Second thoughts, second opinion

As soon as I agreed to go inpatient at Jefferson Headache for lidocaine infusions, I began to have second thoughts. At first, I just hated the idea of being cooped up for the first week of June. I spend a lot of time outdoors in the summer. I knew I’d feel like a hostage, especially if the weather was nice. But then I started to poke around online and read accounts of this treatment, and my doubts became serious, not just based on personal comfort.

The infusion starts with a picc line inserted in an arm vein that snakes into the heart. I’d be connected to it the whole time, except for 15 minutes a day for a shower.  When I read how high amounts of lidocaine often cause hallucinations, I decided I only wanted to do this if it had a strong chance of reducing my headaches significantly.

Don’t get me wrong—I used to willingly hallucinate often in my 20s and I enjoyed it mightily. But tripping in cemeteries with a band of merry pranksters is a far cry from hallucinating alone in a hospital bed. From conversations with my headache group on Facebook, I started to see this as a treatment of last resort, something you’d consider if you had one constant headache that no medication would eliminate. That’s not the case for me. So I decided to get a second opinion.

I’d cancelled my appointment with Penn Pain Medicine when I went back to Jefferson, so I scheduled a new one. They looked at my MRI and pointed out all the funkiness in my cervical spine that could be causing the pain. They suggested that what I really have is occipital neuralgia, “result of compression or irritation of the occipital nerves due to injury, entrapment of the nerves, or inflammation” (WebMD). I’ve read a lot about this and thought that was probably accurate. My spine docs had been treating the nerves in my neck that communicate with the occipital nerves--why not just treat those nerves directly?

They want to do an occipital nerve block, which would hopefully block the pain in that actual nerve instead of the medial branch nerves in my neck, the way the rhizotomies did. They asked me to collect all my medical records and deliver them this week (if I have them faxed, they go into the Penn system at large and can take forever to get to these docs). I see them again in a few weeks, at which time they’ll will try this nerve block.

Meanwhile, the Jefferson doc had prescribed Cymbalta, which is a SSNI. It works for both depression and pain. It’s not fully in my system, but my headaches have been pretty minimal for the last few weeks. I’ve even had days with no headache at all. But I will say that since school ended, my life has been incredibly low-stress. I just finished a millionth draft of a novel I’ve been working on for many years. I spend time on my beautiful porch, in my backyard, in the woods, and in the kitchen.

I’ve been tracking my headaches, and they’ve been triggered by the following: a too-loud and tinny microphone at a reading at the Free Library, chaotic time with family, weird bright spotlights at Starbucks, and a stimulus overload at my niece’s dance recital. When I’m in my quiet house, I’m almost always pain free.

I’m teaching second summer session starting in July. That will be the real test. I am so done with teaching while in pain. By then I’ll have had the occipital nerve block, the Cymbalta will be in full swing, and the Jefferson doc may have administered the full migraine protocol of 31 shots of Botox all over my head (which the Penn docs want me to get).

May has been a great month overall. I’m very psyched about this book. I have a few people reading it, and then based on their feedback, I’ll do some more revision and then start looking for an agent.

But if I go back to teaching in July and the headaches come back full force, the Jefferson doc says I can go inpatient the week after summer session ends. And I’ll do it, no matter how beautiful the weather. Pain is ruining teaching for me. For more twenty years, my classroom was my happiest place. With a headache, it’s torture.

Inpatient

Today I saw a new doctor at Jefferson Headache, and at the beginning of June, I'm going inpatient for five days.

I'd asked to see the director at Jefferson for a consult, so they gave me an appointment with a fellow (I saw a different fellow there last year--he couldn't help). I thought I'd see the fellow, who would call the director in, who would tell me they still couldn't help me but give me some ideas on where to go next (he wrote the diagnostic criteria on cervicogenic headache).

Instead, I met this doctor, the fellow, who specializes in cervicogenic headache (very rare), and she spent well over an hour with me going through my history and offering treatment ideas. She finally decided that she wanted to bring me in for five days (Jefferson and other major headache clinics do this a lot). I'll get a picc line and meds, including lidocaine, dumped in until something works. I'll also take classes on posture and nutrition, take yoga, see a psychologist and a psychiatrist.

I'm bummed that this is happening in June and not January. The thought of being inside for five days when it's nice outside makes me want to scream. But the thought of more teaching with headaches makes me want to scream more, and I'm on break for May and June, then back in the classroom in July. So it's now or never, or at least not until winter break next year.

