a snail's life

I get a 'word-a-day' email. Today's word was "argillaceous" meaning "made of, resembling, or relating to clay: clayey." Sometimes the word is interesting or useful, but the thing I love the most about this email is that there is also a "thought for the day." These thoughts are rarely related to the word of the day, but are generally more meaningful to me. A few days ago, the following was the "thought for the day:"

How can a society that exists on instant mashed potatoes, packaged cake mixes, frozen dinners, and instant cameras teach patience to its young? -Paul Sweeney

It's an interesting question. I am one of the young people about whom Mr. Sweeney ponders.

Though my family rarely ate frozen dinners or mashed potatoes, instant or otherwise, we ate at restaurants on a regular basis in order to avoid the trouble of cooking after a long day at work or because we had to rush off to some other obligation so quickly that the prep time required for a full meal would not accommodate our plans. We are not an impatient people (both my parents work with special needs populations), but we are instead a busy people.

Products or services that expedite a process, such as the packaged cake mixes, dining out, computers, commercial airlines, dishwashers, etc., rarely are utilized because the outcomes of the process are improved, rather because the quickening of the process allows for more and more processes to be added to one's day. It's not that we're necessarily impatient, rather that we have created an endlessly demanding lifestyle for ourselves. I firmly believe that lifestyle is chosen, not demanded. There are countless people who make it joyfully through each day without the hustle and bustle (many of the ones I know are economically poor. interesting.); however, most of us are addicted to the initial rush and ultimate numbness that results from frenzy. When I have a particularly full day, I don't have the time to consider the implications of any single component. I just keep going and going and going. It is the unfull and unscheduled day that I feel the emptiness of my life of busy pursuits. It is these days that I feel the regret of rushing through a patient's appointment, not listening to their sorrows, because three other patients were waiting. It is the slow day, that I feel restless and paranoid, like I've missed something, instead of blessed to have a few moments of peace. Perhaps a better question for Mr. Sweeney is "How can a society that exists on instant mashed potatoes, packaged cake mixes, frozen dinners, and instant cameras teach contentment to its young?"

I've found that it is very important for me to intentionally slow myself down, not to learn patience but to learn worth and tranquility. Without deceleration, I have no time to reflect upon what it is I do each day, and then I am but a robot performing my intended function. Time and disciplined relection are necessary for me to be human, to contemplate and feel intensely, and to judge how I should live.

"Old Age-itis"

I have a 96 year old patient who comes to see me every 2-4 weeks for manual therapy. She may be the feistiest patient I've ever cared for. Every time I inquire about why she came in this week, she says, "I have old-age-itis." She never give much information as to how this specifically manifests, so I have to investigate by palpation and further questioning. I'm not sure how much good I do for her, but she keeps coming back, and every time, I learn more and more about her life.

She's ruthlessly independent and very proud of it, as she and her husband (also 96) still live alone. Neither of them drive, so every Tuesday their baby girl (age 70) takes them to doctor's appointments, the barber, and out for a nice lunch. She refuses to let me help her move from the chair to the treatment table. She once told me that old people are like five year old's, they want to try it for themselves because no one believes they're capable.

She is as sharp as a tack, recalling the difficulties of the Depression and quickly criticizing the current state of the educational system. She proudly states that as this country goes down the tubes, she'll know how to live without electricity or running water because much of her life was spent under these circumstances. She's appalled that young cashiers at the supermarket can't do simple math and require the assistance of the register to determine the change she is due. And, having the wisdom that comes with age, she disciplines herself to not go down certain roads of conversation (politics in particular) as it will be fruitless and only work -up herself and everyone else in the room.

Obviously, this lady has made an impression on me. Most impressive is that I want her to teach my other patients what it is to take care of yourself despite the obstacles.

So many of the people I treat are chronic pain patients who have allowed their illness to define them. Instead of acting like a five year old, they submit to the low expectations of most medical professionals they interact with and refuse to take me up on ideas concerning critical components of self care, such as good nutrition, sleep, and especially, staying physically active. Like 96 year old patient using a walker, we all need some help in becoming healthier, be it a therapist or a workout buddy. Asking for help or taking the advise of a professional does not have to be a marker of personal deficiency. Rather, aquiring assistance helps us to recognize that refusal to pursue what is needed is the major barrier for improvement.

