Experts and biases

I wrote a while back about my view of doctors as experts on the health of the body who I trust to investigate it and advise me on it. I’ve been thinking about this lately because I’ve been seeing some doctors about my ankle. I’ve seen a podiatrist after each of my acute injuries, followed by a physical therapist. I quite trust the podiatrist I’ve seen to diagnose acute injuries; he was the one who identified that my original sprain wasn’t a simple ATFL sprain but rather of multiple ligaments and a tendon. But he hasn’t had any ideas as to why I had persistent pain.

In the spring I saw a new podiatrist and another physical therapist. Just lately I’ve seen two orthopods (both primarily surgeons, I believe). I’ve had three x-rays and two MRIs. So I’ve been through a lot of physical exams and imaging findings and discussions about my injuries. One of the things that I’ve been quite disappointed by in the MDs is the lack of interest in the exact nature and pattern of my symptoms. They all ask questions about the history, but they don’t seem interested in precise answers, even though I’ve written up a detailed timeline and can describe the location and quality of the symptoms clearly. They do more or less a standard exam for gross tissue injury in the ankle, look at my films, and declare that there seems to be nothing awry and they aren’t sure why I’m in such pain.

At the last doctor I finally got a reasonable enough explanation of what a diagnostic injection to my ankle joint would do and decided I’d like to have it done. They basically shoot anesthetic into the joint, and then you do things that should hurt. If it helps, the joint may have a problem. If it doesn’t, then it’s probably a soft tissue problem. So they did, and I did, and my foot still hurt, but there was something interestingly different about the quality of the pain. A tenderness that I’m accustomed to was less prominent; the pain was less focused, and less intense, probably about 3/4 as intense.

After the injection I was thinking about what exactly hurt less, and why it might hurt less. I remembered something that my most recent physical therapist mentioned a few times: the cuboid bone. He said that mine was in the wrong place, and he was trying to put it back. The cuboid bone is below the fourth and fifth metatarsals, and abuts the calcaneus (heel bone). So it’s near the main (talar) ankle joint, but not exactly in it. Hmmm. It sounds like something that might have been remitted by a local anesthetic in the joint, but not entirely eliminated by it. I started searching for problems with the cuboid, and sure enough, there’s a thing called cuboid syndrome that almost exactly matches my symptoms.

Holy cripes, people. I might have a thing that there’s a name for! And specific treatment for. And yet, I’ve had it on and off for literally three years, and no one except my PT has ever said the word cuboid to me! I want to call all the doctors I’ve seen and say “Why didn’t you mention this thing?!?!” I can see from the literature that cuboid syndrome is mostly a diagnosis of elimination and it’s not a very well-defined phenomenon, but fuck. What else were we doing with the X-rays and MRIs besides eliminating things and what were we doing with office visits besides discussing my symptoms and their possible explanations?

Technically I haven’t heard back from the newest doctor yet since I reported my results, so I probably should give him a chance to actually come up with this idea. But regardless of whether he does, what I’ve been thinking about is the way that even as a expert in an area, it’s so easy to stay inside the little box of your well-worn standard tests, and not know about, or not think about, other possibilities. I see this happen not infrequently at work, and I know that I also occasionally fall into it myself. The first thought on seeing a thing that is anomalous and isn’t explained by common problems is “That can’t really be possible.”

And a lot of times, especially in tech support, it’s true. It is more likely that someone messed up something subtle in their firewall configuration than that our system (which is otherwise functioning normally) is not functioning correctly just for them. It is more common that you didn’t attach that custom information to your data, or didn’t do so correctly, than that it’s not being processed because of a bug. But it’s also intensely frustrating to be on the other end and deeply know that you must somehow have the information that is needed and just can’t convey it to the person on the other end. It’s a reminder to all experts to be humble, curious, and open; to search for details in the data and entertain new ideas about what might explain them. If you listen carefully, you might get just the information you need to help someone.

What are markets, really?

I just finished a book called Welcome to the Urban Revolution: How Cities Are Changing the WorldIt’s an interesting book; I learned a lot from it, although I don’t agree with everything that he says (he has both a weirdly rosy view of certain cities, and a weirdly pessimistic view of the broader situation). The section of the book that I ultimately found most thought-provoking is part of a short preface to the section about Chicago where he introduces what he thinks a market is. I’m going to quote that five-paragraph section (pp. 254-255) almost in its entirety here because of how much it interested me.

