“Carpal tunnel” What?

“There is nothing wrong with your ulnar nerve.” The neurologist spoke in the soft, mixed British-Asian accent of highly educated students from that part of the world. “It is all median nerve. Carpal tunnel.”

Never mind that distal fourth and fifth digit numbness in both hands cannot possibly be explained by carpal tunnel. If the doctor says carpal tunnel, you get treated for carpal tunnel.

So I went to a new pain doctor, and he gave me an injection in my right wrist for carpal tunnel, which was decidedly less fun than many of my other injections, particularly the part where he digs around with the needle to inject the numbing medication, while telling me to “let him know” when he hit the median nerve. Which he did. Often.

And sure enough, the excruciating burning and pins and needles in that hand disappeared. And sure enough, I still have zero sensation in the tips of my ring and pinky fingers, and slightly above zero in the tips of my other fingers. But I have to admit, this is not going to keep from working the way the loss of tactile sensation and excruciating pain in my hands did. So I suppose I should just shut up and be grateful and get used to it.

And I am. Getting used to it. I am somehow still managing to learn new modes of fine motor coordination without the level of direct feedback I once had. My hands are improving, in surgeries. I am able to adjust retractors to hold them steady in real time by compensating for the slight, uncontrollable movements of my hands. And certainly, that is all the surgeons care about. They just don’t want things to move, and whether I have been holding them for twenty seconds or twenty minutes is of no import to them whatsoever.

I also received a cortisone injection under each shoulder. Unfortunately, the one on the right didn’t work. I have not tried to swim since the last flare-up. But according to the new pain doctor, and tentatively confirmed by my shoulder surgeon (who apparently has a thing for me, but that is a thing for another post), the bursitis that was removed back in January of 2015 is likely reforming in that same area, and the cortisone can’t do anything about that. This new pain doctor, bless his heart, apparently unaware of my previous trip down this road, suggested nerve blocks and nerve ablations.

Anyone who has read Book One is probably a little confused. After all, wasn’t the ultimate goal of that January surgery to remove the part of my shoulder blade that caused the first bursitis so it wouldn’t come back? So why is it back?

To be fair, it isn’t bad, yet. But unless I never want to swim again – and despite four months of physical therapy to engage the “correct” muscles when using my shoulders while swimming – it will continue to worsen. A mere two years and change from the original surgery.

So back into the wilderness I go, that same vast jungle of medical unknown from which I thought I emerged last year. Distal digital numbness? No known cause. Re-emergence of the bursitis? Ditto.

If nothing else, we have been able to clarify swimming as a direct causal factor to the pain and tissue derangement under my right scapula, having first sent me back to the surgeon after swimming in the ocean in August, and then each time following a swim workout since. Troublingly, each time, the pain has rescinded just a little bit less.

But why? I want to know why. What the hell is it that I do when I swim that aggravates that area? I don’t just want to throw treatment after treatment at it, or more random physical therapy (which may have very well exacerbated my carpal tunnel, yay) in which people with enough medical training to help with 99% of pain and weakness associated with anything from athletic to surgical injury are at a complete and total loss to explain why, despite the strengthening of the muscles they have pinpointed, I don’t get any better.

I’ve made significant postural and muscular changes to my upper body. My shoulders are aligned with my spine. The larger and smaller muscles underneath them have taken back the jobs they held before being rudely superseded by my traps. But it doesn’t seem to matter. I get into a pool and start swimming, just a crawl, the same stroke I’ve been performing, more or less the same way, since I was a child, and something goes awry.

And no-one knows what or how. A phalanx of medical professionals has come up totally empty. And even now, as I lean my head back to stretch my neck, I can feel that familiar, saw-blade edge rubbing under my scapula, just like before.

I went through all of this for more than just a reduction in pain, although that was the primary goal. I wanted to swim again. I said it to everyone. And everyone assured me there was “no reason” why I couldn’t get back to it. Time and again. No reason. It undoubtedly would have been more accurate to state, “no reason that I can think of.” Which means there could be many, many reasons, and they just don’t know what they are, and prefer to deliver the supposedly comforting fiction that they therefore must not exist. Which is not comforting, to me, at all.

Oh, I understand the motivation. I play the same games with myself, often forcing myself to deal with uncertainty by dwelling on best-case scenarios instead of worst-case ones, because it doesn’t affect my ability to handle the outcome and why spend time feeling like crap if things are going to be OK?

But not for this. No, no, no. Not my shoulder. I have already denied, confronted, raged against, settled with, and been released from the possibility that I might have permanent pain and disability there. I just don’t have it in me, looking back on the emotional horror of those harrowing two years, to wobble back and forth on that same razor’s edge once more for months on end while game new doctors venture into the wilderness with me to try to figure out what’s going on back there.

The pain persists, both the residual mental fallout and the shoulder itself. I want desperately to comfort myself, to get in the pool, to slip into that quiet, pale blue and let the cyclic motions of my body and breath relax my mind. And I don’t dare. And I feel that deep ache at the pit of my stomach growing with the pain in my shoulder. No-one can help me. That’s what I think. It’s over.

And nothing but trees and darkness, everywhere I look.

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“You know it’s dangerous for someone like you to take opiod medications.”

My head was in my hands as I rocked back and forth in the chair across from the neurologist. “I know, I know…” I moaned, “…but I just can’t keep going like this, I can’t…” The pain this morning had been extremely bad. Tears were threatening to render me unable to speak. I took a deep breath.

“So here’s what we’re going to do,” she continued, writing new prescriptions for much higher doses of my current, non-opiod medications. I had my doubts, but I took them anyway.

