Hello from the Other Side (of back surgery)

Been wanting to post an update ever since I survived back surgery 16 days ago (morning of Nov. 30th). I've started writing about it and had to stop a couple times in the past couple weeks, and today is the first bit of time that I am finally able to share the initial story.

I say initial because the day of my surgery was pretty much in the middle of the 6 month span that this process is likely to affect my life. On the front end, since mid-August, I've had >3 months of worsening symptoms from my sciatic nerve root compressed my herniated L4-L5 disk (plain English: burning, numbness, pain, and weakness in my right leg and foot, and up to 12 pain pills a day of 3-4 different types of pain medication to allow me to continue working). And now, ahead of me, 3 months of recovery (fine print: 3 weeks of temporary disability from work, 6-7 weeks of physical therapy to restrengthen my right leg and foot, back and abs, a month or two of no driving, two months of no strenuous exercise, an indefinite amount of time with no bending over, and 3 months for my sciatic nerve to gradually heal and the nerve pain to go away completely).

On one hand it's nice to know that there's a 3 month post-surgery recovery window in which I can relax and not feel like I have to be immediately better. On the other hand, since I am not particularly patient nor disciplined by nature, I have to work at controlling my mental reactions to the speed of my healing process.  But anything that doesn't kill us makes us stronger, right?

I had to breathe deep when I saw some initial reactions from friends to my posts about surviving surgery, to the effect of, 'of course you'd survive, but how's the pain now?' On one hand, very few people experience immediate and total relief of sciatica symptoms, and EVERYONE who undergoes surgery has a recovery period where the word pain-free is a joke. On the other hand, I really was terrified of surgery. I was partially afraid I'd end up worse, worried about general anesthesia, local anesthesia, you name it. And the truth is it's not always pleasant to be hospitalized in a foreign country, even a top-notch one, because when you're in your deepest throes of needing to feel safe and secure, a foreign language, even one that you're fluent in, can push you to the edge of anxiety when no matter how you express yourself, folks just aren't getting it, or in the least, they're just not able to communicate their reasoning to you.

On the day before and the day of my surgery, that was precisely what happened: language/culture blunder #1 began with an anti-anxiety and leg pain medication that was given to me the night before, but not the morning of. Every day for 3 months, I've been on pain medications for my sciatic nerve pain in my leg, but somehow it got left out on the morning of, and so during my wait to go into the OR I was suffering and this compounded my nervousness about surgery. So when he finally arrived in the OR, Language/Culture Blunder #2 ensued, and instead of giving me the two meds and putting me on local anesthesia like we'd agreed, in the end, the anesthesiologist ended up putting me on general anesthesia. And later told my surgeon that I'd asked for it, who of course believed him. At least that was the response when he boasted that the surgery had only taken 35 minutes, and I complained that how could that be when I'd been unconscious for 3 hours.

Putting those blunders aside, I set about firming up my mental state to go through the first few tough days of recovery. Truth be told, I was amazed that my back muscles did not hurt. The incision site stung a bit when I moved funny, and I had some serious weakness in my lumbar/sacral area for the first week, but beyond that, I was able to walk, sit, and stand completely unassisted within a couple hours of waking up. To me, that proved the claim of endoscopic surgery that's it's much less invasive and permits faster recovery and mobility than traditional open back surgery, where muscles are sliced by a scalpel rather than perforated by an endoscope. Sure, it was hard to walk the first two days, and I did not really want to, but with the urging of the nursing staff and my doctor, I hauled myself out with my IV stand and did my laps in the 1st floor lobby. Walking a few minutes every hour since the day of my surgery has contributed greatly to my recovery process.

Unfortunately, there were two more hiccups in my first few days. The first could also be considered a cultural blunder of sorts. I thought I'd prepared my small mountain of pre-surgery paperwork as thoroughly as possible. The insurance company had requested a quote in writing from the surgeon and his team (which was mostly adhered to, with the exception of a couple members whom insurance didn't end up covering) as part of the pre-surgery approval process, but hadn't requested a quote in writing from the hospital. I had a choice of two or three hospitals that the doctor operated at; I was told one wasn't covered by the insurance, and another didn't answer my calls. So I went with the third hospital that answered my phone call and gave me a quote— although it's known as one of the most high-end and pricey hospitals in the area, the amount quoted over the phone sounded totally reasonable. In retrospect, I really should have gone in person to get a written quote.