It’s best to be clear about what we mean when we talk about a market. A market can be simply understood as a regular, patterned set of transactions between a group of buyers and sellers, which results in the predictable exchange of some mutually recognized value. That’s how we normally think about markets. This makes markets seem like generic exchange mechanisms but markets are anything but [sic].

The different markets within a city — whether for fish, houses, parking spaces, or engineering contracts — are defined by local and regional customs, laws, conventions, infrastructure, and spatial relationships. Many different forces in the city, not just its buyers and sellers, shape how each market works. In turn, each market determines which business models can thrive in a city. By constraining the types of business models that succeed in a city, a market also shapes the way the city itself develops….At their most mature stage of development, different local markets cluster activities together to create unique efficiencies and synergies in the physical form of a citysystem.

To explore the local character of markets, take the example of housing in a residential neighborhood. Theoretically, the housing market involves a generic product unit, a square foot of living space. The price for that unit is determined by supply, demand, and the cost of its production….But in reality, the nature of the product, its value on the market, and how the transaction is managed are all determined by dozens of local cultural, political, legal, and institutional factors. The cultural or social background of neighbors determines whether a home in this neighborhood secures a premium price. It also determines the allowable activities and income that can be derived from the building, such as whether an owner can operate a home business or rent units. Political and legal factors determine whether and how the building can be expanded on its lot and how much it will cost to do so….Institutional factors determine the availability and cost of finance, or whether owners have to look after their own water and sanitation services. These factors are part and parcel of the residential housing market. They greatly determine its prices and the nature of the building, its ownership structure, liquidity, and sales transactions. These local factors are not separable from the market. They define and govern it as much as the market governs the moments and ways that a city can pursue transformational change. To the extent that a city can shape its markets, it can also shape its own development.

Local markets are also socially regulated, even in free market economies. There are vast differences between the forms that a particular market takes in different cities….Each distinct market uses different buildings, supports different activities, and produces different externalities, such as waste streams and noise. These condition arise from historical compromises between different ethnic and economic groups and from political accommodations to religious, mercantile, labor, and government institutions. Conceiving a market that is void of culture, historical conventions, and institutions is a truly academic or ideological exercise.

To the extent that we manage national economies and multinational companies without reference to the diverse, evolving urban markets on which they stand, we welcome a world of economic surprise.

As with some of the other writing, this gets a bit incoherent in parts, but the basic notion here that even a free market is necessarily governed by its cultural, social, and institutional context is interesting to me. I generally tend to be a bit more of a free marketeer than a lot of people who are otherwise politically similar to me, and I often start my thinking about an economic issue from the basic idea that the cost of something is largely governed by supply and demand. When supply is low, and demand is high (see: Portland real estate right now) the price rises, and interfering in that process (by introducing rent control, for example) may have undesirable results by creating strange economic distortions. Brugmann’s contention, if I understand his argument here, is that a citysystem is necessarily an active participant in creating the conditions of a market, and reacting to them (as Portland City Council is currently being asked to do) is only changing the way that they are influencing them, rather than introducing a previously absent influence, and may be quite desirable from the standpoint of the wider well-being and economic dynamism of the city.

The concept Brugmann is illustrating of course has much wider applicability than Portland’s current housing crisis or even than real estate, but it’s a convenient example of why I was struck by this passage and wanted to pull it out for later, deeper consideration. My current conception of “free market” seems to be lazy and imprecise, and I’d like to think about how revising it would improve my understanding of the economic systems in cities, and especially the role of government, citizens, and culture in driving them.

Short hair, clear self?

Yesterday I decided to buzz my hair. Everyone was getting a haircut, and I’ve always wanted to buzz my hair just to see what it would be like, but I never had because, like Cognitive Behave Yourself, I have a high forehead (and large ears), and in general I have a small head and larger body so I thought it might look strange. But when is a better time than now to find out? So I threw caution to the wind and let my friend buzz it all short.

Before - on the beach

Before – on the beach. Hair was already driving me crazy three weeks out from a cut.

After - at home

After – at home. So short! So easy!