Additionally, many of chronic pain patients have related psychiatric issues, including depression or histories of abuse. Many are fully aware of activity, both physical and mental that compromise their state of mind, yet they have been unable to become the master of themselves. They are held captive to unhealthy patterns that are paralysing. I am fully aware that there are immovable external stressors such as poverty, lack of an educational foundation, physical disability, etc. However, we each are endowed with the free will to choose how we percieve and manuver within the external pressures of life. At 96, my patient doesn't see her near blindness and chronic illnesses as unconquerable obstacles of fully living each day, rather they are just part of the context that helps her to see the world for what it it: difficult, but not unbearable. cruel, but not without goodness. finite, but not without hope.

adventures in bicycling

A friend of mine is currently in Israel filming a documentary concerning the everyday lives of Israeli's and Palastinians amidst the ongoing conflict. As the three man crew are all avid cyclists, their only transportation across checkpoints and between town to town is bicycles. (http://www.epicpedal.org,%20www.epicpedal.blogspot.com/) The email update of their conversations with folks from both sides of the divide shows that though the physical journey is harrowing, it is nothing compared to the emotional whorlwind of hearing the life-journeys of enemy neighbors. Though he was not explicit on this point, I imagine the elements of cycling and listening reciprocally amplify the intensity of the experience. Lately, I've started to notice that there is something about riding a bicycle as a form of transportation that changes the way you live a day.

Since late April, I have traversed the 4 miles to and from work on my bike more days of the week than not. I only use my car on the weekend unless weather or scheduling does not permit. (This typically means rain, but lately, I've been thinking of adding expected highs of more than 105 degrees to the list.)

The impetus for this change of transport were many: save money by burning less fuel, get some exercise, and do a small thing to decrease the amount of waste and noxious stuff out their. In order to make this happen on a day to day basis, it requires some planning. I buy groceries for the entire week's breakfast and lunch on Saturday and store it in the office refrigerator. Also, I keep shower stuff in a locker at the campus gym so that I can shower before heading to the clinic to care for patients. More challenging is getting up a full hour before I normally would in order to get to the gym for a short workout and shower, and then pedaling home after an exceptionally exhausting day. Likewise, it's difficult to recover from mistakes such as forgetting socks (I've gone a few days without them) or to get home fast enough to clean up for a night out.

Some of the more interesting challenges come when rolling down the street. I've nearly been hit by people opening parked car doors. I've had a near collision with a walker who quickly manuvered in an attempt to avoid me in the same direction I steered to avoid her. The wind has been so strong at times that I've almost fallen over when riding up hill in 30+ mph gusts.

With all of these obstacles, I'm amazed that I saddle up every morning. However, I've noticed a change in me that makes these physical difficulties seem miniscule. For starters, biking creates a space to understand the relationship between physical effort and outcomes. Biking is a small way of seeing that muscles, lungs, and not simply my brain are important to participate in the provision of needs. Though technology and modern life has made many necessities readily avaliable at a moments notice, I'm not sure it's good for us. Humans for most of time have known what it is to wait on and tend to nature to create space for our presence, but in the US, with automobiles and corporate agriculture, we are able to separate labor from sustanance. Yes, we work to put food on a table, but in a knowledge society, I think we are missing out on a sort of intimacy with our daily bread that makes it easy to economically oppress others. Perhaps if we all had to bike to work we would sympathize a bit more with coffee growers in El Salvador, diamond extractors in Liberia, and the struggling farmers among us.

One's world becomes smaller on a bike, but also fuller. Essentially, biking slows and simplifies my life. The world of medical education mores extraordinarily fast. One of my best friends, weary in her studies, confessed that this life was too much for her, as her preferred pace of life was more consistent with watching the sprinkler shift in the backyard than running ragged to round on patients, then attend class, then meetings, then, then...etc. Perhaps there is a way that sprinkler watching or analagously mundane activities inform our experience of life. For me, 20 minutes of biking at dawn sets my expectations of the day. As long as I keep the wheels turning, then I'm moving. Sometimes there are downhills, when I coast, and sometimes there are hills I must push through. But, regardless, the speed I'm capable of on a bike allows me to see and experience the ride. Potholes rarely catch me off guard on a bike, nor do hills, and I'm able to drift in thought from casserole recipes to important conversations because the pace allows for it. In many ways, I've made my life to mimic this ride. I work only as hard as necessary in order to enjoy the experience rather than plow through every obstacle with the same rigor. Additionally, time has become both more and less important to me. Because biking takes longer, I have to plan to do certain things efficiently or not at all so that I can embrace the aspects of my life that have meaning to me. Prioritizing and expecting more from my experiences have changed the way I approach each day. There's little to be done about the demands from others, but we each can consciously choose to slow and simplify life.

Finally, biking makes me happy. The wind in my face is so much more refreshing than recycled air from a car AC. I love feeling strong and healthy. Local residence has begun to wave each morning as we pass each other along our way. And, lets face it, biking is "so in right now." It's novel and admired, and I think, along with my buddy in Isreal, that it can do a part in changing the way things are done for the better.