I started receiving phone calls from billing to my hospital room only a few hours after my surgery on Monday afternoon, telling me that Dr. so and so had left his invoice, and what would my form of payment be? I told them to call my insurance. They informed me insurance wouldn't be covering. I was annoyed but didn't think it was too big of a deal because I could probably take some more cash out. I told them we'd deal with it tomorrow. But on Tuesday, after my doctor had discharged me and Margo went to billing to cash out, came the biggest surprise. The total for the hospital's portion of services ended up being about 18 times (Yes, 1800%) more than I'd been quoted over the phone. This huge discrepancy was one that we weren't prepared to pay, even 14% of it, which was my copay. To our dismay, they were also unwilling to bill us, in other words, I had to pay in full immediately prior to leaving.

I didn't have enough cash to cover it, nor was my credit card limit high enough to charge it. So less than 30 hours after my surgery, I spent about 6 hours sweating profusely and making calls in an attempt to raise those funds. Those 6 hours were enough for another entire blog post. Then I pleaded with billing to accept the 70% we were finally able to raise by Tuesday evening and bill me the rest, but the heads of department refused. So my discharge was cancelled, and the hospital held me hostage for another night until we could deliver the rest the next day.

As a result of the stress, my temperature rose and I immediately came down with the cold that my daughter had had a few days earlier. Aside from stressing out me, my husband, our friend who was taking care of our daughter, our daughter, my family, Margo's family, and other friends, being kept prisoner by a hospital was incredibly embarrassing. Margo had to go home and collect our daughter and I spent that third night alone in the hospital. Before he did, he got me a coffee and a chocolate glazed donut, which helped me feel a tad more human for a moment. After he left, at nightfall, I worriedly tried to send away the nurses who came to my door offering to check my vitals, fearing I'd be charged more. Their eyes widened when I explained the reason why I was still there even after I'd been discharged. They, and the dietician in charge of my meals, assured me that it was "all included," and to not worry. I accepted. Then I remembered my surgery bandages hadn't been changed since Monday morning, and got freaked out that my fever was from a surgical infection. The nurse on call assured me my temperature was low enough to not cause concern. She mercifully helped me change the bandage free of charge. The meals kept coming. My fever got under control. In the midst of such a degrading experience, I felt fortunate that some hospital staff still had my best interests in mind, and I will always remember their kind faces and words.

I finally went home on Wednesday around 11 am. Whereas I had turned my nose up at the Krispy Kreme stand when I was admitted, I gobbled down another chocolate glazed and bought another couple boxes to give to the people who had helped with our daughter in our absence. It took a few days for my fever and cold to disappear, thankfully, because their symptoms was making recovery harder. I kept walking a little every hour, forcing myself out of bed even though all I wanted to do was stay there and watch Netflix.

The first week flew by. Aside from getting in and out of bed, sitting down for meals, walking, and showering, I was pretty much totally dependent on Margo for everything around the house and for assistance getting dressed and changing my bandage. My back didn't hurt but I kept getting shooting pains down my right leg every time I'd get up from sitting or laying down. They were so strong I'd have to grab something to hold on and use my deep breathing. But they'd subside in a few seconds and then I'd be fine. I was only on paracetamol that week, which is saying a lot when you compare it to how many meds I'd been on prior. After speaking with friends who'd had back surgery before or knew others who had, they were shocked that I was up and about so quickly and that my incision was so small. That made me feel a little better. But at first, I was still spending more time resting (laying down) than up and about (sitting or walking).

On Day 5 or 6, I was finally able to lay on my back without pain in my wound area.

On Day 7, one week after surgery, things started getting better fast. The weakness in my lower back was gone, and I was walking normal pace. I was upright for 5 hours without laying down.

On Day 8, Monday the 7th, I quit using a bandage—the gauze and tape were driving me nuts—and my wound seemed to be healing well. I went for a ride in the car for the first time since a physical therapy consult, and was told I was doing very well. I started Lyrica for the nerve pain, which I was told shouldn't last for more than a few weeks.

On Day 9, I was finally able to completely dress myself (including socks, which are still challenging). I was upright for the majority of the day, and only had to lay down a few times.

Day 10, I stopped taking paracetamol. So I was completely off the morning pain meds. It was a watershed day for me, and the first time in over 3 months that I hadn't taken pain medication upon waking. I had my first beer in 3 months too, man was it good! :-)

On Day 12, I went "out" for the first time (aside from physical therapy)—to our office holiday party—I was mostly fine but by the end I was feeling pretty tired, and achy in my lower back.

On Day 13, I went "out" again, this time to the mall, to get some lightweight walking shoes. I was out for a good chunk, and felt pretty darn tired afterwards. The morning after, I was achy in my hips.

Day 14 was my last day of antibiotics (Cipro), and a day of rest took the edge off my aching hips. I finally was able to lay on my stomach for a few moments, something I haven't done for a few months (it's almost always made my nerve/leg spasm bad). The lesson learned was to be active but to increase my activity gradually, not in large amounts.

