ADHESIONS

ADHESIONS

As I walked into the department of physiotherapy to check on a particular patient’s progress yesterday, I was overwhelmed. The whole place was filled mostly with my post-operative patients. Smiles and pleasantries were exchanged with many. Some thanked me for the surgery others informed me about their progress but amidst all this I was being overwhelmed by something else.

An entire hall sized room filled with people on walkers, sticks and crutches struggling to regain their lost range of motion across the operated joints. Struggling to regain their pre-operative agility, aided by various modalities of physiotherapy.

“My god I did this to them ……” I felt it in a rather apologetic fashion instead of a resplendent or conceited manner.

As an orthopedic surgeon trauma surgeries comprise a bulk of my surgical routine……smashed knees,crushed shoulders, extremities that need reconstruction etc are a part of a daily routine. Once operated the patient needs to undergo “Immobilization” of the operated part to allow it to heal adequately and appropriately.

“Immobilization” is a precarious friend. Too less of it and you would end up in a re-fracture, too much of it and one ends up in an almost intractable stiffness.
It is a necessity, but one that needs to be precisely calibrated.

Something deep within was seeing me as responsible for the struggles of these patients too, but in a very impersonal fashion.

True they required the surgeries, true that if it were not for the surgery they would have lost the function of that limb for life, true that post surgical immobilization is a must for adequate healing and very true that this process would always lead to stiffness across the immobilized joint but all this was pointing me to something deep within.

The body is a dynamic process it responds to your repeated needs and can raise or diminish its functional capacity as per your basal demands.
That is to say that it’s the same human body when subjected to repeated basal stress of gym exercises day in and day out that transforms itself into a professional body builder and it is the same human body shielded from all stresses that becomes a couch potato.
Similarly when subjected to immobilization for a prolonged period the joint accepts a particular position as itself and develops “Adhesions” to stay that way, losing its flexible range of motion. It is as if a continuously repeated or practiced position (immobilization) makes the joint forget its capacity for the range of motion.

But something deeper was occupying my concern, I wondered if so evident was the case with the gross body what would be the scenario with the fine mind.

Theoretically it should stiffen much quicker and return to normalcy rapidly too because of its subtle nature.

And upon pondering it was found to be true.

As children we all had conceived a world of all possibilities, none of us had dreamt mediocrity and a life wasted just to earn the daily bread. As children none of us had imagined boredom and jadedness. As children we had pictured a life of an endlessly fulfilling adventure. We may not have exactly known how but we knew it would be so.
But that pluripotent (an immature {cell or stem cell} state capable of giving rise to several different {cell} types of state) state requires differentiation into a particular state for its complete flowering and expression and that demands a prolonged immobilization in a particular position.

That is becoming an Architect, Fashion designer, Engineer, Lawyer, Doctor, Business professional etc demands being with this particular discipline of interest for a prolonged period. Being immobilized (psychologically) in a particular field by attending a particular college, pursuing a particular course.

Then there is immobilization in certain labeled social and emotional roles like boss and subordinate, father and son/daughter, mother and son/daughter, brother and sister, friend of so and so’s, Foe of so and so’s etc……… And before we know it ……..
“Psychological Adhesions”……

We get stiffly fastened and rigidly immobilized within the confines of our role plays.

This is what we term as our comfort zone which in reality is actually nothing but a Discomfort zone.

What can be comfortable about a car that doesn’t move, a ship that doesn’t sail, a plane that doesn’t fly and a life that doesn’t overflow with enthusiasm for this moment and a joyfully restful anticipation of the moments to come.

But let us not rush to blame the society for what it has done to us for that would be like me blaming myself for the stiffness of these patients.
All of us need to be immobilized into certain disciplines and roles for a while in order to gain proficiency in certain areas of life, to be the experts at this, that and the other. And this like fracture treatment is bound to create a certain amount of “psychological stiffness” within us. But we need not continue to bear with this contracted “psychological stiffness” of ours.
Just like a post-operative immobilization patient feels the discomfort in going about his daily routine due to his stiff joints. We too experience emotional claustrophobia as we move about in our lives on a day to day basis. But instead of challenging these “Psychological Adhesions” (stiff psychological stand points, beliefs and role plays), like the fracture rehabilitation patient does with physiotherapy, we try to accustom our lives alongside and around this disabling psychological stiffness.

