Fool’s Paradise

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Back when my classmates were playing with blocks, I was stacking cartons. The glove compartment, as far as I know, might as well have been called the smokes compartment, because that’s all we kept in ours. I can visualize the plastic sealed, blanched white bodies, stacked in rows; I can still smell the unmistakeable insult of the ash that used to cling, like velcro on the lace of my shoes. He was going through two, three packs a day, habitually pounding cigarette after cigarette as if each puff was giving him life… when in fact, it was doing the opposite.

So, I’d draw family caricatures and bold, arching, colorful print that read something along the lines of “Please Stop Smoking DAD” and variations of. I’d sneak letters into his travel bag, and on the occasion I’d get to see him, I would beg him to quit. For us. For a healthier life. For, at only six years old, I was already afraid that the next time I’d see a plastic sealed, blanched white body, it’d be his.

What I had yet to learn was that the success of behavior change is determined by adherence, which can only be cultivated intrinsically. My father continued to smoke for many, many years, and despite positive behavior changes that renovated different aspects of his life, he could never fulfill the intricate web of physical, emotional, spiritual, intellectual, environmental, and social health. Because wellness is a cumulative interaction between these six dimensions of health, behavior change that hinders the maintenance of this balance may –in consequence– be fleeting, inefficient, and even detrimental.

The film, “Fat Chance,” portrays the journey of behavior change intended for weight loss that is later redirected to self acceptance. Rick Zakowich is first introduced, thirty pounds lighter but not much happier since the start of his plan to lose weight. Feeling pressured by cultural standards of beauty and acceptance, he uses appearance-based motivation to take on behavior change involving diet and exercise. It is no surprise, considering how heavily our society weighs the significance of body image, to hear a even medical professional deviate from motivational interviewing. The physician advises, “Best way to make yourself feel better about yourself… is to lose weight so that your blood pressure improves, so that you look better.” Inherent in modern American thinking is that looking better equates to happiness.

As Rick finds support from those who are content with their obesity, he adapts to a new perspective that directly antagonizes fat shaming culture; he ends the documentary by saying, “The way you are is fine. Walk through this world in that way.” On a superficial perspective, one could argue that Rick achieves a step towards wellness by coming to self acceptance, increasing his self confidence, and joining an empowered community. However, despite it being a step in the right direction, Rick fails to recognize the danger of extremes. By orienting behavior change strictly towards emotional and social health, he completely neglects the other essential components, such as physical health. There is no doubt that self love, in the right context, is deserving of praise, but the fact that he is happier does not eliminate the risks of being overweight. By the summer of 2008, my father ended up in the ICU. If he, then, had settled on self acceptance and placed another cigarette between his lips, would you have applauded him, too?

Fat shaming and fat acceptance fall on opposite ends of the spectrum, and through understanding the crucial interplay of the six components of wellness, we unveil the importance of moderation. Had the medical professional taken a different approach, like educating the benefits of exercise, rather than implying blame or demonizing Rick’s body image, perhaps Rick would not have fallen victim to an illusory state of happiness that is likely evanescent. Increasing studies now indicate that cardiorespiratory fitness and physical activity can improve multiple aspects of wellness and reduce the comorbidities tied to obesity, with or without weight loss (Dallow). This outlook on exercise may be a better approach towards positive behavior change, than one that is based on appearance. Furthermore, it would be of a greater benefit to implement behavior change that caters to both fitness, confidence, community, and other aspects of wellness. With Dr. Lerner’s medical knowledge and morale amongst Rick’s new connections, the support group could potentially be the perfect medium for a wellness program. With less emphasis on weight loss, they could tackle multiple obstacles at once and find a more permanent solution. In contrast of what they have been told by others –they can have their cake and eat it too.

To ensure safety, longevity, and efficacy of such program, professional advisement to promote adherence is crucial. Though the responsibility of wellness falls on the shoulders of each individual, it is equally important to have health care providers take the lead on public education. Patients are more likely to adhere to behavior change if they understand risk and the gravity of their conditions, so medical professionals can play a key role here (Stonerock). Proper motivational interviewing along with professional, objective, and evidence-based opinions is essential to assist others, particularly in the transition from earlier to later stages of the Transtheoretical Model. In “Fat Chance,” Dr. Moe Lerner highlights that obesity is caused by metabolism and dieting. Not once does he mention the importance of physical health. Despite his sensible attitude, his perspective holds a very narrow, almost defensive, focus to justify obesity. By relying on rationalizations and believing his physical state is not a problem, he, along with Rick and the others in the support group, regress and sink deeper into the precontemplative stage (Dallow).

