Showing posts with label head injury chronicles. Show all posts
Showing posts with label head injury chronicles. Show all posts

Wednesday, January 04, 2023

"He's an asshole but I don't remember why": a post-head-injury phenomenon

Since my head injury, my brain behaves as though it's trying to save disk space, by deleting information it believes is no longer needed.

One such category of information is information that was used to make a decision that has been finalized and shouldn't need to be revisited.

One example of these decisions was choosing my condo finishes. I chose my kitchen counters on the basis that they were the least worst of the available options, but my brain has deleted what the problem was with the other ones. I couldn't explain to you what was wrong with them or why my current one was better.

Another example of these decisions was setting up my mortgage. I remember various questions I asked when deciding on the specifics of the mortgage and I remember that I was satisfied with the answers, but I don't remember what the answers were. I couldn't explain to you why this particular kind of mortgage meets my needs best, even though I'm confident that itdoes.
 

Another example of these decisions is deciding that someone I don't have to deal with in real life (a writer, a public figure, etc.) is untrustworthy or should be disregarded. 
 
For example, maybe people I trust on a particular topic don't trust this individual. Maybe this individual's politics are problematic. Maybe I learn that this individual is racist (as I've mentioned before, I'm bad at detecting racism myself, so I can't always tell until someone else mentions it).
 
So I decide to disregard them. I don't pay attention to the untrustworthy things they say, and instead spend my time and energy on trustworthy people. I don't read them for fear that I might unknowingly internalize their racism, and instead opt to read the people who first recognized that the problematic individual is racist.

Decision made, my brain deletes the information I used to arrive at that decision.

Then, sometime later, this individual comes up in conversation. I recognize the name as someone I've made a deliberate, informed decision to distrust for very good reasons. My interlocutor, being a decent human being, would want to know about this.
 
But all that's left in my brain is "He's an asshole . . . but I don't remember why."

***

What's super interesting is how people react to this!
 
When I can't remember or articulate why he's an asshole, people's visceral reaction is "You have no proof, therefore your allegation is non-credible!"
 
And then, they quite frequently go from "Your allegation is non-credible" to "Therefore, the person you are making allegations against is trustworthy!"
 
 
I haven't figured out what to do with this. If I were in my interlocutor's position, I'd want to know that he's an asshole. Based on what I know of my interlocutor, I also think they'd want to know.

But when I present what I know, minus what my post-head-injury brain has deleted, it often comes across as giving the asshole additional credibility.

I don't know what to do with this.

Saturday, June 11, 2022

Cause and effect

In 2009, City of Toronto workers, including garbage collectors, went on strike because the employer was trying to take away their sick days and leave them with a much worse arrangement.
 
Media coverage at the time (including, bizarrely, the Toronto Star, whose stated principles explicitly include being pro-labour) villainized these workers, stoking public anger against them.

Rob Ford leveraged this anger to be elected as mayor.

Doug Ford leveraged Rob Ford's apparent popularity to be elected first as city councillor, then as MPP, and eventually as Premier of Ontario.

Where he took sick days away from workers in a pandemic, among many other disastrous policies.

Here in this third year of a pandemic that those in power have no desire to end, I wonder where we as a city and as a province would be if the City of Toronto hadn't tried to take away workers' sick days.

There wouldn't have been a strike. Rob Ford wouldn't have become mayor. Doug Ford would be running a label company (or would be city councillor at worst). Ontario would almost certainly have a government better suited to the task of getting us through a pandemic. (And also, Toronto municipal workers would have a better sick day regime and therefore be better able to avoid spreading COVID.) Toronto would likely have a different municipal government as well, since it was Rob Ford's mayorality that led to John Tory being considered even remotely palatable. (Remember in 2007 when Ontario rejected him for being too far right?)

***

On a personal note, there's one vital thing that would be different:

One change made under Rob Ford's mayorality was to contract out part of Toronto's garbage collection to Green For Life.

On February 17, 2018, at 2:30 in the morning, I was in bed fast asleep when I was frightened awake by a horrific noise.

I jumped out of bed, ran to the window to see what the noise was . . . and woke up on the floor with an enormous lump on the back of my head.

Every aspect of life has been more difficult since.

The source of the noise that frightened me awake? A Green For Life contractor seemed to think 2:30 in the morning is a good time to empty a dumpster into a dump truck.

Butterfly wings.

Wednesday, May 25, 2022

Read Aloud

In my work life, MVP of all computer tools since my head injury is the Read Aloud function in Word. (Similar functions exist in other software, and comparable tools are also sometimes embedded in the OS or downloadable as apps.)

Since my head injury, I've had to work harder to focus visually, especially on text and especially on a screen. This makes the revision and editing parts of my job much harder! I can easily focus enough to read for comprehension, but the deeper level of focus required to catch the kinds of errors my brain usually autocorrects takes an enormous amount of work - and all too much of that work is going into buckling down and focusing, before I can even start putting effort and energy into the actual work of my job.

