A small bead of sweat dripped off of my forehead from the workout I had just finished.  Working out used to be one of my favorite parts of the day.  I would get up early and it would be the first thing that I did.  It would always give me the energy to help me get through the rest of my day.  Unfortunately, after I was diagnosed with Fibromyalgia, all of this got thrown out the fucking window, just like everything else that I enjoyed in my life.  First, I had to severely reduce how much time I was working out for since I would get fatigued so quickly.  Then, I had to reduce the weight I was lifting to weight that was so easy, that I couldn't even break a sweat from doing the exercise.  I also, had to change the way I actually lifted the weights.  I had to do this type of training called concentric training...basically, I do the upward motion of the movement really fucking slowly and then do a quick eccentric to avoid less wear and tear which decreases how much muscular hypertrophy and strength you would obtain from your workouts but at least it helped with injury prevention which was supposed to be my focus, I guess.  The worst part was that progressing was a real bitch in my workouts, now.  Most people were able to add a rep or increase the weight they were lifting each week, without a problem, and seeing this increase would make them feel motivated to keep working out to continue seeing improvement.  Every time I tried to do this, my body would feel like absolute shit the next morning.  It was insane how much my pain would worsen just from making my workouts a tad more challenging, meaning I was forced to keep the reps and weight the same for weeks...even months, sometimes, before I could finally progress in my workout, slightly.  This was de-motivating as fuck.  I used to be addicted to improving during each of my workouts but, just like everything else in my life, the Fibromyalgia fucked that up for me, too.  Everyone told me that I should just be happy that I could still workout at all and that I should be grateful for this.  I swear, every time I hear that I should be grateful for my blessings or for the things I am able to do, I get so fucking mad.  It was like just hearing that one statement caused my entire body to be filled with anger.  This was my life, now, though.  Gone were the days of working out for enjoyment.  Now, working out was just something I had to endure.

I placed the light 8 lb. dumbbells back in their correct spot, next to the exercise mat that I used.  It had taken me so damn long just to get to the 8 lb. dumbbells, it was almost depressing.  I, carefully, stood up and could feel a couple of my bones and joints pop like crazy as I did so.  I made my way to the wall, next to my little workout area, where a whiteboard was and, on this whiteboard, it read, "Days Since I've Been a Pathetic Fucking Loser."  I grabbed the expo marker that was sitting next to the whiteboard and erased the number that was currently on the board and wrote in the new number which was, "26 days."  It had been 26 days since I had been bed ridden the whole day, feeling sorry for myself.  This may not sound like too long of a time but, believe me, it was in my case.  I still remembered when it was extremely common for me to be bedridden at least, once a week, unable to leave my bed from the combination of depression, anxiety and pain levels.  I should have been proud of myself for how far I had come but, of course, I wasn't.  At this point, it didn't even matter to me.  My life was so shit, for the most part, that even these small little victories, didn't make me feel any better at all.  I figured that at least I was trying my best until the inevitable happened and my body finally shut down from all of the pain or I had a heart attack from all of the fucking stress that I was constantly under.  It was only a matter of time before I died...hell, every day I woke up, I honestly felt like it could potentially be my last.  Feeling like I'm on the verge of death was just...common-place for me.  I really did hope that when I did die, I would get to die with some kind of sliver of dignity or after I'd accomplished something worthwhile.  Fat fucking chance of that happening, though.  

*

*

*

"Alright, Makoto, can you come over here and sit in this chair for me, please?" I asked, standing next to a chair that I had carried up the stairs from the kitchen with the father's help.  

It did feel pretty pathetic for me to ask for help lifting a single chair but Andy, Makoto’s father, seemed totally okay with it.  From what I had seen of him, Makoto seemed to have gotten her curly hair from her father, in addition to his brown eyes.  He had a slightly muscular build, although, not as toned as his wife…not that many people were, in his defense.  Andy also, had a very kind and compassionate complexion.  I could tell just from the few conversations that I'd had with the father since starting, that he was definitely willing to do anything to help his daughter succeed and was very interested in her condition.  Usually, he was the one at the house with Makoto and I since he worked from home while Minerva, apparently, was a female boxer, who spent most of the day training for fights.  It was no wonder the woman looked so ripped.  Since this was the case, Andy was more knowledgeable about her autism as well which only made my job easier.  

