Messages in a Bottle #13: Placebo Effects

<Image Text>: Doctor says to patient, “You have an extremely rare, hard-to-treat disease. Are you trying to make me look bad?”

I bought pink Himalayan salt pills today instead of my usual generic salt capsales. I know some people think the “highest amount of trace minerals of any salt” are independently useful, but my default assumption is still that salt is salt. I have a scientific image to maintain at all costs, after all. My conception of myself as intelligent largely depends upon carefully managing my own treatment in line with medical guidelines gleaned from published peer-reviewed sources with a preponderance of evidence, etc. etc. etc.

I’ve been called stupid plenty of times in my pre-ADHD-diagnosis days, so even though I have an excellent track record of identifying what is going on with me and my sibling – even when the medical establishment itself is befuddled – I have only ever learned to (mostly) trust myself because I can always cite my sources. It isn’t just me claiming something is true, it’s “the literature.” The bully-in-my-brain is far harsher than any true academic peer review I’ve ever received. I can’t point to a pile of studies that suggest that one type of salt is better for dysautonomia regulation than another, so thus it isn’t. It could be the greatest thing, since, well, normal salt, and I would remain a skeptic until there’s been at least one meta-analysis.

I’m not buying the pink stuff because I think it will work better; I’m buying the pink stuff because I’m hoping it will taste better. I have heard from numerous qualitative narrative sources with “lived experience” (aka Facebook groups) that it tastes better, or, at least, that it comes with a better pill coating that makes it taste less like anything. Even after two years of taking salt pills, I still gag a little three times daily when I take my prescribed grams of salt daily for dysautonomia. I know there are white salt pills out there that are so well-designed that they truly do taste like nothing. In a world where science can design “burpless” non-odorous fish oil tablets, simply masking the taste of pure salt isn’t an intractable user-design challenge. But, those resulting fancy “sports performance” salt pills are almost twice the cost of simple salt pills. Since I take half a dozen of them daily, that cost differential adds up.
Today, though, Amazon had a sale that reduced the cost of pink salt pills with an external pill coating to the same as the uncoated white salt pills that I normally buy. I jumped on it. Even for a month, it would be nice not to have to choke down the taste of pure salt in the morning. (If you don’t have dysautonomia, grab your salt shaker and shake it into your mouth immediately upon waking up. That should give you a sense of why taking my morning uncoated pure salt pills remains so unappealing even years later!)

I readily admit that this sale could set a dangerous precendent as – after a month of potentially not gagging a little three times daily – I might not have the willpower to return to the cheaper stuff. I still suspect that even if I do end up shelling out more regularly for pink Himalayan salt tabs, it will still be because of my taste preference, not because some salt is better than other salt. I have that self image to maintain, after all.

I could be wrong though. I have an excellent track record of identifying my own symptoms once they rise to the level of being so intrusive I can’t ignore them anymore. I can be fairly oblivious to sub-threshold issues. This morning’s purchase reminded me of one of those times when I convinced myself I was falling for the placebo effect, but I had accidentally stumbled onto a real medical issue that benefitted me to treat but would probably never have risen to the surface if not for my own ADHD inattentiveness.

This week’s Message in a Bottle is the story of how I accidentally empirically detemined that I was deficient in zinc simply because I failed to plan ahead. I wrote up the experience in a post that I originally intended for my nascent blog in 2017, but by the time I actually got the zinc test that confirmed I was deficient, I had forgotten about it. Any memory that I had ever written that post remained lost to the far corners of my brain – though I do take zinc and get my levels checked every six months – until this morning. It’s a bit of a mistake to claim that there is no filing system within the ADHD brain. If there wasn’t, I’d never have been able to retrieve the memory in response to any reminder at all. It’s more like…there’s a poorly designed filing system based on quixotic semantic associations that change every few months.

I couldn’t retrieve the appropriate filing index for “I once wrote a blog post about wondering if I had zinc deficiency” when I was tested for zinc deficiency. That would be too simple. I could retrieve that post after buying pink Himalayan salt pills this morning because the index was actually tied to the semantic category of “all the things in the world that might cause placebo effects.”

Also, for anyone wondering, yes, there have been a few published studies suggesting that zinc can mitigate some ADHD symptoms in those with measurable deficiencies. But, its effectiveness seems to be limited to symptoms of hyperactivity and impulsiveness. Thus, zinc itself is probably not ever going to help me remember whether or not I have written any posts about zinc deficiences. However, paradoxically, having my rather “unique” mental filing system and network of semantic associations has actually been one of the most beneficial aspects of having ADHD for me as a scientist. While everyone else is thinking “B” when “A” is mentioned, I’m usually the one activating “X, Y, Z” and going “but, umm, what if it was actually this…” (Also the one going “I need to zinc think about this for a moment” because once I realize what they might be missing, I also realize what I might be missing, too!)

