“Are you mad at me or something?”

“Are you mad at me or something?”

This is a question I’ve rarely, if ever, needed to pose to a doctor, until today. After months of waiting, I finally got to see a new primary care doctor since my doctor, although fantastic, is too far away now that we have moved. There is a saying about how all good things are worth waiting for but today certainly proves that the contrapositive is not true. This doctor spoke to me as if I was a defendant in a lengthy trial for an especially despicable crime. Granted, I struggle to accurately read tone, but my guess is that nine out of ten patients would have felt equally criticized, judged, and made to feel ashamed. For example, consider the following two questions with identical verbiage but different stresses, which, in my opinion, are received very differently:

  1. “So all these people in your family have some anxiety and depression? Wow.” (And imagine that transmitted with a “something is gross” look on the speaker’s face).
  2. “So, all these people in your family have some anxiety and depression. Wow.Wow is not needed and comes across poorly—like you’re unbelievable or some awful and freaky anomaly.

Depression and anxiety often have a genetic component anyway, so nothing about it should be “wow.” I was also told that metal health was not going to be discussed: too bad because that’s one of the two chief complaints I put under “what brings you here today.”

After I asked her if she was mad at me, without looking up from her notes said, “No. I don’t know you.” She continued to make notes. The words hung on the thickness of the humid air, painfully slow to dissipate.

“Oh, because you seem to hate me or something,” I added, as a way to justify my question.

Nothing. Then, eventually, “No. I have never met you.”

True, but it did not really address my impression and concern.

I desperately don’t want to go back there but I’m not sure where else to go. I’ve also heard that one of the doctors in the practice is supposedly very nice, so I want to switch but I’m not sure if I can and I feel too shy to ask. Sometimes I need a few days to bounce back and get the gumption to take the troubleshoot and take the next step. For now, it’s too raw and upsetting. Nothing got accomplished at the appointment and now, after months of waiting, I probably have to start a new search wait all over again.

 

Logic Puzzles

I love logic puzzles, the ones where a complicated problem is posed with a variety of stipulations and you have to find the arrangement that satisfies the given scenario without violating the rules. For example, seven botanists (Amber, Ben, Carlos, Devon, Emily, Frederick, and Giovanni) each hold one of three jobs at a greenhouse: pruning, watering, or fertilizing. No more than three people are responsible for the same job. Devon cannot work with Ben. If Amber does watering, Frederick does not do pruning…etc.

I’ve enjoyed these types of brain teasers ever since I was a young student and first encountered them in math class. After the initial exposure whet my appetite, I became a voracious consumer. Unlike readily available crossword puzzles, which I also enjoy, logic puzzles are much more esoteric. This is particularly frustrating for someone like me who gets single-mindedly obsessed with certain interests at a given time. I’ve learned that this hyper-focused fixation is a common trait held by those on the autism spectrum. It’s not always a good thing, because the drive to pursue only the obsession (termed a “special interest” by autism professionals) places such impenetrable blinders up on all sides surrounding the interest that even activities of daily living and biological needs can get ignored. Although this behavior seems diametrically opposed to the presentation of ADHD, at times, I’ve become so immersed in a special interest that I forget to eat or drink for much of a day. Some special interests seem to persist throughout life or at least for many years, while others are more intense and short-lived. Unfortunately, the latter can lead to forgotten purchases and forgotten clutter.

I’m lucky to have a job with such diverse and interesting assignments. The past two days, I’ve been tasked to develop logic puzzles and associated questions. As difficult as it can be to solve a logic puzzle, a challenge that I find thrilling, it’s that much harder to create them because you have to imagine all of the possible permutations and adapt the conditions appropriately to ensure that the solution for each question is the one and only unique answer. Tackling these types of assignments and turning in well-crafted, tricky puzzles brings me a deep sense of excitement and pride. I find that even when I’m trying to fall asleep at the end of the day, I’m running through scenarios from the exercises I wrote. If a movie festival is to screen six movies from ten available features, and exactly two movies must be played from each of three genres (comedy, drama, and action)…Then the etch-a-sketch screen in my brain starts sketching a rough grid for the problem, to start working through possibilities to satisfy the rules.

It’s not often that I get this specific type of assignment, but every so often when the opportunity rolls around, it’s like seeing a long-lost friend. I am instantly reminded how much I love them and how lucky I am to have a job that requests them on occasion, and a crazy brain that seems to receive a nearly unparalleled jolt of joy when working on them.

