Lessons from the Bedside: Physical Therapy and Change

"They are NOT getting me out of this bed. They just make my pain worse."

"Whew! That physical therapist worked me too hard."

"I'm just not up for occupational therapy today." (No matter that the patient was also "not up to it" yesterday, or the day before, or the day before that...)

If you're a nurse, you have no doubt witnessed these scenarios. Though it's easy for me to discount patients' complaints and reluctance to work with PT/OT, I have to admit, I have a lot in common with their attitude—especially when it comes to change.

Currently, I'm in the midst of quite a bit of change. I'm shifting careers, learning new skills in the writing world, and trying to keep up with an ever-changing healthcare system, all on the coattails of moving from Cambodia back to the United States and working through reentry. Change, like physical therapy, is difficult. As I've observed my patients in the hospital over the years, here's what I've learned about both change and physical therapy:

1. It's painful.

Some patients won't move their feet off the bed for PT/OT until they've had their pain medication. I don't really blame them. Retraining your body to stretch and move and function in a new way can be very, very painful. Change and transition can be the same: a season of retraining our bodies, minds, and spirits to try new things, form new habits, and leave the comfort zone of our beds (or homes, or jobs, or cities). Yet just like with therapy, increasing our activity in these uncomfortable areas only increases our strength and ability to thrive in new ways. It may be painful, but it's worth it.

Adobe stock photo

2. It's scary.

"Don't let me fall!!" patients will exclaim when they transfer to the chair or the bedside commode for the first time. Their legs are weak and shaky, or their balance causes them to sway. Yet the therapist is always there, providing support and holding onto them, a trustworthy safeguard even when patients doubt their abilities. Similarly, in times of transition I too am fearful, and I do my fair share of crying out to God, warning Him I'm losing my balance and am going down, fast! How often I forget He is there, holding onto me, supporting me, even if I don't believe He's strong enough to catch me. It can be terrifying to walk when we're weak because there is always the possibility we will fall, but when we take wobbly steps forward, we arrive to new and important places (like the bedside commode! Just kidding. Kind of.). It's scary, but it's worth it.

3. You'll want to quit.

To be honest, sometimes I have a hard time not judging patients for "being babies" about PT/OT.

"I can't go any farther," they state. Or, "I just can't go anymore. I just want to go back to the bed."

As the patient healthcare professionals they are, our physical and occupational therapists encourage the patients to keep going. They remind them of the benefits of therapy, and they point out how far the patients have already come. Still, some patients refuse to keep moving.

Unfortunately, with all my judging of patients, I am the same way when it comes to anything new. New location, new method of transportation, new routine, new job—anything new throws me for a loop, and like a grumpy old woman who's stuck in her ways, I sit and pout and complain that I can't go back to the way things were before. Even if "before" meant I was bed-bound and my muscles were atrophying.

Like most people, I enjoy comfort. Neither getting out of bed to retrain muscles to walk nor getting out of old routines to form new, healthier habits is comfortable. It's hard, and we'll want to quit, but it's worth it.

4. It's a process, and it takes perseverance.

I wish physical therapy only took one session to accomplish all its goals. I wish one day of accepting change completely reformatted my brain to eliminate all anxiety and stress about new things. However, both physical therapy and change involve growth, and growth is a process. Processes require time, and time requires perseverance.

Little by little, cell by cell, muscle fiber by muscle fiber and neuron pathway by neuron pathway, as we persevere our bodies and brains shift.  The old, unusable junk is broken down and rebuilt into a new, healthier, stronger version of ourselves. Over time, we find ourselves able to jump higher and run faster than we did before knee surgery; we find ourselves utilizing stronger character traits of leadership, servanthood, and compassion as we relate to and lead those around us. It doesn't happen overnight; it's a process, and it takes perseverance, but it's worth it.

5. It's possible.

Though I witness many people who, like me, grudgingly swing their legs out of bed to start therapy, I also watch incredibly motivated patients work day in and day out to regain their strength. These patients focus on the positive and rarely complain. Nothing can deter them from finding something to be grateful for—including the opportunity to participate in occupational and physical therapy. Each time a therapist knocks on the door, they never refuse to get up or tell the therapist to come back later. They are willing to move forward in their healing.

Change and growth, whether physical, mental, emotional or spiritual, inevitably involve pain, fear, exasperation, and teeth-gritting perseverance. Change is all of these things, but it's possible. And it's worth it.

"Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will." Romans 12:2 (NIV, bolding mine)

When Failure is a Guarantee

As many of you may know, I am currently in shift toward copyediting and writing as a career and away from nursing (see Why I Quit Full Time Nursing). The transition into the writing world has taken place over the past few weeks, and though I mainly feel peace and excitement about the change, I'd be lying if I told you I'm not nervous.

I am. I'm nervous, and I'm worried, and sometimes I'm overwhelmed.