“Thank you for fitting me in today,” I said, sincerely, aware that the appointment was now close to over. I had called her office this morning as soon as they turned on the phones, after another hellish early morning wake-up from the relentless burning in my hands, which felt as though they were under a too-hot faucet that wouldn’t stop. An hour before, they had felt as though they were submerged in ice. I could sleep through that. But not the heat. I finally, reluctantly, got out of bed at 4:45, did my morning exercises, made coffee, and waited for the sun to come up. It felt uncomfortably familiar, and a thread of fear wrapped itself around some deep part of my soul.  I resisted the urge to pull it tight.  I pretended that it wasn’t upsetting, how much the dark morning reminded me of when I was still confined to my apartment, writing this blog in predawn hours, in so much pain I could barely even take care of myself.  The kind receptionist had returned my call an hour later to let me know about a cancellation, upon which I pounced.

Now in the exam room in the early afternoon, a cool brightness glowing in from the snow-covered city outside, I looked at the stack of small, pure white, square sheets in my hands.  “So, all these pills – this is just until we figure out where the problem is and treat it, right?”

There was a pause. “Well, I need to tell you,” the neurologist responded, “you’re never going to be completely pain free.”

It wasn’t exactly a surprise. I think I reacted well.  But I discovered that some small part of me had thought, after the second shoulder surgery, that pain free might be an option. That small part of me crumpled right there in her office. Of course I will never be pain free. Of course.

“It’s ok,” I had replied. “I can work with a pain level of 3 or 4. It’s just been getting to 7 or 8 and I can’t compartmentalize it when it’s that bad.”

“Okay. But I just wanted to tell you, there is no treatment that will completely fix this. You’ll always have some pain.”

I nodded to let her know I understood.

And I did. Too well.

But as I walked back out to my car, coat open because I didn’t feel like bothering with the buttons, mostly ignoring the icy wind that whipped through the thin sweater underneath, I realized I had still held out a tiny speck of hope, however pale and fragile, that I would be pain free at some point in the future. The realization that I wouldn’t cut through with a far sharper edge than the wind, leaving bleeding edges on my emotions, already weakened by the lack of sleep. I didn’t want to think it.

I don’t want to think it. The idea that I could be truly well, at some point, eventually, if I just did what the doctors and physical therapists told me, had kept me from slipping into the abyss from which my depression had been tempting me. And the neurologist just snuffed that glimmer out, small candle that it was – as gently as she could, it was true, but it is dark now nonetheless.

It’s what I’ve been begging for, of course, for a doctor to tell me the goddamn truth, for once. But the problem with the truth is that it’s unpredictable, and often unpleasant. Or, in this case, devastating. I will always have pain. I will always take pain medications. My hands will never be as they once were.

I can’t even think about the implications for my work. My blood-drawing accuracy depends on being able to feel veins under the skin. The loss of tactile sensation has meant that I’ve missed every stick I’ve tried in the last week and a half. And now it seems I may not get it back.

I don’t know how I got here. A few months ago this was manageable, an annoyance more than anything. Now it’s frightening, and to some degree, permanent. I want to ask why. I want to scream and rant at a god whose existence I have never been fully convinced of at the top of my lungs. I want to blame someone for this. I want to take it out on them. It’s just too much.

And too little. Pain is invisible. No-one will ever know how bad it is, how hard it is to go about one’s daily business on top of it, to push it aside, to quell the fear that comes with it, to act as though it didn’t exist.

I pause from typing and stretch out my fingers. They look deceptively healthy. Normal sized, and a well-oxygenated, peach-pink color, more red at the tips from the collection of capillaries there. I curl my fingers into my palms and clench them to reassure myself that I still can. Will I get to a point where I can’t? I don’t know. What does partially fixed look like in the current scenario? Will some sensation return along with the lessening of the pain?

The neurologist answered a question I didn’t ask. But there are a dozen others following on its heels. And I may very well not like the answers to any of them, either.

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Last night I did not sleep.

The pins and needles and burning in my hands are now unchanged by any sleeping position I can discover. I tried taking nearly every medication in my night stand – insomnia, nerve pain, muscle relaxant, prescription-level (and now nearly impossible to obtain due to its side effects) anti-inflammatory prescribed in similar doses to horses. Everything except the opiods, which I am often tempted to take just for their mood-altering properties, a road I dare not set out upon. Nothing worked. I tried meditating and could not relax. I tried watching TV and gave up around 3 AM. I laid in my bed, perfectly prone, arms straight down and pitched slightly out in an attempt to keep them as stretched and relaxed as possible. It did not make any difference.

I must have dropped off, finally, fitfully, around 4, and then awoke again at 7:30 and dozed intermittently for another couple of hours before I gave up and got out of bed. And now, my forty-something body, unrecovered from the day of physical labor yesterday, hurts all over, in particular my upper back, the very muscles I have now developed to combat persistent shoulder pain that I thought was an after-effect of my surgery, but which now seems to be due to another cause entirely.

I can’t do this again.

As I lay awake in the dark, that thought was on reel, incessant, useless, over and over in my head, even after the few tears I shed were decommissioned due to exhaustion. I didn’t even have the energy to weep. All I could do was beg the god of my understanding, slumping out of bed to assume a praying posture against it, on my knees, head bent on clasped hands.  Please, please, please help me, please make it better, please make it OK.

I don’t think have another trip down the chronic pain hell-hole left in me. Last night, I received a text from Momma Ape about another surgery to remove one of the implants whose placement resulted in a six week hospitalization that, frankly, nearly killed her. I had thought that this weekend’s post was going to be about my feelings regarding her going back to the same surgeon and hospital for a corrective procedure, an idea I vehemently opposed, to make a grossly inadequate understatement. I was all set and ready to go on one of my card-carrying, this-is-why-people-read-my-shit rants.

