Nice


“I urge you to please notice when you are happy, and exclaim or murmur or think at some point, ‘If this isn’t nice, I don’t know what is.'”  – Kurt Vonnegut

I’ve done enough whining on this site about the times when Parkinson’s is getting the best of me that it would be wrong not to write about the past week to week and a half. The simple fact is, that for some reason I don’t fully understand, over that timeframe, I’ve felt great.  Indescribably great.  Great as in how good one can feel when compared to how crummy I felt.  Great as in I’ve actually reduced taking my meds from once every three and a half to four hours to once every nine to ten hours. It’s been literally years since I’ve felt this good.  And while my voice and handwriting are both bordering on being illegible, those seem like minor complaints.

The balance problems that were not only getting me but actually literally knocking me down have largely vanished. Where I was prone to falling or crashing into walls or doorways or furniture multiple times per day, I now move normally and freely about 90% of the time. I’m sleeping six to seven hours a night, and while I still sometimes take a quick nap in the late morning (I’m convinced because  of the cumulative side effect of my morning cocktail of six different meds), I’m awake and alert the rest of the day, and avoid the afternoon naps I’d been taking.  I never imagined I’d feel this good again.  Ever.

Why am I feeling so good?  Well, I’m not sure. Here are my guesses:

  • On the cardiac front, I’m still watching what I eat, and exercising an hour to an hour and a half every day. I recently had my annual physical with my doctor, and the numbers are very good:
    • Weight: 212 pounds (down from 235 before my bypass surgery)
    • Total cholesterol: 120 (down from 230)
    • LDL (“bad” cholesterol): 48 (target:  < 100)
    • HDL (“good” cholesterol): 54 (target:  > 40, ideal > 60 – still have  a little work to do here!)
    • Triglycerides: 88 (<  100 optimal)

While exercise and diet have been big contributors to my improved numbers, my nightly dose of Lipitor has been just as big a factor.

Heart disease, while scary and deadly, has been pretty easy to prevent.  Just eat right, exercise, and take my Lipitor, and my numbers go down. These have been tried and proven methods, and the numbers provide an excellent indicator of progress.

Unfortunately, for Parkinson’s, it’s not as black and white. There are no proven biomarkers to determine how likely one is to get Parkinson’s, and once diagnosed, it’s known as a “snowflake” disease, as in everybody’s instance of the disease is a unique combination of symptoms and side effects that progress and evolve and react to treatments in varying and often times unpredictable ways. Treatment tends to be reactive and is dependent upon symptoms and is often trial and error.

So why am I at this point, eleven years into my diagnosis, suddenly feeling so good?  I have no idea.  What my guess is, is that after my recent appointment with my Movement Disorders Specialist (MDS), Dr. Z., we’ve arrived at a combination of meds, Deep Brain Stimulator settings, exercise, and physical therapy regime that are perfect for where I’m at in terms of the disease’s progression and how my unique instance is behaving at this time.  Specifically, Dr. Z added an additional med to my daily cocktail, which has enabled me to cut back on the amount of Carbidopa / Levodopa I consume.

I do know that I am incredibly lucky to be treated by a MDS, especially one as gifted as Dr. Z, at one of the premiere institutions in the country, Northwestern Memorial in Chicago. Because I treat there, I have access to resources that sadly aren’t available to too many people who are suffering much more than I’ve suffered.

The other thing I know is that I’m better off appreciating these days when I’m feeling so well instead of wasting time trying to figure out why. I don’t know when this “honeymoon” period will end, I just know that it will.  It might end tomorrow, next week, next month.

Until it does, all I can say is, “If this isn’t nice, I don’t know what is.”

Parkinson’s and Grief vs. Self Pity


“Grief is a process where nothing remains the same, even the big stuff, and none of it, sadly, fits back inside that old, comfortable box.”   – Peg Rousar-Thompson

 A few years ago, fearing that I may be suffering from the depression that is common with Parkinson’s disease, I went to a therapist for a brief time.   This was about the same time I had started to write, as a way to fill the hours I suddenly found myself awake for in the middle of the night.  After a few sessions, the therapist and I agreed that I wasn’t depressed.  If anything, I may have been suffering a slight case of anxiety, and by writing I was probably already engaged in the most effective therapy.

