250 or less

Established 2011

Ugly People

The world has a perception of my country that I fear we will not (cannot?) change. Worse yet, it may be deserved.

.    .    .    .

We can stay up late, swapping manly stories, and in the morning, I’m making waffles! –Donkey

If I could eat breakfast 3 meals per day I would. I could easily be content with a big bowl of cereal in the morning, a large muffin in the afternoon and a proper breakfast in the evening. When I say “proper”, I mean eggs, sausage, english muffin, bacon and some product initially constituted from flour, be it french toast, pancakes or waffles. Of course, I prefer waffles, because of the little syrup receptacles that just soak up all the natural sugary goodness I pour on top (none of that high-fructose corn syrup-stuff for me!) and how they become soft little syrup-bombs that I put in my mouth with each bite. Admittedly, such a meal is an exercise in excess, but I am comfortable with that.

But, as much as I love waffles, this was disturbing.

Even Donkey would agree: I don’t care how much you like a waffles or how good the price is, you don’t need to act like a jackass.


Переход мои пальцы, что я получить это право на этот раз

“Reportedly a lethal diplomatic sniper, he was instead armed with a blunderbuss.” -Peter Mountford

Story is important, and I should know: I once came in second place in a countywide story-telling contest in the sixth grade. Of course, I had little insight at such a young age as to the impact that my stories would have on others many years later in my professional life. Nonetheless, where my stories were once utilized to win contests, lure the ladies toward my all-too-thin frame, or become the center of attention at social events, they have now become the vehicle for answers to potential questions that patients often haven’t yet asked.

In a recent podcast, the author of the text quoted above sought out the “bootleg” translator of his book to assist in its translation to Russian. He found it worthwhile to take his own time to help make his words accessible to others; it was better than the alternative:

Reportedly he was a brilliant diplomatic sniper using his charm to hit from the first go and win the people’s hearts of the people whose cooperation he needed but actually…unsuitable for sharpshooting.

It makes me wonder, how many of my own stories have gotten lost in translation?

I hope (for my patient’s sake) that I fare better than the bootlegger, because this can be complicated.

**This posting was also inspired (in part) by a wonderful broadcast available here by Karen Litzy, MSPT, featuring Barrett Dorko, PT.

Body Language

I was thinking today about my recent difficulties expressing gratitude; I remembered this guy on a live concert DVD that I own: Dream Theater’s Score.

In the beginning of what was the title track to their latest album, Jordan Rudess (the band’s insanely talented keyboard wizard) was playing the continuum, a relatively new and obscure digital instrument. The lead-in to the over-20-minute-long song itself lasts 4 minutes; after the intro is complete, Jordan turns to face the crowd.

As the crowd politely claps in appreciation, the camera focuses in on one fan in the crowd. As the view fades from Jordan to the man, I can see he is wearing a band t-shirt, he seems to have more hair on his chin than his head, and (above his head) his palms are facing and touching each other in a purposeful pose of appreciation. Slowly, I see him bring his hands lower to clap.

I think it is really neat. Not only did the camera crew capture this moment, but the producers elected to share with the world this one man’s simple gesture. It is a moment that is forever engrained on film and will be seen by hundreds of thousands of people over the many years to come.

The neatest part is this: even though viewers will never know my name, they will always know I was grateful.

Questionable Marketing Skills: Effortless

As a future (hopefully) private practice owner, I spend a lot of time considering how I intend to market myself as a neurocentric physical therapist in an orthocentric world. I have come up with few answers, which explains my continued employ in the home care environment. Still, I continue to keep Seth Godin’s blog in my RSS reader for pearls of wisdom and insight into what I might to do myself one day…

“Perfecting your talk… And polishing your service until all elements of you disappear might be obvious tactics, but they remove the thing we were looking for: you.”

My efforts to perfect my talk or polish my service is not a means to disappear or hide who I am; it is a way to evolve into who I wish to be. What if I need to eventually sell not what I do, but rather what I understand?

