Healing Is Hard:

• Healing is hard. I wrote that over and over again in my notes for this.

• It is hard like meditation is hard. It takes time, you have to let it happen.

• It is uncomfortable and painful.

• We cannot control healing, the pace at which it happens, or complications of healing. We cannot go back to our previous level of control over our health immediately, it is a gradual process…and it takes longer than the 6 weeks that it takes for the stitches that secure our flesh and muscle to have the same strength as the healing tissue.

• We all have an uncertain outcome and timeline; however, the inevitable outcome for all of us does not change. This is much harder to accept when it stares you in the face.

• Stress and sleep deprivation impair healing.

• Some inflammation is necessary for the process, but it’s painful. Too much inflammation can be counterproductive and impair the process—basically the body attacking itself in an attempt to heal.

• Healing is hard. Pain is exhausting.

• We live in an “on the move” society. We are goal oriented, moving forward, pull yourself up by the bootstraps, go-go-go. Fight the good fight. Battle the cancer. This is not always possible. Sometimes we just live with the sucker punch that has landed, just when we felt our lives were manageable, and we had at least some of it figured out.

• We do not value quiet contemplation, sitting, just being. We call that lazy, or daydreaming.

• We focus on the ascent and the peak, not the plateaus or decline.

• Chronic pain wears you out every day. Even on the low pain days, your body and pain receptors are primed to interpret any stimulus as painful or noxious. Constant vigilance for the return of pain keeps us from being able to focus on anything else. No wonder chronic pain and depression are linked, and nobody is sure which causes which.

So, what can we do about it?

• Control what we can and let go of the rest of the things that aren’t truly important.

• SLEEP. SLEEP. MORE SLEEP.

• I am not a sleep expert, other than having trained and lived a profession that runs on our ability to maintain our poise in the face of chronic sleep deprivation.

• This did not make it any better as a patient; in fact, I felt more helpless.

• I have never slept well in the hospital, likely because whenever I am there, I know that sleep is a gift that can be taken away at any minute.

• The truth is nobody sleeps well in the hospital. Not providers on call, nor patients nor family.

• some sleep is better than none, and even laying supine without sleep can help. This is totally contrary to the advice of sleep experts. I tell myself it’s just a nap and pull my shoulders away from my ears.

There are some steps to help. The following are low risk or over the counter. For most patients, they can be safely used, alone or in some combinations if needed:

• Over the counter medications:

• Benadryl

• Unisom

• Melatonin

• The bummer of being in the hospital is that we lose all control of things that we could buy at Target and take at home. Don’t be afraid to ask for orders for these, early and repeatedly if needed.

• Prescription medications, like Vistaril (a relative of Benadryl and Unisom) or Ambien, if this works for you

• Block the noise and light and decrease disruptions as much as possible:

• Eye masks and ear plugs

• Bundle care when able—combine vital signs with an ice water or other beverage for your medications. Try to time bathroom trips with these. Also do this at home when you can.

• Hospital menus are overwhelming. The food generally isn’t good. Find a few things that are palatable to you, write them down, and preorder them if you can. The biggest blessing I had during my second hospital stay was when the nurse picked up the phone and ordered for me, so that the food could come when I was due for medication. That someone else could help me with this never occurred to me.

• Warm blankets can help with sleep. At home you can achieve this by putting them in the dryer.

• Limit visitors at night. Unless the situation is critical, you’ll both sleep better.

• Everybody sleeps better the more everybody sleeps. Let your loved ones sleep in their own beds when possible.

• This may not be a popular statement, but one blessing of the pandemic that we noted in OB patients is that they had fewer visitors, improved rest in the hospital, and were ready to go home sooner. They didn’t feel obliged to entertain and parent while they were in the hospital. They gave birth, bonded with their infants, worked on feeding instead of having an endless stream of visitors.

• we are generally trained not to accept help or turn away visitors. This is particularly true for women, and those in caregiver roles or professions.

One of the best things about giving to others and helping them is the endorphin boost that the giver experiences. Don’t deprive your friends and family of that by refusing their help or food as you are comfortable. Pain management:

• As the opioid crisis has made abundantly clear, there have been unrealistic expectations for pain and treatment of pain for both providers and patients. Nothing is pain free. Try to avoid narcotics if you can. I personally hate the way that they make me feel…and they impair my sleep.

• Ice is totally underutilized. Secure it to your incision or area of pain if possible. Amazon sells an amazing array of ice packs with some way of attaching them to where you need them.

• Tylenol really is safe for many patients, and works in a different way than ibuprofen or aspirin or other medications known as non-steroidals like naproxen. If you can take both types of mediations, alternate them so that you can take a different one every couple hours (i.e. Tylenol extra strength every 6 hours, with ibuprofen at a dose you tolerate every 3 hours between the Tylenol).

• What was previously known as complementary and alternative medicine, or CAM, is now very widespread and available in many hospitals. This can include, but is not limited to:

• Essential oils

• Aromatherapy

• Massage

• Acupuncture

• Acupressure

• Reiki

• Meditation

• Yoga

• Music

• Basically whatever works for you that isn’t dangerous in your condition—go for it.

When you go home/healing at home:

• Do the things that work for you to relax, recover and rest. There is no one size fits all solution for healing.

• Lean into your strengths. We’ve all done personality assessments, from Myers/Briggs to enneagram. Our strengths and vulnerabilities seem to come out more when we are stressed. This is not the time to try to change or improve on areas where we already struggle. that’s ok.

• We do know that time in nature and light exercise, like a short walk, are invigorating for almost everyone. at least half the time, you will feel better if you take the walk instead of the nap. Trust me, I have napped more in the past 6 months than I have since my 2nd year of residency, including our baseline chronic sleep deprivation and when we had infants.

• Sometimes, the nap and rest is what you need, and that’s ok.

• Strive for a balance

• Some is almost always better than none or too much, whether it is sleep, food, drink, treating yourself, exercise, family time or alone time. Only you know what you really need.

• Music can decrease pain and help with healing, for imaging, such as MRI’s, office procedures, anesthesia. I offered this to patients in the clinic for years, and yet couldn’t think to advocate for it or ask when I was the patient.

• Journaling, especially a gratitude journal, seems counterintuitive in the face of illness. It’s not. again, expressing gratitude or wishing others well, noticing the little things, has been shown to boost endorphins.

• Let others help you. Really.

• We need to do what we know is right, and important, regardless of who is watching (or not watching). In the end, it’s your own life and nobody else’s. There are no do-overs.