Awakening any Sunday

Perhaps this morning is a useful example for the trends. Roughly five hours of sleep, woken up by pulsing-searing-electrical pain signals from the furthest-lowest left-side somatosensory nerve cluster. Rolling out of bed, slowly, stiffly, then C5/C6 and C8 cervical radiculopathy signals ignite in robust sensory overload. Just ignore those, they ache as always, yet only radiofrequency ablation may solve their woes - and no thank you to an operation involving a long cannula-needle inserted into my spine. Moving forward from the bed... remove the eye mask, its sensory deprivation so welcome in slumbers...

Now to find favored long fluffy cable-knit red socks first - a pleasant awareness of vascular pump-circulation thudding sensations reduced. Then in preparation for that med-tec loveliness which is my cervical traction collar, on goes a rose-hue cashmere half sweater buttoned atop sleepy silken camisole. "mmmm anschmiegsame Geschmeidigkeit ‡".

Then stretches, stumbling, gathering of presence and place and time now unifying into a commonality of time - it's The Morning. I hear birds chirping with the crisp breeze of a soon-to-be sunrise of mid-Summer. Coffee, oh but for its receptor activations on acetecholine, dopamine agonist, and norepinephrine boost ... taste as a secondary, primarily it is medication. Those interactions with the metabolic system stimulate internal processes throughout the CNS - ANS - PNS and that lovely meta-grid of Dopaminergic Pathways deep within the Corpus Callosum. Pain aside, it is nothing new, this calm state of early morning is one to transcribe into the site, here right now; one to remember not for its perfectness or idealistic qualities but for its simple state of awareness in the present.

I close my eyes, focus on breathing, slowly make contact with each cervical and spinal nerve as the minds-eye transits out of the cerebellum to the travel lower lower, out to each extremity and back, making contact with each sector and member of the body... acknowledging its presence, "hello legs, hello toes, waist and pelvis, aching joints, all those ligaments".. and move on to the endocrine nodes, "good morning thyroid, anterior pituitary, remnant-repro structures long removed, adrenal lobes" Acknowledging each's present state - calculating how each contributes before checking the sequence of hours and days - for which medication is needed today? The knobs and levers now mine to control: plans for weekly plasma curves, Cmax / Tmax / AUC, and the rest of the pharmacokinetics and pharmacodynamics - each complexity of dose + duration + modulations with CYP450 attribute to their interplay.

Holding the post-coma reigns, adjusting nearly the entire neuro/endocrine array of medications of injections and pills and time-release capsules, all of those elements which allow now for consistency of experience, to maintain my Self. It's challenging, with six hormones and three neurotransmitters, and anywhere from six to eight tertiary and ancillary Rx to modulate those primaries.

Externalizing the management structure is time consuming, complex in interactions, extremely challenging to adjust for concurrency of stability with consistency of mind and body. The ANS is so much better at all of those things, and yet this structure and several others never fully woke up with the rest of me on that bed in the ICU so long ago. Drifting thoughts, a tissue or two, not for crying but few streams of silent tears which fall - all on their own, frontal-emotion not attached yet those tears appear just as quickly as they depart. Perhaps another autonomic function triggering its role in an unknown-to-me manner for some evolutionary purpose long ago.

The doctors were rarely helpful [1], even "Cross-Functional Integrated Care Teams" of specialists, nor ombudsmen, occasionally a wonderful Nurse Practitioner brings the light back into my eyes (thank you Sue).

• [1] Except for Dr. Amber, who patiently and with honest care truly listened
• [‡] "anschmiegsame Geschmeidigkeit", loosely translates to "cozy softness"