Can you see the gaps?

In the voids inside my mind
There’s an ocean, deep and dark
At the bottom of the ocean
There’s reflections of the stars

If you can see the stars
At the bottom, in the deep
If you can see the rainbows
That even the sun can’t reach

If you can see me dancing
Unaware of being watched
If you can see the world
Before a mind, before a thought

If you see distant reflections
Of reflections, of reflections
And if you can see the deep, the dark
The silence between worlds

If you can see the void
That stands in front of me
If you can see how full it is
And how empty it can be

If you see what it’s like
To not know at thirty
What they knew at three

But to know things
And to see things
That nobody else can see

Then maybe, just maybe
I can see you
And you can see me

After this, I am never again putting up with bullies telling me that my medical conditions are imaginary.

After my diagnosis of adrenal insufficiency, then the last foothold that bullies had made into my mind, it fell away like sand.

It wasn’t just that the diagnosis was so obvious, so grounded in specific laboratory tests that nobody with any knowledge could argue with.  It wasn’t that, so much, at all.

It was what I felt in my body.

It was the way I felt life returning to my body.

It was the way I felt sturdy rather than fragile.

It was doing forty jumping jacks in a row, fast.

It was going up seven flights of steps to use a treadmill for ten minutes, then go all the way downstairs, and then back up to my apartment.

It was doing things, large and small, that my body couldn’t do before.  Couldn’t.  Not even a little.

It was feeling that fall away from me again, temporarily, when my body first adjusted to the dexamethasone dose I was on, and having it come back again when we raised the dose.

I realized that the reason the bullies got to me so badly was because deep down I thought maybe they were right.   I’d experienced a severe but undiagnosed chronic illness for years, and it had gotten much worse six years ago.  I painstakingly hid as many aspects of it as I could, let people believe there were other reasons that I could do less online, because every time I described an illness, I’d get bullied for it.  I’d get told I was making stuff up for attention.  When I was hospitalized last year, I sought help online with obtaining access to a life-saving treatment, and some bullies even had the nerve to capitalize on a life-and-death medical situation to give them a platform to denounce me again.  Then when I described the situation, one of them had the extra nerve to come here and tell me that because I was fat, I couldn’t possibly have enough eating problems to need a feeding tube.  (I’ve lost nearly 70 pounds involuntarily.  When it was only 40 pounds in 2 months, a doctor told me I was burning muscle and that it was going to affect my heart.  Do I have to be dead of starvation before I’m thin enough for my gastroparesis to be real?)

And on some level I accepted this.

And I accepted it because I thought that maybe I really was imagining things.  After all, I had no firm diagnosis for this mystery illness that was causing me so much trouble.  Maybe I didn’t want to get better.  Maybe if I just wanted to enough, I could jump and run and walk up stairs.  Maybe I didn’t have to be in bed all day.  Maybe the vomiting and burning hot and freezing cold and total limpness were something I could make go away, with everything else, if I wanted to enough.  Maybe I was somehow making it up, and then fooling myself into thinking I wasn’t making it up.

And I can tell you that nearly everyone I talk to with a hard-to-diagnose condition has thought this way.  But those of us who have been bullied or harassed, and had rumors spread about us that we’re faking everything?  We think this way more.  We may hide it well, but most of us think this way, at least on bad days.  And it’s a terrible way to think.  It winds around your head and makes it hard to take any action at all in life.  It makes you doubt the deepest things about yourself.  It can make you passive, it can make you lash out, but either way it makes you less effective at anything you’re trying to do.  It’s hard to get anything done when you’re divided against yourself, doing the bullies’ work for them.

Anyway, this has all changed.

I don’t think like this anymore.

The test results tell me that everything I felt wrong with my body all these years, has a measurable, physical cause that’s very simple:  I don’t make enough cortisol, because I don’t make enough ACTH.  Years of depletion has led to chronic and even life-threatening illness.  And this is clearly adrenal insufficiency (a medical diagnosis), not ‘adrenal fatigue’ (a vague catch-all that requires no actual proof of an adrenal problem at all).

But it’s not the test results.

It’s what I feel in my body now that I’ve gone on dexamethasone.

It’s being able to run and jump and climb stairs and go for long walks.

It’s feeling sturdy for the first time in years.  It’s feeling the fire of life course through me for the first time in years.

It’s realizing I could live to old age, and starting to wonder what it will be like to have grey hair and wrinkles.

No bully can take those realizations away from me.

And the change that has happened in me makes me realize how disgusting this form of bullying is, and what a low form of humanity anyone is who deliberately participates in it.  And I’m angry.  It’s an intense, focused anger.  Focused on everyone who has ever tried to make me doubt who I am and what I am experiencing.

Because I have a better fucking track record than most people with chronic illnesses, when it comes to having things show up on actual test results like this.  And yet every time, every time I have to prove myself.  Sometimes the proof comes at the last minute.  One day the proof may come too late to save me, and you’ll have that on your conscience, if you even have a conscience.

But seriously:

Problems urinating, dismissed out of hand as psychological in 2000, diagnosed around 2006 as spasticity of the urethra, treated with an implant that helps my muscles relax.  But not before I had infection after infection after infection.

A variety of really nasty symptoms, dismissed out of hand as being ‘fat and lazy’ and other things of the like, for years.  By the time, around 2003, that they found the problem, my gallbladder had not only produced two large gallstones, it had failed completely and was sitting in there dead by the time they pulled it out.  The surgeon was visibly angry at everyone who had delayed diagnosis and treatment.

Breathing symptoms.  Got me thrown out of emergency rooms more than once because treatments for asthma didn’t help — cyberbullies then proceeded to use those stories to convince people that “even ER doctors think she’s manipulative, see?”  They never thought to check if it was something other than asthma.  Eventually they found an infection and atelectasis in part of my lung.  Even after that was fixed, I was getting told that my continued breathing problems weren’t a big deal, were all in my head, all that kind of thing.  Until I got assigned a new pulmonologist, who did a CT scan and found “mild bilateral lower lobe bronchiectasis and scattered peripheral tree-in-bud opacities consistent with small airways disease”.  When treated for bronchiectasis, the problems got significantly better.  Imagine that?

I had ongoing joint pain that I knew wasn’t arthritis, so I avoided telling doctors about it because I didn’t want to tell them about one more thing wrong with me that didn’t fit in the usual box.  Finally a doctor badgered me into admitting that I had joint pain, then had me perform a series of movements.  He diagnosed me with benign joint hypermobility syndrome on the spot — a condition that’s characterized by overly flexible joints combined with widespread joint pain.  The test is really simple.  Bullies claimed I was faking this even though I posted pictures of my thumb flat against my wrist, which is impossible to do without a hypermobile wrist joint.  (I can also stick my foot behind my head and other fun party tricks that I really shouldn’t, medically, do.  But I do do it sometimes because it’s the fastest way to prove to a doctor that I’m not kidding around about being hypermobile.)

