt, standing in front of glacial waters on a rocky beach.

Dr. Jay Lemery wrote Enviromedics because he sees climate change as the greatest health crisis of our time.

Out of residency, I took a job at Weill Cornell Medicine teaching wilderness medicine. It was ‘how do you take care of people in remote austere places?’ ‘How do you practice without advanced technology?’ I had been a resident during 9/11 and started at Cornell in 2004; disaster medicine was everywhere. I really dug it because it kept true to the core principles of medicine, of innovation and physical diagnosis. Somewhere in there I began to think about climate change and environmental degradation. The science was being politicized. I thought, this is crazy. I did a lot of contract work for the National Science Foundation supporting Arctic research, tons of which is climate related. I was also a past president of the Wilderness Medical Society, a nonprofit academic organization. We would help establish the Everest base camp medical clinic during climbs.

We were in these spectacular places, supporting researcher’s health, supporting the science, and I just noticed this glaring absence of the medical community in this conversation on climate change when it is so clearly affecting our health. That was my big moment.

“I just noticed this glaring absence of the medical community in this conversation on climate change when it is so clearly affecting our health.”

What did you think the conversation was missing?

So much of the conversation around climate change is about polar bears or abstract concepts like parts per million of carbon dioxide which, if you study this stuff you know is a big deal, but for the layperson means absolutely nothing; just a number, literally, out of thin air. I thought, we have to do better.

As doctors, me and Auerbach know sickness. We’ll be seeing a lot more of it in the future because climate change will be a driver for sickness. In our book, we took composite vignettes of the patients that we see everyday. These are not specific cases but are the natural extension of the data we’re seeing. We know extreme heat drives morbidity and mortality for people with preexisting illness; we know what heatstroke looks like; etc. So then instead of talking about polar bears you’re talking about your parents’ risk of chronic lung disease and your kids’ risk of asthma.

My own sister lost her house in Vermont during a hurricane in 2012, when all of northern New England got nuked by extreme rain. A little beautiful stream diverted into her living room, turning into a river. These are real things. Talk to people in California about their wildfires. The air is degraded; people are losing their homes; huge swaths of land are gone; people are dying. There’s nothing healthy about that.

“The air is degraded; people are losing their homes; huge swaths of land are gone; people are dying. There’s nothing healthy about that.”

How is climate changing making people sicker?

Heat waves can kill people but very few people die from heatstroke, relatively (although we’re seeing more more of that this summer in India and the Middle East, where you have very vulnerable populations who just cannot cool down). It’s really the people with chronic obstructive pulmonary disease or heart attacks or congestive heart failure who die. Heat makes their bodies work harder. When you’re walking around on a hot day, your pulse goes up, you’re working harder to sweat. That’s enough to push someone over the edge.

The cover to Enviromedics: The Impact of Climate Change on Human Health.

Extreme weather, too. Hurricanes kill people and destroy infrastructure. Look what happened in Puerto Rico and Houston. In Houston, a tremendous downpour caused catastrophic flooding and people were killed and internally displaced. In Puerto Rico you had a relatively vulnerable place get pummelled (I was part of a study that pointed out that the death rate was in the thousands, not 64 as the government said at first). Try living in Puerto Rico without power for nine months; that’s a big hit to your health and wellness.

Another one: Part of the bedrock of public health is that we separate the areas where we eat, go to the bathroom and grow food. But when we have a heavy downpour, which we’re seeing more of, you end up blending all those places. That’s water insecurity. Even in Boston or New York you can’t drink the water for a few minutes after an extreme downpour because it overwhelms the sanitation pumps. Now that’s just a couple minutes of inconvenience but in many places in the world your food is compromised; sewage has contaminated your crops. That’s where you get these horrible diarrheal diseases. Diarrhea is still one of the biggest killers of children across the world. Water insecurity is a huge deal.

What are the biggest climate-caused or exacerbated health issues?

Even among climate scientists, there’s debate. Is it extreme heat? Is it the rise of sea level which will make coastal living impossible? I think that, between extreme weather and the increase in temperatures, climate change will undermine our food supply. Food security will have the biggest health effects worldwide because it will undermine our access to nutrition. Lack of nutrition is a wonderful way for disease to thrive. That’s going to be the biggest, I think.

“Food security will have the biggest health effects worldwide because it will undermine our access to nutrition. Lack of nutrition is a wonderful way for disease to thrive.”

What are some of the more subtle ways in which climate change affects health?

