Stumbling Into Place

14 weeks ago today, I stumbled in my living room and ripped my hamstring clean off my hip.  Little could I imagine at the time how that unforeseen stumble would shape the next few months.  I returned to work 2 weeks ago to a new workplace completely different from any job I have ever had as a nurse.  I am pleased to say that after completing my first 2 weeks as a nurse case manager, I feel I have "stumbled" into the a wonderful work environment with collaborative and dynamic teams that permeate a culture of mutual respect.   It may be generous to say I am grateful for my injury, but without it, I don't know if my eyes would have opened so readily to this new opportunity for change.

Rehab at the bike/desk on my lunch break!

     This was not just any job change for me.  I found tremendous joy working as a Labor & Delivery nurse.  When I looked down the barrel of my post-surgical recovery, making the choice to leave was not an easy one; it was the result of countless hours weighing the values of joy, family, balance, health, recovery, and finances.  Believe me, I had countless hours on the couch, especially those first 6 weeks, to think about it!

     So here I am; a full-time working mom, juggling day care for a toddler and summer vacation for a 6 year old.  It is not easy, but it is a hell of a lot easier than running after a toddler after ripping off your hamstring!  When Michelle made me a mom almost 7 years ago, I felt a strong sense of duty that I, and not someone else, should raise and care for my child.  Why would I pay someone else to raise my child? And then Emily came 15 months ago and things got a bit more complicated. And then came the hamstring avulsion and things got a LOT more complicated.  Now I am the mother I thought I would never be: I go to work to make the money to pay other people to watch my children.

    But here is where my values have not changed. Even before the injury I was losing it.  Losing my shit. So burned out with the day to day grind of motherhood that I was not parenting anymore, at least not the way I envisioned.  I had over scheduled my kids, running around town as an under-paid chauffeur, short-tempered and reactionary. I had one day a week at work to enjoy stimulating adult interaction but was so exhausted at the end of 14 hours that I had nothing left for the girls...or my husband Barry for that matter.  When the injury happened and I could no longer run, chase, squat, drive, or actively play with my girls, something had to change.  It hit me.  Maybe, just maybe, if I work an 8-5 job and find daycare for Emily and after-school care for Michelle, I will actually be more available emotionally to my family and a more effective parent.  

    Ripping off my hamstring helped me realize that it is okay to recruit other people to help you with your children.  It is fair and equitable to pay someone to help you with your children if fulfilling your career goals makes you a more patient and effective parent.  Though it is heart-breaking to hear Emily's sad cry when I drop her off at day-care, I am happier and more patient with her sweet cheeks and toddler tantrums when I pick her up at the end of the day.  Michelle and Barry get a mom/wife who is not so quick tempered since she has been participating in meaningful and fulfilling grown-up work during the day.  Oh...and then there is the pay-check.  I'd say it's a win-win.

     I have 2 great perks with my job in regards to rehabilitating my injury: my office is next door to the orthopedic center where I have PT once a week, and we have a mini-gym at the office complete with treadmill /bicycle desks! Sitting longer than 30 minutes is still challenging for me, but our computers are adjustable so I can pop up to stand and still continue working effectively.  Stumbling in my living room has resulted in so many positive changes, it is hard not be a little bit grateful for the temporary set-back and inconvenience of it all.

Who knew? I'm a cubicle nurse!