And then last night happened.

Before the crisis that spawned this blog in the first place three years ago, I was bigger and stronger than I am now. I’m not unhealthy, and I am strong again, though not as strong as I was despite my pretendings at work to the contrary, and also not as big. I may very well be underweight, a possibility which I am unopposed to intellectually, but which my body image issues override and thereby refuse to entertain, making it a condition that is unlikely to rectified in the foreseeable future.

I also had no idea what was in store for me the last time and oh, what I wouldn’t give for that blissful ignorance now. If the issues with my hands do not rapidly improve, or at the very least, do not get any worse, I am not sure I will be able to work. This past week, we had to help a large mastiff outside following a life-saving, forelimb amputation procedure. The dog weighed upwards of 125 pounds. One nurse lifted the back with a sling, while I slipped a large towel under the front to help the dog get outside to the walking area.

I could not manage my share of the weight. Not because of how heavy she was, although that certainly was a factor, but because I was unable to command the strength required to grip the towel and lift the dog at the same time. My hands would not cooperate. A third nurse guiding the head had to switch places with me.

It was the first time I had been replaced by a non-male nurse due a strength issue since I started working there last year. It was humiliating, and worse, frightening. I could swing a 65 pound animal off an x-ray table, no problem. But I couldn’t lift that same weight via sling because of the loss of tactile capacity and burning, pins-and-needles pain in my hands.

Even in the surgeries yesterday, which, fortunately, only involved managing soft-tissues elevations, I had to watch my own hands as much as the surgeon’s to make sure things weren’t slipping, because sensation in them disappeared seconds after taking hold of the instrument in question. Even while simply standing with the next instrument to be used, or waiting for further guidance from the surgeon, because of the demands of sterility, I was unable to let my arms drop to my sides, the only position in which my hands are even remotely comfortable, because I would have been placing them outside the sterile field.

For one procedure, the surgeon was on the phone with the client for an extended period of time after we had opened the room and scrubbed the patient, and I was forced to remain in sterile pose, hands clasped at my sternum, for over a half an hour before he himself came into the suite, scrubbed and gowned, to begin the mass removals.

Following that same operation, I was asked to hold pressure to a debulking site in the subject’s mouth for close to ten minutes because the area was not amenable to suturing. I lost sensation in my fingers completely long before the ten minutes was up. I placed my left hand over my right so I could relax my fingers without relieving the pressure, which helped a little, but not much.

It was excruciating. And of course, I told no-one. The fragile eco-system that is the veterinary surgery support staff at that hospital demands that each member operate at maximum capacity for virtually ten hours straight, in particular when one or two members are unable to work and call out – likely, now that I think about it, due to the stress entailed in that very situation – and my position, in particular, is extraordinarily specialized. There are only two other nurses who can act as surgical assistants in the OR, one of whom is full-time, like me, and already has a full slate of surgeries of her own each week, and the other of whom is semi-retired and one of the primary caregivers for her grandchildren. If I go down, or even if I can work but not in surgeries, the efficiency of that eco-system will devolve significantly, and may result in my eventual replacement.

As it is, though, even that worry is superseded by the fear entailed in the diagnostics of the upcoming weeks. I have always been the zebra among the horses. I probably get it from Momma Ape, in some strange way. I am concerned, and I think rightly so, that the tests will fail to show a definitive cause for my condition. The the doctor will insist on the treatments that would have accompanied that cause anyway, telling me that sometimes it works even if the diagnostics are inconclusive, but probably doing it because it’s the only thing she knows how to do to fix what may (or may not) be wrong with me. These treatments will run the gamut from unpleasant to excruciating, and what if they don’t work? I will be stuck bouncing around the far reaches of medical science once again, waiting until I stumble upon a practitioner who has seen my condition, and its resistance to common treatment, and knows what to do. If I get that lucky again. Which I am more than a little worried I won’t.

I got lucky with my shoulder. But it wore me down. I don’t know if I have that much strength – or luck – left. Not after last summer with Momma Ape. Not after the previous two years plus of relentless pain and fatigue. No. No. No. Not again. I can’t do this again. I just can’t.

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not so small


“Trace the exact path of your pain for me.”

I sit on a padded exam table facing the neurologist, having passed the slew of tests to determine if the pain and numbness in my hands is due to something in my brain as opposed to my periphery. I trace a path from my ring finger , down the side of my palm to under my wrist and forearm, over my elbow and up my triceps.

“What about the left side?”

“It’s the same, only not as bad.”

“Trace it for me anyway.”

I do.

She writes prescriptions for two new medications. She also wants me to take a nerve conduction test, on both sides. She recommends I pull out some of my leftover opiod pain medication for the procedure. I have learned it is never a good sign when a medical professional suggest you take pain medication prior to a procedure, but it’s not like pain is a new thing. I’d had such a test before to assay for carpal tunnel and it, well, sucked. But this was before my whole pain scale had been shifted up several levels. Perhaps this won’t be as bad.

But that’s a post for another day. This is a post about the remainder of my conversation with her (the neurologist). I pressed her for details. What was she expecting the results of the test to be? Getting an answer for that was like pulling teeth. But getting an answer for my next question; i.e., what are the treatment options for the likely diagnosis, which was some sort of impeded nerves in my arms, was more difficult still.

Still, I pressed on. Jesus, lady, after everything I’ve been through, don’t soft pedal me, I need to know what I’m getting myself into. I was afraid she would say there was no treatment, but instead, she said something worse.


