When I Finally Fell

Nine years ago, on the first day of December, shocked, dazed, and bewildered, I found myself sitting in the "quiet room" off the waiting room of the ER of Northwestern Memorial Hospital in Chicago. My belongings had been taken away from me and there was a security guard at the door. At one point someone inquired about his whereabouts over the radio and he responded, "I'm sitting on a 64." That was me. A 64. I didn't need a code book to tell me what it meant. A 64 was a psychiatric patient.

It could be said that landing in a psychiatric hospital was my destiny from the moment I was born with a brain that couldn't properly produce and process neurotransmitters the way healthy brains can. It was inevitable that at some point my depression would plunge to depths beyond what I could cope with. Moving to Chicago that August had set in motion the events that would land me in the quiet room.

I graduated from college in May of 2003, spent the summer working at a mortgage company, and then, in August, moved to Chicago to pursue a MFA in Writing at the School of the Art Institute of Chicago. The only time I'd been to Chicago prior to the move was when I visited in late July to look for an apartment and the only person I knew was one of my best friends from high school.

One of the school buildings on
Michigan Ave.

I loved Chicago from the outset. I loved the old buildings, the big-city energy, and riding on the el. I loved that much of the School of the Art Institute of Chicago was housed in skyscrapers; how cool is that? One of those buildings was on Michigan Avenue, across the street from the Art Institute of Chicago (the museum) and there was a cafeteria on the 12th floor with a phenomenal view of the lake and Grant Park. I hadn't expected the waters of Lake Michigan to be so turquoise! It was one of many things about the city that delighted me.

I lived with my friend when I first arrived, having been unable to find a satisfactory apartment during my brief visit the month before. She lived in Roger's Park, at the far north end of the Red Line, when I first moved there, but shortly afterward she relocated to Hyde Park, as she was starting graduate study at the University of Chicago. The trip from Hyde Park to downtown had to be accomplished by bus, a less congenial form of transportation in my view than the el, which spurred my efforts to find my own place. I ended up with a great studio apartment in Logan Square.

My first apartment was on the second floor at the bottom of the "U" of this courtyard building.

It was spacious, as far as $500/month studio apartments go, with a separate kitchen, a walk-in closet, lots of windows, and had recently been refurbished with new kitchen counters and cabinets, a new fridge, a fresh coat of paint, and the floors had been refinished. Shortly after I moved in, the landlords replaced all the windows, too. It was my first place of my very own, and I loved it accordingly, taking great pleasure in cleaning it from top to bottom every week. I liked that the buildings across the alley from my kitchen window had back yards, so I had a view of nature rather than the wall of another building. (I also, at night, had a view of rats swarming the dumpster behind a restaurant, but that, too, had its own charm, since it was part of living in a big city.) I liked that my apartment was just off the far end of the Logan Square Blue Line el stop. I also loved the address of the apartment itself: 2649 ½ N Spaulding. It was the "½" that delighted me: I hadn't known that fractions were permitted in an address!

My little kitchen!
(I took only nine photographs during my time in Chicago--this is one of them.)

I had also, much to my surprise, fallen in love. My high school friend had introduced me to a coworker of hers as a potential roommate and friend. The roommate option ended up not working out, but it had been practically love at first sight for both of us. He lived in Logan Square, too, and I loved walking from my place to his and marveling at the old apartment buildings on Kedzie.

In those first months, Chicago was, for me, the buildings I'd read about during my history of American architecture studies: Burnham and Root's Mondanock Building, walking past Louis Sullivan's Carson Pirie Scott Building every day on my way to school, the iconic Sears Tower, and the view north along Michigan Avenue of the Wrigley Building, the "corn cob" buildings, the Tribune Tower, and the John Hancock Building; it was the taste of Indian food on Devon Ave, vegetarian food at the Chicago Diner in Boystown, nachos at the Heartland Cafe just down the block from my friend's Roger's Park apartment, chocolate chip pancakes at the Bongo Room in Wicker Park, the Puerto Rican dishes cooked up and offered for free one night a week for a time by the motherly bartender of the Whirlaway in Logan Square, and last but not least, Pasta "YiaYia" (a divine concoction of feta, cinnamon, brown butter, and garlic) at Logan Square's Lula Cafe; the Picasso statue downtown, the view of Graceland Cemetery from the Red Line, the bizarre (in my opinion) wood fire escapes on the back of every brick and stone apartment building, the black dust in my apartment (no doubt from the coal-fired power plants still burning in Chicago at that time), the unfortunate sewer aroma that emanated from every storm drain, the constant cacophony of horn-honking Chicago drivers, swarms of pigeons with missing toes (frozen off during the frigid winters?) perched on the underside of the elevated line that rose over Wabash Ave outside the building that housed most of my classes, and the pleasure of stumbling upon the vibrant sounds of the Hypnotic Brass Ensemble, as this was during their early years when they were still playing on the streets of downtown Chicago.

A portrait of the artist as a young graduate student.

