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September 30, 2018

“Do the Thing Anyway” & 9 more Lessons that Chronic Pain Teaches Us.

In September of 2016, I underwent a heart procedure that would alter the course of my life.

I first noticed an increase in the frequency of my migraines a few weeks after I was discharged from the hospital. At first they were episodic in nature, and then, insidiously, became chronic.

In November of 2017, I was diagnosed with chronic daily migraines.

To say that this past year has been a challenge does not do it justice. I have been forced to reexamine every assumption I’ve ever made about myself, the field of medicine, the world, and human nature.

After months spent struggling with my daily pain, I made a conscious decision to learn from it.

So, today, on the anniversary of the day that changed my life, I’d like to pass along some unsolicited advice about overcoming pain. When I refer to pain, I don’t exclusively mean physical pain, as science has shown us that emotional and physical pain are more often alike than discrete.

I’m not delusional enough to think that any of these ideas are original; they are simply the amalgamation of a decade spent training in psychotherapy, 15 years of yoga practice, a lifetime of spiritual inquisitiveness, and, life’s greatest teacher, a really sh*tty situation.

1. The present is a present 
With chronic migraines, pain-free moments are few and far between. We’re often told to “appreciate the good days,” but I believe this advice can be damaging.

Regardless of my pain level, it is so easy to get caught in the trap of worrying about the future (i.e., “Will I be able to accomplish my goals?”) or mourning the past (i.e., “My life has been stolen from me”).

Observing the present moment with nonjudgmental awareness allows me to approach both the good and the bad days with gratitude and compassion. The days I am able to walk along the beach are just as poignant as the ones I spend in bed with ice on my forehead and my dog curled up next to me.

With mindful awareness, the future and the past become less invasive, allowing me to appreciate the beauty of what I have rather than what I want.

2. It’s okay to slow down
Prior to chronic migraine, my pace of life was exceedingly fast; I would transition seamlessly from one activity to the next with no consideration for my physical or mental state. It wasn’t that I simply devalued the concept of “downtime”—I detested it. To me, rest was the space between moments of productivity, not a moment to be valued in and of itself.

Our culture constantly reinforces the notion that forward movement is essentially better than stillness. We reward “hard workers” and rebuke those who are “lazy.” Further, women are often expected to forfeit self-care in the service of others for fear of being labeled “selfish.”

Chronic migraines forced me to reassess these deeply entrenched assumptions. Without moments of rest and self-care, I am unable to effectively contribute to society at large. As such, taking time to binge on mindless television with my husband or rest in warm Epsom salt baths are no longer indulgences colored by guilt. Rather, these pauses have become an act of love—for myself and for those around me.

You can’t pour from an empty cup, so make sure to take time and refill.

3. You aren’t missing out
This lesson is a natural extension of its predecessor. From a young age, I suffered from a case of intractable FOMO (“fear of missing out”). I was the first to accept any invitation, often without attention to whether I genuinely cared to be there or not. The idea of choosing relaxation over a social engagement was foreign to me, as I feared missed opportunities to connect with loved ones and create lasting memories.

When chronic migraines initially hit, I was clumsy and guilt-ridden as I turned down plans, trips, weddings, and even job opportunities. As it turned out, many of the opportunities I turned down were later accessible when I was better equipped to accept them. Further, the people who love me were often willing to alter their plans when I found the courage to ask. For example, I made plans to meet a good friend at our favorite restaurant. When a killer migraine hit, I stressed for hours about how to approach the situation without being perceived as flakey. I asked him if he minded coming over for takeout instead, and we had a great time catching up on my couch. It was that simple.

4. Spend your spoons wisely
If you haven’t heard of “Spoon Theory,” google it right now—it’s a game changer. The thrust is that we each have a finite amount of energy units, or spoons, available to spend throughout the day. Chronic illness restricts the amount of units available, and, as such, we learn to choose wisely whether a situation is worth one of our prized “spoons.”

Having fewer spoons has forced me to reconsider my priorities and to privilege activities that are consistent with my values. Before taking action, I often ask myself whether a situation is “worth a spoon” or is in the service of creating a meaningful and fulfilling life. If it is not, then I make the decision to forfeit the opportunity, with the knowledge that other opportunities will present themselves in time.

This lesson extends to relationships, where learning to set healthy boundaries and wisely pick our battles leads, counterintuitively perhaps, to more stability in our closest relationships. Clear and calm communication circumvents stressful arguments, and sometimes the petty things simply aren’t worth the migraine.

5. Do the thing anyway
In the past year, “do the thing anyway” has become a sort of mantra of mine. It began when I had a patient who was suffering from debilitating chronic pain. This person loved the beach, but would never visit it for fear that walking on the sand might exacerbate their pain. I pointed out that they were in pain either way and asked, “Would you rather be in pain on the beach or alone in your bed?” And so, “do the thing anyway” was coined. To me, it’s shorthand for “Don’t let your pain take the wheel.”

Often, I allowed my migraines to drive the car as I sat in the passenger seat telling myself, “I’ll do it when I feel better.” After it became abundantly clear that my pain would not be getting better anytime soon, I decided to hop back in the driver’s seat. The pain is still along for the ride, but it doesn’t have to stop me from doing the things I enjoy, accomplishing my goals, or making memories with the people I love.

