the lemon’s outta juice

to preface this post…on occasion, when i write, i have things i think are interesting to say (debatable), and sometimes it’s for catharsis. today it’s the latter. so i’m not trying to solicit pity or advertise first-world-mom-problems or ask friends to provide uplifting words of encouragement. i just have a lot on my mind i need to get out, and this is not going to be pretty.

when it comes to family and general adulting, our social-media-laden lives would have outsiders believe that life is one of a few things:

1. picture perfect family life, with happy kids, nightly home cooked meals, and hand made crafts around every corner. i am guilty of these things (hey, i like to cook and bake, and i’m a little crafty, so what)
2. amusing parental musings, making fun of yourself and your family/children, creating a sense of comedy and trying to convince people how witty and down to earth you are (also guilty here)
3. a fun grown-up social life, where you still do things to be cool and relevant, and not seem totally out of touch with your youth (yes, i go to lollapalooza, so check that one off too)
4. the perception you can do it all – work full time or part time or full time mom or whatever, have brilliant well adapted kids who do everything under the sun but stay balanced, blah de blah

there are a myriad of other things i’m sure i easily qualify for that don’t come to mind. now i know anyone reading this knows just as well as i do that it’s all a bit of a facade, and while there are truths in all of these things, there are also the unspoken that don’t get as much social lime-light.

i believe we’ve done (generally) a better job at understanding we all have our own shit. everyone’s got opinions, there’s no one-size-fits-all approach to parenting or life itself. breastfeed, formula feed, buy organic, don’t…whatever it is, i hope we can all agree we can all be entitled to our own opinions on these things, and be a little judgy if you must, but try to respect it ain’t always your monkey and therefore not your circus so politely butt-out

so this is a lengthy lead in to the topic i planned to write about, which i’ve been long-hesitant to put out there on the interwebs because i worry that i’ll come off as callous, or whiny, or whatever, and open myself up for judgy-side-eye. and the other thing is, this isn’t going to be some grossly insightful first-of-its-kind post, either – at the end of the day i know i live a good life, and the fact that i have these types of issues and the ability to get resources to help, i know is something to be thankful for.

tonight, i almost imploded, overwhelmed by my inabilities, non-desires, frustration, you name it. i had a laundry list of things i had to get done personally around and outside the house, coming off a long commute, feeling the pressure of time and my children’s fatigue from a long day at school and after-care, the looming bedtime routine that was too-fast approaching, and my computer sitting in my bag on the floor, where i had a document i had to get patched up and sent out as soon as i could.

some friends know my girl was last year diagnosed with inattentive type ADHD, and yes i know there are opinions out there that kids are over-diagnosed, and yes our daughter is medicated. we went through a battery of methods to try to figure out how to unlock her potential since she was 4. at first we thought it might be this, so we tried that. then that seemed okay, so we tried something else. 4 years later, our pediatrician made the diagnosis and we confirmed it with a developmental neuropsychiatrist.

honestly in some ways it is a relief to have some kind of diagnosis, but i beat myself up regularly – did i take too long to get to the bottom of it? did we miss early signs that were there all along? would she be in a better place now if i had done more then? have we even really uncovered what is happening in that elusive mind of hers – is it the ADHD? is it speech? is it IQ? is it self esteem? i honestly don’t know and i CANNOT tell you how infinitely devastating it is to be a mother, to have born this child from my body, and not feel like i have the ability to break through. of all people on this planet, it should be me. and if i can’t, what kind of mother am i? do i work too much? am i not patient enough? does she need a little tough love? am i not present enough? do i prioritize the wrong things? should i be doing more? did i not ask it the right way?

