Time is Tight

I once received a new letter from someone seeking to join a cohort of ladies that were working together to get in shape.  Unfortunately for her we had already filled all of the spots, but something in her application made me think about a former patient of mine. When answering the question about what had kept her from meeting her goals previously, Jeanette wrote:

“I haven't made the time for me...always putting others before me...and nothing at the end left for me...but if I don't start taking care of me again and getting back into shape...I won't be around for anybody!  I'm wanting to get back to being fit and healthy...in order to do ALL I have to do...and show my daughters that I want and need help to be around a loooong time! 

About 10 years ago, when I was working as a Physical Therapist in New York City, I had a patient named Alan come in the door.  He had just returned from Afghanistan, where he had been working as a photojournalist. He was in his late 40’s, and was overweight, which had contributed to the development of arthritis in his knees.  They had recently become too painful and he was unable to handle the hiking over uneven ground that he faced in the areas around Kabul (the sidewalks of New York weren’t a lot better!). We got along great, talking about photography, politics and journalism, and he introduced me to authors I’d never heard of, buying me books by Hubert Selby Jr, John McWhorter, and Herbert Asbury.  I treated his wife for her back pain and met his son. After a couple months of working together he no longer had knee pain and I discharged him. Two years later, he returned for another injury. He had had further success as a writer and had been able to buy a vacation home upstate where he would go on the weekends with his family. He had also gained a lot more weight. He had difficulty moving, would get out of breath with light activity, and his calves and ankles were red from lack of circulation.  His Physician was monitoring his heart. We had lots of talks about losing weight, but I was there to fix his back pain, not be a nag or his dietician, and he already knew that his situation was a result of eating too much and exercising too little. He was the cook in the family, and per Alan, ‘they expected him to cook good meals,’ especially at the country home.  

(“I haven't made the time for me...always putting others before me...and nothing at the end left for me...but if I don't start taking care of me again and getting back into shape...I won't be around for anybody!”)

I remarked that his wife and son would rather have him around and healthy than simply have good food.  He acknowledged the truth of that ‘choice’, but I’m sure he didn’t believe that in reality those were his only two options.  This time around we weren’t able to relieve his pain and after awhile we decided to discontinue therapy because we weren’t making enough progress to justify it.  I didn’t see him again before leaving New York for Oregon.  

I’m unable to remember the reason why, but a few years ago I thought of Alan and decided to look him up.  The first thing that came across google when I searched for him was his Twitter feed. The second was his obituary.  I don’t know the specific cause of his death, but I’m certain that it had to do with his lifestyle. In fact, what compelled me to look him up was a concern for his health and I remember being worried about what I might find.  Alan was a friendly, fun, intelligent and generous man, and though we don’t really form true friendships in therapy in order to maintain professional distance and perspective, I enjoyed my time working with him as much as I enjoy time with my oldest friends.  It saddens me immensely that he left behind his wife and a 9 year-old son, but what makes me frustrated is that many of the people around him, including him and me, were aware of the problem, which has a simple--but not easy--solution.  

The self-awareness of Jeanette reminded me of Alan, and also reminded me that we often project the adverse health benefits from lack of exercise decades into the future.  Both of us knew that his lack of exercise was going to knock years off of his life. But I figured that would mean dying in his late sixties instead of his late seventies.  For a lot of younger people, that doesn’t seem so terrible and that there will be time to fix things later anyway. We should never forget that changes like weight gain and the loss of ease of movement often occur imperceptibly over time, but we should also never forget the risk of the biggest change of all, and that it isn’t always as far away as we think.