Cane

In the clinic and around the hospital I carry with me a cane. The cane serves several purposes. Its main purpose is a way to nonverbally tell patients of my difficulties. I initially was resistant to the idea of using a cane, as I feared it would portray vulnerability to patients. I was also afraid that those who see me periodically might view it as a regression. Functionally, it serves to help me traverse the long walk especially in the hospital. And lastly, it helps my body sense its position in space (proprioception).

As I mentioned, I was initially hesitant about the idea of using a cane, but when my program director, as well as PM&R physician and Neurologist suggested it, I finally put aside my stubbornness and reconsidered my stance. Upon getting the cane, one of the first people I told was my residency family in an email titled ‘Cane’. You may sense from this excerpt of that email, my reluctance to use it: I hope you guys aren’t too thrown off by it- don’t be mistaken I don’t need the cane for mobility – I can get around without it. I wrote this in late March and have come to the realization since then that the cane does in fact serve all those purposes. Even though I was reluctant at first, I now realize that I need the cane and often use it as a crutch.

My walking stick
My walking stick

 

Yes, it works as a symbol for patients that ‘something is off’[1], but it also works to help me in physically maneuver around the clinic and hospital. What I didn’t realize were the countless other purposes it served. Firstly, I have a cane with an LED light on the end of it and pediatric patients are amazed when I turn it on. The light also serves as an “ice breaker” with many adult patients I see. These added perks of the cane are superficial though. I mentioned in earlier posts the issue of neck tremors or ‘titubation’ that still afflicts me to this day. For some reason, sitting and using the cane as a pseudo armrest prevents these episodes. Thus, when I am in a meeting where I anticipate I might suffer from an episode, I’ll often have the cane by my side to thwart any episodes. Other people in the room must wonder why doesn’t he just put the cane on the floor? Also, at first I thought it would only serve as a symbol to patients of my disability, but I now know that it not only serves as a marker for patients, but to anyone who happens to come across me, or see me trudging along. It has gotten to the point that if I anticipate meeting anyone new, I’ll take out the cane for that activity.

The idea of it as a ‘marker’ stemmed from the notion that if one second of my encounters with patients is taken up by questions about my condition, then that is time lost; my hope with the cane was to possibly bypass some of those questions. I’ve come to realize that the cane, even though an inanimate object, tells a story to anyone who sees it. While it may not paint the whole picture, it at the very least gives people a starting point for a story.

That made me think, even though my crutch is a visible one; we all have our own canes that we rely on for everything from nervousness to boredom. In thinking of myself prior to my surgery, I would often use my son in any social situation I deemed awkward; I would also use music to alleviate emotions like anger, sadness, or boredom. But in thinking about this piece, I’ve realized that these are all forms of a ‘crutch’ and that we all have metaphorical canes that we rely on. Many of us would deny these crutches in our lives. Now, I am not telling you that use of these ‘crutches’ is negative or advocate that you should stop using them. (You use it for a reason, and there are, without a doubt, many unintended benefits to using them). What I am asking is that you recognize that everyone has these crutches. Simply acknowledging that they exist will increase your empathy and encourage tolerance of others.

[1] I’ll often notice when I meet a patient for the first time that their eyes immediately focus on the cane.

Time

To some, time represents a variable—one that can factor into an equation; Einstein famously conquered time in his Theory of Relativity, deducing time to a mere number that could be changed. We as a society are obsessed with the concept of time: one needs to look no further than the library or cinema to find scores of entertainment surrounding this topic (think of the novel 1984, or the Back to the Future movies). In fact, Nostradamus was made famous because of his perceived ability to break the laws of time and foretell the future. There is actually an entire industry devoted to this ability to ignore time to see into the future (i.e. psychics).

Whether or not you believe in people’s ability to see into future, time has been a key factor in my recovery and plays a role in everyone’s lives.