Our time together was extremely helpful anyway, if only for a very revealing exchange early in the first session.  I was trying to explain what I was going thru, when I said “I don’t want to sound like I’m feeling sorry for myself, but …”

She stopped me in mid-sentence.  “Why don’t you want to feel sorry for yourself?”

I stuttered and stammered, when she said, “Why wouldn’t you feel sorry for yourself?  You’ve got Parkinson’s disease.”

I was stunned.   It’s not that I hadn’t felt sorry for myself before; I had, plenty of times.   After all, I was only in my mid 40s when I received my sentence, my diagnosis.  It’s just that it hadn’t occurred to me it was okay to feel sorry for myself.   I think this was when I started to understand the difference between grief and self-pity.

They say then that one of the first things people go through after being diagnosed with Parkinson’s is a period of grieving, or mourning.  I think this is common for the diagnosis of any chronic disease.  Suddenly you are flawed, and the image you held of your future self is dead.  With a sentence of Parkinson’s comes the awareness that things are going to be different now, and that the days still left will be days of diminishment and loss.  It’s only natural to grieve for these losses.

There are also the expectations of how one is supposed to behave under these circumstances.  To understand these, one only needs to stand in the line at the supermarket and read the headlines of the National Enquirer.

One of the stories the Enquirer has been most successful with over the years has been the famous celebrity stricken with a terminal disease.  The story always follows a similar arch – how tragedy strikes when least expected, often times just as the celebrity has finally found some peace in their life, then on to the courageous and inspirational struggle, complete with some short-lived triumphs, followed by the shocking photos of how the once-beautiful icon we all remember has decayed once that struggle goes south, through to the brave final days, followed by death and memorial.  These stories are as sadly predictable as they are inevitably true –whether it’s Patrick Swayze, Christopher Reeve or all the way back to John Wayne.

The reason these stories sell so well is the meaning we derive from them.  It’s the same story that we see played out amongst those we’ve loved and lost.  Whenever someone close to us is sentenced to a prognosis of a terminal or incurable disease, we react the same way the Enquirer acts – we rail against the senselessness of it all and then take inspiration from their “brave” fight or their “positive attitude”.   It’s all a part of our attempts to find some meaning, to make some sense out of what appears to be evidence of the chaotic randomness and fundamental meanness of existence.  It’s the same reaction to the awareness of our own mortality that drives us to the belief in an afterlife and the creation of personalized images of Heaven.

Then comes the time when this “senseless” and “tragic” fate becomes our own life sentence.  Having seen this story play itself out countless times before, it informs the expectations we have of ourselves, and also the expectations of those around us. It doesn’t take long to realize what a burden these expectations add.  And, if we stop and think about it honestly, we’re surprised to admit how much importance we place on how we are perceived by others.

In the first days after being diagnosed, I promised myself I’d approach my newly defined fate with courage and dignity, resist the urge to ask myself “why me”, maintain a good attitude, and make the best of my remaining good time.  This sounds great, but in reality, I was a wreck, completely overwhelmed by and obsessed with my condition.  I anguished and brooded over the appearance of every slight symptom, such as the subtle and constant presence of a small amount of saliva inside my right cheek, attaching levels of importance to them that now seem laughable.   But the zenith of my self-absorption was reached when I realized how impatient I had become to having to listen to the seemingly insignificant problems of friends and co-workers.  As I half listened to them, I found myself thinking so you’re going through a divorce – it could be worse, you could have Parkinson’s – so you have advanced Rheumatoid Arthritis – at least you don’t have Parkinson’s like me.  I finally listened objectively to myself and realized what a pathetic self pitying ass I had become.  First, it was so early in my diagnosis that the disease was little more than a minor annoyance, and second, I realized that just because of my so-called personal “tragedy” that the rest of the world didn’t stop, and there were still real people out there with real problems, living real lives.  This may sound painfully obvious, but it came to me as a major epiphany, and jolted me at least partially out of my dark clouds of self-absorption.  Unfortunately, I landed in the even darker and more dangerous clouds of denial. 

