Sunday, June 30, 2013

Knitting a Blanket for my Daughter

I’m working on another knitted blanket for my daughter. I made her one before she was born, which she loves and uses daily. I hadn’t really intended to make her another blanket, but she saw me starting this one, and she asked who it was for. “Who do you think it should be for?” I asked her. “Me!” she said. “Should I make it for your birthday?” I asked her. “Yes, it can be my present!” she tells me. I did actually have someone else in mind when I started the blanket, but that’s okay. I guess this one is for her now.

I do try to knit her something for her birthday and for Christmas, but so far I’ve made toys. Her first Christmas it was a simple stuffed bear. Her first birthday I made a platypus, which I still think is one of the coolest things I have made. Her second Christmas I made a stuffed toy dog which hasn’t been a big favorite, but perhaps she’ll grow to love him more eventually. For her second birthday I made a reversible turtle/frog toy that was absolutely delightful to make and which I actually made a second of for another friend’s child, because it was so much fun. And last Christmas I made her a reversible doll, which lately has become more interesting for her. I had planned to knit another toy for this birthday, but it appears she wants a blanket instead.

It’s interesting, knitting something for her now that she has some input into the gift. One thing that is different is that I am actually knitting in front of her now. Up until a few months ago she would get into my yarn and make a mess if I tried to work when she was awake, so I saved my knitting for after bedtime. Now she’s able to either play with something on her own or, if she wants to sit with me, respect the limit I set about not pulling on the yarn. I have to admit that I’m pleased she’s so interested. “You knitting it?” she asks me. “With the knitting needles?” I tell her “Yes, I’m knitting with the knitting needles.” We talk about some of my other tools too, the scissors and the row counter and the yarn itself. She looks the yarn and looks at me and asks “I knitting it? With my yarn?” and I smile. I definitely want to teach her to knit, although at 2 months shy of three years old I know she isn’t ready yet. The fine motor coordination just isn’t there and won’t be for several years. “When you’re bigger,” I tell her, “I will teach you to knit with your very own yarn.”

She has an opinion on how the blanket should look now, too. I am working in the log cabin style, which means I work a block in a color and then pick up stitches along the edge of the block in a new color, working in a new direction, to create the next patch. There are different ways to do this; you can be very mathematical and precise to make a very structured looking design, but with this blanket I am just having fun creating different size patches of bold colors. I was thinking summer when I was putting the yarn colors together so I have plenty of yellow and orange and turquoise and pink, bright colors that make me think of days on the beach. But as my daughter is watching me she’s suggesting “put more green in it” and “put more pink in it.” She clearly has her own sensibilities and style.

She’s also quite impatient. Even a small blanket takes quite a while to knit. After all, if I knit 120 stitches across 240 rows (which, depending on the thickness of the yarn and the size of the needles, will come out to about a 30 by 30 inch square), that’s over 28 thousand stitches. It just doesn’t come together all that fast. But yesterday while I was working she asked me every 5-10 minutes if I was done yet, very much like a child on a car trip asking “are we there yet?” It reminds me how different time seemed to me when I was a child, how each day stretched on and a month seemed like forever to wait for something. Now as an adult my time just flies by, regardless of the amount of fun involved. It feels like my baby has turned into a little girl overnight. So I’m grateful for quiet moments to knit when I can find them; moments that allow me to see my daughter in this fleeting moment while she is crossing the threshold to childhood, dragging a hand knit blanket behind her.

Tuesday, June 25, 2013


I was driving home late from work yesterday feeling really defeated, overwhelmed, and discouraged. I’ve been coping with some really difficult situations at work and lately it feels like the hits just keep coming. I had spent over 90 minutes seeking counsel from a wise and trusted mentor and still felt like I just couldn’t see a way to make things better. And then, while I was driving, it hit me. A solution just clicked into place and I had it. I ran it over in my mind a couple times, trying to check all the angles, and it seemed good. More, it felt right. It felt right in a deep, solid way that I trust, a feeling like two pieces locking into place somewhere behind my heart. So I called my mentor back that evening and checked it with her, and she thought it might be workable too. So then I pitched it to my immediate supervisor today and she is also tentatively in favor. It’s a really different approach but I think I might actually be able to make this happen, which would be a really, really good thing. Not just from my personal perspective, but I actually think this would be a much better solution for my entire department to accomplish a couple tasks in a more efficient, effective way.

What I’ve learned over time is that my intuition shows up in those deep body feelings. For me, intuition is a solid sense of rightness and surety that is actually a physical sensation in my chest when something is right, or, sometimes, a deep sense of “yucky” that feels a little sick to my stomach when something is really wrong. I don’t get those feelings very often, maybe 4-5 times total over my life, but when I have them I’ve learned to pay attention because they’ve always been right. I wonder what feelings other people have; I suspect it’s probably different. One of the best explanations of intuition I’ve read is that intuition is your mind coming up with an answer outside the system of logical processing we rely on so heavily in American culture. Which I think is really interesting when I put it together with some of the reading I’ve done on mindfulness and brain function. There is some research that shows that cognition (thinking) is actually a whole body function, not just a brain function. Our sense of interoception (our perception of the internal state of our bodies) plays a huge role in how we perceive external events and thus in how we assess our surroundings and make choices. And it is well established in psychiatric circles that our implicit memory (the memories that don’t feel like memories, like memories of how you do things or deeply internalized experiences) profoundly influences our current perceptions and experiences.

Which is not to say that you should prioritize either intuition or logic over the other. You notice in my flash of insight about my work situation I ran the intuitive solution through a more logical analysis to check it, and then checked it against a couple other people I trusted who were also familiar with the problem. Because intuition is happening at a biological level that underlies our rational logical cognition, and because it is influenced so strongly by implicit memory, it can lead us astray. It is particularly likely to lead us astray when current circumstances resemble an old and painful situation that we haven’t managed to resolve. But logic can also lead you astray, particularly if you ignore the deep body sensations that can be the way the less verbal part of your mind communicates. If there is a conflict between intuition and logic, that’s a signal to go searching for more data. Something is causing the mismatch and seeking that missing piece of information can save you a mistake. When intuition and logic line up though, when you have both your logical mind and your deep unconscious body memory telling you the same thing, then you have an answer worth pursuing.