Take allergies. The aeroallergen ragweed and pollen levels are going bonkers because they’re responding to higher CO2 levels. Seasonal allergies are lasting longer than they have before, particularly in northern cities. In Canada there’s good data which says ragweed allergies used to last for only a couple of weeks a year; now it’s months. That doesn’t kill people. But if you suffer seasonal allergies you’re incapacitated for the time you’re outside. You’re miserable.

Ticks and mosquitoes, which carry tropical diseases like zika, yellow fever, dengue and malaria, are moving higher in latitude and altitude. In the East African highlands people who have been historically spared from malaria are now susceptible. It’s a double whammy: more people getting malaria and those getting it have no tolerance. We’re going to be seeing more of this in the U.S. as well. Lyme now exists in all fifty states; that’s unprecedented. There’s no mystery to it. Bugs like warmth.

Yet, if you think about what’s happening it’s not just global warming. Although rising temperatures is one of the drivers what we’re actually witnessing is a global energizing. We are energizing a very complex system, the planet. I’ve had people in climate communication say not to use that word because it’s too optimistic. Katharine Hayhoe out of Texas calls its global weirding, which I think is very effective. It’s really what we’re seeing. The weather is just wacky, with more crazy anomalies we haven’t witnessed before. Climate change is crazy town.

“Climate change is crazy town.”

What sorts of climate-related issues do you see in your own emergency room in Denver?

On hot days we see tons of people come in with chest pains, shortness of breath or exacerbations of their chronic illness. Extreme heat exacerbates preexisting conditions. On those days with heavy wildfires we’ll see exacerbations of asthma. Researchers who look at these things aggregately are able to see spikes from these weather anomalies.

That issue of causality is interesting. When can one definitively blame a health outcome on climate change?

“Let’s not be naive.”

You don’t need direct causality to be a threat multiplier. There are great epidemiological methods to tease out different variables–if you look at our book it’s all right there. Causality, when you see it, is important. But it’s also important to acknowledge that we cannot definitively prove this. For example, the 2003 heatwave in Paris was beyond historical experience. Fourteen thousand people in France died, 32,000 in northern Europe, a very well resourced part of the planet. Can I definitively say that was due to climate change? No. But what you can say is that this heatwave is beyond historical experience and that we know we’ll be seeing more in the future. Undoubtedly the data we’re seeing from temperatures across the planet are driving more extreme heat events and we know that this is a threat multiplier for health. Let’s not be naive.

You can purchase Enviromedics: The Impact of Climate Change on Human Health on Amazon.

Heart Disease Q&As

What Women Need To Know About Heart Disease

A heart attack can look very different for a woman than it does a man. As a national heart disease spokesperson, Shalini Suryanarayana wants women to know the warning signs.

When it comes to maintaining a healthy lifestyle, Shalini Suryanarayana does everything considered right. She eats a vegetarian diet, drinks alcohol only on occasion, doesn’t smoke, maintains an average weight, keeps active, and exercises regularly. In 2012 she was running a couple of miles every day, in training for a team event to raise money for breast cancer.

But when she was struck by a cardiac event that same year at the age of 47, the University of Vermont program director got many things wrong.

“I just wasn’t thinking very straight,” Suryanarayana says.

Heart disease is the leading cause of death in both men and women in the U.S., accounting for approximately one in four deaths nationwide. It can affect people of all ages and ethnicities and can strike with no warning and none of the associated risk factors like smoking, obesity, diabetes, high blood pressure, or depression.

But unlike the chest-clutching pain and squeezing sensation commonly associated with heart attack and cardiac events, symptoms in women can be much more subtle and diverse, sometimes manifesting as a shortness of breath, indigestion, back or jaw pain, fatigue, nausea, sweating, lightheadedness — all common symptoms a woman might easily attribute to more mundane conditions like menstruation, menopause, the flu, or just everyday stress.

In fact, to say a cardiac event “struck” would be an overstatement in many cases. Despite the life-threatening ramifications, cardiac events in women like Suryanarayana can more closely resemble a series of sudden but trivial discomforts.

Shalini and her dog, Budderball.

Despite the life-threatening ramifications, cardiac events in women can more closely resemble a series of sudden but trivial discomforts.

Consider Suryanarayana’s description of events. While out walking her Boston Terrier, Budderball, one day, she says, “I felt a little pressure on my chest, which made it feel like it was a little harder to breathe. But not a huge problem. It would come for a few seconds, and then be gone. Then later it happened again. The only time I had experienced that kind of shortness of breath is when I had an allergic reaction to a medication, so I thought I must be having an allergic reaction to something. I wasn’t worried about it. I just thought, Oh, I’ll go to the doctor sometime next week.”