Day 15, my physical therapist added a few new exercises, and my hip was sore the day after, and my nerve pain shifted from up high to down low in my calf. I have a hard time with backslides, but I tried to stay optimistic. I was given another week of disability, and am thinking I will probably be good enough to go back to work next week. I saw my neurosurgeon for my 2 week checkup, and whereas he is happy with the results, he prescribed me more exercises for my right foot and shin, which are still pretty weak (I have a hard time walking tiptoe and on my heels on the right side—am basically unable to do so).

Day 16 (today), I got up from bed without any shooting pain down my leg. To me that's huge progress. They say that if you are improving consistently during your first 3 months, that you will only continue to get better.

Now, as my neurosurgeon is trying to impress on me, it's more important to focus on my overall health rather than worrying about the consequences of my surgery (i.e. that a spacer was inserted, that I might have any mobility limitations). He's urged me to take steps to care for my other remaining, unherniated disks, by losing weight and, once I'm further along in my recovery, by exercising. He assures me that I won't have any limitations in my activities once I'm recovered, and I am trying hard to trust him. Based on my progress so far, I am inclined to keep the faith. Margo says I am walking much more upright and without a limp, and for my part, not having to take 10 or 12 pain pills a day is a big enough difference for me.

In retrospect, even though I would have preferred not to go through this, I am compelled to count my blessings in terms of having had access to insurance that covered the majority, a clearcut and supportive Mexican workers' comp system that allowed me sufficient time off work for recovery (and  free follow-up care parallel to my private doctors), family and friends who've lent big helping hands in these last two weeks, and most of all, my husband who has been taking care of every last detail and listening to my every last peep during my recovery process. My recovery has been a straightforward trajectory without any complications so far. I am truly grateful.

Any major surgery is an experience that brings your mortality and aging into clear focus, and of course for someone who loves life and being incredibly active, it's a hard thing to face and deal with. But considering that I am only one of billions who deal with this on a daily basis, I'm going to keep focusing on the positive, the small victories, and the sweet things in life that help us rise above the pain. Although I still have the road to recovery in front of me, it feels good to be emerging on the other side.

The Chronic Pain Club

There was a YouTube channel that Bee used to like to watch when she was a little younger and was starting to learn nursery rhymes: The Mother Goose Club. It has a catchy jingle that sticks in your head which I suppose is what you want when you're promoting language acquisition. For adults, luckily, it fades from the memory before annoyance hits. But the song keeps popping into my head every time I think of the latest clubs that I am now a card-carrying member of.

I wish I could say the same about the rhythm that's colored my life as of late: sciatica. The name of the condition is cool sounding, latin in origin and pronunciation. Back in the day, when I used to have low back pain that was largely stress-related (but in poring over old results, probably did have a physical component that's rearing its ugly head today), I used to come across the term sciatica in my Google searches and, although some symptoms are hard to completely rule out, sciatica-like leg pain was always off the list. The problem occupied a "type of back pain other people have" sort of category, one that mystified and slightly intrigued me, but as long as I didn't have to deal with it, fabulous.

Fast-forward to this summer, when a lot of different things were happening. I was traveling a lot with my family and for work. I went to the Yucatan Peninsula for the first time with my parents and brother, and to a nearby National Park with Bee and her Dad and some close friends. I went on 3 long distance trips by myself (without colleagues- y family accompanied me on the last two). The nearly 3 months of heavy traveling was sandwiched in between training high seasons at work- long days with relatively higher stress levels (Good stress! But stress nonetheless...). It was a heady summer. I was feeling great.

But most of August, which is when the last two work trips occurred, I kept feeling this burning sort of pain in my right leg that wouldn't go away. It was weird because it was a pain I'd never felt before. But I didn't pay much attention to it- first, because I was busy traveling, and second because I often have pains that come and go. Just that, this one wasn't going away, and it took me a while to realize that. Actually, I never did fully come to the realization that something serious was happening on my own. My body had to sort of whack me over the head and smack me around seriously in order for me to pay attention. I am sorry I didn't listen sooner.

The weekend after an important training week at work was a three-day one, and I was jazzed because I'd finally made an appointment for acupuncture in San Miguel, and to go to the hot springs as well. (See, I do practice self-care... ;-) The stretches and physical therapy exercises for my hip that I'd been trying all week weren't doing much to help my leg, and in fact, my middle lower back had started to ache as well, which was somewhat concerning. I was unaware of the physical train wreck I'd been holding off for a month.

The Sunday before Labor Day, I woke up in terrible pain in my lower back. I basically could not sit straight or stand unassisted. I was only able to go to the bathroom with my arms around my husband's neck. I sort of freaked out too, because this was not my first time my back has gone out, and I know how it can sideline you. But once my tears of embarrassment, and of frustration, had abated, the tears of genuine pain were ushered in. This level of pain is on par with childbirth. After trying several different kinds of medication, none working, and a humiliating 30 minutes on the floor at one point in a botched attempt to crawl to the bathroom (Lest you think otherwise, Margo did try to prevent me from trying), I knew I had to do something else- I was picturing myself getting carried out of my house on a stretcher, and really did not want that to happen. I made a few phone calls, finally spoke with a doctor who recommended a specific medication, which ended up working, and I was able to sleep through the night.