My saviour is Read Aloud. When it reads the text to me verbally, the kinds of errors my eyes and my brain usually gloss over come out sounding conspicuous and bizarre. Overly-French structures sound heavy and awkward, and basically anything that needs attention sounds jarring.

Because Read Aloud reads the text at a steady pace, I don't have to keep myself on task - the computer is doing it for me. Depending on the text and my eyesight, I might read along with the text on the screen, or I might look at the French while listening to the English to make sure every concept is present, or I might put a cold compress over my eyes or work on a vision therapy exercise.

Sometimes I correct errors as I go, sometimes I flag things for further attention with the Comments function. Then, once the readthrough is finished, I can put all my effort and energy into actually fixing the things I have flagged for attention, without it all having been drained on finding the things that need attention.

***

I've talked before about how audiobooks don't work for me because they go in one ear and out the other and I don't retain the story, so it seems super counterintuitive that Read Aloud would actually help with my revision and editing. I've been thinking about this a lot, and I've come to the realization that this is because I have a lifetime of experience reading for information.

When I read with my eyes, my brain is actively working to glean and assimilate meaning from the text, so it overlooks straightforward typos like public/pubic. When I listen, I'm not using the same mechanism as I've used my whole life to glean and assimilate meaning, so my brain isn't working to make sense of the text, and therefore isn't "helping" it.

I once read a book called Drawing on the Right Side of the Brain, which helps you learn to draw by using your right brain to see lines and shadows. You learn to think "This line needs to be at this specific angle", rather than the left-brained inclination to think "I am drawing a hand." You think about the structure of the subject rather than what the subject actually is.
 
Using Read Aloud for revision works similarly. It doesn't trigger the functions in my brain that try to make the text make sense, so I can focus on the structure, on whether anything is out of place.
 
This does mean that I don't retain the content when revising. It goes in one ear and out the other just like audiobooks. (If it's my own translation, I assimilated the content during the drafting phase. If it's someone else's translation, I won't retain it.) But that doesn't actually matter! I don't need to learn the content or remember the plot, I just need to make the text work. If I ever need the information, I can look it back up! And if, for some reason, I need to actually assimilate the information, I still have the option of reading with my eyes.

Sunday, March 15, 2020

A self-psychology exercise

In the aftermath of my head injury, I stumbled upon a self-psychology technique that may be useful to some people struggling with social distancing. This isn't helpful to everyone, but I'm sharing it here for anyone who can use it.


Many people find themselves from time to time imagining what life would be like if they didn't have to go to work/school today, or at all. If they could do whatever they wanted today, or in life in general. For example, you might think about how nice it would be to have a snow day like when you were a kid. Or, in the aftermath of my head injury, I often thought about how nice it would be to be retired like my parents.

Now, I'm not suggesting that a pandemic is a snow day! But they do, from time to time, have some moments of similarity.


So when you notice one of these moments of similarity, simply take note of it. Simply pause and say to yourself "If I could do whatever whatever I wanted today, I'd be doing exactly this."

Waking up naturally rather than to an alarm? That's a moment! Playing peek-a-boo and making your baby giggle? That's a moment! Putting your feet up and tuning into your favourite TV show? That's a moment!


I know, it sounds like I'm leading up to trying to convince you that quarantine is exactly like retirement and that you should feel grateful.

But that's not what I'm trying to do here. I know full well that this will vary widely from person to person, and that people who chafe at the idea of staying home likely have a very different vision of what they'd be doing in retirement. And I'm not trying to convince you to feel anything or to change your emotions.

I'm just saying, when you have a moment, take note of it. No emotions required. You don't have to feel grateful for the moment, you don't have to savour the moment, you don't have to stop feeling any negative feelings that you might be having about the pandemic or about any other aspect of life.

Simply note to yourself: "Right at this exact moment, I am doing exactly what I would be if I could do whatever I want."


Some people will find that comforting. If it turns out you find it comforting, it may help you get through this. If doesn't add to your comfort, no harm done. (If it takes away from your comfort, you can totally stop whenever you want.)

Some people will find that there are more moments than they expected. If it turns out you do, it may help you get through this. If you don't experience many moments, no harm done - this exercise simply won't take up your headspace, you can rejoice in your self-knowledge, and life will proceed exactly as if you'd never read this.


In my head injury aftermath, this could press pause on a despair spiral. EVERYTHING IS A HELLSCAPE!!!!!!...but this shower is nice, and there's literally nothing else I'd rather be right this exact moment. And, for at least the duration of that shower, everything wasn't a hellscape. It got me through the next hour or so.

The next few weeks are going to be about getting through the hours. Maybe this will help some people get through some of those hours.

Friday, September 06, 2019

System reboot status

My attempt to update my system was stymied by the all-consuming bra-induced back pain that I suffered at the beginning of the year. I've figured out some things I should try and identified other areas to address but haven't figured out how to address them.  I'm posting what I have so far to keep myself honest.