“But then the next morning, first thing in the morning when I opened my eyes, I woke up experiencing that same shortness of breath and pressure on the chest.”

What Suryanarayana didn’t know at the time was that her heart was struggling to pump blood through an artery that was more than 90-percent blocked. She estimates she experienced, and subsequently dismissed, symptoms for a good 18 hours. But, she admits, “it might have been more than that. Because my symptoms were so mild, I might not have even noticed it.”

Despite a long family history of heart disease, it took the prodding of two loved ones that next morning to persuade Suryanarayana to go to the ER. “I was like, ‘No, I have to do a presentation for work, and I’m supposed to leave in two hours,’” she says. But rather than inconvenience anyone, she insisted on driving herself.

“My poor brother. He was frantically trying to give me a ride, but I wouldn’t wait for him,” she says. “That was a terrible, terrible decision. I put a lot of people at risk if something had happened to me on the way.”

Suryanarayana’s doubts and absence of urgency toward the situation continued unabated at the hospital. Because the pressure she was experiencing inside her chest didn’t hurt per se, she was reluctant — despite the insistence of her brother, who is also a doctor — to term the feeling “pain.”

“I get there, and I’m checking in like normal, and they’re asking me about my symptoms,” she says, “and I said, ‘I guess some people might call them chest pains.’”

They’re asking me about my symptoms, and I said, ‘I guess some people might call them chest pains.’

“I’d barely said the words ‘chest pains,’ and boom! Everybody flew into action. They had people just swirling all around me. And thank God they did.”

Surgeons placed a stent to reopen the artery that had been blocked to allow Suryanarayana’s blood flow to return to normal. “Had I made a different choice at any point in the line, had there not been an experienced person in the ER, my story could’ve been very different,” she says.

Suryanarayana and Budderball have since appeared in local and national heart disease awareness campaigns, and Suryanarayana served as an American Heart Association 2016 Go Red for Women spokesperson, sharing her experiences and encouraging women around the country to take a proactive approach to their heart health through regular Well-Woman Visit check-ups. (Sadly Budderball passed away this past December.)

Now a Go Red for Women ambassador, Suryanarayana here discusses with Folks the crucial role genetics plays in one’s health story, how women in particular can balance vigilance with paranoia with conditions like heart disease, and how sharing her story on a national scale helped her overcome the embarrassment she’d originally felt about her condition.

“Had I made a different choice at any point in the line, had there not been an experienced person in the ER, my story could’ve been very different.”

 

Your mother is one of the first women in your immediate family to live past the age of 45. Is that where a family predilection for heart disease lies?

You know, I don’t know too many of the details. I just know that the women in my mom’s family — several of the people closest to her —all died at about the same time. I remember when I was young when my mom’s birthday — that birthday — came up, she cried a lot. She lost her mother at that age and her sister at that age. It was a powerful day for her. That really stuck with me.

Years later, when I passed 45, it clicked. I remembered that. Not long after that, I had to get the stent. So it really did seem like that [age] was a marker.

Was there any particular culprit that you knew of that affected the women in your family that way?

It’s straight-out genetics. And it turns out it’s not just the women in my mom’s family. Pretty much 100% of the men have had cardiovascular issues. Diabetes and heart disease is just rampant on my mom’s side of the family.

By the time it hit my brother and me, we were both pretty young. But in both our cases, they caught it early and did something proactive. After that our health was actually better than it had been prior. I didn’t have tissue damage because I didn’t actually have a heart attack — I had what’s called a “cardiac event.” It’s sort of the precursor. So once the stent was in, that blood flow was much better. A few months after my event [and stent placement], they measured my ejection fraction [the percentage of blood pumping out of the heart], and it was the same as someone who had never had any issue. We’ve all got something, and in a way I’m lucky because I found out what my something is.

The hours leading up to getting a stent — how you dismissed your symptoms, how you had to be talked into going to the ER, how you kept insisting to the ER staff you were having an allergic reaction — it brings up a larger issue with women’s health. With the laundry list of symptoms that accompany, say, menstruation alone, women get so accustomed to feeling poorly and having to just ignore health issues and work through pain on a regular basis.

Exactly! And some of the other symptoms with heart disease, like lower back pain — women would rarely associate that with a heart problem. And an upset stomach. That could be anything. It’s different for everybody, so unfortunately there’s not a silver bullet or a magic checklist. For me personally, that shortness of breath feeling. I had none of the pain in my left arm like you hear for men. None of those really popular and well-known signs.