WHAT DO I DO. WHAT AM I DOING.

tonight i lost my shit more than once. i started off fine – i set the stage and expectations for what we were going to do tonight. i provided a gentle but clear outline. she said she understood. but when we started working, and i swear it was all positive speak and encouraging, her difficulty to even repeat back to me the simple instructions i had just given started to make me tense up inside. doing math facts sounded like just reading the times tables out loud without any real absorption of what she was stating. i asked her to read her favorite part of her book report book again for review, and then tell me back the storyline. she couldn’t. she just stated snippets of incomplete sentences but couldn’t relay back a sequence of events to tell the story, even with lead in questions. it felt like she was grasping for something to say just to make me happy so she could move on and watch TV. i snapped. i know i shouldn’t have. she doesn’t deserve it. it’s not helpful. i’m the adult, she is a child – she needs me to be better, she needs me to guide her.

but i was mad and frustrated and lost inside. i don’t know how to help, and the guilt and sense of inadequacy is paralyzing. how can i not know how to connect to my own child? all of these things the teachers send home for us to try to work on – i can’t reasonably ask her to do all of that AND her homework when we walk in the door at 5 o’clock at night. she is exhausted. she needs some time to unwind. yet i know she needs the extra practice.

meanwhile her little brother is just in the background. like always. independent but still, i feel, neglected in the shadow of his older sister, whose needs are far greater than his, or so i tell myself. but even if that’s true, it’s still not fair. i literally spent maybe 10 minutes of total time actually attending to him one-on-one tonight. the rest of the time i was interacting with him i was sending him away or telling him to stop bugging his sister, or stop whining or stop doing whatever i decided was what he needed to not be doing.

so i lay the self-guilt on even thicker. it’s late. the kids are tired. i’m tired. i have dinner to handle. i have work waiting for my attention. i know i don’t bring my best self home to my family and it’s shameful. i know something needs to change, but i don’t know what that is. i feel like i am failing my kids. i get that that’s dramatic and that they have a home filled with love for them, but it is really effing hard some days to want to pat myself on the back for the good life we give our kids when it feels like i can’t give enough. i know i’m really beating myself up over here today….i really just needed to get it off my chest, hoping that putting it in writing may release some of the burden so i can do better tomorrow.

What would I tell my mid-20’s self (career edition)

Recently my grad alma mater blasted an email requesting alumni to provide “words of wisdom” to clinical-bound first year students for their Clinical Practice Ceremony. A few years prior my (true) alma mater connected me to a graduating senior interested in learning more about the field of physical therapy through the Career Center. You know, a little forced self-reflection. Hmmm, what would I tell a bright-eyed, ambitious young person at crossroads like these? 13 years into my career, if I could go back to my young-to-mid 20’s self, what would I say?

So I’ve thought of a few ideas. Some are optimistic messages. The ones that would inspire a young-20-something to really feel it. And others are  practical anecdotes, the ones you sort of wish you knew in your 20’s to tuck away for a later date, when your sight is the long-game and your priorities typically make the shift (that one, when your plans extend beyond the weekend and even beyond yourself).

1. In this profession, more than many others, you truly have the capacity to positively impact another person’s quality of life. Don’t take that for granted. YOU will learn the skills to do this and become an expert at analyzing movement and its impact on function. This can be as elite as working with professional athletes to perfect core control and torque production with their throwing arm; to helping a new mother learn strategies to hold and feed her newborn baby while protecting her healing body; to getting a weekend warrior back on the hiking trail; or reducing fall risk in an older patient. The issues for which your patients come to see you are a big deal to them; and so you must take that into relative context and make it a priority to achieve. And more often than not, you will help them do that. Sometimes they even bake a plate of cookies in gratitude.

2. Pay attention to your foundations. You may learn fancy techniques like the Chicago Roll, the shotgun, a Mulligan MWM, ART, Graston, McKenzie, Maitland…but pay attention to your foundational classes. The best therapists are masters of critical thinking; and that is steeped in expert knowledge in the basics of anatomy, kinesiology, physiology, neurology. Only with years of practical clinical experience will you confidently be able to develop shortcuts. Don’t be enamored with fancy titles and techniques – if you know the fundamentals, you will be able to develop a treatment plan and truly build an arsenal of sound clinical practice guidelines. I’m grateful for the sometimes painful exercises of critical thinking we were subjected to in my program. I never recognized until after the fact just how valuable that was.

