While recovering from my postconcussion syndrome, I learned a lot about saying no and letting go. I’m not usually prone to doing this, so it was a surprise to me to find out that not only could I do it, but I have carried on doing it and enjoying it! I don’t have any literature to support today’s post, but my own personal experience (an N of 1 study!).
I wonder how often in rehabilitation or pain management, we even think about scheduling time for the people we work with to just do nothing. I think sometimes we might under-estimate the amount of energy that goes into following a programme of therapy. Here’s just a little from my experience.
Every day I was going to work for half a day, returning home to sleep for an hour and a half. Then I would do my speech language therapy for about 20 minutes, then need to stop and rest for another half hour. By then I would have a thundering headache so would go for a walk or do some bellydance practice to shake it off, then need another 30 – 45 minutes to rest to recover.
I’d then need to start to think of cooking dinner. Start to cook dinner, one thing at a time (no multi-tasking when you have PCS!). Sit and rest again. Serve dinner. Sit and rest. Chill out doing some photography while resting. Go to bed at 8.30 and crash. Sleep until 6.00 – alarm on and the day starts all over again!
OK so that doesn’t sound too hectic, but let me add in these factors:
- Every activity I did was harder and took longer
- No multi-tasking so each activity had to be either broken down into small chunks, or completed in one hit. (No answering the phone in between writing reports, no talking to the family while cooking dinner, no TV on in the background, no music on – get the idea?!)
- Each activity increased fatigue and headache
- When fatigued, my brain would just slow down until I couldn’t remember what to do next
- Every day at work tasks would be left incomplete – so I had to track what had and hadn’t been done, something that was hard to do because of my PCS
- My progress was being watched – for improvement, so no opportunity to have an ‘off day’
- All the rehab activities were designed to extend me – so in turn, increased my fatigue
- Having to sleep took out 90 minutes every day, plus going to bed at 8.30pm makes me a very boring chick!
- I had to say no to social, physical and sensory-laden activities because they were too much
- This meant I had to be more assertive than normal, increasing my stress when I felt more vulnerable than normal
All in all, constant increase of pressure and expectation in every facet of my life – and I’m someone who usually thrives on challenge and extending myself, but like everyone, I need the occasional day when I just puddle or let things flow.
Some very negative things happened to me when I admitted that I couldn’t maintain the level I hoped for – my motivation for returning to work was questioned, the authenticity of my injury was challenged. How incredibly devastating, because I knew I was putting everything I could into doing what I was doing!
Some things I learned from this:
- Injury or pain adds greater demands than normal
- Rehabilitation is designed to extend you – so it’s harder than normal life
- It’s not helpful to challenge someone’s motivation – perhaps its more helpful to ask about how important something is, and how confident the person is to achieve it
- Time takes on added significance during rehabilitation – the usual pace of activity is slowed, so it’s harder to do just the normal everyday things
- Assertiveness is needed just to cope with the effects of the pain or injury – and this can be a challenge on relationships as well as increase anxiety in the person
- If you’re the case manager or manager, check in with the health care team to determine ‘how much’ to ask of a person, and when the person says ‘I need to reduce demands’, confer with the health care team instead of implying the person ‘just doesn’t want to return to work’
And finally, it’s important I think to schedule time to do nothing.
What do I mean?
In each day, time to sit and ponder and smell the roses and enjoy something passive.
In each week, time to not ‘have’ to achieve a goal or strive to meet a challenge.
In each month, time to take stock of achievements and appreciate gains and share setbacks.
Throughout the rehabilitation, allow consolidation time where no new goals are planned – time to do nothing.