Saturday, February 6, 2016

Crutches Be Gone!

There they are, the crutches and air boot cast that have been my constant companions for more than four months. They have been dumped unceremoniously in the corner of the front hall, soon to be relegated to the dusty storage room. My metatarsal fracture has healed.

I saw the surgeon on January 19, two and a half weeks ago. The X-ray showed that the fracture line was no longer visible; it finally had healed. As I have written before, I stepped in a pothole, turned my left foot, and fractured my fifth metatarsal bone on September 12. From then until December 17, I was in an air cast and on crutches with no weight bearing -- three months. For the final month, I was allowed to walk in the air cast bearing weight. 

I am now having to learn to walk all over again. My brain does not remember how to walk. Also, after four months of carrying my weight on my right leg only, and then limping lop-sidedly in the cast, my muscles of the left leg have wasted away. The situation has not been helped by the hours each evening and weekend that I spent on the couch with my foot up, trying to get it to heal. The left foot hurts quite a lot when I put weight on it. 

I have been going to physiotherapy. I have lost range of motion in my toes and ankle. My plantar fascia is very tight and painful, and my arch is falling. The weakened muscles are not supporting my knee and ankle properly. I likely have some adhesions in the complex architecture of the foot.

It was such a strange sensation when I took the cast off and tried to walk. I found that I couldn't balance properly and wanted to carry all my weight on my right leg. My left foot felt like a block that couldn't bend, and I could only take little tiny steps on the left side. My walking was extremely slow and I had to consciously think about every single step -- how to swing my leg, put the foot down, bend it, and weight it equally. 

People who know me will remember that I am usually a person who person who zips, races, and rushes about at top speed. I have always been athletic, and have taken for granted my ability to balance, bend, turn on a dime, climb, run, scramble up a steep embankment, and walk over rough ground. Right now I don't have these capabilities. I can walk, very slowly, indoors in hallways, or outdoors on flat smooth sidewalks. Stepping over a curb, an angled surface, or a branch, or walking around a bit of snow or ice requires consideration and conscious effort. I have acquired some sympathy for elderly people and other people with mobility limitations who walk so very slowly, now that I have experienced it myself. 

But every day my ability to walk improves. Four days after I was allowed to walk without the cast, I went shopping at the mall, wearing shoes. I took one crutch with me for balance and to relieve the weight on the left a little. I didn't walk very far -- just around a department store and a little way down the main hallway of the mall. I was on an excursion to buy slippers, as I found it too painful to walk around the house in bare feet, as I usually do. 

Now I have worked up to outdoor walking, little by little extending the distance. Last weekend, I did two walks around the neighbourhood with Rob, 1.3 and 1.9 kilometres in length. On Thursday, I walked down the hill to a meeting in a distant building and back. My phone app told me that it was 3.1 km round trip, but I think it was incorrect because I have measured that distance before. I think that it was probably more like 2.4 km round trip.

I have been wearing my hiking boots or my sturdy Keen walking shoes to work. They provide good support and a sense of security if the parking lot and sidewalks are icy. I am sure that they look a little incongruous with my dress pants, blouses and blazers. 

Today Rob and I are going to go for a walk in the park. There are extreme wind gusts. But the sun is shining and I am so excited to be able to get out and walk outdoors again. 

Sunday, January 31, 2016

The Tyranny of Productivity

Recently, I had to step back from some of my duties at work in order to spend time on the couch with my foot up so that a fractured bone could heal. The experience has led me to take a hard look at the kind of life I am living, and how work has almost completely taken over my life.

The first observation is that when I broke the bone in my foot, I did not at first make any adjustments to my work schedule at all, except to attend doctor's appointments every few weeks and one cast-fitting appointment. I did have to change my means of mobility, hopping on crutches with a cast on my foot, and getting a special parking pass to park closer to my office and to buildings where meetings were held. Whenever possible, I did change the location of meetings to be closer to my office. But, remarkably, it did not even cross my mind to take days off work, or to cut back on my hours. I continued on working my eleven- and twelve-hour days, exhausted and in pain.

Looking back on it, it seems clear that my priorities were all wrong. How could I have been so oblivious to my body's needs and to my own health? How could I have been so focused on my obligations and projects at work that I looked at the broken foot as a temporary and annoying nuisance that hopefully would go away soon and in the meantime I tried to get on with things the best I could? I assumed that the bone would heal all by itself, on schedule, without any assistance from me. 