Unfortunately, after my command, Makoto didn't really budge from where she was lying on the carpet of her room but she did tilt her head back to look at me.  

Should have figured it wouldn't be that easy, I thought to myself.  Hmm, if they had like a beanbag chair or something, I could have her start with that but they don't.  I could recommend the father buy one but it could take a while to get here and I know they want a lot of these goals met before school starts.  What else could I do to make this less awful for her?  Hm, what else is soft that she might like to...shit.

I sighed and then made my way over to Makoto, who was still lying on the carpet. 

"Hey, Makoto, is it alright if I pick you up?" I asked as the girl shook her head, yes.  

Remember, use all the leg strength you don't have and not your back, I instructed to myself as I, carefully, squatted down to pick her up while she, slowly, sat up, straight.  It'd be pretty fucking embarrassing if I threw out my back this early on in the game.  

After taking a deep breath, I picked Makoto up and carried her towards the chair that I wanted her to sit in.  I sat down on the chair with Makoto placed on my lap.  Her tiny body was positioned right on my tender hips but I tried to bare the uncomfortableness of the position.  Makoto didn't seem thrilled about having to sit somewhere other than the carpet but she was managing.  

"Okay, Makoto, we're going to sit here for 1 minute," I said as Makoto frowned.  "Don't worry, we'll suffer, together."

Other than some minor squirming, Makoto and I both were able to push through the agonizing situation for the both of us and I made a note on my iPad that for the next day, we would move to a minute and a half on my lap.  After giving Makoto a small break, we then moved onto the next non preferred activity which was learning how to wash her hands.  She wasn't a big fan of this and, often times, when using the restroom, she would choose not to do it.  Apparently, she didn't really have a handle on how to do it, either, so it was part of my job to also, teach her the steps of washing her hands as well as enforcing it in her daily life.  

"Okay, Makoto, want to show me how you usually wash your hands?  Remember, you have to use warm water."

The small girl thought for a moment and turned on the hot water all of the way and let her hands sit under it until the water was scorching hot.  

"Hote!" the girl yelled as she moved her hands back in distress and then turned off the hot water, completely.

She then turned on the cold water all of the way and, once again, let her hands sit under the running water until it was ice cold.

"Code!" the girl blurted out as she removed her hands from the freezing temperature and then turned the cold water all of the way off.  

"Uh, Makoto, try turning both at the same time," I recommended, after watching the poor girl struggle during her first two attempts.  

Makoto stared at the two knobs and then began turning both of them.  It took her a total of 3 and a half minutes of adjusting the knobs until the girl found a water temperature that was satisfactory for her.  

"Nice job, now get your hands a little wet," I instructed.

Makoto put her hands under the water for a couple of seconds and then withdrew them when they were wet enough.

"Next, go and put a little bit of soap on them."

Makoto used the soap dispenser to get a dime sized amount on the palm of her hand and began shaking her head, no, rapidly, and attempted to shake it off.  She must not have liked how it felt on her hands.  It wasn't too surprising.  Not a lot of the kids I had worked with enjoyed the feeling of soap or sanitizer on their hands.  Before the soap could slide off of her palm, I gently rubbed both of her hands together for her, getting them nice and soapy.  Luckily, Makoto didn't hit me or anything which had happened in the past but she did seem annoyed.  As soon as her hands were completely lathered, I gave my next direction.

"Now, you just have to rinse off that nasty soap you hate so much.  Make sure you rinse them well or else that soap won't come off all the way."

Despite that last part I added on, being an attempt at making sure Makoto rinsed her hands off well, I ended up regretting it, since Makoto rinsed her hands off for a good 2 minutes, before finally being satisfied.  

That didn't go too terribly, I thought to myself.  The only step she struggled with was the soap so I'll just add that, for the time being, she needs a physical prompt for that step, on my iPad.  

I added the note and then gave Makoto another break, where she got to play a game on my iPad, before we moved onto brushing her teeth.  According to the father, Makoto struggled with three different things in regards to this non preferred activity.  The first aspect that she had a tough time with was the initial steps of the process which included wetting the toothbrush and putting the toothpaste on it.  The second was that she didn't brush any of her teeth for long enough and would only brush for a total of 20 seconds, before spitting it out which probably didn't do much of anything for her.  Lastly, she, apparently, refused to use her mouthwash.  

