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Editor's Notes |
jules-rothstein@attbi.com
If you keep quiet and still, you may start to hear the seconds of your life ticking away—or so it may seem.
We measure time by the oscillations of magical quartz crystals and by an atomic clock, both of which keep our timepieces more precise than we need them to be. We also measure time by the events that mark our lives and scar our bodies.
Forty years seems like a broad expanse under any circumstances, but for me it seems even more so when I consider events. I remember my deranged high school classmate, an anarchist who made a mistake while making a bomb and destroyed himself and a building that was an underground bomb factory in Greenwich Village in the late 1960s. I compare him with the current students of my old high school, who on 9/11 ran in terror from the collapsing World Trade Center.
Not only were my classmates and those students on 9/11 living in different times, they seem to have been living in different universes. When I hear many children of the Age of Aquarius, the "peace generation," now beating war drums, I cannot help but feel as though my world has entirely disappeared. Of course, I am engaging in the self-indulgent excess that was the hallmark of my generation. We always thought we were different, unlike any who had gone before us. But now we must admit the inescapable: We have aged, just as the carefree people of the 1920s aged the day the stock market crashed, and just as their children aged when American innocence let out its last gasp on battlefields from Pearl Harbor to Okinawa and the beaches of Normandy. As time passes, the world changes, and so do our bodies. Very few humans allow either to happen with grace and acceptance.
I am reminded of an elderly patient who began every session with an inventory of what she had lost in life and the people she loved who lived no more. I was not very tolerant of her. She was the proverbial stranger in a strange new world, but all I could see was how counterproductive her ruminations seemed to be.
There was a time when I and my peers would have viewed the research by Hulzebos and colleagues (pages 8–16)—who studied patients with postoperative complications following coronary artery bypass surgery—as being about "them." That is, we would have viewed the research as being only about patients, and not about us. Today, however, the subjects under study do not seem so distant. The possibility that we can identify people at risk—and do something about conditions that may not be inevitable after all—is more personally comforting than it once might have been. At the same time, that possibility remains just as exciting as it always has been to me as a physical therapist. Here is something we can know and use. The bigger lesson? Sometimes "they" are us.
Chronic leg ulcers, the kind studied by Houghton and her associates (pages 17–28), used to be a condition that happened to other people. But now, as I read this optimistic report, I think not only of all the patients I have seen but also of the insulin pump hanging on my belt. In this case, I am not "them," and perhaps neither are you; but the line between us and those we care for is becoming less distinct. After decades of passionately speaking out on the need for research about our interventions because such data are a means for our profession's survival, I am now reminded that such research may also be a means for personal survival.
Cress and Meyer (pages 37–48) have the audacity to remind us that, to function independently, we may need to achieve critical levels of performance in various physiological systems. They offer people who have a positive view of this process some guidelines as to how we might provide interventions to stave off dependency; however, people looking for the fountain of youth will be disappointed. Kim and Eng (pages 49–57) offer similar insights into the lower-extremity torques we need to remain ambulatory after a stroke.
Perhaps those of us who are finding that our bodies have become time keepers can draw some solace from the report by Eason and associates (pages 29–36). Although this paper also does not offer an elixir that halts aging, the authors do use an animal model to show that, for those of us for whom glucocorticoids are a necessary life companion, anabolic steroids may keep us from becoming weaker. If this is true, it should strike a positive note for both young and old who must turn to this most potent of anti-inflammatory agents. Although glucocorticoids wreak havoc on almost all who take them, the side effects are often worst in those who are least able to tolerate weakness and muscle loss—that is, those of us who carry AARP cards and whose bills are paid at least in part by Medicare.
Before the ubiquity of television news, there were the pompously narrated newsreels in movie theaters. In the most pretentious of voices, the narrators always reminded theatergoers that "Time Marches On." For those of us who were kids then, that meant, "Time marches on for other people." The researchers who report within the pages of the Journal this month make it clear that time marches on for all of us. Their data are relevant both for the practitioner and for those who receive the intervention.
If you still find it difficult to feel unity with patients and clients because you are young and healthy, check out the case report by Pesanelli et al (pages 58–67). They report on a 35-year-old man recovering from an inguinal hernia who received postoperative rehabilitation and who was able to return to work.
As I consider that there is time for all things under heaven, I realize that I cannot and should not want to freeze-frame the scenes of our lives. I think of my 6-month-old grandson and realize that he is part of time marching on, as is the growing independence of my two daughters, who know more than I ever did and who demand their opportunities. And I think of physical therapists, whose job is to maximize the quality of life across the lifespan—not to stop time.
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