Thomas Erickson
July 2023
For the first fifty years of my life I cultivated my mind.
I was raised to believe that learning was the path to having a good life. Learn to read. Do well in school. Develop social skills. Get into a good college. Find a profession where your interests and abilities overlap. Be curious; seek out new things; keep learning. And, as a consequence, advance along the career path: develop more expertise, accrue experiences, develop your work portfolio, expand your network of contacts. My body had little to do with any of this. Well, that’s not true. It is more accurate to say that it played a supporting role: possibly important, but by no means in the spotlight. I didn’t pay much attention to it. Yet I was not a sedentary person: I biked, to school and then later to work. I practiced a martial art. I hiked and backpacked and body-surfed. I kept a garden. And so on. Much of what I did for fun involved physical activity. But still, I took my body for granted.
My philosophy was ‘live an active life, and the body will take care of itself.’ Bike to work. Walk to the store. Use a push lawnmower. But exercise just to exercise? I was loftily amused by people who sweated at weight machines in the gym, and paid money for the privilege. I rolled my eyes at people who jogged, puffing, along the tarmac. It didn’t look like fun.
I no longer roll my eyes. Except when I am exercising my eye muscles. That’s just after I do my neck exercises, and before I do my shoulder exercises.
These days I devote much more attention to my body than to my mind. In part this is due to having retired: I have more time. In part this is due to the ever-accumulating pile of evidence that my body is in decline. This is well established in the scientific literature: people lose 3-5% of muscle mass every decade from age thirty on, and considerably more as they reach their sixth decade, as I have. I would like to say that as a scientifically literate, inquisitive, and vigilant adult, I had kept abreast of the literature, had been monitoring my changing body, and had developed strategies to contain, if not avert, sarcopenia (as the phenomenon of losing muscle mass is charmingly called). But that was not the case.
Instead of forethought, I must credit a humble stone path for sounding the alarm. Eight years ago, in the wake of the death of our last living parent, relatives were coming to visit. Because relatives were coming, the house and yard needed to be in respectable states. (In our household routine cleaning is catalyzed by impending dinner guests, and larger-scale external maintenance by impending relatives.) The exterior and yard were actually in good shape, and so why not use The Arrival – still two days in the future – as an impetus to re-do the backyard flagstone path, which over the years had grown uneven and weedy. And so I set to work. (Hire it out? Certainly not. The ‘live an active life’ philosophy requires its practitioner to carry out all household manual labor.) I will skim over the two days of hot, sweaty work: stones were levered up, a layer of soil dug out, a line of weed cloth put down, followed by a layer of sand, and then each flagstone thumped back onto the path and pushed and tugged into place to form a harmonious composition. The path was completed. It looked great, arcing across the back yard, the reddish flagstones contrasting nicely against the green of the yard. It met with near universal acclaim: ‘Beautiful geometry! ‘A work of art!’ ‘A stone mason could not have done better!’ Only my right shoulder dissented.
At first its complaints were no louder than the murmurings of the rest of my body. Shoulders, back, thighs, and calves were sore immediately afterwards. The soreness transmuted to stiffness the following day, and in turn dissipated into a sort of tautness, which I imagined as a web of new muscle developed in anticipation of some new and greater effort. Except for the right shoulder. Its soreness did not follow the expected path. It went the opposite direction, gradually becoming more painful over the ensuing days. I went to my doctor who examined me, and sent me on to a specialist. “Torn rotator cuff,” he pronounced, and referred me to a physical therapist.
It was my first visit to a physical therapist, but not my last.
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After the rotator cuff, it was the elbow. It was a small spot of pain – about the size of the tip of my little finger – dwelling in my right elbow. It made itself known only occasionally, but when it did it did so with considerable force: a sharp, hot, shot of pain. Generally, an episode of pain was triggered by some vigorous activity involving frequent gripping, grasping and holding. Gardening, especially digging with a trowel and pulling weeds by hand, was the usual and most evident culprit. The last episode followed the reassembly of a recalcitrant bookcase, which required a lot of one-handed squeezing and gripping. After that the pain remained, even after several months of enforced inactivity, and so I finally returned to physical therapy.
I should say that I like physical therapy. I really like it. I like it because the examination and evaluation is so transparent. There are no x-rays that produce ghostly white shadows; no blood work that produces mysterious BUN/Creatinine ratios; no machines that hum or buzz and spit out a number. Instead it’s a very human interaction. Very one on one:
“Raise your arm like this, and I’ll rotate your wrist.”
“Ow!”
“Does that hurt? Good! How about this?”
“Yes!”
“Good! Where exactly? Touch the place. Good. … How about this?“
“Ow.“
“Excellent! Hold your arm out and I will press on it – try not to move it. You’re strong. Good. Squeeze your fist as tightly as you can. Good. Now hold your arm this way and squeeze again.“
“Ouch!“
It is clear that my therapist has figured out my problem. She can hurt me at will. She doesn’t need to use force; just a particular configuration of the arm, or twist of the wrist, and the gentlest possible press produces pain. She understands what will produce discomfort, and what will not. She can give an account: it is these two muscles and they attach to the tendon right here. She presses. And I believe.
If you like evidence, as I do, this is perversely satisfying.
I also like physical therapy because often the current problem is part of a larger system. The thigh bone is connected to the knee bone, and the knee may be unhappy because of the thigh. In my case, the elbow tendon is irritated because my arm has been overcompensating for weakness in my right shoulder, the ur-problem that launched me into my first bout of physical therapy. I thought I’d gotten the shoulder back to about 95% of where it should be by the end of my sessions, and I had diligently continued the exercises even after physical therapy had ended. The problem no longer made its presence known in my daily activities. But apparently I’d only learned how to move the stress from the shoulder to the arm. Too bad, but yet oddly comforting to have a narrative that makes sense of it all and connects it to problems I already knew about. While I’m not keen on having the problem, I prefer multiple manifestations of a single problem to having multiple problems.