     

10 Weeks, I See a Light!

I see the light (in Wyoming)

     Post-op protocols vary wildly for hamstring avulsion.  From brace vs no brace, early weight bearing vs later, early PT vs late PT, instructions are all over the map.  I have adhered to my surgeon's protocol diligently and as of last Friday, my surgeon felt I had exceeded expectations for healing and gait function.  I would say my protocol tends toward the conservative side, and for good reason.  Tendons and ligaments are slow healers without a lot of blood vessels to feed the healing.  Working a muscle before the tendon is ready to bear the load has a high potential for re-injury, or injuring other supporting muscle groups that are forced to compensate when the affected muscle/tendon group is not ready to play.  I am not terribly competitive by nature, but I admit extreme satisfaction to be told I was ahead of the curve!
     Over the past 4 weeks, I am astonished at how much my range of motion has improved. 4 weeks ago I was unable to flex my hip enough for the recumbent bicycle.  Today, I rode on the upright stationary bicycle for 20 minutes.  4 weeks ago, I could barely flex my left knee past 90 degrees.  Today, I sustained a comfortable "childs pose".  The scar tissue "tightness" I felt at 6 weeks is virtually gone today.

Emily slept, I hiked!

     Admittedly, I probably pushed harder than I should have over the weekend. We were in one of my favorite places near the headwaters of the Green River in Wyoming and I felt great.  I weathered the 4 1/2 hour drive with minimal discomfort and found walking on the dirt roads easy.  Barry was carrying Emily in a framed baby backpack carrier and Emily was a huge fan.  Emily has always slept well while being worn, and was badly in need of a nap. Since I felt so good, I popped 25 pound Emily into the pack and Barry helped her onto my back for about a 1 1/2 mile hike on a dirt road. It worked.  She slept, and I hiked...without pain.  I imagine that by  the fall, my favorite time to hike in Utah, I will be back to many of my favorite local day hikes that feed my soul. I was shocked at how strong I felt, but nervous because this is when I know I could overdo it and have a set back. 
    To get busy learning how to NOT overdo it while gradually strengthening my legs appropriately, I had my first Physical Therapy treatment today. Overall, PT went well.  I was able to perform all the exercises but was shocked at how weak my hips actually are.  After hiking with Emily on my back, I thought I was totally killing it.  But today, I could feel my legs shaking just doing simple bridging and hip strengthening.  My PT, Robby, was great.  Though he was not very familiar with my rare injury,  his skillful knowledge of healing tendons put me on a plan of treatment to gradually strengthen while protecting the repair.  Many people have been telling me how "great" my walking looks, so it was the reality check I needed for Robby to point out that my gait is still a "little wonky looking".  Oh yes, we have some fine work to do!
     There have been times I wished, mostly out of my own impatience, that I was on a more aggressive protocol.  But after my small hike this weekend, improved functional range of motion, and my PT session today, I am certain that I have been doing the right thing for my body.  As a recreational athlete, there is no race for me to win.  Only the intrinsic joy of moving my body through the activities I love.  A slower pace may actually be the key to winning my race.

My Baby Ate Poo

Too cute for poo! You see the problem in the
kitchen with keeping eye on baby while
engaging in food prep.

It happened.  Emily, almost 14 months old, ate her own poo.  Apparently when Michelle was a toddler, she engaged in this behavior once or twice as well.  With both girls, I was not present to witness such a milestone, but must rely on the account of Barry.  Perhaps they were showing off for daddy.

     The incident had a suspenseful set-up.  Around 4:00 PM, my step-mom who had been watching Emily all day, picked up Michelle from school and joined me at the pool after I finished my aqua-exercises.  I met them in the locker room and my step-mom let me know with certain trepidation that Emily had not procured a bowel movement for her all day.  If there is anything you want to be sure of before getting your toddler into her swim diaper, it is that she has thoroughly emptied her bowels BEFORE getting into the pool. With two excited girls ready to swim, we took our chances and dressed Emily in her swim diaper, cover, and swimsuit, per pool regulations.

     At this point, you are probably thinking- and then she pooped in the pool! Right? She did not poop in the pool.  Giant sigh of relief!  With the poop bullet effectively dodged, we opted to dry off quickly and shower/bathe the chlorine off at home.  At home, I fed Emily some dinner while the tub was filling up.  This was a super bonus for her! Emily loves loves loves the water so to go swimming and then get in the water after was a huge win.  But alas, no poop.  With certain caution, I set her in the bath with fingers crossed that we would not end up with floaters.