Productivity is a hard taskmaster. And administration, perhaps especially in academic institutions, demands devotion of all of one's time to the pursuit of productivity. In the academic culture of overwork, there is always too much to do, and multiple competing tasks. It is common to triage, completing those most urgent and important things first, and deferring, delegating, or neglecting those that cannot be addressed in the time available. Because of the excessive number of things to be done and the guilt one feels for not completing promised acts, work time becomes stretchy. The work day stretches to accommodate work demands, via earlier starts ("breakfast meetings"), staying later (in my case often to 8 or 9 at night), by holding evening events, by working on weekends, or by working through holidays. 

After awhile, you don't even remember who you are. You become your title, a working machine. Your body is just something you stuff food into so you have energy to work. It is something you exercise so that you can keep going at your work rather than breaking down, akin to doing regular car maintenance. Weekends are periods to refresh your mind so you can get back at it on Monday with renewed vigour, or else brief interludes into which you try to pack your whole (non-working) life.

But, if I am honest with myself, my excessive working is not completely the fault of my workplace. I was having a conversation with my daughter recently about my struggle to reduce my long hours so that my foot could heal (this was after I had been told by the doctor at the seventh week post-injury that the X-rays showed that the fracture was not healing). She said, "Oh Mom, you have always been a work-a-holic." She reminded me about my previous job and the one before that, and the long hours I have always worked, and the way I always have been wrapped up in work. 

It is true. I throw myself into my work. I always have done so. Even as a child at school, I turned every assignment into a gigantic project. I would comb the library, reading everything about the topic that I could get my hands on, design elaborate experiments and analyses, and write really long, illustrated reports. I enjoyed it. I learned a lot. 

For the most part, I have had the kind of work that I could throw myself into. My work has involved creative problem solving and design, reading, learning, relationship building, mentoring, teaching, and writing. These are all things that I enjoy doing, that I am good at, and that can make a useful contribution to society.

I have tended to look at productivity as a good thing, something to aspire to and to keep me on track. Many of the things that I have accomplished in my career and in my life are because I have had my sights focused on particular outcomes and I have persisted to achieve those outcomes. I have been a productive member of the organization and of society. 

But too much of a good thing can become a bad thing. This is what has happened with me in my current job. The balance is all out of whack. I have been working too many hours for too long, and my body, health, creativity, and life have suffered. Probably my work has suffered too. The research shows that excessive work actually leads to lower productivity. Exhausted people are not at their best, cognitively. Putting one's head down to get the job done negatively impacts relationship-building and team work, which are central to the success of projects in an organization (not to mention to one's enjoyment of being a member of that workplace). Being too focused on task productivity does not allow time for contemplation. Reflection and time to muse are necessary for visioning and creativity, and excellent leadership is visionary and creative.

Paradoxically, in order to be a good leader, I need to spend less time working and I need to be less of a slave to productivity. In order to thrive as a human being, and to be healthy, I need to spend a lot less time working. 

I have known this for decades. Sometimes I have managed to do a better job of restricting work demands on my time, and letting work take its place as just one of the elements in my life, not the dominant one that has precedence over everything else. But I am my own worst enemy, because whenever I manage to get work trimmed down to size, I start saying yes to new projects, or I start looking around for new challenges. 

Now that my foot has healed and I am on the path of learning to walk again, I have resolved that I am going to keep work in its place and keep my work hours down. I am beginning the process of tiptoeing toward retirement. I will still throw myself into projects, both work-related and those long deferred creative art and writing projects that are waiting for me. But I am also going to spend time with my grandkids and Rob. I am going to travel and paint. I am going to putter in the garden and daydream. Never again will I chain myself to the kind of work that obliterates me. 

Sunday, December 13, 2015

A List: After Susan Sontag

I have been reading Maria Popova's wonderful collection of quotations from writers on writing. You can find it at Brain Pickings. I have read most of these writers, and also several of the books on writing that she quotes from. This morning, I was reading some of Popova's nuggets on list-making as a writing starter activity, and I came across an excerpt from Susan Sontag's As Consciousness is Harnessed to Flesh: Journals and Notebooks, 1964-1980 (a book that I haven't yet read) - her list of "things I like" and "things I don't like." It has inspired me to create my own similar list.