Saturday, June 22, 2013

Graduation Banquet

I attended the graduation banquet for the psychiatry residents last night. My husband and I hired a babysitter, got dressed up (very unusual for us), and drove across town in order to attend. I don’t know if these banquets are traditional everywhere but they are a staple of the two programs where I have been as a student and as a teacher. Typically they are held at a nice restaurant and there is an after dinner program of speeches recognizing the graduating residents, roasts and silly skits, and awards of varying types. The event is a little on the dull side, typically, but pleasant. I wanted to attend this year because the graduating class of residents includes one of the residents with whom I worked closely. I also wanted to go because this is the same program I graduated from years ago.

The event made an interesting juxtaposition to the rest of my day, which had been filled with work related stressors. I had been called in from a day off after the people I supervised engaged in a massive and unprofessional argument over who was doing more work on the service. While I was in the office dealing with them, (on my day off, remember) which was upsetting enough, I was tagged by the most senior person in our department for a necessary but very unpleasant and work intensive task. Which is due by the end of next week. On top of a few other stressful circumstances at work, plus my usual duties, it was the kind of day that makes me wonder why I’m working at this place. Especially after another colleague this week told me about his wife’s new job as a psychiatrist in a different local facility, which will pay her about $30,000 more than I make per year and involves less call and no administrative or other “extra” duties beyond seeing patients, and only 10-12 patients a day at that. Listening to him, I have to confess I felt insanely jealous of her. More money for less stress sounds awfully good some days.

The banquet reminded me why I keep hanging in there with my current job despite all the stresses and frustrations. I love teaching the residents. It is my favorite part of what I do, even beyond seeing patients (which is my second favorite part, and a close second at that). I love working with them one on one, in small groups and in larger groups for lectures. I love both the informal mentoring and the formal teaching. I love working with psychiatry residents and with the family medicine residents. I was surprised and delighted when one of the psychiatry resident groups gave me an award for my work with them; it feels really good to know that the teaching that means so much to me means a lot to them too. I love the sense of continuity that I get from teaching, the sense that lessons that were shared with me are being shared again down the line. Hopefully some of these doctors will become teachers in their turn as well. One of the speakers talked about the family and community of the program and I prize that sense of being part of something bigger, something that reaches backward and forward and equips young doctors to be of service to people in need.

Friday, June 21, 2013

Despair and Hope

I skimmed through the news this morning. I don’t usually read the news, although I generally feel guilty about it. Echoes of my high school civics and history teachers sound in my head, telling me I have to know what’s going on in the world. But I usually don’t have time in the morning to sit and read the paper (yes, we actually get a newspaper) and for some reason I can’t pick up NPR on my radio without an extremely annoying amount of static. I do have news apps on my phone, but somehow during the day I never get around to checking them and then in the evening I’m focused on family time and then a little bit of writing before bedtime. I also end up finding the news rather upsetting most of the time. There’s only so much bad news I can take some days.

This morning’s news was a great example – the “shocking report” of the day from Huff Post was that the World Health Organization had published a study showing that over 1:3 women worldwide will experience physical or sexual violence in their lifetime. Most of this violence occurs at the hands of an intimate partner. What is really bad about this is that this is not “shocking” at all. 1:3 is the same statistic I found 20 years ago when I researched domestic violence for a high school speech. So really what this report is saying is that we’ve made absolutely no progress in 20 years on women being subjected to violence. That’s discouraging, to say the least. Appalling might be a more accurate word.

Last night though, I was reading an email essay from Jim Wallis at Sojornours. Mr. Wallis is a Christian activist who leads Sojourners, a social justice organization based on Christian Principles. Mr. Wallis’s essay last night was talking about cynicism – the belief that things are so bad in our country they can’t get better, the thought process that says that there is nothing that I can do so why even try, why not just make my own life as secure as possible. Mr. Wallis suggests that cynicism like this is dangerous because it blocks personal commitment to change, which is the only thing that can create change. And he offered a corrective – faith. Faith is a very Christian virtue, and biblically (Hebrews 11:1) is “the substance of things hoped for, the evidence of things not seen.” Essentially, faith empowers us to act in hope; hope that things can change and that we can make a difference. Another way to say this might be trust.

This strikes a cord with me because when I’m working with patients despair is often a real and palpable presence. I often see people who have had so much pain and suffering in their lives that they no longer believe anything will truly help them. They have no hope or trust left in themselves or in the world. My job becomes one of addressing despair and engaging them in trust and hope before we can get started with anything else to help them heal. I will sometimes tell someone directly – I know you don’t have hope right now. That’s okay. I will carry the burden of being hopeful for right now, until you are able.  And even though as I write it I recognize how odd that looks and sounds, it is a pretty accurate description of what is going on, and it does help.

When I’m working with patients, I choose to have hope. I hope that they will get better. I hope that my saying to someone who is or has been abused “it’s not okay for this person to treat you that way. No one is allowed to treat anyone that way, no matter what.” makes a difference. And hope is something I choose for my personal life, too. I choose to hope that if I keep signing petitions, keep writing about things that matter to me, keep working and giving to help others that this world will improve. I hope someday I can read the news and smile.

Tuesday, June 18, 2013

Movie Week

We’ve been spending a lot of time these past few days on the couch, watching TV as a family. I don’t typically advocate lots of TV time for young children, although I don’t ban it from my house. I agree that getting my almost three year old out and about, encouraging her creativity, and generally keeping her physically and mentally active is much more desirable than television shows. Unfortunately, we’ve all been under the weather this week. My daughter had Roseola, which is a viral infection characterized by a high fever and then a rash. I seem to have picked up some kind of garden variety cold which is mostly resolved but still dragging me down. And my husband, who is typically the healthiest one in the family, is battling an infected toe with warm soaks and bandages. So quiet time on the couch in front of the TV has been very appealing this week.

