Seeing things as they are....September 1996... I got my white lab jacket ( the short one as not to confuse the patients ) ,my official hospital staff badge, strung my stethoscope around my neck and went out onto the acute care floors. Everyday was exciting but a bit overwhelming especially the first with my four new patient that day.
Cleaning old wounds....Newbies had acute care rounds. Acute care meant being on the floors and wound care assignment. You had to be on your toes. One day you were sent to the psych ward and another day you might have been at orthopedic rounds. You really did work with some very sick people and there are nerves attached to that but you found your happiness. Charts were interesting, people were medicated and very funny sometimes. It was a a really great day if I would be able to scrub in and observe a future acute care patient's cervical decompression or witnessed a brain injured patient without inhibition curse out an ego laden resident. I have to laugh as I write that because I can not even imagine the scenario presented among the manged care, manged time mentality. Would I even have ever seen a surgery as a PT? Healthcare is much more stressful now. Everyone's role is so segmented and I doubt anyone eases you in with four patients for a few days. Maybe they do; but, that only means someone is carrying the guilt of not going to see someone. There is only so much time in one day to be seen and supervised for your work.
My perspective early on in my career was that I made a difference. Even on acute care, length of stay was a few days and I would see them maybe graduate from a walker to a cane. A decade of experience later I often wondered why I was even being paid to be there. By 2009, working acute care meant a decent per diem hourly wage but half the time it felt like my role was getting people from chair to the bed for the nurses to avoid or being the escape goat if Mr so and so fell. I know the last time I worked on acute care , going into a random person's surgery was a HIPPA violation and my optimal stats included 10 patients on a 6 hour day. The extent of my intervention across the board of diagnoses was an order to get the person out of bed and to walk to and from the bathroom or commode so that the physician could write the discharge order. In the event someone else felt this occurred ,such as an aide over the night shift dragging the medicated and tired patient across the floor, with an early am round of discharge orders, I might not see Mr. so and so again. So again I made my happiness. I did things a different way, massaged swollen legs and taught them some yogic breathing.
A Blast in the past....Back to 1996...My first two years out of physical therapy school I had the option of requesting a 6-9 month rotation among three divisions: In patient sub acute rehab you taught group exercise and one to one visits. Outpatient rotation was where it was at. That was what you went to school for. This was what you were paying your dues for . People came greeted you , for the most part, with a smile and took home their troubles. You did not need to put away your fears you killed someone yesterday in ICU getting them out of bed or dump bed pans to get the person ready for PT. At 23 years old I thought being able to work in outpatient meant you were experienced. You were worthy having paid your dues on acute care and were rewarded with never having to literally clean out an old wound again.
Now...... Outpatient to me means burnout and acute care means watching a broken system move patients down an assembly line. Believe me, I wish I could see things from the rose colored glasses of my youth but somewhere along the early 2000's I shifted back into my sports medicine roots and smelling the antiseptic floors began to remind me of cleaning old wounds on med/surg. While always interesting for an anatomy geek like me, suddenly nothing became as deflating as being asked first thing in the morning to take part in the cleaning of a human gross anatomy lesson for a smelly infected wound. But, I remember being excited about those things. I do not remember exactly when my perspective changed an I stopped being happy. After less than two years I remember leaving that first job bored but I think now that I was being impatient. I thought i was missing out on more knowledge. I deserved to expereince more money, more dynamics , more ...... who knows. I was Eve and that serpent was talking. My perspective on the future haves made me miss out on some things. That first job was a great one. I left it a little too soon by focusing on what it wasn't verses what it was.
I sometimes miss living by luck of the draw....At my first job I would try to get to work early so that I could have the pick of the litter on cases that day. It really was a crap shoot but like any lottery, people played for the chance of getting that one case on the VIP floor. Being in NYC also had it's advantages after work and being on the floors had some of the most colorful moments. I know because I laughed a lot more than on outpatient or than in in any other outside position since then. I still laugh remembering the stress breakers like a funny assignment nurse or walking into a patient "escaping". It may sound awful but sometimes dealing with pain all day or life and death situations makes the silliest things funny. It is all perspective and I can not believe I turned into the person that never wanted to do a wound care again.
