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)

The Truth About Depression: 5 Observations from Someone Who’s Been There

I have a confession.

I’ve struggled with depression for years. I’ve struggled with anxiety, too. For a long time, I tried not to let the world see my struggle. I let shame seal my mouth shut. But today, I want to begin sharing this part of my story—a part that I’ve desperately wanted to erase from my past but remains there nonetheless. I want to write about mental health because it matters, and I don’t think people talk about it enough.

So here is some truth about depression. I’m not a clinical expert or mental health nurse or any kind of therapist. I simply have observations from experience, from a raw wrestling with this intangible mood-killer and productivity-killer and sometimes people-killer. It’s my hope to begin writing more about my personal journey toward mental health, but for now, here are some foundational observations.

Observation #1: Lots of people are fighting the dragon of depression.

In high school, my English teacher used to say that “everyone has their dragons,” meaning everyone has things in life they are fighting against. The dragon of depression is a lot more common than we believe.

When I was a freshman in college, we had a chapel speaker give a lecture on depression. Opening with a statistic, he stated, “One in seven people suffer from depression.” One of the guys in my group started counting how many people were sitting in our row and said, “Hey, that means at least one of us would be depressed!”

I tried to shrink in my seat. That one person would be me.

I don’t know if that statistic is true or not, but I do know that a lot of people experience depression. It isn’t always physically debilitating, and we can’t see it with our eyes, but it still exists, and it’s a lot more rampant than we would like to believe.

Photo credit: Kateland Pricer

Observation #2: Lots of people treat depression like a literal dragon—like a terrifying, mysterious myth.

Unless you’re a conspiracy theorist, you probably don’t spend much time talking about myths. You probably spend a lot more time on what you believe is true and relevant and affecting everyday life.

That makes complete sense—when it comes to actual myths. The problem is, depression isn’t a myth. In that way, it isn’t like a dragon at all.

However, just like a dragon, depression can seem terrifying and mysterious. As humans, we tend to shy away from the unknown, and our solution for the mysterious is to pretend like those things simply don’t exist. I don’t think anyone quite gets depression unless they’ve been there—and even those of us who've experienced it don’t completely understand it. We don't understand why it affects some people more than others, how it creeps up or vanishes or lingers, or why certain treatments or medications do or don’t work. 

Even though we can't explain it, we must acknowledge depression. We have massive educational efforts for diabetes and heart disease—we even have billboards talking about stroke symptoms—but for some reason we refuse to address depression on a wide scale publicly. Yet ignoring depression can be dangerous—perhaps just as dangerous and lethal as ignoring a dragon’s existence.

Observation #3: Stigma is a Silent Killer.

In nursing school we once had a slide dramatically titled, “Hypertension: the Silent Killer.” I chuckled at how dramatic the slide was, but I never forgot it. Later, I decided that in the mental health world, stigma deserves that title. “Stigma: the Silent Killer” is not an overstatement.

Over the past few years, many courageous people have been speaking up about mental illness and opening the floor for a nationwide conversation around it. I have been so encouraged by this! However, these speakers are still a rarity. We have a long way to go.

Stigma is why the people experiencing depression are the ones you would least suspect. Because of stigma, we hide it and try to compensate and sometimes overcompensate. We pretend we're okay, but inside we hate the mask we put on. Stigma leads to isolation and contributes to shame, which leads to self-hatred, which leads to increased depression, which leads to more shame. Ultimately, stigma leads to a startlingly high suicide rate in America and globally. 

If depression is a dragon, stigma is its right-hand dragon buddy. With stigma around, people believe experiencing depression is weak and shameful. The greater the stigma and shame, the less likely people are to seek help. (Trust me, I waited four long years due to stigma and pride before going to therapy and finding help.)

Observation #4: It can always be better.

One of the flaws of depressive thinking is the belief that “it can never be better.” It all seems pretty hopeless.

Sometimes, it takes a friend to hope for you—to believe that things can get better. I was blessed to know a great group of girls in college who also struggled with depression and were brave enough to talk about it in everyday conversations. We hoped for each other when we couldn’t hope for ourselves.

Several of those girls are some of my best friends today. What happened for us was an anomaly, but it doesn’t have to be. It can be better. For individuals, for myself, my friends, and for society. Sometimes "better" is a simple step of courage away, found in working on a project we enjoy or joining a Bible study. Sometimes it's scheduling a coffee date with a friend and holding onto the knowledge that in exactly two days we'll have a friend to sit across from—encouragement and hope in tangible form.  Sometimes "better" is found in a text saying someone's praying for us.