This apparently, in the case of what occurred to me, was somewhat of a miracle, because the next morning I got up out of bed and was able to walk without assistance. Various trips to the doctor and MRI results later, the verdict was in: I had a very large L4-L5 disc hernation and sciatica. And just like that, I was unceremoniously inducted into the Sciatica Club.

I won't get into the gory details of my less-than-pleasant exchange with a rather knife-happy orthopedic surgeon who wanted to operate on me immediately (hey--maybe he'll end up being right in the end, but where I'm from we don't take the recommendation of surgery by scaring, insulting, threatening, and making ultimatums to patients very well, and so no, you are off my doc list although you did recommend quite a nice medicine, thank you very much). Or another questionable doctor who I went to see the day after, desperate for a second opinion, who was the closest thing to a quack that I have ever experienced personally.

Since then, I´ve also been inducted into the world of IMSS specialty medical services, where state employed doctors maintain their private practices and skim off the patients who have private insurance and want better care than the government is prepared to provide. I was out from work for a week on sick leave, another week on temporary disability, and a few days of personal leave. I have attended 8 physical therapy sessions, have had better days and worse days, but I have not had a day yet where my symptoms disappeared.

In retrospect, the sciatica was happening most of August, I just didn't recognize the symptoms. We can't really pinpoint when I herniated my disk, but it's likely that it happened on one of my trips in June, where I fell twice, and also lifted something rather heavy by myself. The natural history of herniated discs and the evolution of sciatica is something I've read more about in the last two months than I probably did reading for my Masters thesis project (Ok, maybe I'm exaggerating). But suffice it to say it's an incredibly complex process that is not yet fully understood.

Part of what's not understood is a large discrepancy between pathology and symptomology. That's to say, some people who have very small hernias have more pain than large ones. And what's more, some people can have large hernias with no symptoms at all, and some people with no hernias have terrible symptoms. Finally, some people spontaneously heal with little downtime and intervention, whereas others go on to have symptoms for years. Doctors and medical researchers do not have a full grasp as to why this is although many theories are being studied in clinical settings.

Going back to the first doctor's threat of this being an immediate surgery situation... Having had a history of stress-related pain and other disorders (IBS, situational depression), it has been hard for me to move to a mindset where I can accept a situation that's not mind over matter, and that surgery might be necessary. I am overweight, I am not always careful with my diet, and so I feel that there is still a lot that I can do to "lessen the load," so to say, on my hernia, and allow it to heal. I am also concerned about potential negative effects of surgery, or even worse, the possibility of a botched or useless surgery (in case you don't believe me, search "failed back surgery syndrome"). Having the appendix out for emergency surgery is one thing, but messing with the spinal cord is another. I am not alone in my concerns...most online literature that I've read, either on spine institutes, research papers, or medical websites, cite that only 1 out of 10 herniated disk patients require surgery.

This must seem like poppycock to most orthopedic surgeons in Mexico, especially that first doctor, but I have find, quite serendipitously, a couple doctors who share my opinion- albeit with reservations. In a number of different online sources, I've read that surprisingly enough, the largest disc herniations tend to be the ones that are resorbed (healed) to the greatest extent. The reasons for this, again, are not fully understood, but do give me a great deal of hope.

However, the caveat is that for those patients whose symptoms do not improve in 6 weeks to 6 months, the longer you postpone surgery, the higher the chances are that surgery will not resolve your condition. This has to do with the potential for nerve damage- in sciatica, the prevailing theory is that the herniated disk presses on and compresses the sciatic nerve, which runs from the tailbone down to the knee (where it splits into 3 branches that run down to the ankle and foot). Most of what I've read explains that the higher risk situations are where the patient has significant muscle weakness or loss of sensation in their extremity- the classic emergency situation is the cauda equina syndrome, where one loses control of bladder and bowels. The worst I've had so far is leg, gluteal, or calf pain at a moderate level that just doesn't go away, or a tingling sensation in the top of my foot, back of my calf, or side of my thigh, so I am not too worried about permanent damage (although it's definitely made my list of troubling possibilities about this episode) although the annoyance factor is a totally different story.