The doctor was excited by the challenge of working with me. She has migraines herself. I've never worked with a doctor who has pain (or at least they've never told me). It's of comfort to me. She says Jefferson is always doing trials of new treatment/meds, and if I decide to work with her, I will have access to that. Right now she is a fellow, but they are thinking of hiring her for real as a cervicogenic specialist. She showed me a presentation she gave recently, all kinds of graphics. These headaches are very very complicated (ALL headaches are complicated). The area where mine are generated is such an intense mix of muscle, nerve and blood vessels. She's super into trying to fix it.

I had an appointment lined up with Penn Pain Medicine, but I'm canceling it. I'm going to do inpatient and give this doctor a chance. I'm looking at the hospital as a writing retreat. I can have visitors (except Buddy, which will be hard. I mean really hard). I think if I didn't do this and continued with the headaches, I would always wonder.

The pain has been better in the last few weeks, mostly because of the weather. I think the cold made me tense up, and the grey was grinding me down. Now when I look out any window of my house, all I see is green. I am scratched up and achy from gardening, but that feels good. I'm looking forward to finishing this novel revision in the next few weeks and getting feedback on it. For the next month I plan to lie really low--gardening, writing, hiking, hanging out with my animals. I want time to go by really slowly.

But the headaches are there, every day. I feel crazy when I go over my history with a new doctor because I've tried so many things that haven't worked. It's really been crazy.

Straighten up

I'm not doing well--I'll just say that right off. I had a few great months with a new med combo, but maybe six weeks ago, it stopped being effective, and my headaches are as bad as they've ever been. I have a bunch of treatments etc. to report, but first I want to say that something in me has to change. I am fighting this so hard. I'm in a constant state of obsessive panic, and it's not helping at all.

Turns out chronic pain is its own disease. We get an injury, illness, and if the pain from that doesn't go away in a normal time frame, it becomes chronic, which is a pain signal/nervous problem now, not whatever initially caused it. It's not an emergency, it's not the body signalling disaster, and it's not going away anytime soon (a good friend with a much healthier attitude about her own pain taught me this).

But still, when the meds stopped being so effective, I freaked out. I began to see my seventh physical therapist, who told me that things would get worse before they got better, that I'd given up on PT too soon with the previous six. I've been seeing her for six weeks now. At this point, I hate it. It's not helping. Often it's flaring everything up worse, and I find that humiliating. I've had two super successful experiences with physical therapy, both for sudden conditions (knee and hip). I worked hard and I got better, and the pain was completely gone. That's always been my dream for my headaches, but it's not happening. In addition to lots of neck and mid-back strengthening exercises, I see a vestibular therapist there who treats me for inner ear imbalance (which I do not think is an element in my headaches at all, but whatever). These exercises involve a lot of eye things, laser headlamps on targets etc.

I appreciate the therapists' efforts. I know a patient with chronic pain has to be a huge pain in the ass. At my one-month check-in, I reported no improvement, and my therapist didn't didn't believe me. It's my fault. When I come in in the morning, I walk into the public area where people are doing all kinds of exercises and all the PT's are lined up on their laptops. My PT asks me how I'm doing, and I feel like I have to be cheerful, so I say I'm fine. And in the morning, I usually am. But chances are, the day before was a roller coaster of pain spikes with maybe three hours of relief total. I never talk about that. Physical therapy is such a positive place, and I don't want to be a drag, especially in front of all those people.

But at this one-month meeting, I broke down. I was furious that she was questioning me, and also just so frustrated that a month in, I saw no improvement. She replied that a month was very little time, and I should give it at least another month. So I'm doing it, and I'm hating it.

That prompted another full-court press of new doctors' appointment, as I do every six months or so. At this point, my regular spine doctor just prescribes, and the fancy spine doctor who I saw for my second failed rhyzotomy is out of the picture. He wanted me to come in when school is out and have another rhyzotomy further down my neck. There's no way in hell I'm doing that. I've come to believe that those procedures have ultimately left me in more pain, and it's sharper and more intense.