Not everything was easy. As part of my financial aid package, I was supposed to get a work-study job at SAIC. Unfortunately, I moved a little too slowly to secure a position, so many filled even as I applied, but I was also hampered by my terrible social anxiety, which made me unable to even enter the offices (or sometimes the buildings) where open positions were available. This inability to get a work-study job weighed heavily on my mind--and was hard on my finances. And while I very much enjoyed my classes, particularly the elective art course I was taking, I had unfortunately been assigned a writing advisor who was a terrible match for me. He was the sort of person who loved critical theory and I was the sort of person who decided not to become a literature major because I loathed that way of thinking about writing. He criticized the first pieces of writing I submitted to him as not being current enough; I protested that I had just moved to the city, I didn't know enough about where I was to even write about it. And then, when I tried, he dismissed my efforts as cliched. At that time, I was so shy and anxious and insecure that I struggled to show anyone my writing at all, sure that it was not worthy of being seen, and his blunt and sardonic remarks confirmed my fears. I swiftly developed a terrible case of writer's block. It's a truly demoralizing thing to have writer's block when you're in a writing program and I was not well enough at the time to advocate for myself. Things were starting to slip out of my control.

On one side, my sun-lit street, on the other side, total darkness

I can vividly remember walking down Spaulding Ave one sunny afternoon in early October and having this sense within me that I was teetering on the edge of darkness. I could picture it so clearly in my mind, the razor thin line on which I walked, the bright Chicago sun on one side, the black depths falling away to the other. I didn't know at the time that I was experiencing my seasonal changeover from my summer hypomania--which had given me the energy and enthusiasm to embrace this move to a large, unknown city--to my wintertime depression. But the metaphor of teetering on the edge of darkness was very apt, and around the end of the second week of October, I fell.

My $75 purple comforter was only
marginally effective at keeping me warm 

The weather changed, becoming cold. I had spent the past four years in Florida, so while I was well-equipped to handle the summer heat of Chicago, I was ill-prepared to withstand the chill. After fretting a great deal about the price, I bought an artificial down comforter. (I'm allergic to real down.) I also purchased an extremely unflattering "sleeping bag" coat. At night I would huddle under my new comforter with my heavy coat over me, too chilled to sleep. My apartment was cold because I was too embarrassed to call my landlord to say that the radiator in my main room wasn't turned on. It was my first experience living with radiators and I thought maybe there was a valve you turned, but this radiator didn't have a handle on the valve and I didn't have a wrench large enough to turn the bolt. I was worried that somehow I had missed something that I was supposed to know and therefore couldn't stand the thought of exposing myself to my landlord's ridicule: this is how you think when you have social anxiety. I also couldn't bring myself to ask them to unplug the drain in my bathtub, so every time I took a shower I ended up in nine inches of slowly draining water that served as a mocking reminder of my failure to be a normal, functional human being.

Money was also worrying me a great deal. My parents, before I graduated from college, had told me not to expect them to support me, and I took this to heart. Thus, I felt I couldn't ask them for help as my savings dwindled and I remained unable to get a job. Having failed at getting a work-study job, I tried and tried to bring myself to ask for a retail job, but couldn't ever work up the nerve. The holidays were approaching and the Magnificent Mile was crowded with shoppers as I walked up and down Michigan Avenue and through every floor of the Water Tower mall, trying to will myself to walk into stores and ask for a job. Even when the stores had "help wanted" signs posted, I still couldn't make myself ask for an application. I spent many afternoons this way, feeling more and more like a failure. I hadn't been able to afford to fully furnish my apartment, so the box my eMac came in served as my desk; I ate my meals sitting on an upside-down plastic wastebasket with my plate on my knees.

In addition to my lack of a job, writer's block, and cold apartment, I was also beset with racing thoughts that kept me awake late into the night as I worried and worried and worried and worried. I told some of this to my parents when I called home and they provided coaching and encouragement, but as the weeks passed and I still failed to call my landlords and get a job, I starting avoiding my parents' calls, letting them go to voicemail and only occasionally calling back. I was too ashamed to admit I hadn't made any progress.

My drawings with text explored the
possible nature of God.

The week before Thanksgiving was Critique Week at the School of the Art Institute of Chicago. There were no classes; each student was assigned a time and a date when he or she would present work from that semester to be critiqued by a committee. This was extremely nerve-wracking for me, as I dreaded being judged, and my critical, sardonic advisor was on my critique committee. My critique wasn't until Friday, so I had all week long to worry about it. The night before my critique, after having dinner with my boyfriend at his place, he dropped me off at my apartment as he headed out of town. The water in my building had been turned off earlier in the day for maintenance and I discovered, when I got home, that the pipes were groaning and howling at high volume. Fortunately, I was able to catch my boyfriend before he left (this was in the days before everyone had cellphones), and he let me stay at his place. I slept better there than I would have with the pipes serenading me at my own, but I was still so nervous that I broke out in hives while taking a shower that morning. The work I was presenting for my critique was a series of drawings with text that I had been working on for my art elective class; I may not have been able to write, but I had been able to get a lot of good artwork done. Still, I was so anxious that I had to sprint for the bathroom, my stomach in revolt, while I waited for the committee to arrive. My critique went well and I did appreciate that my advisor understood it better than the others. Afterword, he told me I could have been bringing my drawings to our meetings, but I hadn't wanted him near them. I was sure that he would ruin them for me with his cold, rational assessments. Later, he sent me a rather condescending email, calling me "kiddo," and told me that maybe I just wasn't mature enough for grad school yet. I may have been the youngest student in the MFA Writing program, the only one who had gone directly from college to grad school, but I knew the problem wasn't one of immaturity. The problem was anxiety. But I didn't know what could be done about it.