Clock

When I was in the hospital my physician told me, “Chris, you will recover, but you have to be patient, it will take time.” I realize now the truth behind his words. While therapy along with cognitive strengthening plays a vital role in my recovery, completing these serves to lessen the time spent ‘recovering’. Hidden amidst these aids to recovery is the secret variable of time. Now in my recovery, there were (and are) times when I would hang onto and rely on this intangible idea as an excuse not to participate in therapy or cognitive exercises; part of me is very rational using only scientific data to guide my decisions; yet another part of me is guided by instinct or ‘gut decisions’. The reason I tell you this is that my rationale for skipping a workout or therapy appointment exposes these two sides of my thinking: my ‘gut’ tells me that I’d improve regardless of the therapy and that time is all I need to recover; but luckily my rational side chimes in and tells me that time is only one underlying factor in my recovery—therapy and strengthening are also crucial to the process. Thus if you think about it like a mathematical equation, it would be something like this: therapy + cognitive strengthening + time = recovery. Every factor is vital to this equation: if you only relied on time to recover (ignoring therapy and cognitive exercises), then you would not get your desired outcome.

But this piece is not titled ‘Therapy’ or ‘Cognition,’ it is titled ‘Time’ because I want to discuss the role that it continues to play in my recovery. I hope you come to the realization in reading this that we all can learn lessons that time teaches us. A great man once told me that “yes, you can come to grips with the fact that time is key to this process, but what people sometimes don’t realize is that you have to give time time.” Sometimes we do not have patience to wait for time to take effect; when this happens our equation is incomplete and we cannot achieve our desired result.

If we’ve decided that time is one of the key variable in our equations, sitting passively on our hands and letting time pass only acknowledges one of the factors in our ‘equation’ while ignoring the others. All of the variables must work together for the equation to work. But in writing this, I know that the factor of time is often overlooked, making us frustrated when we do not get what we want. Just remember that it may take time, and that sometimes you have to wait for time.

Legacy

We all think about what mark, if any, we will leave behind. The simple, straight-forward approach is to think what will be said about me at my funeral? Will everything said during my eulogy be true and honest? I call this the ‘simple’ approach because it’s an easy way to think about the legacy you’ve left behind. The harder (and more exhaustive) way to think about this is to analyze and ask yourself if you’ve lived every moment of your life, treated everyone as if no one is watching. I bring this up because I have come to realize, through my condition, that I hope to be remembered for the kindness I showed others. I have always lived my life according to the Golden Rule[1], but since this tumor resection, I have come to two realizations: 1. without the compassion and empathy I try to bestow on others, my recovery from and coping with my newfound condition would be drastically and negatively different. And 2. My condition has allowed me to see the amazing and beautiful true nature of my fellow man. These two ideas are not exclusive, in fact they are intertwined.

golden-rule

I have always strived to show others true compassion and empathy. I suppose my entrance into medicine was an extension of this ideal; a way to hone and polish these traits. My 30 years on this Earth, before this ordeal, were devoted to this ideal. Little did I know that in an attempt to achieve this I was actually preparing myself for the struggles that lay ahead. The reason I say that my compassion and empathy have been crucial to my recovery, and furthermore that this condition has put the kindness of others on display, is that this compassion towards others has allowed me to appreciate the kindness that others have shown to me. It’s like appreciating a beautiful piece of art: anyone can be mesmerized by a captivating painting, but the person who has studied that painting, the artist, and the story behind the piece of art will appreciate it more. My life has been devoted to this ‘art’, in fact I chose a profession where this ‘art’ can be studied further. My point is that now the proverbial tables have been turned and the empathy and compassion I have worked tirelessly to portray to others is now shown to me; I firmly believe that had I not been so attuned to this trait, my appreciation of it would be diminished.

I understand that there is a difference between pity and empathy; I also understand that while much of this ‘kindness’ from others is actually rooted in pity rather than empathy, this only represents a small portion of these kind acts.

3_7_Legacy

Thus, I return to my original point and the title of this piece: legacy. I have had long conversations with my stepfather surrounding the idea of reincarnation. His response struck me. “Yes, I believe in reincarnation. By touching your life, my spirit lives on in you, and anyone else’s life I affected. So even after I die, my spirit lives on through you, your kids, and your kid’s kids. So in that sense my soul lives on after I die, and so yes, according to that definition, I do believe in reincarnation.” I once mentioned that meeting with old friends who knew me before the discovery of my tumor gave me great angst. But I’ve since come to realize that what my stepfather said is correct: your actions and ultimately your soul lives on through the lives you touch. Now even though part of me is anxious at the thought of seeing friends that I haven’t seen since my surgery, I leave our visit being grateful that this person knew me before my affliction. When I meet new people, I can’t help but remember that this person did not know me before the surgery and thus has no memory of the person I was; thankfully in the former scenario, this person knew me both before and after the surgery and thus doesn’t make any incorrect assumptions about me; at my funeral I wouldn’t want it to be said about me: “Chris, a disabled man, was a kind, loving person.” Instead I hope it is said that, “Chris, who I knew before his surgery during his tennis playing days, lived a life of empathy and compassion.” What do you want said at your funeral? What do you want your legacy to be?