In a society that strongly antagonizes fat and with a disproportionately increasing prevalence of obesity, there is a strong need for leadership towards fitness in all populations, especially obese individuals. The fact that Dr. Lerner’s personal stake in the issue does not take a backseat to his obligation to the public, and that another medical provider advises Rick “just do it” as a plan for losing weight reveal how the medical care system has ample room for improvement. Physical therapists, and all medical providers, can and should “provide key elements of effective behavioral change interventions” so that the general public can adhere to wholesome decisions about wellness (Rhodes). Even the most effective interventions whittle down to scraps, in the absence of patient adherence.

It is easy to believe a person is well when one aspect of wellness has been satisfied. One might say being fat and happy is better than being skinny and unhappy; one might argue the opposite. During an interview, supermodel Kate Moss was quoted saying, “Nothing tastes as good as skinny feels.” When we fall victim to such paradigms that cater to one aspect of wellness, such as emotional health, we neglect all else. The temporary contentment that follows blinds us from seeing the short-lived nature of it, and the resulting imbalance may put an us in a worse position than we started from. Fooling ourselves about our well-being is like sipping on a pina colada, floating comfortably above a circle of sharks. In shallow waters, it becomes more clear that a fool’s paradise –though paradise– thrives only in the minds of fools.

 

References

Bezner JR. Promoting health and wellness: implications for physical therapist practice. Phys Ther. 2015;95:1433-1444.

Dallow CB, Anderson J. Using self-efficacy and a transtheoretical model to develop a physical activity intervention for obese women. American Journal of Health Promotion, 2003;17(6):373-381.

Fat Chance. Dir. Jeff McKay. Perf. Rick Zakowich. YouTube. NFB, 17 May 2015. Web. 19 Apr. 2017.

Rhodes RE, Fiala B. Building motivation and sustainability into the prescription and recommendations for physical activity and exercise therapy: the evidence. Physiother Theory Pract. 2009;25:424- 441.

Stonerock GL., Blumenthal JA. Role of Counseling to Promote Adherence in Healthy Lifestyle Medicine: Strategies to Improve Exercise Adherence and Enhance Physical Activity. Prog Cardiovasc Dis (2016), http://dx.doi.org/10.1016/j.pcad.2016.09.003

Dear Johnny (Part 2)

Maybe you could call it apathy. Comfort?

I don’t think that’s what it is.

Johnny, I’m knee deep in responsibility these days, and I feel like I’m wading. It’s not that I don’t want to be here. I really do. I have so much going for me that I can’t seem to put it in words.

But when you’re constantly surrounded by intense, driven academics who thrive off approval and grading and measurement of successful outcomes (after all, that is the quintessence of physical therapy), there’s this incredible pressure to prioritize every test, every little detail. And that’s what I’m lacking. Yeah it’s perfect timing, just in time for finals and the busiest time at work. I’m dragging.

It’s almost been a year since you’ve been gone, and I still talk to you in my head… when I think of how transient and unpredictable our lives are, it’s hard to believe that a GPA, or praise, matters as much as we’re led to believe. How inconsequential it is whether I get a 100 or an 80 — because I talked to Anna and Jason and Jay the other day, and it scared me shitless that people like them could be gone in a second. People like you.

But maybe it matters. What do you think? Maybe it should matter.

It’s conflicting, because a part of me is feels like I’m at the tail end of a dream; it’s like I’m playing tag with my dreams and it’s so close I can almost feel it. But at the same time, I’m wondering why I’m not –um, I don’t know– on a boat buck naked with a pina colada this second. I think, if you were alive, you’d see how much I’ve changed. You’d say I don’t need a distinguished career to help others –and you’d be right, I know.

It’s weird talking about you in past tense, like you only used to exist.

 

Like I said, I still talk to you a lot. But you know better than anyone else, there’s a difference between being listened to, and being heard. Sometimes, I get frustrated talking to you. It’s like being surrounded by others but feeling completely alone.

I talk to you the way I used to talk to God, back when I had one, at least. I question, I provoke, but I never get a reply. I have to use my imagination, but what’s the fun in that.

I’m really happy these days, though.

I don’t like that there’s some sort of trade-off between being truly happy and keeping perfect grades in perspective, but it is what it is. I’m pretty sure no patient has ever said, “My physical therapist changed my life; did you know she got a 4.0 in college?” and I’m banking on that.