Looking at myself in the mirror last night, I looked sort of like an oddly round-cheeked Vulcan, and sort of like a friend of a friend. I always have an expressive face and the absence of hair exaggerates it. My ears aren’t really that big (I think…).

Mostly, I keep forgetting that I have shorter hair at all, since my normal cut is low-maintenance, so looking in the mirror is surprising (as is attempting to ruffle my hair, something I do when I’m tired or thinking). I learned that my hair doesn’t stand up when it’s short, but just falls down.

I got a lot less reaction at work than I expected; mostly positive. That was nice. Then I was walking home today and I saw some guys coming the other way. I wondered what they might think of me, and realized that I didn’t care. It seemed okay, for a moment, to be myself without any pretense. To be just a regular working person going home to her cat, carrying toilet cleaner in a water bottle pocket in a backpack. Just one different ordinary person among many different ordinary people.

I guess I’ll find out as things go along whether a little doing something that you’ve always been afraid to do because of what people might think may result in greater clarity about how much it matters what people think. I’m still going to grow my hair back out, though.


Aphasic perception

I have these moments sometimes of incomprehension. They feel like what I imagine a hunter-gatherer, or someone from a very different culture, might experience if dropped into the middle of this one; or perhaps more like aphasia in an adult, a sudden inability to decode symbols that once were meaningful. They happen perhaps when I’m depressed, or when I’ve had a few drinks and I’m tired. All of a sudden, nothing makes sense. Why are there roads? How can there be all these plants in tidy organization? Who takes care of them? Why do people live in houses? I have a house? Why do I have a house, surely I can’t possibly need one? How am I allowed to have all these things when other people don’t have them? What is other people’s experience like? How could I possibly know? How can I imagine that I know anything at all? What was I doing at work today, acting like I knew things? Why does it matter what my opinion of anything is?

My thoughts remind me of the kind sometimes reported by people meditating deeply, or otherwise having a profound spiritual experience, except that they lack the sense of connection that those same people report, a sense of everything in the universe being one. It’s possible that this is what is happening, neurologically. The temporal lobes control that sense of oneness; I’m not sure anyone knows exactly what part of the brain controls the belief that your life experience is perfectly normal and your cultural benchmarks have value.

You’d think these episodes would be useful, but they aren’t. Perhaps universal lessons are best served with a side of oneness.

It’s been nailed: the problems with biking in Portland

I haven’t written anything about advocacy in nearly a year, because I stopped having anything very useful to say, and also I nearly stopped riding my bike.

And then I saw that Liz had nailed it, and I felt the need to let everyone know: it has been nailed. She speaketh the truth, and she speaketh it clearly and without venom but with the palpable sense of frustration that I also felt.

I’ve started to see more and more people speaking from the place that I felt I was in a little over a year ago just before I quit advocacy, and if I were still riding my bike I’d want to get those people together so we could figure out what to do next. They’ll probably get together anyway, or already have — I hope so. Liz, Brian, Carl, and Will — if you’re reading this, please go have a beer together, and figure out what kind of advocacy arises from clear seeing of the truth.

My gimpy self will thank you, if I ever get back on the bike.

I am not broken; I choose love

This piece was written originally last year in my private journal, and it’s much more personal about my love life than I usually share publicly, although details that originally referred to specific relationships have been depersonalized to maintain privacy.

I share it in hopes that it helps me continue to center on what I believe and value, and that it helps others understand me, themselves, or someone else.

The question that is always raised for me by weddings: marriage is held up culturally as the end all and be-all. Even if you aren’t getting legally married, the “I choose you and you choose me” partnership is held up in a similar way. Even in polyamory, the “primary partnership” seems to be what most people aspire to.

As I asked myself once several years ago, what if that’s not the road that I personally would be happiest on? I remember walking home one night to my apartment on 19th, thinking, “I suppose I could do that. It seems to be what I want. But what if what I want isn’t the thing that would make me the happiest? Or if there’s a way that I could be equally happy, that’s just different.”

It’s always been the case that some people didn’t marry, and for some it’s most likely that they didn’t or couldn’t find a suitable partner, but for some, it’s almost certainly because they were happier that way. In the end, it doesn’t matter really if you’re happier that way because you’re weird or emotionally immature, or just because you prefer not being partnered.

