Achievement, Ambition, Empowerment, and Contentment

Whew, that title is full of some big ideas.

I've had a few conversations lately that have stirred my mental pot, especially around those big ideas.

At work the other day, I overheard a lunch conversation that started with this: "if you could snap your fingers and have a new career that didn't require you to start all over with school, what would you do?" Most of the women are older than me. And most couldn't imagine having a different career. Me? If I could snap my fingers to a different career? I'd run an international aid organization of some sort. I know, kinda random. I'd love to have the organization and management skills to change lives through charitable giving. Don't get me wrong. I love my career. It allows me the other things I value in life: a marriage and family. But I occasionally wonder about a life full of international travel and saving people from starvation and disease.

I was lucky to have a visit recently from a friend who moved away a while back. I'll call her Janey, to protect her identity.

We stayed up late drinking wine, and she told me about the possibility of a career turn that would involve 3 intensive years in a fast-track nurse practitioner program. It would be an amazing career move. And a physical move. It would also create insane demands on her and her family. Did I mention she has 2 young children? It sounded terrifyingly overwhelming to me.

She discussed how tedious her current job was, and the general boredom she felt in her career. The concept of her current job sounds amazing. But yes, the details of her job were a bit mundane and repetitive. Yet it's a good job, and allows her to work from home. This is handy when you have 2 young kids.

We were both the recipients of world-class educations and the encouragement to be whatever we wanted to be. We were taught that we shouldn't settle for boring jobs. We should never accept the status quo. We should feel empowered enough to reach for whatever we wanted, no matter how difficult.

But now we have kids. And mortgages. And a tenuous sanity to preserve.

So I had to ask myself:  What's the difference between settling down and just settling for something less?

And then:  What model of achievement should I be presenting for my daughters? And what should I be teaching them about ambition, and empowerment?

I'm starting to think that our focus on women's empowerment is becoming a double-edged sword.

(WARNING: If you get squeamish about medical details, are looking to avoid description of birthing, or just generally want to avoid incidents of TMI, skip down to the next part with bold font!)

I was reading a post on my local mommy group website where a mom was inquiring about hypnobirthing as a way to avoid tearing during birth. I took the hypnobirthing class. I used the philosophy to have 2 unmedicated births. I tend to think of it as a good strategy to get through birth without unnecessary medical interventions. It never occurred to me that one could PREVENT themselves from tearing during childbirth. Doesn't that kind of depend on the size of your baby and your general skin elasticity? But there are those out there that encourage women to empower themselves to have exactly the childbirth experience they want. So if you don't want to tear, you can work hard enough to find a way not to tear. Wow. That's a lot of pressure... What if you DO find a childbirth technique that promises to help you avoid tearing. But you tear a little anyway. Does that mean you're a failure? I'm content to see tearing as a possible (and likely, given my prior experiences) side-effect of the birthing process. You get a few stitches, you use witch hazel pads and a peri-care bottle for a week, and you move on. Does this mean I'm too content with the status quo? Should I feel more empowered to demand the birth I want when Little Miss makes her grand entrance in a few months? But I don't want to feel like a failure when the midwife pulls out the needle and thread...

(OK, you squeamish readers can start reading again here.)

Do the current messages in our society really help us? "You can have it all! Get your career established first. Travel the world. Then when you're financially secure in your early 40's, have kids then." And "Don't settle. You CAN have a career! And a marriage! And kids! And fun leisure time!" And so women wait so they can have it all! And then they have to struggle with infertility, because a 30 year old body bears children more easily than a 40 year old body. The realities of biology don't change because we've suddenly become more empowered. Skin stretches, and then sometimes tears. We start our lives with lots of eggs. Most of the good ones are gone by our 40's. The limitations of a 24 hour day aren't swayed by successful women encouraging us all to do more, be more, achieve more. There are only 24 hours. We really can't clone ourselves to simultaneously attend a work meeting and a preschool dance performance. 
Or maybe I'm just not empowering myself adequately...

I brought up the topic to a wonderful group of moms from my church. They're smart, they're successful, they're kind, and they're wise. They're my grounding force in the face of the questionable advice provided by society and my local online mommy group. Once a month, we share food, wine, support, conversation, and prayer. Because we know our limitations. We need each other. And we know that there are just aspects of life we need to turn over to a higher power.  But we discussed my questions. 

Not one of them thought we could "have it all". According to them, we have natural seasons in life that demand and allow our energy to be directed to different areas. We have marriage partners with whom we give-and-take to make our family work well together. Our careers are just part of the picture. We have priorities that truly are more important. Like our marriages. And our children. When you sit with a group of women that include some who have buried children, it somehow becomes perfectly reasonable to shape your life and aspirations around those of your own children. It all falls into perspective. 

Of course, perhaps our expectations would be different if we could all afford to hire out parts of our lives - childcare, shopping, cooking, cleaning... Have you ever noticed that women to talk about "having it all" seem to have their own staff? Or at least have mothers living nearby who are willing to do those things for free?