Things I Like:

Coffee, pine trees, our cat Oliver, lady bugs, snow, cheese blintzes, 100 recipe chicken cookbook, red wine, baby clothes, towels, marble, reflections on water, pebbles, mountains, paint, garden soil, new ice, dancing, watermelon, pens, pads of paper, Thai food, fields, hoar frost, yellow, the pattern tree branches make against the sky, pancakes, lists, the letter o, collections of objects, the Gulf Islands, purple violets, The Passing Cloud, K.D. Lang's cover of Hallelujah, cheese, Margaret Atwood, black tea, wood grain, leaves in autumn, butterscotch, words, terriers, rayon fabric, Tsimshian and Haida art, my family, brie. 

Things I Don'Like:

Sewing, green pepper, volley ball, intravenous needles, gore in movies, post-modern art, bullying, perfume, Stephen Harper's Canada, makeup, suicide, maggots, cigarettes, public toilets, undercooked chicken, hospitals, caraway seed, medical procedures on eyeballs, rose hip tea, vomit, foam pillows, nylon, being called a lady or a girl, scotch, frostbite, firearms, gold coloured cars, wire worms, amputations, wet socks, cluttered counters, anime art, haggis, torn medial meniscus, television, grey or beige shirts, litter, dried oolichan, gum recession, hairspray, the smell of diesel, going to work Monday morning, greasy hair, dog poop revealed by melting snow in the spring.

Things I Like:

Good writing of any genre, October, British Columbia, raspberry jam, Rob, cherry blossoms, walking, chocolate cake, magnolia trees, my friends, the Group of Seven, grandchildren, long hair, food columns, jazz singers, alpine areas, pear trees, log houses, pottery, art blogs, blues music, backcountry skiing, kisses, margins, finishing a project, ideas, quilts, swimming in lakes, the camper, language, wild flowers, kayaks, research, cycling, wilderness trails, fly fishing, beets, turquoise, folk art, the angle of the light, beads, view from an airplane window, a wood fire, Haida Gwaii, trees, Mom's shortbread.

Saturday, December 12, 2015

The Mind Thinks It's a Body

Today I was at the the ski shop buying skis and boots for my son for Christmas. My son was with me, of course, to choose the boots and have them fitted, and to choose the skis, bindings, and poles that he wanted. He has been an avid boarder for the past twelve years, and now is excited to get back into skiing again. Rob, who has researched all the hot ski gear in every category, also was present providing his insights.

Buying ski gear is not something that you walk in and do in a few minutes. We actually started yesterday evening, and spent nearly two hours with the ski shop guy, Steve, choosing the right boot. Then we came back again today to have the boots heat molded, and to pick out the rest of the equipment. During the hours we spent at the ski store, we were surrounded by ski stuff and ski talk. We swapped skiing stories with Steve, talked about technique and ski design, reminisced about skiing in the old days, and drooled over all the beautiful new powder skis, ski clothes, goggles, etc., surrounding us. The experience was a mini-immersion into ski life and served as a powerful impetus to get out on the slopes. 

However, I am on crutches, with a broken bone in my foot. I fractured the fifth metatarsal thirteen weeks ago, and it has been very slow to heal. It is healing, but oh so slowly. I am in an air cast, mostly non-weight-bearing, and am allowed to put limited weight on the heel only. Unfortunately for me, I am not likely to be out on the ski hill any time soon. Realistically, my next step once I can start to weight bear is to learn to walk again. 

Yet in the ski store today, my mind seemed oblivious to the facts of the matter. I could see so clearly in my mind the mountain where we usually ski - the runs on the Huckleberry chair, the Chutes in whiteout conditions, the traverse across the top of the bowl on the Red chair, and the way you can peek over the edge in one place to the sheer drop of the cliff to the left of the traverse. I can see the ski lodge, with red cheeked skiers at the picnic benches, peeling off their snowy touques and gloves, and parents down on their knees helping little kids to get their ski boots on or off. Hot chocolate with rum, and the terrible greasy burgers that cost an arm and a leg. In my mind I am there now, clomping in my ski boots, exhilarated from the last run.

In my mind, I am skiing that difficult ridge run under the Red chair, and I am swooping and turning with confidence, not stiffening up or having to stop every couple of turns to catch my breath. It is not just remembering. Rather, it is as if my crutches and current mobility limitations are irrelevant. I could be there on the slopes tomorrow, skiing just the way I always have. 