I've never been good at accepting when I'm sick, much less hurting, but I managed to get through several years of occasional bouts of back pain in my twenties. But these bouts never last more than a few days to a week, and so these two months of nearly non-stop pain have been a new realm for me. Even though the one terrible Sunday in early September was the only day I had severe, disabling pain, in the last two months, a day hasn't gone by that I haven't had pain or numbness in my leg. And that's even though I have been on medication as well- and I probably haven't had another severe event for the same reason. I haven't been able to get comfortable or go back to regular activities, and that's taken a toll on both me and my family physically and mentally. Not being able to lift heavy stuff or perform load-bearing activities (read: my daughter, laundry baskets, doing dishes, or luggage), creates a challenging dynamic. Not being able to sit in one position for more than a half-hour, and needing to lie down regularly to take pressure off the disc has led to awkward situations and difficult conversations at work. Being dependent on others, when I have always been highly independent, is just plain hard.

The idea of taking disability or being disabled is getting wider acceptance in our society especially as self-care and patient advocacy increases, but at the end of the day, the stigma remains, and the stark truth that you're just not as productive as you normally are brings it own set of complications to the recovery scenario. How are you possibly supposed to focus your energy on healing when all you can think about is; how much have I paid in medical bills this month, will I get reimbursed, will I make it through the work weeks once temporary disability is up, how can I make it up to my husband, my daughter, when I can I start to exercise, will physical therapy work...will I ever get better?

The whole situation is enough to depress anyone, even if you're taking a peck of supplements, watching your nutrition, and getting enough sleep. After exhausting my readings on disc anatomy, sciatica mechanics, physical therapy, surgery options, hernia resorption, sciatica forums, ad infinitum I have drifted into the "chronic pain management" websites, because, like it or not, I have a de facto membership in the Chronic Pain Club.

There are often silver linings in situations like these, and my case, is no exception. I need to lose weight, urgently, and although I continue with thyroid issues, this will motivate me more strongly to control calories in the hopes of shedding some pounds and taking some load off my back. To help with this, I have also looked into the anti-inflammation diet by Dr. Weil, which is largely vegetarian, which is a goal I'd been wanting to move toward anyway. Money issues and pain will be a factor, but I am going to try and join a gym to start swimming regularly. If I can, it will be meeting a goal for regular exercise that I've also been wanting to accomplish for some time.

Finally, although it's always important to be mindful and compassionate with others, there is nothing like a time of illness or pain for you to become more aware of what others in your same boat, or worse, are dealing with. The forums I've lurked on in the past month are filled with individuals going through so much pain and suffering that it's almost shocking to think that I don't run into more people with these type of issues on a regular basis- or perhaps it's our tendency as a society to minimize these types of issues for the same stigmatic reasons I mentioned above.

In any case, if there's anything I have realized as a result of this, is that I am definitely not alone in this, it's quite a common condition, and what a shame, because for how painful and disruptive it is to life, I really wouldn't wish it on anyone. Human evolution to walk upright was an amazing and wonderful thing, but the long term impact on our discs and spine of being vertical was one thing evolution really got wrong. Believe it or not, it's believed that disc degeneration begins in adolescence. I can only pray with time science and medicine--and popular culture--can implement ways to prevent and treat these type of problems, starting in early childhood, because no one deserves membership to this club when it could be avoided.

No time to the right time

I miss writing. The words rolling off the tip of my fingers onto the keyboard. The blissful feeling of capturing a whole thought and expanding it, for it to blossom into something meaningful, even if only to me.

But creative expression needs time, not something I have large excesses of these days. Taking a full-time job, indeed, one that requires me to travel as well, means that writing has swiftly arrived at the bottom of my priority list, below rather more important things like spending time with my daughter, eating, and sleeping. Being out of the house 10 hours a day, five days a week has meant that even things like chores and exercise are mighty challenging to pull off.

This is where I make my perfunctory statement of awe and respect to working parents worldwide who manage to have not just one but even more children, hold down full-time jobs, and manage to still do things like throw birthday parties and get up at five in the morning to run or meditate or what have you.

Mind you, I am not complaining. Not even venting. I love my job, and the role I play is something I have been wanting to be able to commit to for quite some time. Circumstances and my daughter's age have led me to finally be able to do so. It's just that it's been a reeeaaally long time since I was in the full-time flow.

When I left the U.S. in 2006 with Margo, my professional trajectory came to a standstill and it has taken me all these years south of the border to re-cultivate it to a level that can not only do justice to my education and experience and support my family. Nothing is forever, everything and anything can change in the blink of an eye, but I am proud of how far we have come as a family—how far I have come personally—and I am so happy that this time in my life is finally here.

The trick is making it, the feeling, the moments, stick. So as to not blow by in the blink of an eye, as often happens in my memory-span of a fly. That is what writing has always done so well for me. From the time I was twelve up until now, taking time to pause, write, and externalize has allowed me to realize, reflect, evolve even.