     At this point, you are probably thinking- and then she pooped in the bath! Right? She did not poop in the bath.  I dried off her chunky delicious rolls and handed her off to daddy so I could get in the shower myself.  

     Apparently, from Barry's report, it went a little something like this; Emily waddles out naked-baby style with giggles of glee while Barry continues prepping dinner.  We do not have a kitchen island (something I plan to remedy once a few paychecks come in from my new job), so prepping food must be done with one's back turned to the naked toddler who is ramshackling her way through the living room.  Assuming she had probably peed in the tub and could happily use some 'free bum time', Barry opts to delay diapering until after the cauliflower is chopped.  As he turns to do a spot check, he witnesses 'the face' followed by a very worrisome deep squat. Emily stands up, pees on the floor, and goes back into her deep squat to procure a few well-formed rabbit turds.  In Barry's horror, he frantically goes to grab paper towels but by the time he turns back around, it is too late.  Quite interested in these little brown things that mysteriously appeared on the carpet, Emily promptly picks one up, like it is no big deal, and pops it in her mouth.

     All this is going on while I am enjoying my peaceful alone-time in the shower.  As I rinse my shampoo, the shower curtain flings open.  Barry thrusts the naked child into my arms announcing "You need to take her! She just ate her own shit! There is poo everywhere...and brush her teeth.  I need to go puke now."  Barry has always admitted an easy gag trigger and this moment was no exception!  Emily, of course, couldn't be happier. This was a big bonus day for her. Pool, bath, AND shower? As far as she is concerned, this is her lucky day. She smiles at me in the shower, plays gleefully with the water, and proudly brushes her teeth before bed.  

  I'm not sure what the score was, but Barry and I agreed that by default parental fail, Emily won big time.

Invisible Healing

   

Dr. Emily says: "It takes time to heal."

Doc Martin explains: "The patient may look normal on the outside,
but intense healing and growth is happening on the inside."

In the past week, a theme circulated through the Facebook group of hamstring injuries I belong to: a theme invisible healing.  As we move through the healing process, there comes a time when we wean ourselves from crutches, the limp gradually disappears, and we try to re-enter our world.  Though we appear "normal" on the outside, the healing continues and accommodations must still be made to decrease pain and continue optimal healing.  As my cyber-hamstring buddies relay, they experience sneers from co-workers, pressure from family, and misunderstandings from close friends when we look normal on the outside but have pain on the inside. Even people who work in wonderful team environments with a generally supportive workforce experience it. Why does she need a stand-up sit-down desk? Shouldn't she be better by now? I saw her at the mall last week, certainly if she can shop, she can come back to work at full capacity! You look great, when is your next race? 

     Sharing our struggles with returning to work, I know that this problem is not just limited to those with proximal hamstring injuries and surgery. This unfortunate judgment and misunderstanding applies for all "invisible" diseases or health problems.  People are silently suffering everywhere you look.  Whether they are healing from injury, going through a divorce, facing mental illness including clinical depression, processing through grief, or dealing with chronic pain or chronic health problems; these situations can appear very normal on the outside while intense healing is going on inside.

     The thing that got to me most about the stories of my cyber-hamstring buddies is that they are amazing people!  Active, dedicated professionals who have given themselves fully to their occupations.  Don't they deserve a little credit?  Are they REALLY just trying to get out of doing their jobs? Are the REALLY trying to get special treatment? Nobody asked for their injury to happen.  It has created an extremely inconvenient stop in the momentum of their lives.  Everyone wants to get back to work, and everyone wants to be able to perform at their prior level.  The nature of the beast is that it takes time to heal.  Our injury is quite literally a pain in the ass, and even sitting for long periods is difficult for quite some time. Everyone healing wants desperately to get back to it! Unfortunately, our intrinsic healing mechanisms determine how fast this will happen.  For the most part, there is very little we can do or think to speed up the process. We are all optimizing our nutrition, heeding our doctors' advice, and participating in reasonable activity for our timeline.