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Subway Sociology #7: Weed Out the Weak

I have spent many years traveling on a graduate student’s budget. Travel was – and is – my preferred way of handling the Christmas holidays, which would rank second after the week-that-shall-not-be-named (aka this one) on my list of least favorite times of the year, except for the fact that my travel tradition actually makes it one of my favorites. (At least, in those years when I can afford to travel.)

Traveling for mental health is my way of flipping the script on what would otherwise be a traumatic time of year, but given that I spent years making an income as a graduate student that didn’t quite leave me destitute – but also didn’t qualify as “comfortable” either – I never got used to the luxury of rental cars. I have never rented a car in any city that had viable public transit. I’ve had my fair share of ridiculous moments trying to navigate unfamiliar transit as a result, but I can’t at this point imagine ever renting a car in a transit city after so long getting by without one. Why pay eighty bucks for parking when I can pay ten dollars for a day transit pass?

I certainly can’t imagine renting one in my own city. I never learned to drive here. We had a car when we first moved, but the lack of street parking, the prospect of “parallel parking” if we ever did find parking, the feet of snow dumped on cars in the winter, and the extortionary private garage parking fees required to avoid dealing with any of the former quickly led to us giving it up. Even for the brief period that had a vehicle, we never drove to any popular tourist locations.

My Partner’s grandparents were traveling with childhood friends who had moved to another Southern state as part of an annual get-together tradition, and their stop in our city was one among several on the East Coast. (I continue to be amazed that there are people in this world who have maintained friendships for more decades than I have been alive, but this, like young marriage, seems to be the norm in the South.) Their hotel was outside the city because hotel costs are possibly the only thing more disproportionate than parking (or rent) in our city. They asked us to show them around, and we (naively) assumed they meant by subway. However, they were not comfortable using public transit, even with locals to personally shepherd them from Point A to Point B. They seemed convinced that the subway would be unsafe, dirty, and unreliable.

Subway Sociology #6: I Seat Drunk People

Did I ever mention that I am an irony magnet?

This is an important baseline state of reality to establish for new readers who might otherwise question how my Partner and I, specifically, ended up being the second and third of (hopefully only) three residents of a large urban city stuck explaining the intricacies of Pokemon Go to a drunk “friend” supposedly hiding from his “ex-girlfriend” at our table at Shake Shack while thousands of gaming confederates across the country caught their Bagon unaccosted during Community Day.

Since that drunk “friend” specifically requested “cover” while he snuck away to the nearest subway entrance, our experience thus represents the sixth valid trial of my subway sociology experiment. My original hypothesis was that the line I take to improv is statistically “weirder” than nearby lines. My current tally of blog-worthy baffles runs 4:2 in favor of the line in question. Suggestive, but not at all statistically significant, especially when properly controlling for my own frequency of line ridership.

My Partner, however, wishes for me to note that I have potentially overlooked two additional hypotheses worthy of testing: a) my irony magnet superpowers extend to subways and b) there are statistically higher rates of oddball experiences on all subway lines (as well as in general) whenever I am nearby. He pointed out that my having previously mentioned hydration drinks being advertised on public transit as hangover remedies without actually describing any real-life interactions with their target audience could be construed as daring the universe to offer me up a live specimen. Irony. Magnet. (He also suggested, after he had finally forced our “friend” out into the wilds again, that I should refrain in the future from being the one to nab seats for the two of us even in a crowded fast food joint well over its listed capacity of 131 people. The risk of my irony powers kicking in is just too high whenever I’m talking to strangers for even a minute…)

Shooting for the Spoons

A lot of popular wisdom is rather dubious when actually examined. For instance, the common career advice to, “Shoot for the moon. If you miss, you will still land among the stars.” Unless the flat-Earthers know something I really don’t, even good old Sol is much further away from us than the moon…

Another bit of dubious popular wisdom I hear regularly from would-be experts (who have usually never heard of most of my diagnoses before) is, “An apple a day keeps the doctor away.” I certainly am careful with my diet, but an apple a day does not keep the doctor away for me. In fact, following the common wisdom for most of my working life to eat as naturally as possible on business trips to minimize GI symptoms has been about the worst possible choice for me. On travel per diem – and thus not responsible for remembering expiration dates for the fresh veggies and fruit that I so often forget in my fridge for weeks until they spoil – I would load up on all of the fresh fruit in an attempt to keep the gastroenterologist away. And, yet, I always felt like my IBS symptoms were worse on business trips anyway. The inevitable refrain from the “apple a day folks” – and many of the doctors that were supposedly being kept away – was that it was just “my anxiety” exacerbating my symptoms. So, I both had to plan for disaster each time and for the bully-in-my-brain to refrain how it was my fault since I couldn’t just “relax.”