I had ongoing problems with nausea and food that stayed in my stomach for way too long, sometimes I’d throw up things I’d eaten days before.  This was eventually diagnosed as gastroparesis, using a test where you eat radioactive eggs and they test how slowly it goes through your stomach.

And now I’ve had this baffling array of symptoms, for years, and the blood cortisol test, ACTH test, and ACTH stimulation test confirmed that it’s a severe secondary adrenal insufficiency.  My response to treatment, according to my endocrinologist, more than confirms it.

How many people with chronic illness can say they have a track record this good?  Of saying they had a medical problem, and having it actually show up on a test in such a clear fashion?  I mean, the problems I have tested as having have not by any means all been the problems I was expecting to have.  But they all eventually showed up as something.  And that’s more than a lot of people can say.

So why the extensive bullying about being fake, when I have more proof of my authenticity as a sick person than most sick people will ever have?

It’s not because there’s any actual evidence that I’m faking anything.  It’s because bullies will be bullies, and they sensed this as a vulnerable point for any person with a chronic illness.  It’s because, I’m sure, a few of them have actually convinced themselves that they are on a righteous crusade against evil, and I am evil.  It’s because I have some people who, for reasons unknown to me, really hate me, and they thought this would be fun.

But it’s also because there’s a cultural norm that says that disabled people are all potential fakers until proven otherwise.

It’s because everyone is always looking for whether the wheelchair user can wiggle her toes, whether the blind man picks up a book and reads it with his eyes, whether the nonverbal person can say a few words here and there when xe’s under sufficient pressure and all the stars align just right.  It’s because people believe that we are all getting away with something.  That disability is about getting something for nothing.  That being sick means getting special privileges.  That everyone would fake illness to ‘play hooky’ from life, if there wasn’t constant vigilance against the possibility.

Governments love to spur on this kind of hatred and suspicion.  Disabled people in the UK right now are afraid to leave their houses because hate crimes have risen.  And the hate crimes have risen as a result of a media campaign saying that disabled people are exaggerating or faking their conditions in order to get benefits that they don’t deserve.  People are afraid of getting beaten up in public, because they’re being scapegoated by the government for the financial crisis that’s plaguing the world today.  And disabled people are always among the first to get scapegoated for such things.  We’re too expensive.  We need too many special privileges.  This always happens, and horrors follow.

According to Paul Longmore in Why I Burned My Book, the idea that you need to watch to make sure disabled people aren’t cheating on our benefits goes back to the English Poor Laws.  I wish I had my copy of his book on hand so that I could tell you everything he knows about the subject.  But basically it made it clear that there were poor people who deserved help, and poor people who didn’t deserve help.  And that we needed to always be careful only to be helping the right people.  And that the wrong sort of people would always be trying to take advantage of our charity and goodwill, so we must always be on guard.

And that attitude is what’s behind the suspicion of any disabled person who isn’t 100% stereotypical.

Speaking of which — you want to find a disabled person who is faking?  Find someone who has absolutely consistent abilities that never waver in any way, who is always able to do the same things, always unable to do the same other things, and those things never shift around.  She’ll be very much like the stereotype of whatever condition she claims to have, and won’t deviate in the slightest.  She will be everything you expect of a disabled person.  And that is why you will never find her so you might as well give up looking.

The people you pick on relentlessly as fakers are the ones who are generally actually more typical of disabled people, but less stereotypical.  We don’t have just one condition, we have two or three or four at minimum.  Our abilities are a moving target that we can’t always predict, let alone anyone else.  We seem to be able to do one thing but unable to do something else that we “should” be able to do if we could do the first thing.  We don’t obey any of the rules people have in their heads of how disabled people are supposed to be like.  And because of this we are vulnerable and because of this we are targets for relentless bullying, harassment, and defamation.

So a lot of us hide things that aren’t stereotypical.  Or we hide how bad things are.  Or we hide how bad things have gotten.  Or we try to play the role of a more stereotypical disabled person, hoping it will free us from bullying.  But then if we are exposed as having hidden anything, ever, or pretended anything, ever, then bullies have ammunition to accuse us of faking, and it all gets worse.  So we’re trapped in a double bind:  There is no way to be ourselves and escape ableist bullying.

I realize how much I have come to accept that I am an acceptable target, when I think of a good friend of mine and what would’ve happened (and it almost did, but for a twist of fate) if she’d met up with the same bullies I met up with at a certain point in my life.  It makes me shake with rage.  It makes me cry.  The very idea of her having to go through this makes me furious.  And I realize that I need to be just as furious that I’ve been forced to go through this, often with very little support and backup, for so long.  Because I matter just as much as she does, and I’m just as real as she is.

I have to say, though, that I have met people who were faking or exaggerating disability in order to manipulate people.  Very few, but I have met them.  And I understand that when done in certain ways, such actions can be devastating to everyone forced to be around them.  It can destroy trust.  It can destroy the cohesion of communities that are important for disabled people.  It can become an almost vampiric scenario where someone is draining time, energy, and money from people who can’t spare any of those things.  That isn’t what happens the majority of times that people fake things (the majority of the time, it hurts few to no people, actually), but it can happen, and I understand why people are changed by it, why they have trouble trusting after something like that happens.  I’ve been through it myself and it left my head upside-down for a long time afterwards.

But I’ve seen much more damage done to disabled people and our communities, by people who are overly suspicious of everyone for faking, than by people who are actually faking things.

In fact, I’ve seen irreparable damage done to disabled people simply at the idea that someone might think they were faking.  It’s an insidious thought that gets into people’s heads and won’t let them go.  It’s torturous.  I wouldn’t wish it on my worst enemy.  And I’ve seen it all but destroy a lot of very good people who’d done nothing wrong.  And these aren’t even people who were directly targeted for ableist bullying the way I have been.  All they had to do was see that the bullying happened, and that was enough to instill fear and self-doubt.  Many people with disabilities and chronic illnesses are dealing with so much self-doubt already, that bullying and witch-hunts simply pour gasoline on the fire.  I would not be surprised if some people who were already feeling they had no hope of being understood, had been driven to attempt suicide this way before.

My self-doubt is gone.

It was like a fog that kept me always looking in the wrong direction.  It made me unable to see myself.

I can see myself better now.  I am strong.  I am as real and genuine as everyone else.  I have done nothing that deserves being singled out and attacked.  I have far more proof of the reality of my medical problems than most people who are not being targeted have of theirs, and that tells me that I’m not being attacked because of anything I’ve done.  But I can see, clearly, that I am stronger than anyone who has ever tried to attack me.  Because I’ve now survived relentless attacks on my character, death threats, emotional manipulation, and head games.  Things they probably wouldn’t have weathered anywhere near as well as I have.