This denial was manifested in my approach to work.  I found myself in charge of a large project that wasn’t going well, and, in fact, needed to be halted and re-evaluated.  But I was going to be damned if I let that happen, and, despite having an hour long commute at the time, I was the first of my team in the office in the morning and the last to leave at night.  I invested so much of my time and energy that when things didn’t go well, which they most frequently didn’t, I’d find myself awake at 2:00 AM on my laptop working until 4:00 A.M.   This was at the same time I was early in my diagnosis and my neurologist was attempting to determine the right mix of medications. The primary drug in the early stages is any one of a variety of dopamine agonists, drugs that are intended to trick the brain’s dopamine receptors into thinking they are still receiving signals even though Parkinson’s has destroyed the transmission.  These drugs can have significant side effects, and only through trial and error can the right dosage of the right medication be determined.  Chief among the many potential side effects of dopamine agonists are sudden and frequent attacks of daytime drowsiness, and feelings of dizziness and nausea.  I remember on several occasions, shortly after taking my morning dosage of Mirapex, the first dopamine agonist subscribed for me, shutting the door to my office and putting my head down on my desk and closing my eyes, waiting for the room to stop spinning.   This plus the daytime drowsiness that was already evident by short nights of sleep and an hour long commute made for a bad time to be in denial.  

Then came the inevitable moment that the project, despite my best efforts, reached what in hindsight was the only logical conclusion it could have reached:  it was cancelled.  My reaction was devastation and depression, and, after a couple of weeks when I was finally able to put some distance between the project and myself, I realized was about more than just the project’s cancellation.  I realized that all the work, all the stress, all the obsessive attention I paid to it were ways of not thinking about Parkinson’s, and I realized that not only was I in danger of working myself to an exhaustion that had no possible good ending, I was also spending months of valuable time obsessing over something I had no control of – as a means of not obsessing over something else I had no control over, that being Parkinson’s.

So if self pity was turning me into an unfeeling and insensitive ass, and denial was threatening to kill me, some kind of balance needed to be reached.  This is where the therapist helped me, and when I think I started to understand the difference between self pity and grief.

Grief, I think, is a natural and healthy response to loss.  It is the questioning of how and why, and even when the answers that come may not be satisfying, maybe aren’t what we want to hear, it is a necessary component of finding the truths buried within our losses.

Pain is a byproduct of loss, and self pity is a natural response to temporarily dull the anguish it causes.   But wallowing too long in self pity is to treat the symptom but not the disease.

When I started writing, I understood none of this.  I was just trying to find my way through the darkness of those sleep deprived nights.  I still don’t understand much about pain and loss and grief and self pity except, I think, that each are naturally occurring phenomenon and need to be dealt with.  I now understand that writing was and is, for better or worse, my way of dealing with these things, and, it turns out, of dealing with just about everything else.  I now find myself compelled to write, usually without understanding why or what the Hell I am trying to accomplish.

Writing has at least provided me with a mechanism for framing some of the questions – whether I eventually stumble upon any answers remains to be seen.  I make no claims about the quality of my writing and have no illusions about uncovering any profound truths – heck, half the time I am challenged to put even one coherent sentence together – all I know is that, for now, at least, this is what I do.

Status Report


Over the past few months, I’ve been tweaking my memoirs project, getting rid of things that didn’t work, changing things that needed changing, adding new material, and experimenting with the ordering and grouping of the individual pieces that make up the collection.    For the longest time, I wasn’t getting anywhere and was beating my head against my desk.   I was having difficulty putting together a coherent sentence (a possible outcome of beating my head against my desk), and whatever words that would come to me would be even clumsier and more nonsensical than usual.

One of the problems was the main character.  When writing a book of any sort, it always helps to have an interesting main character, not just to advance the story, but also because as the writer, you and this character are going to spend a lot of time together.  This has been a problem on the memoir project – the main character is me.  I’ve become so sick and tired of myself that I can hardly stand to look in a mirror.  Putting my shoes on, I am disgusted with the sight of my feet – so you can imagine how bored and impatient I grow spending so much time in my head,  exploring my memories and my perceptions and observations of the world around me.

Then one day, a couple of weeks ago, things started flowing, and the progress that had eluded me for weeks suddenly occurred.   I have a couple of chapters to revisit, but the bulk of my changes and additions are complete.  I have no idea why the dam that had been blocking me suddenly burst, but it did.   There will be time later on to figure out how and why, for now, I am happy to ride the current and see where it takes me.