I have to confess, I really like watching TV with my daughter. First of all, when she’s watching TV, particularly when she’s not feeling good, she’s actually cuddly. She’ll snuggle up to me and let me hold her for extended periods. Which is a bit of a rare treat. My daughter is many things- inquisitive, intelligent, adventurous, creative, affectionate – but she is not a sit still and cuddle kind of kid. I am a cuddly kind of Mommy, but snuggles are not the kind of thing that I can (or want to) force. So I have to take advantage of the cuddles where I can find them.

Second, I still really enjoy kids movies. Most of the movies we own that are kid appropriate predate my daughter’s birth and actually belong to me. Hey, I admit it – I still love Disney cartoons (and also Pixar, now owned by Disney, and DreamWorks). I like the playfulness, the color, the escape from reality and the happy endings. I also think that keeping movies kid friendly by placing limits on violence, sex and language forces better story telling. The writers have to use actual narrative to keep the movie engaging. I particularly love old fairy tales, which are among the first things I can remember reading for myself as a child. I know the animation studios sanitize them, sometimes beyond recognition, but that’s ok. I know the original stories and I can read them whenever I want. Part of the charm is seeing what new twist can be placed on an old classic. So I am okay with her movie selections. I don't even mind watching the same things over and over again, at least not much.

Third, I am taking joy in sharing my old favorites with my daughter. Her favorite movies are The Muppet Movie (a 1979 film that tells the story of how the muppets got together to create the muppet show) and The Muppets (a 2011 film about a muppets reunion in an effort to save their studio from a greedy oil baron). I adored The Muppet Movie as a child, and watched it over and over, just as my daughter does now. So I really get a kick out of hearing her talk about Kermit, Fozzie, and Gonzo and reciting lines from the movie. We introduced her to Cinderella recently, which was another childhood favorite, and it went over really well too. Some movies are still too old for her (she is not quite three and so of course is still easily scared by some things – sharks, kids getting separated from their parents) but I am looking forward to sharing more and more of my own favorites with her as she gets older.

Fourth, I love popcorn, and nothing goes better with a movie than popcorn. I have many memories of watching movies with my parents and sister (these were special occasions when Mary Poppins came on TV once a year or so, since we didn’t have a VCR until I was 7 or 8) with a large bowl of popcorn shared among us. Happily for me my daughter also shares my love of this salty treat, and so our cuddles are made even better by sharing a bowl of crunchy goodness. We do make the low fat microwave version instead of the oil popped over the stove kind I remember from childhood (faster, easier, less mess, less fat) but otherwise I feel like I am recreating a family tradition for her.

Hopefully by the weekend we will all be back to good health and we can go back to our usual policy of limited TV and high levels of activity. I know that it in the long run it is healthier for all of us to be off the couch. In the meantime, however,  please pass the popcorn.

Saturday, June 15, 2013

Finding the Right Therapist for Mental Health Problems

How do you choose a psychotherapist who is right for you? It’s an important question. If you are spending time, energy and money to make major changes in your approach to life then you want the right person to help you. Psychotherapy is a major personal investment, and research demonstrates that the relationship between the patient and the therapist is the single most important factor in recovery. But most of us realize there are thousands of therapists out there. Finding the right one can seem overwhelming, especially when you are already feeling unwell. Here are some simple ideas to get you started.

Consider if you plan to work through your insurance company or pay out of pocket for your therapy. Many good therapists take insurance but there are others who will ask you to pay them directly and then seek reimbursement from your insurance company on your own. Your insurance company may have a directory of therapists they work with, which is a good place to start. Larger clinics with many therapists will usually take many kinds of insurance, so these can be good resources if there are any in your area. Online directories (here are a few:;; are other referral resources that can provide basic information about therapists in your area. You may even be able to find feedback from other patients by looking online, although any online griping should be taken with a grain of salt.

Look for a therapist who is convenient to where you live and your working hours or other time commitments. Most psychotherapy will need to take place weekly, or at least every two weeks. Don't add stress over the difficulty of getting to your appointments to your current problems.
If you live near a university with a teaching hospital they may have clinics available in which you can see therapists in training. This is often a very good way to find a therapist. Often you will pay a reduced or sliding scale fee. Trainees are well advanced in their education by the time they see patients, are under close supervision by an experienced therapist (so that you get two therapists thinking about your problems, not just one), will be up to date on all of the latest information in their field, and usually bring excellent energy and dedication to their work with you.

Find a therapist with an appropriate educational background. Typical degrees for a therapist are in social work (MSW with qualification as LCSW), psychology (PsyD or PhD), counseling (LPC) or medicine (DO or MD with training in psychiatry). After the basic schooling therapists also have to serve an internship or residency under an experienced supervisor and must also pass licensing exams. Your therapist should be ready, willing and able to discuss his or her educational background and training with you and should have appropriate licensure documents posted in his or her office. It is important to note that many medical doctors who practice mental health care (called psychiatrists) are not well trained in therapy. The few who are often emphasize that training and tend to be very good, but do not assume that every psychiatrist will provide psychotherapy.

Talk to a prospective therapist about their experiences in practice. Many therapists will specialize in an area such as family therapy or posttraumatic stress disorder therapy. Obviously you would want to choose someone whose experience matches the challenges you are facing. Sometimes you can find this information online but it is usually good to speak directly to your prospective therapist about the types of problems they work with. Also discuss with a prospective therapist if he or she has a particular approach to psychotherapy. There are many different types of psychotherapy available. Some therapists are skilled at multiple approaches but other therapists specialize.

Arrange an initial consultation, and approach it as an interview. You and the therapist should both be learning about each other and deciding if you can work well together. The therapist will need to learn about who you are as a person and the circumstances of your life in addition to the current difficulties for which you are seeking help. The therapist should ask you questions but should also spend much of the interview time listening to you. You need to learn if the therapist listens well, appears knowledgeable, is caring and patient, and is someone you are comfortable speaking with about very personal matters. If you don’t feel comfortable with a therapist than no matter how well credentialed they are, this is not the right therapist for you. Choose someone else on your list and arrange another initial consultation.

