Wednesday, May 06, 2020

Boundaries in the age of COVID: Part 9

I found this piece intriguing, weirdly comforting. So well-written. An artist plunged himself into total darkness for a month, allowing his mind to neuroplasticize around lack of visual input and light stimulus, dump out all the junk that had accumulated. In these COVID times, I have been feeling somewhat discombobulated without any access to normal sensory input through the eyeballs at the ends of my fingers and hands, without familiar smooth grooving through normal mind channels. Anyone else out there feeling deprived of tactile sensory input these days? Tied inextricably to self-expression, livelihood, self-worth?
I must confess to experiencing a bit of grief about having fully retired my practice (although, as I keep reminding myself, it was high time). In some ways, the sensory deprivation described in this article reminds me that I liked, really really liked what I did for a living. Human primate social grooming.
Certainly, coming to terms with a new existence is now required.

Ow.
It feels like a gut cramp sometimes. Part of my brain is dismayed that I actually burned a bridge. It thinks I self-amputated something, like both hands maybe. Brought home my stuff from work. Now sitting in giant plastic plaid bags all around my living room. Every time that part of my brain notices those bags sitting there it screams, Traitor!!

That would be the part of the brain that spent the last 50 years of existence, especially the last 35, touching people for a living. The part I'm moving toward and want to fully occupy one of these days is the part that knows all about that but needs to learn how to get along in life without it. This is the no man's land I am currently crossing. I keep reminding both these brain parts that we're all old now. We had all been thinking about this for a long time. And I'm sorry that COVID times have precipitated the event a bit earlier than we had planned and all agreed to. But I'm just not up for continuing our familiar existence of running a practice for just another few months when it would have to change so radically into something different, with screen consults and bank e-transfer or in-person with credit card tap technology and shields and PPE and no touching. You wouldn't like that very much either, would you, brain?
C'mon brain, we can do this. Together we can neuroplasticize, find any creativity that may exist within all this new sensory deprivation.


https://www.1843magazine.com/features/into-the-dark

Tuesday, May 05, 2020

Boundaries in the age of Covid - Part 8

The biggest boundary of all I feel right now is the one that still exists between my old self and my newly retired self.

It's like I'm moving carefully through a bleak no-man's-land between two opposing armies at the moment, full of craters from explosions going off, still riddled with land mines, nothing to see but burnt and broken trees, no end in sight, mud and blood, lots of mud and blood.
And corpses: although I've not seen any of those yet, I expect I might yet, and all I can do is keep going and hope I don't become one of them.

OK, it's not nearly that bad, objectively speaking. I'm only trying to describe how it feels.

Moving out
This is the week that our provincial government said it was time to try to open up.
I've been getting emails from my professional association and college with new advice on how to conduct a private practice in phase one.
Basically, it boils down to, don't touch people unless you really have to, wear gloves and mask, leave lots of time between patients so you can clean and disinfect between them, only one person at a time in the reception area, have a shield up, no cash, only credit card tapping.
That's phase 1.
Phase two in another two weeks, people can start doing acupuncture again if they wish.
(Seriously?)

Anyway, I finally had enough energy plus motivation this week to go in and pack up my stuff, move it out. Anything that fits into my rather small quite old Saturn three-door, that is.
I felt spurred on by flashes of guilt feelings over the fact I'm not paying rent there anymore. Even though the clinic owner has not returned to work, I felt guilty leaving my stuff in there, occupying the room I enjoyed for the past three, almost four years.

Two carloads.
Very stuffed carloads.
It was tiring. I haven't done any physical exertion much at all in three months.
I felt old.
And tired.

I use a bunch of sturdy plaid plastic bags I bought in Vancouver at the dollar store, the kind you see everyone in third-world countries using to move their things around, strapped to bicycles or donkeys or whatever.



They come with a zipper that breaks after a single use usually. The bags tend to split easily too.
Oh well.
They weigh nothing and fold flat.
They're great.
Mine have hung in there with and without zippers and with taped-over splits through a complete house move, three office moves, and now this final move into retirement. I have brought home all my files, office stuff, laundry, pillows, bolster, cooling fan, equipment, small things like tape supplies, etc. Bulky things like body wedges. Heavy things like charts and file folders.
All kinds of things that multiply in drawers.

There are still a few things I have to go back for - a floor lamp I really like, and a bunch of large rectangular things - a mirror, artwork, framed and unframed, a whiteboard.
One more trip at least. If the lamp doesn't fit into my car, I'll walk it home.
Weyburn is small.
I'm only about a kilometer away.
What's left will be the treatment table, a large three-drawer file cabinet, and a wardrobe sort of thing that held my clean laundry, one side shelves and the other side drawers, with a sliding door.
I'm hoping Susan will take the treatment table. It's a nice one. It has a heater in it and everything.
I don't know if she will want the file cabinet. Probably not. She does everything in the cloud.
It can go to the secondhand store. Maybe they'll give me a bit of money for it. Depends when they open up again, and when Susan will need the room.
I want to keep the wardrobe myself.
No idea how to get it home.

My current fantasy
Susan keeps the treatment table.
I keep up my license, inactive status. I think I can still treat the odd patient with an inactive status. I become a consultant that Susan can call in if she gets a tough case she can't handle.
I do not maintain a practice. These will be her patients, treated by me but no responsibility, and she pays me a percentage of their fee.
It's just a fantasy - we have yet to talk, really, about anything to do with our work relationship.
It's just a thing that crosses my mind as I cross that no man's land that helps me keep going.
With all these old high thread-count sheets and pillowcases, I have a lot of material I could use to make face masks.
If I had any energy to make any.
Lots more crossing to do first.