- Even though I reset my system to zero on my birthday, I'm once again significantly behind. This tells me that the system as it stands is untenable, but it's not apparent to me what could be cut out.

- I need unstructured time in my system - time I can spend staring at the internet or rereading old fanfic or googling weather patterns in the south Pacific. When I originally designed my system, my specific intention was to eliminate mindless staring at the computer.  I even scheduled in specific time for gaming and internetting to acknowledge and address that I do have these needs. But it turns out the "unstructured time" itch isn't scratched by "designated time for the things I end up doing when I'm supposed to be doing other things", so I need to figure out a way to fix that.  I currently have no idea how to do so and also get done all the things I need to get done.

- When I started working from home, I had a system of shortish work segments and even shorter breaks, which was an excellent fit with my strengths, weaknesses and temperament. However, since my head injury, transitioning between the two has been difficult - I have trouble jumping directly from focusing on X to focusing on Y, and time is lost futzing around during each transition.  So I'm now experimenting with longer, intensive work periods and a a different rest structure that better meets my post-head-injury needs.  I'm not sure if it will help - the strengths, weaknesses and temperament that were conducive to short segments and shorter breaks are still present - but it should at least be informative, and I can extrapolate from there.

- A few months back, I decided it was high time to return to my pre-head-injury sleep patterns. That was a mistake. So I've made the decision to treat my post-head-injury sleep patterns like a new normal, and adjusting various practises to make it easier to go to bed when my eyes start closing themselves, and be able to wake up naturally more often. (Thank you, working from home!) It's kind of disheartening to have to approach this like it will never get better, but if it ever does end up getting better, then I'll just find myself waking up bright and early and fully-rested, which is better than the status quo of waking up thinking "FUUUUUCK!" every single morning.

Sunday, August 04, 2019

The Segoe UI font is easy to read with convergence insufficiency and accommodative insufficiency resulting from head trauma

Recently, for the first time since my head injury, I received a text to translate that I could actually read effortlessly!

I immediately checked what the font was, and it turns out it's called Segoe UI.  I changed my default Firefox font to Segoe UI, and now life is so much easier!

So if you're ever looking for a font that's effortlessly readable with convergence insufficiency and accommodative insufficiency resulting from head trauma, Segoe UI fits the bill!

I'm working on adding Segoe UI to my blog's style sheet so everyone can enjoy its effortless readability (just plugging it in turned out to mess up the font size, so I need to do some tweaking).

However, I'm not the audience of my blog - in fact, I am the one person in the world who has the least need to find my blog readable! - so if at any point you find the font has become less readable, leave me a comment to let me know, ideally articulating the specific problem (too big? too small? too fat? too skinny? too much of some other characteristic that I can't even fathom?)

Thursday, June 27, 2019

Phosphenes and false memories

When I was a little girl, I had an unsuitably early bedtime. I wasn't even tired until about 2 hours after my bedtime. (Not a good parenting strategy, BTW. I became incapable of falling asleep in less than 2 hours even when I was tired, and it took until I was nearly 30 to overcome this.)

However, when I was small I did want to be a good girl, so I would lie in bed with my eyes closed trying really hard to fall asleep.

But a small child doesn't have the inner resources to just lie there doing nothing. I needed something to amuse myself.  Something that I could do while lying in bed with my eyes closed.

So I started watching the colours that I saw behind my eyelids when I closed my eyes (which, I would learn decades later, are called phosphenes). They would move and morph of their own volition, making for an interesting light show.

After some time, I gradually gained control over how the phosphenes moved and morphed.  It never became easy to move them - imagine the nuance of playing a theramin combined with the force required to fight the repulsion of like magnetic poles - but with effort I could manipulate them. I made it into a game, with my goal being to produce a red and blue checkerboard (the reason why I chose a red and blue checkerboard was lost to history) and I was able to reach the checkerboard almost every night.

However, around the age of 8, I developed a new intellectual skill. At the time I called it "thinks", but I now know that it's called Mary Sue fanfiction - mentally writing stories inserting myself into various works of fiction. I found this a far more enjoyable way to spend the hours before I fell asleep, and my phosphenes fell by the wayside.

That pattern has continued ever since, with the addition of romantic fantasies once I reached the point in my life where that was of interest.  But every once in a while, during a bout of insomnia, I'd reach for the phosphenes again and find that I was out of practice, but could still manipulate them.

Until my head injury.

In the aftermath of my head injury, I completely lost the ability to daydream or fantasize. (It began returning 4 months later, but even now a year later, it's still not available 100% of the time like it was before the head injury.)

So, as I lay in bed waiting to fall asleep, I reached for my phosphenes.

And they weren't there.

I could see a pattern that looked like a red and green lava lamp, but it wasn't moving at all. And, behind the lava lamp, I could see the eye of Sauron. But it wasn't my phosphenes. It was immovable, unchanging, and vaguely terrifying.

I spent a lot of time lying in bed with my eyes closed after my head injury, and this eye of Sauron was always staring back at me through the lava lamp. I couldn't control it, I couldn't change it, my old familiar patterns weren't there, and I couldn't even fantasize.

