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4 Things I Have Learned From Working in Rehabilitation and Long-Term Care

None of us is immune to tragedy. We are all connected by the perpetual human condition of grief and loss.

Grief often comes to us in all-encompassing waves of loneliness. Immense loss, broken dreams, quiet, glassy moments that suffocate. It can feel like we are in an airless, cold, deserted cave. Now more than ever, we look around and see the myriad polished illusions of other people’s lives and sink into a new depth of loneliness. It can feel that only a chosen few of us are destined to experience such profound loss and pain.

The reality is that this is just not true. You don’t have to scratch too deep beneath the surface to hear the pain of a person’s life, whether 15 or 105.

These truths just happen to come out more easily when someone is in a rehabilitation or long-term care setting. The illusion is already shattered and everyone knows it. Rather than putting on lipstick and listing our latest accomplishments, we are rolling up our sleeves, looking pain in the eye, and figuring out how to embrace it and find new strength from it.

The illusion of happiness is just as fallible as the illusion of health. We embrace positivity, when in reality, embracing pain is the path to strength and peace. All of the patients I have met who have grappled with their pain in profound ways have found peace in their life. Peace doesn’t have to mean health and prosperity. It can mean the ability to sit on a hospital bed and try as hard as you can to pull yourself out of bed by yourself. It can mean taking 3 exhausting steps from a wheelchair with people surrounding you because if you don’t try, you’ll never know what you can accomplish. Peace is accepting that we don’t control what happens. It’s acknowledging that bad things happen to good people. Peace means letting go of the illusion that we get to control what happens in our lives. None of us has complete control, which means all of us will, at some point, experience profound pain and loss.

"Life is a gift in terrifying disguise, and we are here to open it, until we find the still-quiet place in the center of it, where fear no longer decides.” - Kelly Flanagan

We cannot control what happens to our bodies. We can only attempt to control how we react to what happens to our bodies.
At any given moment, I can end up in a bed with a call light, unable to move and totally reliant on someone else cleaning me up after I use the bathroom. It doesn’t matter how often I go to the gym, how careful I am, or how much broccoli I eat. It doesn’t matter if I’m a good person, or if I have a million dollars. It doesn’t matter if I’m the president or if I’m 32 years old. Our bodies are stunningly miraculous in that they operate, in general, without a major breakdown or fiasco on a daily basis. Each of these days of health is an absolute gift. We don’t get to decide when one part or another is going to break or fail. The only thing we may or may not get to control is our reaction. I say “may not” because some brain injuries, particularly to the right brain, can turn the most loving person into a hard-to-live-with-friend on a good day.

So I have to ask myself: If I need a machine to get me out of bed, and a nursing assistant to stand by my side to get on and off a toilet, what kind of reaction am I going to have? There are generally three reactions I have seen:

  1. Anger
  2. Embarrassment
  3. Gratitude

Every single person who shows gratitude astounds me. Their vulnerability is palpable and illuminating. Here we are, two people on this earth at the same time, and they need me to help them in a moment of their darkest hours. They are scared, and tired; their dignity stripped in so many ways. And yet, they rise above this limited human shell we all embody, reaching to something way above and beyond the pain and grit of the moment: it is absolute and pure grace. I hope I’m strong enough to choose gratitude when the moment comes.

I do not at all understand the mystery of grace - only that it meets us where we are but does not leave us where it found us. - Anne Lamott

Our bodies are designed to fail.
Our bodies do not last. We will all die. Talk to anyone in their 90s, and they will probably embrace that this is a good thing (see point #1 referring to pain). Hips break. Hearts congest. Lungs get obstructed. It gets harder to chew and swallow. Bowels get blocked. Bladders leak. Memories fail. Bones become weak. Muscles break down. Ear cells are damaged. Eyes deteriorate. I can guarantee you that there is not one part of the body that is immune from aging. One must be, to put it bluntly, tremendously and relentlessly brave to get older.

So again, we must choose. These are the reactions I generally see:

  1. Bitterness
  2. Apathy
  3. Peace

The first two reactions come easily to most people. The last comes with a strength that goes above and beyond what we see during the Olympics. It is finding joy, connection, hope, and meaning where you are, at the end of a journey. Their darkest struggles and lifetimes of pain are transformed into an illuminating light and strength that is a pure gift to everyone around them. I hope I can find the immeasurable strength to search for peace when my body starts to fail and I can’t do the things I used to do so easily.

“But dying's part of the wheel, right there next to being born. You can't pick out the pieces you like and leave the rest. Being part of the whole thing, that's the blessing.” ― Natalie Babbitt, Tuck Everlasting



We desperately need a real and transformational conversation about what it means to grow old or severely impaired in this country.
Say the word “nursing home,” and watch everyone cringe. The phrase is obsolete now, replaced by the more medical term “skilled nursing facility.” Many of us believe that these places are reserved for the very old, or for people who have no family or resources. This is simply not true. Visit a local skilled nursing facility and you will see all ages, all conditions. A devastating diagnosis or emergency situation can easily wipe out any family’s built-up resources. Medicaid is available, but only after all assets are sold or spent down. The reality is that most of us are only one medical emergency away from living in a skilled nursing facility. Due to intense regulatory measures meant to ensure safety and dignity, these facilities rely on intense rules in order to adhere to hefty state regulations, which on the one hand, protect the rights of residents, and on the other hand, limit their choice and freedom at a time in their lives when they need it most.

The problem is that this is such an easy problem to ignore. By the time we need these services, we are often not in a position to be strong advocates or voices for ourselves or the community. We have to make do with the option that exists.

What would happen if instead of looking at these facilities and asking, “What can we do to make their lives better?” we instead look at these facilities and ask, “How would I want to live if I found myself in a position as a patient there?”

“A few conclusions become clear when we understand this: that our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer; that the chance to shape one’s story is essential to sustaining meaning in life; that we have the opportunity to refashion our institutions, our culture, and our conversations in ways that transform the possibilities for the last chapters of everyone’s lives.” ― Atul Gawande, Being Mortal: Medicine and What Matters in the End

These are four things that I have learned from working in rehabilitation and long-term care. Tomorrow is Monday and will learn even more new things. That’s what I love about my job. If you are reading this and wondering what I do, I am a speech-language pathologist and I work with people to regain independence with voice, speech, language, swallowing, and cognition. If you are interested in pursuing a career as a speech-language pathologist, please contact me and I will connect you with one of our mentors in the SLP Diversity Corp who lives close to you to learn more information.