For anyone who enjoys them too, I’ve included one below that I made. If you want to check your answers, you can email me at ambersayer(at)gmail(dot)com

A pizza shop owner makes fresh pizzas every morning one at time before opening her doors at 11:00AM for the lunch rush. There are currently seven fresh pizza topping options on her menu: basil, chicken, olives, eggplant, mushrooms, peppers, and tomatoes. To ensure the pizzas are prepared in a logical order according to demand, preparation time, recipe yield, and oven time, the following conditions must be satisfied:

• If the mushroom pies are made earlier than the olive ones, then the basil pies must be made later than the tomato ones.
• The chicken pies are made second or sixth.
• Exactly two pizzas must be made between making the olive pies and the chicken pies.
• If the mushroom ones are made later in the morning than the olive pizzas, then the basil ones must be made sometime before the tomato pizzas.
• The olive pizzas are made earlier than the tomato or the pepper ones, but not both.
• The basil pizzas must be made immediately before or immediately after the chicken ones.

1. Which one of the following could be the order in which the pizzas are made from first to seventh?
a. Basil, chicken, tomatoes, olives, mushrooms, peppers, eggplant
b. Mushrooms, eggplant, olives, tomatoes, basil, chicken, peppers
c. Peppers, eggplant, olives, mushrooms, basil, chicken, tomatoes
d. Eggplant, chicken, peppers, basil, olives, mushrooms, tomatoes
e. Tomatoes, chicken, basil, eggplant, olives, peppers, mushrooms

2. Which one of the following pizza types CANNOT be made fifth?
a. Basil
b. Peppers
c. Tomatoes
d. Mushrooms
e. Eggplant

3. The exact baking order of all seven pizza flavors can be determined if which one of the following is known?
a. The basil ones are made third, and the tomato ones are made sixth.
b. The pizzas with peppers are made first, and the chicken ones are made sixth.
c. The mushroom pies are made second, and the tomato ones are made fourth.
d. The basil pizzas are made third, and the eggplant ones are made fourth.
e. The pepper pizzas are made first, and the mushroom ones are made sixth.

4. Which one of the following is a complete and accurate list of the possible slots in which the mushroom pizzas could be made?
a. First, fourth, sixth, seventh
b. First, second, sixth, seventh
c. First, second, third, fifth, seventh
d. First, second, fifth, sixth, seventh
e. First, second, fourth, sixth, seventh

5. Which one of the following could be a possible partial list of the order in which the pizzas are made?
a. Basil, chicken, and mushrooms as first, second, and third, respectively
b. Peppers, tomatoes, and olives as first, second, and third, respectively
c. Chicken, basil, and tomatoes as second, third, and fourth, respectively
d. Mushrooms, olives, and tomato as fourth, fifth, and sixth, respectively
e. Basil, chicken, and mushrooms as fifth, sixth, and seventh, respectively

The Hazards of Driving

Driving is one of my least favorite routine activities. For as much as people complain about the MTA in New York City, the extensive public transportation is one of the things I miss most about living there.

I have never been a good driver. Within the first several months of having my license, I ran a stop sign on a two-way stop street that I thought was a four-way stop and hit another car. Not only did I misread the right of way, I wouldn’t call what I did a “stop”; it was a yield at best. Thankfully, I was only moving about 15 miles per hour when I hit the other car, which didn’t have to stop, so she was traveling closer to 30. Bodily damages were minor, but the cars were not unscathed and my confidence in my ability to operate a motor vehicle vanished the moment that airbag inflated in my face. Rightfully so. As much as I’ve worked on trying to be a better driver, I have yet to feel competent and safe behind the wheel. My ADHD medication helps improve my focus, but it does little for reducing the anxiety that swells when I take the wheel because my problems driving safely are not solely products of inattentiveness.

The main issue seems to be my lack of proprioception and position sense. Similar to my hazards of walking, I have little awareness of where my body (or car) is in relation to other moving and stationary items. I crash into things multiple times per day with my shoulders, hips, or limbs. Door jambs, countertops, bushes, fences, boxes, you name it: I swipe it, catch my body on it, or topple it. One door frame in our old apartment was visibly darkened at the level of my shoulder from habitual collision. I have no appreciation for my body’s volume and especially none for its orientation relative to other items while I’m moving. This extends identically to being in a car, both as a passenger and driver. In the former, I’m just relegated to an anxious “backseat” driver, paranoid that my pilot has poor lane position and other cars are veering towards us as they pass. I hate highways for this reason. It always feels like the cars are not traveling parallel to me but closing in about to sideswipe us. I’ve learned that my best course of action is to not look out the window and stay immersed in some distraction phone process or reading material; the resultant carsickness is preferable (especially to the driver) to the incessant anxiety and frantic bracing of my limbs on the dashboard in preparation for a phantom collision. Over time, trust has been earned by most people who drive me, so I stifle my fears and avoid concerning myself with the passing traffic, even if it means missing the landscape.