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Not that my problems are limited to one. The period of enforced inactivity during which I rested my arm was due to recovery from surgery for prostate cancer. My recovery was trouble-free, and as it progressed I met and usually exceeded the various physical and functional milestones on the road to recovery. However, as I approached the nine week mark, I was faced with a dilemma. Nine weeks was a major milestone because at that point, I would transition from not being allowed to lift more than ten pounds to being able to do anything. It would be quite wonderful if the body really worked this way: if, in the midst of a state of tremulous frailty, a surge of energy would erupt and rush through my body – muscles swelling, sinews knitting, chest expanding – and like a superhero casting off his disguise I would burst forth from the cocoon of convalescence.
Sadly, the body does not work this way. It is rules that work this way. Rules do not recognize ambiguity or multiplicity or context or nuance. They are alien visitors to the natural world. They create clear boundaries and deadlines in ambiguous situations characterized by gradual change. They expect to be obeyed. And this makes sense. We understand that a rule is most effective if it can be remembered and followed and perhaps enforced; its accuracy has little to do with its effectiveness.
I wonder if, one day, perhaps not so far off, we might have computerized agents that would guide us more gradually. ‘You can lift fifteen pounds, this week,‘ such an agent might say. As I convalesced, it would gradually relax the constraints; it might be guided, perhaps, by the use of sensors to gauge my degree of activity and whether the body is responding well, or not. It is not far-fetched, I think, to imagine that devices that can track our pulse and pace and blood oxygen levels, might be able to detect the subtle physical remonstrances though which the body says, ‘hey, that was a little bit much.’
But in the absence of such intelligence assistance, one is left with inflexible rules that one must follow, or break. Generally, I am quite good about following rules. Their clarity – especially if they make sense (like “don’t lift heavy things after you’ve had abdominal surgery”) – compensates for their rigidity. But sometimes special circumstances arise. And before the nine-week ‘you can lift anything’ milestone arrived, special circumstances did arise.
We have a Makrut lime tree that grows in a pot. Makrut limes appear bumpy and deformed, and are dry and packed with seeds inside. But their leaves, which have a curious doubled form with one leaf growing out of the tip of the previous one, have a lovely flavor that will be familiar to lovers of southeast Asian food.
Our Makrut lime lives happily outside during the summer, but winters unhappily inside, increasingly beset by scale.
Normally, about every six weeks during the last part of the winter, there will be a warmish interlude, and I take the lime tree outside for a shower. It’s the only way I’ve found to effectively combat scale: set the hose’s nozzle to jet, and blast the leaves and stems with pressurized water. It is wet and chilly work, and takes its toll in tattered leaves, but nothing else is effective. But this winter the six-week rhythm was undone by my surgery and ensuing convalescence. As I slowly recovered my strength and stamina, the lime tree ominously journeyed in the opposite direction, scale gradually colonizing its leaves and stems and producing an increasing drizzle of sap that left the leaves shiny and the floor sticky. Armed with paper towels soaked in rubbing alcohol I tried to stem the tide, but, as in the past, such manual measures only slowed the scale’s advance. About a week before the ‘You can do anything’ moment, the Makrut began to drop its leaves, something that had never happened before. And, at the same time, temptingly, the outside temperature crept above freezing.
I had to act.
The issue, of course, is that the lime tree – a dwarf, but nevertheless three feet tall and in a pot to match – weighs in at considerably more than ten pounds. Quite the quandary. But I’d come up with a clever solution. A hand truck! It lived in the garage, and was intended for moving furniture about, but I realized that the lime-tree-and-pot could be slid onto the hand truck, and rolled smoothly outside, and let gently down the stairs to the theater of shower operations. We will move rapidly past the issue of the weight of the solid-steel hand truck, tarrying only to note that it can be pulled and moved by leverage and leaning rather than lifting. Not such a great transgression of the rule, if, indeed, it was any transgression whatsoever. And, of course, I was only a week away from the ‘you-can-do-anything’ moment, so surely there should be a bit of leeway.
The hand truck worked admirably. The lime tree bumped gently down the four stairs of the back porch, endured its shower, and bumped smoothly back up to its place in the sunny southwest corner of the kitchen. I was unaffected, due either to good planning or an over-cautious rule. The lime tree, on the other hand, left about half its leaves behind, an anomalous green halo on the snow, along with, presumably, most of its scale.
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Spring has bloomed into summer. The lime tree, although bedraggled, survived to return to its natural outdoor habitat, where some combination of predatory insects and bright unfiltered sunlight eliminated the scale. Pruning has eliminated leafless branches, giving the tree a more balanced and open form. New leaves and twigs are emerging, as it takes full advantage of the light and warmth and humidity. If past years are any guide, it will leaf out, flower, and perhaps produce a few of its dry bumpy limes. It will be in robust health by the time fall arrives and it needs to move indoors.
I too returned to my natural habitat. Some cautious bike rides, walks transitioning into walk-jogs, and then into full runs. In June I went to Yosemite, where I was able to do my favorite hikes, including the toughest ones. Later in the summer I went to Iceland and tramped about looking at rocks with a bunch of geologists. Other activities followed.
I have also returned to physical therapy. Now I’m working on my left thigh, which can produce odd flashes of localized pain during intense hiking descents. In the satisfyingly systematic way of physical therapy – in which the body is understood as a web of interconnected muscle, tendon and bone – addressing this turns out to involve working on my core muscles, my posture, and my balance. It’s not so much about strength, as about everything working together as a system. Bend. Stretch. Balance on one leg, with your eyes closed. It’s kind of fun, actually.