On anger

 

“I heard what you recommend, and I want you to know I’m not doing any of that.  Ever.”

“This is stupid.  YOU are stupid!”

“You are the problem with the entire medical system in this nation.”

“I won’t be doing any therapy today, so don’t waste your time.”

“I hate you!”

 

Rehab is hard work.  Just when the body’s natural desire is to rest, patients are asked to participate in several hours of therapy a day—to take advantage of the spontaneous recovery of brain and body to retrain them in a positive way.  It’s hard! 

 

And it’s frustrating.  Many patients are used to doing things on their own, and now they are asked to take annoying precautions like calling for help to get up (to prevent future falls), or swallowing one little sip at a time (instead of choking or aspirating).

 

A lot of patients feel deep resentment toward their new situation.  And it’s completely understandable!  They didn’t ask to suddenly acquire physical and/or cognitive disabilities.  They certainly didn’t ask to experience swallowing trouble. 

 

Sometimes, patients take their anger out on whoever happens to be nearby, especially those responsible for temporary moments of suffering.  Nurses administering shots and medications.  Therapists asking them to do exercises and confront their new disabilities face-to-face.  Family members and friends who encourage them not to give up—when giving up sounds so much easier.

 

Their anger isn’t really toward the nurses, or the therapists, or their loved ones, no matter what they say.  Their anger is really at their new situation.  Nurses, therapists, and loved ones just happen to be “in the wrong place at the wrong time” to receive the brunt of the anger.

 

I can think of some people who have supported me through tough times and received the brunt of my anger and resentment—whether to their face or otherwise.  I’m thinking of some teachers and professors who gave me tough love when I was learning how to navigate academic life.  And some supervisors who gave me real advice when I was learning how to be an independent clinician.  And my siblings, who accompanied me in the journey of growing up.  And of course my mom and dad, who have guided me through all my years—toddler, elementary, puberty, and young adult life—a very scary journey.

 

Who in your life has received the brunt of your situational anger?

 

Let’s take some time to thank those who have been there for us, especially those we did not show much appreciation for.

 

And when others lash out at us, let’s remember that sometimes, they’re mad at something bigger than us.

 

And when we feel like lashing out, let’s pause and choose the kindest words we can find.

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PS, a brief housekeeping announcement:  the automatic email service offered by blogger is changing and/or ending in July of this year.  I'm still working on figuring out an alternative.  But I still plan to update on the 15th of every month, so if you don't get an email July 15, check out the website for the post!

Lack of Insight

Sometimes, the brain doesn’t accurately analyze reality.

Take this scenario:

   

When this happens for clinical reasons, it’s called “lack of insight.” Patients whose field of vision has been cut in half don’t realize they’re ignoring their clinician sitting to their left. Patients with newly amputated legs try to get up to go to the restroom—and fall.  Patients whose swallow muscles are impaired insist that they can take five pills at a time—and end up coughing and spluttering as something goes down the wrong pipe to the lungs. Patients who can't balance to walk ten feet beg to go home without any help or medical equipment. They fail to recognize their confusion, dysphagia, aphasia, visual impairments….

In my own life, this is called “lack of insight.” I take on tasks far too difficult too handle. I walk into emotionally triggering situations without preparing myself, and I end up exploding. I strike up sensitive conversations, unaware that I’m saying insensitive things and causing a lot of hurt. I fail to recognize my hubris, my weaknesses, my biases and prejudices, my selfishness.

Can you relate?

How can we overcome our lack of insight?

Honestly, I’m not sure I ever will, not really. I imagine I’ll always have biases and prejudices, hubris and weaknesses, and of course selfishness.

But I’d like to be intentional about gaining insight. I try to read articles and books written by people of different perspectives, especially marginalized perspectives. For folks without books and articles to speak for them (I’m thinking of my patients and their families), I have to listen intentionally to their individual needs in the moment. I try to find out what they need me to say or not say, do or not do. And often I find out what I thought was helpful was actually not really so helpful at all—in fact, I’ve been hurtful.