Otherwise, I might be screwed.

 

Oh, by the way, Trump is president.

know.

 

Miss you bud.

Jane

The 30th Time I Saw Myself Die

“Are you fucking crazy?!”

He grabbed me with firm hands, jerking my shoulders to square up to his own. I could see his lips moving, his eyebrows were screaming, but all I heard was a deafening white noise. People were screaming, pointing at me. A woman was covering her mouth with both hands. Like I had done something wrong. Like I had killed a cat with my bare hands.

I pressed pause.

The bodies around me froze in place. Their gestures were still yet piercingly loud, hands and arms spread open to match their fury; the man gripping my shoulders had so much tension between his eyebrows I wanted to dig a finger into his skin. Help the guy relax a little. Good god, man, you’re going to pop a vessel. 

I poked at his forehead, but it didn’t work. His face was  scrunched into a rock solid, mean expression. 

I clicked rewind, and watched the events play back. I could see myself jogging from down the block. I had on thin spandex shorts and a heavy black hood, and peaking from underneath were two green cords that coalesced together to plug into the phone in my pocket. My head was nodding to some Kendrick bit, and I was lightly bouncing to the rhythm, taking note of the blinking red crosswalk light. I still had time to cross. I waved to Jose, the neighborhood fruit stand man, and smiled at the little old lady at the end of the block, swiftly jogged onto the pavement of West 157th —

And BOOM. 

Like a homerun slugger splintering from impact, the metal body of a black Caddy caved  against my frame. It dent sharply, like the exhale of a collapsed lung, cloaked in tar and years of bad habit. At maybe, 60, 70 miles an hour, the fuming machine rammed directly in my side, flipping my lifeless body in circles like dice in cupped hands. It crushed bone into dust as easily as a giant would a flea. As the screech of braking tires overtook the orchestra of horror, I pressed pause once again. 

Resume.

The Cadillac blared its horn as it barely missed my back. It skimmed so close to my body I could feel the whip of my clothing as the wind snapped my sweatshirt against me. I didn’t gasp. I didn’t react. I just kept running… until he stopped me in my tracks.

I faced the man then scanned the crowd once again. Their terror had quickly dissolved to anger, to shaking heads and disgusted faces. He let out, “Are you fucking crazy!?”

I mean, I think that’s what he said. (I was never really that great at reading lips.)

I removed my headphones in time to hear the rush in his voice, “You almost died. YOU ALMOST DIED.”

My heart was a steady 50, maybe 60. I shrugged. “I’m fine.” 

I tugged my hood over my eyes and casually resumed my jog. The crowd shook their heads in a bitter grumble, and I left them in the cold clutter behind me.

I pulled up at the next red light, and removed my headphones once more. I almost died. I almost died? 

There, standing alone, I shuddered. 

I shook with fear — not because I was an inch from death, but because close calls have happened so many times they no longer phase me. This comfort I feel, is uncomfortable. My apathy makes me reckless. 

After all, I’m the protagonist and the narrator — I can’t die. I have chapters I haven’t gotten to yet.

The signal turned white, so I returned the beat to my ears and my feet to the streets heading to Harlem. As I slipped past the row of cars stalled at the red, I could feel their headlights following me, testing me, watching the litter of emotion I was tossing behind. 

Don’t Need A Wish Today 

It’s been many, many years since I decided to include in my daily ritual: a question of reflection. A means of checks and balances that is commonly absent, without the extra effort. With so much going on around us, it can be difficult to… pause… and think about WHY it is you do the things you do.

My question for the day has always been: “What are you grateful for today?”

Some days, it’s easy to come up with an answer. Some days, it’s not. And often times, I have to inquire if, by repeating the same answers, I am dulling the top coat from its shine. Like the twenty thousandth time you’ve told your significant other “I love you” you realize the words, though true, have lost true sentiment behind it — how impressively quickly novel turns to casual.

Upon waking this morning, I stared at the post-it stuck on my bathroom wall and came to the same conclusion that I am frequently led to. But no matter how many times I respond with this same answer, it still find it –to put it eloquently– really freaking shiny.

Today, I am grateful that all things I want, I already have. It is unmistakably empowering to feel satisfied. I am so lucky for this unpredictable life and the ability to comprehend how and why I’m here.

I Can’t Feel My Nose

Ok, let me begin by saying I had a dentist appointment for 2pm.

I waited 2 months for my insurance company to get their act together, and today was finally the day I had approval. When they called to let me know, it was like I was Charlie and the woman on the phone was handing me the golden ticket in a Wonka Bar. Giddy up baby.

