Watching Those Eroding Goals

By Roberta L Spencer ( with anonymous quotes )

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“When I saw the question in the post-conference survey asking what was the worst thing that happened during the conference, I immediately thought of your bicycle accident.”

id-morning on August 5 last summer, I woke up in the hospital recovery room.

I was groggy coming out of anesthesia, not aware of any discomfort, and a little disoriented due to the drugs. My nurse said my vital signs were fine and told me to relax. Around noon I was awakened by a calm but persistent voice speaking over the hospital-wide intercom. The announcement was sharing the news about a “Code Green.” The nurse casually said “Oh, someone is on the loose.” I asked if it was an intruder. He said “No, that's a ‘Code Silver,’ we never have those.”

“What ever happened with the intruder with a gun? He was lucky he stayed out of recovery room: I have no doubt you would have taken him down with one arm.”

Following the nurse’s advice, I tried to relax. I woke up when I distinctly heard the next intercom announcement urgently stating “Code Silver, Code Silver!” It was as if all the staff in the recovery room skipped a beat, but they remained very professional, straightaway continuing to care for patients. I remember my nurse telling me not to worry, that the recovery room was locked. Truthfully, with all the drugs I had, I remained strangely calm even though my mind was telling me I probably should be worried about this situation. In just a few short moments, the next intercom announcement was "Code D, Code D." Curious and uncharacteristically serene, I asked the nurse what that signified. He said it meant a DISASTER! He again reassured me I was safe in the recovery room and I went to sleep.

I learned later that evening that there was a report of a man (not a patient) with a gun on the next floor. My husband, who was awaiting news of my surgery in the waiting room, told me that everyone in the waiting room was ushered into a secure room where they were locked in and held there for about one hour. The alleged gunman was apprehended and everything quickly went back to normal.

Why was I in the recovery room? I had a biking accident at the Delft Conference and broke my left humerus, at the very top of the bone near my shoulder, in two places. I am unsure if the break was a discrete event or a step function but it clearly introduced a discontinuity. After becoming familiar with the Delft health care system and saying good bye to my terrific friends and colleagues in Delft, I headed home.

“How did the surgery go? (It is difficult to type an email message with having one´s fingers crossed).”

The following morning after the operation, the surgeon informed me that the metal plate and seven screws (to secure the repaired area) looked just the way he wanted. The doctor was very pleased with the outcome then gave me a 20% chance of an 80% recovery. That was the doctor’s claim – his expectation for my recovery. My claim was quite different: actually I simply did not believe the doctor’s prediction and had no idea why he made it.

“I think there are many pirates that would be jealous of your scar. You can use it to really impress your grandchild with, and make up stories on how you got it while fighting in Holland!”

The sterile bandage ran from high on my shoulder almost to my elbow; I could only think the incision was gigantic and I anticipated having a significant scar. I imagined I would need a tattoo to mask the scar.

“Concerning the tattoo: You should wait and think twice. A scar is very much more attractive.”

“Perhaps I can join your club as an associate member, since I had a bicycle accident myself just 15 days before the conference!”

The process has been a journey, especially starting with the dire recovery prediction. Once the big pain focus began to fade from the surgery, I noticed all the other associated discomforts related to my arm being immobilized. Holding my arm in a sling promoted correct healing of the break, but the unintended consequence was that other muscles, especially around my scapula, became stiff and everywhere weakened. However, a particular challenge has been that when I pass by the refrigerator, the magnets fly off and stick to my arm.

Community support bolstered my outlook. Many System Dynamics friends and colleagues wrote get-well and inspiring messages to me, including a motivating description of “dynamic variables: assess their short-term decisions and feelings (I don't want to, it hurts, why do I have to ...) and the longer-term implications for their conditions (full recovery in x months, remission, limited range of motion in x months, weight loss/gain).” And there were more variables to think about: bone health, soft tissue health, mobility, strength, bruising/swelling, stiffness, muscle mass, pain management, healing, recovery, and mental-psychological ones like fear, empathy, anger, trust, patience, impatience, hope, emotional strength, complaining, burdens created for others, etc. Plus, the insurance “red tape” -- really a complex system.

“I hope you are feeling better every day (I can still remember recovering from hepatitis and feeling awful, but always much better than the day before).”

Everyone advised rest. How to rest was the question. Getting better meant to me to work harder, and this philosophy does not quite fit here. Never having experienced any major health issues I was really unaware. It does afford time to reflect on life and think about what the “new normal” will be versus the “old normal” -- an expectation-setting exercise based on reality. I was looking for some guidelines or a roadmap to show the way for an optimal healing process -- and there isn’t one.

“Basically you need to exercise to get better but if you do too much too soon you get worse.”

I started physical therapy, very slowly, three weeks after surgery. I was in a sling for a total of five weeks. My “policy” was to have a positive attitude and wisely limit exercise. My “pitfall” was that my rosy outlook may have caused premature exertions.

“Your journey is challenging but some of the stress, while painful and difficult, will boost the resilience of your mind and body.”

