I rather think it’s predictable where we’ve ended up.
If we won’t listen to warnings –
no, that will warm the planet!
no, that will result in workplace accidents!
no, that will poison a community with biotoxins!
no, you have to put up a sign so people don’t swim with piranhas!
no, brominated vegetable oil is not fit for human consumption!
no, you can’t detain people indefinitely on pretrial charges; then you’ll have a debtor’s prison!
no, we cannot rip kids from their families and keep them in a shithole at the border!
no, you can’t just drain the state and municipal coffers when we have ghettos with no plan for revitalization!
no, you can’t just throw plastic into the oceans ad infinitum!
no, you do have to warn the public of a deadly pandemic on the horizon and protect people and their welfare, rather than doing insider trading to profit from their suffering!
no, you can’t allow price gouging of a fucking Epi pen!
Where exactly the living fuck do we expect to be right now, then, America?
I feel we’ve sorely lost our way. But I also feel out of the loop, as my chronic illness has kept me in a state akin to semi-consciousness. Maybe when I fully wake up, I’ll find some sense has been knocked into some folks. Or even – shudder – some empathy.
It’s funny how people talk about “getting their shit together.” It’s like, does anyone reach that point of, “Hey guys, you know what? My shit is together. There is nothing more to be done here.” But after this year I feel like I’m pretty damn close. I may in fact have my shit together.
I don’t know why this is coming up for me now. My emotions don’t alway process in sync with dates and anniversaries. But maybe it’s the approach of Rosh Hashanah. Maybe I’m hurtling toward a time when last year, I didn’t think I would make it to 2019, and wasn’t sure I wanted to. Maybe my body knows something I don’t.
A year ago I was terrified I would never feel happy or have any quality of life again. My brain was under constant assault. I described it to my dad as “traumatic stress disorder.” There was no “post-“. The worst fate I could imagine at that time was going through another day as bad as the one I’d just had.
In some of my absolute lowest moments, where I could not
function cognitively enough to read a book, listen to a song, or play a computer
game, I somehow managed to come up with the idea of hiring someone to
coordinate my health care. I was scared that answers to my predicament might be
locked inside me, and it would take some serious organization to pull them out.
My dad found someone fitting the specs and now I have a patient navigator working
for me.
Around the same time, a serendipitous discovery resolved my
most distressing symptoms – not enough to work or exercise, but enough to not
feel like I was being tossed in a washing machine at all hours of the day.
Armed now with a few usable hours, I used them carefully, setting about what my
friend Bethany calls “constructing a mental prosthesis.” I used the 7am-8am
window to plan the rest of my day, since my brain could not function enough to
make decisions the rest of the day. That very simple model grew on itself until
I was generating daily to-do lists of upwards of 30 or 40 tasks…and going to
bed with them all done. I started developing a detailed complex of protocols to
make decisions for me throughout the day, with regular engineering to minimize “crashes”
(which were just any time I had to make a decision on the spot, exhausting my reserves).
With a trashed working memory, I made it so the only things
I really needed to remember were: look at to-do list app for what to do. Look
at “Unscheduled Time” protocol if there’s nothing planned in the app. Write any
new ideas or desires in the Notes App – my to-do list app scheduled regular time
for me to look through these. For the first time in my life, I was following up
on every new idea I had, sorting them into lists that I actually utilized. I
was writing regularly. I was listening to new music every day. I was contacting
a different friend or family member every day. My calendar every day was full
of new adventures, albeit often very small ones that accounted for my frequent
inability to comprehend a five-minute video. I learned that doing a very small
thing is better than despairing that you can’t do a large thing.
I stopped getting trapped in wishing for what could be. I
stopped wishing I was someone else and focused on learning to draw out the
gifts I did have. I learned how to break the cycle of decision paralysis,
though I often forget. The point is at least knowing how. I’ve learned lessons
that I won’t soon forget.
I got in touch with all the people who I was scared my life
was too lame for, and made sure everyone knew they were important to me.
I learned to ask for help once I needed help, rather than
asking in a way that let on that I already knew the answer. Among other things,
this led to actually asking writers to look at my work and to co-writing a play
with my aunt.
I realized I could be as proud of the work I put into taking
care of me as I had been of my work as a research assistant in the past. I asked
my patient navigator to give me a co-author credit on the presentation he made
about me for a conference. He said yes. I had, after all, essentially taken my
own history for it, putting something like ten to fifteen hours into that part
alone. All of a sudden, when I was at social gatherings, instead of saying I
had been “working on my health” as usual, I could say I’d co-authored a
scientific presentation. About myself! How cool is that?
I quickly found like-minded and like-bodied patients online
and dove into that community, and was repeatedly overwhelmed by their kindness
and ingenuity. I was surprised and amused by the access I had to prominent
advocates I had admired from a distance. “Remember that filmmaker and that author
I like?” I tell friends. “I talk to them every day now.” In fear and wonder I
started properly nerding out about my medical condition instead of running from
it. I fought self-stigmatization telling me not to identify with a life of
illness, and wondered how people that brought me so much laughter and validation
could be considered a problem.
I set tough boundaries with people around me. I stopped
fearing being too much. I let myself be difficult and a handful sometimes. I
realized that I was still easier company than the people running my country who
made everyone in the world deal with their shortcomings. I stopped lying about
how well I was and letting those lies hurt me and confuse others.
I watched my country and planet start the descent into
fascist mayhem. I despaired over my government’s indifference to migrants and
needed to do something. But unlike in my college years, I didn’t put disproportionate
labor on myself in order to get activists to include me. I accepted that giving
money can be the most strategic and sensible thing, if not the most gratifying.