Whatever form it takes, I believe it can always be better. I believe we can create a culture where it isn’t shameful to talk about depression, a culture where we hope for each other, a culture where we know we were made to need each other.

Observation #5: A change in culture starts with individual conversations.

Practically, how do we effect change? I believe it starts with awareness and conversations.

When we talk about depression, stigma is dismantled, and the truth comes out: depression affects nearly everyone at some point in their lives, and it doesn’t mean we’re weak. In fact, those who experience depression are some of the strongest, most courageous people I know.

When we can talk about depression and hopelessness and pain, we gain opportunities to sit with others through the darkness, which perhaps is the greatest help of all. When we can talk about depression, we open the door wide for those who are struggling to find the courage, hope, and community that really is out there for them. For me. For us.

I believe it can be better. I believe it starts with you and me, carrying on this conversation about the uncomfortable topics of depression and mental illness, through blog posts and social media and real-life conversations in coffee shops and work cubicles and homes. It starts with stark transparency and healthy vulnerability and bold humility.

The truth about depression is…it can get better. And it starts with us.

Thank you to my friend Kateland Pricer for graciously letting me use her photo! Katie created a set of photos that captures feelings I could never explain with words. Her email is K.pricer@yahoo.com. She is incredibly talented in the creative realm and just an all-around awesome person!

Navigating the Bumps in Life

One of my favorite things in the whole world is to ride on the back of a motorbike down the red dirt roads to the villages of Cambodia, between rice patties and trees and children and cows, the wind against my face and my eyes feasting on the landscape. This is the stuff of poetry.

And then there are the bumps.

After all, they are dirt roads. The small bumps make me slide forward in the seat little by little, until it’s finally time to get readjusted. Then there are the bigger bumps, the ones that make your body weight shift upward (like when you accidentally hit a pothole and fly up off your seat…except not quite that big)—and those are the ones you can use strategically. You can use the jostle to pop right back into position. Or you can ignore it and just stay really uncomfortable. If you ignore it long enough, I'm sure you could probably lose your balance (but don't worry, I've never done that on a motor bike!).

I’ve been thinking lately how there are a lot of bumps in life, and how I’m in the middle of one right now. There are bumps when we move, when we change careers, when we begin or end relationships. Sometimes we expect them, and sometimes we don’t. But in either case, we have the choice to use them strategically or to ignore them.

The thing about these bumps is that they don’t really have much to do with the horizontal direction you’re heading. You can be on your way anywhere: you can be on a straight stretch of road, you can be on a blind curve, or you can be approaching an intersection. They have to do with your positioning vertically—how you’re sitting on the bike that’s beneath you. How you relate to the thing that is always with you, no matter where you go.

I’m in the middle of a bump. I have the chance to evaluate how I’m relating to what's always with me—myself and Jesus.

Am I where I want to be with Jesus? Am I engaged in the kind of relationship for which He has made me? Am I delighting in Him, and am I believing He is delighting in me? Am I seeking Him, listening to Him, loving Him, obeying Him? Am I overwhelmed by His presence, His love?

And am I where I want to be as a person—am I mentally and emotionally and physically healthy? Am I forgiving and showing grace to myself? Am I anxious or depressed or buying into perfectionism? Am I taking care of myself?

Here I am, with the choice to inventory and let go of the things that are weighing me down, to reposition and make sure I am in the place I want to be with regards to my God and myself. In her book Packing Light, Allison Vesterfelt (one of my favorite blogged) writes,

“You have wants, desires, needs, and ideas. These are all things you ‘pack’ with you for your journey. You might not even know you’re carrying them, but they’re in there. You’re walking around with a heavy suitcase” (p. 252).

I want to use this bump strategically. I want to toss unnecessary baggage off the back of the motorbike, focus on and enjoy the thrill of adventuring with Jesus, and make sure I’m in good shape internally.

And when this bump is over—well, perhaps the best thing about bumps in the road is that they remind us that we can reposition at any time, really. We don’t have wait for a huge unsettling event in our lives to check our internal well-being and our relationship with the Lord. All it takes is a little intentionality and we can slide right back to where we’re supposed to be—or a little closer, at least.

We may not always have the choice of avoiding bumps in the road, but we do have the choice in how we respond to them. Wherever you are in life, I pray your bumps afford you the joy of repositioning and enjoying a fresh perspective of yourself, of your surroundings, and most of all, of the Lord.

What are some bumps you're facing in life right now?

Are you anticipating bumps on the upcoming road, or have you just come through a bumpy stretch?

How do you usually handle bumps?