If you don’t have a reason to get out of bed in the morning, it won’t matter how healthy you are, will it? If you don’t have pleasures, positive goals, love, or meaning in your life, why bother with self-management? We all need reasons to live, but sometimes we don’t have them or we forget what they are.
I often teach doctors and diabetes educators about the importance of reasons to live. Here’s one of the stories I share with them. I’m blogging about it because reasons to live do us no good if we don’t act on them. When we do, it can change our lives.
I used to lead a six-week self-management program at Kaiser Permanente hospital for people with a variety of chronic conditions. A 60-year-old woman named Iris came to one of these classes. Iris had high blood pressure and Type 2 diabetes, and two and a half years before, she had had a stroke. Since then, she had mostly been moping around, not doing much of anything.
Iris never would have come to class, except her family dragged her. Each week, a different family member would bring her, so over the course of the six weeks, we got to meet the whole family.
In the Chronic Disease Self-Management Program, as it’s called, everyone is supposed to make an action plan for one thing they are going to do for themselves in the coming week. (See ideas for action plans about half way down this Web page.) Every week, Iris’s action plan was the same.
“I’m going to get on my exercise machine,” she would say. She had this LifeCycle at home, and she would say, “I’m going to use it three times, for 20 minutes at a time,” or something like that. And she never did.
I mean, not one single time did she get on that LifeCycle. One week she said her knees hurt. Another week she didn’t have anyone to help her on or off. Anyway, she never did it.
The fourth week, she gives us the same plan —”I’m going to get on my exercise machine.” And I just said, “No. Don’t tell us this same plan that we know you aren’t going to do. Pick something that you WANT to do.”
“Not something your doctor told you to do,” I continued, “or something you think you should do, or something that would make your husband happy. Something you want to do. Because wanting to do something means it’s important to you. It puts some energy behind it. That way, you might actually do it.”
So Iris said, “OK. If that’s the way you’re going to be about it, my plan is, I’m going to cook a meal.” Not really a health behavior at all. But it was a striking thing to say, because in an earlier exercise, she had told us that what caused her the most pain and the most grief was not being able to cook. Cooking had been her main role in life; she cooked for her whole extended family. And she hadn’t cooked for two and half years (since her stroke)!
So we were all pretty excited about this. She came back the following Saturday and I asked, “How did it go?”
“Well, I don’t know if I did it or not,” Iris replied. She said she had started to cook a couple of dishes. Then she got tired on her affected side. She called her husband in, and he acted as her sous-chef. She told him what to do, and together they prepared a dinner. They had such a good time doing it that they did it again later in the week!
Iris was just beaming as she told this story. Her son was with her that day. And he said, “You know, she exercised every day this week.”
She exercised because she had a reason to. I think we all have to find our positive reasons to live and give some time and energy to them. Otherwise, why bother? For Iris it was cooking. What is it for you?
When things are going badly, it’s harder to focus on the good things, but that’s when it’s most important. It’s so easy to sink into despair or depression with the things that are happening to our environment, our economy, our politics, and our bodies. It’s easy to forget the good things, the love, the beauty, the fun, or just to let them go.
But we really shouldn’t ignore the good things. Our bodies need reasons to live. Studies of nursing home residents show that those who have something to do — even if it’s just taking care of a plant — live longer and are healthier than those who don’t.
I’m basically writing this message to myself, but perhaps it might speak to you. As I told Iris, when you don’t know what to do, do something you WANT to do. Give some energy to your reasons to live.