Should you intervene when someone else is disabled? When a family member is becoming increasingly disabled deciding when to intervene is difficult. This is especially a problem when it impedes the freedom of that person. Driving provides so much freedom, that to inhibit that is a major blow.

As teenagers we can’t wait to get behind the wheel. As parents we look to that day with mixed feelings. We will no longer have to be taxi driver, on call for our children’s needs. But then we worry about what they’re doing and their safety. Once the children have shown a competence we both relax, some.

As we age many things happen to our bodies. Our reflexes slow, our eyes develop cataracts and for some our memory and concentration fail. We compensate for some of these naturally. The thrill of speed and power gives way to a desire for safety and comfort. When I became a parent our family car became a van. Honestly, the four of us couldn’t fit in the sports car.

As my eyesight started failing, my family began to worry. My kids did not like me driving the car pool. My one son avoided riding with me. But they never openly confronted my ability to drive.

In retrospect I know they struggled with the question of when to intervene in my driving. This was a dilemma that many families brought to me as a physician. Often I had a patient who couldn’t remember what day it was or where they were. Yet, somehow they always seem to find their way home. With them rational conversations were likely to end up only in hurt feelings. The solution often came in hiding the car keys or getting rid of the car. For someone who is aware of what is going on it is still an emotional issue.

How much are we responsible for the behavior of others?

Family members have responsibilities that friends don’t have. There is a mutual dependence that will be changed. If you stop somebody from driving, you will have to provide another way for them to get around. Most of us do not live where there are good and accessible alternatives to the car. That was one reason we moved to a city. I now live within an easy walk of four bus lines. With an electronic bus pass I can walk on and off any bus any time. With a phone app I can check the bus schedule while I’m walking down the street. On nice days I enjoy taking a long walk.

While we don’t like confrontation, we also don’t like to see people hurt. That includes the person whose abilities are failing, and those who might be hurt by their actions. At one point I was working as a member of a kitchen crew. We had more people than jobs. I started ladling out the soup. I was a little clumsy. A friend noticed, and offered to take over. He had the courage to risk my hurt pride.

We often see people having difficulty doing things. Sometimes it’s just finding directions. Sometimes I can guess what they’re looking for and point. I appreciate people telling me when the light has changed, and it is safe to cross the street. Other times it may be in carrying something. I have found that most people like a question like, “How may I help you”.

There are many times when we probably should intervene in what a friend or family member is doing. I have shared a couple of personal examples, but am sure you have many more stories. I would love to hear about them and your reasons why you did or did not intervene. Please feel free to leave those comments here.

If this blog has helped you, I would appreciate you at least “liking” it. If you know somebody who might be interested in it please “share”.

As All Ways, Seek Joy,

Coach Dr. Dave,

Author of the forthcoming book, “recipes for lemonade (Thriving through disability): Dr. Dave’s personal recipe”

www.www.bsmk-med.com

What prompts us to consider ourselves disabled? From the time we are children and realize we are individuals we begin to take stock of who we are. Small children don’t seem to worry about what they can’t do. When they fail they pause and try to figure out how to succeed. When do we lose the joy of finding new ways and new abilities?

When I started wearing glasses in elementary school I began to have to pay attention to what I was doing. Wrestling with other kids would invariably get my glasses hit.  I would have to take them off. Since I was rather myopic when playing football, catching and passing the ball were no longer an option. Since I was big for my age I could play in the line and often centered. Years later I played rugby, and found the same problem as when we played football. Playing on the wing I was the last person to realize the ball had been kicked to me. That is scary when you have guys bigger than you running full speed at you, and no one’s blocking. I moved to the scrum, and later got some contact lenses.

Wearing glasses didn’t seem strange to me. Both my parents wore glasses and later my sister and brother wore glasses. Many other people were glasses so that problem was not unique.

When I was in my mid-20s I was diagnosed with glaucoma. At that point I felt I could see as well as anyone else. Being a doctor I realized that someday that might change. A few years later I was doing physicals for people to drive trucks. One of the requirements is that they can see to the side. I realized that I could not pass that physical any longer. I like to think that I could do anything but this was not something I had set my hopes on. If my livelihood depended upon my driving a truck this would have ended my career.

Over the years my vision changed very slowly. There were a number of accommodations I made to see as well as possible. I got antiglare sunglasses. I would let my wife drive when possible. And eventually I tried to plan my route so that left turns were less often. Later I learned to check from side to side on the road ahead of me. Looking across the road from one shoulder to the other assured me that I had seen everything ahead of me.