I don’t have any hope that they will stop what they are doing.  Because I can see now that what they are doing has nothing to do with reality.  No amount of proof is enough.  In fact they probably want me scurrying around trying to prove myself.  They enjoy that.  Because what they want is control over my life.  They want me to be scared and running around frantically trying to please them.  I’ll probably be dealing with this until they get bored or something, if that ever happens.

But there are things we can do to minimize the impact of people like this.

We can make it a community norm that it’s intolerable for people to bully each other about their disability status.

We can support people who are being bullied about their disability status.

We can support people who are not directly being bullied, but who express fears about whether their illness is imaginary, whether they are just somehow making things up without knowing it, that kind of thing.

We can make things safe for people to admit to feelings like that, without condemning them as guilty just because they’ve doubted themselves.

We can work against community norms that say it’s really important to catch disabled people “cheating” at being disabled.

We can make sure bullies know we aren’t listening to them, and we can make sure that their victims (both direct and indirect) know that we are on their side (because there’s nothing bullies love more than to make their victims feel as if we are alone and everyone is against us).

We can work for love and compassion and against one-upmanship, bullying-as-funny-entertainment, and ego.

There’s all kinds of things we can do.

And inside of ourselves, we can dismantle this self-doubt.  Because self-doubt of this kind, it’s what this kind of bully wants.  They don’t just want to make other people doubt us.  The real fun comes from watching us squirm, watching us doubt ourselves, watching us tear ourselves apart.

I for one will never tear myself apart over this again.   Because I know now, know in my bones, that this has all been real, all along.  I feel it every time I walk up and down four flights of stairs without my legs giving out or even getting out of breath.  I feel it every time I exercise without vomiting.  I feel it every time I do jumping jacks, run, skip, and do all these things I couldn’t do before.  I feel it in the fact that I never anymore get so exhausted that I need a bipap to breathe.  I feel it in every single change my body has made since starting dexamethasone.  This is what reality is.  Anyone who thinks otherwise can screw themselves, but you won’t get a voice on my blog, not to tear me apart, and not to tear anyone else apart either.  It’s what Dave Hingsburger taught me years ago:  I’m okay, you’re mean.  That’s all I need to know.

I am not your fairy tale miracle cure story.

But more on that in a minute.

In the past couple years, I’ve been quietly preparing to die.  I hadn’t told anyone the full extent of what was going wrong with my body, because it was inexplicable.  Whenever I aspirated and got an infection, I became much weaker than the infection should have made me.  Sometimes I became severely weakened by stress alone.  I knew that there was something going on above and beyond the medical conditions we were aware of.  But I also knew that my symptoms could come from so many different things, it was unlikely we’d ever find it, or that it would be something treatable.

In parts of the chronic illness community, people use a term called ‘spoons’ to describe how much energy you have to do basic things.  I have mixed feelings about the idea, and the Spoon Theory story that originated the practice.  But sometimes it’s a useful thing.  What happened when I got sick was that my spoons would go negative.

When I say negative spoons, I’m not just saying I really didn’t have much energy.  I don’t mean that I felt sick and tired in any way that even the average chronically ill person feels sick and tired.  I mean that I felt like my level of energy was spiraling downwards in a dangerous way.  Where the less energy I had, the less energy I had to replenish it.  At my worst, I would be lying in a hospital bed, going in and out of delirium, and in lucid moments I would notice that it took too much energy just to keep my heart going.  I’d wish that I could stop and rest.  And then I’d realize what that meant.

When I was not acutely ill, I had a constant, subtle sense of fragility.  It felt like one good illness could put me in the hospital or kill me.  And often it did.  I had four hospitalizations between late 2012 and early 2013.  More recently, I was having periods of time when for no reason at all, I’d become unable to move or stay conscious for long.  I knew something was badly wrong.  And apparently so did my doctor, because he started sending me to more specialists and running tests.

This was the result:

Results of cortisol tests, showing cortisol too low to measure, ACTH too low to measure, and cortisol rising up to 8 and 9 when my system was artificially flooded with ACTH.

What does this mean?  When they measured the level of cortisol in my blood, it was consistently too low to be measured.   ACTH is a hormone secreted by the pituitary gland that tells the adrenal glands to make cortisol.  My ACTH was too low to be measured as well.  When they flooded my system with ACTH, I made some cortisol, but not as much as they might have expected.

And what does that mean?  It means that my pituitary gland isn’t making enough ACTH, and hasn’t been for a long time.  And that my adrenal glands have therefore not been making enough cortisol.  I have something called severe secondary adrenal insufficiency.  We don’t know the cause yet.  But the upshot is that it’s extremely treatable.  I’m on a steroid called dexamethasone, that replaces the cortisol my body can’t make.

That health crash I had six years ago?  The one I worked hard to conceal until after the worst was over, because I was afraid of being bullied for having too many medical conditions?  Where every single health condition I had took a nosedive, I ended up bedridden, and needing a power chair, and all kinds of changes took place?  We now think that was the time that the adrenal insufficiency became serious.  It may have been around for quite some time after that.  And if we hadn’t treated it, my expectation that I wouldn’t live to see forty, may well have been accurate.

On dexamethasone, I improved rapidly.

Prior to dexamethasone, I could not jump even when holding onto a grab rail.  On dexamethasone, I could do jumping jacks.  First five, then ten, then twenty, then forty.  Before, I couldn’t walk up one flight of stairs.  Now I can walk up and down eleven.  I’m walking everywhere with a cane now, and barely even needing to use the manual wheelchair I bought (thinking that it was more realistic that I’d need a manual wheelchair than that I’d start walking everywhere — I still do need it sometimes, but not that often). I can do 400 meters on a treadmill, I am starting to be able to run (my legs wouldn’t even move that way before) and skip and balance on one foot, and all kinds of other things I thought I’d lost forever.  I’m going on walks in my neighborhood.

Perhaps most amazing is the way I feel after exercising.  In my entire adult life, I have never felt this way:  When I exercise, I feel invigorated afterwards.  I feel more energetic after exercising than before.  This is entirely different than before, when even minor exercise made me throw up, collapse, or both, and could leave me sick and with my body temperature running high and low for weeks.

And this is amazing and magical and wonderful.

But every time I try to talk about this with a nondisabled person, or even with many disabled people, I run into a very ableist way of thinking about this:  The miracle cure story.

It runs sort of like this:  A disabled person has been hanging in the balance between cure and death (because what other possibilities are there for a disabled life?).  Hope means finding a cure, despair means not finding a cure.  They do find a cure and everyone rejoices and everything goes back to how it should’ve been (with them not disabled, of course) and things are great from there on out.

So I run into a lot of people suggesting to me that I’ve “found hope” (I haven’t).  Or that I’m “cured” (I’m not).

Here’s the reality:

I will be on steroids for the rest of my life, according to my doctors.  If I don’t take them, everything goes back to how it was and I would eventually die.