The outside, professional world, and my movements in concert are working wonders on my self-growth and that of my family's. But those subtler, sweeter sides of life—things like writing, gardening, crafts, spending time with dear, dear friends or just sitting and thinking—are getting shaded out in the meantime.

But the gardener in me knows that seeds, though lying dormant, are faithful to the stirrings of life, and will spring forth at a moment's notice. They just need a little light shone into dark corners and new leaves will emerge when the time is right. It might not be this spring, but a growing season is something we can always count on.

2014-in-Review

This is an adaptation of a holiday letter I sent to family and friends. I have been wanting to blog more but it is one of things that is falling by the wayside in my return to a full-time job in the last couple months. 

2014 was full of happy days and new adjustments. 

In February, I had the great fortune to spend my birthday with friends and family on the coast in Sayulita and Vallarta. Afterward, we drove up the coast to give a reading to the "Writers Who Love Mexico" group in Xaltemba. We stayed in Guayabitos, where there is a lovely wide, shallow beach that is great for kids. 

In May, we were invited to another book talk by the Patzcuaro and Morelia book clubs. We were hosted at the lovely Casa Encantada over Mothers' Day. The local expats there were incredibly supportive to our family and the immigration issue in general. They lamented how terrible the negative narco press has really impacted tourism and business. It's a shame because in my opinion Michoacan is one of the loveliest states in the Republic.

In June, I finished up a four-month temp job as Training Advisor at Peace Corps Mexico, and my parents came to visit. We went up to visit volunteers in the Reserva de la Biosfera de Sierra Gorda and then came back and threw Margo a 40th birthday party. Soon after, we traveled to the University of Guanajuato to give a talk to an American-Mexican law student exchange program hosted by law professor Beth Caldwell.

This spring, we foster-homed a wheaten Scotch Terrier for a few months from April to June. I had taken her from a friend in the hopes that we could adapt to a dog in our lives, and it really was great for her to have more space to roam. However, Margo is not particularly fond of dogs, and didn't have sufficient resources to care for her properly (we lack fencing, and she roamed...and future vet bills would have been a problem). I eventually realized the best option would be to rehome her. Lucky for the pup, a coworker and his wife adopted her permanently, and it's a much better living situation for her. Everyone turned out happy!

Soon after we got an aquarium, which is definitely less time-consuming than a dog, but is still a mix of disappointment & delight :) I may have a green thumb but aquaculture seems to be a whole new learning experience for me.  To renew my faith in my ability to foster living things, planted a few garden boxes and held a late summer/early fall home gardening workshop series. This summer I also started a new regular exercise and physical therapy routine...which has been a nice little bit of time and care for me.

This fall we began to edit a translation of Amor and Exile with the hopes of completing an edition in Spanish. It's been an incredible way to improve my written Spanish, and we are working with an incredible team of volunteer editors (Mexican nationals) who are as committed to the vision of truth-telling on the issue of undocumented immigration as Nathaniel and I have been. Look for it in 2015. 

In November I returned to work full-time at Peace Corps as Interim Environmental Education Program/Training Specialist. I went on my first official volunteer site visit to Puebla and Oaxaca only a few weeks after starting. I hope to earn the permanent position in the near future...I feel like Peace Corps Mexico is a place where I can grow and contribute in a way that I had long wanted but had been unable  to achieve in exile. I am so very grateful for the incredible team of coworkers and the opportunity to provide training and support to volunteers who dedicate their lives to service in far flung rincones of this country! 

In the meantime I am now charged with maintaining a balance between work, home, and aspirations for the future. My daughter amazes and challenges me daily, and Margo impresses me with his reserves of commitment, devotion, and cariño for this family. Like any nuclear unit, we struggle to maintain connections with our extended family, but I feel very grateful for consistently supportive parents and for the blessings we´ve received from our wider community of friends and networks. Onward to 2015! There will be much to experience and discover. Felices Fiestas desde de la Tierra de la Flores de Nochebuena!

Winds of Change | On the Current CIR Debate | Amor and Exile

**Note: This is probably more subject matter than should have gone in one blog post. Time is more precious than ever, and I've been more exhausted in the last 3 weeks than I can remember being since college over 15 years ago. There's so much to say, too little time, and some trains are fast departing from the stations of my life that I can't afford to miss. But I wanted to simultaneously speak to recent accomplishments with Amor and Exile and going to D.C., the perspective of many years having observed and been a victim of immigration politics, and also acknowledge that my intense involvement in this issue, to the exclusion of other, more earthy parts of my life, has taken a toll, and I'm in the process of achieving a new equilibrium.**

Cycles are being completed and new chapters are opening in my life, and for this I am grateful. But in many ways, some things are as they always were.