The therapist should also be focused on you and your problems. Beyond answering reasonable questions about their training and experience, a good therapist will not talk too much about himself or herself. And anything a therapist does say that is personal should be brief and directly relevant to your problems and treatment – for example, giving parenting suggestions based on their own experiences. A therapist who freely shares many personal details and experiences is probably going to be more focused on his or her own issues than yours, and should be avoided.

Another option for psychotherapy is to use book based or online psychotherapy. These types of therapy are not as well studied at this point as working with a trained therapist and don’t allow you to develop that all-important relationship. On the other hand, they are often much cheaper and more readily accessible. There are many good books available for many types of problems. It is usually best to get a workbook, something that requires you to reflect on what you’re reading and attempt to apply it to your life. The series “Treatments that Work” from Oxford University Press has many different manuals that systematically take you through overcoming problems like insomnia, depression, and different types of anxiety disorders. You can also combine these approaches; working in person with a therapist to review and discuss the material in your workbook can help you learn faster. A good therapist can also gently point out your blind spots and keep you from missing or misapplying important points in the workbook.

An important note: If you are attempting to work through your difficulties using a book and are not seeing real and significant progress within 2-3 weeks then I suggest seeking a therapist. If at any time you feel suicidal, you should not be trying to work through your problems on your own. Seek help through an emergency department or the national suicide hotline (1-800-273-TALK) immediately.

So, to summarize – use your insurance company’s information or online resources to locate some possible qualified therapists. Pre-screen the information by looking at factors such as educational background, experience and feedback. Consider the first visit as an interview and if you don’t feel the therapist is a good match, keep looking!

Thursday, June 13, 2013

Timeline of Recovery from A Trimalleolar Ankle Fracture

When I broke my left ankle in three places last January, I did plenty of internet research. Like all good nerds, when faced with a new and frightening situation my default mode is to gather information. I found plenty of excellent information, particularly from the American College of Orthopedic Surgeons. But what I couldn’t find, and rather desperately wanted, was a sense of what to expect at what time during my recovery. Instead I found plenty of people writing about how they still limped years later or otherwise had problems. I did find one very upbeat, positive writer from Hawai’i  who talked about completely recovering over an 18 - 24 month period, which is what my orthopedic surgeon had said to me during the first visit. But I wanted dates, times, milestones – some kind of map for this new and unexpected journey. I never found one, so I am writing one now.

Acute Injury and Surgical Repair

26 Jan 2013: My husband and I decided to go ice-skating for our date night. It seemed both wholesome and romantic. I had visions of us gliding around the ice hand in hand. In reality I was on the ice for less than 5 minutes when I fell, badly, and was unable to stand up again. I don’t recall the actual injury much and I wasn’t in extreme pain afterwards, although I knew I couldn’t stand on my left ankle. My husband helped me hop to the car and off to urgent care we went. I was honestly quite surprised when the doctor told me my ankle was badly broken. The nurse splinted it up for me and they sent me home with crutches, painkillers and a referral to orthopedics for Monday morning. I iced it and went to bed.

28 Jan 2013: My first orthopedic appointment. My ankle was too badly swollen at this point for the doctor to operate, so she set it back in alignment in the office (ouch, ouch, ouch) and splinted it a little more thoroughly and sent me home to elevate and ice for the next week to get the swelling down. I was told not to put any weight on the ankle for at least 6 weeks after surgery and believe me, I had absolutely no desire to do so. My husband and I decided to buy a knee scooter from Amazon (our insurance didn’t cover one, although it covered everything else) because I felt very unsteady on the crutches. I started writing online for something to do while I was stuck on the couch.

31 Jan 2013: The knee scooter arrived! I could now get around our one story apartment relatively easily, which was a huge relief. We taught our two year old daughter not to touch Mommy’s “boo boo foot.”

4 Feb 2013: I had surgery to repair the fracture, which required a screw on the tibia (bone on the inside) of my ankle and a plate and multiple screws across the fibula (bone on the outside, which was cracked clean through and misaligned). My doctor resplinted me after the surgery and sent me home. I had the surgery under general anesthesia which I would not recommend; I was extremely ill afterwards. I had requested an option for local anesthesia and sedation but the anesthesiologist talked me out of it. I should have stuck with my own instincts because I threw up multiple times that evening and felt groggy and out of it for about 48 hours. The surgery itself caused quite a bit more pain than the actual fracture and I needed pain medication every 4 hours for about five days and then about every six hours for another 5 days or so. I did try to do some ear based acupuncture on myself but found that I couldn’t place the needles properly by feel or using  mirror. I noticed that the pain was consistently much worse at night than during the day, which accords with what other people have told me about pain. My mother and brother in law both came to stay with us in the first week after surgery to help my husband as he cared for both a toddler and his invalid wife.

15 Feb 2013: I took my last dose of narcotic pain medication, after this point all I have ever needed was Tylenol.

Early Recovery

22 Feb 2013: I had my post-op follow-up appointment (with a different orthopedic surgeon as mine had the flu) and the heavy splint was removed. I was put in a hard plastic CAM walker (although no walking yet for me!) that I could remove to shower, which was a huge relief. I did still need to sleep in the CAM walker. My leg had all kinds of multicolored bruises all over it, from the injury, the surgery and from the pressure of the splint on my leg. I also still had ink and betadine from the surgery. Bleah. But at least I could wash my leg now!

25 Feb 2013: I returned to work after 4 weeks away, although I took it pretty easy the first week and focused on administrative projects. My coworkers kindly helped me out as I was still unable to bear weight and was getting around on my scooter. My husband and daughter took me to and from work every day because I couldn’t stand alone to get the scooter in and out of the car.

8 Mar 2013: I was able to actually go down to the ED on my scooter and see a patient there, which felt like a huge personal victory. It was amazing to feel that sense of capability and confidence again as I did the work I care so much about. I received a lot of sympathy and condolences from the staff in the ED too, an added perk.

