In my work as an occupational therapist, I counsel and provide interventions for client’s who have experienced neurological events. This could be strokes, head injuries, multiple sclerois, Parkison’s Disease, etc. I also work with clients recovering from orthopedic injuries, such rotator cuff tears, elbow dislocations, and wrist fractures. Often in the course of gathering their functional history, the topic of driving comes up. They may be asking them about whether they can return to driving, or more likely, I am asking them whether they have discussed driving with their doctors. Usually these discussions lead to their concerns about being in the passenger seat, not behind the wheel.
In our USA society, most of our community life is built around our expectation that we can drive from our homes to different places. This could be running errands to the store and bank. This could be visiting with family and friends. This could be joining faith communities or civic groups. Let’s not forget school, work, and volunteer tasks.
Having lived without a vehicle during college and when I lived in NYC 25 years ago, I have experienced what getting around by bicycle and public transportation are like. But, I am half a life older than the bicycle days, and no longer live in a high density area (we do have a bus that goes from our local Post Office to the Mall across from where we work, on Tuesdays, one trip there and back… not many options there).
Now, you might expect from my comment above, about being a therapist, that I am mostly referring to older adults, and might have the thought that they are retired and do not need to drive anyway. But, first, I am seeing more clients who are having their strokes at 30 to 40 years old. This is a health care issue related to our lifestyle (nutrition, sedentary work and leisure interests) as much as genetics. Second, retired folks do not expect to sit and watch their stories and talk-shows all day. They may be at a different pace and time of day, but many are as active, if not more so, after dispensing of 40+ hours and commuting each week. Driving is essential in our culture.
Some of the lessons which I have learned while working with client include Safety First, Humility, Patience, Gratitude and Acceptance.
Safety First: Driving, regardless of our age or health status, requires many skills. One must have good coordination and control of arms and legs to steer and reach the peddles. And, one must be able to turn one’s back and neck to check blind spots. One must have good sensory awareness of sights, sounds, and even vibration. Without precise vision, one may not notice what is in the mirror or side of the road, read signs or approaching lights and signals. One who is aware of the sound of other vehicles or emergency vehicles can prepare to adjust speed and lanes as needed. Having awareness of movement and vibration from road surfaces, give one better control as road and weather conditions change. Even when all of these processes are going along well, one must have good attention, reaction time, and ability to think clearly. Driving requires split-second decision making, and recalling to where you want to go.
The main safety point is that when controlling one to two tons of machinery at 30 to 70 mph, one must be in good shape to avoid injuring or killing oneself, passengers, or other people on or near the road. I have known people who have driven through their garages and store fronts because of hitting the gas peddle rather than the brake. I have read news stories about pedestrians being killed or injuried by drivers who did not respond to road conditions. Rarely is a convenient trip to the store or other activiy worth someone’s life.
Humility: Given that we expect that “normal” people can drive, when someone may not, or chooses to not drive, we may begin to see him or her as being less than normal. Thus, when someone is in this position and has to arrange for rides, he or she may experience embarrassment about being different. This can be anxiety evoking.
However, we all have limitations. The humble person recognizes these. He or she does not spend energy hiding the limitations, but finds a way to continue on with life’s activities. Forgoing one’s independence to ask for a ride to the bridge game, or grocery store, or cookout requires humility. Arranging for someone to swing by on the way to church requires humility. Arranging one’s routine to fit with other family member’s trips in town requires humility. However, humility should not connote being inferior. Humility requires a boldness to accept that we can accomplish much more by working together.
Patience: Independence in our society implies that someone can pursue tasks that he or she chooses to do so. When relying on other people, whether family, friends, a bus, taxi or medical transport service, that person has to set the clock to match those of others. This requires planning ahead, arranging dates and times for pick up and drop off, and possibly, with public transportation requires stops along one’s route for other’s to get on or off the bus. In our area, for clients with medicaid, the medical transport van requires 5 days prior notice to schedule. That might mean that therapy cannot be scheduled less than a week out. If some misses an appointment on Monday, she or he cannot just come in on Tuesday. Again, if someone’s activity has finished, that person may need to wait until the driver is ready to go.
All of this potentially requires periods of time waiting. Waiting for one’s ride to arrive. Waiting for one’s ride to return. Waiting while other’s stops for errands. Waiting until another day when someone is available after work, or after other responsibilities. Patience is required when we do not have control of time. We can fill this time with standard waiting tasks, such as reading, puzzles, music, TV, conversations, naps, and household tasks.
Gratitude: When in the position of being dependent upon others, and waiting for their schedules, it could become easy to grumble about inconvenience. However, the inconvenience could go both ways. The driver might be thinking about having to go out of the way to pick up and drop off someone. The passenger could be thinking about the inconvenience of waiting. An alternative to irritation could be gratitude.
The gratitude could be for the act of transportation. The gratitude could be more metaphysical thoughts about being well enough to get out from home to participate in social tasks, even with the inconvenience of relying on others for transportation. The later is probably more an expression of one’s beliefs, to be shared with one’s concept of what is beyond our temporal preoccupations. The gratitude for the ride is more direct, and can be expressed more directly. Certainly, a verbalization of thanks is a start. Maybe offering some gas money would give tangiblity to one’s appreciation. Being a cheeful traveling companion, with engaging conversation might make the trips something that the driver and passenager might start to look forward to. Whatever the form of expression of graitude, it should be shared by both.
Acceptance: As we age and experience changes in our health, we can go on as if nothing were different until the changes accumulate to such a degree that others confront us with reality. Or, we can accept what our bodies and minds permit us to do. Neither is an “either-or” equation. As we face health challenges, we can make changes in our health habits and lifestyles to reduce risks and slow progression of problems. We can participate in rehabilation to regain prior functioning, learn what our safety limits are or what strategies we might use to compensate for losses of prior abilities. We can adapt our routines to better fit our energy level and envrionmental demands. We can set aside tasks, which no longer hold interest or are within our abilities. We can seek assistance with tasks that we value, but cannot accomplish independently.
While we might accept changes as they occur, we should not accept that our abilities are inevitably in decline. Sometimes, becoming a passenger is temporary, during a recovery period. Someone who fractures a wrist or tears a shoulder tendon may be able to return to driving in six to twelve weeks. Someone who has a minor stroke might resume driving after demonstrating that his or her sensory-motor performance is sufficient to drive safely. Someone with coordination difficulty might respond to medication to reduce tremors sufficient to handle the wheel. However, beyond a threshold of safety, when we need to open the passenger door of the vehicle, humility, patience, gratitude and acceptance will make the ride smoother.