I recently traveled to Washington, D.C. to deliver a copy of the book I co-wrote with Nathaniel Hoffman, Amor and Exile: True Stories of Love Across America's Borders. The trip, which in essence launched the publication of our book, was many things to me at once: a dream come true to tell my story to our nation, a collaborative vision seen through to completion, an eye-opening experience about the way politics are done in my country, and a reminder that I must continue to find grounding in my daily life back home.

Nearly 12 years ago, I began dating my husband and discovered what we were up against in terms of immigration laws that effectively shut out a large number of North Americans from access to legal immigration to the United States, even when married to American citizens.

Almost 6 years ago, despite the successful protest of the passage of even harsher immigration laws (HR 4437), which would have made it a felony to merely be in association with my husband, we came to the conclusion that the only way for my husband to obtain legal status was to move abroad to his home country of Mexico. We packed our belongings and moved south, where we've been ever since.

A few years after we moved here, I began seriously contemplating the possibility of writing about my story. Everytime I told our story about why we'd moved here to someone, they'd respond, "But you're married!?" as if it was a no-brainer that my husband should have U.S. papers. It drove me crazy that nobody understood why things just weren't that simple. On one hand, part of me wanted to wash my hands of the issue entirely, just focus on my field (ecology) and pursue my dreams of a green business or non-profit in a country that sorely needs environmental conservation work. I did restore a good part of our land with greywater and organic vegetable production. I did publish a short collection of regional recipes using Mexican native food plants (The Bajio's Bounty). And I remained tangentially involved in the environmental movement here in Querétaro. But the pull of fate in the direction of writing a memoir and adding my voice to the millions of disenfranchised by U.S. immigration law was too strong. I kept adding to my many notebooks of visions I was having about "telling a story about migration."

In winter of 2011, only a few months after my daughter was born, I began writing my part for Amor and Exile. Ever since then, my life as been drawn inexorably deeper into the path of advocacy on behalf of families like mine. Starting with the story that is now part of Chapter 9 of Amor and Exile, entitled "Alienation," in which I tell of our passage south to Mexico, I began the laborious task of encapsulating my most painful struggles and my lofty ideals (of the ones that still remain) into prose, exposing them to my coauthor's critiquing and making them universally understandable, as opposed to making sense only to me. The first years were an internal struggle—overcoming the fears and anxieties with making our story. I first received great support from family, friends, my coauthor Nathaniel, and then from a therapist who helped me creatively work through my trauma and heal many hurt parts of having to leave my country to keep my family together, essentially against my will.

Our manuscript was finally done in December 2012. It represented two and a half years of writing and collaborative editing. In the first few months that we began "shopping around" our manuscript with our agent, was when all the Comprehensive Immigration Reform debate hit Congress. I'd written my story without any specific political language, mainly because it was telling a past story, also because it was anyone's guess as to when actual reform could happen. Moreover, as I tell in the book, part of my personal peacemaking has had to do with separating my political hopes from my own personal goals and motivations—in other words, I can't pin my personal happiness on political outcomes.

That being said, I'm well aware of what the current debate represents and I would be amiss to not be a part of it. It's been satisfying to be able to make contact with many individuals who are advocating on behalf of families like ours. Coming in contact with dozens of families like mine has renewed my resolve to continue speaking out on this subject—even though the "best" reforms available (waiver reform) really would only allow my family to apply for a waiver a couple years earlier. It's too little too late for us—but it could be a lot for some families.

Being in D.C.—getting the community support to go there as a result of our Indiegogo campaign to "Send Amor and Exile to Washington"—was an incredibly uplifting experience. Going from totally disempowered, silenced for so many years due to my family's lack of legal recourse—to dialoguing with Capitol staffers and representatives themselves was to come full circle in terms of where I was and where I now am. We have no guarantee that our efforts will actually make any difference in the long run in terms of policy, but I am convinced that at least in terms of personal views, dozens of individuals have been affected as a result of our work. And I can only pray that it will continue to have an impact in the long term.

Because ultimately, as things are currently being played out in the Senate, it is truly a political game in which our lives hang in the balance. A game whose players have no problem sacrificing billions of taxpayer dollars for even higher and more electrified fences in the name of immigration reform—always with the risk that every compromise will never be enough to satisfy the most extreme negotiators. I'm personally more skeptical about the long-term positive impact of the most recent version of SB 744 (if the Corker-Hoeven amendment to spend $30 billion in additional "border security" is included) compared to the original version. It's the product of compromise that might get some of us home a little sooner, that might prevent some of us from having to go into exile, but my question is, how will it affect generations of migrants, citizens of both countries even, to come?

It's really easy to fall in the trap of thinking about only our own families' problems, I did this for many years as I pitied myself and couldn't imagine how I was going to make my life work in a foreign country. I saw myself as somewhat different than the rest, when in reality, we're all in the same boat. I am so thankful to my fellow friends in exile for opening my eyes about that. What I dread happening is that we, the exiled or separated, forget to think of those who will come after us, as we are thrown a bone, while draconian regulations continue to be passed.

