Lessons for the Fully Ambulatory

I’ve been quiet for a little bit because in early January I finally learned what I had done to my knee playing ultimate frisbee last September — I tore my ACL. We went ahead with reconstructive surgery, which was done just over 3 weeks ago. I’ve been recuperating since then, and very slowly regaining a semblance of my normal everyday life.

It’s my habit to observe myself and my surroundings carefully, when entering a new situation. This one was no different; so today, some highlights from the past 6 weeks of observation … both internal and external.

1) We identify a lot with our bodies

In my unconscious I have long preferred to think of my physical body as something like “a 20-yr-old’s body that might just be a little rusty”. This is quite a delusion. And one that I’ve long told myself, to maintain my preferred self-concepts of youth, health, power, and ability. My identity has chosen (if you will) to clothe itself in those garments, and notice how very dependent they are on the physical body for validation.

But here I was confronted with my first real injury and my first real surgery. The effect was something like when a movie actor breaks the 3rd wall, and perhaps exposes not just the audience, but also the cameraman and the film crew and the entire soundstage apparatus, and the hollywood commercialism behind it too. Deconstruction, is the word.

I have long thought of “me” as this youthful, capable mix of flesh and mind. But this simple injury dispelled the illusion of such a tidy “me”, and drew my attention to how unrealistic and unfair the illusion was in the first place. In its place I have begun to accept much humbler facts:

  • I am just a human, no more and no less. My physical body is somehow part of the “me” that I know, but it is not the whole thing. More importantly it does not deserve the lion’s share of that constituency.
  • I am getting older, and one day far from now, I will definitely die. It is no use at all to fear the passage of time. It is even worse to deny it, and to ignore the wearing-out of my natural hardware.
  • If I want to set clear goals like “be able to play ultimate frisbee at age 50”, I will simply have to put in the work required for it, consistently, for a very long time. No amount of wishful thinking or delusion will help either way with that.
  • Some goals, such as “play ultimate at age 50” may turn out to be impractical. Initially such a thought fills me with dread. But, in the grand scheme of human history and the cosmos at large, it turns out this is not a huge loss.
  • There are still many ways to be a successful human, even without the ability to sprint, leap, change directions explosively, or squat 250lbs.

Such lessons might not be news at all to those who don’t take themselves so comically seriously; or, to those who aren’t as physically active as me; or, to those who have had much earlier histories of injury, illness, misfortune, and appropriate coping. But I don’t fit into any of those categories, so I am learning the above lessons at age 30.

More than anything, I think most of this comes down to a fear of death; not just any death, but the long slow decline of independence and vigor which leads to death that seems to characterize later life in western civilization. As youthful able-bodied people, we prefer not to grapple with the eventuality of that decline; instead we quietly imagine ourselves to be somehow immortal.

2) Our healthcare system is strange

This is the first time I’ve had to take full responsibility for any serious medical work. Even including the psychic shock described above, the very worst part of this whole experience was simply trying to find out how much the damn operation was going to cost us. And yes we’d like to know sooner than the day before surgery, please.

We’re well into the digital age but the right hand still doesn’t seem to know what the left hand is doing; everything is still processed manually, and might I add, with seemingly no urgency. I’m complaining just a bit about this, but I am a hyper-literate gainfully-employed member of the prestige class of our society who stood little chance of not being able to afford the estimated charges, even if they were high. But without those myriad advantages, what is this experience like? Say for a minority, single-mom with 2 kids working 50 hrs/wk?

The timing of all this makes me pay closer attention than ever to this election cycle’s discussion of our system. I wouldn’t go so far as to call it “broken”, but it certainly deserves some optimization.

3) Social pressure seems to be born from capability

I’ve been repeating the joke that if anyone wants a magical pause button from the conventions of yuppie life, he or she should have ACL surgery.