I have to keep injectable steroids around, because it’s that important that I get them every single day, even if I have a stomach bug or a clogged feeding tube.  I don’t have any other meds where it’s so important that the doctor has insisted on injectables.  Even meds that are dangerous to go off quickly.

Any time that I become stressed out or sick, my symptoms come back and I have to take more steroids.  This puts me at higher risk when sick, hospitalized, injured, or severely stressed out.  To give an example, when I found out my mom had been in the ICU, I went from feeling great, to too weak to breathe easily, in a matter of seconds.  And when I run down my stress hormones like that, I don’t make new ones, so I have to put them back artificially, it’s called ‘stress dosing’.

I have to be constantly aware of my body and of my stress levels and other factors that affect how much steroids to take.  And I have to largely play it by ear.  There is no blood test to tell you if you’re on enough steroids or not.  You have to learn that yourself.

I’m still autistic.  I still have a variety of other conditions, although some of them are much less severe now that I’m on steroids.  I still need a feeding tube.  I still need to communicate by typing.  I still need a wheelchair sometimes.  I still have stamina problems, just not as severe as before.   I still have severe chronic pain, which is getting worse as I try to train my body to move around instead of lying propped up in bed all the time.  I still have autonomic dysfunction.  I still have hypermobility syndrome.  I still have gastroparesis and bronchiectasis and the hellish interactions between them.

And even though it’s under control, I still have severe adrenal insufficiency.  Having something controlled by medication is great, but it’s not a cure.  A cure would mean I wouldn’t need to take medication, wouldn’t need to watch my stress levels and illnesses very carefully, wouldn’t need to be constantly alert to changes in my body.

This is wonderful, but an inspirational fairytale ending it ain’t.

Feeding tubes and weird ideas

My favorie BADD post: Tube-ageddon.

I haven't had much time to write anything here about the hell I went through getting my GJ tube. I had every indication for a GJ tube. I had gastroparesis so bad it was starting to affect my breathing, in a way that doctors said was likely to result in infection after infection until I died. From the emergency room onward, doctors were saying my best hope was to get a feeding tube.

Yet the pressure I got from doctors, while in the hospital for one of those infections, was to just keep getting infections, go home, wait to die. Most of them wouldn't say that outright. But some of them did. Some of them we confronted and they absolutely agreed that the only alternative to the tube was death — which could have happened to me by now, without the tube. But they still insisted on telling me not to get the tube, basically that I was better off dead than with a tube. We had to rally a bunch of people on the Internet to call the hospital before they suddenly changed their tune. My pulmonologist told me she could tell exactly when I started getting people calling the hospital, because the tone in my charts changed instantly to “let's get her the tube after all”.

Most people think of all feeding tubes as the same, all reasons for getting them as the same, and so they believe in false generalizations about their capacity to prevent lung infections, or indeed cause them. But they aren't all the same. They're all different, and the reasons for getting them are all different.

I have gastroparesis. That means my stomach is partially paralyzed. In my case it became severe before it was diagnosed last year and confirmed with testing this year. It's probably due to neuromuscular problems inherited from my mother, who has autonomic neuropathy among other things, a common cause of gastroparesis. My symptoms are similar to hers so doctors are assuming whatever we have is related. Anyway, it makes food remain in the stomach a long time. After awhile, this means that you can't eat very much and you drop a lot of weight. (I may still be fat, but they tell me by the end I was burning muscle.) by the end I was having trouble keeping down two small cartons of Boost a day, which isn't enough calories to live on. I was already on a liquid diet so there was no less food I could keep eating.

It also meant that the stuff staying in my stomach was riding up my esophagus again on gas bubbles formed by food sitting in my stomach for ages. I could feel it happening several times a day. I'd belch and food or bile would ride up with it. If this happened overnight, my bipap machine would shove the stomach contents down into my lungs from my esophagus. This began happening several times a week, and from January until March I had about five lung infections requiring antibiotics. I never stopped taking antibiotics, by the time one course was over I'd be on the next. Which is dangerous in its own right.

So when I showed up in the ER a few days after a CT scan showing what they called a “ground glass appearance”, they had no problem admitting me into the hospital, and even in the emergency room they were telling me if I wanted to live I needed a GJ tube. This wasn't news to me. They had been talking about a feeding tube since last fall, when one more nausea med added to the five they'd started me on, made me able to go home without one instead. I'd been discussing with my friends what kind of feeding tube served my needs best as a person with gastroparesis. And the GJ tube had always seemed like the best option.

A GJ tube is like a combination of a G tube and a J tube. Half of it goes into the stomach, which is a G tube. The other part goes into the first part of the small intestines, which is the J tube. The G tube gives you the ability to drain your stomach contents out into a cup, and dump them down the toilet. This means that if you do it often enough, you won't have anything building up in there and going up into your lungs. Right now, even bile and stomach acid can build up to dangerous amounts because of my stomach not emptying often enough, so I take acid reducers and I drain my G tube several times a day.

The J tube portion is the part that stuff comes in through. I eat through it. I drink through it. I get all of my medications through it. This means that nothing has to come in through my stomach. Which means we are bypassing the worst part of my digestive system. Not that the rest of my digestive system is wonderful. My esophagus is slow, my stomach is slow, and my bowels have been producing blockages since I was a teenager. But with liquid food going into my small intestine at a fairly slow rate (one feeding in roughly twenty four hours, I wasn't able to handle the twelve hour version without getting very sick) I seem to be able to handle things much better than when it was going in my stomach. I love it. It's so much easier than feeling horribly sick all the time.

I still take nausea meds, but half of them have been changed to PRN instead of daily. So daily I take Phenergan, Reglan (which speeds up my digestive system), and Marinol. And I can also take Benadryl. Lorazepam, and Zofran as needed. I used to have to take all six of those things every day, so this has really cut back on the amount of medication I need, which is good because every single one of these meds is severely sedating and it was badly affecting my ability to think straight. If I were still trying to eat, I would be taking every single one of those nausea meds at the maximum dose, and still wouldn't be able to eat enough to maintain my weight.

[Photo of me holding my tube. The J tube section is visible, the G tube is hidden behind my hand, and there's a little cloth thing from Trendie Tubies around the base, with owls on it.]

But I had to fight for this tube. Even though it was the only way to save my life. I had to fight against people who were certain I was better off dead. And I needed the help of a lot of people on the Internet, to do it. When I did get the tube, it was done without a working anesthetic. And even though the local anesthesia didn't work on me, even though I was yelling and screaming, they didn't stop to give me more, they just kept telling me that the Versed meant I wouldn't remember it later. Yeah right. It seemed like the entire process of getting the tube was one giant clusterfuck after another, and like people were making it as hard for me as they possibly could. (Later, when I had to get the tube replaced, we discovered that Propofol is the med, in combination with others, that really does the trick to keep me unaware of what's happening.) They treated me like a child, repeatedly expressing the fear that I would pull the tube out like young children often do, and blaming me when part of the tube got lodged inside me, probably as a result of over zealous physical therapy early on that was a clusterfuck in its own right.