We discussed the concept of "vocation". Martin Luther (the Reformation guy, not the civil rights guy) discussed vocation as a gift from God. Both bankers and blacksmiths have the ability to serve God in their jobs. They have the task of being the best banker/blacksmith they can be, in order to help others and fully utilize the gifts that God has given them. There is no such thing as a lowly or exalted job. There is just OUR job, and we need to do it well to give glory to God. You can be a wonderful 7-11 cashier. You can be a wonderful nurse. You can be a wonderful CEO. You can be a wonderful street sweeper. They all give glory to God! 

You can be a wonderful wife and mother. These are also vocations. Think it's not important? Imagine losing your spouse or child for a moment. Yeah, they're pretty important. Imagine not being around to teach your children what love is about and to prepare them to go out into the world. Imagine your children not having a mom. Yeah, the job is pretty important. 

So I'm thankful for the perspective my friends bring. I'm thankful for not needing to live up to the expectations of society. I already have some pretty big jobs on my plate. I'll stick with those and let others battle the angst of their "empowerment." I think I'll just pray for the power to do my own jobs well.

Hope you have a great week!

Thanks and No Thanks

Christians are encouraged to give thanks in all things. If we look hard enough, we can find gratitude amidst annoyance. So I'm going to give that a try today.

I'm thankful for warm down coats. I'm thankful for furry mittens. I'm thankful for fleecy warm hats. I'm thankful for soft silk long johns that disappear nicely under my work clothes. I'm thankful for warm fleece socks to go over my knee highs. I'm thankful for warm scarves. I'm thankful for shiny burgundy work clogs with a thick sole to lift me out of puddles. I'm thankful for the NextBus app that keeps me from having to wait too long at the bus stop in the sideways rain. I'm thankful for a dry train station in which to wait for the train. I'm thankful for my umbrella to keep the sideways rain out of my face. Mostly. I'm thankful that down coats dry well after a drenching. I'm thankful for a fulfilling job in a warm dry building.

I am truly thankful for these things. But I have to admit a few "no thanks" elements of my day.

If asked, I'd quickly say "no thanks" of offered the following:
Sideways falling rain
Temperatures in the 30's with sideways falling rain
Umbrella-buckling wind
Urban wind tunnels that exacerbate the umbrella-buckling wind
A warm train full of damp people

But at the end of the day, I'm going home to a warm dry house and a loving family. The pros outweigh the cons, and I really can't complain. And besides. There's so much to give thanks for!

Sorority of Moms Meeting

I left work 45 minutes late today because I believe in the sisterhood of motherhood. My job floats me between hospitals, and today was the first time I've been back at one of the sites in a few months. So today was the first time I saw Jane* since she came back from maternity leave. On my way out the door, I asked how life was, back at her full-time job with a 4 month old at home. Boy did I open a can of something...

"Is it supposed to be this hard?" The floodgates were opened, and the last 4 months just came pouring forth. I smiled, nodded, and said "yup" a lot. She joined the chorus of all of the working moms I know. "There's not enough time in the day. Daycare gets her best hours. I'm always stressed. I'm always behind. I never feel like I'm doing a good job. I love coming to work. I love my job and don't want to give it up. But this sucks. And daycare is so expensive. And nobody at work understands. And none of my friends are working with kids. Am I doing something wrong?"

I did her the favor of not sugar-coating things. I wasn't telling her anything she hasn't already noticed herself. Being a mother is a full time job. And having a career that you love outside the home is a blessing. But having both can feel like a curse.

Moms know this. That's why moms need other mom friends. So we can vent after a long day of work about how much something sucks. Society isn't so understanding of that need to vent. "You chose to have the child, right? You chose to go back to work, right? So why are you complaining? There are so many childless couples who would LOVE to be in your shoes. There are so many unemployed families who would love your job. Stop whining!"

But moms know what it means to be that candle burning at both ends. And we know the isolation it brings about. Motherhood is supposed to be so fulfilling, so wonderful, so all-consumingly joyful that all inconveniences are too petty to mention. But many of us don't feel that way. Some of us experienced failure for the first time as a new mother. Sleep deprived, oozing hormones, and feeling helpless at the hands of a colicky newborn, motherhood does not always feel like sweetness and light. To deny this is to devalue motherhood. Because it's hard. It just is.

So if you believe in the sorority of moms, find a way to support another mom this week. Take the new mom at work out to lunch. Surprise her with a mid-afternoon latte. Just stick around and listen. Or offer to help her out with something so she can go home early. She probably needs it.

*Of course her name's not Jane

The Future of Elder Care

As I've mentioned before, I have the privilege of working with the elderly. It's not the most glamorous group to work with, but I generally find it rewarding. I learn a lot. Unlike school, I can acquire wisdom, not just knowledge. Good stuff. I've met the people I want to grow up to be like. Sure, God willing, we'll all get to the age of 80. But not all of us will do it equally well. 

I came to the realization at work yesterday that I'm worried about the future of caring for the elderly. I think we have a growing problem that isn't being discussed yet in our field. And I blame it on airplanes.