15 Mar 2013: BIG milestone – able to walk again with my left foot in the CAM walker for support and protection. My orthopedic surgeon was pleased with the x-rays and stated everything was in alignment and healing well. So I was able to put weight on my foot for the first time in about 7 weeks, but only in the CAM walker. "No unprotected weight bearing!" said my surgeon. I needed crutches and walking definitely hurt. I had to concentrate on putting my ankle firmly on the ground because I had been focusing on keeping it up and off the ground for the past month and a half. Once I started walking though I made pretty rapid progress, moving rapidly from needing two crutches and going only short distances to taking longer walks to needing only one crutch.

18 Mar 2013: I drove myself to work for the first time since my ankle fracture. My mother had kindly swapped cars with me (my husband and I both drive manual transmission cars but she has an automatic transmission car she let us use) so that I could drive. It was amazingly liberating but I did miss the extra time with my family. I know my husband was relieved.

21 Mar 2013: Off crutches! I was able to walk in the CAM walker without any other supports. It was amazingly freeing to be able to move around and hold things in my hands at the same time. I actually enjoyed helping my husband tidy up our house that evening, moving fairly easily from room to room. My ankle did get tired easily and I often needed Tylenol after a long day, but at this point I had very little pain. The CAM walker had a slightly rounded bottom that rocked with my steps which allowed a fairly normal motion, and I made sure to wear a thick soled shoe on my right foot to keep my leg lengths even.

22 Mar 2013: First visit with physical therapy. At this point it was just stretching and some resistance band strengthening. I was shocked at how stiff my ankle had become and how limited my range of motion was. It was a little frightening, honestly. But it came back fairly quickly over the next 6 weeks and I progressed rapidly through the different strengths of resistance bands. I was very faithful about my physical therapy, doing my exercises at least twice and sometimes three times a day.

25 Mar 2013: Ooops… I took a few steps without the cast. I was getting into the shower and honestly I just forgot. It didn’t hurt although my ankle was terribly stiff. Shhhh… don’t tell on me… I did try very hard throughout this process to respect the limitations set by my doctor.

20 Apr 2013: My husband, daughter and I went for a hike on the Maryland side of Great Falls (an awesome cascade of rapids and waterfalls just west of Washington D.C. – well worth seeing if you are ever in the area). We walked for about 2 miles on the C&O Canal Towpath, which is a fairly level but graveled surface and I did well. I was proud of myself, although I attracted more attention than I wanted due to the CAM walker.

Late Recovery

26 Apr 2013: My third post-op visit and I am cleared to walk without the CAM walker! Still no running or jumping and I did need to use a supportive lace up brace recommended by my physical therapist. My physical therapy moved to standing single leg raises, standing calf stretches and balance exercises. I couldn’t balance on my left ankle at all (not even for 1-2 seconds) when I first came out of the CAM walker. My ankle was also very stiff and I actually was limping more and having more pain than I had a week previous.

3 May 2013: Even more physical therapy! I started doing a cross-over walk called cariola, lateral lunges, marching on an unstable surface, more single leg raises and more balance exercises. My exercise pattern shifted to a single longer period once a day, but I continued to be faithful about doing the exercises and again I saw pretty rapid improvement.

5 May 2013: I drove a manual transmission car (my husband’s) for the first time since my fracture. No problems.

7 May 2013: I was able to do yoga for the first time since my fracture. I kept it simple with a few rounds of sun salutations and moon salutations. It felt really, really good to move again.

10 May 2013: We drove down to my mom’s house to switch cars back.

12 May 2013: I stopped needing the lace up brace and was able to get around fine without it, although I still tired easily, had a limp, and experienced more pain than I had experienced in the CAM walker. The pain was not severe but did require Tylenol at times. At times I would get a deep pain in my left leg that meant I needed to stop and rest for a while.

13 May 2013: I was able to drive my own car to work again, which felt great.

16-24 May 2013: We travelled to San Francisco for work related conferences and stayed in a two story apartment. I was able to manage the stairs although I did hold on to the railing carefully, and when I was tired I stepped down without alternating feet, so that my good leg did all the bending and weight supporting. This was a very active trip, since I was walking to public transit each morning and then walking from public transit to the conference sites and then walking around the conferences. Plus doing some fun touristy things in the evenings, including an extended walk on the beach. All in all it went very well although I did have pain at times and I did limp more during the trip due to the increased activity. I noticed that carrying my toddler (piggyback is her preferred method) was a pretty sure way to ensure that my ankle would hurt, which makes sense, since she adds about 30 pounds of weight.

28 May 2013: I was able to balance on my left ankle for 30 seconds during physical therapy! My therapist moved me up to more challenging balance exercises including standing on my left leg while tapping targets with my right toes and throwing and catching a ball while standing on my left leg.

7 June 2013: Fourth and final orthopedics visit. My surgeon said she couldn’t even see the fracture lines and that I should have the hardware in for at least a year, but that if bothered me after a year she would take it out. I told her that it wasn’t bothering me yet and that no offense but I wasn’t eager to have more surgery. She laughed and told me I was released from all restrictions although she cautioned me to be reasonable and careful in returning to running. My physical therapist was more directive, telling me to practice walking quickly before I tried running and to start running in short intervals (15-30 seconds) when I did start.

13 June 2013: Today I was able to jog for a few short intervals (probably 15 seconds, about 50 steps) for a few times during my walk. I’m trying to walk 30-40 minutes daily, and although I can’t get walk faster than 3.3 mph right now without pain the jogging actually didn’t bother me at all. I can walk for about 2 miles at a stretch. I rarely have any pain in my ankle and when I do usually a few minutes of rest will take care of it. The screws in my ankle are not painful although I do feel them if I sit cross legged on a hard surface. My ankle still gets stiff especially after I’ve been sitting for a while. I don’t have full range of motion compared to the other ankle but I am not functionally limited. I can do stairs with alternating legs although I do hold on to the railing for balance. I expect to be released from physical therapy at my appointment next week. At this point, almost 19 weeks after surgery and 20 weeks after my ice skating accident, I feel that I am about 95% recovered and I am confident that I will continue to improve over the next few months. I am looking forward to a busy, active summer including biking, walking, jogging, and moving to a new house.