Saturday, April 25, 2020

Boundaries in the age of COVID: Part 7


Last night I had the following dream:

I attended a woman for treatment, for some upper back pain. She had short brown hair, long enough to cover her ears though, and brown eyes, no glasses, round face, wore a white lab coat of all things.

She was a chiropractor and wanted to crack my back. I told her in no uncertain terms to do no such thing.
She was not happy, because she didn't feel she would be paid unless she did that. I told her I'd pay her NOT to crack my back.
She still wasn't happy. I guess she really wanted to make noise so her own personal relationship with herself would feel fulfilled or something.
Anyway, my back, my boundary. 


In the same office in my dream was an optometrist. I had purchased eyeglass frames there, and they had come apart, and I wanted either repair or a new pair the same. During the span of the dream, this was never resolved. 

I really liked the frames, you see. 
They were white with cutouts in a sort of teardrop pattern. Super gross obviously, but in the dream, very trendy. I know I was anxious to have them on my face again. 
My dream brain keeps me amused. 

I think the teardrop business may have had to do with how many of those I produced while watching the virtual vigil for Nova Scotia yesterday.
But I digress. 

..... 

New topic.
This morning I had a facetime call from an Irish physio I met in 2012 when I taught a workshop in the UK, who has a certificate in chronic pain management, who lives in Norway, and has ties to Cognitive Functional Therapy (Peter O'Sullivan) through Norwegian colleagues who are also professors in physio schools there. 
She wanted me to know that the class had meant a lot to her, had taught her it was fine to be interactive and not operative, that she had started a whole education project/network of physios who work from home, showed me her new "office" which was her bedroom with bed removed, some space for her to demo exercise, a plant in the corner for visual pleasantness, how she showed people how to self-treat based on my techniques, how she still had my manual from 8 years ago propped up on a shelf.
She wanted to talk about how she had moved to video consults with her patients in their own homes. How interesting it was to see their environments without having to be physically there, how much easier it was for stroke patients and spinal cord injured patients and their caregivers to not have to physically bring themselves to a clinic.
She sounded worried that I was going to retire my little hands-on practice, said she thought it would be great if I decided to maintain an online practice instead, where anyone in the world could consult with me if they wanted to.
I told her I would have to think about that.
I'm ecstatic however that at least one physio in the world that I've personally taught got it, really got it, and is running with it. What did she get? She got that she is competent with or without her hands, to assess and interview and treat. That novel sensory input can be delivered verbally. And that if people really need some hands-on, she can nimbly come up with a creative plan that involves them doing something to their own skin organ at home.
If she gets her network built she may actually be a mover and shaker for helping the profession evolve itself away from stupid stuff toward being much much better, toward being the interactive profession it originally intended to be, and away from the stupid operative profession it morphed itself into over the decades I practiced, much to my continual dismay.
.......

New topic.
I'm still reeling around in a fog, not really up for charting a new course through choppy water.
For being extroverted, out in the world.
In fact this whole stay at home business could not have come at a more opportune time for me, personally.
Whenever I get like this, I have to just wait until motivation comes back on its own. I've never ever figured out how to entice motivation to be there when it's simply not. Just washing out a coffee cup is a big effort.
I know getting a haircut would help, but that can't happen for a few more weeks at least.
I'm OK financially, I'm existentially safe, I'm actually not feeling depressed for a change, so at least I have that much going for me. I count these blessings every day.
My own boundaries are rearranging themselves. It must be like how insects feel when they pupate. Or like how embryos feel when they are at the mercy of forces pulling them this way and that into physical existence. In the past, I've likened the process to molting like a bird or a dog, or shedding skin like a reptile. But this time, it feels like it's a lot deeper, and a huge sap of energy.








Friday, April 24, 2020

Boundaries in the age of COVID: Part 6

I am fascinated, riveted, horrified, by how sane societal boundaries are being obliterated at the highest level of US politics.
Vanished.
Poof.

Evaporated.

So, Trump is using presidential office and daily briefings to pronounce nonsense and flagrant foolishness about treating the coronavirus, most recently applying UV light to the inside of the body and/or injecting/ingesting disinfectant.

Americans have to put up with this daily cringe show because he got elected by some bizarre combination of those who voted for entertainment rather than cohesion, and an electoral vote system supposedly designed to keep people like him out of office but which, instead, the Winds of Fate blew inside out like a cheap umbrella. 


The poor doctors who come with him into his briefing room each day.
They are hanging in there, but the toll is mounting. Deborah Birx used to be a lot more smiley. Now she just can't. 



Reaction to her president's ideas 
They are hanging in.
What a decision to have to make, every day.
Abandon their own professional boundaries to serve, to try to keep people alive, put out science-based messaging.
Or lend their presence to someone who erodes them further every single time.
It must be so demoralizing.
I get an image of a couple of people devoted to truth frantically bailing water even with just some little sand pails, who have looked up to notice, to their chagrin, that they are actually trying to bail out the Titantic, who then resume bailing. 


The disinfectant company has had to put out a disclaimer.

Seriously???
Yes

..............

Improper use of disinfectants - official disclaimer 

Breaking Down Trump's Thursday Press Briefing | Morning Joe | MSNBC 

Mad World YouTube, Adam Lambert with lyrics

Sarah Cooper on Twitter with the full quote


Parts 5, 4, 3, 2, 1





Sunday, April 19, 2020

Boundaries in the age of Covid: Part 5


Today I was pondering the relationship between viruses and humans.

Can viruses evolve? 