Oh, no, I thought. I’m not going through that s**t again. No, I’m supposed to be better now. I’m supposed to be fixed. I was disabled for over two years. I’ve had chunks of both of my shoulder blades lopped off in order to relieve said disablement. It took a year and a half to get back here, but I’m finally working again. At a physical job that requires full, four-limbed competence, by the way. There is no light duty version of what I do. In fact, if I do have to take off work for an injury, I have to submit a stack of paperwork with a doctor’s signature on it before I’m permitted to work again.

I asked about conservative management, which she was quick, if less certain, to acquiesce to, but the damage had been done. Besides, I know enough to know that if something is preventing the nerves in my arm from conducting signals, the mere fact that it is localized to my periphery all but guarantees a physical, rather than physiological, cause. And even now, as I type this, missing letters because of the numbness in my fingers and having to pound on the keys as though I were punishing them, I know that I am in for another medically challenging, not to mention expensive year.

I just wish I understood. Or I wish I didn’t feel like I needed to understand. Haven’t I learned by now that asking why things happen is a pointless, not to mention demoralizing, exercise? But when I have a moment and I sit down and think about what I will do if I have to have more surgery, I can’t keep that destructive little voice in my head quiet. Why must I perpetually tumble from one crisis to another? When do I just get to live my life? Why does the rug keep getting pulled out from under me?

I nearly lost Momma Ape last year. She rallied, but during and after, and upon returning home, she required 24-hour care, and I suddenly had to be the Momma Ape in our relationship. I wasn’t prepared for it. It was something I knew would happen at some point, of course, but I imagined that some point to be some twenty years away, give or take. I wasn’t ready to stop being my parents’ little ape yet. But Poppa Ape’s inability to be assertive with the hospital nurses and doctors, coupled with Momma Ape’s incapacitation, suddenly demanded that I be the ape who was in charge of doing what needed to be done.

And I hated it.  I don’t want to have to do it again.

I learned from it, too, of course. I learned I could manage such responsibilities, well, if not easily. But I’m still dealing with the pain and resentment of losing my parents as an anchor, of having to become my own. I suppose everyone has to come to that realization, early or late. But I could have used some time to get used to it. Instead, it was followed by a break-up with my significant other, and now, still grieving that loss, still unable to let go, I am facing yet another situation that could divest me of the independence I’ve come by at such a steep price.

I just don’t want to do this. I don’t want any more goddamn tests. I don’t want any more pills. I don’t want any more f***ing surgeries. Please, please, I don’t understand why it’s too much to ask to just go about my daily life, the greatest injustice in it being the fact that I am overworked and underpaid.

I don’t want to have to do this again, have to find people to drive me to and from things, have to beg for lenience from bosses, to have to go back to Momma and Poppa Ape and ask for help with my medical costs again. I had just – quite literally just, as in the last two weeks – paid down all of my financial outstandings except for my car. And just this week, I had to load up my credit cards again for new specialists and prescriptions.

I remember thinking, recently, how little I wanted to go on living if I was to have to do it on the current terms. As true as it was before, it is even more so, now. Why must I stay in this perpetual state of medical and monetary dependence? It’s all I’ve ever known and I hate it, I hate it all the way down to my core, and I just want to prove to myself, even if it’s only for a short period of time, that I don’t have to be dependent upon anyone if I don’t want to be. I don’t understand why I am still denied that opportunity. I don’t understand why this s**t keeps happening to me, and worse, why, if I’m to be forced to deal with it, I have to do it alone, dependent upon others for my physical health, but denied the emotional support of a partner, so I didn’t have to be so goddamn strong about everything all the time.

People will tell you how strong you are like it’s a compliment. Like you wouldn’t trade that strength for an easier ride in an instant. It’s hollow praise, given from a vantage point of surreptitious guilt and relief. I remember hearing it from one of my closest friends during the ordeal with Momma Ape, and from another when I was making arrangements to move out of the domicile I shared with my now former significant other. I don’t know how you can be so strong during all this. I don’t know what I would do.

Please. You’d be the same way. Not because you want to be. Not because that’s how you are. It’s because you don’t have a choice. Survive or fall apart.

I don’t get to do the latter because there’s no-one to pick up the pieces. And so somehow, I have to find a way to get through this next thing, whatever it is, trying and painful as it will undoubtedly be. And to think I had actually made plans for a year from now, assuming I’d still be working full time. I suppose I should have known better than to assume that my medical issues were behind me. I suppose I should be on the lookout to avoid making that mistake again. Not, it seems, that I ever learn.

Apparently, even my own tempered and limited optimism is not so small as to avoid being noticed, and crushed, by the vagaries of fate.

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The pain is still here. It is a different kind of pain, responsible to different nerves, reducible by certain shoulder positions, exacerbated by many more others. It is accompanied by numbness in my fingers and concomitant tingling followed on its heels by a burning so exquisite it requires all of my concentration to ignore. The pain shoots up the underside of my forearm, and chases up my triceps, eventually engaging my shoulder and my neck.

It awakens me in the larger small hours of the morning, the numbness and tingling subservient to a burning toward which none of the phalanx of pain medications prescribed to me over the years can approach. Sometimes I can find a position that lessens it and go back to sleep. Other times I get out of bed and try to find ways to occupy myself until the general unstiffening of my wakeful, upright body allows it to subside.

I am able to work now, unlike before. I work with animals, listening to their hearts and lungs, holding them, restraining them, pulling their conscious and unconscious bodies into awkward positions for radiographs and surgeries and keeping them there in such a way that within seconds, the numbness, tingling, and burning descend like a heavy, indifferent weight that thickens my flesh until I am permitted to allow my and the animal’s limbs to drop.