The following week was Thanksgiving, which I spent with my boyfriend's family. I had met most of the attendees of the dinner before, but fretted enormously ahead of time over what I should wear and felt, as soon as I was dressed, that I was wearing exactly the wrong thing. I don't imagine anyone else gave it any thought, but I spend the evening feeling awkward and foolish. I was waiting, too, for the imminent onset of my monthly premenstrual migraine.

At that time I was getting a three-day migraine every month. They were quite severe: I'd spend those three days in a shadowy underworld of pain. I was used to having a mood drop with my migraines, especially as they abated, but this time, the drop was unusually severe. I found myself unable to sleep on the night of the 29th of that month, feeling more and more agitated as I was beset by a frightening desire to hurt myself. I'd had some thoughts of harming myself in the past, but I had made it very clear to myself that this was a line that was never to be crossed: it might be contemplated, but never, ever acted upon. For the first time, I found myself very much in doubt of my ability to resist the urge. Every time I tried to block the idea from my mind, it would think of a new way I could injure myself. Walls suddenly seemed like places to bang my head, windows were things to be smashed and jumped through, every corner of every shelf and desk and table presented itself as an instrument for pain, the razors in the bathroom cried out to be used, the knives and utensils and the blue flames on the stove in the kitchen started singing a siren song, and the urge to run out into the traffic on the busy boulevard was powerfully strong. I sat in bed, I dared not move, as my world morphed into a horror movie. I knew it wasn't right, I knew I should wake my boyfriend, I knew I should ask for help, but I couldn't bring myself to express my horror. I clawed at my forearms with my fingernails, hoping it would suffice, that it would ease my desire to inflict pain upon myself with more dangerous objects. Eventually, I slept. I have no particular memories of the next day, which I likely spent in a migraine daze, trying to shut out the need for injury that had woken in the night. But again, late that night, the desire rose to a level of torment. I was shocked, appalled, flabbergasted, bewildered, utterly opposed to the idea of hurting myself, yet I seemed to be drawn toward it as powerless as an iron filling drawn toward a magnet. I didn't know what to do. I knew full well that I wasn't in my right mind, that things had gone terribly wrong and beyond where I'd ever been before, but I had no idea what one did in such a situation.

Finally, on Monday, December 1st, 2003, I realized that, as a student at SAIC, there must be a student health center I could go to. I was able to get an appointment with the doctor that morning and I presented the problem to her as an unusually severe episode of my typical postdrome migraine depression. After voicing dismay over the general severity of my migraines, she sent me to see the counselor to discuss the self-injury urges. When the counselor heard what I had to say, she cancelled the rest of her morning appointments, hailed a cab, and took me to the hospital.

The counselor spoke to the triage nurse in the emergency department on my behalf. It was 12:05 in the afternoon. According to my records, security searched me at 12:10 and I was placed in the quiet room. And there I waited. I had nothing to do. There was a TV with the volume turned down and poor reception on the wall, but I had no interest in the daytime talk shows being aired even if I could have followed their progress. At one point I was escorted to the bathroom to provide a urine sample; later, the security guard outside the door arranged for some lunch to be brought to me. It was a turkey sandwich. I am a vegetarian, so I had to make due with eating the roll. At 2:00, I saw the intake psychiatrist. She decided that I needed to be admitted. At 4:15 I was moved to a small bay on the edge of the ER to wait for my medical exam. A new security guard watched me from across the hall. I began to cry and quickly overwhelmed the meager supply of tissues I had on me. There were no others to be had in the little room and I was having to wipe my streaming nose and eyes on my hands. That was the lowest point, crying under the impassive gaze of the security guard with snot all over my hands, not knowing what was in store for me, feeling frightened and alone. After what seemed like an age, the security guard left her post and came back with a box of tissues. When a nurse came in to get my vital signs, she was very kind. "You're doing the right thing," she said. They let me call to leave a message for my boyfriend. "I'm at the hospital," I told him, but I was too confused and overwhelmed to remember to tell him which one. At length, I was medically cleared for admission to the psychiatric unit. That meant I was transferred to what, I discovered in my hospital notes, is called the psychiatric emergency department. It was now 5:50 in the evening. In the psych ED, I was placed in another small room, this one with a bed, a small table, and two chairs. All of the furniture was bolted to the ground. There was a door communicating to an office where psych nurses were doing paperwork, I presume, and a one-way window through which they could watch me. I was told to change into two hospital gowns, one with the opening in the back, the other opening in the front, and was given footies, the hospital socks with rubber treads. They interviewed me again, I believe, going over the information I'd given to the admitting psychiatrist and other details. But mostly I sat there on the bench-like bed, cold, hungry, and forlorn in my hospital gown. I'd been clinging to keep control over my depression and anxiety over the years, clenching tighter and tighter in recent weeks, digging in with everything I had, and now I'd let go, had signed over my authority of my own sanity to the professionals at the hospital, and was plunging, numbly, toward I knew not what. At long last, a bed opened up for me in the psych unit. I was placed in a wheelchair with my belongings in various bags on my lap, and an orderly and a guard took me via skybridge to the building where the Stone Institute of Psychiatry was then housed. At shortly after 8:30 in the evening, I was admitted to the locked 8 West psychiatric unit where I would remain until the evening of December 12th.

