Your Pain is Not Special. It Is Normal.

Self-Care Tip #243 – See yourself as special rather than your pain and know that you will find your normal again.

What is your normal?

When we were kids, we all had a perspective of what normal was.  Let’s say it was “here.”  Let’s imagine we were lovely then, nurtured and emotionally bonded.  We struggled through peer conflicts, social anxiety and rivalry.  We wanted a bike.

Two Sisters

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Then we got a little older.  Maybe our parents divorced.  Maybe, a sibling died.  Maybe we were abused or in an accident and damaged.  Damage changes normal.  What we never would have thought would be acceptable in our lives became acceptable.  We suffered.  We lived.  Life was indiscriminate and ignored our status.  We think there must be a mistake.

What is our normal at one point, filtered through remaining hopes, grew into regenerating fantasies, through real potential and it moved again.  We are older now and more suffering comes.

Where is our normal?  We survive our child, our own dear perfect boy, hanging from a tree.  Normal?  No dear God!  No!  And we continue to live.

Two years.  Two years are what it takes for our biology to catch up to the shock.  Two years are what it takes for us to begin to accept and realize that in this new normal we care again.  We choose it in fact.

People don’t remember his name or talk about him and we can’t remember his eyes.  We are ashamed and lose our breath from panic just trying to see them.  We want to bang our head because we know there is something wrong about feeling normal! Ever! Again! after that.  But we do.

Our normal mutates over financial ruin, abandonment and a growing healthy list of disfiguring illnesses.  We accept them and say yes please.  Live.  We want to live.  This is acceptable.  This is normal.  Our friends die.  Our memory.  We can’t find our teeth.  Our heart stops.  We die and the world finds normal.  The world chooses just like we did.

What we don’t think will ever be allowed to happen while we brush hair, clip our nails and microwave food, happens. We endure these changes.  We find normal again.

What is your normal?

My brother, Vance Johnson MD, is a physical medicine and rehabilitation specialist.  He said that during his residency, close to 100% of spinal cord injury paralysis survivors he worked with wanted to die after their injury.  Many of them would beg him to let them die.  They would cuss at him for keeping them alive.

I leaned very heavily on the studies and data during those times.  It was very hard.

Vance said that what kept him faithful to his task was knowing that close to 100% of them after two years would be glad they were kept alive.

Even the ones who were basically breathing through a straw and that’s all that moved on them; even they wanted to live.  These people found a new normal.

Where is our normal?  We will want it.  We will adapt.  Biology will catch up to our reality.

Remember that your pain is not special.  You are special.  Not your pain.  Pain is normal.

Question:  When this happened to you, how did normal find you despite the rubble?  How does this concept feel to you, that your pain is not special?  Does it make you angry or what?  Please tell me your story.

Choose Back! …As Long As Life Chooses You.

A Girl On A Footbridge

Image by jyryk58 via Flickr

Self-Care Tip #241 – As long as life chooses you, it is your right to choose back – so do.

Although I am not a geriatric psychiatrist, I have still been given the pleasure of serving a “golden” few.  What has impressed me has been their willingness to start over.

Starting over takes courage and humility whether it is deliberate or not.  Sometimes fear dances between the lines of all the emotions and intentions. But still, wouldn’t you agree that it takes courage and humility to negotiate fear?

(Enters Hans.)  Hans was seventy-three years old.  He had struggled with brain illness on and off he thinks since he was at least twelve.  There were big spaces of time when his disease exacerbated, and he largely suffered.  But he chose, at this age, to try again for improved brain health.

Is there a time when we start thinking, don’t keep trying to start over?  Maybe in the dying process.  In case you don’t know, the dying process is a specific term.  It means the time when a person is facing impending death.

This area of medicine is not my specialty but I imagine at some point we want to stop with that starting over process, give up, but not in a hopeless way.  In a way that says,

I can stop trying for new anything and sit in the space of what I already have in me…

…Which hopefully includes all the ingredients and interrelations of life.

But how far before that point in life do we consider starting over reasonable?  I’ve heard of kids being told they’re too young to ride a bike, or cut with a knife, or understand the dinner conversation.  No one bobs their head at that.  But find a seventy-three year old who believes that after a lifetime of perceived failure by onlookers or themselves, who still says,

Now let’s give this another go,

…and if it hasn’t been said, it’s been thought,

give it over already!  You’ve hit your seventy-times-seven chances!

It’s like they’re shopping in the teen-ware.  We blink our eyes and angle our heads.  Even the thought of starting over as a real option feels indiscreet.