"If you can't get rid of the skeleton in your closet, you'd best teach it to dance." George Bernard Shaw —
What I remember wanting most when I would go see a repeat acute care patient was to know that he or she would smile when I walked in the door. That would mean that he or she was alive and not feeling worse by my intervention. The reality though was that it would mean their life was not turned upside down, that they felt cared for and were not in pain. I liked to make it about me but it was really about them. That is one thing I desired about outpatient orthopedics, the fact that the patient always seems to greet you with a smile even if it was a fake one when you say hello . Working on the floors brought all the skeletons out of the closet and you had to make them dance. A smile was successful treatment for me and my vulnerable feeling patient. So maybe I smile at those acute care days more because I have a better perspective of those challenges. Maybe now I see those opportunities were great perks. Maybe I value the obtainment of grace under fire, courage to think on my own, suffering with good friends and great memories. I am surprised how thinking about that now feels very similar to my thoughts on leaving high school. I was the prom queen dating the high school basketball star and while not every moment was a laugh I have my rose colored glasses on over it all the time. Despite that, the truth of why i had to leave will always be there. I know I say that my senior year was one of the best experiences of my life but somehow I would not want to go back knowing I would have to live every tear since then again.
Ever notice how life is like high school over and over again?When you finish all the requirements and reach a certain expected level of knowledge and maturity you just graduate. Some chose not to eat from the tree of knowledge but I ate the forbidden apple of knowing more by wanting more and once I tasted the possibilities outside of that temporary Garden of Eden, the willpower proceeded to follow an ongoing lust for that taste. Sometimes I have too much and am unhappy. Sometimes I have too little and am unhappy so the lust or desires I have need to be controlled though my taking the time to listen. I need to look and listen to the present need every day. The view from a distance before or after is farther from that truth. My high school mind didn't understand too much of that present perspective. My twenty year old mind didn't either. My thirties are a blurr but now at 41 I know I had plenty of boring regular days I just don't remember.
I want to remember those boring regular days in the past. I would like to know my mindset when I wasn't on a high or low. I am saddened at the realization that my focus on the future well into my thirties was an attempt to make detachment to things in the past and present easier. Unfortunately the moments I missed or avoided are behind in Neverland but tied to the true experience. I should have journaled more because everything in the future and past a bit biased. In high school I intuitively knew that. I had a diary. Somewhere in my twenties I stopped . No one writes to themselves anymore. Now we let everyone know everything so now I blog. We all have the desire to manipulate our memories into only being the things that made us laugh and grow. The evolution of the blog is therefore quite interesting. It is as if society is hoping to record proof of our present experiences because if left to our physiology, we would rather foster an illusion. The truth is we are not receptive to reality. The program is nature's plan of survival at all costs.
Happiness is a perspective.It seems , according to author Rick Hanson, PhD., and his research on neurophysiology, that our brains are wired to remember the trauma as if it were in the present because subconsciously we know the information obtained surrounding those moments are very important to our survival. As ugly as they are we are not pre- programmed to forget them. It is a survival feedback loop so that we avoid past real dangers. Thanks to that Insulary Cortex, if you are a die hard planner and an over achiever you might just make up the reality of future dangers. Unfortunately you are also evoking a made up visceral response to accompany those experiences before you actually have them. Thank the deep brain's Insula for that too. It anticipates the risk of the future and reroutes the experience to optimize a certain stress or non stressful reaction. This is especially the case in chronic pain because the Insula is a major relay point for the pain tracts. This is why you really need to replace the experience of physical pain with a happier perspective of the situation. With all the pleasure points of the brain , you need to practice for a desired pleasurable outcome in order to rewire your brain. You are better off seeing the reality of what is sad but focusing on the perspective of the present moment leading to happiness. Call it optimism if you want but it appears that you can buy your ticket to the island of happiness. Here is the problem most people have. It is not free and not everyone has the skill set to save enough experience points to buy it.
If you want guaranteed success, find an uncomfortable but healthy discipline this year.The yoga practice I picked up along the way has made me realize that the present perspective is my reality to make. I need the discipline more than I need the postures. How else will I look on the bright side of feeling a year of avoidance in my muscles and my mood? It takes earning points from being present as well as understanding that I already spent all my points I failed to save from the past. Finding happiness looking forward to a future feeling is mute. Why make it there when I can make it here instead?
So I try on some yoga techniques such as meditation. I teach it to my patients. I request my family try some too. For me, the practice keep the lenses clear and the motivation to experience truth strong. I am more receptive when I practice and I am more accepting of the pain. I am sure we all wish some days we could go right back into every happier moment of the past or jump into happier moments in the future but in reality we know we can't experience anything more than a blurred memory or hopeful wish. Don't worry. By now you have made anything happy in the past seem 10 x better than it was and anything sad in the future 10 x worse. So this year focus on the now. What building blocks for contentment are there in your present state? Have faith the greater plan wanted it that way . Tap into that faith sooner verses later and settle your mind. A recheck grounding for a few moments into the present will grace you with the ability to be greeted by a smile of self reflection every time.