I wasn't even sure if I was human any more.

After some months, the eye of Sauron went away. (Its departure correlated with my first burst of vision therapy progress, but I can't tell if this is a cause and effect relationship.)  I also regained the ability to fantasize, so I luxuriated in my newly-regained imagination and stopped worrying about my phosphenes.

Then, a few weeks ago, my phosphenes came back.

And they're completely different!

Sometimes they consist of green figures that remind me of Chinese characters (I can't read Chinese so I couldn't tell you if they're actually Chinese characters, and it's not logistically possible for me to draw them. But wouldn't it be interesting if they said something in Chinese!)

Sometimes they consist of indescribable shapes and colours that are completely different from the indescribable shapes and colours I had previously.

A new and interesting feature is that occasionally a cartoon character will peek its head out from behind the swirling shapes and colours. I can't name any of the cartoon characters, but I have no idea if they're my brain's own creation or existing cartoon characters that my subconscious memory somehow internalized. (Again, it's not logistically possible to draw them, and I haven't been able to google my way to a "Yes! That's it!" moment of recognition.)

These new phosphenes are so interesting and different that I've put daydreaming/fantasy aside, and spend some time exploring them every night as I wait for sleep to overtake me.  I can't control them like I could the old ones (or, at least, I can't yet control them - I haven't a clue whether I'll eventually regain that ability), but I can sort of look around, zoom in, and generally watch the show.

But the most fascinating thing about Phosphenes 2.0 is that after I spend some time watching them, I get a false memory.

Example of a false memory: I was climbing up the side of a building. Partway through I thought "This doesn't seem safe - I shouldn't be able to hang onto the side of a building with just my fingertips." Then I thought "Don't be silly, you've done this thousands of times, people do it every day!"

Of course, I've never actually climbed the side of a building, and I'm not physically capable of hanging off a building by just my fingertips.  And people don't do it every day.

But, somehow, my brain served up that ridiculousness like a memory (as opposed to like a dream or a predream).

Ever since my phosphenes returned, this happens every night. The Phosphenes 2.0 Show, followed by a false memory, followed by the realization that the false memory is false, and then I promptly fall asleep.

It will be interesting to see how long my brain keeps this up for!

Sunday, November 11, 2018

My 2019 New Year's resolution

So I've been feeling that turning 38 is the beginning of a new chapter in my life, and trying to figure out what it's going to be.

Then, in the past few weeks, things keep happening where being perfectly diligent results in bad outcomes, but being less than perfectly diligent results in good outcomes.

And I realized this needs to be my next new year's resolution: be less diligent.

The need for less diligence isn't just a result of the bad luck I've been having the past couple of weeks.  It's also a result of the fact that my system hasn't been serving me well.

My system was originally designed when I was 22 and unemployed.  Social media didn't exist then, and my personal care required far less diligence.

Since then, whenever something comes up that I need or want to be part of my routine, I've been adding it to my system.  But I never took anything out, because everything in there seemed just as necessary as it has always been.  I did notice problems with this approach, but I still continued it.

However, since my head injury, this has all been snowballing.  What with the massive amounts of rest I needed in the aftermath of my head injury, and the general need to scale back on everything, and the addition of vision therapy to my routine, I'm essentially 6 months behind. Parts of the system were designed to be cumulative, so if I don't finish the task today I have to do it tomorrow, but since the head injury it has gotten ridiculous.  I feel hopelessly behind, which is a stupid feeling to be living with every single moment of every single day when you're meeting all your work deadlines and paying all your bills on time and getting ahead on your mortgage.

So my project for the next year is to destroy and rebuild my system.

I will continue following the current system until my birthday, but for the purpose of gathering data. I will note what aspects aren't serving me and reflect upon how to fix those problems.

Then, on my birthday, I will erase my backlog so I'm no longer "behind", introduce any fixes I think of between now and then, and continue following the system for the purpose of gathering data.

The next year will be spent pinpointing which aspects of the system don't serve me, and figuring out ways to fix them so they do serve me. Then I will reboot the system again on my 39th birthday, to reflect everything I've learned in the interim.

And, hopefully, I will enter the second half of my life with a system that serves me well and reflects my actual needs, rather than punishing me for not meeting some completely arbitrary standard of diligence.

Thursday, August 16, 2018

The Dyslexie font helps me read with convergence and accommodative insufficiency resulting from head trauma

The biggest problem with the visual issues that came with my head injury (for the googlers: my diagnosis was convergence insufficiency and accommodative insufficiency) is that I can no longer effortlessly skim large, dense pages of text, especially on screen.

Instead of "YAY, a new article/blog post/fanfic!", my visceral reaction is "AAAAH! Wall of text!"  It takes work to read things that would previously need no work, and all too often I'd just skip interesting articles or stories that I would otherwise enjoy, because I don't have it in me to put in the work. (Especially after a full day of translating, where I have to put in the work).