Adobe stock photo

Yesterday as I drove down the road under the cloudy Texas sky, I thought about my fear of rejection. Over the past few days I've submitted freelance articles and queries to various websites, with the knowledge I will eventually either be rejected or accepted. At one point in life (okay, for most of my life), the possibility of rejection would have prevented me from trying at all. My fear of failure and the belief I had to be the best simply wouldn't allow for such a huge, unnecessary risk. For all those years, failure was not an option.

As I slowed my car down for a red light yesterday, I suddenly realized that still, failure is not an option.

Failure is a guarantee.

Over the years, I've read accounts by writers and bloggers about the rejection letters they received from editors, publishers, magazines, and websites. They described heartbreak and frustration and anger and discouragement, and they also described perseverance and perspective.

As I submit my articles, I know my work will be rejected sometimes (probably more often than not in these beginning stages). It's inevitable. Yet I am learning to maintain my sense of self-worth and identity so I can move past it. I know who I am, and I know my work is not a reflection of my value.

Still, it is disheartening to know failure is a guarantee—and about the only one I could think of that comes with writing. That, and a low budget.

All afternoon, I pondered the change within me from being terrified of failure to accepting it as a part of life. Later that evening during a time of worship with my church small group, I had another realization, just as sudden as the one about failure. I knew in that moment I had to lay down my editing career and writing dreams at Jesus' feet, and I had to leave them there. For the first time in my life, I found how easy it is to become a workaholic (now that "work" was something I loved). I had to invite Jesus into every word I wrote and every article I completed. If I did these things, I knew:

Success was not an option either. It was a guarantee.

Success is living and breathing in the presence of Jesus, holding onto the hem of His robe and offering my talents and gifts at His feet. It is using my work to glorify Him, yes, but more than that it is a continuous, desperate, building desire for more of Him. With this unquenchable thirst for more of Jesus, with Christ as my whole world, there could only be success. There already was success. Perhaps success isn't something attained or accomplished but something as fluid and active as recognizing the presence of God.

Moving and breathing and talking in His presence is success. I have success in my lungs as I breathe and type now because I am breathing and typing with Jesus. Success will never be a thing that can slip from my hands because success is knowing Jesus, and His Spirit lives within me. And if ever I become desperate to grab hold of success again, I have only to remember:

Turn to Jesus, for not just success but life is found in Him.

Reentry: Still on the Road

It's no secret I've had a rough time in reentry the past few months. I washed my clothes by hand and hung them up to dry for weeks, and I binge-watched Netflix and drank Dr Peppers by the case to make up for the time my favorite soda and I were apart.

Now, several months (and seasons of Bones) later, here I am.

Life in Waco is falling into a pleasant rhythm, and for the most part things have calmed down both externally and internally. However, every once in a while waves of grief and feelings of missing Cambodia hit me rather suddenly, like a flash flood with no forecast of rain. I'm still learning to navigate these surprise storms. Recently during one of these waves of grief, I heard a song my friend Marc wrote called "Heading Home." The song begins, "There’s a groaning, an aching in my bones/There’s a longing in my heart to find a home." As I listened, it seemed to gather up within me leftover remnants and threads of reentry--the values I've learned, the pain, the hope, and the lessons I'm still learning now--and place them in a bundle right in the center of my heart.

The lyrics didn't tie up the loose ends or weave the threads into a stunning tapestry. No, they simply brought all the frayed fibers to one place so I could see them. All of them, in their varied colors, sizes, shapes and textures, all at once. The hurts and hopes and tears and shouts, all at once.

All of them, all at once, were beautiful. I no longer felt the need to tug at this thread or change the color of that one. With all their quirkiness and shortcomings and distinct characteristics, they were beautiful.

Stock photo from Adobe

While I quieted my soul and listened to this song, I realized a few things. First, even though I'm settling down into life in Waco, I'm still heading somewhere. For a woman with an unshakable travel bug coursing through her veins and wanderlust written on her heart, knowing I'm still traveling is a comforting notion. (However, I am excited for no more reentry processes when the journey ends!!)

Second, the place I'm heading is to be with Jesus in person. To have more of Jesus, to spend more time in His presence, to know Him more. This lines up with one of my greatest prayers and desires lately, which has been to want Jesus more than I want a country, and for my loyalty to be to Him and not to a culture. Home is a Person, not just a place.

Third, I realized the journey home can be beautiful in itself. A road trip by myself through the Texas countryside is one of my favorite things. More than getting to the destination, I enjoy simply driving, soaking in the landscape and praying or listening or singing until my throat hurts. I may be homesick, and reentry may be hard, and I may not truly arrive home for a while, but the journey home can still be beautiful and is uniquely qualified for enjoyment.

As I sat examining this bundle of threads and these lessons learned, I stopped struggling for a moment. Instead of trying to reconcile two very unique cultures and countries, I simply began to thank God for each lifestyle and cultural difference as it came to mind.

