Okay, I can do this.

Why? by Katherine Steichen Rosing

It's Friday again, and I know I can't hold off any longer. Everyone is gone; there is no one stopping me. I hesitantly draw the blinds and pull out the plastic box with everything I need inside, ready and waiting. Reluctantly I sit down and spread its contents on the table in front of me -- the bottle containing the powdery chunk and the bottle of diluting solution, the vial access pin, the hollow syringe and its pointy needle, a gauze pad, an alcohol swab and a square Band-Aid.

With everything in its designated place on the purple and white placemat, I prepare myself for what I know I have to do, the task before me. I take a deep breath and open the syringe package, laying it back down in its place. Then, I pull back the two plastic tabs on the access pin (the vial perforator), peeling the two sides halfway open like a banana, and pinch the half concealed pin between my right pinky and ring fingers. I remove the clear tip from the syringe body then connect and twist the pin into place, hearing plastic grind against plastic. Uncapped, the syringe sucks in one cc of air and then exhales it into the water after the blue Micro Pin punctures the vial's thick gray rubber stopper.

I measure out some of the bottle's transparent contents and squirt them into the glass container with the white lump in it. I take my time swirling them together into a liquid mixture -- an injectable form -- using a methodic, circular motion. As the snowy chunk melts away inside the glass, I marvel at how two-hundred-and-fifty dollars -- an exorbitant sum for a twenty-three-year-old college mom to shell out all in one shot -- can dissolve so quickly. Once the lump disappears in the water, I begin to draw it up into the body of the syringe, extracting the colorless fluid from the vial.

My chest tightens in nervous anticipation as I watch the empty syringe chamber fill, impregnating itself with liquid as it sucks the mixture from the thick vial between my fingers. The black rubber plunger steadily creeps backwards inside the graduated cylinder. I watch as the fluid swells inside the tube and meets each of the lines marked on the outside of the syringe: one, two, three.

At the eleventh notch, I stop drawing up the mixture. I withdraw the perforator pin and place the container upright on the table beside a coffee-mug stained copy of a Nancy Mairs essay, letting the tiny bubbles slide down the inside of the glass. I replace the red cap, covering the blue Micro Pin. I lay the syringe down long enough to half peel the sterile plastic wrapper from the one-and-one-fourth inch needle, and then I place it between my pinky and ring fingers, twist the pin off, and screw the needle on in its place.

I had just turned nineteen when I had my first symptom, and who would have thought that a little tingle in my left foot would have led to this? At twenty -- with a baby in my belly and an I.V. Heplock in my hand, my life took the scenic route, a five-day detour to the Cleveland Clinic that permanently altered the course of my life. After the doctor and his parole board of interns reviewed the evidence they had gathered during their thorough investigation, a Spinal Tap and an MRI -- compiled with the incriminating symptoms found at the scene -- the verdict of MS was confirmed. The diagnosis was Relapsing-Remitting Multiple Sclerosis, a life sentence of neurological deterioration.

Now, as I stare at the contents of the clear plastic box and try not to think about them, I can't help but wonder which is worse...the ailment or the cure? Grow gimpy gracefully or defy those fine lines and wrinkles inside my head by stabbing myself in the leg? I want to be good and to prove to myself and to the rest of the world that I can do it, but I can't. I know I need it, and needing it makes it easier. But, when I don't need it, when I'm feeling fine and have no symptoms, it's impossible. But that's not entirely accurate, because even when I'm sick I weigh the options and consider the effects of doing it or not doing it, needle or no needle, and often, the scales tip towards not.

Every time I think about injecting the medicine vial with sterile water and doing what I need to do, I have to face the sober reality that MS is a degenerative disease and that there is no medication -- not even Avonex will prevent permanent disability. There is no cure. A grim truth that's only rivaled by the hope that God is in control and nothing will happen unless He wills it. If it happens, it's beyond medical power or human control to stop it anyway.

But I'm not a quitter. I don't want to give up so easily, so I go back to facing the needle. I want to prove to myself and to the rest of the world that I can do it. I can't, but I keep trying. I try to continue injecting myself with Interferon beta 1A because I know that giving up on my shot is giving up on my life.

So, as I hold the full syringe in my hand, I uncap its needle and contemplate the sharp steel shaft that I'm about to plunge into my thigh. I can feel its magnetic power drawing me in, and I already know the tremendous influence it will have on my body -- how it will make the tremors and muscle spasms go away, how it will focus my mind, and make me feel like my old self again. I hate it, but I need it too. It's too hard to go without it. I know I've tried. I've resisted it as long as I can -- but fight it as I might I come back to it. I'm drawn up in this syringe, trapped inside it -- as much as the fluid I inject into myself is. I'm dependent on this needle now, and the more I try to deny my problem, to rebel against it, the more I know I need this one-and-one-fourth inch shaft rammed deep inside me.