Stay with me here for the explanation. I worked with 4 different patients yesterday (only 4, it was a short day, and one required a lengthy evaluation). They were all in their 80's. They all lived in their own homes. But only with the assistance of family. 

One was married, but had health problems that require a significant amount of assistance from her husband. He's thankfully healthy enough to provide the care. If he gets ill, they have adult children and grandchildren in the area to help. One of those granddaughters was there at lunch when I visited her. If it weren't for the family members, the lady would need to be in a nursing home.

One patient was never married. He lived a simple life in a menial job. He was retired and doing fine until his health problems began. He'll be fine when he goes home, even if he has lingering cognitive problems. His nephew lives next door. His niece lives one town over. They already were helping him. In fact, his nephew visited at the hospital today. But without his family, I would recommend discharging him to a nursing home.

Two patients had lost their spouses, and were now a widow/widower. They have varying health problems that require ongoing care when they go home. They both have very involved adult children who will help care for them at home, and are already very involved in their hospital care. Without the family members, they would be discharged to nursing homes.

Without local family, all of these patients would end up in nursing homes. They are not people of means. They might have a few resources, but the money would dry up in a year or two, with the taxpayer then picking up their nursing home tabs. You and me. People need nursing homes, and we need to help pay for them. This is a fact. But more people will need these nursing homes in the future.

Our generation is one that has grown up with reasonably affordable air travel. It's no big deal to pick up and move a few time zones away from family. We can always fly home at the holidays. Many of us have moved to cities and settled down among strangers, far away from family and friends. Right now, we're young and relatively self-sufficient. We don't need someone to check in on us and make sure we've had at least one square meal and our daily assortment of medications. But the day will come in the future when we will depend on the help from others for our survival. And if our habit of moving far from family continues, who will come check on us? It's frequently the case that having one supportive family member will make the difference between leaving the hospital to go home vs. leaving the hospital to move into a nursing home. If families keep moving away from each other and more people age alone, we will run out of nursing homes. 

The older I get, the more I see the wisdom in having large extended families settled in the same area. We definitely suffer from not having grandparents, aunts, uncles, and cousins in the area. And I'm sure that the older we get, the more we will suffer. 

As Seen on TV

I currently work at the primary acute rehab facility in Boston. So if anyone gets discharged from a major Boston hospital and needs rehab, they come to us.

So when I see a news report of a bad accident or other injurious event, I always think, "Good luck buddy. I'll see you in about a month," and most of them do come to our hospital. But because I only work 2 days per week, I don't get to meet many of them.

But today, I did. I recall the extremely injurious event. I recall thinking my usual thought. I was thrilled to see him looking better than I would have imagined. I was not thrilled to tell him that, in addition to his serious bodily injuries, he also had some serious cognitive injuries.

So I'm going to change my reaction from now on. I think, "Hope you don't need to see me in a month" might be better for my patients. And some prayers. Definitely some prayers.

SCOTUS, Aphasic Ladies, Pot, and a Car Crash

I was planning on posting pictures of our gummy candy bonanza, but then today happened.
There was a pretty significant SCOTUS decision made today, and I had a long an eventful work day. The gummies, news, and musings are all swirling around in my head and I thought I'd spew them out to share with any insomniac friends (or 2 AM nursers) who cared...


So I think by now we all know what SCOTUS concluded:  the healthcare mandate IS constitutional, and will become the law of the land.
Healthcare coverage is a truly wonderful thing. You don't know when you're going to be jumped on the street by a few guys with baseball bats. You can run weekly marathons and eat an organic paleo diet, and it's not going to prevent you from ending up in a coma with tubes that you breathe and eat through. Your habits MIGHT help you actually survive getting your skull bashed in to get to a rehab hospital, but doing the right things and having good genes aren't going to prevent you from needing healthcare.
And preventive medicine is a wise and wonderful thing. Spending a few hundred dollars teaching people to control their or their children's diabetes can save hundreds of thousands of dollars of medical care in the future. A few thousand dollars of prenatal care can prevent many more thousands of dollars of intervention if birth defects are prevented. It's just money wisely spent.


We have amazing healthcare in our country. And lots of it. You can find a healthcare provider on just about every corner in Boston. And lots of good ones. Yes, I know that not everyone in the U.S. has top-notch specialists on their street, but if you are willing to drive a bit, you can get to one. I take great comfort from the idea that, if needed, we could fly any family member to Boston to treat any rare malady that might occur. Healthcare is easy to get. Healthcare is of high quality. Healthcare for everyone!


According to a few randomly-googled sources (CNN, MSNBC and kaiserEDU.org,) healthcare spending is currently around 17 or 18% of GDP. That's almost 1 out of every 5 dollars spent in our nation. Wow. Don't get me wrong, I think spending money to birth healthy children and keep them healthy is a good use of my money. I think spending money to keep my family members' blood pressure in check to prevent debilitating strokes is a good use of my money. But here's a question:  is there such thing as spending TOO MUCH money on healthcare? Is there a percentage of GDP that we Americans could all agree is just spending too much on our health? Would we ever hit the "outrageous" mark? Or even agree that there is such a thing?