New neurologist has switched up my meds, and has me in three times for steroid infusions to lessen the inflammation around my neck joints. I did the first one Thursday (two hour IV), and that night took my first dose of Baclofen (a stronger muscle relaxer). Monday morning I had the worse stomach sickness that I can ever remember ( I very rarely get sick to my stomach). It's the first time ever that I've called out sick for anything headache-related, but I literally could not stop throwing up. The neurologist's office was closed for Good Friday, so my primary care doc called in an anti nausea, which saved me. He thinks it might have just been a stomach bug, but I've read that Baclofen can cause intense nausea So I'll call the neurologist Monday and try to figure out what happened, but I'm in no hurry to repeat either the IV or the Baclofen.

She did swap out my arthritis med meloxicam for Indocin, a stronger NSAID. There are certain headaches for which Indocin is the only cure, and it's weird that no one's ever tried it on me before. It's actually helping a good bit. It's not taking all the pain away, but it's lessened.

I also saw a rheumatologist last week to see if any of the is Lyme damage/increasingly degenerative arthritis. I liked her a lot. She said a major piece of this is that I have bad forward-neck posture and I have to fix it. So I've been trying to keep my head back, particularly in class. It helps if I lean against the wall. When I'm walking, I try to thrust my chest up, which makes me feel like some boastful, busty high school girl. She ordered a ton of blood work, and I see her in two months.

But the main thing I want to do is get my head on straight. I'm waiting on a referral for a cognitive behavioral therapist specializing in chronic pain. I just don't know how to manage this mentally. I'm doing a horrible job, in fact. I am alternately furious and filled with self-pity. I am completely self-absorbed, and veer on the brink of real depression much of the time. This isn't going to work for the long haul. I try to be objective about how fucking great my life is: fulfilling career, great marriage, sweet house, great family, darling dog etc. But when the pain's bad, it's all I can see. Much of the time I feel like my life is collapsing into itself, a sandy sinkhole.

Then there's this guy I've been reading, John Sarno. His theory is that chronic, untreatable pain is actually psychosomatic, the mind's way of distracting us from a great amount of anger or anxiety that we don't want to look at. The mind creates muscle tension, which results in this awful pain. He goes through all sorts of physical conditions, including bone spurs impinging nerves like I have, and points out that many people have these same conditions and don't have pain. The conditions are unremarkable. My spine doc always told me that back/neck pain was like that--some people with a ton of arthritis have no pain, while others with just a little have lots. I'm open minded to Sarno. Supposedly, when you "get" that this is true for you, the pain just disappears. 20/20 did an episode on it years ago. I've been paging around one of his books, but there are actual writing tasks I am supposed to do to get to the heart of it. And it's not like you have to actually get rid of the anger or anxiety. You just have to get clued in to the fact that your body is tricking you. I'm actually of two minds about this: when I do start CBT, I want to check this out. But it's also kind of insulting, like my pain isn't real, and I'm kind of a nut. Truthfully, I've never been that kind of person, feeling sick when I don't want to do something etc.

But I'm no longer the person I was. I think sometimes I idealize that person as super cheerful and always energetic, and maybe I was much of the time, but I'm not any more. I don't like who I've become at all.

Pain-free is so lovely.

The latest rhyzotomies are  a failure (it’s been seven weeks--can you freaking believe they didn't work??!!). The post-burn stabbing pain nerve freak out is still happening, although in the last ten days, I think I’ve found a way to control it.

A few weeks ago, my doctor suggested I try a med called Neurontin. It’s an anti-seizure that’s also used for nerve pain. I actually had a huge bottle of it that my last doctor prescribed, but I’d never tried it because of anecdotal reports of major weight gain.

But since the rhyzotmies, I’ve been in pretty significant pain. Prednisone didn’t help, and neither did cortisone shots in my head and neck. Zanaflex wasn’t doing much, and Percocet might as well have been Sweetarts. I was so frustrated and also freaking out as I moved into the end of the semester and finals and a massive grading load.

So I finally tried Neurontin. It worked right way. I still have to take the preventative regiment of Zanaflex and Mobic (an arthritis med I’ve taken since this all started). About once a day, a big nerve pain spike breaks through and I take a Vicodin to get it down. I’m hoping as the rhyzotomied nerves settle, I won’t have to take that anymore.

The last ten days have been amazing. I’ve been more social than I’ve been in a year. I have been in a great mood. I have felt more optimistic about pretty much everything in my life, which is a testament to how shitty pain really is.

I talked to my doctor a few days ago, and he’s happy with this med combo. He still thinks the rhyzotomies might work (hilarious). He wants me to call again in a few weeks and check in. If I’m still in pain, he’ll start test-blocking more levels, and try more rhyzotomies.