[1] http://www.wisegeek.orgt/what-is-the-golden-rule.htm#didyouknowout

Thinking Ahead

In my current state I have found myself constantly, almost obsessively, contemplating different aspects of a future visit that I had not thought about before. For example, I now always consider the physical entrance and exit to any locale I am headed. I am concerned with details and wonder, “Are there railings there? Are there steps at leading to the house? Where is the bathroom in the residence? How many people will be there? Do I know anyone that will be there?” These are just a few of the thoughts that race through my mind before I even step foot at my destination. Earlier this year, my thoughtful wife surprised me with tickets to a show by one of my favorite comedians Aziz Ansari. Even though I absolutely loved the show and found his performance extremely funny, getting to our seats was my nightmare scenario: we had to park very far away and had to traverse uneven terrain to get there. It was a sold out show with thousands of people attending. To make matters worse, our seats were in the top row of a large theater, and getting to our seats meant ascending up many flights of stairs. Stairs, as long as they have railings, are no problem for me; the trouble was that for these stairs there were no grab rails. Thus I had to go unsteadily and unsupported up multiple flights of stairs. Because we were late and everyone was already seated, I was contemplating having to grab onto one of the unsuspecting audience members in the event I had to steady myself or prevent a fall. Luckily, I made it up the stairs without falling, and we were able to enjoy the show. After the show we were able to find a stairway with railings, thus leaving the show, while still slow, was much easier. Now I tell you this, not because I simply want to recap for you a difficult situation I had to endure, but because I feel it highlights an important point: thinking ahead is very important and a skill that is vital to everyone, not only to those stricken with a brain tumor.

think ahead

If you examine any craft, whether it be music, art, or business, those with success in their craft have an uncanny ability to think ahead. For example, a novice chess player may think 1 or 2 moves ahead; however someone proficient at the game may think between 3-5 moves in advance;[1] a grand master could possibly for see up to 8 moves in the future; the top chess players in the world are known to sometimes map out entire games in their heads before the first move is made. It doesn’t take a statistician to see the trend here: increasing proficiency is directly correlated with how many moves ahead one can predict. This philosophy goes beyond the game of chess. The ability to think ahead leads to success in all fields. In medicine this is especially pertinent, as your physician often has your management plan mapped out in his or her head before even seeing you: okay, this is this patient’s second visit for back pain. Since we’ve tried some NSAIDs (non-steroidal anti-inflammatories), I think it’s time to begin trying some physical therapy. I’ll make sure there are no red flag symptoms[2] and prescribe physical therapy. They might push you for imaging (i.e. x-ray, computed tomography, magnetic resonance imaging), but there is no need for this yet. Imaging now would only result in exposing the patient to unnecessary radiation and increase health care spending. They might also push you for stronger pain relieving medications (i.e. opioids) but unless the pain seems almost unbearable there is no need to prescribe this. Remind them that these medications can have adverse effects, including death. This is not an uncommon thought that runs through a physician’s head before seeing the patient. Like with chess, thinking ahead is vital to the success of any clinician; a more proficient physician will have the ability to remain many steps ahead of the patient. In sports, fans almost believe the player to be prophetic in the amazing plays: does Roger Federer know that if he serves in a particular spot that his opponent will return the serve in this area, at which point he’ll run around his backhand to hit a forehand to win the point? How far ahead does he have the point mapped out?

The point here is that whether we like it or not, we should constantly be pushing ourselves to think further and further ahead. I believe that even in our daily lives the more we can think ahead, the more success we’ll have. For me this means plotting an entrance and exit strategy, for you this may mean planning out your shopping trip to maximize your efficiency.

[1] http://www.angelfire.com/nf/chess/Thought.html

[2] See my earlier post for a definition of red flag symptoms