I’m doing a lot of praying for humility these days.

What should I do when I gain some insight? When I realize I’ve been rude or hurtful, I’d like to own up to it and apologize. When I’ve made someone else’s story of suffering about me and my response to it, I’d like to stop and listen. When I’ve put myself on a pedestal, I’d like to step down.

I’m never going to get this exactly right. And my insight will never be perfect. But I can strive for what the Greek philosophers called arête—always seeking to better myself and knowing that I will never be perfect here on this Earth.

I'm sure I'll always suffer from lack of insight.  But every day I'll pray and try to do a little bit better.  

Our abilities are _______

I’m trying to figure out a good metaphor for our abilities.  Working in a rehab hospital reminds me daily that abilities are neither static nor intrinsic.  But what are our abilities, exactly?  Are they rights?  Obligations?  Gifts?  None of these metaphors seems to quite fit the experience of being a human with limited abilities.

It’s so tempting treat my abilities as rights.  I feel it’s my right to be able to process information quickly enough to drive a car, to run errands, read and follow a recipe, to process conversational language, to read and write, to work quickly and efficiently.  But then my monthly monster visits and I’m drowning in brain fog, barely able to understand simple sentences, unable to remember basic information or even balance for walking.  I never know how long it will last—sometimes hours, sometimes days.  For over a decade, every time I “misplace” my ability to think straight, I wail and cry like a child that’s lost their favorite toy.  It’s my right to think straight, I moan, pounding the ground with the heavy thud of weak uncoordinated tear-drenched fists.  It’s my right to be “smart.”

I’m lucky that this removal of my cognitive abilities is temporary and somewhat predictable.  As a therapist, I know many people whose cognitive abilities have been more severely damaged by stroke, brain injury, dementia….  If abilities are rights, then Someone upstairs isn’t playing fair.  And yet so many of my patients, family, and friends with disabilities find moments of extreme grace, even in their suffering.  This doesn’t make sense if they have been stripped of their rights.

No, our abilities aren’t rights.  Not in the cosmic sense, anyway.

Then come the nagging doubts.  If these abilities aren’t my right, maybe they’re my responsibility.  If I fail, I have to try harder—I’m supposed to be able to do these things.  I have to strive as hard as I can to optimize my abilities until I’m burnt out and exhausted.

This never works.

So are my abilities gifts?  Have I been given the gift of language, the gift of balance, the gift of whatever my IQ is, the gift of breathing?  But what about when these “gifts” are rescinded?  A true gift-giver doesn’t ask for the gift back.

Again, the guilt.  Maybe it’s my fault.  Maybe I’ve damaged the gift/ability through some sort of negligence.  Maybe I deserve to lose the ability.

Of course this is a preposterous and very harmful way of thinking.

Maybe I don’t understand the way gifts work.

Some gifts are long-lasting—a book, a ring, warm socks, a beautiful handwritten letter.  I can keep and cherish those gifts for years to come, their presence a constant reminder of the love of the giver. 

Other gifts are ephemeral—a box of chocolates, a ticket to a show, a kiss, a home-cooked meal.  Are these gifts less important or less valuable than longer lasting gifts?  Is the longevity of the gift the correct way to measure the love of the giver?  (If so, what does that say about long-lasting fruitcake?)

Every day we receive gifts.  Perhaps our abilities are more like ephemeral gifts.  We receive them anew each day, each moment.  The ability to breathe.  The ability to stand.  The ability to swallow.  The ability to speak, to read, to write, to do the things we love to do.  Gifts, all.  Given each day.  Never a guarantee.  Not rights, not obligations.  Gifts.

Some days we receive gifts we don’t want to accept.  The “gift” of not being able to stand.  The “gift” of not being able to think straight.  The “gift” of not being in our healthiest prime.  Should we reject these gifts?