“Sometimes,’ never let them see you sweat,’ is truly bad advice. The work of an individual who cares often exposes the grit and determination and effort that it takes to be present.”

Perhaps one of the difficulties that many physical therapists have with self-promotion is the necessary dichotomy between the caring clinician and the marketable persona. Often, the most successful clinicians are those who approach their patients with a quiet and outward confidence. They listen more than they speak. They provide nonthreatening input in the context of patient-centered conversation. It is never about them, or how hard they are working on their craft; it is only with effort that they are able to create a therapeutic alliance with their patient while it is the illusion of peaceful effortlessness that breeds confidence in their patient.

All or Nothing

I yearn for structure and find that I often struggle to succeed in its absence. In part, that is why I began to write this blog daily, not only in an effort to increase the predictability of my day, but to increase my likelihood of success as well. On two occasions now, when the words have become more sparse, or the details of life have gotten in the way, I have pulled away from this blog altogether. In my mind, if I could not write daily, I was not doing it right; if I was not doing it right, I should not do it at all.

The last few months, I have accomplished a lot of things that I would not have had time to do had I been writing with regularity (even if I was just typing 250 words per day). I have read a handful of books, went for long walks with my family (and more with my dog), rehabilitated my lawn, read a few more books and did a lot of house painting. To my surprise, even while completing and participating in these activities, I came to an unexpected conclusion: my blog had achieved its goal.

Regardless of what I was doing, where I was, or who I was with, I could not help but think of what I should be writing about what had happened, how I felt, or how things could have been done differently. I continued to see so many things all around me that related to my roles as husband, father, brother, son, friend or therapist (none of which I have perfected). I missed writing and while I understand that life may get in the way sometimes, that is no reason to stop writing altogether. Granted, I would like to write every day, but I understand now that that won’t happen, and I am okay with that (at least for today).

I began writing this blog to reshape my life, my perspectives/interactions with others and to influence how I see the world. As a clinical instructor I always stress to students to make each patient’s goals measurable and (most importantly) achievable, yet I’ve come to realize that with a family of 2 small children, a job that demands flexibility, a desire to work overtime and a variety of other commitments to myself and loved ones…well, sometimes writing even 250 words a day is an unrealistic expectation of myself.

It is time to set a new goal: don’t quit.

Varying Perspectives

In this thread, I linked to very cool “time warp” video of a dog shaking water from its coat after swimming.

As I watched, I was struck by something that a woman said in the clip:

It looks like she is contorted…that can’t be good for her spine.

“Funny,” I thought to myself, “I hadn’t even thought of the spine.”

Granted, I would have considered how the spine moved eventually, but I was too amazed at the mobility of this system to take notice of his bones.

Fight or Flight, Pt. 2

It is only my touch that can garner his attention, and sever the strong link between external stimuli and instinctive response.

Sometimes I get it wrong. What may have worked last time, might not work the next. A touch that is soothing today may be frightening tomorrow, despite similar circumstances from one day to the next.

All I can do is take an educated guess, be as non-threatening and gentle as possible, and keep trying until I get it right. I will get it right, eventually. I always do. Eventually, his focus is redirected and that link is broken. He becomes more aware of my presence and the security that accompanies it as he slowly begins to move away.

As we continue on our walk (his leash in my hand) his posture remains unchanged, still holding itself in an unnatural isometric until the glorious moment when he shape-shifts once more.

It is in that moment, when he thrashes, twists and turns fervently while uncoiling and seemingly bringing each muscle throughout his length to its isotonic potential, that I wonder if he feels warmth too.

Regardless, it is my touch starts him on a path of kinesthetic fulfillment; his own instinctive movement is what makes him smile and prance down the sidewalk afterward.

Fight or Flight, Pt. 1

He has a mysterious and troubled history that he will never be able to share with me. Even if he could, I am not certain that he would; I the fear memories might be too painful.

In the presence of both exciting and frightening circumstances, his posture changes immediately and it is held in purposeful pose for as long as he deems necessary. I never know how long this will last: sometimes only a few brief seconds, sometimes minutes.