Please don't accuse me of supporting "Death Squads". I work in geriatrics, I think preserving the health of seniors is part of the Fourth Commandment. (That's "Honor your Father and Mother" for those who didn't attend Catechism class...) An extra healthy month at the end of a 95 year life IS valuable. BestestHusband wisely stated once, "I'm happy that we live in a country that values life." We were discussing DNR orders and related topics, and the fact that it's not easy to discontinue someone's feeding tube or breathing machines. Life is valuable. We need to err on the side of preserving it, even if much money is spent to do so. This is a noble concept.


But reality sets in at some point. Doctors and nurses must be paid. Enteral feeding supplies aren't cheap.  I've never worked in a medical facility that has its own money tree. Rationing already happens at various levels.


I do it regularly.


When I evaluate a patient, I must admit that I consider multiple variables in deciding "yes, she needs therapy" vs. "no, she's fine without us." Some of these variables are patient-specific:  medical history, pt motivation and participation level, family support and discharge plan, the baseline activity level of the patient. In other words, if a 40 yr old IT manager who just got married has very mild deficits but wants desperately to get back to being 100% of her baseline self so she can get back to work and start her married life with her husband, I'm picking her up for therapy. I'm going to max out my available time with her to help her meet her goals. Conversely, if a 75 yr old man with a history of medical non-compliance has mild deficits, but at baseline sat in a recliner watching TV all day and was taken care of by his wife, I might not pick him up. Especially if he didn't seem to try very hard on his eval. Do they have the same deficit level? Yes. Do they have the same ability to significantly benefit from the services I offer? No. Does the optimist in me say that "everyone deserves a chance" and "maybe I can help him despite himself"? Well, yes. But sometimes external factors make a difference.


The factors that I also take into consideration include:  what is our current caseload; who's available to help manage a large caseload; are many people up for discharge soon; how needy are the other patients on my caseload? These are factors that some might argue are unfair to consider when looking at a patient's allocation of therapy time. Maybe. But the factors and the limits they impose are REAL.


This allocation issue came up today at work. My optimism-killing patient is off caseload. He was sucking time from the patients who really WANTED to do therapy. The other therapists have to keep him a few days longer and are grumbling about it. He's sucking their energy, their spirits, and their time from more motivated patients. One of the therapists is pretty sure his family is bringing in pot that he sneaks out to smoke. Well, they sneak him out to smoke it. He's pretty dependent and can't really get himself too far... Let's compare this guy with a sweet aphasic lady I saw today. She's so impaired that she can't communicate basic requests for toiletting, food, or going to bed. But she's SO MOTIVATED to get better! I think I could easily spend 3 hours a day with her in speech therapy. Her husband would spend another few hours helping her out with homework activities. She would benefit from the therapy. My time invested in her would yield good dividends. It's a good resource allocation. Our pot-smoking, therapy-cancelling, drug-seeking, medically-noncompliant gentleman... well, I'm arguing that he's not a great allocation of our scarce resources. Who would you give an extra 30 minutes to? The eager aphasic lady? Or the "screw you" pot-sneaking guy?


Are we allowed to decide this on a grander scale? Who decides? I like to be an optimist and give people a chance. But this guy clearly blew his chances. Right? Or did he? If all Americans get healthcare that is subsidized by all other Americans, do we get to a point that we start setting limits on what people get?


What sets those limits? Age? Genetic factors? Lifestyle factors and behaviors? Financial resources? Realistically, we know that increased financial resources will always get you increased medical services. (The US has many well-respected hospitals with private-pay patients that fly in from all over the world.) Certainly at some point we as Americans need to calmly discuss that fact that our current habits of healthcare use just aren't sustainable for the long-term future. But will we? Can we get past the "I'm special, and I need all available resources.!" but still honor the Fourth Commandment and our nation's history of revering life?


So now to mention the car crash:  I was having a patient read from the newspaper to practice using clearer speech, and I noticed a picture of a strangely-familiar face to the side of the article he was reading. I eventually got the chance to look at the picture and recognized the face of a nurse I used to work with. Under the picture, it said "Tragic: Sarah E.*" She was one of those wonderful nurses who spent her career honing her calm demeanor and ability to create happiness and peace in the patients in her care. She worked with patients who had advanced dementia. She was a mother and grandmother. And she was killed in a car crash on Sunday by an illegal immigrant. Tragic. Life is sometimes just really unfair.


Can we create a "fair" healthcare system? Can we afford it?


Time to go into practice working with rich people who can afford to pay privately. Might be my best bet for job security...


*Sarah E's family could probably use some more prayers, if you're inclined to pray for strangers. God knows who you're referring to, I'm sure...

Bragging Rights

I'd like to brag about my husband for a bit. He's on a plane to Germany, so he probably won't read this for at least a day or so. After picking up some more interesting gummy candies in Heidelberg, he'll check in to see how things are going at home, and he'll probably get a bit embarrassed. 


Sorry honey.


But I have a really great husband. 