With the laundry list of symptoms that accompany menstruation alone, women get so accustomed to having to just ignore health issues…

So with heart disease and the way it manifests, how much do you think relates to how subtle heart attack or cardiac event symptoms can be for women, and how much to how women are accustomed and conditioned to having to just suck it up when it comes to illness?

I don’t know how much of one or the other, but I do know there’s not a woman I know who doesn’t have a pretty high tolerance for all kinds of inconvenient pain and issues for whatever reason, whether they’re trying to take care of their family or their job or whatever. I imagine that is a big driver for why women don’t hit the Pause button and try to figure out what’s going on with themselves. This notion of self-care, I think women struggle with that. We deserve better.

Now I’m so different, though, having had that event. I am so quick to drop everything now and check it out. I’ve not had anything serious since then. But I’ve also learned to get very comfortable with the idea that if it’s nothing, that’s cool. Much better to go to the doctor and find out I was mistaken and it’s nothing, than to not go and to find out I was mistaken and it’s something. I learned the lesson of picking your mistakes wisely.

So with such common heart disease symptoms, how is a woman supposed to tell the difference between warning signs and the usual being-alive issues that happen as a matter of course? How do you balance well-informed caution with outright paranoia?

One thing is knowing your family history, trying to figure out what you might be genetically predisposed to. So if you find out you do have a family history, then you know any of these kinds of symptoms you’ve got to take seriously. Then secondly, it’s being attentive enough to your body, really taking the time to know your body. So that upset stomach that you have? If you can’t attribute it to something you ate, or you don’t have upset stomachs frequently, make a mental note that that’s the first sign. Then that should heighten your vigilance to note any other symptoms. Because it’s usually that combination that would confirm [a diagnosis]. It’s either an extreme version of any one of these [issues] or a combination of them that should set off the red flags.

If you could go back now and talk to yourself back when you were having the cardiac symptoms, what would you tell yourself?

I would’ve taken it a lot more seriously. I really thought I could outrun my genetics just by being careful in all these other ways [like diet and exercise]. I didn’t really understand what that meant, how your body can be wired so that, no matter what you do, certain things might still happen. And I would’ve let someone drive me!

I really thought I could outrun my genetics just by being careful in all these other ways [like diet and exercise].

It can be difficult for people to talk about their health conditions, even among loved ones and friends. Why did you decide to go public the way that you have with yours?

Well, I really didn’t want to. In fact, when they first asked me about it, I thanked them and politely declined. I was in the hospital recovering from the procedure, getting ready to check out, and [the vice president of the hospital] said, “We’ve heard you have a really good attitude. We’re doing this billboard campaign for heart health.”

 

They said, to date, all the photographs and the billboards had been of older, overweight, white males. He said, “We really want to showcase that heart disease can affect anyone. It would be helpful to have a woman, a person of color, someone who looks younger.” And I said no. I was kind of embarrassed. I felt like, I have this thing that’s wrong with me. Why would I want to broadcast it to the world?

So my brother — he knows me pretty well — he said, “What if you get some woman to go get her heart checked out because she sees that poster and says, ‘Wow, that could be me’?” And I thought, He’s right. It’s really not about me. I shouldn’t get all weirded out and embarrassed about my own situation. Maybe it would help somebody else. So I called that guy back and said, “I’ll do it. But I’m embarrassed about this photo shoot idea, and I have this really cute dog, so if I could bring my dog with me…”

Before you became an American Heart Association Go Red for Women spokesperson and ambassador, was public speaking something you were interested in or comfortable with?

I love speaking extemporaneously. In my work I often have to do presentations, so I was very comfortable with the idea of talking. [But] I’m much more nervous about my speaking engagements for the Heart Association than I am about others. With heart disease, I’m knowledgeable about my own situation, but I don’t feel like an expert in a global sense. I try really hard to make it clear to people that I’m not a medical person, and it’s different for everyone.

This notion of self-care, I think women struggle with that. We deserve better.

And I have to say — I started out by not wanting to speak or to let this be known that I have this issue. [But] after my first two presentations, it was so cathartic. It was like therapy for me to be able to talk about it. Every speech I gave, every time I talked about it, I got more and more comfortable. My first perception was that there is something wrong with me, and as time went on, I realized there is absolutely nothing wrong with me. We all have things. The human body works a certain way, and some things work better in some people than others. It’s not something that you can control in and of itself. Once you know about it, you can do your best to shape the way it progresses. By making good choices, I very likely bought myself a lot of time, and, I think, because my body was stronger, I was able to handle the procedure and recover quickly. But that helped me so much, having accepted that role and learning to talk about it with people. It made me feel much more comfortable with my own situation and with trying to help other people not feel embarrassed or shy about their situation.