The Ragtag Daily Prompt today is patience. We still have some fog. We hope for clear sailing. We hope the fog bank will shrink. Right now we can see what is under it and avoid it. Patience, patience. Mask and immunize, please, please, push back the fog.
For the Ragtag Daily Prompt: innovative.
Return to kindness and tolerance and love.
I have been working with orthopedic massage for three years. My sister died in 2012 and my father 14 months later, in 2013. My father’s will was from 1979. My maternal family grieved via five years of lawsuits. I lost my sister, my father, and my maternal family. For good, as the song says.
I showed up for a massage in 2014. The ortho massage person said, “You are locked in an armor suit. Toes holding on to the floor, knees locked, head and shoulders forward, a fight or flight defensive posture.” I lift my toes up and say, “My toes aren’t clenched.” But they were.
For the next week I was to walk around, or attempt to walk around, with my toes off the floor. I practice: toes up, knees bent, lift foot, gently touch heel ahead, then shift weight forward, weight even on great and little metatarsal, toes are not to grab the floor, lift the trailing foot and repeat. I am furious that I have to relearn how to walk. HOW TO LET GO OF THE ARMOR SUIT?
I go once a month, now. I went weekly for a long time, then biweekly. Pieces of armor would drop off in the massage, but I would armor back up at work. Posture, posture, posture, breathe, don’t tighten those muscles up, check in with toes and with abdominal muscles…
Yesterday I go. We talk. It’s been a really weird month and I don’t know why. Letting go of all sorts of things and people and stuff. My pile of stuff to get rid of, clothes, books, mugs, art, is getting larger. And I was very grumpy the day before the massage. I thought, well, it’s been a dark February, I hate taking pills, maybe I need some sun, I mean, vitamin D.
But at the massage: a huge piece of armor, locked muscles in my lower back and hips, is gone. It feels weird. I didn’t know it was gone. Certain movements feel entirely unfamiliar, because I am used to moving the muscles as a locked group. My brain attempts to tell individual muscles to move and then there is a pause… as the brain and muscle negotiate unfamiliar territory. Medial gluteus medius… moving that feels so odd and unfamiliar.
Ortho massage says, “Usually when I ask you to move muscles, you are ON or OFF. FULL STRENGTH or no response. This is all new: modulation. Gentle.”
It feels so strange..
He knows how I feel. He says, “I felt so unbalanced as my armor dropped off. As if it dropped off bits at a time, a piece on the right side and suddenly I don’t know how to move because it’s all different. ”
Yes, that is what I am feeling. Unmoored. Light. There is less gravity. Gentle. Surprised. Less grumpy afterwards: I am so surprised, I had rather given up that I would EVER drop ANY of the armor suit. Pleased and a bit shyly proud. And deeply deeply grateful…. to my ortho massage person and to many others: friends, books, kind strangers, my patients, my colleagues (that is, the ones who have been kind. There are quite a few who were not. Let them go.) and the parts of my family that I keep… the ones whose actions DO mean they love me.
And my significant other says that I’ve seemed more peaceful this month. I check. I do feel more peaceful, which is so odd when I started the week feeling peculiar and unmoored and as if something was wrong. Something wasn’t wrong, I just had not even realized that I dropped a huge piece of invisible armor. The night before the massage I went to a dinner. Because of the deaths and lawsuits, I had very little social life for many years. A decade, really. After the dinner I thought, that was odd. I am not who I was ten years ago. I am not sure who I am in a social setting. I am surprised to be invited to a dinner. And I let the old me go: it’s ok. I will find out who I am after a decade as a hermit, a hermit due to circumstances, not by choice nor under my control. I let it all go: and I think that is the moment that piece of armor finally let go.
Are there toxic people?
No, I do not believe so….
I think there are toxic interactions.
Toxic behavior. And it takes two to tango, really.
Do I have to stay away from someone who behaves badly? Do they set me off? Well, that’s about me, isn’t it? I need to go look in the mirror and see what is bothering me. What does this remind me of? Are they getting under my skin? So what part of my skin needs better boundaries?
I realized that my father drank too much when I was in college. I read about it and went home, ready to intervene. My mother and my sister refused, much to my surprise. And slowly I realized that my mother was enabling the drinking.
I set boundaries with my father. I said that he could not come to my house drunk and he could not drink at my house. I refused to sleep in my parents’ house because he was falling asleep and there were cigarette burns in the floor and an 8 inch diameter one between the couch cushions. I told my mother I was having nightmares about fires. She joked that she would be mad if he burned a hole in the waterbed. I told my father I was afraid to sleep upstairs and moved to my grandmother’s, two doors away. I was lucky that I had that option.
My father stopped drinking a decade later. I took my young son to visit, and found that my father had started again. I asked my mother, “Why didn’t you tell me?” She replied, “I told you I would leave if he drank, but I am not going to leave.” I said, “We are not staying with you.” and we moved to my mother-in-law’s house.
