Discovering the Meaning of Gradual

The neurosurgeon said, “No restrictions anymore. Just add things gradually.” Easier said than done, apparently!

I confess. I am not very good at “gradual.”

Six weeks post-neurosurgery, I met with my neurosurgeon for a six-week post-op follow-up. His assessment: “Recovery is going well. As expected. Prognosis is good.” He lifted the restrictions I had been living under, told me he expected my continuing symptoms (light, sound, screen, problem-solving/concentration, emotional control sensitivities) to resolve over the coming months, and advised me to reengage in things I wanted to do “gradually,” listening to my body to determine my limits.

Sidenote on a parallel track: Six weeks after my neurosurgery and one day after my appointment with my neurosurgeon, my little French bulldog, Aelin, Fifth Eye’s Chief Canine Officer, ruptured two lumbar disks in her back and underwent emergency spine surgery. What another unexpected and crazy curve ball added to our family’s life! We have had entirely too much neurosurgery in our household in 2022. Aelin’s post-surgical instructions mirrored my own and brought on a wave of perhaps too much empathy as well as ever-present reminders of what recovery looks like as we seek to help her along that path that her little doggy brain does not appreciate at all. By two weeks post-surgery, she was totally done with being confined in her crate. “Let’s go!” was her plan despite her neurosurgeon vet’s instructions that now that her staples were removed she could begin gradually (there is that word again!) adding back supervised, on-leash walks. Impatient, demanding, and eager to return to past and now forbidden or drastically limited activities, she seems to not naturally recognize any limits or risks at all.

Unfortunately, I do not have a supervisor watching my every move who can monitor my use of my available capacity with a watch or a pedometer. While my family, friends, and colleagues provide endless encouragement and reminders to not overdo, to take breaks, and to be patient with my recovery process, it is difficult to do.

So now I find myself trying to figure out what “gradually” means in a practical sense in so many different aspects of life. I know this: If I overdo it, I develop uncomfortable and debilitating headaches. And the headaches sometimes take days of concerted rest to recover from. So I do have a strong desire to avoid them in the first place. Yet figuring out where my evolving limits are on this multivariate spectrum is very challenging.

One critical observation I have discovered is that mental capacity limits and the resulting mental fatigue are not something I have extensive experience measuring and recovering from. As I reflect back on my decades of life, there were relatively brief periods when I pushed myself very hard and felt like my mind turned to rubber, unable to absorb new information and process it appropriately. It sometimes happened during finals weeks in college, during intense periods during certain consulting engagements, in periods when I was simultaneously operating a startup and raising a venture-led round. These intense bursts rarely lasted more than a few weeks or months, and a few days of concentrated rest was typically fully restorative. 

Recovering from 12 hours of frontal lobe surgery in and amongst some of the important nerves and structures of the brain is different. Part of the difference is that my brain sustained physical damage from the surgery, and nerves and brains do not heal as quickly as other parts of our bodies. The post-operative swelling has to work its way gradually out across the resistant blood-brain barrier and the nerves that had to be exactingly separated from my fibrous meningiomas were likely irritated by the surgery. That means that there is physical healing that will take an unknown length of recovery time. Our frontal lobes are the part of our brain that we use to do higher-order executive functions like emotional and impulse control as well as creative problem-solving and complex synthesis. In my case, my tumors were sitting on top of my optic nerves, so visual stimulation like light and screens can overtax my still-healing nerves. My job and my life are intensely mental, expressed in listening, reading, absorbing new information, complex problem-solving, writing, and communicating. All of that is “frontal lobe stuff,” affected by my healing process. 

I am now nearly 11 weeks post-surgery and it is clear that while I certainly can engage in “frontal lobe stuff”, I have not yet reached my full previous capacity. It is clear that my capacity is steadily increasing, and that is the challenge because it turns the problem of figuring out my limits on a multivariate scale into aseemingly endless game of trial and error as my capacity evolves daily and different mental efforts use up that capacity at different rates, with sometimes additive effects.

Of course, the role of a startup CEO is endlessly demanding with new needs and challenges always appearing and creating pressure to figure out how to solve them, either directly or through guided delegation. And my driven and passionate personality does not appreciate being limited, so I am always tempted to push the edges and find a way to contribute just that little bit more to moving the various balls forward. Working through this process has certainly provided new opportunities for developing new ways to work and collaborate with others. Always a silver lining in every new challenge.

Lately, I am often hearing the admonition to listen to your body (aka brain) to determine what my limits are. One major challenge with effectively implementing such advice is that there is a delay between the “overdoing” and the headache onset. The best analogy I have been able to come up with for my friends who have not had to recover from neurosurgery is that feeling when you are enjoying some alcoholic drinks with friends and suddenly realize “oops! Maybe I should have stopped a drink or two ago” as a wave of sudden onset tipsiness hits you. Now you are stuck because you cannot un-drink that last libation and are forced to ride out the effects over time. With frontal-lobe neurosurgery recovery, the same feeling happens when bright lights and/or loud noises (which can be just a burst of raucous laughter or a child’s squeal) and/or too much screen time and/or too much concentrated thinking and problem-solving and/or a burst of frustration or other emotion or some combination of the above suddenly catches up with me and becomes a painful headache. When did I cross the line between ok and too much? How do I discover what my combined capacity is across all of these mental dimensions and measure my utilization of that capacity?

Weeks ago, I started with maybe 10 hours a week of “brain-work.”  Most recently, I seem to be ok with 40-50+ hours a week of brain-work.  More than that burns me out and demands concentrated rest to back off the symptoms of overdoing it. It is definitely a moving target and different types of “brain-work” demands can use up capacity at different rates, so the total hours of brain-work is only a loose metric, however, it does give me something to track and pay attention to so I can try to prioritize breaks and recovery as my capacity gradually increases back to the 80 to 100 hours per week level that I could push to in prior years. That which you measure you can manage – and improve! I am so thankful that my trajectory of improvement has been strong and steady, so gradual seems to be working!

For other posts related to my neurosurgery, click on the “Neurosurgery” category on my blogpost site at www.StartupCEOReflections.com.