The idea that we should all aspire to a level of emotional maturity where we regard partnership as the highest and best thing you could do seems weird to me in itself, and boy is that ever in the air at weddings. Sometimes they seem to be all about how the participants have journeyed through independence and arrived at interdependence, had the courage to be vulnerable, et fucking cetera.

Which of course is delightful for them, if that’s what they want; and as I’ve understood from many people I know who’ve married, it is. And I’ve often thought that it’s what I want, and that perhaps it’s only my own emotional development that’s holding me back. But how does one know this? You can certainly assume that if you desire partnership, but don’t have it, that there is something you need to change. Or you could assume that your ideal partner hasn’t come along yet (a notion I’ve certainly entertained as well).

Or you could entertain the novel and culturally odd notion that perhaps you just prefer being single. Which I always find funny when I say it, because of course I’m not “single” in the sense that most people mean. But I do practice solo polyamory — I consider my own needs to be primary to myself. And to be honest I’m content with that right now, and maybe forever. And I simply do not want to believe, nay refuse to believe, that this makes me invalid, immature, selfish, or otherwise a terrible person — simply to want all my romantic and sustaining relationships to be relationships of choice.

I love my current partner, and past partners; my life wouldn’t be complete without those experiences. (Just this morning I was thinking of something a former partner said a long time ago, that sometimes you can love someone best by just loving them, and not telling them anything about that. That’s how I feel about past partners sometimes.) They’ve given me experiences that enrich and deepen my life, that are irreplaceable and precious. And in many ways, the preciousness of what has been given is entirely unrelated to the purported seriousness or depth of the relationship. I’ve had some absolutely wonderful experiences of being loved by long-term partners, and I am so glad I’ve had those experiences.

But I’ve also had absolutely amazing experiences with someone who was closer to a friend, even though we spent most of our time together cuddling on the couch and talking nerdy, and I know we were never in love. I cherished our relationship without having to love him, or want to marry him, or even necessarily have a conventional sexual relationship with him. I would never want to live the rest of my life without romance — that’s surely not me. And I can’t say that I’ll never want a partnership. But I’d like to live, in the meantime, with the peace, contentment, and confidence that come from saying “I’m okay with the way I’ve chosen to live, right now.” Not necessarily “I’m content with the state of my romantic relationships” but “I’m content to choose relationships of choice, and to run my relationships based on ongoing mutual joy.”

I’ve been told this by others when I didn’t want to hear it, and maybe it’s a little ironic that I’ve come around to it myself, much later. But sometimes we hear this when our relationship with someone is not the one we want with them, and therefore hearing it means the relationship is not one of mutual joy, for us, and nothing can turn it into one at that time. So ending those relationships can be the right decision; so can ending other relationships, even though I may sometimes miss the other person. That I miss what they could give is evidence that it was worth a try; that I don’t miss the rest is evidence that it was time to let it go.

I think, in such a modus operandi, one does have to be peculiarly alert for patterns that interrupt joy; that certainly is something that I’ve seen: that choices I made to protect myself from stress also inhibited joy. Those tradeoffs are worth looking at; understanding what makes me cherish relationships, what makes them tick for me, is so much more critical when I have very little in the way of an external standard to judge against. What I owe myself is not a constant assessment of my theoretical deficits in being a “full partner” to someone, but a continuing awareness of what choices make me a better partner to those I love, and what choices on their part make them better partners to me, so that I can ask if they might be willing to make those choices.

Comments are disabled. If you want to discuss this post, please reach out personally.

Experts and empathy

I recently had a chance to interact with the healthcare system in a way other than routine preventive care or straightforward injury, and it was an interesting reminder about how people outside a system may relate to experts. I think of doctors as experts on the health system of my body, people I consult about what I need to do to stay healthy and what the best way to proceed is if I become ill or otherwise in need of care, because they’re educated in that particular system. But part of that consultation process and trust is that I expect them to be able to explain intelligibly what’s going on and why they’re making the recommendations they are.