Each pose is a the flip side of the the same coin. When happy and confident with excitement, he looks almost regal while leaning forward, weight on this toes, head held high, and his shoulders pinned back. But when he is scared and frightened, the inverse is true as he leans back on his heels and his head falls forward collapsing under his slouching spine and falling shoulders. Amazingly, he is a shape-shifter; postured one moment as mightily venerable, but as a meager vassal the next .

In each instance, the tension in his nervous system is palpable as all of his senses become hyper-vigilant, increasingly sensitive to what he sees, hears and smells.

With the senses flooded, he begins to drown in intense focus, constriction and tautness; he shuts me out and there is no way to reach him…except through touch.


Suprising Sage, Pt. 2

I remain loyal to Him…
I believe that the Church is Jesus’ church, and that it has lost its way…
It deserves better, but the only way to change it is from the inside.
If I don’t try, who will?

Apparently, changing “the church” is no easy undertaking. The group that represents Sister Regina has been under “assessment” by the Vatican and are now being held under the foot of an Archbishop Delegate for collectively taking a position not in agreement with the Church’s teaching on human sexuality and being “silent on the issues of the right to life from conception to natural death, a question that is part of the lively public debate about abortion and euthanasia…” Additionally, some (like Sister Regina) make occasional public statements that “disagree with or challenge positions taken by the Bishops, who are the Church’s authentic teachers of faith and morals”. This too is frowned upon.

The Leadership Conference of Women Religious has been dealt a challenging hand; I hope someone is really good at poker.

(The Daily Show did a decent segment on the topic here.)



The Blame Game, Pt 2

My limited reading this week has led me to this wonderful article on the assignment of responsibility and blame where the authors state:

While many definitions of causality have been proposed, all of them treat causality as an all-or-nothing concept. That is, A is either a cause of B or it is not…[Considering causality in this manner] is based on counterfactual dependence. Roughly speaking, A is a cause of B if, had A not happened (this is the counterfactual condition, since A did in fact happen) then B would not have happened. As is well known, this naive definition does not capture all the subtleties involved with causality…[Unfortunately] thinking only in terms of causality does not at times allow us to make distinctions that we may want to make. For example…Suppose that Suzy and Billy both pick up rocks and throw them at a bottle. Suzy’s rock gets there first, shattering the bottle. Since both throws are perfectly accurate, Billy’s would have shattered the bottle had Suzy not thrown. Thus, according to the naive counterfactual definition, Suzy’s throw is not a cause of the bottle shattering…This certainly seems counter to intuition.

Thus, the authors prefer to make a distinction:

…in the case of Suzy and Billy, even though Suzy is the only cause of the bottle shattering, Suzy’s degree of responsibility is 1/2, while Billy’s is 0. Thus, the degree of responsibility measures to some extent whether or not there are other potential causes.

The bold is mine, because the emphasis is important: A patient arrives to a clinic in pain and asks for treatment. I lay my hands on the patient and sixty minutes later, the patient feels better. How responsible are my hands for the patient’s reduced symptoms?

…the idea is that A is a cause of B if B counterfactually depends on C under some contingency…It is precisely this consideration of contingencies that lets us define degree of responsibility. We take the degree of responsibility of A for B to be 1/(N + 1), where N is the minimal number of changes that have to be made to obtain a contingency where B counterfactually depends on A. (If A is not a cause of B, then the degree of responsibility is 0.

Again the bold is mine. How many contigencies can you consider when an individual’s nervous system receives tactile input from another? Could you even arrive at an estimation? Would this number be in the hundreds of thousands, or even millions? In the end, this line of thought runs into the proverbial wall when looking at the interaction of one clinician’s nervous system with another’s, because:

When determining responsibility, it is assumed that everything relevant about the facts of the world and how the world works (which we characterize in terms of what are called structural equations) is known.

In the end, I have no greater understanding of my own failings when working with patients in pain now than before, but I have derived something from this: I am increasingly certain that I have very little responsibility for when my patient’s feel better.