Collin

I like computers

10 minute read

The last few months have been defined by a pretty significant health and wellness issue. I’ve been wanting a blog for a while but never felt like I had the time for it. Lately, that’s changed, so I’ve put this site together and thought it made sense to devote the inaugural post to talking about recent event. I’m a programmer by trade, and going forward my goal is to have this site be a mix of personal and technical writing.

Background

First off, a little bit about me. Hi. My name is Collin. I write software for a living. I’m not young, but I’m not old either. I’ve always had a bunch of cats, but I now also have a wife, a banjo (soon to be two), a house, and an embarrassing video game backlog. I grew up in Atlanta, and moved to San Francisco in 2011, got married, stayed in SF for about five years, and then moved to Durham, NC, where I’ve been ever since.

Timeline

On July 2, I woke up to an incredible headache. Remarkable enough that I texted my wife who was out of town visiting family to let her know. It was a symphony of hammers inside my head pounding in unison to be released from my head, sinuses, and teeth. I’m not really a headache-haver. Sure, I get them every now and then like anyone else, but the solution has always been to reach for the nearest bottle of something that’s supposed to help with it, and take the maximum recommended dose, and within an hour, forget that it ever happened.

This was my approach. Popped a couple of advil, and then limped upstairs to my office where I began the ritual of powering on my laptop, removing the previous night’s sins from my desk so I wouldn’t have to look at them, and then trying to remember what I was working on yesterday. There’s a sweet spot when you’re living on the east coast but working for west coast startups – you generally have a few hours in the morning where you can have uninterrupted focus time to get things done before Slack starts inserting itself into your life. I wasn’t going to miss the opportunity so I muscled through it.

That same day, the advil wore off. Not uncommon to have a stubborn headache so I took a couple more. Made it through the day’s standup, a number of mixed-value meetings, and even got some actual work done. That night, again, I needed to take more. I went to sleep and woke up with the same headache. Same intensity. Same collection of hammers that I had apparently wronged and were now out for revenge. This continued for a week, and I soon had the unpleasant feeling that this was something new, something significant. I had a doctor’s appointment previously scheduled for the end of the week so I resolved to just bring it up then. There’s a calm that comes from knowing that there is some kind of concrete action or plan to resolve something, even if it’s not where you want it to be at the moment.

My doctor, to my surprise, referred me to Duke imaging for a brain MRI due to having brain cancer in my family history. I told her that I was surprised by this, as I clearly felt that aside from the headaches that I was doing just fine. She said that for someone of advancing years, sudden onset of headaches is a huge red flag, especially with the family history. Good enough for me, and we got it scheduled for the following week. Just enough time to fully stew in my fears of what having brain cancer might entail, and revisiting all of my past mistakes, and considering the ways in which I felt like I hadn’t lived life to my fullest.

Thankfully, the MRI came back as “normal for someone of his age”, according to the radiologists. Why does everyone keep talking about how old I am?

With the scary stuff out of the way I then found myself in a neurologist’s office a couple of weeks later. At this point I had figured out that if I put myself on a pain management schedule I could get through most days without too much pain. This involved taking four advil when I woke up, two tylenol four hours later, rinse/repeat. The neurologist said that this sounded like New Daily Persistent Headache (NDPH) which honestly sounds like a long winded way of saying “no fucking idea”. He put me on something called Topiramate, which I would only recommend my enemies take. Not only does it drain you of your energy, but the worst side effect was that fizzy drinks did not taste fizzy anymore. It also did fuck all for the headaches.

So at this point where about 6 weeks in. I’m guzzling pain pills, beta blockers, psychotropic drugs, and feel like absolute shit. The advil has torn my stomach completely up, so I’m in pain upstairs and downstairs. I wake up in the middle of the night after the advil has worn off, crying. There’s no escape. I’m completely unable to work, and I am on what I think is my second week of PTO. There’s no way that I can manage to do my job in this condition. This continues for a couple of weeks and I eventually go on FMLA and start trying to navigate short term disability. I now need to concern myself with what it might mean for this never to go away. I made the mistake of looking at the NDPH Subreddit which is full of folks that are living my greatest fear. Short term disability and FMLA are things I am very grateful for, but they don’t last forever, and the thought of this was everpresent in my mind.

This is also right around the time that things started improving. I found that if I could do some light cardio (25m on the elliptical) that this would grant me a blissful one to two hours of reduced pain. So, I started doing this twice a day, every day. A week later, I decided that I needed a headache specialist and not a neurologist, and with the guidance of my PCP, I started titrating off of the Topiramate and the beta blockers. I could actually enjoy Spindrift Grapefruit soda again! You take little victories like that very seriously when everything else sucks.