A sense of anxiety about future, regret about past, listlessness about the present all these and a myriad more shades of jaded emotions remind us of our discomfort arising out of our own psychological adhesions and stiffness.

We need the rehabilitation of psychological physiotherapy to break all our psychological adhesions and restore our full range of psychological motion.

Anything would do……. listening to a soothing piece of music one loves, travelling, painting, hiking, writing, praying, running , dancing , kayaking, Meditating or just sitting silently and enjoying a sunrise or sunset …………

Anything that does not require of you to be the YOU that you have come to believe that you are.

Anything that keeps your identity away and connects you to your own wordless presence.

The you beyond all labels, the you beyond even the concept of you, the you that is effortlessly present in spite and despite your psychological attention, inattention or contemplation.

The technique of being connected with this aspect of yourself is the real religion; the practice of repeatedly reaching that place is true spirituality; the experience of that wordless place is God.

The Malingering (abridged)
[The credit of creating this abridged version goes to my dear friend Abhishek Shukla]

She is 48 years of age and pain has been her constant companion for over two decades now. Perthes disease has destroyed both her hips and the degenerative scoliosis, that set in probably a decade ago, is only making each day more difficult.
With her bag full of investigations, previous prescriptions and treatment records, she met me in my OPD about 2 months ago.
“You don't need to suffer with this!! I could replace both your hips and if need be, correct the scoliosis later on with another surgery!!” I exclaimed even before I could complete my turn and give a meaning to X-Ray box's life's purpose - mounting the x-ray film. Her condition was so obvious...
Too quick and too direct; that’s what it was…I would realize this an instant later.
I gradually lowered the X-Ray film, the barrier between my eyes and hers, a noticeable woebegone air - like a dark halo - had surrounded her. It seemed my words had struck her like Zeus' bolt.
“Wouldn’t you like to go through these reports first” she spoke after an expected silence, seething...
“I don’t have to lady… in factPerthes was my top differential diagnosis the moment you walked into my OPD.Seeing you from a distance of 50 meters - forget these x rays - your gait speaks louder than these reports. And, just like any other doctor, I despise distrust…..” The frontal lobe of the brain is solidly pounded with its social sensibilities and thankfully, none of all this was ever verbalized.
These same social sensibilities simulated a smile and politely undertook the masquerade of going through the heap of papers, wearing a contemplative look, stifling a yawn and wondering what to have for dinner.
“Hmmmm… so please tell me what brings you here?” I asked, having completely exhausted myself, either with the farce of going through the report. Infused with the satisfaction of my sham attention to her records, the lady began speaking. Most of it was a ramble and it continued for a while until my patience weaned and I blurted, “But why are you here now?”
I would never know what worked – the tone of my voice, or all that pent up boredom gushing through the barrage of my patience – but, it had halted her seemingly unending jackhammer of a conversation.
“To be treated of course!” she said defensively.
“Which I have already explained how…So let's discuss only what’s relevant in that regards". I continued.
“But I don’t want to get operated!” she said. I immediately softened because I could almost hear “I cannot afford to get operated", "I am too afraid to get operated", "there is too much at hand currently in my life".
“Pain relief, that’s what you are here for!” (And that’s not treatment, by the way!)
An invisible yes was palpably present even in its auditory absence. A cocktail regime of pain relief was tailor-made as per her requirements and she left.
A fortnight later she arrived in the OPD for follow-up, visibly better than the previous visit.
“So how are you now?” I made a cheerful but redundant remark, I instantly bit my tongue. Off went the train of endless ramblings, obviously confused (considering my diagnosis) I looked at her husband, who had been desperately waiting for an eye contact, which I now realized, instantaneously falsified all her claims in a moment of eye roll.
“But are you okay as long as you take the medicines?” I randomly interrupted at some juncture.
“Yes I am” probably it was the sudden and unexpected arrival of the question amidst the heavy traffic of monologue that brought forth such a short and truthful reply, at least at that instant.
She then went on to describe the side effects she was experiencing; which by the way, do not exist anywhere, in any medical text, on these drugs. I was also made aware of how her life now is even more miserable due to these side effects, albeit without pain.
“These medicines cannot be the cause of the symptoms you are experiencing, they don’t have any such side effect profile!!” with my patience thinned out, I quickly bid adieu to my social pleasantries.
What followed then from this point on, almost on a fortnightly basis, was astounding and annoying at the same time.
As one regimen provided pain relief, she would concoct another set of side effects. As soon as this lady would get better with a particular regimen of pain relief like the first one she would come to OPD and inform me about vague and even fanciful side effects these medicines were having on her. Knowing clearly that no such side effects exist for these drugs I would either inform her so or maintain a disregardful silence regarding the issue……and at the end of each such episode I would find her admitted in the hospital next morning. Admitted at night via emergency due to exacerbation of her proclaimed side effects specially vomiting and fainting.
Then I would change her medicines to new ones and yet the same set of events would recur.
When I saw her admitted for the third time while on plain paracetamol…… I saw red!!!
Then it dawned on me…she was a malingerer!!
It was that time in life where one does a deep dive within to find answers for issues rendered irresolvable.
Why is this experience being given to me??
What do I have to see, learn and assimilate??
This deep dive was effortless as my pent up frustration had already imploded. I was falling, as if through the fabric of space and time, into an unknown place of silence.
And it was there that it happened…
“Do you love your current life position absolutely???” A question seemed to arise
“Not absolutely…”
“Then why don’t you change either??”
“Either??” I wondered…
“The situation or your stance!”
“I mean how can I change this situation…….blah blah(explanations upon explanations) blah blah blah…… and obviously I don’t like it this way so how can I feign to like it i.e. change my stance?”
“Isn't that malingering??”
I felt a sharp stab.
“You complain about your current life situation, wish for a better alternative, resist, ridicule and humiliate the present moment for its ‘not enough-ness’ but when asked to do something concrete about it you shirk behind a barrage of excuses…that’s your vomiting episode… and when asked to change your opinion about the current situation you come out in a firm denial, because you are incapable to change it, stating , “but I don’t like it how can I feign otherwise”, that’s your fainting episode against reasoning.”
“Aren't you malingering your life away??” The knife that had stabbed was turning…slowly…