Thank You for the communal way of living in Cambodia, and thank you for the individuality of American people.

Thank you for rice and fish and the Mekong. Thank you for microwaves and refrigerators and ovens and pre-packaged food.

Thank you for my students in Cambodia, for the church, for the rhythm of life there; thank you for the job I have in the States, for my coworkers, for healthcare here.

I could keep going for hours, but the point is gratitude humbles me and reminds me how beautiful this world is, even with its pain and frayed edges and tangled up threads. In some way, all those worn out threads create something beautiful in their messiness. I cannot and will never be able to make sense of the disparities between countries and the heartache that hits every time I leave a country. Yet when my focus is on the Maker of cultures rather than on the cultures themselves, I find rest. I don't have to stress about reconciling the differences and similarities and roughness and tangles—because no matter what, I'm still on the road, and I'm still heading home.

Lessons from the Bedside: What Foley Catheters Taught Me about Emotional Nakedness

It’s undeniable we celebrate weird things at the hospital. Things like bowel movements, being able to walk without assistance, and really big, long, straight veins. The day when patients’ Foley catheters come out also calls for celebration (except when patients are incontinent; then our little nursing hearts sink a little...)!

It was on such a day when a patient should have been celebrating his Foley catheter coming out that I learned an unexpected lesson about my emotional health.

“Please, can you take this catheter thing out?” my patient had begged all day.

Several hours into the shift, I heard from the doctor: the Foley catheter could be discontinued. I gathered supplies for wound care and for removing the catheter before knocking on the door.

“Good news!” I remarked cheerfully. “The catheter can come out!

Stock photo from Adobe

Surprisingly, the patient sighed deeply, as though disappointed. Although confused by his sudden change of heart, I proceeded to provide wound care, and the conversation turned to other things for a few minutes.

“Okay,” I finally said, “if you’re ready, let’s go ahead and take out the catheter now.”

“Do I have to take my pants off?” he mumbled as he started to roll his pajama pant legs up (up, instead of pulling his pants down).

“Um, yes.” Questions patients ask will never cease to amaze me. (Also, how anyone can wear pants over a catheter by choice will never cease to amaze me.)

“Okay. I just feel so humiliated…” More mumbling. Another deep sigh.

Finally, I understood his hesitancy. He was embarrassed and would rather wear uncomfortable, inconvenient pants than have his privates bared.

As nurses, often we forget it’s abnormal to see people’s bodies — all parts of their bodies. We wipe butts on a daily basis, put in catheters and take out catheters, and deal with every kind of bodily fluid you can imagine. Human anatomy is no big deal; it’s our job to assess it and make sure it’s functioning properly.

However, it is a big deal to most other people. Once I clued in to why this patient was balking at the chance for his number one request of the day to be granted, I was able to address his fears accordingly. Thirty seconds later, the catheter was out. Mission accomplished.

After washing my hands and stepping out into the hall, I began thinking about how this patient had considered discontinuing his Foley “humiliating.” His use of this specific word was actually shocking because to nurses there is nothing humiliating about having a catheter removed. In fact, to me the words “humiliating” and “catheter” have no reason to be in the same sentence.

Yet something about this patient’s words struck a chord with me. I knew that same hesitancy, the same feeling of being humiliated, the mumbling and the deep sighs — but not because of physical nakedness. Because of emotional nakedness.

Despite years of dealing with depression and some serious time spent in therapy, I still find it difficult to open up emotionally, even to my therapist. I still hate admitting my weaknesses and the natural anatomy of my feelings to anyone , myself included. What seemed ludicrous a moment ago when I was with a patient I now recognized in myself: I would rather wear uncomfortable, inconvenient masks than show others the fear and sadness I once believed were ugly and shameful. I would rather roll my pant legs up and acknowledge just a little ugliness than pull my pants completely down.

Yet in the same way healthcare workers in the hospital don’t think twice about seeing patients’ naked bodies, I finally realized mental healthcare workers probably don’t blink an eye at the raw, bare truth about people’s mental and emotional states. When something isn’t working right, someone has to look at it. Nakedness is simply part of our jobs.

With this perspective, I’m learning to be more intentional about overcoming my habit of stalling before getting to the heart of my struggles when I show up for a counseling appointment or pick up the phone to call a friend; I’m learning to try to pull down my emotional pants and check my shame at the door.

Is stripping emotionally vulnerable? Sure. Should we be careful whom we share our emotional and mental nakedness with? Of course. (Wouldn’t want to moon anyone by oversharing inappropriately!) Should we be ashamed and humiliated by emotional nakedness? I’m starting to understand the answer is no.

As a nurse, my job may include physical nakedness. As a human, it will always include emotional nakedness. Because of this encounter at the bedside, I’ve decided: it’s time to stop fighting it and strip right down to emotional nakedness.