    When I go up to work next week to clean out my locker and say goodbye, my co-workers may wonder why, if I have come so far and look so normal, I felt I had to change jobs.  Maybe some will think I gave up, maybe some will think I abandoned my post...or maybe that is just the doubting-Thomas in my own head, projecting my own fears.  In the end, I am the only one who can judge the physical risks I am willing to take. Our disability laws in the United States require employers to provide "reasonable accommodation".  For me, "reasonable accommodation" meant changing jobs.  For others, it may mean a special desk, working from home, or adjusted work hours.   

     I implore to all the colleagues, managers, and supervisors out there welcoming back anyone from medical or family leave, that the best "reasonable accommodation" to ensure maximum efficiency starts with a healthy dose of empathy.  Whether we are coming back after physical injury, medical treatment, a new baby, the loss or care of a loved one, or psycho-emotional crisis, we are back because we want to be. I challenge our society to take a few breaths and withhold judgment.  Be kind to each other.  Assume the best intentions and know these healing individuals are doing absolutely everything in their power to get back to where they want to be!

A New Job

Today I officially accepted a new job as a RN case manager and said goodbye to my wonderful job as a Labor & Delivery nurse.  I was writing a much longer post, but decided the letter I wrote to my co-workers sums it up.  Read the April 7 post, The Athletics of Nursing, if you want a closer understanding of the physical demands of my job and what set me on this new path post-injury.

Dear friends and colleagues,

As I'm sure you heard, 2 months ago I sustained an injury that detached my hamstring tendons completely from my hip.  I required surgery to repair it and have had a great outcome, recovering as expected.  However, the reality of recovering a major tendon repair like this is that it is considered excellent if after a year, my hamstring operates at 80%.  Due to the physical nature of our jobs, I have had to think long and hard about the risk of re-injury at the bedside and how that would impact my family. Considering all factors of health, family, finances, and work-life balance, I have made the very sad decision to leave Labor & Delivery.  For the past 5 years, I have been so fortunate to work with such an amazing group of people. The dedication, team work, and camaraderie of our unit has made it a joy to come to work every day, even on the hardest days. Facilitating the beginnings of life is intrinsically rewarding and has provided me much joy!

I am remaining with the University Health System and have accepted a position in case management.  L&D will be a hard act to follow, but I am optimistic that I will find joy helping people navigate the healthcare system, all while being gentle on my healing hamstring.  Keep up the amazing work you do. You make an extraordinary difference for our community and I will truly miss you all!

Love,

Kelly Martin RN

 

Emotional Work

About a week after surgery, I was perusing the internet for chat boards and forums for other people who have injured, avulsed, or had surgery on their proximal hamstring.  After a long thread on "Runners World" or some other site, a woman indicated that she just started a Facebook group for those of us afflicted with this injury.  Since these injuries are rare, this Facebook group has accumulated people across the globe to share experiences, rehab protocols, successes, and set backs.  The group has provided post-op comfort measures, tips on managing activities of daily living, but most importantly, has provided an psycho-emotional outlet for a group of active individuals faced with a sudden disability and the ramifications of a lengthy recovery on an active lifestyle.

     As we share our experiences, we relate, laugh, cry, bang our fists against the wall, adapt, reorganize, and accept the new path our lives have taken.  I direct this post to these new found friends who may be surprised to find how a physical injury deeply effects our emotional well-being and psychological health.  The loss of function is akin to deep grief; suddenly, the way we defined ourselves prior to injury no longer exists.  Whether you define yourself as a long-distance runner, competitive cyclist, avid climbers or hiker, leisure sports enthusiast, or any occupation with significant physical demands, our mental health is intricately woven with physical loss.