I was bleeding…
At this juncture you too might have felt an uncomfortable prick if not a stab. I now point this question straight at you, “Do you love your job?”; “Do you love your current life situation?”; “Are you completely at peace with it?” (Excruciating, isn’t it?)
A discomfort encapsulates you now but you have your defense, ready!
“I mean nobody does but it has to be done”; “Bills and EMI’s have to be paid boss!”; “Welcome to the real world, money is the arbitrator of our reality not words and ideas”; “what do you suggest one should do, do you have any better ideas”. If you listen to yourself, you too will hear ‘blah-blah-blah’ in there, somewhere.
To tell you the truth, you are someplace between blatant denial and assertive defensiveness.
And when asked to soften your stance, forget feeling good about the situation (since you cannot change it anyway) the mind goes “this is not what I came looking for, this cannot be the purpose of my life”; “how can I come to terms with it, it is so unfair”; “I deserve much, much better” and a ubiquitous ‘blah-blah-blah’.
As I bled my own reality a great sense of compassion and gratitude arose within me for the lady. At least she paid heed to her physical symptoms, got herself diagnosed and came to know that she is diseased and what exactly that disease is.
But until today I had never even paid any heed to the symptoms – anger, irritation, frustration, lack of love, lack of gratitude and wonderment, lack of compassion – within me.
Until today I had never bothered to even wonder if something was wrong with me, leave alone diagnosing and attempting to cure.
Until today I was living in a defensive premise of “this is normal, everybody is like this”
But it was not possible anymore.
The dagger of honest enquiry had ripped through the veils of egoist mind. The diseases of “self-denial”, “Follow the herd and not your instincts”, “Do things because they have to be done not for the love of doing them”, “Disbelief and Doubt” had suddenly been exposed.
And I was forced to ask myself
“If I am the one sabotaging myself, why is it that I believe so less in my capacities and capabilities?”
“Why is it that I doubt the good that has already come my way, but believe instantly in the most farfetched imaginations of the ominous?”
“Why do I think the way I think, about myself and life?”
“And if it does not serve me well then why do I continue to harbor it within me?”
“If belief is a practiced thought, why then should I harbor such self diminishing, self destructive beliefs within me?”