Today was one of those days that just epitomized some of the great things about BestestHusband.
He got up before the rest of us to walk the dogs.
He put away dishes, helped get breakfast for the girls, and helped us all get out the door for swim lessons.
He was, as usual, an enthusiastic and encouraging component of swim lessons.
He ironed the laundry.
He carried a mini trampoline around the corner to a birthday party*.
He hung out with a bunch of 3 and 4 year old girls and their moms for a few hours.
He held someone else's baby for part of that time.
He read nap time stories.
He then went outside and moved dirt and rocks to make more improvements to the garden and yard while the rest of us napped. 
He did bath time for the girls.
He watched YouTube videos of Kriss Kross' "Jump Jump" with the girls.
He let the girls "help" him pack his suitcase.
And all along, he was funny, affectionate, and wonderful to all 3 of his girls (yes, including me). 


Thanks to a recent column in The Atlantic titled "Why Women Still Can't Have It All", the topic of work and family has come to the forefront again in the blogosphere and in my online mommy network. I'm happy to hear some people discussing the concept of FATHERS that are also making career sacrifices in order to have a happier home life. Because BestestHusband did this years ago, and continues to do it today. After college, he was recruited to join a firm doing very lucrative investment banking work. Very. Lucrative. But he looked around at the employees and saw that they had miserable marriages and family lives and said, "No thanks." He knew even then that he wanted a family someday, and would have to make sacrifices to have a happy home life. And the company that he's with now, the one with an extremely family-friendly culture and hosts summer outings to places that have bouncy houses and entertainers for the children, pays a lot less than other companies. Companies that don't provide paid paternity leave and an understanding and flexible schedule for parents who need it.


Of course I did that too. I purposely chose a career that was family friendly. And less lucrative than others that would make being a mother more difficult. That's what the so-called "Mommy Wars" want to discuss -  my sacrifices, and my forsaking of a graduate degree that I must do to care for our young children. But let's not forget all of the wonderful husbands out there who attempt superhuman balancing acts and make sacrifices for their families. Their efforts demand our recognition, too.


So here are some updated photos of the garden that BestestHusband has sacrificed his weekends to create:

BH moved a LOT of dirt and rocks to make this garden.

He had to remove a large shrub and move another cubic yard of dirt to add this extension to the garden. (Anne, these are your seedlings in this corner!)

Didn't he plant some gorgeous lettuce?

The tomatoes look lovely, too.

The spinach is spectacular.

Lots of spinach. Yum!

He planted TWO kinds of mint!

Zucchini blossoms!

He moved a lot of boulders to build this retaining wall.

Side view of the garden, including small boulders.

BH did pretty well in creating a garden out of an infertile slope.

Thankfully, the plants are helping to hide the boulder - the one that got away...

All in all, if he likes to move heavy things to get some exercise, I'm happy with the results. But it's yet another way that he invests his time and energy into taking care of the family. He could spend his weekend mornings on a single scull on the Charles River instead of letting his daughters "help" him in the garden. But he doesn't. He gives his time to us.


Anyone at The Atlantic want to write about that?






*A, hope you don't mind that we shared the trampoline...

The Death of Optimism

I think therapists tend to be optimists. I'm sure that other careers, like teaching, attract optimists as well. If you spend your days pouring all of your time and energy into helping someone get better at something, you have to have a deep belief that people CAN get better.


I would lump myself into the Optimist category. But every now and then, I encounter a patient that overwhelms and defeats my optimism.


I worked with such a patient again yesterday. It was our second or third session together. Joe* is in his 40's, and had a significant stroke on the right side of his brain. (MCA CVA for those who like medical jargon.) The left side of his body is paralyzed, and his brain tends to ignore that it's there. (left neglect for you jargonists out there) So he'll start swearing about how much his left shoulder hurts. And you have to point out to him again that it's because he's sitting on his left arm. Now, most people can learn how to pay attention to their left side again, and they get much better. But his stroke has significantly affected his overall self-monitoring and error-detection. How do you fix a problem that you don't think you have? Why would you exert maximum effort in a therapy session to fix something that isn't broken? This definitely affects someone's rehab prognosis.


Joe doesn't understand how cognitively impaired he is. His mind jumps from idea to idea, seemingly uncontrollably. Sessions with him are exhausting. You can spend 30 minutes just trying to get him to read through his medication list. He won't do structured memory tasks, but I tried to work on his memory by helping him learn his lengthy list of medications. We didn't get very far.


My favorite moment from yesterday's session was a conversation that went something like this:
Joe: "I think I might need to fire my doctor and get a new one."
Me: "Why's that?"
Joe: "I was taking tons of pills at home, but he couldn't keep me from havin' a stroke. Shouldn't he have known I was goin' to have a stroke?"
Me: "Didn't you just tell me that you smoke all day long, eat nothing but greasy food, never exercise, do drugs, are diabetic, and until recently weighed almost 400 pounds?"
Joe: "Well, yeah."
Me: "I think your doctor's done a great job of holding off your stroke as long as he did."
Joe: "yeah, maybe you're right..."
And then he changed the topic again.