I have assembled a new list of agents to submit query letters to, and I hope to begin that process this week.  I am also exploring alternate publishing methods.  For those that aren’t aware, I thought I had completed the project earlier this year, and had sent sample chapters to a respected New York agent, who responded very enthusiastically and asked for the entire book.  I sent him what I had, and for whatever promise he found in the sample chapters, he found the book as a whole lacking and backed out.   It stung badly, but I recognized what he found to be missing, and I reluctantly went about applying his cryptic remarks as constructive criticism.

Objectively looking at the version of the book I submitted, I now see how right he was.   There were large passages that were overblown and pretentious, and in fact had little to do with the overall story I want to tell.  Simply put, the manuscript wasn’t nearly as ready as I thought it was.   In poker terms, I had fallen in love with my cards, and over played their value.  It’s very easy not to see the flaws and mistakes in your own writing, especially when you know that parts of it are good.  This is exactly where I was – the parts I recognized as being good were blinding me to the parts that weren’t.   Only after the agent’s rejection was I able to begin looking at my work more objectively.  Whether I’ve been objective enough remains to be seen.   This is one of the lessons I have learned – you need to be brutally honest and unsentimental when reviewing your work, because potential agents and editors and publishers, who are reviewing literally thousands of documents, have no choice but to be brutal in their assessment – and you only get one crack at each of them.  The other thing I’ve learned is that once you get past your own ego, and recognize and address the flaws, your document will be indisputably better.

Despite the flaws that still surface in my frequent reviews and the self loathing I am too often subject to, I remain convinced that the assembled collection has a worthwhile story to tell.  My affliction with Parkinson’s disease has changed me and the way I view the world and my own past.   It has taken my life’s journey on an unexpected and dark detour.  My hope is that, for the reader, my book can shine a light, however dim, and help illuminate the dark paths that are as unexpected as they are inevitable in everybody’s journey.

So, as Walter Cronkite used to say …  that’s the way it is.  Stay tuned for additional developments …

 

Heaven and Hell


(7-4-2011) 

One of my favorite photographs is of my wife, Debbie, sitting at the kitchen table in our apartment on 18th Avenue.    I took it about a month after we were married.   In it, she is smiling broadly, and her smile expresses such pure and simple happiness that it has never failed to put a smile on my face. 

That was thirty years ago now, and we were just taking the first steps in our shared journey to a destination unknown.    She is older now but to me even more beautiful.  The same deep green eyes that lit up that photo still brightly shine, but now with the added depth of Motherhood and 30 years of loving and being loved.  I wonder if it is because I am so in love with her and have lost any pretense of objectivity that I don’t see the same lines and wear on her face that I see on mine when I look in the mirror.  Whatever it is, I see her how I see her, and I am still moved to tears when I watch her sleep.

I never planned to love anyone as intensely as I love my wife.  I can’t imagine what I’d do without her.  We’ve come so far on this journey, the whole time never straying from each other’s side.

But now we are slowly approaching the dark days that will be the late stages of Parkinson’s disease, and, even though it’s still a ways off, I ask myself, do I want to subject her to this?  To seeing her partner, the man she loves, become a hollow shell.   To seeing her soul mate growing sick and weak and incapacitated.   To becoming my care giver and being forced to spend her remaining good days in the darkness of my bad days.

I am faced with a dilemma:  I love her so much, I can’t imagine what the good days let alone the bad days would be like without her.   At the same time, I can’t bear the thought of her having to take care of me, feeding and cleaning me, bearing witness to my fading dignity.   Eventually I’ll become enough of a burden to test even the strength of our union, and it’ll only be natural for the love she’s felt for me to fade and be replaced by bitterness and resentment directed toward the unrecognizable figure I will become.

So I try not to dwell on these things.  I usually push them out of my mind.  The answer to my dilemma is to not waste good time thinking about the bad times that lie ahead, but rather focus my energies on appreciating the good days still left.  Most of the time, this isn’t difficult to do.  But there are constant reminders of Parkinson’s presence and the inevitable speculation of how fast the disease is progressing.

I’m a creature of habit.  Whenever I leave the house, for example, I ritualistically check my back pocket for my wallet, my front left pocket for my phone, my front right pocket for my keys, and my shirt pocket for my reading glasses.  This morning, while up at my cabin, I was working on pulling some ancient wire fence out of the woods when at some point my glasses fell out of my shirt pocket.  The underbrush and dead leaves were thick enough that after thirty unsuccessful minutes of raking and looking through the weeds, I gave up.  My Dad was working at his workbench in my garage, and we were due at my Aunt’s house for lunch.  I told him we’d have to leave early enough to swing by Ladysmith and buy myself a new pair of glasses.  I went inside and cleaned myself up, changed my clothes, and my Dad and I headed out in my Prius.