The hardest phone call I've ever had to make was the one I made the next morning when I called my father to tell him I was in a psychiatric hospital.

A description of day-to-day life in a psychiatric unit deserves its own post, though I will say that it was much more mundane and certainly more well-lit than the psychiatric wards of pop culture's imagination, but the reality of being in close quarters with some of the low-functioning patients, especially when you were a nice, very anxious girl from the suburbs like me, was not always easy. One of the notes in my chart mentions I was upset about an incident the day before when another patient became "agitated," a term that does not adequately convey the experience of seeing a belligerent schizophrenic patient tackled and sedated by the nice nurses and mental health workers. But in all of the days I spent in psych units over the next two years, I only saw that happen twice, and while it was extremely unsettling and the possibility that such a thing might occur kept me on edge much of the time, the truth is that I met many very nice, very normal people in the hospital and the vast majority of the low-functioning patients were completely harmless.

Patients tended to self-segregate according to diagnosis, so I spent most of my time with the three other patients who were being treated for depression. One of the other patients was a girl, L., one year my junior, and we got along very well together. It helped immensely to have this other "normal" person my age to talk to! Every time I left the hospital, it was with numerous email addresses of other patients and promises to keep in touch, but once outside the hospital, the desire to remain close usually fell away. I am rather sorry I didn't keep in touch with this girl; I would have, but I lost her email address and didn't find it until nearly two years later. I decided it was unlikely at that point in time she would wish to resume the intimacy that was so helpful for both of us in December of 2003. If L. should happen to read this and recognize herself, I'd like to say that I've thought of you often over the years and wished you well!

I've previously said that, conversely enough, needing to be hospitalized for psychiatric reasons is one of the best things that ever happened to me. I cannot possibly underscore deeply enough what a relief it was for me to discover that my inability to respond to the world like I thought I ought to was not because I was a profoundly flawed human being, but because I suffered from a brain chemistry imbalance. It was also heartening for me to learn that I not only suffered from a brain chemistry imbalance, but a very severe one. I'd suspected as much, in a way, that what I felt was beyond the norm for depression, but it was an affirmation of sorts to be so sick as to impress an inpatient psychiatrist, who dealt with the sickest of the mentally ill on a daily basis. Quite frankly, the doctors and mental health workers who treated me were amazed that I'd coped as well as I had for as long as I had for how very, very sick I was. Suddenly, I went, in my understanding, from a person who was terrible at coping with life's challenges to someone who had been doing an amazing job of coping! It was SUCH a relief. I can't emphasize it enough. And thus I was able to forgive myself for years of not being able to feel happier or less anxious.

What happened next is apparently fairly common for people who have been holding themselves so tight for a long time to keep themselves together: I sloooooooowed down. My thoughts slowed, my speech slowed, my gait slowed. The slightest distraction could interrupt my train of thought. I felt loose and limp and sometimes loopy. I laughed for no reason. A little bit of this could be attributed to the medications my psychiatrist had put me on, but part of it was the reaction of a mind that had finally, at last, been allowed to let go.

By the 12th of December, my mood and my new medication had stabilized to the degree that my psychiatrist was willing to discharge me, but she did so with reservations. I was still very sick. But my insurance coverage had run out: it had a limit of ten days per year for inpatient psychiatric hospitalization. So back out into the world I went, heartened by my new diagnosis and not realizing exactly how unwell I still was or how long it would take to achieve balance. But I had never been well. I thought it was rather funny, when I read over my chart notes recently, to see that I reported having experienced episodes of "mild" depression over the years; now I know that I had been suffering near-continuous depression, with some very severe episodes, since I was ten years old. At the time, though, depression was my norm. I had no idea what true happiness felt like. It wasn't until years later, after I'd been diagnosed as bipolar II, put on lithium, undergone extensive Dialectical Behavior Therapy, and gotten most of the drug Geodon out of my system, that I would experience happiness untainted by depression or anxiety.

It would have been lovely if I'd been able to find out I was bipolar II and had been put on the right medication without having to go through the trauma of getting so off-balance and such a danger to myself that I required inpatient psychiatric care, but I consider myself lucky that I was only 22 when it all began. Had I stayed slightly less off-balance, I might have continued on, deeply unhappy, anxious, hating myself, and just barely coping for years. Instead, it worked out that my last inpatient stay was in February of 2005 and by the time I was 26, life was on a steady, upward trajectory and I was experiencing joy on a daily basis. So yes, I was lucky to be hospitalized.