The part that makes all of this most difficult is his baseline pre-stroke personality. My co-worker describes his life as "chaotic." She's stating it nicely. Here are a list of things he's told me about his life:

• While he was in the hospital after his stroke, his mom had his new van towed and "crushed".
• She evicted him from the apartment he was renting from her because he didn't pay rent while he was in the hospital.
• He's taking her to court.
• His 17 year old son is in trouble with the law, and is wearing an ankle monitoring bracelet. 
• He recently paid $1000 bail to keep his son out of jail. He's afraid his son will miss his court appearance and he'll lose that money.
• His 17 year old son told his teenaged girlfriend to get an abortion.
• He wants to "bust him in the mouth" for doing that. That's not what their family does, even if it was going to be a "mixed-race kid."
• Joe lives with his girlfriend and her 3 teenaged kids.
• She helps him with his medications and doctors appointments.
• They want to have a baby together.
• They just got a pit bull puppy.
• When Joe gets home, he's going to start running, playing basketball, and lifting weights every day.
• He's going to have a 6 pack and a body like you see on TV.
• He's going to go back to school and become an RN.
• He'll support his son and keep him out of trouble. 

(Nevermind that he never does his homework exercises and can't support his own weight, and left the previous rehab hospital against medical advice, one of the best in the nation, because he just wanted to go home. Oh, and he didn't finish high school, and isn't really very literate...)


His personality is one that does not take constructive criticism well. This makes providing feedback in therapy sessions quite challenging. He "fires" therapists regularly. He yells and swears at the staff regularly. He yells at me for "cutting [him] off all the time." I consider it "redirecting him to task." Especially in the context of needing 30 minutes to read through his list of medications...


I love it when patients have big plans, with big goals. I'll never forget the 54 year old hand surgeon that had a cerebellar/brainstem stroke. Let's call him Larry*. His mind was intact. But he had severe ataxia - a lack of motor control. He had difficulties speaking, eating, walking, bathing, etc etc etc. Returning to vascular surgery was out of the question. And he knew it. But he specialized in reattaching fingers. Working on hand transplants. He successfully amputated a guy's big toe and used it to replace a mangled thumb so a patient could have a useable hand. And he and a friend had been playing around with a new hand prosthetic design. So he set reasonable goals for himself. He and his friend turned their attention to the prosthetic. He decided that he could continue his love of hand surgery via teaching. He just needed to improve his speech to be able to do it. AND HE DID. If I told him to do 20 repetitions of an exercise, he did 50. When friends came to visit, he told them to grab his therapy notebook and do exercises with him. He toughed it out through the most intense electronic stimulation treatments I've ever administered. He set goals for himself, and he just worked his backside off to reach those goals. 


Larry fostered optimism, even in pessimists. And when he gave an intelligible lecture (with Powerpoint images of severed fingers!) to our medical and rehab staff, I KNEW he'd be fine.


But Joe... he's not a do-er. He doesn't set reasonable goals and work hard to achieve them. So even if he did wake up one day and realize that he had problems, I have no evidence that he'd set out to solve those problems. He doesn't have a history of being a fighter. Of being someone who doesn't take "no" for an answer. Someone who will sacrifice towards a bigger goal. Because he does drugs all day long. He creates drama wherever he goes. He doesn't play by the rules. He lives in a different world than I do. One of drugs, prison time, welfare checks, baby mamas, and street cred. And I"m having a hard time seeing it as an environment that will help him recover and regain his own life, much less start a better one. He's ready to discharge himself from the rehab hospital so he can sue his mother. Can you imagine a guy like him in court? It's going to be a nightmare. 


So I need help being optimistic on this one. I've never had a patient's situation upset me so much. I know that miracles can happen. There is still room for a miracle in his life. And he needs a miracle more than anyone I've ever met. No, I take that back. His son needs a miracle. His girlfriend's kids need a miracle. Because the sins of the father will be visited upon those kids and direct their future more than they can even imagine. He's going to be a handful to take care of... 


Pray for Joe. And pray for my optimism. Thanks!




*Of course I"m not using their real names. The HIPAA police would come after me.

Stewardship Sunday

Wow, it's been a while since I posted. But certain things are still the same. There is clean laundry on my spare bed, waiting to be folded. There are tumbleweeds of dog fur roaming the house, even though I recently swept. And I have a ToDo list longer than any week can reasonably manage. We like to be predictable and reliable around here. 


Here's some of the fun NEW things for this week...

• We got a Sodastream. It's fun.
• We had fun at two big of play dates. It rained a lot this week, so the play dates were a Godsend...
• The girls came to my Physical Therapy appointment with me. They actually were angels.
• HeyMama has starting sleeping without a pull-up. And last night I didn't have to change the sheets!
• MeToo transitioned from "barnacle" to "fish" at swimming lessons. The bruises on my neck from her death grip are finally fading...
• HeyMama tried paddling without the kick board, pool noodle, or barbell floaties. She still has the flotation belt on, but doggie-paddled across the pool like a champ!
• We're selling our double stroller tomorrow and getting a single with a standing board. I stripped the stroller to the frame and washed the fabric. That was an interesting experience.
• In one day, I took the girls to swim lessons, helped host a church meeting/cookout at our house, and went to work in the afternoon. Then deployed praying mantis egg sacks into our garden after dinner. Swimming, God, making money, and eco-friendly pest management, all in one Saturday. We're not usually so ambitious or productive. 
• I jumped around and made myself hoarse in front of a bunch of kids singing some of my favorite childhood Sunday School songs. 
• I held a few newborn babies. I concluded that I do like them still. But am still content to hand them back to their mothers. 
• I wore one of my great consignment store dresses from the previous week's conquests, and again appreciated NOT wearing maternity or nursing clothes or holding my own newborn. 