A week later, I noticed that I would have little breaks in the clouds where I’d have stretches of hours where the headaches just did not happen, or if they did were at a very low and tolerable intensity. Over time, these little breaks and stretches became more frequent and longer in duration. This allowed me to adjust my advil/tylenol regimen down, giving my stomach some much needed relief.

Today, ten weeks after this all started, marks two consecutive days without taking any pain meds at all. It still lurks beneath the surface, reminding me that it’s still there, but the pain is tolerable / annoying instead of a full-blown crisis. The only things I really take now that are different when all of this started are a number of daily supplements and vitamins that are generally recommended for folks that have migraines.

Root Causing

So… wtf? I’m angling back towards normalcy with no clinical answer as to why this all started. My hope is that this trend continues, of course, but I was hoping for some kind of a reason that I could latch onto to describe why my life got turned upside down for a few months.

I am pretty sure it’s not cancer. I don’t think it’s a migraine, as evidenced by the complete ineffectiveness of the topiramate and the other things that the neurologist had me try. Migraines, I learned, also have starts and stops, and whatever this thing is was persistent, and for a while, constant and never-ending.

If it’s not anything like that, then what variables might explain the onset of the headaches, and the onset of the arc to recovery? My best answer for this is stress. Let’s start with some context.

My career has almost been wholly defined by working at startups, even in Atlanta. I loved working for them because they were exciting. Take a crazy idea, a handful of folks crazy enough to try it, a shitty u-haul storage unit that doubled as an office, and a potential windfall if it all worked, and you could not find anything more different than the stodgy, corporate, cubicle farms that offered stability, a discount on company stock, and possibly a gold watch in twenty-five years if you could manage it.

The startups were always stressful though; it was just part of the package. But I wasn’t too phased by it. Did I feel it? Of course. But the alternative – boredom – was far worse than anything I could imagine.

The stress of working at startups comes from many places. I’ll list some here that I’m acutely aware of, but this is by no means exhaustive:

  • not knowing anything as a junior programmer
  • not knowing nearly enough as a senior programmer
  • being expected to wear many different hats
  • major product and company decisions being made by folks without a lot of experience
  • company might run out of runway if they lose on a bet
  • startups tend to be stocked with grumpy wizards
  • chasing new shiny things instead of chasing first principles
  • while junior, needing to start all over again every 2-4 years
  • in general, trying to squeeze blood out of every rock

The stress of my current job is unlike what I’ve experienced before. To be fair to them, I knew that this would be the case before I joined, and it was also part of the reason I was hired (to fix things). What I misjudged was my ability to shoulder it. I will not go into details here but will only explain my relationship with the stress. After spending a month getting a lay of the land, I knew that this project had to fundamentally be changed to resemble something that could deliver new features on a reliable schedule, but that was going to take a while. I thought that I’d just really put the pedal to the medal and get it into that shape so that the following quarters would feel like a more normal job instead of being in crisis mode all of the time.

So, the first six months were nights and weekends. Again this is something I decided to do because I felt it was necessary, not because my employer expected it of me. Of course, nobody told me to not do this, but that decision was mine alone. Was this strategy effective? Yes, in many ways! Our availability numbers have improved by 25%, the architecture is more stable, observability black holes have been fixed, and in general the kinds of support issues we respond to these days are different than the ones we were dealing with a year ago.

However, it’s hard to take your foot completely off the pedal, especially when you’re getting positive feedback from being in Sport Mode all of the time. While I managed to do this somewhat, I was never able to actually unwind myself from the hyperfocus of trying to shape this thing into the image of what I thought it would need to be, and attaching its success to my own sense of self-worth. That is what was different about this stress, and I believe is what contributed to the sudden onset of these headaches. I think my body couldn’t take it anymore.

And it is also why I believe that I’m on the road to recovery. I still have bumps where I wake up in pain, and some days are worse than others, but the overall arc is trending to the right direction. What is a similar variable that also explains being on this arc? I haven’t worked or programmed a goddamn thing in a month.

I think those two observations in tandem are pretty compelling. At least, more compelling than any other theories like NDPH.

Next Steps

I don’t know what the future holds. But if my takes on this are at all the right ones, it’s clear to me that I need to redefine what work looks like. In the coming weeks, if everything continues to improve, I will need to work out what a return to work looks like, and how I will do this while prioritizing my own health.

It’s been a wake up call. I’m lucky in the sense that I think some people just have strokes and heart attacks instead. For that I’m grateful and I’m looking forward to what a future with these guardrails looks like.