Inpatient treatment also gave me a chance to see others with mental illnesses up close. I now have far more compassion and understanding for low-functioning individuals whose traitorous brains leave them only tenuously connected to reality and are unlikely to ever be well. As uncomfortable as they may make us, they deserve the best possible care. I fervently hope that psychiatric medicine will continue to improve and more and more individuals will be able to break free from the tyranny of a dysfunctional brain and know the relief that I've felt.

It was a cold night when I left the hospital in the company of my boyfriend; I remember that they offered me a warm coat from supplies for needy patients they kept on hand, but since I had several warmer coats waiting for me in my cold apartment, I declined. I was done with the hospital. My problem was diagnosed, they'd found a medication I could tolerate, and I was sure everything was just going to get better from there on out. I didn't know that within a month I would be back in 8 West. But I DID get better, even though it took longer than I thought it would, and I got much better than I ever dreamed I could possibly be. So I will declare the 12th of December to be a day of awakening, a day of finally moving forward, a day of hope.

And if you happen to suffer from a psychiatric condition, or suspect maybe you do, and things start getting really scary and you feel like you're not sure you can control yourself anymore, go to the hospital. They know what to do. Ideally, it's better to get treatment before you get to the point where you need to head to the ER, but psychiatric disorders have a way of making you act against your own best interests, so if it comes down to needing to be protected from yourself, call 911 or have something take you to the hospital or take yourself. An inpatient psychiatric stay might be the best thing that ever happened to you; it was for me. Finding the right treatment can take time and it can be so hard, but getting your psychiatric condition under control is SO worth it! Feeling good, feeling balanced, feeling normal, being able to respond to the world in a normal way: it's an amazing feeling. Don't let any of the stigma attached to mental illnesses dissuade you from seeking the treatment that you need because there's no reason to be ashamed of having some issues with the way your neurotransmitters are functioning. Get help. It's worth it.

My life has never been the same since the December 1, 2003. But that's a good thing. Being in a psychiatric hospital may sound terrible, but it was far more terrible to feel the way I did for years prior to the hospitalization. I may have been in a locked unit, but it was there that I was first able to begin the process of finally breaking free.

You can read about my second hospitalization here and my third hospitalization here.

Injuries Afoot

This pretty scene doesn't LOOK dangerous...

The time has come at last to relate the tale of the injury that has had me on crutches for a month now. Part of why the story has been so long in coming is that it took more than three weeks to determine what the injury was. There was no doubt about how it occurred, however. 

The collie and I pose for a post-swim portrait.

It was the first day of my most recent gig looking after Mr. Gorgeous and the weather was exceptionally fine. His owners informed me that their teenage son was routinely convincing Mr. Gorgeous to swim in the lake for exercise and that I was welcome (though not required) to continue this program. Mr. Gorgeous' lakeside house has its own private beach and dock and is a very pleasant place to hang out, especially on a sunny day, so I put on my bikini, strapped Mr. Gorgeous into his lifejacket (in case his aquatic ambition was greater than his stamina), and we made our way down the steep hill to the lake shore.

The rocks that caused all the trouble.

The shallows of Lake Washington, like most lakes and rivers in this area, are lined with stones, most about the size of the palm of your hand, and usually sport a slippery layer of algae. I waded in with Mr. Gorgeous (he was feeling a bit uncertain about the size of the wind-pushed waves), an activity that required quite a bit of sliding and gripping and constantly readjusting my balance as I attempted to walk into the waves on those slick rocks. Mr. Gorgeous ultimately declined to go beyond where his feet could touch, but since I'd already gotten wet and adapted to the chilly water, I decided to go swimming myself. After splashing around a bit and jumping off the dock, lying in the sun to dry off and then sitting in the shade to admire the view a bit longer, Mr. Gorgeous and I made our way back up the steep hill to his house, where I proceeded to read outside on the chaise lounge for about an hour, and at last went in for a long, lovely shower. I had just come back downstairs, clean and happy and ready for dinner, when I put weight on my left foot and experienced a horribly sharp stabbing sensation in my foot near the ankle. My pain scale runs pretty high--scratching my eyeball and having a migraine so severe I thought I might die top the list--but this pain merited a full 9 out of 10. It made me exclaim and jump involuntarily even if I knew I was going to happen. I found I could hobble on the outside of my foot without causing that stabbing pain, but something was clearly wrong. However, the foot wasn't swollen or discolored and had full range of motion when I didn't have weight on it, so I figured it wasn't fractured. I took some Advil, followed the tenants of RICE (rest, ice, compression, elevation), and decided to see what the morning would bring. When I experimentally put weight on it the next morning, the severe stabbing pain was still present. So I called in the cavalry and the cavalry brought crutches. It was eighteen days before I put full weight on my left foot again.