3. Don’t burn bridges.  This is probably a good rule of thumb regardless of profession, but I can only speak from personal experience. The therapy world is small. Much smaller than you might think. Be a professional. Be courteous. Be respectful. You never know if you’ll cross paths again.

4. Your options are endless. Stay open-minded. Most people enter this field to help people. There are so many ways to do that. Clinically there are subspecialty fields in which to practice, the breadth of which is huge, and you will graduate with the basic knowledge to embark on any path. You can work with kids in the school systems. You can work with amputees to learn to use their extremity again. You can work with patients post-stroke, leveraging the concepts of neuroplasticity to reorganize movement patterns. You can rehab people post-op from ACL reconstruction to rotator cuff repair to total hip replacements. You can do this in people’s homes, rehab facilities, hospitals, private clinics. You can change your mind mid-profession and turn in a different direction. You can move up the management ladder and focus on business operations.

5. Recognize burn out. Recalibrate and plan. It’s easy to burn out in this profession. Walk into any private therapy clinic and chances are you’ll see lots of young faces working. Why? Outpatient therapy is fast-paced and hours are long. In other settings sometimes the emotional toll is too much to bear day to day. Other places, the work feels monotonous. Insurance and payer pressures force high productivity expectations with increasingly higher demands to improve efficiency while remaining uncompromised on outcomes. There are times when it might feel like you can’t do it anymore. Now reference #4 above. Is it time to consider a new option? Have the circumstances in your life altered your priorities to the point that it might be time to make a shift?

6. Know healthcare is a business. PT’s are by and large inherently altruistic. The bottom line matters less than a successful outcome and happy patient. The older I get in my field, the  more I want to believe that, but the more I realize it’s naive and ultimately unfair to ignore that the responsibility to be a good practitioner also means respecting the business. This isn’t to suggest that decision should be driven by the dollar; only that to pretend the dollar doesn’t matter is actually irresponsible. Be part of the solution – provide high quality care at every opportunity. Don’t be lazy or complacent, which only lends to wasteful healthcare dollars. Know when you’ve hit the plateau, and if that happens, be comfortable cutting the cord. Learn how to communicate that effectively to your patient.

7. Work-life balance is a dynamic concept. Ah the utopian space called work-life balance. It’s a very popular thing to talk about. Here’s the thing I’ve learned – it’s not an end goal. It’s a dynamic, nebulous and oft elusive amoeba that you can sometimes hold and just as quickly lose. Reminds me of this toy from the 80’s:

PT’s love to talk about finding the right work-life balance. You know the main reason I think it’s so elusive? Because PT’s at their core mostly want to do what’s right for the patient. Jeez, we get so attached to these patients, we really do. Which often means not settling. Which often means working hard. Which pushes us into the “work” side of the tipping scale. So work-life balance is hard for the inherent workaholic in us. Embrace it. Your workaholic attitude is why you care about your patients. Just remember to take some time for yourself in there because you’ll make yourself nuts if you don’t.  If you don’t think you want to spend extra time outside of your clocked hours, this probably won’t be the right profession for you. Because people who truly care about people sometimes put in more than 40 hrs/week.

8. Physical Therapists are FUN! Well, most of us are. Seriously though, therapy environments are social and collaborative. If you think PT’s are making therapy fun to keep you distracted, you are partly right. But I also think if you get a group of happy, positive, energetic people in a big room working with and helping people all day, you are bound to have a few laughs. I’ve had more memories than I can remember – the job is active and unpredictable day to day. You get the opportunity to meet so many different personalities, some you will never, never forget.

So there you have it. A somewhat spontaneous reflection on my career, these last 13 years.