I have told no-one at work how much of my work causes me pain. It does not matter. I need the work, and the work needs me. Whether I work or not does not change how much pain I am in in the mornings. It does not change whether I wake up in the middle of the night. It does not change my tolerance for certain positions over others, nor does physical therapy or exercise.

Pain medications are largely ineffective. I take muscle relaxants at night which seem to help a little. I take prescription-level anti-inflammatories during the day which help a little, but cause a different pain in my stomach, my digestive system now thoroughly ravaged from a nonstop diet of varying doses and types of pain medications over the last 3+ years.

Complicating matters, I am a high-functioning autistic for whom interpersonal interaction is an energy-sapping practice at which I still constantly fail and self-berate. My ability to layer on pain meds is limited by the amount of anti-anxiety, anti-depressant, and anti-insomnia psychosomatics I require for normal-seeming functioning.

I am never going to be a person who doesn’t need to take medication. And it increasingly seems that I will never be a person who doesn’t have pain.

Momma Ape’s condition continues to appropriate the distinction of being much more severe than mine; after nearly dying this past Summer from complications from invasive, lengthy spine surgery, she has yet to recover her full strength, and postoperative issues persist. I do not lean on her any more. I am single again, and doubt whether I will ever be able to choose an appropriate partner, considering my physiological inability to read people and situations, and so I have no mate to lean on, either. I have friends, I have co-workers, but there is no-one, here, now, who sees me on the inside as well as the outside.

I am alone, staring down a long road of barely tolerable existence brightened only by my work with animals, work I have thrown myself into in order to avoid being alone with my thoughts. I wish I could work all the time, but my physical and emotional limitations won’t allow it. So I have come back here to try to keep the darkness at bay.

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Book One

This marks the end of Book One and the beginning of Book Two.  To read Book One in its entirety from the beginning, click here.

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dare I think


Hey TGA, why haven’t you posted about your pain lately?

Indeed, why haven’t I? It’s not like I don’t still have it. But it’s crossed a line, now, into that previously elusive territory known as “manageable.”

Of course, I’m wary of classifying anything in my life at all as manageable, because very little actually is. I can’t even count the space inside my body in that category, as the last couple of years have so aptly demonstrated. The sum total of stuff I have control over is comprised of the dead surfaces on my meat suit and those contained in my living space, and perhaps my car, and… and nothing. That’s pretty much it.

Well, that’s not entirely true. There is a space that is purported to exist between my ears that I supposedly have some control over. And I do think, with the help of many friends, therapists, and Momma Ape (and TNC and MS Apes, too) that I have learned to get a hold of certain negative thought patterns and processes before they spin out of control. (Sometimes.)

For instance, right now, I’m in the tenuous position of probably being physically well enough to work while mentally uncertain if it’s practical to try to do so. Not to mention that MS Ape and I have been having conversations about life-changing events that may or may not occur between us in the next few months, complicating the issue as to how long I can skate along working from home as a writer supported in part by parental apes because I’m making practically no money at all, as I refuse to enter into a financial partnership with someone without being able to contribute in some way to expenses.

But instead of getting hopelessly entangled in my own crazy via the rantings and ravings of my autistic, anxiety-loving psyche, all that fulminating has yet to exceed the dull roar level. This is in spite of the stepping down of pain medication that I’ve been undergoing at the same time.

Right. Sorry. Back to my pain.

That’s what this blog was started for – pain. Because I was in so goddamn much of it, all the time. I needed to write so that it wouldn’t swallow me up. I go back and read some of the early posts from 2014 and I am horrified at what I went through, and how long I went through it. But now, countless misdiagnoses and mistreatments and then finally two corrective surgeries later, that pain is subsiding. Recently, I stopped taking the extended-release muscle relaxant at night, and while the first few nights of that I barely slept, I’m now often able to sleep unassisted as long as I’m not in too much pain.

I can’t believe I just wrote that. And what do I write next? I wanted to transition this blog into a blog about my autism, but it’s far from the neat, decisive break I had planned on. Instead, I have all of this leftover morass from the pain and suffering I endured, now spread with a thin layer of guilt at having emerged into a space that is, or will be, relatively pain-free.

How do I talk about what a glorious feeling it is to take medication for pain, and have that medication actually work? How do I recount with glee how much I love being able to help MS Ape unload boxes from my car into my storage unit? How do I wax poetic about placing an ice gel on my shoulder and fifteen minutes later, having my shoulder genuinely feel better? How do I do these things without feeling as though I am leaving behind countless others whose pain has not yet been – may never be – relieved?

So many people don’t understand the first thing about chronic pain. They dismiss sufferers as histrionic whiners who just need to suck it up and get over themselves already. And I’m different, not in that I have that pain, but because I know that pain, and through the act of writing this blog, have remained intimate with what the day-to-day is like for someone in that much pain. Right now, I could step sideways, ratchet my own discomfort up a few pain levels, and be right back in that space, perched on an emotional and mental edge, where the slightest disturbance in my environment or routine tips me over into free fall into an abyss with no bottom.

So perhaps what I should be doing now, since I’m no longer in that much pain, is advocating for those who are, stepping into the role of going to bat with doctors, therapists, and insurance companies for others the way I was forced to learn to do for myself. But I don’t know what that looks like, or if my education and autism limitations would allow me to pursue such a route. I have discovered, over these last few weeks, that I need a job that is primarily a telecommuting commitment. It is so exhausting to go out and interact with other apes that if I have a limited supply of energy to do it with, I’d rather spend the fuel on friends as opposed to co-workers.