I've actually had quite a bit of trouble with my feet and legs over the years, but never had an injury that required crutches. I was born with short muscles in my legs, to the point that I was a tiptoe walker until I was about six. When I was eight, I developed inflamed growth plates in my feet. This happens when the bones of the leg grow faster than the muscles, causing the tight Achilles tendon to put tremendous strain on the not-yet-calcified growth plate in the heel. Because of my tight calves and hamstrings, I was already predisposed to this condition and then it didn't help that I grew like a weed: I shot up 10 inches in less than three years. Until I stopped growing and my growth plates hardened in my early teens, walking on hard surfaces, walking moderate distances, or running more than a few yards (the condition became apparent when I joined the school's girls basketball team as a third grader) caused pain severe enough that I was forced to limp or walk on tiptoe. Something as simple as a trip to the mall--requiring lots of walking and standing on hard floors--could become an achy, agonizing experience.

The big toe on my left foot is turned out about 31° and is starting to underlap my second toe.

It was while seeing a foot specialist as an eight year-old that I discovered I had another anatomical anomaly: a bunion. A bunion occurs when the big toe starts angling toward toward the second toe, causing first joint to protrude outward. The bunion can get swollen and painful. My bunion is genetic in origin and has gotten more severe and painful over time, though it's better now than when I was working ten hour days on my feet! I've largely found it to be an amusing abnormality, almost like a party trick, though it does make it difficult to find shoes, especially high heels, that will accommodate the bunion's bulge. The way it is deforming my foot also contributes to the fact that in terms of length, my left foot is a full size smaller than my right!

My knees do not line up over my feet. The left foot turns out at approximately 42° and the right at 28°

Another structural anomaly that has present since I was little is that if my knees are pointing forward, my feet turn out. It's more pronounced on the left side than the right. It makes me ill-suited for activities like riding a bicycle that require the feet to point forward because my knees are then forced to turn in. When I pedal a bicycle, my knees cross over the centerline of my body! Between the way my feet and knees turn and my short leg muscles, I've got a bit of a funny gait, most pronounced, again, on the left--I sort of swing my leg around instead of picking the foot up and putting it down in a straight line. It means I'm not cut out for running and I simply physically cannot properly execute the "frog kick" component when swimming breaststroke! None of these imperfections have been disabling (though they have often been painful and placed limitations on my physical activities and my shoe choices over the years), but over time I've come to regard my legs and feet, especially the left side, as inferior products, only adequate as a means of getting around.

And then there was the SI issue. I tentatively took up snowboarding when I was in my teens and one time, when I was fifteen, I took a hard fall on my tailbone on the infamous "Cascade concrete," a surface more akin to ice than snow. I remember sitting there, slightly shocked, making an assessment of my body, and thinking, "Wow, I think I just really hurt myself." But all the parts worked when I tried them and so I got up and continued to snowboard poorly. (Snowboarding poorly is still a great deal of fun, for the record.) My initial assessment had been correct, however. One, I'm pretty sure in retrospect that I fractured my tailbone. For a couple of months, it was too painful for me to sit on directly, but I was too embarrassed by the injury's location to see a doctor. Two, the jarring of the fall put my sacroiliac joint out. It spent fourteen years locked in a twisted position that, unbeknownst to me, was the source of my constant low back and hip pain. I had so many other unpleasant things going on in my life during those fourteen years that the pain in my hips was never a priority. Another reason I didn't attend to it was that I was quite used to having pain in my lower body by that time and I figured it was another manifestation of my oddly angled feet and unusually tight muscles. By the time my physical therapist diagnosed the problem, the SI position was extreme enough that my left leg was more than an inch shorter than my right! Walking around on legs of different lengths is really hard on the body, especially the back. The SI problem is was also responsible, I just learned, for the fact that my left leg is much skinnier than my right. I first noticed this phenomenon when skinny jeans became fashionable. Pants that were tight on my right thigh were loose on the left, so much so that I was compelled to measure the difference: my right thigh had a circumference one inch greater than that of my left. I've lost muscle mass in my right leg since the migraines have forced me to adapt a sedentary lifestyle, but my right calf muscle, for example, is ¾ of an inch larger in circumference than my left. This left-side weakness is the result of long-term irritation of the sciatic nerve.

What does all this medical history have to do with my recent foot injury? We'll get to that soon!

So there I was, dog-sitting and on crutches. I remember, as a kid, thinking that they looked like fun, and maybe crutches are fun if you're young and spry and full of boundless, squirrelly energy, but I found them to be incredibly hard work. Had I not been building up my arm strength through working with horses, I might not have been strong enough to have used crutches at all. The first few days were especially painful, both under the arms and in the palms of my hand, which is where you are suddenly bearing your body weight. It took some time to figure out the rhythm and I failed to negotiate a step my first day and fell hard, resulting in large, ugly bruises on my knees. (After that I carefully made my way up and down stairs by stepping on the outside of my foot.) Another major inconvenience of crutches is that you can't carry anything! That meant I had to hobble around on my foot in order to fill bowls of dog food or glasses of water until I realized that, thanks to the hardwood floors, I could maneuver around the main level of Mr. Gorgeous' house in a wheeled desk chair. Still, it was hard work to get anything done and I couldn't wait to see my PT so she could assess the foot and start treatment.

One of the bruises I sustained while learning to use crutches!

