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A Shot in the Dark

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I hate today. Don’t I sound like a child? I guess in some ways I still am. You would think I would be used to this by now, but I don’t think I ever will be. I don’t cry anymore, so I guess that is progress. But I still sulk, so clearly there is room for improvement.

It doesn’t hurt. Okay, it hurts a little. But I can take it. It’s not the physical process of injecting myself that bothers me. I mean, I’m a nurse after all. It’s what the injection represents that I still can’t quite get my head around. And today I am due for another shot.

I take the auto-injector out of the fridge and set it on the kitchen table. I glare at it. It needs to warm up a bit, so I decide to jump in the shower first. Standing under the steady stream of hot water I consider the love-hate relationship I have with my shots. I was diagnosed with rheumatoid arthritis twenty years ago, when I was just barely a teenager. My immune system was attacking and destroying my joints, something I didn’t fully understand at the time, but understand all too well now.

I was given options for aggressive treatment, but I remember the doctors telling me it could impact my fertility down the line. I was only thirteen years old, but I knew even then that I wanted to have children one day, and I flat-out refused to take any medication that would compromise my future ability to have a healthy pregnancy.

I don’t know if that was the right decision for my body, which is now held together with enough screws, mesh and wire to rival the bionic woman, but I know it was the right decision for my family. Today I have three beautiful, healthy children who have brought me more than enough happiness to cancel out the pain my disease has caused me. But two years ago my body reached a breaking point. I had just given birth to my third child and my immune system was in full attack mode. My joints filled with fluid and I was unable to walk, unable to pick up my newborn baby, unable even to change a diaper, as my knees, ankles, wrists and fingers were swollen beyond recognition. I was essentially paralyzed.

I was started on a four-month course of chemotherapy in an attempt to quiet my overactive immune system, but the side effects were harsh and the benefits were minimal. This course of treatment was deemed a failure and I was forced to consider taking things to the next level – i.e. the shots.

The shots are part of a newer class of immunosuppressant drugs called biologics. They are a group of genetically engineered proteins derived from human genes that work by targeting parts of the immune system involved in inflammation.

My response to the shots has been tremendous, and after decades of being limited by swollen joints, I am finally free to run, jump, and play at will. I never imagined that the results could be so dramatic, and I have taken full advantage of this respite, fully aware that no one knows how long it will last.

Biologics are associated with a number of dangerous side effects, including lethal infections and cancer. They have also been shown to quit working abruptly and for no known reason. They carry the FDA’s most severe black box warning label, advising consumers of the serious risks associated with their use. They are a last resort, to be used only when all else has failed, because while they have effectively saved my life in the short term, they may very well kill me tomorrow.

Fifteen minutes later I walk back into the kitchen wrapped in a towel, trailing wet footprints as I go. It’s still there, waiting for me. I plop myself down on a barstool, rip open an alcohol swab and run it up and down my left thigh. I pull the skin on my thigh tight between my thumb and index finger, pop the cap off the auto-injector, and with the click of a button the needle plunges into my leg. I squeeze my eyes together tightly. It burns. Ten seconds later the auto-injector clicks, signaling that it has finished emptying its contents into my body. Mission accomplished. I open my eyes to see my husband staring at me from across the room. He mouths the word “O-U-C-H” in slow motion. I roll my eyes at him, but start to laugh despite myself. I know that this has not been easy on him either, and I appreciate the comedic relief.

I hop down from my stool, toss the spent auto-injector into a red biohazard container, and wonder idly if the miracle drug I have just injected into my body is poison. I quickly push the thought aside, knowing that only time, which is both my best friend and my worst enemy, will tell. I have right now. I have today. And when I really think about it, I am no different from anyone else, the present moment being the only universal guarantee.


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