Clearly when I’m driving, this is an impossible coping mechanism. I have to look. Not only do I still have the sense that cars or objects in my peripheral vision are coming towards me laterally, I also react accordingly, moving my vehicle unnecessarily and dangerously to one side or the other, often swiping things in the process. The right side of my car looks like it has race car stripe across its entire length: scars from the year I parked next to bushes that I collided with every time I pulled it in. There’s also a large dent on that side from hitting a dumpster. I can’t visualize my lane position and the moving cars around me capture my attention and distract me from staying attentive to the world through inside my windshield. On the highway, other cars often honk at me. I thought it was because I tend to drive obnoxiously slow (at least to Connecticut drivers) because I do have an appreciation for the fact that moving faster on the highway means my reaction time must be faster. They are honking because I allow my car to drift from the central position in the lane and encroach others, not because I’m not paying attention, but because I can’t tell where it is relative where it should be. I often think I’m correcting the position when I’m actually exacerbating it. I also noticed that I have to fight the urge to maintain focus ahead (where I’m going!).

My natural inclination seems to be to want to watch through the rearview mirror or side mirror. I have to fight my tendency to fixate on these targets and reroute my gaze appropriately ahead. As soon as I stop consciously reminding myself to look ahead, my eyes relax their focus back to their inappropriate mirror selection. Driving does not go well when you’re looking behind instead of ahead!

Lastly, it’s hard to control my thoughts while driving. For me, operating a car obviously requires dedicated attention but all of the rapidly presenting visual stimuli overwhelm my brain and monopolize its processing power. My OT has said this is an SPD issue and that many adults with SPD struggle with driving. My brain fixates on interpreting and organizing all of the visual cues coming in and it cannot filter out unnecessary “noise” (the color of that house, the number of people walking on the sidewalk, the license plate number of the oncoming car). All of the information is treated as equally important and it’s so superfluous that it gunks up the system and steals processing speed or mental RAM from appropriately tuning into and analyzing necessary cues. I imagine it’s analogous to setting a band pass filter to screen out certain frequencies of noise: a normal brain can filter out the clutter, the details of the moving surroundings, and gone in on the critical data. My brain completely lacks a filter and all visual messages flood in equally fast and loud, and are simply processed in the order in which they are received.

My eyes are like cameras set in sport mode, methodically snapping a series of pictures of my surroundings every fraction of a second, amassing enough stills that they could be viewed in succession and make a near seamless stop motion animation movie. The faster I drive, the faster my lens’ shutter speed and the higher the percentage of photos pile up. There’s no conceivable way to process the sheer volume that aggregate in even a single mile, let alone a trip of twenty or so and it’s frustratingly impossible to change my eyes’ setting to operate at a reasonably controlled rate. Essentially, my brain cannot keep pace with my eyes and I not only get a massive headache, but I fail to interpret or react to crucial main points in favor of useless details, should the details have been spotted first. Strangely, the visual inputs that evade processing when they inundate and overwhelm the processing speed don’t disappear. They seem to get stored in a holding area. Once visual information enters in a substantially slower rate (certainly when the drive is over but likely at the end of the day when my eyes close, ceasing the import of new input), each cue is systematically removed from storage and digested. I am bombarded with images of hundreds or thousands of images passed in the drive: useless details like car colors, passengers eating, bumper stickers, overgrown grass, a runner’s form as well information that should have caused adjustment in response to potholes, stop signs, traffic lights, brake lights ahead, a turn signal, etc. My mind will not welcome sleep until each picture is acknowledged. Too late.

There’s not an easy or favorable solution to this problem besides limiting the driving I do. I am extremely reluctant to drive, to the detriment of plans I’d like to make. I’m hoping that continued work in OT may improve my ability to filter out extraneous visual messages, but the interaction of factors that contribute to the hazard of my driving make it such that it’s unlikely that I’ll ever be a competent and secure driver. Eyes and a brain that collect and store endless visual information? I’ve got that covered!

 

 

All kidding aside, I severely restrict the amount of driving that I do, even though this is very limiting and sometimes prevents me from getting to places or seeing people that I’d like to visit. I know this greatly frustrates some people whom I’d like to see more, but thankfully, many are willing to visit me. I also like walking and biking and can often obtain rides when absolutely necessary.