Maybe. I am not a virologist, nor an evolutionary biologist. But I'll give it a shot and say that I think the (conceptual) boundary that remains firm between us (as humans) and them (viruses) is that they can't replicate by themselves the way we can - they need hosts. If the hosts have naive immune systems/no antibodies, the virus wins and the host likely dies. If the immune system of the host rejects the virus, it will quiet down, become a relatively ignorable squatter. Be put-up-withable.
The plus side is (from my human point of view) that viruses are not smart. Not that humans are particularly, either, but we can at least alter our own behaviour more flexibly from one moment to the next. We have agency, sort of. Flatten the curve. Slow down the tsunami of viral replicative explosion.
Damn though, this virus is like velcro, the way it can jump inside human cells. 


Can viruses become less lethal over time? 

A virus doesn't care about anything. Literally. It has no agenda at all. It doesn't know that it's lethal or not lethal. It wouldn't care anyway.
It's not even a living organism, because it can't replicate by itself. We can't either - we need some cooperation from others. 
But what I mean is, the virus can't find some other virus it finds cute, form a relationship, settle down and raise baby viruses the way humans do.
It can't get fat then divide itself into two like bacteria can and do.
Self-replication is an inherent descriptor of "life", the basic unit of which is a self-replicating cell. Viruses can't. They are pesky parasites instead. 

So there is this boundary between life and not quite life. 

Viruses might evolve a bit, as in change over time, but they don't"evolve" so much as they "emerge." Then get passed from one species to another, passively and unintentionally.

Think: immune systems of indigenous peoples of the Americas were naive to exposure to measles and smallpox viruses. 

Lest we forget, entire populations of humans were thus obliterated. 
Their immune systems were swamped. They had no immunity. The viruses likely weren't all of a sudden "stronger" or "more lethal" in and of themselves - they had bigger impact because they found a bunch of multicellular beings to infect with immune systems that had no ability to resist, not enough time to adapt, learn to resist, resist, and thereby preserve biological integrity of hosts.
Let's hear it for true adaptive agents - immune cells in our fancy human bodies.  We can help our immune systems adapt as a collective, by stages. Little by little. Thank goodness we as humans are at least smart enough to be able to recognize a signal from the top of the troop calling us to attend to and follow simple rules and admonitions to stay safe.
So after thinking about it for awhile today, my provisional conclusion is that viruses stay the same mostly and the arena in which they operate changes, either in their favour or against it.

It's like we're all in a massive swimming pool stretching farther than the eyes can see. We each have an inflated sport ball. Our job is to keep that ball underwater somehow until the pool is drained.
The ball is our life.
The pool is our arena.
Our agency is to hold the ball underwater.
We do not know when or how the pool will drain.
We don't know how big the pool is. 

We don't know the drain rate.
We do not know how long it will take.
Just hold that ball down.
Yeah, it's going to take a bit of behaviour change, some effort, some cooperation.
Everybody all together now.
Hold it down.
Hold it down.
Hold it down.
You can do it.
You can do it longer.
Please continue to do it.

Look, the curve is flattening.
Look! It's trending down now.... a little.
Keep holding it down.

Epidemiologists are saying, we're winning. Keep doing what you're doing.
...............................

REFERENCE LINKS


1. Viral evolution, Wikipedia

2. How the corona virus works inside your body
3. Hold the line

BOUNDARIES IN THE AGE OF COVID POSTS


Part 1
Part 2
Part 3
Part 4

Saturday, April 18, 2020

Boundaries in the age of COVID: Part 4



Comfy teeshirt mask


Financial boundaries

I wanted to pay some bills and deposit a cheque. I phoned ahead to inquire about hours - the internet has not been updated recently and you know what a mess everything is out there with COVID and what not, new social boundaries upsetting everybody's apple cart all at once: wise move. I learned that yes, hours had been reduced. I could pay the credit card bill and the phone bill over the phone. If I had to attend in person, only the doors by the parking lot were opened and I would be screened upon entry. Okydokey then. 

I paid what I could by phone, and the next day ventured out wearing my new comfy teeshirt mask.
I opened the door, and saw a plexiglass kiosk in the foyer, attended by a banker guy who was already attending someone, who asked me to wait outside. No prob. Lovely day out.

The person he was dealing with came out, and I went in. I'm not here to rob you, I remarked. He smiled. What can I help you with? he asked. I want to deposit a cheque, I said.

He said, If you don't need to cash your cheque, you can deposit it at the front door into the night depository. Put it into an envelope, write your name, your phone number on it, and what account you want it to go into. 


Oh, OK. And out I went, walked around, went into the front foyer of the credit union. I had never used any of the stuff in there before. A table had been placed in there with envelopes, a pen, and instructions. I got everything ready and opened the night depository handle. A large bin folded out, but no slot to put an envelope into. WTF, I wondered.  Closed it. looked all around, couldn't find a slot, tried again, nothing. Then I saw a notice that had been scotchtaped juuuuust a little outside my tunnel vision, a completely psychosocial phenomenon, not ophthalmologic. OK, it sticks. Got it. I applied a bit more determination and violence to the effort and shazam, it opened wide enough to stick an envelope in the top.