Did I mention that I'm excited about downsizing our double stroller for a single? In my mind, this opens up the possibility of taking public transportation this summer. Look out world! No parking worries + 2 girls who like to skip naps = lots of fun summer adventures!!!

My naked double stroller.

Ok, it's crazy late, and the red wine I had with dinner isn't helping me be more alert...


Food waste:  I was a green leafy executioner again this week. I killed half a head of lettuce and half a bunch of mint. I think I also killed a bit of cucumber. OH!!! I almost forgot to mention my YOGURT FAILURE! I tried making a gallon of yogurt. I instead got a gallon of warm milk. I tried using a different culture, and I don't think the milk was warm enough to start culturing. If it weren't for the red wine still in my system, I'd be much crankier about the milk and effort wasted. I'm still deluding myself that I can do something with the yogurt-scented milk... I sent out the question to my local mommy network, and have hope that someone will come back with good ideas...


M&Ms:  not too bad this week. But ice cream was my drug of choice.


Money:  I bought a Sodastream. New in the box from a local mom, so half price. But it wasn't a necessity...


Patience: We did a lot of playing this week. A lot of it was inside, but it was with friends. Friends help with patience. A LOT!!!


Exercise:  I went to the gym only twice this week. My goal is to prioritize this more in the upcoming week.


Ok, time for bed. Hope you had a great week!

I Love Aphasia

I love aphasia. Actually, that's a lie. Because aphasia really sucks. Aphasia is a communication disorder that is the result of some kind of neurological trauma. It most commonly results from strokes and traumatic brain injuries, and robs people of their ability to speak, understand spoken language, write, read, or all of the above. So I hate aphasia.

But I do love working with people who have aphasia.  There are varying degrees of disability that depend on the severity and location of the trauma that occurred to the brain. In my experience, aphasia is like snow. I have never seen 2 examples of aphasia that are exactly alike. In my perfect job, I would work with individuals with aphasia all day long.

Now, many of my healthcare co-workers don't share this opinion. It can be extremely frustrating to try to help a patient get dressed, walk, find food they want to eat, and express what is causing pain or anxiety when there's a breakdown in simple communication. Because aphasia can impair pointing. And gesture. And the other myriad ways we try to get our point across when we can't get the right words to come. And it can also prevent a person from even knowing that they don't make sense. Imagine how frustrating it must be to make perfect sense (to yourself, at least...) and have people staring at you like you speak Martian instead of handing you that sweater hanging in that closet over there like you've been asking for for the last 10 minutes.

But I have the luxury of sitting down and just trying to work through the communication piece. And I find that most patients are relieved to have someone who can take the time to try to communicate, especially when that person also has tricks to help recognizable words actually come out.

So I was reminded today at work how much I love working with people with aphasia when I sat down with Mr. Jones. Of course his name is not really Mr. Jones, because HIPAA would hunt me down and have me de-licensed. Well, HIPAA's just a law, it can't hunt. But someone would hunt me down... But back to Mr. Jones... He's a gruff elderly gentleman, shaved bald with a wicked potbelly and dry sense of humor. My favorite kind of patient. I sat him down in the vacant dining room (his room was too noisy) and offered him a drink:
Me:  "What can I get you to drink?"
Mr. J:  "Eh, anything."
Me:  "Well, we have lots of things in the kitchen, coffee, tea, juice, soda, water... What would you like?"
Mr. J:  "Coffee... with Splenda."
Me:  "How many Splendas?"
Mr. J:  "One."
Me:  "Any cream or milk?"
Mr. J:  "No no no!"

I was quite pleased with myself. Our significantly aphasic gentleman just very clearly told me that he wanted coffee with Splenda. So I poured him a cup of coffee from the kitchen, stirred in one packet of Splenda, and proudly placed it in front of him on the table in the dining room. I was not prepared for what came next.

Mr. J:  "What the hell is this?!?!"
Me:  "It's coffee. With one Splenda."
Mr. J:  "I can't drink this sh*t!"
Me:  "What's wrong with it? It's just what you asked for! Coffee with Splenda!"
Mr. J:  "NO!"
He pushed the cup away with a look of disgust.

Now, I happened to know that Mr. Jones can read better than he can understand, and once he reads the word, he's able to say it out loud. (Aphasia is funny like that.) So we went through a 10 minute process of me asking questions in multiple-choice format, all written on paper, until I finally understood what he really wanted.