Sometimes, it takes adaptation. Although I may not be able to commit to a full boat day, I can meet friends at the dock, premedicate, hydrate, and join them for a few hours on the sandbar. Likewise, I can’t spend long stretches in front of the computer preparing my dissertation for publication, but I can wear my blue-light glasses, prop my laptop on a transformer-like stand, and work for two hours each weekend until it is done.

Pain doesn’t preclude us from living a full life. Instead, it can inspire us to live with creativity, flexibility, and perseverance.

6. Be kind to yourself
I’ve always held myself to a high standard, and have a penchant for beating myself up when I fall short.

Chronic migraines have forced me to be more honest about the feasibility of goals—and to adjust expectations accordingly. In truth, I simply can’t do some of the things I’d like to do in the way I’d like to do them. There’s a beautiful quote by chronic pain advocate Erica Carrasco that says, “I’m not in that body anymore. I’m in this one and this one needs more care and appreciation.”

Practicing self-compassion requires vigilance, acceptance, honesty, and a commitment to unconditional self-love. I need to consistently remind myself that I am worthy of patience, compassion, and kindness simply because I am a human being.

One thing that has helped me foster self-compassion has been to actively challenge stigma by living my truth out loud. By speaking authentically and honestly about my experience with migraines, I’ve learned that I am not alone in my struggle—others struggle too, and struggle is a normal part of the human condition.

I try to internalize the kindness shown to me by others and throw away the shade. Because it doesn’t serve me.

7. Be kind to others
This lesson is closely related to self-compassion. As a clinician, I am acutely aware of the universality of human suffering. Invisible illness is a tangible reminder, however, that a person’s pain may not be perceptible to others. There are days when my head is pounding and I’m seeing stars, yet I look in the mirror and my exterior is unchanged. Similarly, on the worst days, I like to take a little more time to do my hair, put on makeup, or wear a cute dress.

This is a stark reminder that everyone has their own struggles, and we are often ignorant to the internal experience of others. Aldous Huxley said it best when he said, “It is a bit embarrassing to have been concerned with the human problem all one’s life and find at the end that one has no more to offer by way of advice than ‘Try to be a little kinder.’”

Be patient with one another, understand that very little (if anything) is personal, and, as Maya Angelou put it, “Be a rainbow in someone else’s cloud.”

8. It’s not what you wanted, but it’s what you got
This was by far the most difficult lesson.

One of my primary motivations for undergoing the procedure was to avoid a high-risk pregnancy. My husband and I have both always wanted children, and, as I approached my 30s, I began to feel pressure from society and my own biology. Ironically, the procedure led me to a condition that poses a significant challenge to reproduction, namely the choice between forfeiting the medications that allow me to function or forfeiting pregnancy in order to continue taking them. Over the course of the past year, every well-intentioned “When are you gonna have a baby?” or “Are you not drinking because you’re pregnant?” has landed like a punch to the gut. It’s still unclear how things will unfold. In the meantime, my husband and I have decided we’re going to open our future home to youth as foster parents.

It’s easy to find grace in those “miracles” that conform to our expectations of how things should be. It’s harder to find grace in the moments of disappointment, sadness, fear, and pain. As Jay Michelson put it, “What is simply is, whether I want it to be or not. We do not accept what is because it is acceptable, we accept it because it is.”

Learning to accept the parts of life that we can’t control frees us up to find alternative ways to make meaning, and, as Viktor Frankl said, “When we are no longer able to change a situation, we are challenged to change ourselves.”

9. Pain versus suffering
Buddhism teaches us that there is distinction between pain and suffering. The Sallatha Sutta explains that when people feel pain, they become distressed, leading to a second experience known as suffering. Suffering, in turn, increases our experience of pain.

In Acceptance and Commitment Therapy (ACT), we distinguish between “clean pain,” the physiological sensation of pain, and “dirty pain,” the mental anguish that comes along with it.

It is extremely easy to get caught in a cycle of suffering. By acknowledging Haruki Murakami’s assertions that “pain is inevitable” and “suffering is a choice,” it becomes easier to tolerate pain in the service of valued living.

When I have a moderate migraine, I can choose to get caught in a cycle of suffering, cancel my plans, and hide in bed, or I can choose to go about my day despite the pain. Sometimes my body needs to rest, but, whenever I can, I choose to “do the thing anyway.”

10. You are exactly where you’re supposed to be
This last lesson took me a while to appreciate. You see, I had a distinct plan for my life—and chronic migraine was certainly not a part of it.

It took me a long time to understand that the universe does not give a f*ck about my plans. As Vonnegut put it, “We are simply bugs trapped in the amber of this moment.” When chronic migraines appeared, I felt like my plans were abruptly brought to a halt. I second-guessed my capacity in every role I had ever inhabited—family member, friend, professional.

And then, after a period of mourning the future I had constructed in my mind, I realized it was my responsibility to edit it.

Serendipitously, I was offered a position to work with patients in a chronic pain clinic, so I accepted. While I never imagined myself working with this particular patient population, I’ve found that my experience with migraines has allowed me to approach my new role from a place of genuine empathy and compassion.

As Thich Nhat Hanh said, “No mud, no lotus.” Finding the willingness to not just tolerate pain but grow through it takes humility, courage, and tenacity—but the payoff is worth it.

In the words of Jalaluddin Rumi, “The cure for the pain is in the pain.”

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