When I was researching vision therapy, I stumbled upon the fact that many child vision therapy patients are initially diagnosed as dyslexic. Apparently the difficulties with reading look the same to external observers, and, since the children have never been able to read, they can't tell the difference between "pulling the letters into focus and keeping them there is hard" and "reading is hard".

I remembered seeing something about a font designed for people with dyslexia. Even though I'm not dyslexic, maybe it could also help me?

It turns out there's a browser extension called OpenDyslexic that lets you toggle the Dyslexie font on and off.  So I gave it a try, my eyes instantly relaxed, and I could once again effortlessly skim and absorb everything.

When I hit a wall of text, I just toggle it on, and suddenly it's back to being effortless to read!  It doesn't change the formatting like Firefox's reader mode does, it's the same layout and design as the regular webpage - just with this funny-looking font instead.  It even works with dynamic, constantly-updating pages like Twitter!

Because Dyslexie is funny-looking, I don't like to use it all the time. When the combination of font, layout, spacing and colours is such that I don't struggle to read, I actually find Dyslexie intrusive. Fortunately, the OpenDyslexia browser extension makes it effortless to toggle on and off, so I don't have to choose.

I don't know if the improvements I experience with OpenDyslexia are specific to my post head trauma convergence insufficiency and accommodative insufficiency, or if the design of the Dyslexie font can make dense text more skimmable to anyone. But if you struggle with walls of text for any reason, it might be worth giving OpenDyslexia a try. It's free, it takes seconds to install, and you can switch if off instantly if it doesn't help.

Saturday, August 11, 2018

Unwanted "healing"

A couple of years ago, my brain started doing that old-lady thing of accidentally calling people by the wrong name.

One of the most unexpected after-effects of my head injury was that my brain stopped doing this.  I can't explain why, it just...didn't happen. For months and months and months.

I'm sad to report that that's over.  In the past few weeks, the wrong name has been coming out of my mouth with pre-head-injury frequency.

I really could have done without that bit of "recovery"! Why couldn't that part of my brain stay "injured", and my vision bounce back instead??

Friday, July 20, 2018

So it turns out I'm not an alcoholic

You aren't supposed to drink when you have a head injury. I didn't have any bottles in the house the day I hit my head, so it was a simple matter to just not go to the LCBO.

Some time passed, with my brain doing a variety of strange things, most of which were extremely temporary (i.e. one day of weirdness), the stickiest of which was vision issues, and none of which were cognitive issues or balance issue or anything that could be exacerbated by alcohol.

But I never got around to going to the LCBO, so I continued not drinking.

After some time, I noticed it was taking significantly longer to fall asleep each night, and I wondered if that was because of the absence of alcohol.  I thought I should go to the LCBO, get just one small bottle, and have just one standard drink under controlled conditions, for science.

But I never got around to it, so I continued not drinking.

The sleep situation stabilized. I started vision therapy. I scaled back and eventually completely eliminated my system of rest breaks.  I spent more days not crying than crying. I started working on waking up to an alarm again (with mixed results).

And I still never got around to going to the LCBO.

It's been five months since I had any alcohol.  It has occurred to me on and off that I should have a drink at home under controlled conditions so I can see how my body reacts, and I just keep...not getting around to it.

In the past, people have expressed concern about my drinking because I like drinking.  People have expressed concern about drinking because I drink alone rather than going out or inviting people over every single time I fancy a drink.  People have expressed concern about my drinking because people have expressed concern about my drinking.

But I'm pretty sure alcoholics don't just...not get around to buying more alcohol, especially when they have already arrived at the conclusion that they should drink alcohol for science.

***

Normally when people talk about not drinking for a period of time, they talk about how they feel better and don't miss it.

I don't feel better for not drinking.  I don't feel worse, but I don't feel better either.  I haven't lost weight.  I don't feel like I've saved money.  I don't feel in any way healthier.  Basically everything feels exactly the same, except for the residual symptoms of my head injury.

It wouldn't be fair to say I don't miss it either. Whenever I see a mention of someone drinking wine in something I'm reading, I think "Ooh, a glass of wine would be nice!" I kind of miss the feeling of  fun-twirling-around tipsy, but I'm so wary of falling now that I wouldn't risk that anyway.  At the same time, I don't really feel deprived, because it isn't something I can't do or shouldn't do.  It's just another thing I'm procrastinating, and I can stop procrastinating whenever I want.

Monday, May 28, 2018

Does good vision care insurance even exist?

I want to get vision therapy for my post-head-injury vision issues. It isn't covered by OHIP and apparently it's expensive, so I started looking at whether there's insurance that covers it.

(I know I probably can't swoop in, buy insurance, and instantly be covered for a pre-existing condition, but nevertheless I was interested in what's out there.)

And I could not find a single insurance plan that covers vision therapy.

I also could not find a single insurance plan that provides enough coverage for people's actual real-life glasses needs. 