Except I think I’m done with that. I just can’t handle it. I’ve done a lot of thinking and reckoning in the last few weeks, and I finally get that this is just the way things are. I’m always going to have these headaches. There is no magic fix. I have to learn to live with chronic pain. Doctors like the ones I've had are fix-it guys, not pain management guys. So I might have to find someone new.

It's actually been a relief to come to terms with this. My life is no longer on hold. I get to lift up the pause and go back to how things used to be and figure out what still works. The last week of social activity was part of that—I just can’t isolate anymore. I have to see people. I have to go to parties. I have to maintain the very awesome friendships I’ve been lucky enough to develop over the years, because they just don’t stay alive by magic.

So I think this means meds for life. This is the hardest thing to handle. Right now I take a f%^*-ton of pills—a Mobic in the morning, five Neurontin three times a day, one Zanafex every four hours, and the aforementioned narcotic when the pain jacks up in spite of this.  I have a pillbox in my purse. I sometimes have to take a pill in the middle of class (Zanaflex is a demanding mistress—if I am 15 minutes late, the pain comes on, and it’s impossible to get rid of. So I’ve taken to setting a freaking alarm on my phone so I stay on top of it).

I never thought this would be my life, but when I think about what so many other people go through, including headache sufferers who can’t even find meds that work, I’m pretty lucky. So far the meds don’t have side effects, just some cotton mouth with the Zanaflex, but that’s it. Zanaflex is interesting, because when I first started it three years ago, it just knocked me out. An hour after I took it, I’d have to take a nap. But now I rarely feel any sedation at all, and I take many times that original dose. I’ve researched these meds a lot, and that’s how Zanaflex works.

Sucky McSuck

This pain is bad. Not all the time, but at least some part of the day. It's been nearly six weeks since the rhyzotomy, and I'm in lousy shape. I'm back to my round-the-clock Zanaflex and since I've run out of Percocet, I take Vicodin several times a day. This really sucks.

I had a decent Thanksgiving weekend, although the headache was always just around the corner, and six loud and rambunctious nieces and nephews meant I was cranky Aunt Juju, not a role I enjoy playing. I was pretty good at school this morning until around noon, and then the pain just settled in and got to excruciating points several times.

I don't think the rhyzotomy is going to work. When I don't have the stabbing pain, I have my regular old headaches. I can't fucking believe this. TWICE this year I had this stupid procedure, when meant a total of twelve weeks of intense nerve inflammation, and just regular shitty headaches the rest of the time. I am so over it. I don't deserve this. I do everything I'm supposed to do in life. I know that no one with health problems deserves them, but this just feels like punishment. I am so angry.

My new doctor said that if this doesn't work, he'll test-block more medial branch nerves and keep going. I just can't see it. Each nerve block is another day I have to get covered from school, and then if any of them work, another rhyzotomy means another six weeks of hell. But what else am I supposed to do? Three solid years of trying everything under the sun has been for naught. I really feel horrible, about all of this.

I have this med called Neurontin. My spine doc prescribed it to me, and my new doc suggested it. I've hesitated because it can cause major, rapid weight gain. Officially, this only happens in 3% of those who take it. But anecdotally, in my Facebook headache group, many people say they gained a lot of weight, like 60 pounds.

I want my life back. In some ways, it feels like it's over.

I just want someone to FIX ME. I want it to be a physical therapist, where I do a ton of hard exercises and whatever bulging discs, pinched nerves, bone spurs, whatever get pushed all back in their right places and this pain goes away. But I've been to at least five physical therapists, plus a bunch of other body work people, and nothing's helped.

Sorry I'm such a bummer. Sorry I don't have success to report.

Grim

It’s been almost a month since the rhyzotomy and I’m still in severe pain from the procedure itself. In attempts to quell the nerve inflammation, I’ve taken a course of prednisone, and a week later, my doctor shot cortisone into the nerve at the back of my head. Neither helped at all. Percocet doesn’t work anymore, and Zanaflex doesn’t either. Right now, it’s just me and the pain. It’s not the headache. In fact, it makes me miss the headache. This pain is vile. It’s sharp and stabbing, and it’s located exactly where this needle hits in this picture. Then it radiates over my head to behind my eye.