Inner boundaries


I have spent my entire life doing more with less effort. It has informed my professional existence the most; once I decided I wanted to become a manual therapist and leave hospital work behind in the early 80's, I found myself leaning hard away from all heavy high-velocity mobilipulation out there and toward slower lighter kinds of handling. In part, this was because of my own lack of decent leverage, in part because I am by nature a ponderer and experimenter, not a recipe follower. I always felt inadequate in almost everything but persevered anyway, figuring out early on that "pain" was usually more about how somebody was feeling, not precisely what, so it made sense to go slow and include the patient in their own recovery from it. There is nothing that can make a late-to-the-manual-therapy-party, short, wide-ish physio with no natural athletic capacity less confident about her future than expecting her to assume that all pain comes from joints or ligaments and that banging around on them will magically "fix" pain that supposedly is coming from them. I realized quite early in the process that I loathed orthopaedic manual therapy with a vengeance. It brought up all my inner porcupine quills no matter what I did to try to grok the nonsense that was being conveyed as part of a set of physical skills.

But I digress.

Anyway, I ended up slowing down and lightening up instead with physio practice and indeed most other things in life.
These days I realize how that is a detriment to me, now that I have retired from actual practice. Now  I see that sometimes an instinct toward higher velocity and more force is a good thing, especially when it comes to opening a sticky night depository bin. I am much more inclined to practice increasingly more ballistic maneuvers at home with my set of colourful barbells that weigh everything from 1 pound to 15 pounds.

Previously: Part 3

Thursday, April 16, 2020

Boundaries in the age of COVID: Part 3


Part 2
Part 1


It's all I can focus on these days, our little viral upheavaler.
Careful what you wish for.
I had wished for a sabbatical and I sure got one. 

So have we all.
When the world starts to spin into new and unfamiliar orbits the mind tries to cope.
Mine seems to be making its way carefully along a rock face, not able to either ascend or descend, just crawl sideways.
The places to grip are far apart but I can still reach them.
The places to put one's feet are likewise still reachable.
Rock climbing is not a sport of choice for someone like me, with short wingspan and Homer Simpson physique, but rock climbing seems to be a good metaphor for the moment.
And even moving only sideways along a metaphorical rock face feels better than not moving at all. 

.......

As John Vervaeke would say, flow is what we all seem to strive for as humans, and relevance realization is one of those cognitive capacities that is more verb than noun. 

I spent most of last summer and fall watching his "Awakening from the Meaning Crisis" video series.
He used rock climbing as his metaphor for focus on relevance-seeking and realizing that results in achieving a flow state. The stakes are high: one wrong move results in obeying the law of gravity/death. But people do it because they love the feeling of flow.
I would argue that they are a bunch of crazy adrenaline addicts. But hey, it's not my place. 

....

He also discussed framing at great length. He would take his glasses off and said, here's the thing - you can look through these frames, which is like looking at life through all your own biases without even noticing them, or you can become aware of them (take them off) and examine them cooley and objectively. 

He would carefully point out how we can get so used to our cognitive biases that we literally cannot conceive of any other way of seeing the world around us: he would present the nine-dot problem, three lines of three dots in a grid, to be solved with four straight lines drawn through every dot. The only solution is to expand the field around the dot grid and draw outside the "box." 
.....

I learned a ton from watching him explain how the mind/brain works. 
His real passion, however, seems to be to find a non-religious way of finding personal meaning in existence, human existence. Both his own and helping others to find theirs. 
He suspects that this is the basic human condition. He is steeped in philosophy and religion and not so much in politics; however, he knows what he doesn't like, and I found myself in agreement with most of that. For example he doesn't like how the 20th century unfolded with all its war and bloodshed or any of the philosophical trajectories that led to that. 
That's how I rock and roll too. 
Understanding what I don't like then either grey-rocking it or arguing against it. 
...... 

I soaked up a huge amount of history as a result, which led me to the Great Courses, where I watched a ton more video series on history and philosophy, all the kinds. Ancient world history. Roman Empire. Egyptian. Persian. Middle Eastern. Mongolian. European. Women in Middle Ages. China. Japan. Vietnam. Black Death. Russian. Soviet. All these and so much more. American history through about 5 different lenses.
The Great Courses is American, so there isn't any Canadian history to find. There is ancient history of the Americas, Aztec and so on, but nothing on how Mexico came to be. Just colonial history that reflects on how the US came into being. Of course. I mean, what's there is great, just not complete or inclusive. 

This is how the US and US culture is.
Self-focused.
I do not blame it for being such - lordy knows it's a big cauldron with a lot of boiling problems and always has been.
Recently I've been watching Heather Cox Richardson's live videos on Facebook. She's amazing. Here is her video today. 
......


Today Trudeau talked about the relationship between the US and Canada and ever so statesmanesquely explained that a special friendship exists that is different from the one Canada has with all its other friends and etcetcetc. This was in response to a context in which yeterday trumple decided to halt funding to WHO.
If you can imagine.
At a time like this.

.....

There is a video on Twitter today, Angela Merkel explaining ever so cogently why social distancing needs to be maintained. 
There couldn't be a better reason for continuing to vote for her as leader of the free world. She gets the math of it. 

... 


Physical distancing

Yesterday I took my overflowing recycle baskets downstairs to empty them into the recycle bins.
Wouldn't you know it, there were two women who live in my building chatting in the foyer where the mail boxes are. They were talking as I left the elevator, and I quickly escaped into the parking garage without them trying to include me.
But dammit, they were still talking when I came back. I wanted to pick up my mail, which I had not picked up in literally days.
They sounded like they were winding up the conversation, so I waited in the parking lot. One of them came out of the foyer into the parking lot. I stood at least ten feet away from the door. I did not have a mask on. I had chosen to not put one on because the last 5 times I've recycled I had run into no one. Dang, my luck clearly had just run out.

So, woman number one and I exchange glances.
....