But I got the tube and I couldn't be happier with it. I feel happier and healthier. After aspirating reflux several times a week for months, I haven't aspirated a single time in the month or so I've had the tube. My nausea is well controlled. My brain and body work better. Despite a couple complications since then, it's still the best thing medically that's happened to me in the past year. And I'm still alive, which even by now I might not have been if I kept getting infection after infection.

[The x ray showing the tube inside my body.]

Why did I have to fight so hard for it? I see two major reasons. One is that I'm perceived by medical professionals as someone whose life doesn't matter much, doesn't have much quality of life. I'm autistic, they read me as severely cognitively impaired, I am in bed all the time, they don't see that I enjoy living as much as anyone else does, and they make that decision somewhere in their heads without even noticing.

The other reason is the way medical professionals see feeding tubes. I've been trying to read the writing of nurses and doctors to find out their views on these things. Not just the horrible ones. The ones who snark at patients on their blogs. But the ones who think they're compassionate and sympathetic and good at their jobs. But in one area that makes no difference:

They all think of feeding tubes as the beginning of the end. They see getting a feeding tube as the first sign that your life as over. Possibly that you belong in a nursing home, as if anyone does. When I made out my living will, the first question of “Where do you draw the line where you want to stop living?” was whether I wanted to live if it meant I needed a feeding tube. They see people with feeding tubes as the first stop on the route to a living death. Other things they see that way are using a ventilator, having a trach, needing any sort of similar mechanical assistance to survive.

My friends see it a different way. They see me as some cool kind of cyborg, with the oxygen, the feeding tube, and the Interstim implant that prevents spasticity in my urethra, allowing me to urinate. They say the sounds my oxygen concentrator makes sound almost steampunk. But then all my friends are disabled, they see adaptive equipment as cool, and as a means to living, not a sign you're dying.

Medical professionals have been shown time and time again, to rate disabled people's quality of life lower than we rate our own quality of life. And yet time and time again, they see themselves as the experts on what our real quality of life is. One reason I try to keep my lungs and my guts in good condition is that as a person who is autistic and physically disabled, I know that if I ever got bad enough to need a transplant, I'd probably die. Because they would take one look at how I sound on paper, and they would decide my life wasn't as worth living as that of a twenty year old who wasn't disabled except for the effects of their lung problems or digestive problems. (Lung transplant is the end of the line for severe bronchiectasis. My bronchiectasis is mild, I'm working hard at keeping it that way. Transplant is also the end of the line for very severe gastroparesis combined with other gut problems. I'm hoping I don't get to that point despite severe gastroparesis. Given how hard it was just to get a feeding tube, which is the standard treatment when you start aspirating this much and being unable to eat even a liquid diet, I don't know that I stand a chance at making the transplant list should I need one.)

I also had trouble getting home. People were asking me if I belonged in a nursing home, or at least in twenty four hour care. I'm not sure why. It's not like it's hard to care for a GJ tube. It's unusual, but it's certainly easier than my old med regimen, which was truly difficult and time consuming. Now we just mix them up, put them in a syringe, and stick them straight into the tube. Easy. Eating is easier too, no more worrying I will throw up, and you only need to set up the food once a day and press a button on a feeding pump. But everyone has this illusion that it's incredibly difficult, and the VNA loves to take people with tubes and stick us in nursing homes claiming they can no longer care for us on the outside.

[The feeding pump on an IV pole with the food (Osmolite, low fat, high protein, no fiber) hanging above it.]

I still don't understand what the big deal is supposed to be. By the time you get a feeding tube, eating is really hard. Either you're having swallowing problems, or something is wrong with your stomach. In my case, my stomach was emptying so slowly that I was constantly severely nauseated no matter how little I ate, I was dropping weight way too fast, and I was aspirating reflux caused by all the food sitting around for ages. I was quite possibly going to die from repeated infections. How the hell is a feeding tube supposed to be worse than that?

I can't even begin to comprehend the fear of these things. I mean I literally can't do it. It makes no sense. It's all based in prejudice. It has nothing to do with the reality of a feeding tube.

I thought the worst part would be not being able to eat. The most I can do is drink a tiny bit of ginger ale, and I have to be very careful even with that. But I don't miss food. The feeding tube ensures that I am never hungry, and always have the nutrients I need. The only times I have ever started craving food, were two separate days where I spent all day at the emergency room unable to use my tube. Each time I came home and wanted to eat or drink something I didn't normally want to eat or drink. But when I'm getting food regularly, it's not a problem. I barely miss eating at all. I never even think about it. Even the vivid dreams I'd been having about all different kinds of food, all those months on Ensure, have gone away. My body seems perfectly satisfied with what it's getting, and it doesn't crave things unless I can't use the tube.

And it makes everything easier. Food is easier. Medication is easier. Absolutely nothing is any harder than normal. It's more like dealing with something easy and mechanical, than dealing with anything hard. We did learn the hard way to flush it with coke after every medication, because by the time there was a clog, you couldn't get enough coke in to dissolve it. So we are dissolving the clogs before they can even form, by leaving coke in for awhile after every single time we use meds. I've also discovered it's possible to reduce the pressure inside me — which can prevent the meds and water from flowing into me as easily — by relaxing my body, especially my rectum, and then everything usually flows in pretty easily. So there are a few tricks, but it has overall been much easier than my life was before I got the tube.

So what is so scary? I don't know. I can't find anything at all scary about this. It doesn't mean anything horrible. It means I'm alive. Being alive is a good thing. I don't fear death, but I only get one chance at life, and I don't want to die just because someone else has decided my life isn't worth enough to them. And so I'm very much interested in anything that will keep me alive longer, whether it's a feeding tube or any other “scary” device used for keeping disabled people around longer than used to be possible.

A lot of people I know have those devices, the ones that medical professionals think your life is over. Feeding tubes. Trachs. Ventilators. Catheters. Ostomies. Central lines. All those things that seem to scare people to death, even though there's nothing scary about them. They prolong life, not end it. And I'm furious at every single doctor who urged me to go home and die rather than get this feeding tube and get a chance to live longer. That is simply not their decision to make, and they were bound and determined to make it for me until I got enough people on my side to convince them that the entire world was watching the crap they were trying to pull.

I am going to work as hard as I can, to change hospital policy so that nobody gets pressured in the way I did. It's incredibly difficult to deal with pressure to die, when you're already sick and exhausted and have no energy to fight back. And they do it in sneaky ways, so that if I had been delirious or something, which I often am in the hospital, I might not have recognized what they were trying to do. My experiences are far from unusual, many disabled people have been encouraged to die rather than get a feeding tube, or a vent, or something else that would allow us to live. My mother, who has many of the same conditions I do, is going through a mess where doctor after doctor refuses to treat her or perform surgery on her, and she keeps having to go back to the Mayo clinic because they're the only ones who seem to be committed to making sure she can live as long as possible. And as a disabled senior citizen way below the poverty line, she gets the “your life isn't worth it to us” thing from at least three different angles. This stuff isn't unique to my life, the pressure to die is everywhere.