When I finally met the requirements for legal blindness I do not know. For many years I had trouble with the eye test to get my driver’s license. My eye doctors would always sign the note so I could get my license. I got scared the last time I went to get a driver’s license. I looked in a machine and saw nothing. It was testing my sensitivity in lowlight conditions. Again, my eye doctor gave me a note that allowed me to continue to drive.

Was it safe for me to continue to drive?

Driving is not just a right but for most a necessity. Many families came to me concerned about the ability of my patient to drive safely. There were many reasons and many stories why they were concerned. In many cases the patient was demented and it was surprising they could find car keys let alone finding their way home. I think that the autopilot that sometimes takes us home when we wanted to stop on the way was active. Like walking, driving can become second nature. In upcoming blogs I plan to talk more about how to have these difficult conversations.

If you or someone you know has had to change their way of doing things would you share that with us?

As All Ways, Seek Joy,

Coach Dr. Dave

Author of the forthcoming book,” recipes for lemonade (thriving through disability): Dr. Dave’s personal recipe “

www.www.bsmk-med.com

So you think you’re not as good as someone else. What’s new? We all feel this way sometime. Don’t settle for the platitudes of friends and family. Friends and family are well meaning. Often what they say is honest. But does it really satisfy your need?

When we are feeling inadequate what is really going on? It is not just a question of the glass half empty or half full. Either we haven’t lived up to our own expectations or we fear we won’t live up to our own expectations. Where did our expectations come from?

My expectations come from my self-image. I would like to excel in everything. I think for some reason I should be able to excel in everything. When I put my mind to it I have excelled at most things. Yet, honestly I’m not the best there ever was, at anything except maybe being myself. Does that realization make me feel adequate? Not really.

What then makes me feel adequate? Sometimes it is simple things like straightening the house and making the bed. Today it’s getting this blog written. I thought about this idea for several days. Now that I am writing it is taking a form different than what I thought it would. This is not the first time a blog has written itself and come out differently.that I didn’t have enough to say. That what I would say would sound trite. Now I see those fears were away for my unconscious to come up with a new answer. The answer for me to have felt adequate seems to go ahead and just do it. That means figuring out what you are afraid of, and finding a way to approach it.

When we feel inadequate we are also feeling overwhelmed. Yet, a monumental task like putting a man on the moon wasn’t done in a day. When President John F. Kennedy tasked the nation with doing that in 10 years, it took a week for a group of engineers and scientists to outline a plan. It took thousands of people working over a decade to make it a reality. The overall tasks seemed impossible. Yet when they broke it down into doable parts it was accomplished.

So, when we feel inadequate how should we approach it? It would seem we need to define the task, break it down into doable parts, and get started.

This may seem appropriate when were overwhelmed by a future task. How about a past event.? I would use a similar formula. Define the task, to find my expectations, review the outcomes, look for lessons learned, and celebrate my successes. We can always claim we tried. We can always identify factors outside and within our control that prevented us from reaching our expectations. Then we can design new strategies to prevent those things from happening again. This process is easier if you have somebody help you work it through. That is one of the tasks of a coach.

What in your life is making you feel inadequate? How have you cope with your feelings of inadequacy in the past. Do you take issue with anything I’ve said here? What wisdom can you add?

As All Ways, Seek Joy,

Coach Dr. Dave,

author of the forthcoming book “recipes for lemonade (thriving through disability): Dr. Dave’s personal recipe “

 www.enjoyhealthandlifecoaching.com

I feel like a two-year-old always asking questions, as if I never understood the answer. I just looked at the “Disability Challenges Survey” I posted a couple weeks ago. Only 12 people have responded, so it is hard to make generalizations. It gives me more questions than answers. I probably should’ve expected this. My father research scientists always said, quote with every answer there comes to more questions”.

The first question was to give me some idea what type of disability people had. There seem to be as many physical and mental and emotional disabilities. I was surprised that no one thought they had a spiritual disability. For most of the world spirituality is part of health. Americans are and exception to this rule. Yet, we are more church going than most industrialized countries. This will give a spotter for further discussions on Facebook and in this blog.

The second question asked about the duration of the disability. As I expected some had been born with a disability some had acquired a disability in some sense said they became aware of the disability. I inserted the latter two categories because I don’t know when I became legally disabled. My condition was slowly progressive. I knew early on I couldn’t pass the physical to drive a truck. It was only many years later that I had to stop driving a car.

The third question asks about how we felt about our lives. Most felt pretty good about their lives and the disability did not diminish the satisfaction much. One’s satisfaction with their ability to work seemed equal to their ability to care for themselves. I will want to see if the same people felt the same about their self-care and work.