I placed my iPad on the bathroom counter and opened the timer app on it since I would use it once the girl was actually brushing her teeth.  I was planning on using a technique called Reverse Chaining to help Makoto learn the steps of brushing her teeth which included me helping her with all of the steps, with use of a physical prompt, except for the last one and then for the next session, helping her with all of the steps, using a physical prompt, except for the last two and keeping this going until she was able to do the first steps.  This way, we would be starting with the steps Makoto already had a handle on and slowly progressing to the ones she wasn't too sure on.   

"Okay, Makoto, are you ready?" I asked as the small girl squinted her eyes and shook her head, no, in response.

Yeah, I didn't think so, I thought to myself.

I placed my hands over Makoto's and helped her turn on the sink water, a little.  With my hands still over hers, I assisted her in grabbing her toothbrush and getting the brush part just a tad wet.  After placing the wettened toothbrush on the sink, we moved onto, carefully, putting toothpaste on the brush; Makoto put a bit too much on and some of it did get on the counter but I figured we could just wipe it up after we were done.  Next, with my hands still over hers, I had her put her electric toothbrush in her mouth and had her begin brushing her bottom teeth.  While making sure the toothbrush was moving against her bottom teeth with one of my hands, I began the timer on my iPad with my other hand.  

"30 seconds for the bottom teeth, Makoto," I said as I continued to assist her with brushing her bottom teeth.  

Once the 30 seconds had passed, I then moved the toothbrush to the top teeth and had Makoto brush those for 30 seconds as well.  Lastly, I moved the toothbrush to the middle of Makoto's teeth and had her brush the front of them for 30 seconds.  I removed the toothbrush from her mouth, much to Makoto's relief, and she had a very annoyed look on her face.

"You can spit, now," I instructed.

Makoto spat the toothpaste into the sink while I turned on the water for her.  I then used the hand-over-hand physical prompting technique to assist her in cupping her hands to get water in them and then I assisted her in bringing her hands closer to her mouth so she could pour the water into her mouth to rinse.  This took a couple of attempts and the girl did seem to get some relief when she spit out the water, after swishing it around in her mouth for a bit.  

"Good job, we're almost done.  I want you to do this last part for me, Makoto.  Just rinse the toothbrush off under the sink and then dry it off."

Makoto thought for a moment, debating whether or not she wanted to do it.  Luckily, she turned on the sink water, grabbed the toothbrush and let it soak under the water, making sure all of the toothpaste was off of it.  She held the toothbrush under the water for a bit too long but that seemed to be common with her.  As soon as she was satisfied with how clean the toothbrush was, she used a towel to dry the toothbrush off.  I showed her how to remove the brush part and then had her blow into it, to make sure to get any excess water out of it but, by this point, I'm pretty sure she was already mentally checked out.  

We're almost done.  Just the mouthwash is left.  

"We're all done brushing our teeth.  We just have to do the mouthwash and then we're all done."

I pointed to the grape flavored mouthwash that her parents had bought her and Makoto stuck her tongue out at it in defiance and knocked it over, aggressively.  

"You can do it.  Only 30 seconds, alright?  Then we can play on the iPad." 

I unscrewed the lid on the mouthwash, poured a decent amount into the lid and then instructed Makoto to drink the mouthwash but made sure to emphasize not to swallow it and just swish it around in her mouth.  It was the kiddie mouthwash so it wasn't like swallowing it would hurt her but I didn't want her to get in the habit of doing it.  As soon as the mouthwash was in her mouth, I started the timer on my iPad for 30 seconds.  She began, violently, shaking her head from left to right and started pacing around the bathroom, frantically.  It was clear that she hated the mouthwash, even more so than brushing her teeth.  Eventually, the 30 seconds passed and, without me even having to tell her to, she spit out the mouthwash and actually began rinsing out her mouth the way I showed her without me even having to help her.  

"Borns," Makoto would say in between rinses which I assumed meant that the mouthwash burned or stung her mouth in some way. 

She's a quick learner, I thought to myself.  Although, moving on from the kiddie mouthwash to adult mouthwash could prove to be a challenge for her.  