All I could find is an inadequate amount for an eye exam every two years (even though optometrists recommend an annual eye exam), plus an inadequate amount for glasses, which maybe maybe maybe would cover a simple pair from the cheap rack at a chain store during a good sale, but would be nowhere near sufficient for people who need complex lenses or multiple pairs of glasses.

Is there even such thing as good vision care insurance that will cover the actual expenses that actual people incur, and maybe even extraordinary expenses for extraordinary situations like vision therapy?

I always figured that high-quality products were available somewhere out there for a price, but it seems that is not the case for vision care insurance. Is high-quality vision care insurance out there somewhere that's just outside of the awareness and google-fu of proles like me, or is there really no such thing?


Thursday, May 17, 2018

Things They Should Invent: customize the user-facing appearance of Word without changing documents' appearance

As I'm dealing with vision issues resulting from my head injury, I've been contemplating whether changes to the appearance of my computer interface would make things easier for me. Perhaps a light grey or beige background rather than stark white? Perhaps a different font might be easier to read?

The problem is that, as a translator, I'm expected to deliver my translations with the same formatting and appearance as the client-provided source text.  So if I were to change the background colour or the font, I'd have to change it back before delivering the text. Since some texts have specific and complex client-provided formatting, changing it back would be time-consuming and increase the likelihood of introducing errors that would make the client unhappy.

I would really like to be able to change the appearance on my screen without changing the underlying formatting - like imposing my own style sheet upon what I see.  Web browsers have accessibility options that let you override a webpage's formatting - I'd also like to be able to do this in a Word document.

Early versions of Word (circa 1993) had the option of making the interface look like WordPerfect 5.1, which many users at the time would have been accustomed to. However, the final document wasn't grey text in whatever font that is on a blue background - the final document was text in the colour selected by the user, in the font selected by the user, on the background selected by the user.

Word could do this in 1993. So why not also do it now, so people with visual issues can work on an eye-friendly interface while creating a document that meets the graphic and/or layout standards of their employer or their client?

Monday, April 23, 2018

"What if I never get better?" is a valid question

Frustrated with the persistence of some of my post head-injury symptoms, I googled what if I never get better.

The first page of results was all pages about depression, reassuring depression patients that it will get better at some point and that if life feels hopeless, that's just the depression talking.


If the first page of Google results represents the zeitgeist, this is a problem.

The full scope of human experience includes situations where you never get better. Sometimes you might spend years or even decades not getting better.  It's not necessarily depression talking, sometimes not getting better is simply an objective reality, and people need to figure out how to live with that, not to be patted on the head and told they're depressed.

This would also make me reluctant to mention to a medical professional when I'm afraid I'll never get better. I'd be concerned they'd get distracted from the thing that's causing me despair and instead start treating me for depression - confusing things by introducing new medications and such, when what I actually need is a timeline and a flowchart and a series of possible outcomes and perhaps to be informed of the existence of assistive devices or palliative options.

***

This is all the more important because, since I started writing this post, I've seen an optometrist (given that my remaining symptoms are visual) and it looks like there's a decent possibility that my problems can be solved with different glasses, and/or vision therapy (which I didn't even know was a thing, but is kind-of-but-not-entirely like physiotherapy for the eyes).

I don't want to fall into the trap of getting overoptimistic, but this is the first time since I hit my head that there seems to be even a remote possibility of just maybe being happy or comfortable at some point in the nonspecific future!  I'm still waiting for the glasses to be made, so keep your fingers crossed!

And this is all significant because it comes from treating me like I'm never going to get better.

I didn't approach the optometrist with "what if I never get better?" - I approached him from the point of view of "this is what I'm experiencing, can we diagnose and/or rule stuff out?" But a productive "what if I never get better?" conversation would have had the same outcome:

Me: "What if I never get better? What if focusing on the computer screen is hard work every single moment of every single day for the rest of my life?"
Doctor: "We'll see exactly what your eyes are doing, and then look into making you glasses to adjust. If you never get better, you'll wear different glasses that do some of the work for you. In parallel, we can also give you some exercises for your eyes, so you can work proactively on making this specific symptom better."
Isn't that a better outcome?  And more hopeful than platitudes and/or psychological treatment that don't address the underlying issue?

Friday, April 13, 2018

Things They DID Invent: shut up and pregnancy test

Something I'm sure I've blogged about before but can't find the post: when I was younger, many of my peers and I had the experience of medical professionals interrogating us about whether we were pregnant.  They'd start with "Is there any possibility that you're pregnant?" and then, when you said no, they'd say "How do you know?" They'd ask about the details of your menstruation and the choreography of you personal life and basically it was a whole gauntlet - which is particularly upsetting when you're a teenager (especially a teenager who feels too young to have sex), if your parents are present, etc.

Because of this, I've long advocated for simply doing a blood or urine test for pregnancy without belabouring the point, rather than interrogating the patient at length if you aren't going to take her word for not being pregnant.

I'm pleased to announce that when I was in the hospital with my head injury, they did just that. They did a number of blood tests to rule out heart attack, do a blood count, test for nutritional deficiencies, etc., and one of the tests they did was a pregnancy test.  They didn't even mention this to me - I didn't even see it until I was handed my printed-out blood work results.