The fourth question asked about satisfaction with factors outside of our immediate control. People seemed most unhappy with their medical care and Social Security. This does not seem to be surprising, since most disabled people spend a lot of their energies and time with medical care and the Social Security system. People felt good about their family and friends. At work their employers seem slightly more supportive than her coworkers. I have been active in many faced based groups advocating for disability services. I often see many barriers in churches. It surprised me that faith communities were very supportive.

The fifth question asks about what changes people would like to see. Medicare and Social Security led the list. In this small survey one person complained that their family treated them the same as they did prior to the hearing loss. There also seem to be a desire to have others treat them better.

The seventh question asks about assistance and what type of assistance people would like. I am not surprised that finding work led the list. The disabled person is twice as likely as an able-bodied person to be unemployed. Relationships with families and family and friends were good.

When asked how optimistic or pessimistic they were about their future, people tended to have a good attitude about the future and their personal future. They were not as optimistic about finding work or being able to care for themselves.

These are preliminary observations. I hope more will answer the survey. More answers will give me more certainty as to what disabled people feel. If you know of others or groups that might not have been asked to take the survey please ask them to take it athttp://www.surveymonkey.com/s/CZL8LN3

As All Ways Seek Joy,

Coach DR Dave

Author of the forthcoming book, “Recipes for Lemonade (thriving through disability): Dr. Dave’s personal Recipe”.

www.enjoyhealthandlifecoaching.com

Helping that is what the man in a wheelchair was trying to do as he held the bus door open. He asked, “Are you getting off?”
“No, my connection is at the next stop.” the man replied.
I thought this was interesting that a disabled person was trying to help an able-bodied person. Why is it that we do or do not want to help? For me I’ve always enjoyed helping, but like most men have been hesitant to ask for help. Becoming disabled has made me rethink this.
Now there are many things I wish I could do but can’t. I can’t read street signs. I don’t see well enough to drive. I often struggle to read the bus numbers. Do I get on the bus and hope it’s going where I want to go or ask somebody first?
I hesitated to ask for help for several reasons. First off it would indicate that I was not fully capable. This idea of being independent and capable of doing everything for me was important to me. I had grown up watching the Lone Ranger and similar shows with an independent hero. Now I’ve come to wonder who made the Lone Ranger’s saddle. The Lone Ranger was an individual in a larger system that was interdependent.
The other day in the locker room I noticed someone had a talking watch. This told me he too could not read a regular watch. We started up a conversation on why or why not to carry a white cane.
The question of whether or not to carry a white cane leads to another issue about asking for help. The white cane isn’t just a tool for me but tells others that I don’t see things. Initially I was afraid of being taken advantage of. Then I had a couple missteps and had to take a few flying leaps, to avoid falling down steps. The white cane now tells the bus driver and others that I probably can’t read the bus number. They readily volunteer the number, which helps immensely.
Why would they want to help? For the bus driver it is part of the job. Others readily volunteer their assistance. When I can help others I feel a sense of connectedness. When others help me I also feel connected. I no longer feel alone and vulnerable. I do not have to do everything for myself.
Helping and being helped is like moving a table. I can pick up and move the table myself, but it is awkward and I am apt to bang things. If someone takes the other end we can move it easily and safely. We might even carry two tables at a time, thus maintaining the efficiency.
What is about helping that you like or dislike? I would be interested in hearing your comments.
As always seek joy,
Coach DR. Dave
www.www.bsmk-med.com

