Wednesday, August 3, 2011

Lesson of the Day: ENDINGS = BEGINNINGS

Back to my blog home page:

The theme today was endings, or it is... beginnings? I think it's both.

An absolutely stunning, petite woman was admitted for rehab just before I went on vacation. While I hoped that she would be well enough to go home before I returned to work, I was secretly pleased yesterday when I turned the corner at the nurses' station and set sight on Rita's serene smile.

She's bald and less than 85 pounds. Her baseline? Thick, black, luxurious hair and 110.

She's fighting her cancer with a vengeance. And she has four daughters doing battle alongside her. You could say, in fact, that at times, they are doing battle with her.

"Ma, maaaaa, take another bite! Just one more..."
"Ma, it's time for your exercise."

There have been moments in the process when her grip on the armor lessens, and I see fatigue. Fear. She has confided that her girls are afraid she is going to starve to death because of how the cancer affects her ability to eat and eliminate waste.

Rita is primarily concerned about her adult children: "What will they do? They have already given so much of their time and energy. They have their own lives to live. I'm afraid they will burn out."

Yesterday, she had a procedure done to drain fluid off her abdomen that set her back five paces. Her stomach pain throughout today was at times intense.

I spent a few extra minutes with her to provide a Reiki treatment, a Japanese technique for stress reduction and relaxation that also promotes healing. I knew this would allow her to relax and manage her pain more effectively.  I have integrated Reiki into my OT practice for years.

If you're curious, check out the International Center for Reiki Training.

In the middle of the treatment, she popped up for a moment, rolled from her back to her left side and picked up what looked like a thin, green pocketbook off her tray table. When she snapped it open, it was a photo album that her granddaughter had made for her, a complete collection of family photographs of her with kids and grandkids interspersed with Bible quotes .

She pointed out each family member, and then, her finger stopped on a gorgeous, sophisticated woman.

"This is me with hair."

I focused on this woman who I already felt was beautiful without hair.  I suddenly realized the severity of her loss. Literally, physically, emotionally. It was more, of course, than just about hair. 

"You know, Rita," I said, "has anyone told you how perfectly your head is shaped?" (It really is.)

She smiled. "Quite a few."

"Well," I said, "I think you look great with very little hair!"

And she replied, "I think I might keep it short...even though it is going to be gray now."

I told her about a friend of mine who did that in her late 40's, went gray. Quit coloring. She looked stunning.

I also told Rita that she is still the same Rita that had hair, that weighed a little more, that had the energy to cook for her big family. The same Rita. That Rita had not extinguished. She was still right here in my presence.

The crease between her eye brows deepened, and a tear welled up in her left eye.


An ending; a beginning.

Later that day, Eileen arrived. When I knocked on the door to introduce myself, an aide was guiding her out of the bathroom. As she pushed with a walker, I observed a bobbing and weaving pattern unlike the more characteristic symptom of Parkinson's Disease, the tremor.

During her evaluation, I had to concentrate deeply on 2 things. 

First, I had to focus on the movement of her lips to understand her, because her speech was barely audible.

Second, I had to follow her lips, as her head and upper body weaved back and forth rhythmically. The only time they stopped was when she took a deep breath. I was exhausted from concentrating by the end of our session, but this time with her was one of the highlights of my day.

Eileen was lovely!

As we tested strength, balance, and cognitive abilities, we made a list of all the activities she cherished the most. After all, as an occupational therapist, it's all about returning people to the highest level of function so they are able to engage in life!

A short time ago, Eileen had been walking 9 holes weekly with a ladies golfing group. "We can swing golf clubs during your balance retraining!" I told her. She had been a voracious reader, but macular degeneration had limited her sight, making her central vision blurry.

"Are you open to audio books?" I asked her.


"Perfect!" I'll bring the application tomorrow for the State Talking Book Library in Sacramento. You'll be going through a book a day in no time."

I explained to her that when we do OT, if a person cannot fully return to the activity they once loved, it is not lost forever. The activity may simply need to be modified.

Eileen paused for a moment during the evaluation. "Sometimes, I wake up in the morning ready to bounce right out of bed like I used to. I forget that I can't. I think it's time to load the clubs in the back of the car and take off.  Then, just getting out of bed is a reminder."

"Eileen, you are still the same woman who golfs with friends. You are the same woman who has helped so many children in your job. You are still the same person on the inside."

So many of my patients tell me stories like this. Someone with a stroke whose arm won't move will report that they dreamed they had full use of that hand or another will say he walked. It all feels so natural and "complete" in the dream state.

Some awaken dejected. Others are motivated by their dreams. Their reactions are usually consistent with their outlooks on life.

They will either see their current station in life as the end of the road, or they will shift through their former perceptions of what life was into a new and meaningful way of living . Living fully. Despite the obstacles.

Dr. Wayne Dyer wrote a small paperback called Living the Wisdom of the Tao. In it, he includes the 16th verse of the Tao Te Ching, part of which goes like this:

"...let your heart be at peace.
Amidst the rush of worldly comings and goings,
observe how endings become beginnings.
Things fluorish, each by each,
only to return to the Source...
to what is and what is to be. "

If a major illness or injury happened to you, would you choose to think your life was ending or beginning?

Endings = beginnings.

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