With trembling hands, I recap the needle and place it on the laminated placemat neatly positioned in front of me on the table. I squeeze my eyes shut tight and try to prepare myself for what my mind is both resisting and begging for.

Please let it be a good stick. Let me feel the slide.

Leg, please let it go in smooth this time. I beg adamantly as if my leg can somehow choose to go easy on me or to really make it hurt.

In spite of efforts to relax, inside my mind a war is raging. One half of my brain is begging the needle to thrust itself through my skin, bringing relief with it. It's trying to convince me that I would be a great heroine, ending my own suffering, if I did it. The other half is asking, Randi, what the hell are you doing! It's revolting against the pain the needle brings when it severs tissue -- clearing a path for itself to deposit its colorless passenger -- and against the horror of allowing me to indulge in self-mutilation again.

But I know that the struggle in my head is futile. I can't handle the way my body feels without that thin liquid. My head had already begun to throb from the lack of my watery friend. My brain aches as if it is being eaten away, consumed, within the confines of my skull, and I know it is. I can almost feel the plaques, the new lesions, growing inside my head and down my spine as my immune system attacks the neurons in my central nervous system and new symptoms emerge. I've gone without it too long and I know I'm running out of time; I need it and I need it now. My hands are already tingling and my whole body is going numb piece by piece. My muscles convulse uncontrollably more often every day. I know I need that damn needle. I'm constantly cold and the steroid treatments never do enough. Besides, a three-day Sol-u-medrol I.V. means facing another needle, the very thing I've been avoiding. I wish I could resist my body's pleadings for the sharp messenger, who brings the clearness. I want to be brave and to endure the numbness, the illusions and the phantom sensations, the feeling of my body being contorted and gnarled by an unknown goblin in my brain.

I want them all to know -- everyone to know -- but I don't want them to know. I know they wouldn't understand even if they knew what Multiple Sclerosis is like and what I go through. They could never understand and I know. Knowing is understanding, and they could never truly know unless they understood. Even the ones around me don't understand -- my family, my friends, my care partner, my husband, my doctor. Usually, with my family, my disease only becomes a significant factor when it benefits them to acknowledge it. They pretend to know and understand, because I don't look sick. They don't understand how hard it is for me to take my medicine. They don't know what I go through or how I feel. They don't understand what it's like to have Multiple Sclerosis. I know. I understand, and I know that they would never be able to do either unless they had it.

The only way I can conceal my problem -- to keep them from seeing my reality and believing they know and understand it all -- is by trying to continue shooting up, as my sister, Becky, calls it. She jokes about my shot to lighten the situation; to get me to laugh like it's all some game and I'm some flimsy addict who enjoys it, but she's right. I am a junkie. Only my dealer is Dr. Jeffrey Cohen of the Cleveland Clinic's Mellen Center, and Biogen Incorporated supplies him with the Avonex I need to inject every week. They help me mask my MS by giving me the drugs that enable my body to function on a daily basis.

At twenty there was no hiding it. On May 23, 1998, I had an exacerbation that landed me in the Samaritan Hospital Emergency Room. The doctor on duty thought I had had a stroke because the left side of my face was drooping and my right eye rolled like Colombo's. I could scarcely form words or make my lips and tongue function. Hearing was like listening to a headphone set with a short in its wiring. The doctor didn't know why I was having the other symptoms I was having. He had no explanation for why I felt like I was in a freezer from the waist down, why I felt like mosquitoes were biting my legs, or why half my body would lock up and my muscles would spasm for thirty seconds at a time. I was four months pregnant, so there was little he could do. Finally he told me it was absolutely impossible for me to be having numbness and hypersensitivity at the same time, honestly admitted he had no clue and sent me home with a thousand dollar ER bill.

During the time between my visits to the Emergency Room and the Cleveland Clinic, I was a lot like the baby that was swimming around in my womb, helpless. Aside from the sensory difficulties I experienced, the gait and balance problems I had while walking kept the PlaySkool toy slogan, Weebles wobble but they don't fall down, bouncing in my brain. I was a Weeble. I wobbled. Only, I fell down. I had a hard time standing upright, and with having to crawl up and down stairs on my hands and knees, I resembled an inebriated version of Cro-Magnon Man. My lack of muscle control gave me the embarrassing honor of being a twenty-year-old grocery store pants-shitter. That first, red-faced, incontinent moment made it impossible for me to stray too far from bathrooms comfortably again. It was so humiliating, but at least the experience concerned my family physician enough that it motivated him to make an appointment for me at the Mellen Center the next morning, June 9, 1998.