Obviously pregnancy needs to be ruled out when a female patient of child-bearing age faints, probably on a more solid basis than recent menstruation or lack of reported recent exposure to sperm. So instead of interrogating me, they simply did the test that they would have had to do anyway.

I'm very glad they did it this way, and I hope they do the same on minors and other more vulnerable patients.

Monday, April 02, 2018

My emergency room experience

When I fainted and hit my head, I went to the emergency room at Sunnybrook.

Upon arriving at the emergency room, you swipe your health card in an automated kiosk, select a category into which your complaint falls, and describe it in a few words. The kiosk then issues you a number.

You sit down in the waiting room chairs, and the numbers come up on these big screens above small glassed-off offices. When your number comes up, you go talk to a triage nurse. It took less than 10 minutes (and perhaps even less than 5) for my number to come up.

The triage nurse listens to your problem, asks questions, takes your vitals, takes down all the information, takes your vital signs, and enters everything into the computer so you can be appropriately triaged.  Then I was sent back to the waiting room. Some other patients were sent into the other "zones", which have different waiting rooms, and I don't know what happens to them after that. (You can google Sunnybrook emergency room zones for more information - no point in me trying to explain it here when I don't have any information that hasn't already been put on the internet from more reliable sources.)

Soon after speaking to the triage nurse (maybe 5-10 minutes, definitely under half an hour), the receptionist calls your name, and you check in. They scan your health card, take your information, emergency contact, name of primary care physician, and issue you a wristband.  Then it's back to the waiting room.

What happens next depends on the particulars of the patient's condition. For me, another nurse called my name, and took me into a room (two examining tables/beds divided by a curtain) where he took my blood and took an EKG. This was about an hour after I arrived.  Then I was sent back to the waiting room for the longest wait of the day.  I later learned that this blood work was the primary diagnostic tool in my case, so even though I was sitting around for four hours, my blood work was at the lab.

After four more hours of waiting, they finally called my name and brought me into the "orange zone", where I was seated in another small waiting area. This made me nervous, because a lot of the patients in this area were in beds with machines and/or IVs hooked up to them. I could overhear that one patient had had a stroke, and another patient's family members were crying. It turned out this was a kind of mixed-use area - the people in beds were ER patients who were going to be staying in the hospital overnight, waiting for a bed to open up in the appropriate ward. They were also using this zone for patients who didn't need actual treatment, which is why I was there.

After sitting around in the orange zone waiting area for a bit, a nurse talked to me, asked me to tell my story again, re-took my vitals, and told me that my tests had come back normal so I just had to talk to the doctor and then I'd be discharged.  Then he sent me back to the orange zone waiting area.

After some more time waiting, the doctor called me and took me to a stretcher in the hallway that could be curtained off.  He asked for my story again, asked me questions, talked to me about my test results, did some non-invasive clothed physical exams (including stroke screening and palpating my abdomen). Then he gave me discharge instructions about how to take care of the bump on my head and what signs to seek further medical attention for, answered my questions, and sent me home.

My total time in the orange zone was 1-2 hours, my total time in the ER was about 6 hours. This was on the Saturday afternoon of a long weekend.

***

A bit about the physical environment:

The Sunnybrook ER is on the ground floor. The main entrance is on the first floor (which is one storey higher than the ground floor), so you have to go down a storey if you come in the main entrance. I don't know whether there was another easier way to access the ER.

The waiting room chairs are padded (with a vinyl-like upholstery that appears to be easy to clean) and have high backs. I can't tell you if they're comfortable to lean back on because I had an enormous bump on the back of my head. They were more comfortable than classroom chairs, church pews, or the chairs in my doctor's waiting room. I've previously blogged that ER waiting rooms should be sleepable, so I was surprised to notice that there was one (but only one) recliner-style chair that appeared to be sleepable. I'm not sure if it was there intentionally for sleepability or it was just an extra chair that they put there for more seating. In any case, I didn't try it out since other patients needed it more than me, and I couldn't lean my head back anyway.

The waiting room was very crowded (on the Saturday afternoon of a long weekend), and some patients' family members were sitting on the floor, or standing. I suspect some patients took those wheelchairs by the entrance so they'd have somewhere to sit, and after a while uncomfortable-looking folding chairs started materializing from somewhere.

There are washrooms right in the ER waiting room - two accessible family-style washrooms (i.e. with the toilet and sink behind the same door). They weren't always perfectly clean - sometimes there were puddles of water or bits of paper towel on the floor - but they were always well-stocked with toilet paper, soap, paper towels, sanitizer, etc. so our washroom experience could be as hygienic as possible. Despite the crowded waiting room, I never noticed a line for the washrooms. There is also sanitizer available in the waiting area.

