At this point I can always tell when a gallbladder attack is coming. They begin with a backache that sometimes lasts days and gradually grows worse, or that comes on rather suddenly and progresses quickly. If I concentrate on the pain I can tell it is radiating from under my right rib cage, all the way across my back and down my right arm. The next stage is stomach pain that feels like the worst sour stomach I've ever had, and then turns into stomach cramping. Next is the band that wraps around my lungs and restricts breathing into shallow and painful panting. Within seconds of that stage the knives have slipped between my right ribs and began stabbing relentlessly, and the backache simultaneously turns into a more localized back spasm. 

At this point, since I know what the hell is going on, I've assumed "The Position" - kneeling somewhere soft with a small trash can hugged to my chest, glass of water and snot catching tissues within arms reach. What happens next can last anywhere from fifteen minutes to several hours, but always includes vomiting every last trace of stomach contents into the handy trash can, sobbing and moaning pathetically, and blowing copious amounts of snot into previously mentioned tissues, - which then join the vomit in the trash to assist with absorbing the mess I've been making. Somewhere inside this stage is where I begin to doubt my decision to not go to the emergency room during attacks, because although I know that all they can do for me is pump me full of pain meds that aren't recommended during pregnancy and then send me home with a bill my insurance won't touch, surely I must actually be dying this time. In case you're wondering; I don't die. Abdominal ultrasounds show no blocked bile duct or sludge, blood tests show no toxic build up that could harm the baby, and white blood cell count is normal; all of that aside, physical pain and exhaustion can spiral me down into thinking that I've had a terrible lapse in judgment and am going to end up endangering myself or my baby. Cue more gross sobbing.

And then... more suddenly than they ever start, the attack ends. The ending is more disorienting than the beginning; I'm suddenly aware that I'm half collapsed on the couch, hugging a vomit filled trash can to my chest with snot dripping down my nose and an ugly cow-like sound half out of my lungs. Suddenly I can breath again, which unfortunately informs my senses that this particular bucket of throw-up contains the strawberry yogurt and the shrimp creole I ate today. The smell is enough to motivate me to sit up and take in my new reality; I can breathe deeply with no pain, my stomach doesn't hurt, my back spasm has released. I can rub my belly and feel baby respond to my touch as if to reassure me all is well. 

I have enough energy to put the trash somewhere the cats won't nock it over, wash my crusty face, blow my nose one last time, and drink that previously mentioned glass of water; at this point I am Dehydrated, as you might have deducted from all the mentions of bodily fluid escaping. 

This particular attack lasted four hours from knife stage to finish. It is three in the morning on the longest night of the year, and I am so tired.

I'm grateful every day that my baby is healthy and unaffected by my gallstones. But I am struggling. After losing over ten pounds in the first trimester, at thirty two weeks I am still three to four pounds under my pre-pregnancy weight. Thankfully I was not thin to begin with, and baby has taken all that is needed from my reserves- measuring perfectly at all appointments. I struggle daily to get enough calories on a fat free, gluten free diet. I pack on the carbs and supplement protein drinks, and struggle to maintain the weight I've managed to reach. My body can handle somewhere between zero to six grams of fat per day, compared to the seventy or so grams that are the daily value on a normal diet. Eating heavy meals, even fat free ones, tend to trigger attacks. The fight isn't just to find food I can eat, it's also trying to convince myself that the benefits outweigh the risks of eating at all. 

Even when I do everything right the next attack is inevitable; it could be tomorrow, or it could stay away for weeks, but it will eventually catch up to me. No matter how much apple cider vinegar or lemon juice I drink, it's coming. 

I am meeting with a recommended surgeon after the holidays to set a time for gallbladder removal soon after I give birth. 

Needless to say, I'll be reaching my deductible and out of pocket maximum within three months of the new year, but I will also have my sweet baby and relief from the worst pain I've ever experienced. 

      I'm not sure why I'm sharing this, but it might be because it's the solstice and the end of the year is coming up. Reflecting on everything, I know I have so many positive things in my life and I'm so happy with where I am. All the gratitude in the world doesn't make the hard days less hard, however.

It's been a really, realllly long night.