As I have written in other places, I think that the key factors in my recovery were: 1) Following my doctor’s and physical therapist’s instructions faithfully at all times 2) Basic good health and high activity level before my accident and 3) prayers and loving support from family and friends. I also made an effort to increase my protein intake during the healing period and to take a good multivitamin, a Vit D supplement (on instruction from my primary care doctor), an omega-3 capsule and a calcium supplement while my bones were mending.

So there you have it. If you are unfortunate enough to share this injury with me, I hope this timeline will help and encourage you. Contrary to some of the bleaker reports you might read on the internet, I have made a good, thorough and rapid recovery. You can too.

I wrote another entry on 27 Jan 2014, one year post-injury. You can find it here : One Year Update

Wednesday, June 12, 2013

Role Reversal

I’m spending this week caring for my mother, who had surgery yesterday to repair the joint of her right big toe, which was badly out of alignment. The procedure went well but of course she can’t put any weight on her foot for at least 3 weeks and so needs assistance. My sister and her sister are going to come in shifts over the 3 weeks so she has help until she is able to walk and drive again. So I am here in the house I grew up in, helping my mom get around, making sure she takes her medicine on time and ices her foot, bringing her food and tending her two cats. It’s an odd sort of role reversal, caring for my parent. My husband and I have been very blessed; our parents are all still very healthy and capable. So this is a new experience, taking care of a parent who temporarily can’t care for herself.

When I was a teenager my mother told me that no matter how big I got, I would always be her baby. At the time the statement was both reassuring and frustrating, but from my adult perspective it has turned out to be a simple truth. In many ways I know I am still my mother’s baby. She sends me an Easter basket every year still. She spoils me at Christmas time and on my birthday (she spoils my daughter even more, of course). She makes my favorite soup and cookies for me when I come to visit and when she comes to visit me she helps us around the house still. When I broke my ankle this winter she came several times to help us with our daughter and just to be with me. It’s very reassuring to me, knowing I can always count on my mom to take care of me if I need her. So it’s somewhat disorienting now, to be the caregiver. I know that my mom feels that same sense of dislocation because she commented to me that she is the mommy, and she is supposed to be taking care of me.

I find myself both anxious and also somewhat pleased to be helping. I got a kick out of the nurse calling me “the responsible person” and I teased my Mom about me being in charge this week. I am proud that I have become a competent, skilled person who is able to take care of her mother, but I also feel an intense desire to do it right. As a consequence, I think I might be driving my mom a little crazy with my fussing over making sure she eats before her pain medicine and my nagging to be careful with the knee scooter. My mom, of course, wants to be as independent as possible. I do feel a lot of empathy for her post-op pain and her one-legged life having just been through 7 weeks of no weight bearing this winter after surgery. I am eager to share my tips and strategies for maneuvering around the house and getting things done (safely) on the knee scooter. I am full of “I did it this way’s” and “this is what happened to me’s” and “maybe try it such and such a way’s.”

I feel very protective of my mom too. I would like to spare her as much pain as possible. When she had mild pain an hour after taking her scheduled medication dose I felt anxious, worried that it would become unbearable before she could take her medication again. I ran through all the options I could think of to try to improve her pain and urged her to ask her doctor if it would be okay to take ibuprofen after her surgery (as a doctor, I think 1-2 doses a day would be okay, but since I’m neither a surgeon nor her doctor I don’t want to tell her). I am doing my best not to nag her about this. I did ask my husband to bring my personal supply of acupuncture needles down when he comes this evening so that I can try to decrease her pain with auricular acupuncture (and yes, I did ask her doctor about that too, and he said ok).

I do wonder how much this week is a glimpse of the future. As I said, all our parents are very healthy, but they are also moving through their sixties now. I hope their good health will last forever. I would love in thirty years to be in my sixties with all my parents still living and active and loving life. But I also hope that if and when help is needed I will be able to cheerfully and lovingly care for the people who have always cared for me.

Saturday, June 8, 2013

Psychotherapy Basics

Psychotherapy is a well-researched and extremely effective treatment for many mental health disorders. Disorders that can be treated with psychotherapy include major depressive disorder, post-traumatic stress disorder, generalized anxiety disorder, personality disorders and many others. Psychotherapy can also be very helpful in disorders like schizophrenia and bipolar disorder which require treatment with medication but which can be made more manageable through psychotherapy. Psychotherapy can also be called counseling, talk therapy, or just therapy. Whatever you call it, the research data is out there to say that it works. The problem is, many people don’t want to give psychotherapy a try.

There are many barriers to psychotherapy; cost, access to services, time, stigma. However one of the biggest barriers I have seen is lack of knowledge. Many people are not aware of what psychotherapy is and what it can do for them. As a therapist, I have heard many people ask “Why should I spend time on psychotherapy? How is just talking about my past or my problems going to help me?” Well, they are right that just talking about the past or the problems they are having is not going to help much. But they are wrong in thinking that psychotherapy is mainly about talking about your problems or your past. Psychotherapy is about talking about solutions.

Good psychotherapy is a learning experience. You spend time with a qualified teacher (your therapist) and learn new ways to think and behave that are more effective than what you have already been doing. You might spend some time talking about a problem but it will be in order to think up a new approach to that problem. Or you might spend some time talking about your past but the purpose will be to understand how the past is influencing you in the present and how you can make changes that will make life easier and less painful. But the overall focus should be on reducing your suffering and increasing your ability to function in your day to day life.

Like learning any new skill, psychotherapy requires significant effort on your part. Therapists will typically assign you homework, either formally or informally. These can be things to do (like exercising a few minutes each day, or starting to try something that frightens you) or they can be things to think or write about (such as writing down your thoughts about a situation and then analyzing them to see if they are true and helpful). If you don’t complete the homework then you are much less likely to make any improvements. Your therapist will often ask you about uncompleted homework and what obstacles prevented you from completing it.