Right at the outer limits of the town of Bruce, on Highway 40 just south of Highway 8, I realized that my left pocket was empty and that I had forgotten my phone at the cabin.  At the same moment, the speed limit  changed from 55 to 35, and a rare cop, a State Trooper, caught me before I saw the reduced speed limit sign and pulled me over.  As he got out of his car, I reached for my back pocket, and realized I had left my wallet, where I keep my driver’s license, at the cabin.  In the more than 35 years of driving, it was the first time I had ever left without my license.  It was of course my luck that this event coincided with the unlikely circumstance of a rare State Trooper pulling me over.

The State Trooper leaned into my window and explained that, even after I had seen him and started slowing down, he had me clocked at 45 miles per hour, 10 over the speed limit.  He asked to see my license, and I explained I had just changed pants and left my wallet in my other pair.  He then, since I didn’t have any identification, gave me a pad and paper and asked me to write my name down.  Now I was really starting to panic, as Parkinson’s has left my handwriting completely illegible.  I tried my best and handed it to him.

“I can’t read that”, he coldly stated.

“Sorry, it’s the best I can do”, I replied, then mumbled something about having Parkinson’s disease.  He asked me to spell my name, and as I did, he wrote it down, and went back to his car.  My Dad and I sat, waiting for whatever would happen.

He came back and gave me a $10 warning ticket for driving without a license.  He was the epitome of class and professionalism, an extremely likeable guy, who could sense that, with my 85 year old Father at my side, I probably wasn’t much of a threat to society.  He could have with very good reason made things miserable for me, but instead, he was kind and friendly and understanding.  I thanked him; we turned around and got my license and phone, and made it to my Aunt’s just in time.

When I returned to my cabin to get my license and phone, I found them in the pockets of my other pair of pants in the dirty laundry hamper.  Not only did I forget to obey my normal leaving the house ritual of searching my pockets, I had neglected my other ritual of emptying my pockets out when I take off my pants.  It was another example of what has been an increasing pattern of absent-mindedness and lapses in concentration, and it leaves me wonder if my short term memory is going, and if these are the first indications of the dementia that often accompanies Parkinson’s disease.   Then I remind myself that I am 52 years old, and forgetfulness is a normal part of growing older, and I shouldn’t panic just yet.

But this is the curse of Parkinson’s.  Its path is unpredictable, and its scope is impossibly broad.  Everything from autonomic to intellectual functions are potentially impacted, making you wonder every time a bite of food goes down the wrong pipe if it’s the well known Parkinson’s effect on the swallowing mechanism, or every time I misplace my glasses or wallet if it’s a sign of impending Parkinson’s related dementia.   The curse of Parkinson’s is, when you boil it down, the curse of heightened awareness.  You become acutely aware of every little sign of the inevitable decline that you know waits for you, and are constantly reminded that you are fading away.

It’s easy to get lost in the darkness of this curse.   Once diagnosed, the darkness is always there, and you can never completely step out of its shadows.   You know that Hell awaits you, and as time goes on, more and more of that Hell is revealed to you.  I have come to believe that Hell is for the living, not the dead, visible in the suffering that we must all endure.

Depression and anxiety and emotional incontinence are frequent symptoms associated with Parkinson’s, and there are many scholarly articles out there that discuss whether these are neurological effects of the disease or reactions to stress, and there are studies underway trying to link these symptoms with the dementia that often occurs with P.D. I don’t know if it is neurological in nature or not, but I believe the root cause of all of these symptoms is heightened awareness.   I know that I have suffered from depression and anxiety and, with a newfound tendency to get weepy eyed over the corniest of stimuli, have become emotionally incontinent as well.