Given I was in the Bronx for an event, I had to speed bike through the rain to make it to my appointment. The winds were aggressively tugging against me, pulling me back two inches each time I gained one. It was a clever optical illusion — in the spirit of the ongoing presidential campaign — where my legs appeared to be pedaling forward, but my wheels were turning in the opposite direction. A delusional progression, you could say.

The appointment got changed to 3pm, so I grabbed some food and brushed my teeth (as if brushing my teeth right before I go in will make it seem like I have the best dental hygiene. Admittedly so, first impressions are everything).

I filled out the paperwork, and sat there organizing in my head the incredible amount of schoolwork and work-related work I had to complete by the end of the day. Needless to say, the task in itself kept me occupied for 20 minutes. At one point, the reception left the front desk unattended to speak with the dentist, so when a woman showed up for her appointment, she couldn’t get in. The door furiously rattled for a good… 6, 7 seconds before I stood up to unlock it for her. She then looked me up and down, glaring at me with a disgusted pout, muttering, “Fucking couldn’t even open the door, taking your fucking time, do I look like a fucking criminal to you? Who do you think you are?”

When the receptionist returned to the front desk, the woman’s eyes brightened as if nothing had happened. Night to day. Sometimes, I JUST DON’T UNDERSTAND PEOPLE.

She then starts trashing my attire to the front desk. Alright, lady, I’m a sleep deprived grad student and I just got back from painting an elementary school; you don’t have to knock me for my sweatpants swag. Immediately, I decide it’s not worth the time effort, so I sit down silently and take a nap. An hour and a half later, I am woken up by the dental assistant. “It’s your turn to come in,” she says.

The dentist introduced himself, with a huge grin on his face. I stood in the hallway as he talked about how 93% of women with breast cancer have deformities on the same 4 teeth because they are on the same meridian lines (oh wouldn’t you love to know how this argument went), about how a man with a 1st grade education can cure cancer by the mere act of slicing skin without anesthesia, and about how Alzheimer’s is supposedly curable in Switzerland. He then asked me about my undergraduate education and seemed to inquire about my dating history (yeah right, like I’m going to stand here in the waiting room and tell you about my Tinder life with HotHead breathing down my neck).

Okay, yes, he was really nice. But he didn’t even talk about anything medically relevant for 40 whole minutes.

When the assistant finally brought me into the room, he was still talking. It was as if his brain would not allow for multitasking, because every time he reached for a tool, his eyes would light up with another thought, and he had to stop what he was planning to do, entirely. He put on gloves, which he coughed into, and then put on a facemask, which he wore under his chin like a fashion accessory (what is the POINT, my man).

We didn’t get started until THREE AND A HALF HOURS after the appointment time, because the guy would not stop talking. When he realized I was using insurance, and not paying out of pocket, he put me into a different room and had me sign off on CPT codes (billing codes, for insurance) that stated I had 16 cavities. 16 cavities? Oh, are these the same cavities that didn’t exist 2 minutes ago, when you were under the impression that I was paying out of pocket?

I get that insurance reimbursements are shitty, but damn. Talk about milking the cow for what it’s worth.

And you wonder why the reimbursement rates are so low. If I worked for Aetna, I wouldn’t trust providers, either.

Anyway, he then asked (again) about the times I had broken my nose over the years. We talked about that for another 5 minutes, before I interjected, reminding him that I was way behind schedule and needed to get going soon. He, without ANY warning, injected me with FIVE local anesthetic needles, which not only numbed my teeth, but my nose as well. I’ve had this procedure done before, but never that high and that much. I just bit down and took it in stride.

And by stride, I mean whimpering for mercy, as quietly as possible.

For the duration, I had to wonder if he was doing work he didn’t need to do — I had seen 3-4 dentists/orthodontists very recently, and they all seemed to think otherwise. I got out of that chair after a grand total of 4.5 HOURS. Treatment time? 20 minutes.

On my way out, he points at his meridian chart and tells me what other health issues I can anticipate (“if X tooth is damaged, then X body part will be affected” wonky logic). I politely nod, but all I’m thinking at this point is CAN I LEAVE NOW.

He then goes, Oh by way. Your nose is fine. I checked that out for you.

He had numbed my nose on purpose. MY DENTIST. numbed my NOSE. To test how strong it is.

This man has forgotten what kind of doctor he is. Next time, if there is a next time, mind your own meridian and I’ll mind my own.