The mind thinks it's a body. I can ski, regardless of my present frailties, lack of fitness, or aging. And because I have visualized it so clearly in my mind, year after year when I go out to the hill, I can ski. I think I actually have continued to improve my skills, even though I no longer have the same courage, stamina, or flexibility of my youth. The stubborn, insistent mind has shaped the capabilities of the body. 

Yet sometimes it works the other way. The body teaches the mind. Really, when you rip down the slope between the trees in deep powder in the back country, your mind simply does not have time to consider and coordinate each physical component of the process turn after turn. The body takes over and does what the mind cannot as you float and dip into each turn, a rhythm that the mind chases to keep up with. "Turn here, and here," your mind instructs, but your knees and edges and arms have already completed that turn and are onto the next. It is beautiful and coordinated. You are flying effortlessly like a bird. The mind is a nagging old woman that you have tuned out. And later when you arrive at the bottom, your mind is incredulous, and replays the run over and over again trying to understand, feel it again, and tap into that flow. 

Many have written about the notion of a mind-body connection. But how it works remains a mystery. It is something that we all experience, and seldom even notice or remark upon. We take it for granted that our minds will bring our bodies to situations and then step back and let the body take over. Somehow those times when we are fully in our bodies seem to also be those moments when we are most intensely alive. And when we are not out there on the slopes, or paddling the kayak, or hiking over a scree slope, the mind is practicing for us so that when we go out on our next adventure, our bodies are already tuned up and ready for it.

Saturday, November 28, 2015

A Found Poem

The Organized Mind

Then, as now, printed words were promiscuous
"same as it ever was"
a kind of parallel, shadow economy 
a plate of black beans
nails, bits of wire, melon rinds, or shards of glass, 
most of the members of the category remain unnamed
a universal order of emergence
nuisances like rats and snakes
this preference for order
over and over every day
because of its affordance
and in and out you go
through the twenty-first-century world of ideas.

Found poem in: Levitin, Daniel J. (2014). The organized mind: Thinking straight in the age of information overload. Penguin: Toronto. (pp. 14, 15, 19, 22, 25, 30, 30, 31, 31, 33, 36, 36, 36)

Sunday, November 8, 2015

Metatarsal Fracture - Jones

Today is exactly eight weeks and a day since I stepped in a pothole, rolled my left foot over, and fractured my fifth metatarsal bone. The fifth metatarsal is the outside bone on the foot, and the type of fracture that I have is the dreaded Jones fracture. Why do I say "dreaded?" Well, this fracture is known to be resistant to healing. For athletes such as soccer players, basketball players, and runners, it can be a career-ending injury. However, I knew none if this when it happened to me.

On September 12, a beautiful warm Saturday, we went to the mountains for our last camping trip of the season. We pulled into the campground late in the afternoon, and I took the dog on a leash and my purse and walked down the road to go and register while Rob and Alex got the campsite set up. It was glorious. The trees were in full colour and the sunshine was sparkling on the lake. The high rocky bluff where we planned to hike the next day was dramatically lit. I was staring about at the beauty of the place and not really watching where I was going. I somehow stepped into a pothole, turned my foot, and fell hard. 

I immediately knew I had injured myself seriously. I thought it was either a sprain or a fracture. I also was bleeding from gravel cuts on both hands and legs. I hobbled back up the road, probably a distance of about two bocks, trying to put minimal weight on my left foot. Back at the camper, I cleaned up the blood and elevated and iced my foot. We decided to stay the night and see how the foot was the next day. 

The next day, the foot was badly bruised and I could not put any weight on it. However, the pain was not very bad, so Rob and Alex went hiking while I hung around the camper. I had not brought my painting equipment along, so I sat outdoors taking closeup photos of the autumn foliage. 

That evening when we returned home, Alex went and got my old crutches (from the days of the medial meniscus tears in both knees) out of the shed. I drove myself to the emergency room at the hospital  and used the crutches. They took an X-ray, and the doctor diagnosed it as a Jones fracture. He said that a fracture of the fifth metatarsal bone was the most common foot fracture. He recommended that I arrange to be fitted for an air cast, a type of walking cast. In the meantime, he put on a fibreglass backslab (splint) and tensor bandage, and told me not to weight bear on the foot. He also said that I probably would be in the air cast for seven to eight weeks. 