(Enters Hans.)  Hans is seventy-three.  He is starting over.  Humbly and with courage, he pursues brain health in the face of stigma.

I think I had celebrated my six birthday when my dad asked me if I felt any different from how I felt when I was five.

Yes!  I feel older!

 Then he asked me how old I thought he was.  When I answered some enormous number like, “twenty-two!” he asked,

Does forty-four seem old to you?  

Of course it did!  But I had an intuition that if he was old, than he’d die, so I said a definitive,

NO!  Daddy you’re still young!  You aren’t old!

Now, almost that same age myself, I am in awe of him and the others in their golden or not so golden years (Enters Hans) who believe that as long as life chooses them, they will choose back.  It is their freedom.

Questions:  When all your senses don’t sense pleasure in life, or you feel old and useless, or you feel that you’ve failed too many times, how do you choose to start over?  Who has inspired you and what did they do?  Please tell me your story.

Goodbyes Are A Way To Connect

15th century adaptation of a T and O map. This...

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Self-Care Tip #184 – Respond to your goodbyes deliberately to be friendly to yourself.

One of the Regional Centers that I work at is closing their telemedicine clinic.  This means I’ve said goodbye to many beloved patients and their families, whom I’ve worked with since round 2003 I think.  Saying goodbye to people we respect and enjoy is not as casual as we stylin’ people make it look.

Two days ago I said goodbye to my girlfriend of around five-plus years and her family.  Moving far far away makes the flat world feel lumpy and luminous.  I now have all her leftover food and knock-offs she didn’t want to haul across the lengthening world to remind me that she is gone.

Watching parents and/or grandparents age is also an exercise in saying goodbye.  My parents have a hard time making it over to visit on week-ends for all the funerals they go to.  Their calendar sends over that whispering voice that they are growing old.  “Look,” it says.  “See me.  I am aging.  Time is connecting and taking me with it.” Even so, their essence holds its own, apart from Time.  That makes me feel more comfortable.  When that whisper gets louder I may respond differently, I can’t know until then.  But for now, this is good.

“Goodbye” is something that begs a response.  “Oh yes!  Goodbye!  See you later.”  I even say, “See you later” to people I know I have less than one percent chance of running into again.  The word calls to me and I respond.  The word implies a disconnection, but even so, beckons us to connect.  It spreads us over the space of our time shared and into the future apart.  Peanut butter and jelly, it sandwiches us up with the one who says “Goodbye” when we say back, “Until then.”

Today with these people and remembering all the ones I won’t get to see before my contract ends, I feel the pull to respond.  My response can be something deliberate.  It is another bit of something I get to choose.  I hope it will connect me.

Question:  How have you responded to the goodbye’s in your life?  How has it been a connecting force for you?  Please tell me your story.

Dad Is In The Hospital. My Reality.

Open-face helmet.

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Self-Care Tip #179 – Get inside your reality and be with Love.

When I was eight my family left me at Grandma’s farm for the summer.  There’s not much more inland to go than Iowa.  If the United States of America were a house, Iowa would be perhaps it’s cellar; full of smells, goods and it is a great place to play.  I played a lot that summer – as well as stepping in a cow-pie or two, riding tractors with Grandpa Jack cutting hay, pulling on cow tits and seeing the milk come out to shoot right into the cat’s mouth.  And I gathered eggs from pecking feisty chickens that would scare the bravest of any Coasters (those of us from the East and West.)  Grandma was no-nonsense and didn’t waste much time on coaching.

Just stick your hand in there and take the eggs.

As an eight-year-old you haven’t known real fear until you face down a mother hen in a musty unlit poop filled coup, and reach under her feathered skirts for eggs.

That summer Dad came to get me early.  I was really happy to see him.  Uncle Mel and my cousin Dougy had been in a motorcycle accident.

Dad is an orthopedic surgeon and since my summer in Iowa,  Dad has called motorcycle helmets, “brain-buckets.”  He’s seen a lot of them in emergency rooms, so he knew what his brother had looked like.  Dougy was in a hospital bed being introduced to his now forever useless arm.  I came in shy, because Dougy was so cute.  I was thinking about what he thought of me.  I know.  I did.  Despite my diva-self, despite the horror and grief, Dougy gave me a brilliant white-boy American smile.  I hid under Dad’s arm where I didn’t have to look but could still hear Dad’s voice.  I think I may have even whined.  I’m still embarrassed.