Unfortunately, while I was en route to my PT appointment, my physical therapist tripped and fell, breaking her collarbone. She waited long enough for me to arrive so she could give me the bad news and then she was off to the ER. She's been out of commission this whole time, so I went to see a different physical therapist. He discovered a new symptom that I hadn't been aware of: my injured foot was shockingly cold. He said that I needed to get it X-rayed to make sure there wasn't more extensive damage, such as a small fracture, than I had suspected. So off I went to my primary care doctor's office. The nurse practitioner was also startled and concerned by how cold my foot was. I had pulses in my foot, so it meant that I was still getting blood flow, but it was a worrisome symptom. X-rays revealed nothing more than a bone spur in the area of the foot that hurt when I put weight on it, but my doctor and my nurse practitioner decided someone with more expertise should take a look at it.

As you can see in this X-ray of my foot, there is a substantial space between the cuneiform bone (the blocky bones that connect to the long metatarsals that go out to the toes) connected to my big toe and the 2nd and 3rd cuneiforms. This because my foot is deformed by my bunion, but the podiatrist thought it might represent a dislocation.

Unfortunately, the podiatrist they sent me to was a quack. He was utterly unqualified to diagnose the injury, though he certainly tried. It would have been better off if he'd simply said that he didn't know what the problem was. He took more X-rays and announced that while perhaps there was a dislocation, it was hard to know because it might just be the way the bones of my foot are aligned because of my bunion and the only way to know for sure would be to compare it to a healthy X-ray of my foot. His recommendation was for me to wear a boot 24/7 and not put any weight on it for the next four weeks and that it should fix itself. For good measure, he would also inject the nerve in my leg with lidocaine, creating temporary paralysis of the foot. My mother was not about to let him inject a nerve (a procedure not without risk) without a full explanation of why there might be a nerve problem in my foot, so we consented to the boot and hustled out of there. In one respect he was right: the foot did warm up when it was immobilized by the boot and I think it was ultimately good for it to be stabilized. But the boot was really hard work. It only weighs a little more than two and a half pounds, but hauling that extra weight around on the end of my leg while on crutches and unable to put any of my weight on it was exhausting. By the time I stopped wearing the boot, I'd been exercising so much just getting myself from place to place that I had lost three pounds!

My heavy boot included air bladders at the back of the heel that I inflated with the clever little blue pump to create a snug fit.

My mother had been leery of sending me to a podiatrist in the first place, but we had trusted my doctor's recommendation. For the next assessment, we decided to go to the experts: the foot and ankle clinic run jointly by the university hospital and the excellent regional trauma hospital, but it was a week before they could see me. I spent several stressful days calling various orthopedists to see if anyone could see me sooner and worrying about the undiagnosed state of my injury, especially if it were indeed a dislocation. Dislocated bones in the foot can present only subtly on X-rays, may only hurt while weight-bearing, and cause coldness in the foot: in other words, I had all the symptoms. The podiatrist's claim that a month in the boot would cause things to straighten out on their own was just plain wrong: dislocated bones need to be put back in place and dislocations in the mid-foot, where I was having my pain, often require surgery to correct. I wanted a definitive diagnosis very badly! My weekend trip to the San Juan Islands helped me relax some and we had set things up in the house to make it easier for me to move around with my boot on, but I was so happy when the day of my appointment at the specialty clinic finally came.

That extra pointed tip on my navicular bone was deemed responsible for my foot pain. 

After a very thorough exam and more X-rays, the diagnosis came back as this: I actually was suffering from two injuries. The pain in my foot was caused by the bone spur and the coldness was being caused by pressure on a nerve because of a back injury. Slipping around and using my feet to stabilize myself on the rocks had caused hyper-extension of my foot and sent the bone spur poking places that it shouldn't and apparently in my efforts to stay balanced, I'd hurt my back, too. I hadn't felt any back pain, but after I started standing on my foot and walking just a little bit, there it was: in my lower back, on the lefthand side, right next to the spine. Because I'd been on crutches since the morning after the injury, I'd never realized it was there. The specialist prescribed physical therapy to address the back issue, which would relieve pressure on the nerve and should alleviate the coldness, the flatness of my arch (it had collapsed), and the occasional burning sensation in the foot. He advised me to stop wearing the boot, since it would likely start causing strain-related problems that would outweigh the benefits, and to carefully begin standing and walking on the foot as much as pain would allow as inflammation around the bone spur died down.

 The muscles supporting my spine are not doing a good job of stabilizing my vertebrae!