Improv #15: Twitterpated

*Knock knock*

“Who’s there”

“Hashtag”

“#who?”

“#whoknewTwitterwasoccassionallyuseful? Not me, at least not until today…”

I do not take the full – or even the half – advantage of social media that a blogger is supposed to, so I can’t actually add my contribution to the #AbledsAreWeird Twitterstorm on Twitter itself. I can say I have been laughing myself silly over that hashtag today. For any spoonie who hasn’t seen it, I highly advise you to check it out when you need a break from the world today.

Since I am not twitterpated by the idea of adding yet another form of social media for my poor ADHD brain to have to manage in general, I’ll add the contribution I would have tweeted if I bothered to maintain a Twitter presence for my blog here instead. (But, though I’m only posting here, seriously go check out the actual hashtag on Twitter too!) I will, though, at least conform to Twitter rules and keep my contribution to 280 characters:

Improv actor share:”Doc 1st thought symptoms were chronic, but thank God my infection was acute. How could I live w/pain forever? Life wouldn’t be worth living!”
Lav(next up w/visible cane):”I guess my share is I’m chronically ill & life is worth living? Kthanxbai”#AbledsAreWeird

Yes, that’s a true story, and from very recently. No, I have no idea what, if anything, I should do about it. The person who made the comment was just a student in a class with me. That class is now over. In principle, I won’t see them again? (I mean, it’s not like I’m going to choose to perform in an indie troupe with someone who’d speak like that when I’d previously shared that I occasionally require accommodations for the physical parts of improv because of my chronic illnesses and they still thought that was an appropriate way to phrase a weekly highlight…)

But, the instructor, who is a regular and very serious theater performer, also did not seem to get that there was anything amiss about that comment. This speaks to the broader complete cluelessness about spoonie sensitivity that the hashtag also makes apparent. There’s clearly a need for more awareness among the theater crowd about a) why a spoonie’s life is worth living, even with their chronic illnesses and b) why if an abled performer doesn’t happen to agree, they should still keep their big fat mouths shut about it since at least 1 in 4 of their audience members will also be living with some form of chronic physical or mental illness.

The theater has been encouraging “tough conversations” around diversity and women’s issues in the theater recently. So, it seems like it might be an appropriate time to point out that many performers – and audience members – are also members part of the largest minority group in America. It is just as critical to have “tough conversations” around how to speak about disability as it is to discuss how to speak about race, class, culture, religion and sexual orientation. I am getting really sick of even so-called Progressives managing to include just about every possible form of inclusiveness except disability in their sensitivity training. I’m also not really high enough up in the theater to know where to start to change the narrative, unfortunately…

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Need a recap of anything I’m talking about in any post? Check out the Glossary of Terms.

Crushing it

Things that went through my mind in the process of composing this week’s blog post:

1. To Partner: “We need more of those crushable baking potato chips that are not potato chips…”
2. Hey, there is an entire site devoted to logging prior weather in the U.S.! Someone anticipated the deep-seated need of the ADHD community for a site to fact check them when they write, “Even though it seems hard to believe when we hit the 70s this week, we were in the 20s just last week” and they can’t perceive time well enough to remember if it really was “just last week” – or only felt like it.
3. Good. My Partner added bread crumbs to our order.
4. That historical weather site was probably intended for historical fiction. Solipsism is great in theory, but the idea that my mind shapes all of reality falls apart immediately upon being reminded that there is (still) no site to determine the actual word I am looking for from the random descriptions of my ADHD/brain-fogged mind. If the Internet were built around me, there would be. Ipso facto, my mind is not the only one that exists.
5. To Partner: “You are right that if we order bread crumbs instead of making them, then they are not ‘crushable’ but ‘already crushed.’ Isn’t tense relative to the frame of reference though? By the frame of reference of the bread crumbs, the description is ‘already crushed.’ Potato chips don’t come pre-crushed. So, didn’t I use the correct tense for their frame of reference?”
6. The moment an AI can obtain ‘bread crumbs’ from ‘crushable baking potato chips that are not potato chips’ – regardless of tense – is probably the moment we achieve the Singularity.
7. This list of random thoughts is about to be longer than the rest of the blog post.
8. This is also why my Partner and I crush games like Taboo and Heads Up. Maybe I should just go with that and make this post about how effective communication in relationships becomes even more convoluted with brain fog?
9. I should still explain why I was originally looking up the weather last week to fact check myself, even though it seems kind of anti-climactic now to state that chronic illness and ADHD can lead to word-finding difficulties when I’ve clearly shown it.
10. Wait, my original example works just as well as an example of effective communication with chronic illness! I can just relay the original conversation from last week’s cold snap that was intended to become a polished blog post verbatim! Crushing it.