The past weekend was grim. My husband worked and I was alone, trying to grade papers, icing my head, and taking pain medication that did nothing. I got very, very depressed. I felt incredibly lonely, but didn’t want to talk to anyone. Pain absolutely warps my thinking. I got a little crazy and very twisted, feeling like I caused this. I felt guilty, dirty. I thought about how people must think I’m making this up. I wished someone would call me and ask me how I’m doing, but then I didn’t want to talk to anyone. I felt like I made this up. I felt like my subconscious mind wants an out, for everything, and this pain does the trick. I felt like there is no turning back from this. I miss my life. Pain has taken over everything. I am really, really angry.

I had pretty serious depression through my teens and twenties. It was a burden I was never unaware of. It kept me apart from other people. It made me want to sleep a lot. It made me do a lot of drugs, some of which actually worked for a time. It ruled my decisions and my choices in friends, boyfriends, jobs. I became a thrill-seeker of sorts because that would bring me out of the depression, temporarily. Being depressed sucked. Everything was flat and monotone, and it got to where I couldn’t take pleasure from anything. So when I finally went on medication when I was 27, it was amazing. The loss of the burden was palpable. I felt buoyant. I felt free.

I’ve been on antidepressants for 23 years now. I do many other things to stay undepressed. I see an amazing therapist. I worked hard to find a career that would be meaningful to me. I make sure I have a decent social life and time in the woods so that my life feels balanced. Periodically I think I might not need medication anymore, so I go off it for a year or so, and then the symptoms creep back, now in the form of anxiety as I get older, and back on I go. I am very successful at staying out of depression. I am proud of that.

Except this is exactly like depression. Same ball and chain. Same isolation. Same hopelessness. Same loss of pleasure. I really resent it.

I’m in two Facebook groups for people with headaches. I’m also in an aspiring novelists’ group. Both are similar in that everyone has a specific goal and is doing whatever he or she can to achieve it. The thing is, most members of both groups are not succeeding, not the vast majority. The headache sufferers are in pain, and the novelists are unpublished. It can seem pathetic sometimes, these hundreds of people looking for the right medication or the right agent, the right physical therapy or the right small press, and never getting it.

And there’s me with my three unpublished novels and my three years of headaches. I’m just like everybody else. I keep pushing, getting treatments and sending query letters, and I keep not succeeding.

At some point I may have to accept that I’ll never publish a novel. Not publishing is the norm; publishing is rare. So is curing a headache, especially one like mine.

Today was a shitty day. For three years I’ve found a way to still be decent in the classroom (mostly by using small amounts of Zanaflex). This new pain has pushed me over a line where teaching is misery. I stand in front of the room and I feel like I have a knife sticking out of the back of my head. Today my very engaging morning class helped push it to the side a bit, but my afternoon classes are impossible because by then the pain has really kicked in for the day. I have hundreds of papers to grade before the end of the semester, and three more weeks of class. I can't even think clearly. I adore my students, and I they know a bit about what’s going on (especially since I had to get subs when I was getting the tests and the rhyzotomy). They are so sweet, but it's just awful. We're working on their toughest essays of the semester, and I need to be on my game, but I'm absolutely clawing my way through.

Then I went to a meeting after class. I’ve cut way back on meetings lately, but this was important. I sat in the back near the door. My eyes watered because the pain was searing. I stayed for the whole thing and talked a bit afterward. On the way home, I thought about what it would mean to live with this.

I have absolutely thought of suicide since this started. I won’t do it because of the people and animals that I love, but it’s there as an idea, an escape hatch. I am so angry that this is happening. I was so angry when I was depressed. I didn’t ask for this. I didn’t do anything wrong. I got Lyme disease and then I hit my head. Big fucking deal. Suddenly this giant thing was dropped in my lap and its eating all the good parts of my life.

I’m not the same teacher, not the same member of the college community, not the same friend, sibling daughter, wife. I am a drag. I have a hard time enjoying things. I just want to stay home. But if I’m not going to kill myself, I have to figure out what I am going to do.

I read this piece in the NY Times the other day, about a woman who survived a near-fatal illness and afterward failed to make the proper transformation that she thought the people in her life expected. I feel the same sense of failure toward every person who asks how I am doing, whether things are getting better. I want to have the right answer. I want to make you smile and say you are glad. That I can’t makes me feel like a failure. It makes me think you think I’m not trying hard enough. Jesus Christ, I let a doctor burn fucking nerves in my spine!!! I am definitely trying hard enough. It’s just not working.