My question to him was whether I would be ready for ski season. I didn't think to ask whether it would impact my work, or daily life, or whether there was anything in particular that I should do to aid the healing of the bone. I didn't ask whether I would be able to weight bear in the air cast. I heard "walking cast" and thought I knew the answer. I thought a fracture was not a big deal and that it would be healed up in seven to eight weeks, and in the meantime I would be walking around in a walking cast.

It was the orthotics guy who fitted me for the air cast the next day that alerted me to the fact that although the cast could be used for walking, I shouldn't walk in it unless the doctor had said I was ready to weight bear. So, it wasn't time to ditch the crutches yet. 

Regular readers will know that I have a demanding job with extremely long hours. Having not considered that the injury would impact my work (I work with my head and computer, and through interpersonal relationships and meetings; how would my foot have anything to do with that?), I went off on crutches to my usual hours of work, eleven-hour days. By the end of that first week, I was miserable. My shoulders, wrists, back, and right leg and foot were so sore from trying to get around at work on crutches. My usual parking space suddenly was way too far from my office, and it was impossible to even get to meetings in distant buildings. I did paperwork to get a special parking pass at work and for the city. I was exhausted. 

When I saw my doctor ten days after the injury, she told me that I had to continue to be completely non-weight bearing. She told me to reduce my hours at work to four hours a day (plus four hours a day at home), and to rest and put my foot up. But work was extremely busy, with some difficult issues facing me. I cut back my hours a little to about nine hours a day, and spent my time at home with my foot up, being waited on. 

Two weeks later, at the three and a half week mark, I saw my doctor again and she did an X-ray. She said that she saw very little healing. She shook her head about the hours I was working, and wrote a note restricting me to four hours a day at work. She told me to come back in three weeks for another X-ray. She acknowledged that sometimes the early healing does not show up well in an X-ray, and said I could start putting a little weight on my heel as I felt ready, then begin to wean myself off the crutches. 

I started putting my heel down for balance. At about five weeks post-injury I started weight bearing a bit on the heel. It didn't hurt to put a little weight on it, so by the sixth week I was walking short distances in the house with one crutch. A few times I actually forgot to grab my crutches and walked away across the room. I felt so thrilled to have some mobility back, and some of my independence! It was wonderful to be able to pick something up in one hand instead of having to have people bring me everything little thing. I wrote a post about it called I Cleaned the Toilet. A few times, I slept with a bare foot rather than wearing the backslab or cast. 

At the six and a half week mark, I had another X-ray. The doctor said that the bone was starting to heal, but very slowly. She said the bone was filling in on the inside (medial) side, but the bone separation was still clearly visible on the outside of the bone. I told the doctor about sleeping with a bare foot, and sometimes taking the cast off when I was resting on the couch with my foot up. She said that I must not put any weight on my heel/foot with the cast off, but that I could continue with light weight bearing with the cast on. I made another appointment to come back in three weeks. I was pleased that some healing was happening but disappointed that I would still be in the cast for another three weeks. 

During all of this time, work continued to be extremely busy and difficult, and I was getting little sleep because I kept waking up in the night with insomnia, worrying about work issues. This was exacerbated by not being able to exercise (walk, cycle, hike), participate in social events, cook, garden or paint. These are leisure activities that are great stress relievers, but now I seemed to have nothing to distract me from work thoughts. Also, my time at work was creeping upwards again, and even included one fourteen hour day.

The next day, a Thursday, the doctor's office phoned our house and left a message to call. By the time I returned from work, the office was closed. I returned their call late Friday afternoon. It was bad news. The radiologist had taken a look at Wednesday's X-ray and saw very little healing. I was told to stop weight bearing, and to keep the cast on at all times. I was told that the doctor was referring me to an orthopedic surgeon. When I asked how long it would take to see the surgeon, the staff member said typically five to six months. 

I was devastated. I hadn't anticipated that the fracture would not heal. I had thought that I would be out of the cast after seven or eight weeks, then have a few weeks of physio, and then be ready for the ski season. Going back to no weight bearing after a week and a half of greater mobility was very difficult. The thought of being on crutches for another five months while waiting to see the surgeon, then having to undergo an operation was horrible. And of course there would then be a couple of months of recovery time after the surgery. I became grumpy and depressed (which did not endear me to Rob). 