I tried to find the way to build up capacity to include resting to recover and fulfill other time commitments for physical therapy, exercise at home, work, and sleep. There were many conflicting time requirements, and trade-offs had to be made more often than I wished.

“When I started rehab after surgery I couldn’t walk. Started in the gym working the stationary bike with my good leg only and the broken one just passively going around and around. Frustrating. But the positive feedbacks kicked in and eventually I was able to run on the treadmill and then on real streets. Hang in there!”

Seven weeks post-surgery the surgeon increased my chance of recovery. He said 100% recovery was not impossible but very uncommon. (Perhaps I will be the Black Swan.) At this point I gradually started strength training. (Where did my muscles go so quickly?) It is surprising to me that healing entails so much more than the one body part, my left shoulder.

I learned to be more patient because everything takes so much longer to do – or I needed to wait for someone’s help. Everything required more energy, more time, and then required rest to reenergize. Being partially incapacitated requires lots of help and support from many teams. This was humbling and I am eternally grateful for all the help people gave.

By late November, about five months post-surgery, I was continuing with physical therapy three times a week and additional exercises for up to 2 hours per day at home. Eroding goals at this point was an issue for me. The exercises were repetitious and unexciting. I needed to be willing to be in discomfort and some level of pain to continue to do the exercises and also to let the physical therapist do his job.

“You will keep on fighting.”

In December the surgeon said I was exceeding all his expectations in healing. I asked him if he sees patients become overall “stronger,” healthier, or develop different skills after a life changing event like this. He said “No, most people are sluggish and adapt.”

“Keep up your rehabilitation exercises and don’t listen to too closely to people who say you won’t get all better. By observation they are already too wrong for words!”

My shoulders still do not work with synchronicity. My left shoulder blade sits lower on my back than my right one; they are not symmetrical. Happy New Year! The insurance company decided I am rehabbed enough (no more physical therapy) even though I still cannot easily open the heavy exterior door to the university.

“Sustained periods compensating can be very tiring.”

“Keep your [recovery] goals high and don’t let them erode in the face of those who say “well, that’s good enough.”

Seven months post-surgery (March 4) the visit to the surgeon included an X-ray to see if I have any loose screws (in my arm!). It’s a little disquieting to think I may have a screw or two loose. He said the screws are fine, to just forget about the screws. He asked to see how far I could move my arm forwards up, sideways up and then behind me. He said something like “people who have had this surgery don’t get the mobility back that you have.” He said that even if I did not get 100% mobility back, it would not matter because I have enough functional use to live my life. But, my goal remains to reach 100%.

“Great to hear you are recovering faster than the doctor expected! If you can do anything you want I would settle for full-contact karate. That will be a great help too if you get difficult customers at the check-in at the conferences.”

I told the surgeon that I have been compliant and proactive with the post-op rehabilitation and I have the desire to go as far as possible. I am looking for continued improvement and avoidance of risk. I asked him what I should do to improve, and what to do for preventing any further injury to the shoulder area. His reply was that what I was doing was fine, and I had no restrictions. This was hard for me to believe so I asked “So, I can play full contact sports?” And he said “You can do anything you want.”

“I was relieved to hear that you have been doing much better recently. The TREND is important.”

“‘Live your life fully’ is great advice, but reason is also vital if you want to age well.”

This April spring, I had “raking success” and was thrilled since five months earlier in the fall, I tried to rake the autumn leaves and I could not manage the rake or the pain. I will not complain about raking again since now, I can!

“The baseline time for recovery from almost anything is about a full year or more. In my own experiences, improvements will continue, even into multiple years!”

The one-year surgery anniversary is coming up on August 5. What percentage will I be at? What will the future hold? Will my subsequent health and fitness actually be better due to this accident? Will I ever have the courage to ride a bike again? What will it mean to have metal in my arm when I am 90? I am more experienced, humbled, and as determined as ever to maximize recovery. There has been a steady and slow return. Almost one full year has passed, but now it seems the window of opportunity to “get well” has been very short.


Roberta enjoying a new skill.

“Whenever one has an injury, a compensating benefit is the connection one can make with kindred spirits via shared experiences.”

There are interconnections everywhere that we don’t think about – in the body with trauma causing physical (and mental) aches and pains that over time lead to recuperation; in people giving tremendous, heart-warming support from all the different parts and pieces of my life. From small acts of kindness to huge favors, all have had enormous effects on me. I needed the interconnection of the physical part with the people part to recover. The support sustained me and strengthened my resolve. How thoughtful, wonderful, and humorous the System Dynamics community can be!

I am extremely lucky to be part of this caring and encouraging community. Thank you for the opportunity. I look forward to seeing you this summer at the conference in Cambridge. (I will be driving this time.)



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The System Dynamics Newsletter is published by the System Dynamics Society.
Editors: Robin Langer, LouAnne Lundgren, Weijia Ran, Rochel Rubin, Erin Sheehan, and Roberta L. Spencer