Managing serious, long-term illness is a project management job. Not metaphorically. Literally. It has a backlog, dependencies, a stakeholder coordination problem, a risk register, and regular retrospectives. The only difference from my day job is that I can’t escalate to someone else when things go sideways. I’m the PM, the project, and the business owner, all at once. And when I miss some dependency or requirement, the stakes can be very serious.
The White Queen, in Through the Looking-Glass, tells Alice that she practices believing impossible things. “Why, sometimes I’ve believed as many as six impossible things before breakfast,” she says, as though it’s a perfectly reasonable life skill to cultivate.
I’ve taken a different approach. I don’t believe impossible things before breakfast. I manage them.
I have hypertrophic cardiomyopathy, a structural heart condition that led to open-heart surgery in February 2025, followed by pericarditis, and more recently a stroke. I’m 42, I work full-time as a Jira Architect and Atlassian platform specialist, and I co-host a podcast. Life continues. But underneath all of that is a real and ongoing workload that doesn’t show up on the professional resume: managing the conditions themselves.
Here’s what my actual backlog looks like.
1. Medication tracking: Is any of this even working?
I’m currently managing twelve active prescriptions. Each has a timing requirement, a purpose, and a monitoring protocol. My beta blocker is taken twice daily, and its peak effect window overlaps with my morning gym sessions. The same medication that protects my heart also suppresses my exercise heart rate, so I have to account for that artifact when analyzing my cardio data. My diuretic has a conditional trigger: I take it based on same-day weight gain of two pounds. That’s not “take this pill.” That’s a rule with a parameter and a monitoring dependency.
The job isn’t just taking the right pill at the right time. It’s maintaining a working model of what each one does, why, what it interacts with, and whether it’s actually doing what it’s supposed to. When something changes — a new symptom, an elevated lab value, a medication addition — I’m cross-referencing against the full stack.
And that stack has real interdependencies. Is that feeling AFib, or am I late on my beta blocker? Is that dry mouth from the Lasix, or am I genuinely thirsty? Think of it like package management — twelve dependencies, each pulling in its own requirements, some conflicting, all needing to resolve cleanly or the whole thing breaks. Every one of those prescriptions is doing something important, and the set I have now is working. But understanding why it’s working, and catching it when something shifts — that’s not automatic. That’s the actual management job.
2. Research and analyze test results: before the doctor does
When my doctor orders labs, I don’t wait for a portal notification to tell me everything is fine. I look them up. Last week I walked into my annual visit already knowing my NT-proBNP value, a cardiac stress marker that’s been elevated, and why it might be. I’d tracked my liver enzyme numbers across two draws and had a working theory about why ALT had moved. I asked the right questions because I’d already done the reading.
My doctors are good. They explain everything once they have the chance. This isn’t about distrust. It’s that showing up without having reviewed my own data feels, to me, like showing up to a production incident without having read the logs. Technically someone will walk me through it. But I’d rather already know. The gap between “the doctor will explain it” and “I already understand it” is where my anxiety lives, and pre-reading is the cheapest way I’ve found to close it.
3. Exercise, officially codenamed “Operation: Keep Rodney From Going Back to the ER, Try 2”
I returned to the gym on March 3, 2026, thirty-three days after a stroke. I have a cardiologist-set maximum heart rate, a target Zone 2 range, and a specific treadmill protocol. Nobody handed me a training plan. What managing my health did give me was a habit of tracking trends, questioning why numbers change, and looking past what’s happening to ask why it’s happening. I’m just applying that same energy to the treadmill.
So I review zone splits after every session. I write down how I felt, what incline I used, how many sets. I compare it against the previous week. Am I improving? Are metrics shifting? If so, by how much? The analytical framework came from years of managing a complex medical situation. The gym is just the latest place it turned out to be useful.
The codename is dark humor. It’s also an accurate project scope statement.
4. Daily metric review and adjustment
Every morning, before I do anything else, I check the previous day: heart rate variability against my post-surgical baseline (which doesn’t exist in any textbook because my surgery changed the normal range permanently), blood pressure trend, body battery, sleep quality and architecture, weight. Then I adjust the day accordingly. If HRV is suppressed and body battery is low, I modify what I do at the gym. If sleep was poor, I’m more conservative.
This isn’t a wellness routine. It’s a daily standup with my own body, and the decisions I make have real downstream consequences that compound over time. Skip it enough days and you’re flying blind.
5. Appointment calendar management: across systems that don’t talk to each other
I currently have a cardiologist, a neurologist, a family medicine physician, a psychiatrist, a mental health therapist, and a speech therapist for ongoing aphasia recovery. Some of these providers share a system: my cardiologist, neurologist, speech therapist, and primary care physician are all part of the same health group, so their notes flow between them. The psychiatrist and mental health therapist are completely separate. Think of it as two Jira instances with no integration — work moves fine within each, but cross-instance dependencies don’t resolve themselves. I’m the human API between them. I maintain the map of who knows what, flag when something from one side is relevant to the other, and make sure nothing critical gets lost in the handoff.