But I feel like I need to do something. While I can genuinely say that I value the amount of personal growth I’ve experienced as a result of my ordeal, I want it to mean something on a larger scale. It meant so much to me to be able to be helpful to others in chronic pain by giving them this blog, something to relate to, something to think about, or at least something to distract oneself from the hideous, blaring space that pain forces one to occupy. Now divested of the original impetus for writing it, I feel like I’ve lost something important, even if it was something that I prayed feverishly to be quit of.

Where is that something? What is that something? And why do I feel like I “deserve” it? What makes me so special? Because of course I think I’m special. Nearly all apes consider themselves special, I suspect, at certain times in their lives. While my experience is unusual (to say the least), it isn’t unique. What makes me think it’s my job to pick up the flag and carry it to the parade?

Maybe what my job really is is to get over myself and remind myself where my fences are, and how grateful I was to find them, courtesy of what can technically be classified as a birth defect, if a rare (and even more rarely pathological) type of malformation. Maybe I just need to write what I feel, and what I see and read, and how I respond to it, and this blog will never have more than a few followers who may or may not remain interested. And maybe I need to be comfortable that, with being a small voice, ordinary, one among many, not all that special at all.

Dare I think I’d rather have pain than have that? Does that make me an awful person? I don’t know. All I’ve been through, and I suddenly feel like I know less instead of more.

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They don’t match.

That was my first thought as I sat on the edge of MS Ape’s bathroom sink, my back to my reflection, peering into a make-up mirror to compare the barely-knitted slices on my left scapula to the healed versions on my right.

My second thought was to observe how much the companion scars from a year ago had faded. I had hoped for permanent, ugly welts, unmistakeable signs of horrific injury and intervention on display whenever I chose to wear a backless dress. I felt I deserved cringe-inducing symbols of the physical and mental suffering I have endured that I could flash like badges in order to force people to respect and honor my ordeal.

But my skin has always healed quickly–far more quickly than anything underneath it–and last year’s insults have since faded into thin, brownish lines, barely visible from more than a few feet away. While those from a few weeks ago remain bright red, swollen, and slightly bruised, I know that they, too, will assimilate into the surrounding skin on my back by the summer, leaving only the barest hint of the skeletal resections undertaken beneath them.

I have been–still am, truth be told–unaccountably frustrated by the paucity of outward signs of my life’s recent challenges. To all appearances I am a perfectly healthy woman with an easy smile and mellow demeanor, always quick with light-hearted sarcasm about the weather or the sublime joys of city traffic when I find myself in close quarters with a fellow ape.

No-one can see the physical pain that follows my shoulders’ every move, or the complex interplay of whirring mental gears that precedes each line in my seemingly spontaneous small talk. No-one feels the heroic efforts behind my falsified politeness at four o’clock in the afternoon when I am so fatigued I can barely hold my head up and my shoulders hurt so abominably that it is all I can do not to scream out loud. No-one smells my dank, sopping sheets at four o’clock in the morning as I towel myself off, shivering and soaking wet, before rolling over to a dry part of the bed to try to fall asleep again, if I can fall asleep again, if I’m not in too much pain, or too emotionally rattled by the hyper-saturated, drug-induced dream from which I was wrenched.

No-one follows the carefully marked walkways in my mind that enable me to circumvent the many whirlpools of depression that wait to suck me down should I misstep, nor witnesses the water slipping over my head when I get caught in one anyway, because my guard was down when I watched a sappy movie, or heard a song that reminded me of my childhood, or caught a glimpse of a mother gathering her little girl in her arms and wished I was the mother, or better yet, still the daughter, that could run to her mother for comfort whenever she needed it.

I’m broken, I’ve been through hell, and I want other people to bear witness. I want visible, unequivocal proof of my inability to meet expectations of normalcy. But it’s too late for that. I’ve cultivated too much functionality at this point, and I can’t back out without undoing all my progress, unraveling relationships, disengaging from the bare beginnings of career writing work to build a justification for the label disabled that would relieve me of the many obligations into which I am now well and entangled.

There is no halfway between functional and non-functional in this society. One is either capable of being independent or one is completely dependent. You either get full (such as it is) disability support or you get nothing. I don’t get to say that I can work, just not full-time. That I don’t always need a handicapped parking tag, just when I have to carry things to or from the car. That I can use the stairs, I just can’t pull open the door that leads to them. That I can go about most daily living tasks, but only in the early part of the day and only with the assistance of handfuls of medications. I am neither here nor there but somewhere in what might as well be a non-existent gray area; I am the special case, the asterisk, the five-sided peg that fits in neither the round nor square hole.

Just like my scars, neither prominent nor nonexistent, just mediocre evidence of some apparently prosaic surgical procedure; everyone’s had something done by the time they’re in their 40s or 50s and what makes me so different from anyone else? And who wants to be special, anyway, right? How many times have I railed about not being able to fade into the background, to be just another worker among bees?

Except that I can’t; I will never be like the other bees. I will continue to be 3/4 of a human being in every way that counts on paper, with regards to my career and my coping with life, and there is no designated track for that, no box I can check or channel through which I can flow unaided. It was hard enough for me to accept it myself. Now I will have to painstakingly explain it to everyone I plan to interact with in any meaningful way, doctors, employers, friends. Yes, I know I seem fine; yes, I’m flattered that you had no idea I was autistic; yes, I know it doesn’t look like anything is wrong with my shoulders, but…

But, I have these scars, and they run deeper than even I can see; I am still surprised at their ability to penetrate the distant as well as proximate, the mundane as well as portentous. And the internal ones, the ones that resulted from the wounds to my pride, my aspirations, my faith, those are not fading into their surroundings. Those will stay bright red and tender to the touch for a long time yet.