Now as the horror of the Boston Marathon bombing fades in our memories, it will still be very much alive for the 260 people injured in that blast. Today they are confronting the real barrier in their journey beyond disability. They like many of us are angry at the bombers and do not want to associate with them. Many of them will choose to join in wanting to punish the family of the dead bomber. Some will not want him to be buried on American soil. For those harmed injured in the blast this can become an all-consuming passion. However, where will they be in five or 10 years if they continue to focus their energy here?
If they are to enjoy their lives in their new bodies they will need to let others deal with the bombers. When they allow their anger to persist the creative parts of their brains will not work as well. They will need creativity to help them learn new ways to live in their new bodies. However, stifling their anger will not help. This is where sharing their anger with others will help. In an ideal situation they will receive group therapy facilitated by trained counselors. In such a situation they will find that they are not alone in her anger and receive comfort and sharing that anger. Any nightmares or flashbacks will be accepted as part of the process. As they feel love and acceptance the negative emotions will be put to rest. They will gradually return to their former selves. But the former sells will be different they will have different bodies and different memories. Events will be able to trigger those memories. This is called posttraumatic stress.
This whole process is that of forgiveness. It doesn’t mean they will ever forget what happened. For those with major injuries they will be reminded of this event daily. They now have the task of making a new life in a new body. It is like becoming a teenager again in midlife. They will have to discover the capabilities and their limitations. Armed with that understanding of who they are they can now dream again of a future life.
How they transition through this second adolescence will vary. Most people with the self-discipline and determination to run a marathon will want to go forward. They think of themselves as capable and are willing to undertake seemingly superhuman tasks. It would be surprising to find any of them stuck in self-pity. True there will be times when they feel depressed and overwhelmed. Depending upon how much support they get from others this may be a serious stumbling block or just a normal passing feeling. Physicians and others involved in a rehabilitation program are aware of this hazard, and hopefully will intervene early.
I saw this problem frequently when I was caring for people with new strokes. After the shock of the diagnosis and some initial return a function, there was a realization that a lot of work lay ahead. We physicians realize that early intervention was helpful in the overall outcome. Some studies had shown that the routine use of antidepressants improved function at one year. Many people are not accustomed to setting lofty goals and working hard to achieve them. Thus, they are more prone to getting overwhelmed and stuck in depression than are people who would run a marathon.
What will the road forward look like for those injured in the Boston Marathon bombing? I hope to explore that in next week’s blog.
If you would like to comment or share this blog feel free. I know that forgiveness is a tough thing to achieve. Turning once focus from one’s loss to want future is critical to achieving a joy filled life.
As always, seek joy,
Coach Dr. Dave (MD disabled))

In the two weeks since the Boston Marathon bombing we have learned a lot. For many of those 260 runners and spectators who were injured, it will be the start of their journey beyond disability. While running a marathon is a journey in itself it is done intentionally. Now they will be running a journey not of their choosing. This is a journey no one takes by choice. It is the journey through disability.
In my last blog I talked about preparing for such a journey and how we don’t do it intentionally. But that the things we do to prepare ourselves and our children help us to prepare for this journey. These skills fall into two main categories emotional skills and social skills. The self-discipline and perseverance necessary for running a marathon will help the runners.
These skills become tested when we have to journey through disability. The first challenge with a disability is accepting the disability. Neither self-discipline nor perseverance will help with this. For people who lost limbs in the bombing it will take them a while to remember that they don’t have 2 feet or two arms. For the last 10 years, I have not seen well yet in my dreams everything appears crystal clear. I imagine for those injured two weeks ago their image of themselves will at times remain intact.
Learning to adjust to a new body will have its humorous moments as well as its tragic moments. When I look straight ahead I see nothing to the left of midline or below horizontal. My wife is short and on several occasions I have turned around and try to walk through her. She is big enough that we laugh about it, but when their small children around I fear kicking them across the room. I joke that my white cane is a kid catcher.
I did not initially think I needed a white cane, and I am sure that those injured in Boston will take a while to accept new ways of doing things. When I went to rehabilitation for my lost eyesight I focused on computer skills and using a white cane was an afterthought. I realized later that a white cane would be handy. When I was coming out of a meeting one evening, I found that I could not see the stairs. They were poorly lit and did not have a contrasting lip. I learned to use the cane but did not carry it regularly until I missed a flight of steps and had to take a flying leap. The white cane has saved me on many occasions since then.
Before we can get to the work of learning to live with a disability there are many other questions we ask. The world is asking why the Boston Marathon bombing occurred. Those injured will also ask themselves why I was the one to be injured. They will always ponder the question and may note that in their moment of triumph they entered this world of disability. Completing a marathon is something very few people do. When I tell people I ran marathons they react in dismay. For those injured in Boston that triumph will bring back the tragedy as well.
The tragedy is that after all their hard work and success they ended up with a damaged body. What was a victory became a loss. Many will not be able to run a marathon again. Actually they will not be able to repeat it the same way. People have run marathons with prostheses and in wheelchairs. But they first had to accept that they were not who they had been. There strong and vital bodies are no more.
For those of us who find ourselves disabled we do not initially want to accept it. If someone might have said I should be using a white cane from the beginning, I doubt I would have listened. I was afraid to carry a white cane and admit I could not see well. I feared others would take advantage of me. I have found that fear could be ungrounded. I have yet to have someone take advantage of me. People readily go out of their way to help me. My faith in other people has grown immensely because I now carry a white cane. I hope those injured in Boston will Find people who will help them confront their fears.
If you or someone you know would like to share their story of how they came to accept their disability I would love to hear. Please comment or share as you feel appropriate.
In All Ways, Seek Joy,
Coach Dr. Dave (MD)
www.enjoyhealthandlifecoaching.com