 

The Power of Attitude

As a young child, I was remarkably upbeat, happy, optimistic, and hopeful about my future and that of the world. Anything seemed possible and I had wholehearted confidence in my ability to transpire my dreams into my reality. Mostly, I credit my parents for fostering this attitude of wonder and self-assurance; they provided me with ample opportunities to explore the world and my capabilities and never set boundaries or limitations on what I was capable of, even if they had their own (realistic) doubts. I certainly had my fair share of physical and emotional falls and fails, but they never seemed to set me back with much permanent or lasting impact. I had a lot of behavioral problems, particularly in my first years of school and in social situations that my older sisters never displayed, and to say that I presented more of a parenting challenge throughout my entire childhood is a gross understatement. In hindsight, it’s clear that much of my misbehavior, rambunctiousness, and hair-pulling frustrating confusion was a product of my undiagnosed autism and sensory processing disorder. At the time, my hyperactivity, finicky-ness, and even “bratty and immature” behavior was attributed to ADHD and my position as the youngest of three girls. Needless to say, the routine misdemeanors, punishment, timeouts at school, less-than-stellar report card marks for behavior (and penmanship) did little to curtail my mojo and I remained a spunky, relentlessly positive kid.

Something began to shift in the months before my tenth birthday. As if double-digits inherently ushered in the cessation of innocence, verve, and faith in oneself and the world, my mindset and affect began to dramatically shift. In the manner in which a windup toy peters out as the duration of its chatter and clatter lengthens after the initial spinning charge, my zest, vigor, and sunny outlook faded in favor of a restrained, timid demeanor.* Doubt replaced hope, worry and anxiety trumped my carefree nature, pessimism extinguished optimism, and my self-esteem plummeted. Within a few months, depression clouded out the very happiness and joy that had previously bestowed upon me the nickname “the happiest girl in the world,” used lovingly, but earnestly, by my dad. A switch had been flipped and my internal world, which colored my external one, changed.

As with most things which are rarely black or white, solely good or bad, some changes brought on by this metamorphosis were beneficial: my behavior, now so reserved, no longer landed me at the back table or time-out position at school, instead, teachers remarked that I was well-behaved. The more I restrained my body and physical hyperactivity and conformed to the expectations and qualities of a mature and “good” student, the more wildly and feverishly my brain ran. There was a constant barrage of anxieties, questions, troubles, fears, and even panic. Sure, there were also hopes and constructive thoughts, mulling over things learned in school, observations made out and about, and intellectual curiosities much like those that characterized my kid brain, but it became harder to hear these over the sheer volume and strength of the pessimistic thought reel. Little did teachers know that as I sat there studiously at my desk, the littlest one in the class with a big brain and bright responses to assignments, I was filled with internal angst, confusion, and sadness. My “proper” behavior was actually just paralysis induced by depression devouring my energy and ubiquitous pensive concerns. Shortly after, I developed an eating disorder that proved to be a formidable foe for the next eight years. The depression and anxiety fueled the anorexia, which in turn, sunk me into more severe depression and calamitous anxiety.

I wish I could say that some other momentous birthday or other occasion caused the same radical about-face in my outlook as did turning ten, but truthfully, nothing had been as exorbitantly formative in changing me. With that said, particularly in recent years, I have found a better balance and allowed some of that positivity, hope, and verve to weasel its way back into my psyche and shine through the constant cacophony of worries, bleak and dispirited thoughts, and emotional pain. My inner strength and confidence have mounted as I’ve triumphed over difficulties and become a curious and dedicated student of myself. For me, self-awareness has had an instrumental role in increasing self-compassion. I’ve even surprised myself in the authenticity of my mental fortitude and strong drive to seek and recognize the silver linings in spite of some tremendous adversities I’ve faced in recent years. I’m proud of things that I’ve overcome and the resilience of my positive attitude when it would be so understandable to completely crumble.

Some days, in accordance with the idiom “fake it ’til you make it,” the optimism and emotional fortitude is somewhat of an act, a tiring attempt to feign stability and tenacity. Although exhausting, there does seem to be some payback from this practice, but thankfully, sometimes the attitude is genuine. My foot injury is an example of the former turning into the latter. After it seems like surgery was in evitable, I experienced slight improvement in the pain and swelling after weeks of nonexistent progress. I have long heard that having a good attitude through illness and injury is scientifically proven to improve healing and perhaps my desire to avoid surgery was so primal and deep that I truly convinced myself that my foot was healing. It’s not. I have objective evidence from imaging studies that fail to demonstrate an iota of progress; it’s exactly the same as it was four months ago. At first, I couldn’t believe the results; I was so assured it was physically healing because my conviction in maiming a positive outlook became so powerful. I cancelled the postponed surgery date in favor for the conservative route.