I recently encountered a doctor who had initially given good care, but who gave me conflicting and unclear information about why he was making a particular recommendation for followup, despite the fact that I had spent time trying to carefully and kindly appreciate the information he did give and his effort made to keep me informed while also articulating my doubts and questions. He also became somewhat defensive and dismissive when I asked for more information, and I became frustrated very quickly. Being dismissed is a huge hot button for me personally, so this behavior poisoned the well very quickly and I ended up asking my regular PCP to weigh in as a second opinion on the best way to proceed.

This was an interesting experience for me, because once I was able to disengage from it a little bit emotionally, I realized that this is a very easy trap for an expert to get into, and it’s not unlike a type of unhelpful thinking I can get into in my role in technical support. When you navigate a system all the time, you know how it works, and it’s easy to be impatient when people don’t know how it works, or don’t understand the obvious-to-you value of your recommendations. But to be most effective in an expert role, you absolutely have to constantly use empathy to understand why the person consulting you wants to know something, and what they want to know, and how to communicate what they need to know in a way that’s going to be effective for them. Any time you neglect that effort, you’re likely to leave someone unsatisfied.

It doesn’t mean that answering their questions perfectly literally is always right, and it also doesn’t mean that answering the same question the same way is always right. Someone else asking this doctor the same question might have been looking for reassurance — I wasn’t. Or they might have been totally satisfied with “I just think it’s a good idea”. I wasn’t. This doctor missed an opportunity to pay attention, and notice what I might need. As experts, we miss these opportunities every day if we’re too wrapped up in ourselves and our competence and our opinions to see what the other person needs. It’s a sobering reminder that the hardest part of being an expert isn’t being an expert (although that’s plenty hard in itself) — it’s using that expertise to help others effectively.

Twitter and context collapse

Returning to a theme I’ve explored previously, I recently encountered two pieces about Twitter and context:

Justine Sacco is good at her job, and how I came to peace with her
Forced context collapse or the right to hide in plain sight

The two pieces explore different aspects of the theme, but both of them are partially about what I’ve previously called notability (see more thoughts on this in part II). Notability makes the likelihood of context collapse — things you do or say in one social context (where you might have many meaning cues) percolating out to others (where you often don’t) — much higher.

Twitter makes content produced by millions of different people both publicly-available (if not publicly-owned) and accessible (there’s that notion of accessibility again). Reporters then pick and choose from that content to create stories. Sometimes they create scandal sensations like Biddle did with Sacco. He was able to do that because he didn’t have any context for what she wrote, and without context, it could be read as being horrible. Almost all of us, from time to time, say things that can be read this way (as the author of the article later found out, when he did it). Sometimes we say them in the safety of a context that doesn’t collapse easily.

Sometimes we forget, and we say them in a medium where context collapses are easy. As Tressie’s piece points out, whether journalists have a legal or moral right to take advantage of this — either to do quality reporting, as I’m sure many of them do, or to create scandals or quick-and-easy thinkpieces or funny articles/listicles (ala Buzzfeed) is a somewhat complex question. One of the things that Tressie’s piece seems to be asking, to me, is whether journalists have the moral right to make someone notable, either at all, or because of something they did or said on Twitter. Do we have the right to hide in plain sight? We have difficulty having good conversations about this because of the slipperiness of the language around it, the issue I tried to address when writing my posts, and an issue that Tressie also raises in her tripartite division of the question: legal authority, moral authority, and economic responsibility.

Notability is an interesting part of that area of inquiry, because journalists often make people notable (although of course a lot of the time they merely write about people who are already notable). But usually in the past, you had some idea that you were about to become notable, because they wrote a story about you or about an issue you were highly involved in, interviewed you or at least asked you to review it…all those things journalists usually do when they do stories about or heavily involving people. Even so, sudden notability in the era of the Internet can have effects people don’t anticipate. But what if you have no idea you’re about to become notable? I wouldn’t be too surprised if my Twitter feed contains things I wouldn’t really want broadcast to the world, in spite of the fact that technically speaking I did broadcast them to the world. The context of people who read my Twitter feed is small (425 accounts right now, according to my widget) and it’s biased toward people I personally know, and who therefore have some idea of what I’m like, and what kinds of things I’m likely to say and think. People who can guess whether I’m being ironic.

To quote Tressie:

I sign up for Twitter assuming the ability to hide in plain sight when my amplification power is roughly equal to a few million other non-descript [sic] content producers. Media amplification changes that assumption and can do so without my express permission.