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Last week I was so, so angry. I couldn’t stop thinking about all of the people who have taken advantage of me throughout my life, most of them men, and how my autism made me such an easy mark, and how it seems wildly unfair that so many people were so comfortable with being so unscrupulous, and that few of them will ever have to face that about themselves, or feel sorry for it, or suffer any untoward consequences because of it.

Most children learn not to take people at face value from a relatively young age. My little sister (TNC Ape, who has taken no crap since pretty much forever) was a far better judge of character at the age of 8 than I will ever be. I now know the peculiar make-up of my neuronal connections is what prevented me from developing much skill at discerning when people were not acting with my best interests at heart, and explains why the list of bad actors is ignominiously, maddeningly long, with the latest (I dare not say last) couple of entries having come into my life as recently as the last couple of years.

But anger is hard to sustain, and now that I’ve taken a moment to check my surroundings, I seem to have wandered into the intersection where morose meets hopeless. The normal, healthy response (not that I’m one to preach about that) to becoming aware of such things is to learn from one’s mistakes and move on. Few people ever actually do this. While I happen to have an actual physiological barrier that inhibits my ability to notice when people are taking me for a ride, that doesn’t explain why I continue to be attracted to (if not actively seek out) experiences and relationships that increase the likelihood of  it  happening.

The battery of tests I undertook for autism and learning disabilities screened for other mental disorders as well, and turned up, among other scab-ripping tidbits, a new unflattering feature: apparently, I have a relentlessly negative self-image that I constantly reaffirm by placing myself in challenging or futile situations wherein I have little hope of being successful.

I had no idea that I did that. I suppose some of the blame for this lack of self-knowledge can be laid at the feet of my ASD. In fittingly autistic fashion, my self-awareness exists in two mutually exclusive states: hyper-self-obsession to the exclusion of all other stimuli, or complete dissociation such that I cannot perceive the effect my activities are having on my mind and body. Neither of these lends itself to productive self-reflection.

But autistic or not, no-one likes to engage in the kind of self-reflection that entails confronting the possibility that their preferred company and experiences might be of a pathological nature. By the time one approaches the middle of her life, give or take a decade or two, she would like to think that she’s worked out the kinks and set aside the worst impulses (or at least mitigated them); that her patterns now do little harm and maybe even a bit of good. Once settled in, why would she want to start kicking over rocks again? I mean, dangit, it took a long time to figure all this stuff out. The last thing anyone would want to do is start over, pulling up trees and digging out grass, knocking down that fence over there and putting a new one up over here. That just sounds like so much damned work.

For the last two years, my proverbial yard has needed a lot of uprootings, replantings, and fence relocations. So any time I came across anything that wasn’t actively causing me physical or mental pain, I put it on the shelf of stuff I would look at some other time, in the future, after I got through whatever particular crisis had crashed in front of me that week.

But now, two weeks after this final surgery (I suppose a “so far” belongs in this sentence somewhere; consider it implied), no new flaming pile of wreckage has landed in front of me, nor are there any others forthcoming (see implication above). I have a relationship with a wonderful ape who has patiently allowed a sweet but somewhat obtuse TG Ape to convalesce at his house for going on three weeks with no sign of a loss of interest. I have a circle of incredibly supportive apes willing to help me with anything I need as I recover. I have even managed to find a telecommuting job in my field. It doesn’t pay much, but it’s enough to keep me going while I look for something long term.

I am secure. The dust has cleared. And as such, that poor, overloaded shelf upon which I kept stacking the not-immediately-pressing stuff has promptly peeled of the wall and been evacuated of its contents like a rotted roof beset by two feet of snow.

All of the usual players in my inner growth resistance movement arrived immediately, megaphones in hand. Petulance at having to dig through another difficult mess. Self-pity because of the circumstances that led to its accumulation. And, of course, fear. It’s one thing to be made aware of one’s own self-destructive behaviors. It’s another to know that for whatever reason, one is ill-equipped to avoid the same pitfalls in the future.

How am I supposed to know when I’m setting myself up for failure? How do I know that I won’t find new and creative ways to self-destruct that seem right just because they’re different? Most worrying, how will I know which people to distrust in the future? My record on that is zero to pick-a-big-number. I just can’t tell. If I want something badly enough, forget being able to perceive subtle warning signs. I’m already compromised enough in that department; add a generous helping of single-minded tenacity and what little awareness I do have is easily overwhelmed.

My friends and family have done so much for me already. How do I explain to them that I need what amounts to an adult baby-sitter when it comes to making these kinds of evaluations? Part of me bridles at the idea that I, who have struggled so mightily to learn how to function independently, have to finally face up to the fact that when it comes to certain, basic-human-instinct things, I will always have to rely on other people’s perceptions above my own. Another part of me wishes that I could just sit down and hand it all off to someone else and thereby completely absolve myself of responsibility for my own well-being.

Because what a lot of people don’t know about high-functioning autism is how incredibly tiring it is. I used to run myself into the ground just going about the daily tasks of adult life. By the weekends, I had too little left to even answer my phone. I couldn’t understand why I couldn’t handle a “normal” (allowing for a little flexibility as to the definition thereof) workload. Now I know why, and I’m much stingier about borrowing from the future to keep myself on my feet. This is probably to the good as far as my health is concerned, but the result is a significant reduction in daily productivity.

If I have to manage a doctor’s appointment, a couple of errands, and a load of laundry all in a single day, that will completely tap me out. Likely as not, the laundry won’t make it to the dryer until the following morning. My efforts to compensate for this limited productivity led me to develop all sorts of time- and/or energy-saving workarounds, such as cooking a week’s worth of food every weekend because I will often be too tired to do anything more than operate a microwave by the end of a typical weekday. (Also, there’s a handy ASD trait that allows one to have no problem – even look forward to – eating the same thing every day. Lucky me.)