The brushing teeth and mouthwash adventure was over and I allowed Makoto to take a slightly longer break on my iPad since she did so well.  There were still a couple of other programs that I had to run during my time with her that focused more on her social skills but as I watched Makoto play on my iPad, all I could think was how impressed I was with her behavior.  In comparison to some of the kids that I'd had in the past, she was pretty well behaved and, on top of that, she learned things, quickly.  I figured that it wouldn't be too hard for her to reach the majority of her goals before kindergarten started.  In fact, a part of me, didn't even think that Makoto needed to spend her whole day in the special education classroom.  I believed that she would be ready to join the other kiddos in the regular classroom, immediately, as long as there were some teacher aides to assist her.  I decided that as the kindergarten start date got closer, I would talk to her parents about this.

*

*

*

Months went by and just like I had predicted, Makoto was able to accomplish all of the goals that her parents had set for her.  By slowly adding time with her sitting in my lap while I sat on a chair and then transitioning to just having her sit on the chair, herself, she was now able to sit in a chair for 30 minutes, before it began bothering her.  Makoto could brush her teeth and use mouthwash without any assistance from me at all and the same could be said with washing her hands which she had started doing each time, after she used the restroom.  Her conversation skills had gotten slightly better as well, after some intraverbal practice programs that I ran with her but I could tell that it was still a bit of a problem area for her.  Plus, her talking to me and her talking to other students would be vastly different, unfortunately.  I had talked to both her mother and father about how well she was doing and explained to them that I felt like Makoto was ready to begin kindergarten in the regular classroom, as long as there were some accommodations for her.  Her father confirmed with me that, after talking with the school, he learned that there would be some teacher aides to help the kiddos that needed a little extra assistance.

*

*

*

Before we knew it, it was my last session with Makoto until she had her first day of kindergarten.  It was towards the end of the session, so I was graphing all of the data that I had taken with my iPad and was writing a session note, detailing all of the things that I worked on with Makoto for that day.  Throughout the session, I could tell that something was bothering her but Makoto still struggled with expressing herself.  It was most likely nerves.  Lord knows, I dreaded my first day of school so I could only imagine how stressed out she was.  I attempted to make conversation with her while she was lying on the carpet of her room, next to me.  

"Makoto, are you nervous about your big day, tomorrow?" I asked.  

Upon hearing the question, Makoto sat up straight and inched her way closer to me.  I noticed she began biting on her lip and squinting her eyes, meaning that the question did cause her some distress.

"I...I...don't want...togo," Makoto said, sadly.  

It seemed that the speech therapist was really making progress with her.  Her speaking was already getting quite a bit better.

"Yeah, I didn't want to go to my first day of school, either," I admitted.  "It's scary, huh?  A new place...away from the safety of your home and parents...with other kids you don't know.  You're totally ready for it, though.  I think you're going to do really well."

Makoto thought for a moment, before responding with, "I-I...want...you...to...go...wit me, Miss Yucky."  

Hm, I didn't expect this.  I have worked in the school setting before but, usually, it's always through my company.  I don't even know if my company is under contract with the school Makoto is attending.  

"Well, that's really sweet of you to say but, I don't know if I can," I said, truthfully.  "I'll still be having session with you when you come back home, though, so you'll still see me every day of the week.  That way, you can tell me all about your day at school." 

I tried to frame my response in the most positive light I could manage but it was easy to tell that Makoto was displeased by my answer.  

"Just do the best you can, alright?  I'm sure everything will be fine, tomorrow.  You'll do great; I promise."

Makoto sighed and laid back down onto the carpet, sadly, while I could do nothing but finish my session note.

*

*

*

Later that night, when I was lying in my bed in absolute fucking agony like usual, I couldn't help but feel some slight anxiety about Makoto and how her first day of school would actually go.  Despite my hopeful words to her, I'd be lying if I said I wasn't worried for her.  School was a real bitch...I knew that better than anyone.  And for someone like her, it would be even more of a bitch.  If I was religious, I would pray for the small girl's success but all I could do was have hope.  The middle of my spine ached from all of the activity that I had gone through during the day and I had some slight soreness in my hamstrings and glutes.  I had placed a pillow under my knees and was lying on my back which was the most comfortable sleeping position for this version of my pain.  Not being able to keep my eyes open any longer, I closed them, hoping that Makoto's first day went a hell of a lot better for her than mine did.