These days, unfortunately I rarely get to see Dougy, but when I do, I still want to hide under Dad’s arm as if he’d remember me there.  I wonder if he remembers Dad’s voice.

Today, Dad is in a hospital bed with a blood clot the size of a rattle-snake crawling up his leg, fighting for his right to walk, let alone live.  It is his voice, or maybe the bed, that brought Iowa back to me.

Cousin Patty was crying at Uncle Mel’s funeral.  She wouldn’t go up to the casket, just sat and cried.  I was a little bummed my cousins weren’t interested in me.  It was who I was at eight years old.

Grandma, who left me unsupervised to gather eggs from angry-chickens, cried and asked me for more kisses.

They taste like brown-sugar!  Give me some more.

Dad’s hands now have Grandma’s same wormy veins, raised over blotched ecchymosis (purple patches from leaking blood vessels into the skin); begging to be touched.

I went to see her with my brother Cam before she died.  She was delirious.  But I trusted her so.  I laid beside her in her hospital bed and looked up for a shoe she told me was stuck in the ceiling.  I thought, “There just might be one and these people don’t believe her.”  I was miffed.  Now I realize I was mostly angry because Grandma was dying.

The farm is gone and I wish I had the metal tub Grandma bathed me in outside on the lawn.  But I do have this connection in me to all she gave, the people who came from her and her showing me how to live and die.

If she was still alive and knew Dad was in this danger, she’d say, “Rob, I’m praying for you.  I Love you.”  And unlike my emotives, that would be about it.  She was from Iowa, you know.

This is my reality.  Dad is in the hospital.

Self-care includes being in our reality.  Sometimes it’s too much for one person to handle.  People need Love.  The reality of the world and of the individual is that we need Love.  We are better to ourselves and others when we can be inside our reality.

Telling you about this is my self-care.  This is part of my Love story.

Question:  What is yours?  Please tell me your story.

Live And Live Despite The Ongoing Loss

Red slipper

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Self-Care Tip #141- Live and live despite the loss.  Be a friend to yourself.

The other day, my hair was barely pinned back in a knotty mass, when I arrived at clinic late with my house slippers still on.  I didn’t realize this of course until I heard this flapping sound echoing behind me as I hooned down the hall.  Distracted by myself, I seemed to suddenly come upon an old man.  He was lovely really, wrinkled, clearly handsome in his day, shuffling my same direction, and also in his house slippers.  It was less than a second when I took this all in and I suddenly felt very self-conscious.  Not awkward for the normal reasons that I should have been, like my nappy appearance, but I’ve never really thought I was “normal.”  No, I felt rude.  I’m much more sensitive to rude than ugly.

Do the younger seem rude to the older?  There with their supple joints, perky bodies and minds, hope, and shorter medication lists?  I felt rude.  Rude combined with awkward is not something most people are comfortable looking at, which is what I unfortunately offered up to this innocent man.  Walking fast felt wrong.  Not sure what to do, I sort of slowed, yet my tardiness to clinic didn’t let my gait relax.  Giving an uncertain smile, I managed not to make eye contact when I said “Hi there,” lest the eye contact lead to further tardiness.  Then off I galloped, luckily for both of us, only 3 doors down.

I didn’t spend more than a few seconds with that stranger, yet remember well what he symbolized for me.  I remember him when I get grumpy about not being able to eat as much as I did 10-years ago.  When I get resentful with my feet, (a size and a half HUGER since I had my first kid,) I see his lordosis (hunched back often from a collapsed spine.)  I wonder how he is doing with his losses.

There’s not much romance in growing old.  What is romantic is a beautiful person, who has been real with their losses and with the joys of life that are still available to them.  There’s no point in my denying that I can’t have cereal and pasta every day any more.  There’s no point in being angry about it.  I’ll just eat slower and force, er, I mean find more pleasure out of what I do eat.

I like to think that the old man in the hall made his and makes his peace with losses and is more glad than not for his life.  If so, maybe he was ok with my fast pace when he couldn’t.  Maybe it makes him more comfortable in a world in which he is becoming more and more of a stranger.  That is something to admire.  That is something that is worthy of life’s privilege.

After yesterday’s blog-post, a reader said it quite fine,

I did not know depression was progressive.  That’s depressing.  As is the realization that aging is progressive.  …On the other hand I can say I’ve had 61 more Christmas times than a new-born and perhaps that makes it worth it!

Question:  What losses are you struggling with?  How do you come to terms with your losses?  Please tell me your story.

