For you faithful readers of the Helen Hayes Hospital blog and for newer readers as well, let me begin by wishing you and your loved one’s a happy, safe and healthy year to come. My title at Helen Hayes is Principal Psychologist and I have been privileged to work with the patients and employees of the hospital for nearly 26 years. I thought that rather then writing about some topic in rehabilitation medicine, I would take the opportunity of being one of the first to post a blog on the HHH website in 2014. This is not some end of the year review, a Top 10 list or a list of the 10 Worst “whatevers” of 2013, but my ruminations about how the annual end-of-the-year self assessing and the inevitable New Year’s promises to change behavior for the positive, and the emotional and intellectual processes and strategies of those who require inpatient rehabilitation.
Forgive me for not being able to remember from whom I heard this, nor to whom it should be attributed. But, do you know the definition of minor surgery? It is any surgery performed on someone else.
By definition, when you are being admitted to an inpatient acute rehabilitation hospital, it is not likely that all in your life is going well. Patients are admitted to acute rehabilitation when medical issues make going home from the hospital unsafe and when receiving therapy will allow for a safe transition either home or to a longer term, less intensive therapeutic environment.
The quip above is relevant to our patients’ and staff from the perspective that we admit folks with a wide variety of diagnoses, ranging from planned or elective knee and hip replacement surgeries to femur, hip or pelvic fractures in the elderly, or from trauma, cardiac surgeries or respiratory disease. Some of our admissions are of patients with progressively debilitating diseases, like multiple sclerosis or ALS (Lou Gehrigs’ Disease). We admit patients who have had strokes, amputations, brain injuries and others who are paralyzed from spinal trauma or disease.
The majority of our patients leave rehabilitation more functional than when they arrived. A large number of patients will leave rehabilitation with permanent, severe disabilities that may improve a bit over time, but will leave them quite impaired and in need of assistance for the remainder of their lives. Unfortunately, some folks have suffered injuries so severe that rehabilitation is limited to family training and developing safe seating systems without making any substantive change in the patient.
So what is the perspective issue about? Broadly speaking, there are two competing and valid philosophies that people bring to their rehabilitation. I will call them, “No one can know my pain without walking in my shoes” and the other, “There but for the grace of God go I.”
Dax Cowart, a lawyer, husband and father is also the subject of a critical bioethics case. Once a Texas farmer, he was checking an oil pump on his property when it exploded, causing severe burns over 70% of his body. From the moment of his injury through his year of treatment in a burn unit, Cowart begged that he be allowed to die, that the treatments were too painful. Despite the odds, he survived, married, became an attorney and sued the doctors and hospital that disregarded his wishes to stop treatment. The judge in his case awarded Cowart the win, and in an opinion that has impacted the lives and care of many people, wrote that no man can know the pain of another or dictate what level of pain should be tolerable. This case serves as a reminder that whether pain comes from a surgically repaired fractured neck in a newly quadriplegic patient or from a surgically repaired ankle fracture, we can not dictate to what extent an individual will experience pain or suffering.
The competing thought, “There but for the grace of God Go I”, is an acknowledgment of good fortune, of gratitude if you will, that despite the pain being experienced, there is always the possibility that life could be worse. Indeed, many patients tell me that when they are doing their therapy and look around the therapy room, they see many others whose condition appears so much worse that they feel grateful to have what they have.
The experience of rehabilitation, of striving to recover lost function and ability, is influenced to varying degrees by early life experiences and the manner and extent to which a person has experienced, overcome and thrived despite the pain and suffering in their lives. One of the critical emotional and intellectual abilities that people must develop if they are to recover and live well is gratitude, a sense of thankfulness that whatever they are facing, that no matter the extent of the losses, that life can and still will be good. The more extreme the loss, the more challenging having a sense of gratitude can be. There are situations our patients, their families and frankly, our staff experience, situations so tragic, where reasons for gratitude are hard if not impossible to find. It is also not unusual to be in a situation in which one can know that there are reasons to feel gratitude, but that emotions, the grief and sadness of the present situation overwhelms what one knows intellectually. Gratitude and the capacity to look for and find the “silver lining” in a situation is one aspect of resilience.
Resilience is a psychological concept that describes an individual’s ability to bounce back from, to find a way to overcome challenges that they face. Every individual differs in degree of resilience and this seems to be a trait that we are born with. Over time, life challenges our resilience and when our ability to bounce back is overwhelmed, a variety of physical and emotional stress responses may occur, in essence creating symptoms that impair functioning. When illness or injury severe enough to require inpatient rehabilitation does occur, our resiliency is challenged. To enhance resiliency in the face of loss, there are strategies we use including education and training that returns a sense of competence and control; changing how and what we think about our selves and our future; learning to become aware of and manage emotions and emotional responses; develop new coping skills that are adaptive rather than self defeating or self destructive. When psychological symptoms interfere with recovery during rehabilitation, counseling or psychotherapy and medications may be necessary in order to allow the person to make use of their innate resiliency.
The truth is, illness, trauma and rehabilitation don’t take time off for the holiday season, the start of a new year, or any other time. The issues faced by patients, their families and the dedicated people who provide the medical rehabilitation don’t change from month to month or year to year. No matter how traumatized, how much pain or how permanent disability may be, perspective, gratitude and resilience must eventually be part of the recovery picture. We at Helen Hayes Hospital understand disability and we understand rehabilitation. We most definitely understand what our patients and their loved ones face. We want more than anything to see our patients’ become as well and as functional as they can become. Each day, we share our knowledge, our experience and our commitment to your rehabilitation with you. Your perspective, capacity for gratitude and resilience will provide the gas to make your recovery engine go.
I wish you all a happy and healthy 2014.
-Bruce Lowenstein, PsyD