My productivity is set by the health of my right hand, and that is determined by how often I use it.
If I rest, and keep the arm close at my side, the hand remains useful for simple tasks like opening doors. But if I do any manual activities for longer than half an hour - including but not limited to cooking, cycling, and typing - the hand blows out. Literally: the numbness starts in my smallest crooked finger and spirals up around the arm to my neck, with shooting pain following posthaste.
From the perspective of all the medical doctors I have consulted in major teaching hospitals in two countries since 1980, this is a permanent and irreversible injury. My hand, elbow, and neck were smashed beyond help and the intricate connections are (to use a technical term) ruined. Muscles, tendons, cartilage, bones, and nerves were broken or shredded. There is no cure.
But the original injury happened when I was so young there was also no option except to work through the pain. You can't really drop out of life in the fifth grade, and secondary school was somewhat compulsory - I didn't live in a place where a government agency wanted to pay my bills, and my family could not afford an adult dependent. I worked because I had to, no matter how much it hurt.
The arm injury is the least serious of my constellation of medical problems (cancer always wins that contest, even in remission) but the most visible and persistent. I am right-handed, and have never learned to switch. When I stumble I put out my right hand, when I grab or stretch or stroke I instinctively use my right hand. I've made efforts to adapt, taping classes and lectures, writing (badly) with my left hand, typing with one finger, becoming an early adopter of computers.
When my daughter was born twenty-one years ago I was too weak to hold her eight pound body with my right arm, too injured to contrive a solution. But I had to, and I did. I never became ambidextrous, but I learned to parent left-handed. And that serves as a metaphor for my life.
If I had been healthy I know that I would have chosen a different career, but I had to pick something that gave preference to intellectual skills over physical ability. I would have liked to be a welder, but instead I went to graduate school and studied public policy. My wonky brain had to take the burden for everything my body could not do, and it had to develop a plan that included health insurance: because otherwise I would have died.
Fast forward past the early career in activism and government service, through the years of writing and publishing, across the peripatetic existence traveling in search of safety and equitable public policies. Glance with repugnance at the fact I married - twice - for health insurance. At forty I am healthier than could be expected, and I have achieved a great deal more than my working class cancer stricken childhood promised. Including acquiring citizenship in a place where everyone has equal access to health care.
But there is still one permanent fact: my hand hurts.
All the time.
When I lived in Portland I could barter with friends for naturopathic care, deep tissue massage, acupuncture. When I lived in Seattle my health insurance covered a small but useful amount of alternative therapies. And, much to my surprise, the treatments helped.
The improvements were small and incremental, but real. People who are into this kind of thing talk about meridians and chi. I don't believe, I just experience, and this is the truth: one session of acupuncture reduces the pain. By the third, the pins and needles sensation is gone. If I follow the whole plan my arm is not normal but it is functional, at about half the level of my left arm - and this is something akin to a miracle.
Now I live in a country where alternative medical paradigms are frowned on, and highly adept practitioners are hard to find. I don't know anyone I could barter with, and until recently I couldn't afford the treatment. When I can't find an alternative I just work through the pain, until I can't work at all.
Recent deadlines, secret projects, and weeks of slogging through the archives had a predictable and woeful effect. I ignored the problem until my hand was flopping, useless and numb, and the pain kept me awake every night.
Then I gritted my teeth and made an acupuncture appointment. The very nice woman who examined me was visibly distressed, offering comments like "But that is horrible!" and "I don't know how you cope!"
I shrugged; I didn't know I had a choice. Objecting to chronic incurable pain is like arguing with the sunrise.
Then I subjected myself to a regimen of needles - at least thirty in each session, every week for six weeks, limited only by what the practitioner herself can tolerate. I don't flinch, I don't feel it. In fact, as soon as the needles go in I fall asleep, impervious to the jabs, and the heat, and the electrical impulses she sends across the metal.
This treatment costs £55, and one sliver of my brain is dedicated not only to multiplying the exchange rate, but also to reckoning what that amount of money would have meant to me as a poor kid or young parent. But when I walk out of the clinic flexing my hand I am endlessly thankful that I can open my wallet and pay.
Hours later I notice that while my neck feels tender something else hurts more. That secretly, against my own advice, I am filled with grief and regret - because my illnesses and injuries have prevented me from doing so much, yes. But mostly because they have taken me so far away from home.