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.

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!

Una nueva cara de las despedidas en mi vida | A new side to the goodbyes in my life

It's unusual to have 4 despedidas in a span of less than a month.

When I think of despedidas, I think of the one we had in September 2006 in Half Moon Bay just before we left for Mexico. We had already said goodbye to part of my family in NY, and to my parents, brother, and now sister-in-law who'd come to say goodbye to us in California.

That was the last time Margo has seen my sister-in-law.

Or some other despedidas that invariably began to occur when I started making friends with expats who, after living in Mexico for a year or two, moved back to their homes in any number of countries with relatively better economies in other parts of the world. Those goodbyes stung unexpectedly; I was surprised by a rupture of attachments that I hadn't even realized I'd made. I mended my heart in those moments and then resolved to not "get so close" to the ones "who wouldn't stay."

Time passed, things changed, my social circles stabilized, and I focused my attentions closer to home, became a mother. The focus drew more deeply toward my immediate family. I found steadfast friends close to home. With the arrival of a baby began the ritual of closer touch with family. I began to write. I went through a transformative therapy process. I published a book. Raised thousands of dollars and descended on Congress. Became part of myriad online networks working to give some "home away from home" to those exiled worldwide. Became much, much more comfortable sharing my, once perceived unusual, now clearly commonplace, political situation with acquaintances, strangers.

In the process, I unearthed some of the power that I had been missing since that first major despedida.

Coincidentally, or maybe it is that swell of approaching summer, three friends are departing Mexico within weeks of each other. I regret that I will not see them anymore and that I will not be able to afford to go visit them. It is very likely that our relationships will go the way of Skype calls and Facebook chats, when what I'd much prefer is a face to face glass of wine on a breezy mid-spring afternoon.

But the goodbyes don't feel as threatening anymore. Have I invested less of myself? Perhaps I have cast my net of affections more widely. But I haven't found myself holding back as I once thought I might. As they say, love begets love, and I think this goes for friendships as well.

When I talk to my friends of their feelings upon leaving, it's with a knowing heart of the mixed emotions. I can empathize with their ambivalence about what's waiting on the other side; as well as their steadfast knowledge that despite the fact that the unknown is fast approaching, now is the right time to fly.

I think of the words I shared with the delightful Rin of the Shambala-tradition retreat center Casa Werma in Patzcuaro, where I stayed during my last book talk sponsored by the Patzcuaro and Morelia book clubs.

One of the things we talked about was that the only real place we can find as home is in ourselves, and this is one of the things I have slowly discovered more and more to be true as time goes by. I can hug my friends tight, and not feel jealous of their departure. I can feel fully grateful for the time our paths have crossed. And when I wish them well I know that they will be, and so shall I—no matter how many tears get shed in the meantime.

As for my own fast-approaching despedida from the offices of Peace Corps Mexico in less than 2 weeks, that represents another story. It's a story of an unrequitted quest to find long-term satisfaction, in my profession, in a way that can fulfill my family's needs and my happiness. That is a continuing saga, to be told another time.

P.S. Buen viaje, Mahli, Annie, and Krystal.