     Here's the short of it: on Thursday, I lost it.  My left hip hurt, my right hamstring (the good one) was feeling the extra load of 2 months of compensatory work. My baby was needy, wanting to be held all day (which strained my lower back) and wouldn't nap unless touching my body.  The utter exhaustion of the day triggered the fear of returning to work (still over a month away). To top it off, my strong-willed 6 year old dished out the evening home-work challenge and my husband and I were on completely different parenting wavelengths.  I felt an inner rage and fury well up inside of me. My head was dizzy with anger and perceived helplessness. I had 2 options in the moment: completely blow my top with an angry outburst like a two-year-old, or lock myself in my bedroom and disengage.  I chose the latter, which though the better option, solved nothing and left me with a fitful night of anxious insomnia.

    Friday morning, the anger continued when I couldn't find the receipt to return a pair of $8.00 shoes that were too small for my 6 year old daughter.  Eight dollars.  My eight dollar temper tantrum.  My sweet toddler sat on the floor of the living room watching mommy huff around in anger looking for a stupid receipt and began to cry.  She was completely beside herself, a little sponge soaking up mommy's emotional state. If I could put words into that cry, it was a little like this: "But mommy, where are you? I am always safe with you and now you are gone. You are here, but you are gone. I'm sad because I don't know how to feel safe right now when you are so upset." I picked her up and cried with her. I nursed her down to a nap and promptly texted Barry that I was completely losing my shit.  He suggested I take the evening off and leave the house and he would take the girls, if that was what I needed to do.  It was exactly what I needed to clear the fog.

     Here's the thing.  I got through this brief emotional crisis with a combination of family support, shared experience of my cyber-hamstring friends, and my antidepressant medication.  It is so important to recognize the toll that physical injury can take on our mental health.  If there was anything lingering before the injury, such as a baseline clinical depression like I have, it will require twice the attention and effort with the stress and ramifications of physical injury. 

     As I confer with my cyber-hamstring buddies, I hear a common rationalization when talking about their injury.  I am have said it myself that "Others have it much worse than I do".  This can be a good tool to give us big-picture perspective, but it can also disallow us to experience the grief that comes along with a serious injury.  It is NORMAL for the marathon runner to grieve not being able to run.  It is NORMAL for the rock climber to grieve not being able to climb.  It is NORMAL for any athlete to grieve the unknown if, when, and to what capacity they will be able to return to sport.  It is NORMAL for the bedside nurse to grieve the inability to return to a physically demanding yet rewarding work environment.  It is NORMAL for a caregiver, now acutely injured, to feel overwhelmed and misunderstood if they are the one who usually cares for a loved one with chronic pain or other chronic health problems.  It is not self-pity to feel angry about the situation. We are not weak for admitting that life just got a lot harder!
     I would like to challenge myself, my cyber-hamstring buddies, or anyone facing a serious injury, to absolve ourselves of the guilt of grieving loss of function, even if temporary.  Discounting the emotional component of physical injury because "others" have it worse off doesn't help when it's your body it's happening to.  When we embrace the loss, we can begin to see that our identity is not what we do, but who we are inside.  This goes beyond the trite cliche of making lemonade from lemons.  It is more like realizing you were not necessarily a lemon to begin with.  Pardon the fruity metaphor, but if you see yourself as a fruit bowl and not just the lemon inside of it, there are a lot more possibilities than simply making lemonade!
   It is hard physically and emotionally. And that is okay. 

In Limbo

Not quite in, not quite out

Not quite broken, not quite healed

Not quite started, not quite finished

Not quite fulfilled, not quite empty

Not quite belonging, not quite outcast

Not quite loved, not quite despised

Not quite successful, not quite failed

Not quite strong, not quite weak

Not quite running, not quite still

Not quite going crazy, not quite sane

Not quite changed, not quite the same

Not quite enough?

enough!

In limbo is plenty 

stalled, yet moving somewhere

un-aware of where