To say that I was hugely relieved not to have a serious injury that would require surgery was an understatement! I started PT again where we are working on strengthening the tiny muscles--the multifidi--that should be supporting the spine. Mine aren't, so my vertebrae are moving from side to side much more than they should, which irritates the nerves. The goal is also to eventually help me building up the strength and flexibility in my left leg, though it's possible down the road, if things don't improve, I might need to consult a neurologist. I've been standing on the foot and walking just a few steps here and there--like from my bed to the closet and other short distances--but have found that while I no longer have the terrible stabbing sensation, I can't move flex my ankle very much if I have weight on it. That means I still have to get around on crutches most of the time. If the problem continues, it's possible that it will be necessary to remove the bone spur or take some other more intensive action. In the meantime, because my arch has flattened, I have been wearing my Dansko shoes to help me stand properly. Otherwise, it puts a lot of foreign strain on my muscles. A month is a long time to be on crutches and it looks like I'll still have to rely on them for several more weeks, but it certainly is easier to get around if I don't have that heavy boot on and I can stand when I need to! I'm also extremely glad I won't have to wear the boot on my upcoming trip to Florida for a wedding because I have the cutest outfit and the bulky boot would have totally ruined the effect! I've had to cancel my lessons with Drifter indefinitely and have been unable to swim and have been severely limited in my ability to take photos, but what can you do? Swimming in the lake with Mr. Gorgeous was a perfectly reasonable undertaking. I've slipped around on lake- and river-bottom rocks many times without sustaining injury. It's an unfortunate twist in my ongoing disability saga and simply getting around the house sucks up a lot of my energy, but it's just what I have to live with.

When walking, because of the way
my hips, knees & feet are aligned,
my leg crosses in front of my body

So what does this foot injury have to do with my long history of issues with the bones, muscles, and nerves in my feet and legs? Well, quite a bit. I was born with short hamstrings, which I've learned can also be connected to an innate instability of the spine, which in turn can impact muscle strength and development. Whether I was born with inward turning knees or my muscle imbalances prevented my knees from assuming a normal, forward-facing position as I grew, I developed a funny gait, especially on my left side, to compensate for the tight muscles and abnormal leg position. An uneven gait can cause further back problems and I'm wondering now if life-long spinal instability and my leg issues may be the reason why I've always had poor balance. My poor balance made it very hard to snowboard, thus upping the chances of me taking a hard fall on my tailbone like I did when I was fifteen. Fifty-eight percent of sacroiliac joint injuries like mine stem from similar traumatic accidents, but my long-standing weakness and instability and stress on the muscles, joints, and nerves, especially on the left-hand side, made me predisposed to get such an injury. And it was the left-hand sacroiliac joint that suffered the damage and spent fourteen years in a rotated position. As I've said, that made one leg much shorter than the other, further impacting my gait, further destabilizing my spine, and in addition to putting pressure on my left-hand sciatic nerve, leading to increased stiffness and muscle atrophy, I'm wondering now if the back pain I used to also have higher in my back created pressure on the spinal cord and is why I have the world's flattest posterior. Obviously, from a genetic standpoint, it's not a place where my body stores much fat, but it intrigues me to think that pressure on the nerves might have contributed to the lack of development in my gluts over the years. It might also explain why in years past I put relatively little muscle on my legs for the amount of exercise--including weight-lifting--I was engaged in. And then it happens that when I do finally get my SI straightened out a couple of years ago, it comes at a time when I'm forced by the migraines to keep my physical activity to a minimum. That means even if my left leg is getting better information through the nerve and had more capacity to put on muscle, it didn't get the opportunity. And meanwhile the weakness of the little muscles stabilizing my spine remained unaddressed. That means I waded into the water with Mr. Gorgeous with a balance problem, a structurally weak foot that could easily move in ways that it shouldn't (thereby allowing the previously unproblematic bone spur to poke into places where it didn't belong), and a spine unable to keep its vertebrae in line (making it very easy for one to get tweaked in a way that put pressure on the nerves). I was set up for exactly this kind of injury to happen.

My legs as seen from behind
and reflected in a mirror--my left
leg is therefore the one on the right.
The size difference is very clear!

On the bright side, I'm glad to finally have some more insight into my long history of stiffness, pain, and injuries. Looking back at old photos, I'm rather amazed to see that the differences in the musculature of my legs was already visible by the time I was four. That means I've been getting poor nerve information in my left leg since I was a little kid! No wonder I've always had wimpy legs, skimpy gluts, back aches, and had trouble with roller skates, snowboards, and bicycles! It's a bit of a relief, really, to realize that innate structural issues causing irritation of the nerves are responsible for some of my physical ineptitude and not a lack of, say, effort or desire or moral fiber. This inconvenient injury means that I'll finally be able to address this left-side weakness that has been hampering my body since I was a toddler, which should ultimately result in stronger, more flexible, and more EVEN legs. I might get a better ability to balance out of the deal, too. Come next summer, if I dare to go wading in the lake (I may not!), it is possible that my body will have the proper tools to slip, slide, and then stand again unharmed.

*****
The injury update, two months out:

A week and a half after starting spine stabilizing exercises, I was able to start walking again without crutches. As communication between my nerves and my foot improved, the bones in my foot went back into their proper positions and the bone spur ceased to poke into where it didn't belong. My strength and flexibility has improved tremendously, my arch has almost completely reformed, and as of the last week or so, there is no longer any coldness in the foot at all. My sciatic pain has lessened considerably in the last few weeks as well. I still have the occasional issue if I walk on uneven ground, but the change from where I was a month ago to where I am now is almost miraculous! It underscores the importance of getting a good diagnosis and the right treatment. I'm glad I persisted in getting a second opinion and that in the end, some very simple muscle strengthening exercises were all the cure I needed!

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