The back story here is that this is Weyburn for Pete'sake. People here loooooooove to visit with each other. They really do. They talk and talk and talk about absolutely NOTHing. Just to hear each other's voices and bask in the reciprocal attention, because it helps them feel real I guess.
I remember when I first moved back here a decade ago how it drove me nuts, people clogging up grocery store aisles, doing what they call "visiting," chatting, gossiping, talking their deepest thoughts about the weather or whatever while I, who had arrived from large anonymous city existence and was used to it, fumed to myself about how they were in my way and was I invisible or something? It felt like I had landed in a large swimming pool of peanut butter, the pace of life seemed so fking slow. 
I mean... I understand, and on the whole, a slow pace of life with a lot of personal social contact even if most of it is full of irrelevant gossip is not a bad thing, it's even therapeutic probably, but sheesh. 

....

So, these two women must have thoroughly enjoyed their recent chat. The one coming through the door was still all aglow from it - I gave her the look that said 'I'm social distancing' and she smiled warmly at me and announced to woman number two that "There is a lady out here waiting."
Dang! I wanted lady number two to not know I was here so she would move along and I could have the foyer to myself. But instead she stuck around! I had to decide if getting my mail was worth endangering myself with no mask on, and chance her talking to me. Stupidly I decided to take the risk and stepped into the foyer, walked past her. got my mail. Meanwhile we said hello to each other. I don't engage with my condo neighbours much, never have. But she held the elevator for me!
Dang!

I said, you go ahead and I'll catch it later, but she said, no, we'll be fine if you stand in that corner and I stand in this corner.
Which wasn't true, because the elevator is only about 5 feet wide, not six.
So, dang. I had to make a new decision, made the second wrong decision of the day and got in the elevator.
The elevator in this building and the parking garage doors are both set to be veeeeeeeery slow to open and close. I'm told by the guy who is chair of the condo board that this was deliberate because people coming in to live in a condo after living on the farm all their lives found things too fast for their personal comfort so all the mechanisms had been slowed down to accommodate them.  

I was very aware of this and still, I overrode my own personal boundary to keep peace and remain socially acceptable and got in. Yes, I stood as far away as I could. Yes, I made minimal eye contact. She was chatty, I was yes/no.
But still, I could kick myself for succumbing in the moment to having been socially polite instead of personally defiant.
If it ever happens again, I'll do better.
Dammit.



 

Monday, April 13, 2020

Boundaries in the age of COVID: Part 2


I appreciate WHO, and the struggle they are having trying to care for the health of humans, not just in one municipality, one city, one state or province, not just in one country, but everywhere all at once. It's clear that their tool is data as they struggle to collect as much of it as they can, dealing with all the multiple intersecting verbs of existence, gears that affect other gears, different political systems that have differing ideas about what constitutes relevance or truth, trying as clearly as possible to present recommendations without being dictatorial about it. 
I have found it useful to consider boundaries.
Boundaries as containment systems. 

Boundaries as limits. 
The old boundaries vanished and new ones are in place. 


Physical boundaries:
Face masks contain breath moisture. They are a deliberate boundary between exhalations of discrete persons. This simple fact spins me off in many different directions of thought. Way long ago, before COVID, viral concerns were a real concern, mainly in Asia; I remember visiting Taiwan just two short years ago and noticing the immigration official at the airport who interviewed me at entry to her country wore a mask. It was a novelty to me.
Most of the rest of the folks I saw there, in streets, restaurants, milling around tourist attractions, in museums, did not, but some did. I asked my hosts about it. They explained that it was fairly common when people were concerned about either having an illness and not wanting to pass it on, or didn't want to catch one from someone else. My attitude at the time was that they perhaps had a touch of paranoia. I still (naively, in retrospect) trusted my own immune system to be able to deal with whatever life might throw at it. 


Travel boundaries:
In mid-February I attended the annual San Diego Pain Summit, 6th year in a row, no restrictions yet on travel between Canada and the US. Life as usual. It seems like a distant memory even though it was only two months ago, because so much has happened since.
I had to get up hideously early on Feb 17 to catch a cab at 4am to get to the airport to come home. The (Asian) cab driver was sick, and was wearing a mask. A very sturdy looking mask. He didn't make any conversation or eye contact. It crossed my mind that I had heard there was a virus killing people far away, but hadn't heard anything about it being local, so I assumed all was probably well in North America. 

He did touch my bag (in and out of the trunk), and he did hand me a receipt.  
I like to imagine he may have been sanitizing his hands like crazy out of my view. And he certainly took great pains to not breathe on me.
I came home feeling fine, have had no symptoms for the past two months. I hope I'm not a typhoid Mary for COVID, one of those asymptomatic people who sheds live virus. 

I did treat a few people after I came home, just a few, as my practice was slow as molasses anyway, a good thing in retrospect: I have always made a big deal about "washing" my hands with a Clorox wipe before touching anyone, even in pre-COVID days. This was before masks were an acceptable thing for asymptomatic people.
I have tried to not breathe on anyone anyway since all this came to pass. I haven't treated anyone since mid-March. 

The grey zone. 
I was in it and still am.
No way to be tested if you are or were asymptomatic. 
You had to have traveled AND have symptoms. The quarantine rule if you had recently come back from somewhere else came up a lot later where I live, mid-March I think.
......
I think I'm clear. I mean, I gave my 96-year-old mother a ride to and from the hairdresser mid-March and she's fine as far as I know. (Unless she's another possible asymptomatic Typhoid Mary... perish the thought.)

The hairdresser was already sanitizing surfaces and having customers wash their hands. Hair salons are currently closed by provincial request. 