Once the initial shock delivered by the MRI’s report on the stagnant state of my foot, I sat with my feelings. In the quiet of the predawn hours where all my clearest thoughts reside, my pride and optimism stripped away, I felt the throbbing pain, the familiar ache from the initial months of injury. The pain had not just returned, it had never really gone away. I had just become committed to silencing it in hopes of encouraging my body to actually resolve it. It looks like I will need the surgery after all.

Of course, I am very disappointed I will have to have the surgery and because I have medical anxiety, I am certainly anxious for that day. However, although I was mad at myself a couple of days ago for my inability to honestly assess the pain and progress of my foot, I choose to remain proud. It’s not easy to be hopeful and positive in the face of a bad injury, let alone the larger obstacles I have faced. As the sands of hopefulness and confidence ran out of the hourglass that ushered in age ten, I lost so much more than just the innocence of childhood. It’s taken two decades to build back some of what I’ve lost and so I will honor and admire all of the positive attitude triumphs, enthusiasm, and growth mindset moments that I can cultivate.

 

*The reason that turning ten served as an impetus for such change is complicated and I’m not sure I fully understand it, but I will attempt to evaluate it at a subsequent time.

I Keep Falling

I keep falling. In the past week, I’ve had three rather major falls of increasing severity. In the worst, I fell all the way down a flight of stairs, save for the very top step. I simply stepped down onto the first step and before I knew it, I was thumping down the entire flight on my back and landed with a big thud at the base of the stairs on the hard floor. My tailbone and sacrum have not yet forgotten nor forgiven the incident. In fact, I had to spend over two hours in urgent care yesterday, after deciding that instead of slowly resolving, the pain seems to be steadily progressing to intolerable levels.

I’ve mentioned before that SPD causes issues with balance, proprioception, body control and kinesthetic awareness, and overall stability. Therefore, I’m predisposed to falls and accidents and my physical history confirms this correlation. I’m guessing that the inattentiveness, impatience, and hastiness inherently symptomatic of my ADHD also contribute to the unintentional recklessness that characterizes my movements. I’m like a spastic marionette, blindly operated by forces outside of my conscious control or ability and with seemingly bizarre, jerky, rapid, and unexpected actions.

My movements epitomize clumsiness and klutziness; they are erratic, disorganized, hasty at times, and sporadically and unpredictably controlled and executed. The only time I step into a veil of grace and agility is when I run, although, I’d be remiss in failing to mention several catastrophic trips and tumbles; I tend to have to steer clear of trails and uneven surfaces, despite their health benefits and forgiveness of the demands on the anatomical structures. I’m so accident-prone that if there is any potential risk of injury or malfunction with some sort of task that demands movement—particularly those requiring any degree of coordination—even if exceedingly unlikely, I’m one of those unlucky few that will experience it. I’m probably why warning labels have to exist on certain products or on informed consent forms for certain activities. When “normal” people read such information prior to engaging in the said activity, they probably wonder, how could that possibly happen? The answer: if you’re Amber. Those who know and love me dearly even joke after I do incur such injuries, “that would only happen to you!”

I don’t wear this as a badge of honor. I certainly wish I could trade this “luck” for highly unlikely positive outcomes like winning the lottery or at least the gold coins at Big Y supermarket! At the same time, I don’t want to cede responsibility or my self-efficacy in improving my balance and coordination and decreasing the incidence of undesired or hazardous movements and the resultant injury risk.

I consciously try to slow my body movements so that I only travel (or flail) at moderate velocities, so that any impact is somewhat attenuated (remembering the concept of momentum from physics class equaling mass multiplied by velocity; reducing velocity with decrease my momentum, impulse, and impact force). Instead of bombinating around like a wild ricocheting bullet, I attempt to pull back on the reins and let up on the throttle. This doesn’t directly improve my coordination, but it can augment the allotted reaction time before an impending crash or fall and dampen impact forces. I also practice balancing and stabilizing my body and limbs during my OT appointments and on my own at home. Admittedly, it’s frustrating work because I have yet to notice an appreciable improvement during dedicated practice (like single-leg stance time) or in “real life” applications (hence, the three bad falls this week). I’m not going to give up though. I harken back to a quote I had on my wall growing up from Jacob Riis:

When nothing seems to help, I go and look at a stonecutter hammering away at his rock perhaps a hundred times without as much as a crack showing in it. Yet at the hundred and first blow it will split in two, and I know it was not that blow that did it, but all that had gone before.

Maybe all of the work and practice is quietly mounting beneath the surface in an undetectable manner, but suddenly, one day, I’ll notice that I am moving more fluidly, controlled, gracefully, and safely.

(For now, I’ve got ice on my back to ease its throbbing. I must not have hit that 101st blow yet…)