I decided that I needed to make a greater effort to rest, stop working so much, and to elevate my foot as much as possible. I contacted my supervisor at work and explained the setback that I had experienced regarding my healing. He was very supportive, and he, another colleague, and the members of my leadership team met with me this week to help identify what tasks could be taken on by each of them and what could be deferred. I am now strictly obeying the restriction of four hours a day at work. I have accepted my immediate future as a couch potato. If this is what I need to do to help the bone heal, this is what I will do. 

Although up to this point I had done a little reading on fractures and healing processes (which had led me to start taking calcium and a multivitamin, as well as to avoid ibuprophen and other NSAIDS), I had not researched my condition very thoroughly. have now begun doing more extensive research on Jones fractures and approaches to treatment. These fractures are often slow to heal and sometimes result in non-union of the bone. The section of the metatarsal where a Jones fracture occurs is poorly served by blood flow. I plan to write another post on what I have learned about fractures of the fifth metatarsal bone, and in particular Jones fractures. 

In the meantime, I am trying to rest, rest, rest. I am trying limit my focus at work only to those critical pieces that I must do, and let others do the rest. 

Saturday, October 24, 2015

I Cleaned the Toilet

Today I cleaned the toilet. Not only that, I also wiped down the bathroom counter and scrubbed the sink. I also did the laundry. I baked a cake. I went shopping. I cooked supper. These things feel like a huge accomplishment. 

You see, six weeks ago today, I broke a bone in my foot. To be exact, it was a Jones fracture of the fifth metatarsal bone. My left foot is in an air cast. I have been getting around on crutches for six weeks. 

As anyone who has ever been on crutches can attest, it is not all that fun. For the first three weeks or so, I could not put any weight on the foot at all, even to balance myself. I quickly discovered that I don't have very good upper body strength. My shoulders, arms, and wrists became very sore from hoisting my weight around on my arms. My right leg, although quite strong, and my right foot ached from bearing all my weight. I was quite unsteady on the crutches. Going between buildings at work, usually a short walk and sometimes a longer walk of up to a kilometer, became next to impossible even for nearby buildings, especially if there were stairs involved.  I could manage only one trek a day of up to two blocks each way and that took lots of time and sweat. 

I discovered that there were so many little ordinary things that I could not do for myself. For example, because both hands were on my crutches, I could not carry a file folder or a cup of coffee. I had to leave a light on at night because I did not feel safe moving around on my crutches in the dark. 

I discovered lots of strategies to cope with my lack of mobility. I rescheduled meetings to my office whenever possible. I obtained a disabled plaquard so that I could park close to buildings. I had Rob move a chair into the bedroom so that I could sit to dress myself, and I learned to lay out all my clothing within easy reach. Similarly, Rob put a plastic stool into the shower so I could sit to shower. Getting ready for work in the morning took so much longer. Wherever possible, I simplified things - no hair products, no scarves, little or no jewellry. 

I have spent a great deal of time this last six weeks either at my desk at work or on the couch at home with my foot up. I have missed a beautiful autumn, unable to go out and walk, cycle, or garden. I have stopped painting (except once). I have stopped shopping, except once with Rob's help. Initially I couldn't cook, then I began some limited cooking with Rob and Alex helping (although with a team effort, we did have a full turkey dinner on Thanksgiving). Initially, I could only do the laundry with someone to help by carrying the laundry baskets, and then I mastered pushing the basket along the floor with a crutch.

Finally, this week I have been able to put significant weight on the left foot in the cast. I am putting most of my weight on my heel, not on the whole foot. I can get around in the house with only one crutch. I can even take several steps without a crutch. It is so wonderful to have one or both hands free! I can pick up the laundry basket and carry it. I can cook a whole dinner without help, including bending down to lift hot things out of the oven. Today, for the first time, I was able to carry a cup of tea from the kitchen to the living room, which involves going down three steps. Today I also went shopping by myself. 

Probably I overdid it a bit today, as my foot is quite sore tonight and swollen.  But it is so wonderful to be recovering, and to be able to to do even mundane things again, like cleaning the toilet. It has helped me appreciate the little ordinary things of life and see them not just as unwanted chores but as the elements of life that make up my existence in the world. 

My therapy cat.
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