There are vending machines selling water, juice and pop (just inside the doors of the ambulance entrance, by the security booth). I didn't notice anywhere where you could get food within the immediate vicinity of the ER waiting room, but I didn't ask either. There is a food court on the main floor between the main entrance and the elevators, and Google suggests that there are other sources of food elsewhere in the hospital, although I didn't investigate. Some patients' family members went and fetched food from the food court, and I suspect one person somehow had food delivered.

There are multiple password-protected wifi networks with "Sunnybrook" in the name, and no open networks. I didn't inquire about whether we were allowed to use any of them, or try to guess any of the passwords. I googled around the idea after the fact and the internet suggests that one is intended for patients and visitors, but I have no firsthand information.

There are a few wall outlets in the waiting room, but the waiting room was not designed with the assumption that everyone will have a device to charge.

I saw the triage nurses give a basin-like thing to one patient who thought he might vomit, and a blanket to another patient who was shivering, so it's possible other items for the patient's comfort might be available upon request.  No one gave me ice for my head bump, but I didn't ask either.

***

The best thing about this ER visit is that every single person I dealt with had outstanding bedside manner.

The triage nurse, young enough to see me as non-young, who squeezed my hand reassuringly when I confided that I had never been in a hospital before and was frightened, even though she's in a hospital every day and, I'm sure, sees hundreds of people with more cause to be frightened than I have.

The nurse who did my blood work and EKG, diligently requiring me to remove only the minimum clothing necessary and exposing only the minimum skin necessary (and covering exposed skin up as soon as the procedure permitted, even when the body part in question was just my calf), despite the fact that we were behind a curtain and my style of dress makes it apparent that I don't come from a more-modest-than-average cultural tradition.

The orange zone nurse, who patiently answered all my questions about what test result numbers mean even though they were normal and I didn't have to worry about them, and took the time to explain to me why I was in this section with stroke patients and people on tubes and machines.

The doctor, who sat down with me, looked me in the eye as though I had his full attention, and patiently answered every single question about what might have happened and what do I do next and how fainting works and how head lumps work and what they tested for and how they ruled out certain things, even though he was also in charge of all the stroke patients and people on tubes and machines - and even took the time to reassure me that I had done the right thing by coming to the hospital and when I should go to the hospital under similar circumstances, even though we could both see that I was the least important patient he was treating that day.

Even the security guards, who were kindly and patiently giving people directions and answering questions about where you can get food and drink and bathrooms and how the sign-in kiosks work, in between actual security guard emergencies.

Several years ago, I fell down an internet rabbit hole of reading ER nurse blogs, and I found that some of them were kind of . . . contemptuous, I suppose, of their patients. On their blogs, they dissed patients for being frightened when their condition wasn't serious, or for coming to the ER for something that isn't an emergency, or for bringing their mother even though they're a grown-ass adult. As someone who met these criteria (I didn't bring my mother, but I was considering calling her because sometimes I want my mommy when things are scary), I was kind of worried about how I might be treated in the ER. So I am quite pleased that every single person I dealt with at Sunnybrook was outstandingly kind and caring. This makes me feel far safer and more confident for next time I need hospital care.

And I sincerely hope there isn't ever a next time.

Saturday, March 17, 2018

Schroedinger's concussion

My contemplations of whether I underassess my own pain aren't purely academic.

A few weeks ago, I fainted and hit my head.

At the hospital, they seemed much more interested in the cause of my fainting, but ruled out a concussion because I did not report any of the symptoms on the list.

And I did not report any of the symptoms on the list because I did not perceive myself to be experiencing any of the symptoms on the list.

Nor did I perceive myself to be experiencing any of the symptoms that I was told to seek medical attention for if I should experience them in the days that follow.

But I wasn't functioning at 100%. I was moody and my eyes got tired easily. Focusing visually was harder work than usual.

About a week after the incident, I found myself crying myself to sleep because I hadn't been diagnosed with a concussion - if they'd told me I had a concussion, I reasoned, I would have rested my brain and probably felt better by then!

Then I realized I didn't need a diagnosis to rest, so I spent my weekend doing strict brain rest like you're supposed to do after you have a concussion.

It helped enormously, but didn't completely fix my problems.

So I scaled back my work and other responsibilities and made myself a program of brain rest that could fit around my work and other responsibilities. (Working from home was a lifesaver here!)

And it helped, slowly but surely.

It's been a month. I'm doing significantly better, and I'm still not completely 100% yet. Most days are better than the day before, although sometimes there's weird slippage. (For example, today my eyes were extremely fatigued in the morning, and I haven't a clue why.)

I have no idea if I had a concussion or not, and I don't know if I can ever know.  I can't blame the doctors for not diagnosing me, because they asked me if I was experiencing symptoms, and I reported what I perceived. I wasn't trying to be brave or tough or heroic by minimizng what I was experiencing, I was accurately reporting what I perceived.

And I can't help but wonder if my own perception has been skewed by my experiences with menstrual pain. And if it hadn't been skewed, might I have reported symptoms and been diagnosed with a concussion? And gone home with doctor's orders to rest, taken a few days off work, and been completely better by now?