Growing Old

Growing old.  When do we stop looking forward to the future?  My husband, who is a Palliative Care specialist, says that even in the end stages of life, we still look forward.

Erikson‘s psychosocial crisis theory of human development says life is a balance between conflicts.  Ambivalence, two opposing forces, is something to embrace and walk with.  I don’t think Erikson ever said it in so many words, but he was largely talking about having a sense of presence in our lives.  He based most of his theory on watching kids grow and then spread the rest over adulthood like the last bit of peanut butter on the knife.  Is that what adulthood is like?

My little girl told me that she’ll never run out of love for me.  (Every now and then, after hours or days of desert-like behaviors, she’ll break open a rock and out will gush something amazingly nice like that.)  Then she looked me over and said, “You’re not old Mommy!”  I showed her my gray and my spots and my wrinkles.  Maybe I was trying to say, “How can you love me in my future?”  Love is evergreen.  I am not.

When I was a kid, my parents loaded us up for a couple weeks every year and hauled us 8 hours in a van to Brian Head ski resort in Utah.  It is where I learned that some things stay green no matter what weather they live in.  The Evergreens, tall, tall, covered in snow except for some undergarments showing through were everywhere.  Even thinking about them, I can taste

Rolo Chocolate Caramel Candies,

feel the weight of booted feet, hear Dad’s bass voice and bits of my favorite ski-story loud to be heard above the chair lift.

Evergreen’s for at least 2 weeks a year, surrounded me and my family.  I’ve heard that Brian Head has materially changed a lot since we stopped going.  I wonder about the trees.  I’m sure there are fewer.

If it is true that every stage of  life has conflicts to resolve, it makes sense to me that in age we must resolve our future with our past.  We can’t just have a past.  If we find ourselves just looking back, than we are turning a blind eye to something we are meant to be present with.  Something that brings balance and fullness to life.  Something that is an evergreen quality.

For me, it is intuitive to look at God to meet this need – future v. past.  I don’t know what it is for others.  Conflict resolution.

When the days on life’s scale are tipping backwards, and we see that there aren’t as many days left on our plate, be present.  It is an illusion.  The past does not outweigh the future.  The opposing directions of time are just fine.

Self Care Tip #71 – Be present with the past by believing in your future.  Be a friend to yourself.

Question:  Agree or Disagree?  What are your thoughts?

Get to Know Yourself to Be A Friend to Yourself.

On the Threshold of Eternity

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Let us put our efforts toward becoming who we can become, who we were wired to be, who we want to be, what gives us pleasure.

We can get beaten up by wanting.  Wanting to be someone who gets energy from being with people rather than from being alone.  Wanting to be someone who is a finisher rather than grazer.  Wanting to blend and lead and be chosen.

Some of this filters out as we age.  Aging fills our lives up with so many responsibilities that wanting to be anything more than someone who gets solid sleep hasn’t crossed our minds in a very long time.  Children get more of it right than us in this regard.  They have space to want more openly.  Our wanting muffles and cramps when we turn away from who we were genetically designed to be.

My patient came in depressed again.  Depression was familiar for him.  A psychiatrist works with a specific area of medicine.  So I get to see people after multiple medication trials before their primary physician refers them to me.  Well this patient hadn’t found lasting help from medications. He came to me with doubt.  I wish I could say we worked it out.  I can say that we are still trying.

What we are working on influences the way his genes express themselves.  We can’t change the genes but we can affect some of how and when they are activated.   We can do this by choices, such as medication therapy, sleep hygiene and exercise.  Choices are more effective when we know what and who we were wired to be.  What are our natural talents?  What are we interested in?  Feeling inner congruence when we are doing something points the way for this.

In Outliers, author Malcolm Gladwell says

“the biggest misconception about success is that we do it solely on our smarts, ambition, hustle and hard work.”

I don’t know if Mr. Gladwell recognized how closely his thoughts harmonized with Carl Jung‘s regarding temperaments.  Doing what is natural for us recruits our best through the path of least resistance – our interest, our attention, our creativity.  Rather than forced effort, drudgery and dragging feet, time looses some heaviness as we get caught up in inner and outer congruence.

Intuitively, we all surmise that when this happens, we have less stress inside and outside of us.  Ah.  What a relief.  This is what my patient is working on and when he is able to say he is doing what he wants to in life, he is less hopeless and panicked.

Self Care Tip #40 – Get to know yourself to be a friend to yourself.

Question:  What do you think?  Have you been using these tools?  Have they made a difference for you?