For a couple of weeks after the operation, I simply couldn’t do much at all:

  • couldn’t concentrate on much due to narcotics
  • couldn’t stay out long in public or with friends due to lack of energy
  • couldn’t exercise or have any adventures, due to an insufficient number of functional limbs

Instead, my existence has been: napping, consuming a lot of YouTube, doing rehab exercises, trying to maintain an adequate calorie intake, and trying to remain relatively positive in my moods.

Here’s the thing: everyone was really great about this whole thing. People asked how I was doing but didn’t pressure me to do anything at all. Thus the internal flow chart of social pressures shifted to something like this:

I can't do anything >> Therefore I don't have to >> Therefore I won't

When I looked at this again, I realized it is just a negative image of the pressures that most of us feel everyday. Here’s what I think that looks like:

I can do tons of things >> Therefore I should >> Therefore I will

In other words, I am suggest that most of the “shoulds” that we experience are based first on the fact that we can. You should have a nice house because you have the means and the taste to decorate it. You should be an informed voter because the information is at your fingertips. You should stay out late with your friends because you don’t have kids. You should wake up early and exercise because you’re young and healthy. There are probably better examples. You get the idea.

By contrast, the last few weeks I’ve been living the life of an elderly man. I can’t do any of those things right now. And so the internal chatter, the herd-pressures from the reptile brain, the endless charades of identity-formation and -preservation … all of that has gone quiet, for a few very rare weeks.

Last week I took the slowest effing walk through the park across from my office. Everybody and their toddlers were moving faster than me on the gravel track. What a bizarre experience. A preview of life at the age of 85, perhaps. But what a remarkable privilege — to be relieved for just a few weeks of my own expectation that I will be healthy, fast, strong, and ambitious. And of everyone else’s expectation as well.

There was no speed or exhilaration to be enjoyed there. All I had was the slow ground beneath, radiant clear sky above, and the blur of happy bodies moving past me.

… and it was plenty.

4) Gratitude as spirituality

Every single tiny milestone along this healing journey is a momentary cause for sincere thanksgiving and celebration. Removing the outer bandages. Activating the atrophied quadriceps again. Achieving tiny gains in my range of motion, degree by degree. Removing inner bandages. Going off painkillers entirely. Fighting my way back to full extension of the knee. Raising a straightened leg, unassisted, off the therapy table.

Three days ago I was cleared from my crutches, freed to walk again. Full ambulation is one of those thresholds that, much later in life, marks the divide between independent, and dependent living. As I said, I’ve been living life as an elderly man for the last few weeks. Gradually, I am becoming younger again.

It’s profound to get to give thanks for such things. How often is one ever prompted to lose the thing he has always taken for granted … and then to regain it? Not often. Most of the time in life, those sorts of things are lost for good.

5) Therapy is close to divinity

My physical therapist provides me with such powerful support and wisdom that she might as well be my savior. That’s a weird statement, but it seems about right to me. I would feel lost in this process of healing and rebuilding, without her help as a guide and a champion.

I tend to be pretty guarded. I go to fair lengths to avoid situations that might cause me to feel weak, vulnerable, or confused. But this injury and operation has struck (as you noticed) very close to the heart of my self-concept. In the wake of the surgery then, I’ve had no choice but to feel weak and vulnerable — it is a fact of my condition, empirically verifiable even.

But my PT, and indeed any therapist of any kind who is gifted for the job, steps gently into that fog of weakness and says happily “It is okay that you feel this way. It’s okay to be scared, or confused, or frustrated, or impatient. I know the way out of here. Let me show you that trail. I’m on your team.”

And so the experience of doing my rehab exercises, and asking questions, and getting feedback, and getting my stats re-checked, and hearing the latest news and instructions, and milestones, and overall hearing her excitement at my progress … it all manifests as a shared gratitude. As though we are rebuilding my body, and indeed my safety and my self, through a shared effort.

I can’t do more justice than that to it at the moment. But what I’m saying is, I am very grateful for my PT. And I think therapists do holy work.

 

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That’s plenty for today. I shall resume ye olde deconstruction topics soon enough.

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