But most disabled people, like most people in general, prefer to be alive. Being disabled rarely changes that fact, not on its own. And the fact that anyone thinks we ought not to, that their pity goes so far as to be a death wish aimed at another person, is so disgusting I don't even have words for it. But they are the ones who are disgusted at my advance directive, which tells them to keep me alive no matter what. I can hear it in the sound of their voice when they ask me about advance directives. Advance directives are supposed to be about making your own choices, but the choice to live is the least respected among them. They would rather I not be here by now, rather I got my sixth, seventh, eighth infection until my lungs finally gave out. I refuse to give them the satisfaction. I love being alive and a tube doesn't change that one bit, in fact it makes my life better.

 

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Hills and cliffs.

I was just having a conversation about a difference I’ve observed between various autistic people. I want to note, before I describe it, that it’s not some kind of cut and dried division, nor is it scientific. It’s just an observation I’ve made. It’s not even a matter of “types of autism” necessarily, because a person can function in both ways at different times in their life, or bits of both at once. But I notice that some of my friends and family are primarily one way, and some are primarily another.

And be aware that when I’m talking about abilities, below, I’m talking about surface-level stuff. I’m not talking about the deeper neurological/cognitive sorts of abilities, which might be both stable and very much similar in all groups of people described, for all I know.

Basically…

Some people seem to have very stable abilities. If there’s things they can’t do, they just can’t do them. And if there’s things they can do, they always can do them.

Other people seem to experience a lot of change and fluctuation. They might be able to do something one moment and not the next, and they might always have various abilities moving out of the way to make room for whichever one is being used.

And I thought of an analogy to this, or rather elaborated on one of my old ones. Think of elevation as ability in any particular area.

Some people seem to have started off at a certain low elevation in this particular area. Then as they got older, they hiked up the slope. At the top of the slope was a nice, large flat area where they could find a place to live very easily on a long-term basis.

Other people seem to have started off at the same low elevation, but what’s in front of us look more like cliffs. We can get very adept at climbing those cliffs, but when we are, there is nothing else we could possibly be paying attention to, since too much is going to dealing with this cliff face. When we reach the same elevation as the other person, we are hanging onto a cliff face with our hands and feet. There is no possible way we could stay there. We might even be able to reach much higher elevations than the other person — the cliff seems to not have a top, from our perspective — but we will eventually have to either climb down voluntarily, or fall down involuntarily, back to our original level.

Some people might actually find a top to their cliff eventually, and thus be able to remain stably at that ability even if it took a lot more effort and falling down than someone else took to get to that point. Other people won’t find that, and will end up having to deal with cliff faces all the time.

And there is a definite difference, even in two people doing the exact same thing, between one person standing on flat ground at a certain elevation, and another person hanging off a cliff at the same elevation. They might be doing the same thing, and at the same elevation, but they’re getting at it in very different ways, and only one of them will be able to sustain what they are doing for very long. There are all kinds of things this analogy can’t get across — particularly the complexity of having skills shift around all over the place while you’re climbing those cliffs — but I hope that is one of them.

This difference between ways of doing things seems to exist within all so-called “levels of functioning” and other ways of trying to divide autism into little parts. Both sorts of people, and all combinations and variations of those ways that skills can work, seem to exist among people with all ability labels. I do suspect that some of what gets called ‘regression’ is actually just that someone was cliff-climbing and fell back down to the ground, rather than that the person was not autistic until they ‘regressed’.

I’d also like to note that at my own version of ‘ground level’ in many areas, there is a lot of stuff that’s invisible to people way high up in the air from my perspective (including me, on my climbs up here). Not all of it is bad stuff. There are abilities down here that don’t exist so much once you start climbing, and that I rely on as my more reliable abilities, that exist without too much effort or forcing. So climbing high in one area can mean leaving other things behind on the ground. And even people who climb cliffs to get to where most people start out, have actual abilities that do stay the same at some basic level on the ground. They’re just not usually considered to be that. (And people who mostly live up high but happen to walk by a cliff and fall onto lower ground, have a very different experience of this than those of us who live on lower ground but climb up onto the cliffs. Even if both sets of people look identical in some contexts.)

I hope I haven’t by now stretched this metaphor to its breaking point, but I figured it might be useful, and I’ve seen this difference create a lot of confusion between different autistic people before. (And I don’t think it’s limited to autistic people, I’m just talking about autistic people because that’s the conversation I was having that got me into this.)

The right to say “I don’t know”.

I’ve been, offline, for many years, writing down things I do or have done that cause problems, either for me or for other people. This isn’t some kind of self-flagellation or anything. I just figured if I wrote everything down then maybe I could figure out how not to do some of these things.

There’s a few sentences that I have had to work really hard to use on a regular basis and in their appropriate context:

• I don’t know.
• I don’t understand.
• I don’t remember.

I say I don’t pass, and when I say that I mean that if you look at me you know something’s different. The most I ever passed for at my peak of passing was eccentric (to people who liked me) and annoying or crazy (to people who didn’t). But it doesn’t mean that I haven’t developed strategies, without even meaning to, to cover for certain situations in which betraying a lack of knowledge or understanding would earn me ridicule, disbelief, and hostility. So I guess it could be said that I pass, or try to pass, in certain areas, although what I pass for is sometimes worse than what I actually am.

I’m sure this is something a lot of people do. The difference is that when most people cover for a lack of understanding or memory or knowledge, they’re covering for fairly standard lacks in those areas. The areas that I don’t understand, know things, or remember things, are relatively unusual ones. So somewhere along the line I developed a strategy of substituting any explanation that sounded plausible, whether it was true or false. I did this unconsciously, and I did it solely to cover a lack of understanding, not with any malicious intent.

Over the years I have been able to nearly stop doing this. But there are still some situations where it happens. The more of the following are involved, the more likely it is it will still happen:

• Pressure to produce language rapidly.
• Pressure to produce answers rapidly.
• Ridicule, disbelief, scorn, hostility, belittling, or actual physical damage, if I do not produce language or answers rapidly.

This was summarized in more official language in my IPP this way:

She reports that pressure to perform according to other people’s schedules and expectations makes thinking things through difficult or impossible. When form is valued over function in decisionmaking, Amanda is likely to perform in a rote way without full understanding of the range of choices available to her or the decisions ascribed to her.

[…]

When Amanda is pressured or overwhelmed, she sometimes reverts to non-communicative echolalia, using responses she has already learned, without evaluating them to see whether they are the ones she wants. Non-communicative echolalia often results in others believing she has made an informed decision when she has not, and in others assuming that she has agreed to something that, upon reflection, she does not want.