When I’m unnotable, my content being both publicly-available and easily accessible doesn’t matter. If I suddenly become notable, it does. If I make myself notable or embark on an activity likely to make me notable, that’s one thing — I have the chance to consider the possibility of context collapse before I experience it. If someone else does it for me, using their power they strip me of the chance to consider that it might not be possible anymore for me to hide in plain sight (a description I like for what it means to be unnotable). And not only journalists do this but other private citizens (Gamergate harassment being one of the hugely scary examples of this recently).

What happened here, I think, is that we all (by which I mean, anyone who publishes their thoughts on the Internet such that they’re publicly available) became published authors, at the same time as it became far easier to spread published information (and the two changes are obviously closely intertwined). Any published author has always been at risk of this type of stripping of context since their words can be taken out of their original work and quoted and spread. When becoming an author was a process, becoming notable was a known possible (and maybe often desired) quality of it. Now that it’s not much of a process, most of us just aren’t thinking of the possible consequences when we undertake it.

Even more stickily, it’s frequently legal to republish something published, under the doctrine of fair use, although it depends on what use you’re putting it to exactly. More practically, it’s very difficult to get people to stop doing that once they start, if the content generates a strong social reaction. If someone takes a tweet of mine and publishes it in a related news story, how likely am I to get it taken out? Not freaking very. This story chronicles one photographer’s attempt to get Buzzfeed to compensate him for use of a copyrighted photo. It was a lot of effort, and that’s a case where it’s much clearer that the site needs to get permission (because it’s a full reproduction of a copyrighted piece of content for commercial gain, and because licensing terms on Flickr are more clearly spelled out than they are for tweets).

We don’t have an existing legal right, that I know of, to hide in plain sight unless we consent to fame. I’m not even sure it’s possible to create one, let alone desirable, because the problem here isn’t really legal, it’s social. But considering the possible consequences, maybe we should at least be talking about it.

Some year, huh?

The only statement I can make about 2014 that I suspect most people would agree with is: that was some year, huh?

The best things that happened in 2014 for me were financial and professional:

I got a new job that came with a shit-ton of new fascinating problems to solve, a pretty nice pay jump (plus a second pay bump in December, earned by hard work and leveling up), and a boatload of really awesome coworkers. I definitely love my work and appreciate being well-compensated, but it’s my coworkers that make me, as Lew says, “look forward to my Mondays.” They’re smart, hilarious, and committed to doing great work solving problems with software. I have crazy respect for them as engineers, managers, leaders, and human beings, and they inspire me to do better work and be a better coworker.

And I bought a house. I have more mixed feelings about buying my house than I do about getting my new job, but it was definitely the right decision for me, even if injuring my ankle again the day after moving into it wasn’t the best plan. I’m more relaxed and happier having my own walls, and I’m hoping that I won’t need to move again anytime soon either, after five years in Portland and five different residences. It was great to host my parents for Christmas and have them see how the house fits me, in terms of its size, function, and location — a little outside confirmation that I wasn’t totally crazy to embark on this. Growing into homeownership is more of a process than I realized; there are a lot of responsibilities, and doing them on my own’s a decent-size thing to take on.

The worst areas of my life this year were definitely the physical and, for lack of a better term, spiritual:

My physical health was again torpedoed by my second ankle injury in two years. One thing I have learned by this time is that I’m too apt to let the whole health thing go when one aspect of it is hard — my eating goes to crap, and I don’t try to make up for the lack of foot-based exercise with other exercise. I’m reaching a point in my life where that isn’t a great idea (not that it ever was a fantastic one) because rebounding will take a lot of effort. I’m doing better than I was when I wrote my last post, in large part due to my shift in thinking around pain, but I’m still not 100%.

I also totally ran out of bandwidth for active civic engagement, and that combined with a physical injury that made getting around and therefore socializing hard meant I got somewhat isolated from friends and withdrew from hobbies and efforts that had been defining my view of myself for the last eight years — bicycling and bicycle advocacy being the biggest one. I’ve hardly ridden at all this year, except in short jaunts to my friends’ houses. I haven’t done any public advocacy since February, which was a conscious choice, and I also haven’t done anything really active within the growing movement around racial justice. I’ve been doing some quality reading and thinking about all of it, but I can’t say I’m totally pleased with my choices, or even very at peace with them.

