put your laptop to sleep for this

Tomorrow I go into the hospital to have some repair work done. The initial injury occurred over a year ago in an attack by a rogue chairlift when I was looking forward to a glorious day of skiing. The surgery doesn't worry me. The problem is that I won't be able to drive for a while, so I'll have to ask other people to help me with the simplest chores. And, instead of taking care of patients, I'll be one.

Some time ago I listened to a program on NPR about the factors that influence the perception of, response to, and recovery from a painful injury or condition. It focused on the differences in perception between persons who feel victimized by an injury, for example, a car crash, and soldiers who are hailed as heroes when they sustain injuries on the battlefield. 

In a futile attempt to revisit the program for the purposes of this blog, I reviewed a mountain of research and literature on the topic. It astounds me that so much academic effort is devoted to a topic that seems intuitive to me. We witness it all the time. Athletes who play through or continue to compete despite injuries that would sideline most of us. The fact that any woman would put herself through childbirth again, after the first ordeal. As opposed to the person who seizes on his injury or pain to excuse himself from work, or to gain sympathy.

"Pain is inevitable;

suffering is not."

~Haruki Murakami~

Many factors affect the way a patient responds to a painful injury or illness. In addition to gender and age, there is a role for:

• social and cultural norms and expectations
• past experience and conditioning
• the sense of victimization vs heroism
• the patient's motivational state
• his emotional state
• his religious inclination
• social support

"Often it isn't the initiating trauma

that creates seemingly insurmountable pain,
but the lack of support after."
~S. Kelley Harrell~

The easy part for the health care provider/therapist is to diagnose and treat the injury. The hard part is to understand the patient's attitude toward his pain, and how it affects his recovery:

• Is he angry, fearful, ashamed, or depressed?
• Who does he feel is to blame for his injury?
• Will he be able to work? Does he want to work?
• Where can he turn for support? Will he accept it?
• How will she take care of her children? Who can she turn to for help?
• Is he using his injury as an excuse or escape, or as a way to gain sympathy?
• Are his family and friends supportive or dismissive?

These dynamics suggest themselves when the patient fails to respond to treatment as expected, or is non-compliant with the treatment plan.

If you suspect this is happening, it may be time to put your laptop to sleep, look your patient in the eye, and sort through some of the other issues that complicate recovery from an injury, issues you won't find bulleted in the EMR. If you're the health care provider, you must explore the patient's whole story.

If, on the other hand, you're the patient, you must be honest and compassionate with yourself.

"Self-care

is a divine responsibility."

~Danielle LaPorte~

jan