Ann Voskamp, author of One Thousand Gifts, writes often about giving thanks for hard gifts and to find little gifts even in suffering.  I love this idea!  It complements beautifully the writings of St. Therese of Lisieux, who teaches us to embrace suffering.  Both authors take this idea a bit farther—we can offer our gifts to others, and to God—each gift in its own way.

So on days when I find it difficult to do the things I am accustomed to, I can choose to reject the gift like an unwanted fruitcake—or I can try to give thanks.

This is easier said than done.  And to be honest, I’m terrible at it.  But perhaps in time I will learn to receive all the gifts I’m given—even the hard ones—with grace and thanks.

This time of year is filled to the brim with gift-giving (much needed in 2020).  Let’s remember to be thankful for the gifts we receive each day—whether they are long-lasting or ephemeral. 

If our abilities are gifts, we receive them moment by moment, day by day—gifts to be cherished even if they burn bright and brief like birthday candles.  And I trust that the Giver of these gifts wants to surprise us with something spectacular each new day, each new moment.

When Poo takes Precedent

(Letting go of our to-do lists and living in the moment in 2020)

I’m a huge fan of plans and to-do lists.  I love seeing everything I have to do laid out before me with cute little boxes I can check off. 

But here's a common narrative in my life:

I’m great at making plans.  But what about when more urgent things come up?

Maybe it’s time we step back and listen to what is needed in the moment.  When we listen to others and ourselves, we get done what actually needs to get done, even if it wasn’t in our plans.

One memorable session, I had an entire hour of therapy planned.  But the patient announced that they had soiled their briefs and bed linens and needed to change.  About twenty-five minutes later, the patient had cleaned themself* (with some help), the brief was changed, the bed linens removed, clothes changed, and the patient was seated in the wheelchair.  What great sequencing!  I thought to myself.  What a great cognitive workout for them!  And now we can work on my therapy plan.

And then the patient looked at me seriously, nodded, and announced that they needed to use the restroom again.

By the time all was finished, there were fifteen minutes left in the session to cover a few items in my Therapy Plan.

What I thought the patient needed was different than what the patient had actually needed in the moment.  

How often am I biased by what I think needs to happen, when I am actually being asked to do something entirely different?

I remember when I was studying abroad overseas, I encountered a lot of volunteers and NGOs doing charity work.  I was (am) no expert, but I did notice a pattern:  the projects that were the most successful were the ones that involved the locals in the entire process, including deciding what their needs were in the first place.  

I am reminded also of a sermon from years ago.  I don’t even remember who gave the sermon, but it was about a priest who was sometimes late for Mass.  Why?  Because if, on his way to Mass, he encountered someone asking for his help, he dropped everything to help that person.  He figured, this must be God asking him to do something more important.  And who was he to deny the requests of his Creator?

This year has been a wakeup call in so many ways.  We are being asked to put our own priorities aside to protect and support others and ourselves in new and different ways.  We are asked to set aside many of our social habits and planned events, to make economic sacrifices, and to wear uncomfortable masks in public in order to defend and protect those with underlying health conditions and immune compromise--and those who do not have the luxury of working from home.  We are asked to set aside our pride in order to listen to and support our Black brothers and sisters.  (Speaking of which, I’d love some help figuring out which adjective is the most supportive.  African American?  Black?  POC?)  We are finding out that even if we have long to-do lists, our mental/physical health may have to take priority sometimes.

This hasn’t been easy for me.  I’ve gone through this year kind of kicking and screaming.  I’m not a fan of constantly changing plans.

But maybe I’m being asked to set aside my to-do list and focus on more immediate priorities.  Like cleaning up some poo (either literal or metaphorical).  Or allowing myself to rest and heal.  Or allowing someone else to speak while I just listen.

Friends, I hope and pray that we will all have the strength and the courage to set aside our to-do lists in favor of the more immediate needs of ourselves and others.

 

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*English speakers have used “they/their/themself/themselves” for a long time as a singular gender-neutral pronoun.  Let’s be descriptivists instead of prescriptivists :)