I got my family relationships in order and taught my immediate
family how to support me with my illness. We started replacing hurt feelings
and resentment with humor, organization, and acceptance of conflict. I
instituted weekly meetings for us to tackle the ins and outs of my medical
care, and it turned out that my care is so much work that this was really
warranted, probably from the beginning. I kept weekly assignment charts, and by
my count we’ve gotten *forty-five assignments* done since our first meeting on
June 14. The medical system is good at creating work for us! So is my body.
I learned that I am not synonymous with my feelings. I learned that objective observation can yield answers if you let go of the outcome you’re attached to. I stumbled upon mind-blowing insights by accident, in a spirit of science. I developed a “spidey sense” and sussed out problems in my medications and environment one by one. I gained my parents’ support as they saw that my suspicions were often correct. I let my body make the rules when medicine didn’t have a clear-cut answer. My body became the boss.
It’s just hitting me how proud I am. At my worst moments in
2018 I remember clinging desperately to a voice I thought I heard from the future
that said, I can’t believe how well it turned out. I’m brought to
my knees. I don’t know why I was spared. I know I can be a bit of a cheeseball
about these things. But I really do make an effort to not exaggerate what
happens to me medically. And I know in my bones that whatever I lived through
last year was unutterably, intolerably bad.
I feel blessed and pinch myself every day and want the world
to know. And yes, I am disabled and I need to bitch about it a lot. Both are
allowed to be true. In fact, I think the latter allows the former to happen.
I came away from hell with the intimate knowledge that the human spirit in me, what makes me me, cannot be destroyed. It is worth protecting and caring for. And it also has its shit together.
Nora Helfand is a writer and former research assistant. If you like this blog, support her on Patreon here and follow her on Twitter at @nhelfand.
On May 2, I was offered some rare hope that a pelvic pain
condition I had struggled with for many years could improve. My doctor put
forward a solid plan for what we would try, with the option of nerve block
injections if more conservative treatment didn’t work.
I felt tremendous relief when she told me this. She took the
condition seriously. She acknowledged that it was a major concern for me. She
knew I had had years of physical therapy with disappointing results. So of
course, I left with more pain than before I came in.
Wait, what? Yes, I believe that offering hope to a patient
in pain can amplify the pain temporarily. It’s pain that one has become
resigned to, and blind to. To exist in a body in pain can cause you to downplay
it after a long enough period of time. Action and struggle have failed to
liberate you, and they only serve to pain your pain, add alarm to alarm.
An unfortunately common camp of pain treatment attempts to pathologize
our very normal reaction to the onset of pain. We are listening to our somatic
alarm system and trying to convey its message, only to be accused by those
claiming to help us of over-focusing on pain and thus perpetuating it. The
accusations are rarely so agitational as I’ve laid out. They come with a
saccharine, compassionate face, making them all the more maddening. “Poor
thing, so stressed,” they muse, veiling the judgment that you’ve somehow
stressed yourself into a medical fiasco. “You’re so much better,” they cheer,
as your tissues move to their satisfaction and you grimace from the pain that
is blacking out your ability to respond.
It is very easy to convince someone that they are at fault
for their situation, even simply by omission. Our evidence-based treatments
have been applied, you’re still in pain; well, what’s wrong with you? Didn’t
you love all that science? Are you being anti-scientific? Get your mind off the
pain and get back to your life.
“But, Nora,” the pain whispers. “I’m still here. I matter.”
In 2013 I allowed myself to be subjected to exercise testing
at the OHSU Human Performance Lab. I had been experiencing widespread pain for
six months and fatigue for longer. I had to run on the treadmill until I
reached maximal effort – a VO2 max – and endorsed that I was too tired to
continue. The doctor and his assistant took a blood sample, hooked me up to
some electrodes and a blood pressure cuff, and stood me on the treadmill with a
spirometer in my mouth. The treadmill was started, and at regular intervals I
was asked to rate my perceived level of effort on a scale from 1 to 10.
I said 1 or 2 at the beginning. The speed and incline
increased, though I don’t think the pace was any more than twelve minutes per
mile. I started to feel uncomfortable. My chest tightened, my muscles burned
and yawned, my face flushed hot. I said a 5 or 6. I felt that I would run
myself into the ground. The doctor asked if I thought I could go long enough to
get just one more reading. I gasped a yes as the room spun. I heard a “Got it!”
and then the machine was stopped.
I felt the weight of the workout crash down on me, and the
stunned doctor’s eyes on me.
“You said a 5 or 6 when the machine was showing us that your
body could not continue any longer,” he said.
I didn’t say anything.
“You are drastically under-perceiving the stress on
your body,” he marveled.
Under-perceiving. I had thought for all this time that I was
over-perceiving. Others seemed able to accept pain and get on with their lives;
why wasn’t I doing that? I guess I was at a 10 and thought I was at a 6. Maybe I
also thought everyone else was at a 10.
Every year following that treadmill testing I would receive
a new diagnosis – postural orthostatic tachycardia syndrome, lichen sclerosus,
vaginismus, adrenal insufficiency, mast cell activation disorder. These were
the diagnoses that came up when I barely complained and hid many concerns from
the doctor, convinced they could not help. What would they have come up with if
I complained a lot? What if I complained in proportion to the problem? Well, I
suppose that would mean complaining all day.
I hope I can find the strength to pain my pain more. Let it
find its voice. This effin’ hurts and it’s okay.