There are a few things that I’ve already decided I want to do in 2015, as a consequence of what 2014 was like. One is regular yoga and meditation practice. Another is more house things. I’m trying to cut myself a little slack as I understand that homeownership is a process, but not too much, because I need to get less intimidated by these things, and just do them. Finally, I want to do more active, adventurous things with friends — the things I stopped doing this year because I was injured, overwhelmed, and busy with mundanities. I think my motto for the year might be ‘centered and capable’.

We’ll see how it goes.

Lost in the mobility maze

A big part of the identity crisis that I’ve been struggling with lately is feeling really uncertain about my physical capabilities. Until two years ago, being physically active was been a hugely important part of how I identified myself and spent my time. Not only are two of my favorite hobbies active (cycling and hiking), but being carfree means being active as a matter of course, something I wrote about just weeks after injuring my left ankle for the first time in July 2012.

At that time I didn’t know I was going to embark on a year-long odyssey to get healed up (something I never wrote about here, although I have an old draft discussing my aggravation/reinjury about a month later). Then a year later I injured myself again, same foot, different piece of soft tissue. Too depressing and irritating for words, really. At first I thought maybe I’d get the normal healing rate this time around, but about two months in I had a flareup, and started the whole mysterious odyssey again. It’s been just under six months now and I’m only starting to feel okay in my daily life again. Predicted recovery times for ankle injuries are six to twelve weeks.

It’s taken me a long time to realize that the hardest part, on a day to day basis, is the self-doubt. Things kept going wrong. First I saw a doctor who didn’t recognize the extent of the sprain, then I overdid it partially as a result of that misdiagnosis and basically had to start from scratch. Then I had a lot of swelling and it seemed to take me longer than expected to heal, and I didn’t get physical therapy. After I did get physical therapy, my therapist was encouraging me to be more active, and then I had a relapse into pain and swelling for no obvious reason (in an MRI taken a couple weeks after the relapse, no tissue injury was found). After more physical therapy, finally I started to feel better and was able to go hiking again. I was stable for only a year, and with some ongoing stiffness (but no activity restriction), before I injured myself again. Thrown back to square one, I tried to do everything right, and I still had a relapse with additional pain and swelling two months in. My doctor and physical therapist both kept encouraging me to try to do more because it was important to build endurance, but the relapses would just come out of nowhere. Any increase in effort, if it didn’t cause a relapse, would cause heat, pain, and often swelling. I could never do as much as they thought I should be able to. And I found it virtually impossible to successfully both do as much as I could (important to increase capacity), and not do more (important to avoid damage or increasing sensitivity). Feet are so involved in everything one does; never overdoing would require a magic portable wheelchair that I could generate out of thin air, or else carrying crutches everywhere all the time, which, are you kidding me?

Because I’ve tried to do everything right, and everything’s gone wrong, I have no confidence now in myself or my leg. The least little twinge could herald a fresh relapse, so I’m hypersensitive to pain and heat buildup, and tend to under-do and over-rely on my other foot and leg, which reinforces the negative pattern of not using the left foot and creates problems in the right foot as well. I’m constantly vigilant, which leads to greater tension, contributing to pain in the foot and exacerbating the chances of relapse or reinjury. And I don’t really know how to break the cycle. I believe I’ve gotten the best advice that my doctor and physical therapist have to give, but they don’t have a clear explanation for my tendency to pain (the doctor says the ligamentous tissue is healed) and they don’t show a lot of understanding of my uncertainty. Not that they’re unsympathetic people, but it’s easy for a practitioner to say “Well, just don’t worry about it! You’re doing fine! Keep trying!” And although I believe that there’s a good chance that some or all of my remaining pain is due to some sort of neural miswiring, overattention, etc. I’m also reluctant to trust myself to purely mental therapy, because it’s not completely clear to me that I’m not doing myself damage, or aggravating some existing damage, when I’m more active.

What I really want is someone who really understands both sides of how I feel. It would also be great if I can find someone who can help me with both empathy and skill. And while I’m asking for things, how about a unicorn and a rainbow too?

Or maybe some internet links! Also this one.