Financial boundaries:
Shortly after I came home mid-Feb from San Diego, future travel plans went totally sideways with the cancellation of all my workshops. Air Canada fully refunded my plane ticket to Asia for teaching workshops in Japan and Singapore, because I had booked the flight in December. So now I have nice fat credit applied to my credit card. That should keep me in groceries for several months; cash transactions are now forbidden. 
....
Just to be on the safe side I applied for CERB. CERB is the Canada Emergency Response Benefit. I qualify, because I earned more than $5000 last year and this year I will earn zip. Nada. Nothing. 

I do get an old-age pension, and they may clawback some, but it won't be for another year or two. Suddenly the government is made out of money and they are firehosing it out onto everybody. Two thousand dollars a month for 4 months.
That's a good thing. Even though it feels totally weird,  a very very flipped boundary in the citizen-government relationship. 



Cultural boundaries:
It was an unfamilar cultural boundary I was experiencing when I was in Taiwan and saw mask-wearers walking around, a cultural boundary which I now consider to have been blown right out of the water, because it's being encouraged here in Canada now.
My own Prime Minister, in the course of asking people to please start wearing homemade masks, made a verbal gaffe while addressing the nation on TV about not wanting people to "speak moistly" which, right after he said it, he commented that he had not put it very well. His very rare verbal gaffe has been made into a comic video. Which brings me to...


Personal boundaries:
He has not publicly commented on this video - it's likely that he has seen it and has decided to "grey rock" it. Grey rocking is when you either let something sit there, as completely inert and unremarkable as a grey rock, or else be a grey rock, and have the same attitude as one might expect a grey rock to have. Either way, not putting any emotional or reactive energy into a phenomenon, especially if you are a public figure the way he is, is to possess excellent personal boundaries that will serve you well in your role as PM, channeling yourself into what is important for the good of the congregate you have been elected to serve, rather than into personal issues or proclivities publicly displayed which serve no one.
He not only exhibits good personal boundaries, but also smart political boundaries. Which brings me to...


Political boundaries:
He has some.
I've been thinking about him a lot, comparing his political boundaries to those of Cuomo and Trump, both of whom I also watch every day. Well, not Trump every day, because he doesn't provide any food for thought, but I've watched him bloviate more than I usually do. And I am prompted to contemplate stark contrasts, how they arise. 
Contrasts between political systems, the ones of Canada and the US even though we are all on a continent with a virus that doesn't give a shit about political boundaries. 
Contrasts in political parties in the US, Cuomo inhabiting one and Trump the other, how Cuomo seems to have a value system in his innermost self and how Trump seems to have none whatsoever and how each of them line up rather well with their respective parties, although I confess: I have massive bias against anything that smells the least bit rightwingy. There is so much here. Maybe later.
Back to Trudeau - he was raised by a statesman and has become a statesman. He's not of the party I usually vote for, but I like his style. 
The party I vote for, where my loyalty was born and has always thrived, is to the left of his. It is the party that was led by Tommy Douglas when I was a child. But I still can admire Trudeau's style without losing any loyalty to my own set of political values.
My party is an outsider party, a leftoid party, sees itself as a party of some distant better future, has a history of reform, religiosity even (Douglas was a Baptist minister), views itself as a pro-social conscience of the nation. I like these values. I feel I somewhat embody them. I've always been a walking contradiction in some ways, pro-social even as I never was interested in reproducing more humans or committing to having anyone else living in my domicile but me, inhabiting a profession with which I disagreed vehemently about certain things, loving some things it stood for and thinking other things it stood for were conveniences more than they lent inherent value to it. I feel quite comfortable agitating from the outside. 


Physio boundaries:
Although I never married, never wanted to, I ended up married to my profession for better or worse. I have put a lot of emotional and professional energy into fomenting change within it which took many decades to clarify to myself first (no easy task) then implement in the form of a book and workshop format.
A lot of physios seem to end up becoming administrators when and if they realize they aren't suited to treating of people. I've never been one of those. I've always been more interested in individuals and their pain problems, never in systems, or meetings, or in general in being part of something bigger than myself. Myself has been more than enough to try to figure out over a life span. Also, whenever I've toyed with being part of something bigger than myself, socially, part of a system or a group, even a progressive group, I have either felt submerged and made to feel invisible to myself, a cog in a machine, or I've become competitive and strove for excellence and realized that if you do that you get promoted to your level of incompetence and have to endure stress about that. And that kind of stress was always enough to make me break out in skin rashes. So I've always been more comfortable as a human, being a lone tumbleweed rolling around by myself, bumping into fences, walls, and so on sometimes and coming to a halt for a while, then having lots of time to think.

....
I retired today, for real.
Up to now, I was thinking it over, sometimes out loud. I had been thinking about it for months and months and months. The plan was, keep my practice up until March 2021 at which time my provincial license was due again. Huh. I guess according to the boundaries of my legislated organization I'll be on the books until then anyway. Whether I pay rent and keep a door open is a different thing. I can still do one (be on the books until the current license is up) without having to do the other (physically maintain a practice).  

I had to reorganize my own inner boundary about all that. 
It was hard work. 
It was emotional work. 
It was like divorce. Instead of staying married and celebrating a fifty-year anniversary, it was more like, ok, we've been at this 50 years so now we can quit this marriage and liberate each other from it.
Come May 1, I'll have to deal with my treatment room and its contents and I won't be paying rent anymore.
Today I went in and left a "goodbye everybody, I'm retiring" message on the phone. 

It felt poignant, and even right now it feels a bit like the skin on the front of my chest has been sandpapered. 
But I also feel a burst of energy now that the deciding is finally done. 