Successful psychotherapy also requires you to be willing to change. It can be difficult to change longstanding habits and ways of thinking. It can be really painful and difficult to admit that you need to change some of the ways you have been approaching life in order to feel better. It can feel like you’re being told that you are wrong or bad sometimes and at other times it just feels really scary. Other people in your life may not understand or approve when you try to make changes. It’s important to keep your goal in mind – feeling better and making your life work a little more easily.

One of the key steps in successful psychotherapy is finding the right therapist and treatment for you. Research has demonstrated that the most important factor in successful psychotherapy is the relationship between the therapist and the patient. If you think about it, this makes sense. Of course you are going to learn more from and be more willing to work hard for a teacher or coach with whom you have a strong, positive relationship. There are also different kinds of psychotherapy that work better for different kinds of people and different kinds of problems. Some therapies are short and tightly focused on a specific problem while others are longer and more broadly focused on patterns in your life that may be causing problems. Some types of therapy will have you do almost all of the talking, while in others your therapist may do about half the talking. Whatever type of psychotherapy you choose, go into it with honesty and a willingness to change your approach and pretty soon you will be feeling much better.

Thursday, June 6, 2013

Culture Shock in Israel

I step out of the church of the Holy Sepulcher in Jerusalem with my mother, sister and our tour guide on a hot and sunny Sunday morning in October. My husband and daughter have already beat their retreat, returning to our temporary home to rest. His day to tour will be tomorrow, when the focus shifts to predominantly Jewish sites, and I will stay home with our two year old. I wish it were tomorrow already, that it was my turn in our usual tag-team parenting dance. I am tired and still half dazed from our long trip and the mutual jet lag, which has us keeping each other up at night. I feel off balance, the rough stone walls, chaotically decorated churches split among four denominations and hordes of people speaking dozens of languages constantly reminding me this is not my home. This is not my space. I am a stranger here, and I am not certain I am welcome.

The Muslim call to prayer is resounding through the courtyard, a wailing chant so loud I can’t hear what our tour guide is telling us at that moment about the history of the building. Instead I try to focus on experiencing the moment, soaking in the surreal juxtaposition, listening to the sounds of one Abrahamic religion after viewing the holiest site of another. A few minutes later my religious triad was complete, as we exited the square into another street to find Jewish men dressed in black suits wearing tallit and kippot dancing and singing while they held the Torah aloft. They are celebrating the holiday of Simcha Torah and we make our way slowly past the clapping crowd encircling them.

There are no cars here, only hundreds upon hundreds of pedestrians pressing tightly together. People don’t give you space here; they don’t keep a distance. It is hard to stay with my family and I grip my purse tightly as I walk along. Our tour guide leads us rapidly through the stone streets to the textile and antiquities shop owned by his friend, where we are served mint flavored lemonade as a precursor to engaging in the American religion of shopping. It is clear that this ritual, unlike others, crosses international boundaries, and we are obviously expected to buy something. The owner of the shop shows us around, pointing out special items and explaining their history and their significance. Everything, of course, is expensive. Then he leaves us to browse while he sits with our guide and talks of mutual friends. We find gifts for family and complete our purchases of tablecloths, beads and embroidered wall hangings.

After our obeisance to the lords of commerce we proceed, winding our way through narrow alleys that used to be Roman main streets. We dodge small children walking alone in school uniforms carrying enormous backpacks and other children pushing wheelbarrows piled with boxes to twice the height of the young worker. Young soldiers carry military assault rifles as they walk through the streets, reminding me of my deployed base in Iraq. A canary sings over us as we eat a lunch from a market stall of hummus, pickles, garlic laden rice and chicken. The hummus at least is comfortingly familiar, the rice and the chicken oddly spiced and tangy. Our tour guide leads us along the Via Dolorosa, the path walked by Christ on his way to crucifixion. My mother is focused on devotion and my sister on history as we criss-cross what feels to my aching feet like all of Jerusalem. I am distracted, unfocused, unable to enter the experience.

It is like this throughout our trip, the entire two-week experience. I am slightly tense, on edge, and uncertain. I love to travel and thought I was immune to culture shock, but I am uncomfortable here, in this beautiful Middle Eastern place. I can’t let go enough to step fully into the role of religious pilgrim, as my mother has done, despite my own faith. Nor can I find my stride as a sophisticated secular tourist in step with my sister. They are enthusiastic, excited, peppering our guide with questions and soaking in the details. I wish I were too. I wish I could find my enthusiasm and joy for this incredible trip, years in the planning. I find touches here and there; a fun display of Sukkot at the Israel Museum, a lovely hike in Ein Gedi nature preserve, a fun moment floating in the Dead Sea, a day at the Mediterranean Sea with my daughter, but nothing I can sustain. Perhaps another time, if I have a chance, I will be able to believe I am welcome.  

Tuesday, June 4, 2013


This was originally published on another site a few months ago and I decided to move it here. I am still working on my patience...

I live in a world that frequently offers instant gratification, and I have to confess I enjoy it. Is there a new book that I want to read? I just download it on my Kindle Fire the day it is published and there I go. Is there a movie I want to watch? It’s usually available the same way, or if not on my Kindle than on the “on-demand” feature that comes with my cable. If I want to eat something I just take a box out of the freezer and microwave it, and it’s ready in 5 minutes. Good food, too – vegetarian dishes and Indian food and all sorts of wonderful things that a few years ago would have required either serious restaurant searching or a significant kitchen effort. Credit cards allow me to buy anything I’d like to have, instantly, without the bother of saving for it. Shopping over the internet means I don’t even have to wait for a store to open. There isn’t that much in my life that requires patience anymore. Most of what I want I can have, and without much waiting. I think this is true for a lot of people today.

I don’t actually think this is good for me. I’m not sure it’s good for anyone. As I am able to get more and more things more and more quickly, I think I am appreciating them less. I am losing the pleasure of anticipation, for one thing. There is an excited, hopeful waiting feeling when you think something good is coming that these days I only get when waiting for the release of the next installment of a movie series I am watching. There is not much chance for my appetite to build up when I can always grab a snack – and I’m referring to an appetite for anything. I lose some of the savor of the event when there is no effort or waiting required.