Eek! Previews

<Image Text>: “You can’t make this shit up.” – Me describing my life.

Emotional flashbacks are tricky to recognize. You can become thoroughly caught up in the fight/flight/freeze responses of the past without even realizing you have shifted. And, even if you do realize you are in one, it can be tricky to recognize to what, exactly, you are flashing back. There are, after all, so many discreet instances of various types of trauma in C-PTSD that they all blend together into one continuous mess. Emotional flashbacks rarely have a clear visual component, whether projected in the real world as per the traditional public conception of a PTSD “flashback” or just replaying a memory from your personal mental mindfield.

Nothing about 2018 was unique, except possibly learning for sure that others knew all along about my childhood trauma and, frankly, my dear didn’t give a damn. I’ve had to testify against abusive group homes before. I’ve had my grad program tell me, “Defend the same week as I fought past abuse or forgo everything by dropping out.” That’s not really that different from a boss whose first words upon learning about the life-or-death stakes of 2018  were that bothering him with that knowledge constituted proof that I was a poor-performer, that I’d always been one, and that I’d probably always be one and whose last words before I went on not-FMLA were, “You have three months. Deal with the issue and return to being useful or this company will have no more use for you.” (Let it be known that his claims about my performance have no official backing. Threats aside, my boss has always managed to be in the right mood on my actual performance review day to rate me a high performer on paper, even if he gaslights that reality later whenever he finds it convenient. But, that doesn’t help much when it’s his company.) Hell, I’ve even had to testify to abuse enablers in the 9th Circle of Hell both of those times the same week as my birthday. And, I already hated my birthday because not correctly perceiving social schemas around birthdays as an undiagnosed ADHD child made them dreaded dates as far back as I can remember.

It really comes as no surprise, then, that it’s typically hard for me to determine what I am reliving in an emotional flashback (or even that I’m in one). It comes as more of a surprise when I do realize. There are only two instances where I can even predict that I’ll have an emotional flashback, much less to what specific memory.

Trust in Mental Health Treatment (Part 4): Choose Your Own Adventure

So, I potentially have good news. I’ve gotten to the final round of the interview process for a new job in my same city. It’s what I do now but with a different organization. I’ll update eventually whether I got the job, but talking about it right now feels a bit too much like tempting fate. I’m not a fan of pure CBT, but even I’ll admit I’m engaging in a bit of magical thinking by staying silent. I know, I know. However, PTSD and its sense of foreshortened future mean talking about anything positive that hasn’t happened seems like it will only make me look like a fool when it doesn’t happen.

I have no such qualms, though, about talking about my fears of what will happen if I get the job. C-PTSD is fine with that. The commute will be just far enough that I won’t be able to make it to my therapist during her normal business hours. She was able to do a limited number of phone sessions while I was in the 9th Circle of Hell last summer because she knew that was an active trauma crisis, but she can’t, unfortunately, do regular phone sessions. I’ll also have to go to trauma yoga on Saturdays instead of during the week. That’s…not terrible. But, it will mean a bigger class in front of which to modify my yoga-for-hypermobility. There will probably be social anxiety compared to the three people that regularly go to the class I currently attend, but I guess I can live. How unsettled I feel not being able to attend weekly therapy, though, is one reason why I never fully wanted to develop trust with a therapist in the first place. Not all therapists are the abuse-permitting social workers of the 9th Circle of Hell, but, in the end, they are all running businesses. They’ll only modify so much, so my brain (bully and other parts) says don’t depend on someone for whom helping me lasts only as long as I am convenient. (Alongside the issues I wrote about in the first three parts of this series.)