Basically, when I’m under pressure, the focus of word-generation starts heading away from communication, and towards the best possible way to get someone off my back as quickly as possible regardless of what I end up having to say in order to do it. This can be a useful survival skill, but it’s completely useless when it comes to wanting to actually communicate. And the last time I really did a lot of it ended in total disaster.

As to reasons I do it… several years ago, a friend of a friend (I’ll call her Jenny just for convenience’s sake) was talking to me and Laura about me. Jenny was trying to explain to me the idea that I might just be uncomfortable moving beyond my “comfort zone” and trying something new and so forth. Laura replied that this wasn’t usually the problem with me, and that in fact my problem was usually a about whether I believed I was allowed to or had a right to do certain things. While that’s not as much of a problem now, I still catch myself seeing something and going “Oh wow, I didn’t know I was allowed to do that,” and then doing it. It’s not usually a “comfort zone” thing for me, it’s a forgetting that something is permitted.

That’s been the case with “I don’t know.” And “I don’t understand.” And “I don’t remember.”

Because there’s a lot that I know somewhere in my head, but I have real trouble accessing that knowledge. I usually think I’m required to give an answer. “I don’t know” is an answer that is easy to forget is allowed.

And there’s a lot that I don’t understand, things people think I should understand or do understand already. I’m used to thinking I’m required to come up with some demonstration of understanding something even when I don’t. The idea that I’m allowed to say I don’t understand is still a bit surprising.

“I don’t remember” is one of the hardest ones. Because it’s the answer to a lot of “obvious” questions a lot of the time, like:

• What did you have for breakfast this morning?
• What did you do yesterday?
• When did you learn ________?
• What was your first experience with ________?

My memory, such as it is, stretches back to some part of infancy, although the things I remember from back then aren’t generally things that would interest most people. When something triggers a memory, my memory is reasonably accurate, although fuzzy on some details. But if for whatever reason the thing isn’t triggered by the exact right sequence of events, all you get is blank space. And straining against blank space only provokes frustration and eventually possibly confabulation, not real memory. So, if you asked me what I ate for breakfast this morning, I might say “scrambled eggs” because that’s something people eat for breakfast. But it’s a guess. And it’s probably inaccurate. (In fact I know it is because today I wouldn’t have had enough eggs left to make those.)

And I know that the responses I get if I admit lack of knowledge, understanding, or memory (in areas where most people have automatic knowledge, understanding, or memory, or in places where I’ve clearly demonstrated knowledge, understanding, or memory in the past) are often really unpleasant:

Some people laugh at me. Some people think I am being stubborn or refusing to tell them things on purpose. Some people call me stupid. Some people add pressure as if they think that will make me more able to come up with an answer (hint: the more pressure you add, the less accurate the answer, so watch out). Some people think I’m lying. Some people think I am being passive-aggressive. In fact, I can vividly remember someone screaming at me, after one of those I don’t understand or I don’t know or I don’t remember moments, “I’ve had it with your passive-aggressive bullcrap!”

I’ve decided at this point that I’ve had it, too. I’ve had it with people who can’t accept what I don’t know, understand, or remember. I’ve had it with people who’d rather I pretend to know something than admit I don’t know it, who in fact find such pretences somehow more honest than my serious and real lack of knowledge. I’ve had it with answering partially, incompletely, or totally inaccurately because people insist I have to, and with the consequences of doing so which are usually some justification for hurling some kind of abuse in my direction or giving me crap later when I try to fill in the gaps or retroactively correct myself or even (horror of horrors) change my mind.

To people of that nature:

If I don’t know something, I’m not going to pretend to know it for your sake.

If I don’t understand something, I’m not going to pretend to understand it for your sake.

If I don’t remember something, I’m not going to pretend to remember it for your sake.

I’ve now explained this. From now on, I don’t care if the gaps in my realtime access to knowledge don’t make sense to you. I don’t care what you accuse me of for taking my time, for refusing to answer questions I don’t know the answer to, or for correcting previous inaccurate or incomplete answers I’ve given under pressure. I have a right to say I don’t know when I mean I don’t know. If people can’t handle this part of my daily reality, that’s henceforth their problem.

And I think in saying this I’m not only speaking for other auties who’ve discovered the same covering strategies I’ve discovered, but for a lot of other people as well. A lot of people who are deaf or hard of hearing (or, like me, have general receptive language problems) end up pretending to understand something, because they know if they slow the conversation down by trying to figure out what people are saying, they’ll get in trouble. This is done so often among people with certain kinds of amnesia that it’s earned itself a medical name. A lot of people with learning disabilities (either the UK or the USA variety of that term) learn to do things like this as well.

And we shouldn’t have to. Other people do not need to be shielded from the inconvenience of dealing with people who doesn’t know, understand, or remember the exact things most people are expected to. Surely the cost of day-in and day-out passing and covering and confabulating is higher for the people doing it (and for that matter those around us) than the cost to those around us of actually dealing with the unexpected gaps in our understanding, knowledge, or memories. And these gaps are nothing to hate or be ashamed of. I for one am not going to cover them anymore.

Being talked around rather than to.

Joel wrote, in Walking While Autistic (something in itself I have way too much experience with, but that isn’t the topic of this post):

I’ve written about having a restaurant bill handed to someone else because I communicate differently sometimes. I know of other times when I went shopping with a wheelchair user, and because I don’t use a wheelchair, it was assumed I must be my friend’s “minder”. In some of these cases, my friends handed the store clerk money only to find the clerk handed the change not back to the customer, but to me instead. The obvious implication is that my friends were not competent with money, and needed someone else to do that for them (also that they weren’t competent to hand someone else the money themselves if they truly weren’t competent with money). I know other times when even people who are involved in the disability rights movement are very surprised when they meet someone in person, and find out that they don’t look or act exactly normal, or even disabled in the way which still “allows for the possibility of competence” in the eyes of the advocate.

I had a strange experience of this sort today.

I went into a hair salon with my staff person and my dog (it was too hot to leave her in the car). Since it was a short distance and the day was good for it and so forth, I was on foot, and not using any mobility aids. While I had a keyboard with me, I was not using it either. I was not even to my knowledge rocking or doing anything else unusual. We just sat and waited.

But even so, when it got to be my turn, the hairdresser talked to my staff person, and talked about me in the third person. She was surprised when I typed something, and did eventually redirect her attention to me in the first person. But I have no clue what quality in me caused her to do this. I’d been blaming a lot of it on the adaptive equipment or on overt stimming, but I wasn’t stimmy today, I wasn’t known to the hairdresser, my staff person wasn’t known to the hairdresser, and I wasn’t using any adaptive equipment that would’ve given me away. So there must be some other cue that people are picking up on. Maybe similar to the invisibility Bev talks about (and that I have seen Jim Sinclair and others discuss in the past).

“We won’t help you until you stop acting like you’re in pain.”

Last night I engaged in a very interesting conversation with a guy who works at the service that helps me out at night.