 The amazing thing, and I sincerely believe this, is that the heightened awareness I’ve experienced hasn’t been limited to the existential evidence of my eventual deterioration.  I have also become more aware of my surroundings than ever before.   If Parkinson’s has convinced me that Hell is here on earth, it has also convinced me that Heaven is here, too, and is in fact constantly within our reach.  I have become more aware and appreciative of every day wonders, the seemingly small things that we too often ignore or take for granted.   The feeling of the warm summer breeze on my face, the reflection of blue skies and white clouds on the glassy mirror of a still lake, the smell of freshly baked bread as it is taken out of the oven, the laughter of my children, the sound of my wife breathing and the feel of her sleeping body against me in the black dark of night, the warmth of the midday sun through my home office window on a Wednesday afternoon, the poetry of grace and speed and pure joy expressed by my dog, Max, as he runs free in our back yard, chasing birds, the shadows cast by late summer afternoon trees, the explosion of stars scattered against the northern Wisconsin sky above my cabin, the light of the lamp against its pine paneled walls, Van Morrison singing “Dweller on the Threshold”, my wife’s smile.  I find myself more aware than ever that I am alive, and as I weaken and diminish physically, my ability to see and feel love, truth and beauty has been enhanced.

Buddhists believe that “to live is to suffer”, and I think this is true.  We all have to deal with pain and loss.  Only through love can we ease the pain of our suffering, and only by recognizing ourselves in the eyes of others can we love.   These simple concepts are as easily overlooked as they are understood.  That it took Parkinson’s disease to crystallize them for me shows how blinded by preoccupation I had become.

To have Parkinson’s is to appreciate what you once took for granted, and to see what you once were too busy to see.  I hate the thought of what Parkinson’s will put my wife through.  At the same time, Parkinson’s has made me aware of just how deeply I love her, and how much I treasure the time, good or bad, that we spend together.

A Face Made for Radio


.... and a voice made for silent moviesI have, as they say, a face made for radio.  I also have a voice made for silent movies.  

Last Friday, the writers group I belong to, the  Kenosha Writers Guild (KWG), taped the first installment of what will be a monthly show on WGTD 91.1, Hi-Def channel 3.  The program is intended as a vehicle to showcase the members and their work.  It is being produced by a pair of talented and experienced radio veterans, and they have added an impressive touch of quality and professionalism to the program.  The program will be hosted by Chris Deguire, KWG writer and professor at Columbia College of Chicago.  In addition to being a tremendously talented writer, Chris has enough experience hosting conferences and workshops to make him a natural to host our show.  So everything was planned, and eight of us submitted short pieces of prose or poetry to read as part of our first episode.

One of the most noticeable symptoms of my instance of Parkinson’s Disease is my impaired speech.  At worst, my voice is soft and slurred with frequent cases of stuttering and stammering.  A side effect of the Deep Brain Stimulation I underwent last year has been, when the nuero transmitters are set to achieve higher benefit, an exacerbation of these speech issues.  Early this spring, under the guidance of my speech therapist, Dr. Norma Villegas, I went thru Lee Silverman Voice Therapy.   In the days before the studio session, using the techniques Dr. Villegas taught me, I rehearsed my reading several times, recording my efforts in a little hand held device I had purchased a few months ago.  I did pretty well and improved with each reading.   These practice sessions coupled with my temporarily turning down the voltages sent by my neuro transmitter left me feeling pretty comfortable and confident as we went in to the studio.

Then we are in the studio, the producers are radio theatre veterans with disgustingly smooth radio voices, and Chris is the host.  I’m the first to read, and he introduces me and conducts a short introductory interview, in which he lobs me simple questions.  Instantly my mouth is stuck and I stutter and stammer some nonsensical responses, sounding like a lobotomized Mel Tillis.  Panicky and anxious, I somehow make it thru the brief interview.  Then it’s time to read and I relax. I think I did pretty well.  The producers assured me they can clean up my incoherent babblings with the magic of editing.  

The other KWG writers who read their pieces did spectacularly well, and I look forward to the finished project airing – it is going to reveal the extraordinary talent and range of our little group.  The first session alone includes memoirs of growing up in Europe in the early 1940s, hysterically funny essays about controlling the thoughts of potatoes and encounters with Santa Claus, poetry, and insightful and moving essays about the boomer generation and turning 60 years old.  And I got to be a part of it!  We all had a great time, and we look forward to the next installment.  

I’m proud and grateful to be a member of the KWG.   I have to extend a sincere thanks to Dr. Villegas and my neurologist, Dr. Zadikoff, who has programmed my neuro transmitter in such a way as to give me the freedom to dial down the voltage when I need to engage in public speaking.  The ability to clearly communicate is one of the many wonderful things that I no longer take for granted.