That matters more than it sounds. Last week I had an annual visit in the morning and a stress test that afternoon with a different team. Whether those two sides had talked to each other in advance — I had no way to know, and no reason to assume they had. The test didn’t go as planned — they found something minor on the pre-test EKG, and out of an abundance of caution, decided to change some plans in a way that required a reschedule. Because I knew my own case well enough, I understood what they found and why it mattered, and could ask the right questions in the room rather than going home confused. That’s the return on the coordination investment.
6. Appointment preparation: the actual project deliverable
Every significant appointment gets a document. Notable events since the last visit, new diagnoses, active medications with any changes, recent lab values with trend data, current symptoms, questions I want answered, prescriptions that need renewal. I hand it to the provider at the start of the visit and ask them to scan it into my chart.
Think of it like a pre-read for a time-boxed meeting with a busy stakeholder. You don’t walk in and start explaining the background from scratch — you send the document so the time gets spent on decisions, not catch-up. A doctor who’s already scanned my notes before we talk can spend the appointment actually solving problems rather than taking history.
It also forces me to organize my own thinking. Writing it down carefully means I arrive knowing exactly what’s changed, what I’m actually worried about, and what I need answered. Half the time I resolve my own questions just in the process of writing them clearly enough.
Last week, I sent a document that was five pages. For a routine annual wellness visit. I had two questions. Some specialist appointments can have as many as ten.
Since 2024, I’ve been to the ER four times. Two AFib episodes, one chest pain that turned out to be pericarditis, one stroke. Go enough times and you develop a strange relationship with the place. There’s a quiet, specific fear that one day someone on staff will recognize you. Not from the internet. Just from the last visit, or the one before that. That you’ve crossed from “patient” to “regular.” It’s not the most serious thing on the list, but it lives in the background.
That just further complicates an already complex go/no-go decision. I’ve actually been doing better. Better than the months either before or after the surgery. Which, don’t get me wrong, is very good news. But it also means my internal reference point for “this feels serious” was set by some genuinely extreme moments, and a symptom that would trigger action for normal people reads as just a hard day for me. Recovery doesn’t automatically recalibrate that threshold. Deciding to go to the ER is still one of the hardest judgments I make, and it’s something I’ve had to choose four times now. And even after I’ve pulled that alarm and made the decision, part of me is still going “You’re being dumb, this is nothing.”
Knowing when something is serious enough, knowing what it might be, knowing that going is the right call even when you’d rather not: that’s only possible because I know my situation in detail. I know my history. I know what AFib feels like in my chest versus what pericarditis feels like versus what a normal bad day feels like. That knowledge didn’t come from my doctors. It came from paying obsessive attention over a long period of time.
Here’s the part that keeps me up at night, and it’s not about me.
There are people who genuinely don’t know what medications they take. Don’t know what conditions they’re managing. Couldn’t tell you the last time they saw a specialist or what that specialist found. Some of them have a spouse who holds all of that. Some of them just… don’t have a system at all.
For a lot of those people, that’s fine — for now. Health ignorance is a privilege that mostly goes unnoticed until it isn’t. But when the complexity arrives, the people who land in that situation without the skills to manage it, without the instinct to track, to research, to document, to coordinate, don’t get worse care only because their doctors are less attentive. They also get worse outcomes because the system assumes a level of self-management that nobody ever taught them was their responsibility.
I’m not writing this to perform resilience or collect sympathy. I’m writing it because I think there’s something genuinely important being missed in how we talk about chronic illness, which is that managing it seriously is a skilled job, in the professional sense of the word. It requires structured thinking, documentation habits, proactive communication, risk assessment, and the ability to hold multiple parallel workstreams without dropping the critical path.
I happen to specialize in exactly that. I have Confluence and Jira in my bones. I think in dependencies. I build tracking systems by reflex. That background has not been incidental to my recovery. It has been load-bearing.
The uncomfortable question underneath all of this is what happens to people who don’t have those skills. Who navigate the same complexity: the same medication stacks, the same specialist coordination gaps, the same firehose of lab results and appointment notes, without a mental framework for managing it. The healthcare system is not designed to do this for them. It’s designed for episodic care: show up, get treated, go home. The program management of your actual health between those appointments? That’s on you.
Most people don’t know that going in.
The White Queen believed six impossible things before breakfast. I manage them. Most days, that turns out to be enough.
Rodney Nissen is The Jira Guy, an Atlassian architect, sysadmin, and co-host of The Jira Life podcast. He writes about Atlassian, project management, and occasionally about what it’s like when your own life becomes the most complex project you’ve ever managed.
This is Rodney, asking, “Have you updated your Jira Issues today?”
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