I was in a lot of pain. By a lot of pain, I mean I was crying and periodically screaming. I don’t cry from pain usually. I didn’t cry when my gallbladder was well into emergency stage, I just went really quiet. If I’m crying from pain, it’s serious. And this pain (and related movement restrictions) was serious enough that a spinal tap was done when I finally did get to the emergency room, because it sounded to them a lot like meningitis. (Fortunately it wasn’t.)

Anyway, I was sitting there trying to string sentences together, while barely able to keep auditory comprehension going, and trying to push through all the pain-induced shutdown to actually talk to the guy. And I’d periodically get the wording wrong or scream in half-pain half-linguistic-frustration or accidentally interrupt him. He told me that he would not help me until I was able to “respect” him the way he “respected” me.

You know… usually, if, for instance, someone’s finger’s cut off, and they’re running around cussing and screaming and not being very polite, other people kind of grasp why they’re acting like that and don’t act like the person is being disrespectful on purpose. Somehow, if the person has some kind of disability label however, this becomes a “behavior problem”. I used to know a guy who went untreated for pain for years, with a dislocated hip, because he had a developmental disability and all the things he did because of the pain were considered “bad behavior”. They didn’t bother looking to see if he was in pain. Hint: Physical pain isn’t behavioral, and treating it as behavioral is a violation of our rights.

(And if I’m not tending to my blog enough, now you know part of the reason. Sorry about that.)

The funny thing about communication.

Joel wrote about how people think about him when he’s using a communication device versus when he’s speaking, in You Must Not Want Company. One remark made was that when someone’s using a communication device, they obviously want to communicate or they wouldn’t be using it. I wanted to write a bit about when I’m communicating but not speaking or using a communication device.

I’ve had a few different friends remark that they were sort of amused by something about me. That was, that they could go for half an hour to an hour of having a conversation or other interaction with me, before noticing that I wasn’t actually talking or typing at all.

One of them was a friend where whenever she visited me (we lived near each other for awhile, now we’ve both moved away) we’d just sit there for awhile without talking to each other, but certainly greeting and interacting with each other. Another is a friend I now live near, who commented recently to someone else that she’s often shocked when she notices that she’s been carrying on a long conversation with someone who isn’t saying anything back, and that it feels totally natural.

It feels totally natural to me when it happens, too. It’s less tiring than coming up with words is, that’s for certain, or than listening to words. It doesn’t cause that awful feeling of exhaustion, pain, and pressure that entirely word-based interactions eventually and inevitably cause. It allows me to actually participate in non-verbal communication rather than being blocked out of it by language (and yes, one tends to block out the other, either way). And the interaction feels a lot more meaningful to me.

Another situation is when I truly can’t move, or can’t respond in other ways (even if able to move). I am automatically fearful when that happens, because some of the worst interactions in my life have been when this has happened, whether this be the kid in college who used to hurt me to try to snap me out of it, or the psych ward staff who used it as a bizarre excuse to tie me down and scream at me (question: When someone is so stiff that you can pick them up by their hands and the rest of their body stays rigid in a sitting position, why do they need to be any further immobilized than they already are?).

I have had two surprisingly good experiences with this recently. One of them was at AutCom last year, when I was exhausted after giving my talk, heading into another bad migraine, leaning against a wall, and not frozen but not able to respond or even focus my eyes properly. The staff person of one of the other attendees came up to me and talked to me, and I realized it was one of the first times that a stranger had talked naturally to me when I was like that, as if they were fully aware I could understand them. That meant a lot to me. Another was after those darned fireworks, when my friend explained to my other friend that freezing like that did not mean that I was unaware of things, but rather than I was likely more aware of things than usual. That’s something a lot of people never understand.

Joel is another person I’ve had a lot of fun with without necessarily talking all the time. Although the two of us can type up a storm together too. (When we first met, we put a laptop on a table, hooked an extra monitor and keyboard to it, and typed back and forth on it for hours.)

I wonder what it is that makes the difference between the people who experience enough communication from me that they forget that I’m not typing or speaking, and the people who forget that I’m there at all because I’m not typing or speaking.

Little phrases.

This week.

I just put that phrase in a sentence starting, “Whereas for quite some time this week I’ve had the ideas…”

But I didn’t mean this week. I meant, this-arbitrary-measurement-of-chunk-of-time-longer-than-a-day.

I could’ve said, the past few weeks, this month, the past few days, last month… those are all phrases in my repertoire for that kind of thing, and they pop out interchangeably.

This is, I suppose, one of the hazards of using and learning language by pattern. Especially when I’m tired, I’ll know which phrases “sound right” together, and “go right” together, but it’s really, really easy to forget to check them against what I’m actually meaning. So “some kind of chunk of time” simply becomes substituted with any chunk of time. A particular topic area gets substituted with its opposite without noticing, because both are connected in some way in the pattern system in my head.

And my speech seems irreparably that way, patterns devoid of internal meaning for the most part, or only tangentially tied to it. But somehow, even though I’m clearly using the same mechanisms while typing, they seem to be tied closer to thought and experience and so forth. Except when I’m tired or hungry or sick or overloaded or something, at which point things start falling apart more.

What people will notice if they see me type, is that while I make the usual kind of typos sometimes, the most common kind of typo I make is a whole-word or whole-phrase typo. My fingers will spit out a phrase that is not the one I want and I have to delete and go over it several times to get the one I do want. I’m not talking about subtle variations, either. I’m talking about things that change the entire meaning of a sentence, but that don’t have to sound as if they’re wrong somehow.

It seems like, there’s a phrase machine somewhere in my brain, and it spits things out without my thinking about it. It spits out words, or chunks of words, according to pattern, not according to tying back to something in my head or in my experience. It does this automatically and my job is to insert the right meanings so it doesn’t veer off course somehow.

It’s very easy to get it to veer off course, too. Consider the following sentences: It seems like, there’s a phrase machine somewhere in my brain, and it spits things out, because they’re supposed to be there. It seems like, there’s a phrase machine somewhere in my brain, and it spits things out, in order. It seems like, there’s a phrase machine somewhere in my brain, and it spits things out, that are closer to one thing than another. Those sentences are all of course demonstrations of the phrase machine in action. They make sense, but they’re not necessarily what I’m trying to get at at all.

I have noticed, though, that there’s a quality to this, that I can sometimes see in other auties, when they are struggling with language, yet still appearing fluent in whatever their preferred form of language (written or spoken) is at the time. One of the first signs I see is a sense of disconnection from the words in the person making them. Even if the words are the right words, the person somehow sounds far back in their head behind their voice, as if their voice is a wall in some respects rather than a messenger. There’s a distance there, and it’s even more obvious when the person is clearly using a lot of stored phrases. I don’t know how I hear those things in other people, though, I just do.

And that is the ramble I have created on the basis of a simple-looking time error in a sentence.