The virus and the boundaries it has imposed:
Here we all are, all of us now a big bunch of human tumbleweeds all trapped, blown up against a fence, trying to find paths forward, trying to see the bends in the future and what direction they might go. 
Somewhere I read that the symbol in Chinese for "chaos" is the same as the one for "opportunity."
I don't know if that's actually true. Maybe I should check with Asian friends.
In any event, it seems that the virus has handed us a fabulous opportunity to reevaluate, maybe even re-invent ourselves, our existence on the planet as connected to nature, each other, our social worlds, able to examine all the boundaries and containment systems that grew as though by themselves and later generations adapted to but maybe, just maybe, we don't really need some of them, can move others, can change a few things in society in order for there to be less horribleness to each other, as humans, still being. 




Sunday, April 05, 2020

Boundaries in the age of COVID

Boundaries. 
Appropriate boundaries.
Social boundaries.

Emotional boundaries.
Sexual boundaries.
Age and experience boundaries.
Comprehension boundaries.
Education boundaries.
Personal boundaries.

Physical boundaries.
Professional boundaries.
Conversational boundaries.
Therapeutic boundaries.
Family boundaries.

Language boundaries.
Cultural boundaries.
Civic and municipal boundaries.
National boundaries.
Political boundaries.
Epistemic boundaries. 




I've had to deal with all of them over a lifetime, I think, either as a boundary setter or a boundary obliger. There may be some I missed in the list. Boundaries seem to be what being a human is all about, negotiating them artfully and successfully. We all have them, and any encounter with another human involves strategic navigation of them. Some are easy to navigate, others are harder. I imagine the more people are involved, for example in governing a country, the harder it is.

One of the ways I keep myself busy these days is sitting back at home (because it saves lives!) and watching leaders lead on live stream on my desk top.

I have watched Andrew Cuomo, governor of New York,  plead for his federal government to help his state by taking charge of a national crisis and not leave states to fend for themselves or have to compete for masks and gowns with other states, the federal government, or other countries. (New York City is in trouble with COVID, big time.) He is always careful to separate his delivery of facts as they emerge, separate from his own personal musings upon said facts and his role as leader and his ongoing playfight with his brother (who tested positive).

I have watched Trump, who seems to have attention deficit disorder at the best of times, put out baffling and confusing and contradictory messaging. He seemed to actually come temporarily into focus a little better when it was proposed to him that he could play the role of a wartime president. His lack of boundaries of all kinds borders on pathological.

I have watched Trudeau, my particular Canadian leader, emerge from his cottage where he quarantined himself, to deliver a briefing, day after day. He is the king of boundaries. He gives facts. He answers questions straight-forwardly most of the time, in two official languages. He skirts all questions about his own personal attitudes toward other leaders. This is also known as being politically wise.

So, these are the three main players in the mask dilemma, act one scene one.
The play itself is about what happens after a country that has dominated and still dominates an entire continent, pretty much, decided in longer ago times to allow its companies to make way more money by abandoning workers in their own country and go offshore to hire workers in factories overseas who would work for much lower wages. It's the old David and Goliath story, but without slingshot.

One such company (3M) is a mask-making company. It makes masks but not many right at home. Turns out the raw materials for making the crucial kind of masks come from elsewhere, i.e., the pulp to make the paper in the masks comes from Canada.

Hmmnn.
Boundary issue.

Watching Trudeau navigate these boundaries is like watching a political athlete do perfect pole vaulting, every single day.
I must say. I do not envy him. The Canada/US border is one of the longest borders anywhere and has had to be one of the most elastic ever since it was put into place. 


The way Canada has dealt with the relationship between itself and the US ever since Trump was bizarrely elected has been that each Canadian official has developed, nurtured, and managed a relationship with his or her closest counterpart in the US government, a strategy they call Team Canada. It worked quite well for the NAFTA renegotiation, one is given to believe.
Together they think they can get the mask business sorted. At least that's the reassuring message from Trudeau, every day. He points out that just a few days ago the US wanted to put military at our common border, but that sort of blew away after Canadian officials pointed out how it didn't make any sense.
In these days of COVID, it's not lost on any of us that thousands of Canadian nurses travel back and forth to the US to work there, and they need US-supplied masks when working in US hospitals. It's not lost on us on an even more basic level that most of our food comes from the US. Mostly California. 

Tricky boundary navigating times are upon us.

The Canadian government and Public Health officials came up with a new word, "Care-mongering." It's been working so far. Quite different from war-mongering.

Sunday, March 15, 2020

Interconnectome

Coronavirus has put a halt to almost all travel plans I had this year. 



I'm waiting with bated breath to find out whether or not the Regina class, which has 40 people registered and has been full for weeks already, will be canceled. About a week ago I asked the organizer to find lots of hand/surface wipes to have for the class. She did - 4 large containers of unscented lysol wipes. Mere days and hours before shelves were laid bare by other anxious people. Hopefully they will suffice. Hopefully the class will take place. 
The one in October in Alberta, right next door, is still in the process of being organized. 
Anyway, instead of taking a year off in 2022, which was the original plan, looks like it's this year instead. 
If anyone really wants or needs to take the class this year, they can take it online from Embodia.

Lemonade from lemons. 

I really do need a rest. I've been traveling/teaching non-stop since 2012, a lifestyle which I never expected and I find super-fatiguing. It's nothing like the hectic schedule many of my much younger colleagues keep, but it seems pretty full to me, six or seven or eight strenuous 3-day teaching events, most of them involving long distance flights, per year. My bounce-back-ability gets smaller every time just like my telomeres do. That my rest came earlier than planned is, at a biological level, totally fine with me. I can rest up and beef up at the same time over the coming months. Weight-lifting is something that actually feels good to me when I'm not too tired to do it. I have weights at home that I lift in a variety of ways.