Forget attachment. I’m still a survivor of enough systemic abuse that I’m shocked I even got to trust with anyone who is part of a system. But, shockingly, I did, and I don’t see myself being the kind of person for whom lightning strikes twice. My therapist attempted to suggest there might be others closer to my potential new workplace whom I could trust, but she shut up quickly upon seeing my look. She then switched to, “Ok, I think you are strong enough that you could do more like once a month. I think you’ve been through enough with irregular support during the Crisis of 2018 that you can manage in 2019.” I’d be willing to take a half day to see her once a month during her hours. I’ll admit to being scared of tapering therapy, but not scared enough to contemplate finding another therapist. The legacy of systemic abuse runs deep, and the system she is in – and the others that both my insurances have covered for outpatient therapy – are really not trauma-informed. She’s the rare exception in a clinic I’d otherwise bitch about. (My psychiatrist, who is not necessarily trauma-informed for most but likes me, has Saturday hours. I could keep seeing him.)

I’d actively choose once a month therapy over trying again with anyone else. But admitting out loud that therapy was an important part of my support system during the Crisis of 2018 was terrifying. What if I’m not really strong enough yet to taper? Last year was pretty damn re-traumatizing.

What if I shouldn’t even be looking for a new job at all because I don’t have the spoons? The commute isn’t just too far to make therapy: it’s also a commute at all. I’m currently a remote worker, and that saves a lot of physical spoons. It doesn’t save mental spoons, though, I’m only a remote worker because I exist within a limbo wherein my boss finds me too useful to purge, but too much of a hassle to talk to.

When I started to panic-think maybe I should just stay with my current company, my therapist very quickly shut me down by reminding me how many of my boss’s communications she has read while I cried. As she has stated, she “can’t ethically diagnose someone” she hasn’t met. But, while she can’t speak clinically, she did suggest that I do some serious research into the various presentations of narcissism and think hard about why my current boss was able to trigger full-scale PTSD episodes when I still saw him in person. 2018 wasn’t the first time I had to testify to ongoing abuse in the 9th Circle of Hell. I testified against the Thesis Defense Rests Stop the same week as my thesis defense (hence the moniker). Yes, each successive trauma adds a straw to the camel’s back. But my boss…also reminds me of someone who abused me personally in a way no one outside the 9th Circle of Hell ever has in my entire life.

The day of my end-of-year-review – which perhaps I will eventually write about – was a perfect example of my the way my boss can start the day in such a towering temper I wonder if I will still have a job at the end it, but then whiplash to being conciliatory to the point he asked if I could use more physical accommodations. What changed in between? A combination of a) something I produced being very well received by clients on a call between the beginning of the day and my review and b) letting him take all the credit for it. With my history, my instinct is to roll over and hand off intellectual credit for anything I do to anyone who scares me because C-PTSD says “stay safe by staying out of sight.” That…works with my boss. It’s probably a big part of why I got concessions and the rest of my office got fired last year.

But, as my therapist notes, he exacts a cost in mental spoons that is likely more damaging to me than the cost of the physical spoons from commuting. It’s not generally a smart idea to work for someone who pings your PTSD to flashback to childhood abuse. Even if I hadn’t experienced childhood abuse, working for someone who can flip moods so drastically and so quickly is not a great idea, period. Nor is working for someone who has flat out stolen the academic work of all those who are under him in a field that typically recognizes subject matter experts as experts. There’s also the pesky fact that I still have the gut instinct that the company itself isn’t financially stable, and I could lose my remote job by 2020 even if I’m able to keep my boss perfectly happy until the day the doors close for good. I’d rather choose my own adventure now, while it still is a choice.

Therapists don’t usually tell you what to do, exactly, but mine seemed worried enough by the prospect that I’d not take a job if I got it because of the fear of losing one piece of my support system that she ended with “we’ll work out what happens with therapy, but I really don’t think you should trust your boss longer when you have another option.”

We’ll see what happens. I don’t know if I will know yet by next week whether I’m their final candidate. Whether or not I do, next week’s post will be a review of the strategies that kept me sane while testifying to abuses in the 9th Circle of Hell in 2018 without consistent access to therapy. Maybe if I write out what helped me then, it will help others unable to access good therapy now, whether because of a therapy break, because they only have access to those horrible therapists in their area that are the reason I’m so afraid of ever starting over with someone new, or because they can’t afford decent care. (The U.S. sucks at mental health, did I ever mention that?) And, maybe it will also help to reassure myself that I can eventually return to working in a real office – with its increased physical demands upon my EDS/dysautonomia – because the mental benefits from reduced anxiety, depression, PTSD and panic are worth it. Maybe it’ll convince me that I can be strong later since I was strong enough before.