By then I couldn't even pull back the foil tops of desert containers, because my muscles, being the Jell-O they couldn't open, were so weak. Taking a shower was such a strenuous activity that afterwards I would flop down on my bed and take a nap before attempting to get myself dressed, exhausted from the workout. I had to be driven, to be helped everywhere, but it wasn't always easy to get the help I needed. At home, I was just faking it and just trying to get attention. In public, I felt like the circus clown performing for the crowd that had gathered under the Big Top. Everyone noticed. Friends and strangers suddenly wanted to help the gimp, but they didn't know how, assisting in ways that ended up doing more harm than good. People gawked and whispered and pointed, drawn by curiosity to the strange, new attraction. One woman smacked her son for staring at me in Wal-Mart, told him it was rude to point at people like me, and then proceeded to talk about me, the woman slumped over the cart with the funky eye and sagging face -- throughout the store. I know none of them knew. None of them would ever understand.

To avoid drowning in the current of bad memories and conflicting thoughts sloshing back and forth in my head, I get up from the table, temporarily escaping the clutch that the capped needle has on my senses and easing the tension in every muscle of my body. I go and find the remote control to zap the cluttering confusion of Montel and his guests out of my mind. I need to concentrate, to focus.

After I pace back and fourth across the dull carpet a few times, I throw my hands up in frustration and return to the table where the needle and syringe are patiently waiting for me, as if they had calculated all of this and were expecting my return. I sit down in the heavy chair in front of the table and try to relax again, closing my eyes in a meditation centered on the shiny-silver shaft, which had penetrated my thoughts and is eagerly waiting to pierce my skin.

No matter how I try to shut it out, my thoughts keep wandering back to the pain of it all. That pain is a strange thing. I fear it and desire it all at once. During previous injections, I whimpered and jerked back in fear when I felt it, because it came as a shockingly sharp sensation in the top of my thigh. It's like pricking your finger on a glass you shattered in the dark; you know it's coming, but you don't know when or how sharp it will be as your hand boldly ventures forward to pick up the pieces, hoping not to prick it at all. My hand would usually wrench itself away from ground zero, when the agony struck, as if it received a shocking surprise when the realization hit that its own palm and fingers -- closed around the syringe and firmly pressing it down, were the inflictors.

Why can't you just do it in one quick motion -- all in one shot -- without stopping? If you did it fast, you know it wouldn't hurt. There wouldn't be any pain.

I'm aware that I'm supposed to use a quick, dart-like motion, but, deep inside, I know I can't. I'm too afraid. There is the hovering possibility of inflicting a tremendously worse, unknown pain on myself if I push the needle through my skin too fast, losing control. Control. It's all about control for me -- my shot, my needle, my MS. I can't handle losing control. It's the only thing keeping me from losing my sanity, slipping over the edge. I control the pain, and I know where it is at all times. I keep that aching jab trapped between two points where I can always find it. If I did it fast, the pain could sneak up on me unexpectedly, overpowering me at any point.

But, I have to admit, I like the feel of the pain too because it somehow puts me at ease, ensuring that everything is going to be all right -- the agony is the reality of it. It is as if the needle blindly carves a path through my leg seeking this stinging discomfort -- its final destination -- and it's always a comfort to know that I've finally found it. That pain is my only guide, the only indication that everything is fine. It allows me to peer under the layers of meat and see what is happening inside my muscle, where the needle is going. The sharp prick has a calming effect, because once I find it, there are no more surprises. I know it won't hurt like that again; the worst is over.

The whole experience for me is a hot-cool pain, the kind you fear and desire at the same time. It's the kind that thrills you with the shock of its electric touch and makes your muscles tense with anticipation and then relax after its climax. It's the kind of masochistic pleasure that only sick people and junkies -- someone like me -- could understand; it's need, and want, and desire, and fear, and hate all rolled into one rigid, stinging-hot flash of cool, rippling intensity. It's the feeling that makes your hand clench into a rock-hard fist, and then suddenly fall limp, dangle at your side and drop open. For me, the whole thing is a tide of adrenaline rushing through my veins like a hurricane on the ocean, crashing against the shore of my mind and then subsiding.

