Sitting in the bedroom of the house that would eventually become our first home together, Zach took a sharp inhale.

“I have something I need to tell you, I don’t know how you are going to take it. But I need to tell you.”

“Okay,” I said, hesitantly, “Go ahead.”

“I’m bipolar.”

He spat it out with the weight of the thousand bricks he had been carrying since we first started dating.

“I take meds and I’m usually fine, but it’s been an issue before. So I want you to know.”

Without a moment’s hesitation I blurt out, “Oh! That’s okay. Is there anything I should know?”

Zach was taken aback, probably for the first time ever, at how someone could not only effortlessly digest the information, but that I immediately wanted to know how I could help.

Over the next several days, he kept stopping me to say, “I can’t believe how easy it was to tell you. You’re not scared?”

Dwarven art for Annie from Zach with love.

The truth is, in the years since that initial conversation, the acceptance and personal management of Zach’s mental health was never the scary part. Like most young people in love, we gradually shared with each other the story of our lives. I told him about my experiences with sexual assault, my difficulty growing up with a mom who also struggled with mental health, and a family wrought with addiction. He slowly told me more and more tales of his struggle to be diagnosed and the stigma he faced because of the pattern of his illness and the ways it would manifest.

As our relationship grew, it became important that we talked about how we wanted to manage his mental health, and what tools we needed to do that. The healing process is never straight forward. There were good days, bad days, and really bad days. There were medications that stopped working for no apparent reason, sleepless nights in emergency rooms, and many, many tears. We realized quickly that the main obstacle to care was health insurance. At this point, Zach was limiting his hours with Bay 12 Games so that he could make a small living, and maintain access to the scant amount of public health insurance that was available. He was unable to access certain public assistance, because most of the time he seemed, well, totally normal. He would go months and months without episodes, and every time he needed to renew his benefits, he was constantly trying to convince others that he really was sick. It was this insurance that was the only thin lifeline tying him to the rest of reality. The fear of losing coverage was constant, as the costs of medicine, medical appointments, and everything else that came along with managing a chronic illness would have bankrupted us, even with the generous and unwavering support we had from our families.

Eventually, circumstances began to shift. I started working and that allowed us to have the income we needed to buy insurance through the Affordable Care Act, which gave some relief. With the shifting political climate the coverage didn’t change, we just now paid hundreds of dollars a month for it. That enabled the boys to make the switch over to Patreon, which then meant Zach was able to work more and longer on the one thing he had always considered his life’s work: Dwarf Fortress.

After a particularly jarring and sudden mental health incident, we decided that the current plan wasn’t working. We were married at this point, so at an enormous financial cost, we added Zach to my work’s health plan and began the difficult process of finding a doctor that would stick with us while we tried to find better solutions. The long standing psychiatric medication was having physical side effects, and some days, Zach was so tired he slept upwards of 15 hours a day. Yes, he was stable, but this is not the quality of life we wanted for him, or for anyone. Our new doctor not only took our concerns seriously, but she listened to us, never judged us, and, most importantly, she worked diligently with Zach to find a combination of medications that kept him stable, and functional. The light returned to him. And our health insurance helped us get some control over our lives.

“ What’s a wedding without a few trolls?”

So, this is the part where we ride off into the sunset, right? Not quite. Managing Zach’s health remains a daily activity. Recently, we became concerned about a small tumor that had been on the side of his nose for a number of years. After a visit to a specialist, it was determined to be cancer. It was removed, only to grow back within a matter of months. It came back with a vengeance and resulted in Zach having partial reconstructive surgery of his face. It required numerous appointments, surgeries and he will continue to need to be screened for additional cancers for the rest of his life.

We are not unique in this struggle. The rising cost of healthcare for someone with multiple chronic conditions is a real fear for many Americans. We continue to make significant personal sacrifices in order to prioritize his health. We have made more than one major life decision, about employment, education, living arrangements, and our wedding, around these constraints. We are lucky, because we have the resources and support to do this in a way that doesn’t bankrupt us completely. But the fact remains that our life is guided by access to quality healthcare. His life, quite literally, depends on it.