A diet gingerale.

You can't make this stuff up. His speech errors are usually well-articulated real words that are somewhat appropriate for the situation. They're just the wrong words.

But we worked together for an hour, and did get some of the right words to come out. And there were moments of joy when they did. Mr. Jones was able to laugh at himself a bit, and I was able to tease him a bit. I have no problems laughing at speech errors (technical term:  paraphasias) and help my patients do the same. Sometimes the substitutions are just downright funny. And in the midst of all of the frustration of ideas locked in a brain with an uncooperative speech system, I assume that they need more opportunities to laugh.

So the next time you find yourself annoyed, trying to get the word out that's on the tip of your tongue, imagine that all of your words were like that. And pray for individuals with aphasia!

Monday Catchup and Gail Halvorsen

Happy Memorial Day to all!  A huge "Thank You" to everyone who has served in our military. 

I'm extremely thankful that there are people in our country who willingly put themselves in harm's way every day so that I don't have to think about how dangerous the world is. I do sleep better at night knowing that there are people who have the skill and bravery to do the dirty work that allows us to all sleep peacefully at night. And I'm extremely thankful that there are families who put on brave faces, and spouses that struggle to do the job of two people so that their household can function while their soldier spouse is deployed far away. 

Whether or not you approve of the reasons that the military gets deployed, you must acknowledge the people who don't get to have a say in these decisions, but feel strongly enough about serving their country that they go along anyway. And they do a really good job of it. They've recently proven that the bad guys aren't as good at finding hiding places as we are. And they bring along candy for children who have never tasted any. And share their rations with people who don't have food. And provide medical care to the sick and injured who aren't even involved in the fighting. 

I know that there are countless stories of U.S. service members doing small things to help the residents of the countries they fought in. I think my favorite so far is that of Gail Halvorsen. PBS introduced me to him a while back, talking about the Berlin Airlift after WWII. Today made me think of him again. American pilots flew life-saving necessities into Western Berlin. They provided a constant stream of food, medicine, and supplies for the beleaguered Germans who lived there, with planes landing every 3 minutes. Gail noticed the children who watched his plane land 3 times a day. He gave them chewing gum one day, and realized that they weren't just bringing these children food, but hope. So he bought up candy at the commissary, fashioned tiny parachutes out of handkerchiefs, and dropped the candy from his plane on his approach to the landing field. 

Gail attaching parachutes to candy. (Thanks for the photo, Wikipedia!)

Of course it was a hit. He became known as the Berlin Candy Bomber. Children across the U.S. raised money and American candy makers donated candy to the cause. Other pilots joined in. One man's sympathy and compassion for a few children grew into a joy-bringing institution. 

@ss-kicking and candy bombing. What a combo within a military force! 

So that's all I've got for today. I'm too behind to even try to do a belated Stewardship Sunday. Thanks to a holiday weekend, I significantly increased my work hours, which always screws me up. BestestHusband was home today with the girls and attacked the Clean Laundry Beast that was lurking on the spare bedroom bed while I enjoyed a "quiet" day at work. That's why I even have time to tell you that I can't catch up with blog posts. Yeah, I know it's been a while. But I promise a new boulder update soon. There is a new boulder. And a new update.

PS. Thanks Anne and Chris for the delightful dinner gathering that made me eat and drink too much. That's probably the biggest reason I couldn't write a Stewardship Sunday post. And the homemade brats were insanely good...

Rhododendron Path

This was part of my commute home from the train station today. I missed a bus by 30 seconds. But got over it pretty quickly...

When I start kvetching about how much I loathe Boston winters next February, please remind me of how much I love Boston springs.

"I Don't Know How You Girls Do It"

One of the joys of my job is that I have the privilege of working with people with 8+ decades of life experience under their belts. I make a point to tap into that experience whenever I get the chance. Functionally I'm assessing their speech, their thought organization, their pragmatics. But really, I'm looking for advice. Nuggets of wisdom. Recipes.


Most of my female patients are mothers. I ask about their kids. The number is usually in the 4-10 range. So I ask for advice. "How did you do it? I have 2, and they keep me plenty busy. What's the secret?" They usually just chuckle and shrug. "I don't know, I just did it!"


But some of them turn the tables. I was actually surprised the first time I heard it: "I don't know how you girls do it these days - kids, jobs, the busy schedules you all keep." They say things like, "Oh it was easier back then. Everyone had kids. We sent them all outside and they entertained themselves." They talk about having their moms and sisters nearby to help. They didn't take the kids to the grocery store to have meltdowns in the frozen food aisle. They didn't drag them to play groups and story times. Their three year olds didn't play on soccer teams. They didn't work when their kids were young, so pumping breast milk 3 times during a work day wasn't a concern. And they certainly didn't worry about whether they were making the best choice in the career/family balance.


I have no doubt that momnesia has kicked in during the 50+ years since they had small children at home. I'm sure they had plenty of struggles of their own. We won't even get into the gender issues and educational and career opportunities available to these women when they were our age. But their words are kind. And maybe even true. And it's the kind of encouragement I need from time to time.