At once, I open my eyes and seize the fluid-filled syringe from the table. I quickly uncap it, staring down the steely shaft. My chest tightens and I can barely breathe as I swab the top of my thigh with the white alcohol pad, turn the naked needle upside down perpendicular to my leg, and touch the tip of it to my bare flesh. My breath becomes heavy and sporadic as I put enough pressure on the needle to see my skin dimple-in underneath it.

For a few seconds, I stare at the small indentation beneath the sharp rod, and then, with one lung-filling breath that blows a gust of determination into my brain, I begin to press harder. I watch as the needle punctures my skin -- watching but not really seeing -- and it's then that the pain comes into it. My hand retreats slightly as I feel the vicious jab of steel severing skin, penetrating the tough protective barrier of my body. I stop a minute to catch my breath and to let the pang subside. I know it's all down hill from here. It won't hurt like that again; the worst is over. Beyond that pinching pang, the needle begins to slide deeper into my leg, as if someone had grabbed a hold of it and was leading it to a desired point somewhere inside my muscle, like a welcome guest led by an impatient host. My leg swallows all one-and-one-fourth inches of the needle, ingesting every trace of shimmery steel until my skin meets the white bumper between the empty needle and the full syringe.

Once the entire shaft is safely concealed inside the pink meat of my thigh -- below my ivory epidermis -- I sit back and take a deep breath to try to calm my frantic nerves before I go on. At first, I'm afraid to let go -- leaving the syringe unsupported, unsupervised and tightly screwed to the needle underneath it -- but I know I have to. I need to relax, to steady myself, in order to finish. My hands are shaking a little with post-traumatic shock and fear, so I clench and un-clench my fists in the air a few times as I stare at the full syringe standing upright on the surface of my skin, anchored there by the needle buried over an inch below it. The terror-striking thought of bumping the whole contraption that hangs half out of my leg -- along with the mortifying sensation of tearing muscle and skin it would produce flashes through my mind, prompting me to immediately, yet cautiously, restore my grip on the syringe. I slide one hand around the cylinder and position the fingers of the other hand around the end of the plastic plunger that will dispense my relief, my clear fluid elation.

First, I pull back on the plunger, extracting a small bubble of air from the depths of my leg, and then I begin to push the watery substance into my body. I can feel the cool liquid stream spreading inside my muscle, rushing to my knee, where it spills over the edge, down the inside of my leg, and forms a puddle in the bottom of my foot.

When the rubber tip on the plunger reaches the last mark on the syringe and rests below it, the liquid is gone. I squeeze one last time to make sure the chamber is empty, pulling the trigger to make sure I had fired all of the rounds. After I'm certain that the fluid and the air bubble had been completely deposited, I am faced with the final task of removing the needle from my thigh. I place the thumb and index finger of my left hand on each side of the syringe, stretch the skin to make the mouth of the hole open a little wider, and with my right hand swiftly pull the needle out in one straight-upward movement. At that moment, I feel the hostage emotions escape, pouring through the hole in my thigh to freedom.

It's over! Once the needle shaft is out, I quickly press down on the bloodless hole in my skin with the white gauze pad in case a thick blood-bubble decides to surface, with streams behind it pushing their way through the fresh exit I had created in my skin. But no blood comes this time, as it had on a few other occasions. I apply the square tan Band-Aid and gently massage my leg, rubbing round patterns on my thigh to alleviate the lingering shadows of pain.

My shoulders begin to sag as I look up towards the ceiling and breathe in relief, hearing both halves of my brain repeat, She did it! in astounded unison. I relax back in the chair and smooth my left hand over the injection site once again to reassure my distressed muscle. Then, with giddy, post-climactic euphoria setting in, I gather the remains of the clear plastic case -- the glass medicine vial, the access pin, the empty syringe and its attached needle, and the plastic cap -- and deposit them into the red, hard-plastic container. Relieved and elated that the ordeal is over, I pick up the gauze pads and the rest of the debris, putting them in the vacant Avonex coffin and bury them in the trash can with perverse satisfaction. I've relapsed back into my injections. But I exhale and let a smile spread across my lips, knowing it's over. I've endured the pain and frustration of my needle and successfully managed to fight off the attacks of the brain-eating beast that lurks inside me for one more week until it's Friday again, and I know I can't hold off any longer.

Bio: Randi L. Hoover-Espinoza is a 2001 graduate -- holding a Bachelor of Arts degree majoring in English -- of Ashland University in Ashland, Ohio. She is a homemaker and currently resides in Ashland with her husband, Jorge Mauricio Espinoza Quesada, of Costa Rica, and her three-year-old daughter, Jordan Marie.