Best, best, best case scenario, this rhyzotomy turns out to be a success and I have a year without headaches. Hurray! Then the nerves grow back and I have to do it all over again. I have to go through this bull-fucking-SHIT recovery inflamed nerve spasm crazy person can’t function pain again. What? I don’t know that I can do that. So every year I have to give a month, or even two, over to recovery pain. Over and over, year after year. What, maybe I make it my summer break project so I don’t have to suffer while I’m teaching? Awesome! Yes, who needs camping and the beach and my garden when I can lie on the couch with an ice pack and take medication that makes me seasick?!

Maybe I just have to live with the headaches. Maybe I have to accept that I am a Chronic Pain Person. Maybe I have to find a therapist who specializes in pain and can teach me how to wrap my head around it. My last physical therapist actually recommended one, but at the time I had no intention of being a chronic pain patient, so I passed. Maybe I have to figure out if isolation is really helping me, since time with my students and the breakfasts and lunches I sometimes have with friends do pull me out of it a bit. This weekend alone was a big mistake, all that time stuck in my head.

For three years I’ve been waiting for my headaches to be over so I can go back to things like my bike, the gym, having people for dinner, going to shows, galleries, etc. Maybe I just have to do those things even though I’m in pain.

Maybe I have to stop talking about it, especially with my colleagues at school. At first I wanted people to know, because I was participating so much less and was in a crappy mood a lot. But now I think it’s counterproductive. When people ask me how I’m doing and I tell them I’m not so great, I feel not only like a buzzkill but like I'm letting them down. Everyone wants a victory. Maybe I should “act as if” I’m feeling okay. Maybe talking about it just makes it worse. At this point, everybody knows about it, so maybe I leave it at that.

New meds, new perspective

So this weekmy nerves are super pissed and the pain is much worse, stabbing and intense. I can toss back pain pills like they are nothing, and they hardly work. So I called my doctor. "The pain's like a bad sunburn, right?" he asked. "The pain is like a knife stuck in the back of my head," I replied. Ah. he got it. So he prescribed Prednisone, which he says will reduce the nerve inflammation and help with the pain. I'm on day two of the taper, so I am hyper, sweaty, and in a particularly good mood. And the pain is pretty mild. I'm going to Buddakan for dinner tonight, and I'm going to chow!

The strangest thing has happened at school. In spite of all this bullshit, I'm having maybe the best semester of my career, and I feel more connected to my students than I ever have. First, I'm teaching English Composition and Research Writing, two classes where I've got a solid system and great material. So there's no stress there. Second, something's happened in the last year, and I'm not sure if it's because of chronic pain, or turning fifty, or what, but I'm finally able to relax and enjoy my students as people. I've always known how awesome they are and what incredible strife so many of them go through just to be in college. But I just really LIKE them. I like getting to know them, I like hearing what they think about the material and about the world, and I love having them come to office hours for advice that turns into a good chat.

It's as though I didn't know I was allowed to enjoy them so much, like I had to keep a wall up and be "professional." My first ten years, I wore suits and kept my hair in a bun at the base of my neck. I was terrified they'd find out I was a fraud.

Well, I'm not, and I suppose ultimately this is about teaching confidence. I'm 22 years in, and I got it. Overall, this means my job is way more fun, and while I'm super strict about attendance and deadlines, I no longer have any adversarial attitude, like I have to control it all. Ironically, my classroom is more orderly and productive than it's ever been.

My favorite thing is students who take me again for the next level of writing course. They are always people I really like, and I help them with academic advising and mentor them a bit more. I haven an especially great group of frequent fliers this semester, and I'm thinking of having them to my house for a holiday party once the semester ends. I've taken students on field trips and once took a class to an Ethiopian restaurant after we read What is the What, but I've never had students to my house. More than anything, I want them to meet each other and become friends. Most of them are really strong students, and I think they can form ties that might last beyond our school and even into the professional world. They are veterans, and single mothers, and older people coming back, and felons, and immigrants. They are superstars. When I think about the typical college student, 18, supported by parents, living in the dorm with a high school education that actually prepared them for college, my students simply blow them out of the water in how much harder they have to work and what they have to juggle. They are amazing.

Anyway, even though this nerve pain is bad, things are looking up, and I'm glad I'm able to look at my whole life and see all the good stuff.  Oh, and this week I heard from two agents who want to read my whole (first) novel! So it's good!