I also see that my skills at patience are atrophying. There are still some things in my life I have to wait for, and it’s hard. I have a young child, and I have learned that frequently young children just can’t be rushed. At least, they can’t be rushed without tears and tantrums on the part of both child and parent. I have trouble waiting though, and doing things at my daughter’s pace, because my mind is rushing around at my normal instant gratification speeds. I find myself trying to hurry her along despite knowing that it’s not going to work well for either of us. I have trouble waiting for a movie or book release and feel frustrated; I think to myself “why isn’t this coming out sooner?” Sometimes I am so impatient that the 2 minutes it takes to pop microwave popcorn seems like an eternity, which even in my most impatient moments I understand is quite ridiculous.

I don’t like feeling impatient. It’s an uncomfortable, rumpled up in the mind kind of feeling. It feels hurried and stressed. I don’t like being impatient with my daughter, because it creates bad feelings between us, which isn’t what I want. I don’t want her to learn to be impatient or to expect instant gratification, either. She’s at an age where my husband and I are starting to insist that she say “please” and “thank you” when she makes a request, and we’re beginning to tell her to wait at times, when we can’t accommodate her wishes immediately. I can see that this frustrates her but I also know that it will teach her patience over time. I also know I need to model patience if I want her to learn patience.

I don’t have any really good answers to this problem. I’m honest enough to say I’m not going to give up purchasing digital books and digital media. The convenience is just too tempting. I don’t have enough interest in or talent in the kitchen to vow to give up convenience microwave foods. But here are some things I think I can try.

I can practice patience in my purchasing. When I want something, I will think about it first. Do I really want this? Do I want it enough to save my money for it, so that I can buy it outright and not accumulate debt? I think I can learn to enjoy the pleasure of anticipating the purchase and planning the purchase so that when I finally own the item I enjoy it that much more.

I can practice patience in terms of my crafts. I knit, and that requires a lot of patience. Most finished knitted products contain tens of thousands of stitches, and that just doesn’t happen in a hurry. It takes patient, consistent effort. Writing also takes some patience and investment of time; time to think of a topic, time to do a little research, time to write it up and then time for other people to find it and respond. 

Most importantly, I can practice patience as a parent. I can take a deep breath and remind myself that my daughter will only be little once, and that someday she will be the one wishing to hurry me along. I can treat her the way I hope she will treat me when that day comes. I can treat her with respect, and kindness, and interest in whatever has caught her attention and slowed her down. I can demonstrate patience to her so that she learns to demonstrate it to others.

Perhaps I can find other ways to practice my patience as well, so I can strengthen that skill. I suspect it will pay off in major ways throughout my life. After all, isn’t the phrase “Good things come to those who wait?”

Sunday, June 2, 2013

Make A Game Out Of It

I’m not much of a formal game player, not like my husband or many of my friends. There are some board games I enjoy but what I like best is the chatting we do around the play of the game. I do like games, though. Instead of formal games, I like to make a game out of things I have to do. I make games out of tasks and situations that otherwise could be pretty annoying.

I was thinking about this today as I was driving to the grocery store. I have recently started doing the grocery shopping alone on a weekend evenings. Usually I wait until my daughter is in bed. My husband stays home with her and I tootle off to one of the local grocery stores to pick up what we will need for the next week. I have found that my concentration and decision making are much better when I am not also coping with a bored, squirming toddler. And I’ve turned the process into a game. I pick a target amount of money and I try to make choices so that the bill comes out under that number. While I’m shopping I’m keeping a running tally in my head (rounded off to the nearest 5 cent increment) so I keep track. I look at options and sometimes swap out choices or even decide I don’t really need something and put it back. To “win” the game I need to do two things; first I want to be within $5 at the checkout of my own estimate (the grace is because I am not figuring out tax as I go along), and second I want to be under my target amount. The prize, if I can win 3 weeks in a row, is that I get to spend all the money I was under on a special treat for my family – something really delicious that we normally wouldn’t purchase. Then the cycle starts over.

Okay, so that sounds pretty nerdy and goofy, I know. But it makes the task of keeping our grocery bill within budget into something a little bit more fun, which is the whole point of making a game out of things. I’ve noticed I make a game out of other things too. In really bad traffic I try to get the perfect distance and slow speed behind the car in front of me so that I can move for longer stretches without actually stopping. This is harder than you might think, particularly since I drive a stick shift vehicle. The goal of the game is to avoid having to hit the brakes while still driving safely. I don’t have a prize for this game, particularly, but it does occupy my mind and help me feel calmer in traffic. Moving smoothly, even at a slow pace, is just more rewarding for me than having to stop and start and stop and start.

I also tend to make a game out of exercise. I am the excessively obsessive compulsive person who tends to log things like minutes and miles and so the game will become can I create a streak of hitting a certain target – for example, 20 minutes a day for 30 days? 2 miles every other day for 20 times in a row? For this game I will often reward myself with a few dollars per achieved milestone. I use the money to buy something I want that I would normally consider too expensive or extravagant (a new TV set, a GPS watch when they first came out and were very costly, my current wish is an iPad so I am saving up for that). If you think about it, a lot of weight management programs are arranged on this principle. They give you a target for exercise or for points and then encourage you to hit the target while recording honestly your actual food intake and activity level.

Turning tasks into games works on my daughter to some extent, too. If I tell her something is a game she is much more likely to participate. So, for example, we might play a cleaning up game. Or we might play an eat two bites of everything on your plate game (with a cookie reward if she can do it). The key thing is to label it as a game, to give it a goal and rules and if possible a prize to increase motivation. I am excited to find more things we can turn into games as she becomes more sophisticated in her thinking. This evening, for the first time, I heard her make up her own game. It was an open and shut game she played with her thermos cup. She would open and shut the thermos and then pass it off to myself or my husband. During our turn we would also open and shut the thermos and then pass it back to her. Pretty simple, obviously, but I was pretty pleased to realized my two and a half year old had just made up a simple game with simple rules and taught it to us. She is truly the child of her parents.