Also, if I flat out state that I won’t be writing about what happened with the job next week, then perhaps  I won’t feel internal pressure to “follow up” with the “bad news” my brain thinks it will inevitably receive. I write a lot about failure on this blog, but I’m trying at least this week to tell myself someday I might also write about success.

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Need a recap of anything I’m talking about in any post? Check out the Glossary of Terms.

 

Written on the Prophetic Plates?

<Image>: Smug cat on a ledge with a broken vase on the floor. <Text>: This is why we can’t have nice things.

My Partner and I are going to a game night tonight hosted by someone I met through an ADHD support group. So, of course, I had a dream that the hosts kept serving me party food on real plates, and I kept progressively dropping them. I desperately tried to explain, “Please stop giving me nice things. I drop things constantly,” but somehow the china I was handed just kept getting progressively finer…

On the one hand, I hope that doesn’t become a self-fulfilling prophecy. It is wet and slippery out today. I also didn’t sleep well – no thanks to that dream.  And, it would be nice to actually make “friends” with people before I break something (of theirs or of mine) in front of them. On the other hand, if there will ever be a household where, “I know I’m clumsy, but I forgot to put my plate down before my hands got too tired” might actually make for an understandable explanation, perhaps it would be a fellow neurodiverse household?

I’m sure this dream has nothing at all to do with the fact that I read the Ehlers-Danlos Society’s “Mental Health Care Toolbox” on Facebook yesterday or the fact that it noted that people with EDS and HSD have a higher incidence of anxiety, depression, and ADHD. Or the fact that I have fallen down in public places twice recently. Nothing at all…

<Image text>: I’m not clumsy. It’s just the floor hates me, the tables and chairs are bullies, and the wall gets in the way.

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Need a recap of anything I’m talking about in any post? Check out the Glossary of Terms.

 

Improv #13/Subway Sociology #4: Party Poppers

*Knock knock*

“Who’s There?”

“Wobbly”

“Wobbly who?”

“Wobbly out in this weather when I know I will fall over? I’m very dedicated to my art, ok? Now offer me a seat on this train before it’s you I fall onto…”

Amtrak preemptively canceled some Acela routes and other regional commuter routes in advance of the snow this weekend. City transit authorities are posting their standard “expect delays on above-ground routes.” In addition to keeping us abreast of their plans to keep us safe – albeit possibly not on time – during the winter weather, both agencies also seem to be touting themselves as the solution to all the city’s partying needs lately.

On the way to Improv today, I saw ads introducing several bus and train operators who “skip the party, so you don’t have to.” I’m guessing several other class members also noticed the recent uptick in public transit emphasis on how their employees ensure we can have a good time by working while everyone else is playing. “Partying” was a prominent theme in our montages today.

There’s nothing more thematically appropriate for that inevitable first time I sublux something on stage and fall over than during a scene in which the administration of a “party school” with a name one letter off of the Ivy League discuss how to improve their image. This was a class, not a live show, so people stopped scene work and asked about me. I almost wished it had been a public show, though, as I doubt I will ever again get such a gift of a scene to play off a sublux and associated fall as “intentional” than during that one.

With a class, it’s…well…as awkward to bring up EDS in advance as it is to sublux something on stage. I’m in the dual position of both performing in indie shows with a troupe, but also simultaneously being a student. I have to actually graduate from the theater’s comedy school if I ever want to audition for anything solo, and graduating to each next level requires not just an instructor thinking I am ready in my performance capabilities, but also having missed no more than two classes out of any session. The Crisis of 2018 ensured that I wasn’t in the position to even contemplate that kind of attendance commitment for the past two sessions, so I never even bothered to register. I also fainted just before the first class of this current session and thus missed its very first class. So, no guarantees I will make the attendance requirement this time around either. My indie troupe – who are all now graduates – didn’t drop me when I got behind last year. I could conceivably have had my first onstage sublux happen during a real performance, with a team who have been warned in advance to just keep going and use the exquisite thematic timing to heighten, heighten, heighten.

But, as with last week’s hair appointment, I don’t typically get that lucky when introducing my diagnoses to new people. Explaining how I occasionally fall over – and to just give me a minute to see if I can reorient my own joints before treating it like a big deal – is still just…awkward. I never know how to respond to the sort of excessive solicitousness that people offer immediately after they first see me faint or pop a joint.