What concerns me about the passage of an SB 744 with extreme border militarization clauses is because of the reasons these regulations are being written in. Does this version of immigration policy engender cross-cultural understanding and reduce the likelihood of attempted illegal immigration to the U.S? Probably not. Would using that money instead on international programs that improve the standard of living in foreign countries, create programs for individuals to more easily access legal immigration channels to the U.S. have more positive effect in the long run? Most likely. But those type of answers aren't as politically sexy as more choppers and barbed wire, when catering to the xenophobic crowd in the U.S.

Much of our populace is still stuck, lamentably, in a culturally insensitive rut that is costing us the ability to move forward as a nation, embrace our immigrant roots, our immigrant present, and our immigrant future. We welcome those who have the financial resources (or luck in the lotteries) to make it across the border "legitimately," but we reject many who are the salt of the earth. Those of us who have acknowledged the migratory and highly adaptable nature of our continent will keep working toward true change, at great personal sacrifice, sorrow, and even joy sometimes, no matter what the outcome on Capitol Hill.

2012 Highlights | Mi Mejor de 2012

Every year has its ups and downs, and with all the challenges we face it's easy to lose perspective. I'm usually good at affirming and reminding myself of all the good things. But all the world tragedies, and seemingly impossible goals can put me in a funk. Yoga is something I do to clear my mind and regain strength. The end of my practice today was my last meditation of 2012. In my mind's eye, as the debris of frustrations and negativity fell away, I saw life as a diamond—precious, illuminated with the light of love. At its heart, through all the rough, the past year has indeed had many diamonds.

Family
My husband and I made a renewed commitment to each other and embarked on a regular effort to strengthen our relationship by improving our communication and seeking more ways to enjoy our time together. Our daughter has been an endless source of joy and growth amidst all of her smiles, precious innocence, discovery of the world, fast-developing personality, love for us, tantrums and toddler opposition. My grandmother turned 90 and my brother was married, both opportunities for the extended family to come together and spend time celebrating timeless rite of passages. I got to know my sister-in-law and her sisters a little better in that special way that only bachelorette parties and the crush of preparing for a wedding can do. On a weekly basis, I marvel at technology's ability to keep our family in touch across great distances in ways that would never be possible otherwise.

Friends
I had the wonderful opportunity, after a 3 year absence, to return to California and participate in my good friend's wedding, spending 4 days in the Sierras. As if that wasn't lucky enough, I also got to see many other friends in a mini-tour of San Francisco and the Bay Area and Coastside, proving that, with the exception of changing poopy diapers at the beach, traveling alone with my daughter can still be fun—especially with the help of my friends. I also feel incredibly lucky to have friends from all walks of life back home in Queretaro, living here by choice, as well as a circle of friends I feel happy to have my daughter growing up among.

Creative expression
2012 didn't produce much artwork on my behalf, but I found an outlet with photography, crafts, and most importantly, the written word. We finished our coauthored book Amor and Exile in November, and despite the regular challenges collaborative editing sometimes presented us, it's been an incredibly satisfying endeavor that I have no doubt will produce meaningful fruit in 2013, no matter where its seeds end up being planted (that's my botanical metaphor to say that we shall soon find out whether a publisher is visionary enough to take us on, or whether we will have the liberty to publish ourselves independently). TBA.

Self care
For the first time probably since high school, I spent a full-year in a regular sport: swimming. It's been over two years since I had done yoga regularly (since my daughter was born) but it was something that I've been trying to commit to ever since. I finally began to reestablish my regular practice toward the end of the year. Staying active is difficult to fit in with a child, but it's been perhaps one of the most rewarding things I've done this year. I began to see a naturopathic doctor in neighboring San Miguel de Allende, taking a more natural approach to address some ongoing health issues. I began to cut out sugar and white flour in favor of more whole foods and whole wheat foods. I'm pretty happy with the change as it's inspired me to try out new recipes, and new foods are always welcome in this home.

Nature
As a conservation biologist, all the poaching, pollution, and development in our city is very troubling. But nature's capacity to sustain our lives still inspires me greatly. The simple act of planting seeds (and teaching others to do so) continues to be a source of satisfaction for me. For the first time my daughter was born, I gave a local horticultural workshop. We also restored some of the our garden spaces. Seeing our greywater irrigated fruit trees bear fruit renews my resolve that small acts can indeed have big effects.

When it comes to setting aside the letdowns in order to embrace the victories, I don't think the metaphor really matters—if it results in a deeper appreciation the very powerful experience of being alive, then it would be a blessing to have the chance to do this over and over again, in the year to come.