My Last (?) Week
in the Collar

Seven vertebrae. Dozens of muscles. A branching river delta of nerves carrying signals between your brain and the rest of you at speeds that would embarrass most computers. It is, by any reasonable measure, a magnificent piece of engineering — flexible, strong, extraordinarily well-suited to the task of holding up the roughly eleven pounds of bone and tissue that constitutes your head.

And then something goes wrong. And someone hands you a piece of rigid plastic, fits it around that magnificent engineering, and says: wear this. Continuously. For three months.

I have just done that. The collar did not come off to sleep. It did not come off to shower. Not once in ninety days, except for supervised dressing changes. It has been on my body continuously since the day it was fitted.

I am not here to complain. Well. I am a little bit here to complain. But mostly I am here because knowing what's happening makes it easier to bear.

Here is the first thing you notice, within minutes of being fitted: breathing feels different.

The collar isn't blocking your airway. Your trachea is fine. What's going on is that your brain has spent your entire life building a detailed model of what breathing feels like — the precise pressures, the specific sequence of muscular contractions, the subtle feedback from the tissues of your throat and chest. It has calibrated this model over millions of breaths.

Your chin will suffer. The chin pad, which appears soft and innocuous, has the long-term properties of sandpaper. Check it daily and work with your care team on managing it.

Sleep is not a passive state. Your sleeping brain is extraordinarily active — consolidating memories, clearing metabolic waste, cycling through precisely choreographed stages of rest and repair. And one of the things it does, automatically and continuously, is reposition your body.

You roll over in your sleep approximately a dozen times a night. The collar makes every one of those repositions a conscious event.

The physics of the problem: the collar holds your head at a fixed angle, and your pillow needs to fill the gap that creates without pushing your head further out of that angle. A standard pillow fails at this. A cervical contour pillow is specifically shaped to solve this geometry. It is not magic. It is engineering.

After a month of honest experimental attempts — conducted with considerable dedication by my wife — I slept in the chair. I was more rested for it. That is how good science works.

The first week is the worst. I want to tell you it isn't, but it is. It improves — not to normal, but to a functional approximation of normal. That is enough.

You already know the collar does not come off to shower. But knowing that fact and understanding what it means in practice are two different things, and the gap between them is worth examining.

You cannot tilt your head back. You cannot duck your head forward. The showerhead, which is stationary, is now your adversary. A detachable shower head converts it from adversary to tool. This is not a luxury. It is the difference between a frustrating daily ordeal and a merely inconvenient one.

The supervised dressing change: the collar comes off, and in that brief window while your spine is unsupported, the instruction is stillness. Absolute stillness. Meanwhile, my wife applied hydrocortisone to the back of my neck by pressing the mattress down beside my head to create the access angle she needed. Not tilting my head. Not asking me to turn. Pressing the mattress down.

Hygiene is now a project. Showering takes longer. Dressing changes require a second person and practiced stillness. You will get good at all of it, the way you get good at any repeated procedure.

Here is a remarkable thing about human beings: we are almost entirely downward-looking creatures.

Our food is below us. Our tools are below us. Our phones, our keyboards, our books, the ground we walk on, the steps we navigate, the shoes we put on — nearly everything that requires our attention and our hands happens at or below waist height. We have built entire civilizations oriented toward a gaze that naturally inclines downward.

The collar eliminates that gaze.

Sagan wrote that we are a way for the cosmos to know itself. I have thought about that a great deal at 3am, lying awake in a collar that does not come off, trying to understand why the experience is harder than the sum of its physical parts.

The collar never coming off means there is no relief. Not at the end of the day. Not in bed. Not in the shower. In three months, there is not a single moment — not one — where you set it down and take a breath and feel, even briefly, like your unencumbered self.

Social isolation accumulates quietly. Going out requires more effort. Engaging requires more energy. You feel conspicuous. Everything costs a little more than it used to. Watch for this. Name it when you see it. Push against it deliberately.