Now it appears that I have to acquire and assimilate on a whole new set of skills among the thousands of other ones I’ve painstakingly stacked and arranged in such a way as to enable me, at a considerable cost but one I’ve been willing to pay thus far, to go about the business of normal functioning. And I don’t want to. I’m already so exhausted by just doing what I’m doing, and it took years for me to figure out even how to manage this rather low level of independent competency.

And I should add that I remain perniciously frustrated by the fact that there doesn’t appear to be any sort of cosmic balancing or score-keeping going on. I’ve been through so much this last twenty-seven months. When do I get to stop? When do I get to take a break? When will I have learned enough to stop learning for a little while and enjoy the fruits of the painful lessons already suffered?

I suppose the answer is never.

F*ck that damn shelf.

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Despite still being exhausted after the most challenging semester of school of my entire life, which now encompasses a full ten years total of post-secondary education, the day before my second surgery I was buzzing around like a four-year-old on Red Bull, fidgety and angry for no good reason.

I didn’t figure out why until I broke down in front of a small group of friends about it that evening. Someone asked how I felt about going through with another major surgical procedure the following day and I started crying, surprising even myself. “I’m so scared,” I whispered, not realizing it until I formed the words with my lips. “I don’t want to be in that much pain again.”

That’s what defines this entire experience; what has defined my life for going on three years. Pain. Constant, relentless pain, varying only by degree. That degree had been considerably lessened since my last surgery, but it was by no means undetectable. It is still extremely difficult to sit in a chair or ride in a car for more than a half an hour. Even the right shoulder – the one that was repaired last January – still complains mightily at having been denied the opportunity to fully recover before being put back on the roster due to deterioration of the functionality in the left.

Pain, ever the rude interloper, has never left me. It has moved from place to place inside my body. Its severity and influence have been considerably blunted in the last few months. But it’s still here, waiting in the recesses of my physical consciousness, too fond of this house in which it’s made a home to evacuate now. And I can’t help but anthropomorphize it, give it a voice, an ego, drive, a goal.

I feel like it’s just been waiting for me, daring me to embark on yet another attempt to extricate myself from the constant pain and fettered physicality that has saturated every aspect of my life for over two years, so it can open its toothy maw and start screeching again, reveling in laying me low, in pushing streams of anguished tears out my eyes, in making me hate myself and my life and everything around me like it did before.

Pain changes you, but it’s more than that. Pain changes everything. It changes how clothes feel, how foods taste, how lights shine. As it increases it takes the rest of your senses with it, turning up the intensity on every aspect of your environment. Soft becomes scratchy, bright becomes blinding, loud becomes deafening. And there is nowhere to hide, because it’s all coming from inside your body, a relentless fire alarm from which you can’t escape, with no way to shut off the flashing and blaring.

I’m not just scared. I’m terrified.

My last post-surgery experience was a hell through which I wouldn’t send the foulest creature on earth. There was no pain control whatsoever for the first six days. I awoke from surgery feeling as though my shoulder blade was in a wood-chipper that was still going, blades thrashing away at the sinews and remaining bone. I was then loaded down with hydrocodone, which added sickness and dizziness to the excruciating pain without mitigating a shred of it, and sent home. Only after six days of unrelenting torture was I able to convince the surgeon to allow me to take something else. It was another full week before I could consider my pain anything like under control.

And this was hot on the heels of fifteen months of barely relieved pain ex nerve entrapment, which apparently was but a mere training period for dealing with the aftermath of that surgery to scrape out bursitis, slice through muscle and saw off bone in an effort to prevent the nerve from getting caught again.

I know I need to do the second shoulder; have known for months. While it is still another year or so away from becoming debilitating, the scraping of bone on bone has been getting louder and more intrusive with each passing week, and I am less and less able, or willing, to rely on it. I could do the surgery now, six months from now, a year from now, but it is going to have to happen, and it seemed to both me and my physical therapist (or it did a few months ago, anyway) that the less functionality lost prior to the procedure, the better.

But twelve hours away from what will be another two weeks of pain that exceeds the capacity of my [considerable] vocabulary to describe it, I suddenly didn’t want to go. I was curled up in M.S. Ape’s arms last night, huddled in the dark with him in the center of our enormous bed, trying to not to cry, afraid to let him go, to go to sleep, to let night pass through and step aside for the next day. It’s going to be OK, he said, stroking my hair. We’ll get through this. I’ll take care of you.

I know he will, as best he can. But he can’t bear the pain for me, or soothe the resulting distress expressed as snappy, thoughtless aggression from a captive animal. I’m scared, not just of the pain, but of the asshole monster I become when I’m in it. I don’t want to be that ape. I can’t believe I’m willfully signing on to place myself in that position once more, and with an audience, no less. M.S. has never seen me like that, and I don’t want him to.

Momma Ape and Therapist Ape both assure me that it won’t matter, that he will understand. At this point, I have to trust them. I have to trust a lot of other apes, too: my surgeon, the anesthesiology team, the rest of my friends and loved ones. Because I’ve learned that when I’m in that much pain, the one thing I cannot trust is my own inner resources to bear me through, because they aren’t enough.

And that’s what’s different this time. I’m purposely embarking upon a procedure that I know I cannot manage alone, asking others to help me ahead of time, and having to have faith that they will come through for me after the fact. It’s one of the hardest things I’ve ever done. It’s one thing to ask for help once you patently are in need of it. It’s another to ask beforehand, knowing that you are completely reliant upon its delivery afterwards, at which point you will be entirely unable to compensate for the lack if it fails to materialize.

Faith in other people. It’s a bigger hurdle than it should be, I imagine. But here goes anyway.

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