As a family doctor, I try to help each person. My clinic and I do have boundaries. If they no show for three visits within one year, we ask them to change to another doctor. People call for referrals often. I can’t do a referral without documenting a diagnosis and doing an examination, so they need a visit. “But you’ve seen me for hip pain!” “Yes, and that was a year ago. Time to reevaluate, right?” And all doctors here are swamped: they want to save their over busy time for people who truly need them. The orthopedist does not want to see that hip unless I agree that they need to: if physical therapy and discussion can fix it, one less person that they don’t get to operate on.
I recently had calls for an emergency referral. I left a message with both the patient and the specialist. I had not seen the person for five months. I have no idea what is happening. If it’s an emergency, they need to contact the insurance, not me, because I have not seen the person: no diagnosis. And insurance should cover if it is an emergency. If it is not an emergency, well…
There is behavior that I prefer not to be around. There is behavior I will tolerate in clinic but not my personal life, since I get paid in clinic. There is behavior I won’t tolerate in clinic. But think of the great ones that are still spoken of: the Buddha, the Bodhisattvas, Jesus. They had boundaries to where any person was allowed to approach them and was received and was sometimes changed by that reception. When I say “I can’t be around him or her,” how do I need to change? Ok, not the crazy person shooting into crowds, no tolerance. But day to day, the things that get under our skin, it’s our skin that is fallible.
I do not want to label anyone toxic. I hope to make a small difference in the world through my clinic. And add to the joy in the world.
For the Daily Prompt: saintly. I am not there.
Sweet Honey in the Rock: Would you harbor me?
In clinic I have two jobs.
The first job is to diagnose. Chief complaint, history of present illness, past medical history, allergies, review of systems, medications (and vitamins and supplements and herbs and any pills or concentrated substances), social history including addictive substance use, family history, physical exam. What is my diagnosis? A clinical portrait of the patient.
The second job is to communicate and negotiate. I have to get a snapshot of the person’s medical belief system, their past experience with MDs, their trust or lack of trust, whether they are willing to take a prescription medicine. I have to try to understand their world view at this visit, at this moment in time. And it’s not static and may change before I see them again. If I can understand the person well enough to communicate with respect, with concern, with understanding, then we may be able to negotiate a treatment.
In clinic the other day I had a new patient who said, “I am not going to be pushed to take prescription medicine.” I responded, “That’s fine. I am not going to be pushed to do medical testing that I think is inappropriate, either.” She actually laughed and said, “Ok. That’s fair.” This is a patient who is coming from alternative treatment but wants medicare to cover her tests. After the visit she called and said that her provider wants a certain test before they feel comfortable proceeding with a therapy. I responded that I need a note and an explanation of the planned therapy before I will order the test. (Honestly, it’s an increasing trend that I get calls from patients with messages like “My orthopedist wants you to get my back MRI prior authorized.” and “My physical therapist wants my hand xrayed.” Our new office policy is: the provider has to communicate themselves, not via the patient. Also, it ain’t always so….)
I had patient once in the emergency room who said, “I have an antennae in my tooth. Get it out.” Her roommate nodded, looking terrified. This was after a fairly confusing complaint of tooth pain. I needed to think about an approach. I said, “I need to check on another patient. I will return.” I left the room in the emergency room and considered approaches. I went back in and said, “I am not a dentist. I can’t take out the tooth. BUT I can call a doctor to help with the sounds that you are hearing until we can deal with the tooth. The doctor is a psychiatrist.”
“Ok. Call them.” said the patient. The roommate practically collapsed with relief. Psychiatry said, yes, looks like psychosis and we have a safety contract and she will come in Monday. People HAVE actually had metal in their mouth that picked up radio sounds, but psychosis is much more common. Also, if you can say the station call sign that is a lot different than voices that are telling you to harm yourself.
I thought about my approach carefully. I did not want to argue about the tooth. I wanted her to agree to talk to psychiatry. So I told the truth: I can’t fix the tooth. It’s Saturday night. Here is what I can do. I never said, hey, I don’t think it’s the tooth, I think it may be a psychotic break. She may have known that it was not the tooth but been too terrified or too disorganized to tell me. And there was a small chance that in fact, it WAS the tooth.
It is not worth trying to “fix” or change someone’s world view. If they trust their naturopath more than me, that is ok. But it’s a negotiation: I am a MD and I will do treatments that I think are appropriate and safe and I may or may not agree with the naturopath or chiropractor or physical therapist or accupuncturist or shaman. But the goal in the end is NOT for me to be correct: it is to help the patient. Half the therapy is respect and trust and hope. And kindness.
The biggest problem with ten minute visits and the hamster wheel of present day medicine in the US is that the second job is often not possible. Complex diagnoses are missed or patients leave feeling unheard, not respected and frustrated. Time to make the connection and to understand is very important and is half the job. Physicians and patients are frustrated and it is only getting worse.
The photograph is my daughter and her wonderful violin/viola teacher, right before my daughter played for a music competition.