Even so, I found it hard to cancel these plans - I like all the people I've met all over the world. I feel connected to them. An interconnectome I never could have imagined. Now disrupted by a virus (another kind of interconnectome dealing disease and death) that knows no bounds except soap and water and hand sanitizer. 


Social distancing is a big effort. Maybe it should be called biopsychosocial distancing. Thank goodness for small mercies like the internet. One does not completely lose contact with one's friends. And at least, the San Diego Pain Summit took place as usual before travel restrictions started happening in March. It was an infusion of warmth and good times and will have to last for the rest of the year by the look of things right now, today, March 15, the Ides of March. The div-Ides of March. 

Wednesday, February 26, 2020

#SDPAIN2020 Final chapter

There were many good speakers throughout the weekend including my old friend Dave Walton, who presented his current research in a presentation with the intriguing title, Blood, Spit, Hair, and Poop: How Novel Biomarkers Are Shedding New Light On The Transition To Chronic Pain.
Dave Walton
Photo credit Julie Tudor



I met Dave long ago (2005) when we were starting up the PainScience Division in Canada. Here's the story in point form. 
  • David Butler (in Australia) moderated a physio discussion forum in the early 2000's, where I met Nick Matheson (from Nova Scotia). Nick contacted me in 2004 with the idea that we should ask CPA to let us make a new division, a pain division. He had to drop the project early though, for family urgent family reasons. So, at that point, I was it. 
  • I realized Neil Pearson, another discussion group member, was living in the lower mainland near Vancouver, where I lived at the time. I contacted him and ran the idea by him. He was in. 
  • I contacted Dave Walton. I remembered a letter to the editor of the ortho group's journal in which he mused about there being a special interest group someday in Canada for physios. He was in. A few others heard the news and wanted in. Soon we were a group of 6 or 7. 
  • CPA didn't want another division at first. So we made a group anyway. Dave built a webpage and we posted stuff on it. We suddenly had a profile. We made newsletters that I sent around to a mailing list that developed. We called ourselves the Canadian Physiotherapy Pain Science Group. 
  • Eventually, we became a division in 2009.  I served on it as a comm-liaison until 2013. Both Dave and Neil served two-year terms as chair. I retired after CPA locked down our stuff and I couldn't deal with the tech side of things on their complicated website. 
Anyway, this year at the summit Dave showed up!! It was good to catch up with him. He has published a book, had it there for sale, was signing it. 

Dave's book
I'm giving it a read. So far, so good.


...........


The panel discussions were wonderful - and Rajam has made both of them available for all to watch. Challenging. Provocative. Graded exposure, health care people. Graded exposure. If the summit can give you anything beyond more facts and knowledge to digest and a wonderful safe relaxed space to meet interesting people, it can give you digestible graded exposure to the difficult psychosocial topics of life.  


THE LIVED EXPERIENCE: A CONVERSATION ABOUT PAIN

Joletta Belton and Keith Meldrum co-presented The Lived Experience: A Conversation About Pain. Both of them had harrowing experiences, not just with their lived pain but with its exacerbation by well-intended but humanity-less medical "systems" of care.
I know those systems quite well, was part of them in younger newly-graduated days. 

They do tend to suck away the soul; my training as a physio did not equip me to handle other peoples' souls very well. I would advance the idea that we are all trained to be operators, working from concepts only, doing stuff to people, instead of interactors, knowing boundary skills on how to be with people. After a while, I realized that "systems" would be the death of my own humanity, so I went private, where I could salvage and deploy whatever was left of it. But when you are a helpless patient they are the mental meat grinders you are forced to go through, for better or worse - great for keeping you biologically alive but not great at helping you become un-shattered psychosocially; in fact, they can make those components of the lived pain experience much worse. 
I have concluded, after 50 years of being a physio, that these "systems" evolved to provide space and distance to protect helpers from the angst and pain of the people they are presumably trying to help, but they backfire bigtime for the person enduring a lived pain experience. 
Mostly. 
Not always.
But mostly. 

You can watch their presentation (and presentations by others from previous years) here



Joletta Belton and Keith Meldrum discuss their experiences
being patients with chronic pain

KNOW IT, OWN IT, CHANGE IT - TRANSFORMING THE WAY WE THINK AND DO HEALTH AND HEALTH CARE FOR THE GOOD OF ALL

This panel was with Sandy Hilton, Mark Milligan, Maxi Miciak, and Uchenna Ossai. They tackled topics of discrimination, white fragility, redlining, systemic barriers to health care, institutionalized racism, colourism; all the psychosocial stressors people in marginalized communities and identity groups put up with daily and take a huge health toll. This is hugely educational. You can watch it for free at this link




Audience (me in the red shirt)
Photo credit: Lisa Flores

...........................

REGISTER FOR ONLINE ACCESS TO ALL THE PRESENTATIONS OF ALL SUMMITS TO DATE

All the presentations were great. Rajam has made ALL the summit presentations, to date, available by paying her only a few hundred dollars. Six summits worth of high-value education, for just a few hundred dollars. She wants the world to transform itself toward better health care. Not just talk about it, but DO IT! You can gain access to this amazing body of education at this link


UPCOMING SUMMITS

This fall's SD Pain Summit East, in Charlotte, North Carolina, is at this link. Sign up now. 

Next year's San Diego Pain Summit in San Diego is at this link. Sign up now. 

Thank you Rajam, for everything you do. See you next year!!