Swim

The only other person at the pool today is Buddha, with headphones–– a large man with a shaved head, crouched in the small cold plunge, eyes shut, face calm. I walk to the edge of the lap pool and stuff the last strands of hair into my swim cap. The water is glossy and smooth and reminds me of the pleasure at being the first to set my skates on the bright ice of a newly frozen pond in Maine. I squat low, wait for the clock to turn over to a clean minute, and dive in. 

I’ve never considered myself a swimmer, never taken lessons, too embarrassed by my skinny legs as a teen to be seen in a swimsuit. But now, having turned sixty, I want to be done with embarrassment. I am alive in a body, and I wish to carry no shame. I want to challenge myself physically in new ways. And I want to relieve myself from the stress of my job.  

I work with the sickest of the sick in one of the sickest states in the country: I’m an occupational therapist in a critical care hospital in Mississippi. I want my time in the water to unburden me from thoughts of dying. Not of death, but of the suffering that can come with illness: the slow slide towards an uncertain future, the healthcare system limbo, the hard fight back to health. I’m afraid too often in my work, in my life. I do not want to be afraid.

Every day I meet patients who are alone from a dozen causes, mute from dementia or brain injury, or silent simply from exhaustion. Some patients complain, some smile and thank me for being there. Some have family members who set up camp in their cramped hospital room, pillows and blankets heaped on the couch, photographs and uplifting messages taped to doors, packaged food stockpiled in corners for the long weeks to come. I meet worried mothers, distraught husbands, pastors perched in hard chairs, their faces passive and solemn. I meet a second cousin or sister-friend on the couch quietly tapping at a laptop. And patients, often groggy, confused or stunned or agitated or inert, waiting, all of them perpetually waiting, for doctors, lab results, pain medication, nurses’ aides, transportation to scans or surgery, and for therapy to arrive and help them begin the long, arduous journey of recovery.

I think of Mr. G., who recently entered our hospital after suffering an embolic stroke in his cerebellum, part of the brain responsible for balance and coordination. He was minimally alert, leashed to a vent at his throat by a tracheostomy’s pale blue tube. An infection in his abdomen complicated matters. Mr. G. was stricken with polyneuropathy, a condition that erodes the neuromuscular system, rendering him perilously weak. Patients with long-term hospital stays, especially those on ventilators, are uniquely vulnerable. Polyneuropathy was common during Covid. It meant starting from zero. It meant weeks to gain the strength to grasp a washcloth, weeks more to bring it to their face. By the time he was admitted to our hospital, Mr. G’s only volitional movement was a wiggle of his fingers and a pump of his foot. My job, along with respiratory, speech, and physical therapies, was to begin the process of rehabilitation.

I learned to swim intuitively, relying on an inelegant dog paddle at first, which morphed over time into something more streamlined. I paddled forward and back along the marked lanes for two, sometimes three laps, trying to gain ease in my body. On YouTube, I found what I was aiming for, the breaststroke, movements familiar to me from my flying dreams when, with a running leap, I would dive into weightlessness using the same sweep of my arms and kick of my legs to navigate the air. Now, in the water, my whole body engaged, the movement feels celebratory. The rhythmic intake and expulsion of breath becomes a fluid meditation. I focus on finding symmetry in my strokes, aligning myself with the blue band of tiles that stretch the pool’s length. Here in the water, my thoughts root down into some trusted center of my body.

There is no shortcut to this work for people like Mr. G. It is tedious, achingly slow work. And it is essential for recovery, if any is to be made. A host of forces influence the outcome. Some are in his control: his tenacity, his willingness to engage in therapy, his hunger for life. Some are out of his control: the impact of medications, presence of infections, the severity of his condition, the prompt action of staff to clean and position him to avoid bedsores, his ability to secure sound sleep. Within this swirl of forces I arrive in Ceil blue scrubs, badge clipped to my collar, walkie talkie in pocket, ready to call for assistance should his respirations become labored, his oxygen levels drop, his bowels let loose unexpectedly. More than providing rote exercises, my role as a therapist comes with unwritten expectations, that of coach, cheerleader, counselor, friend. Mr. G. is only one patient of ten or twelve I may see in a day, each with their own stories, their own traumas, their own challenges to healing. Sometimes I carry their faces with me on the drive home, through dinner and into sleep, even into the next morning while I make coffee, then return to work to pick up where we left off. Days off, I swim.

The water’s temperature is good today, cool enough to enliven the skin but not so cold as to be uncomfortable. Liberated from gravity, I’m reminded of the year I took gymnastics as a preteen, my rail thin physique like the ones I saw in the Olympics, like the others lined on the mat with me, bending and bounding through warm-ups. We leapt on the balance beam, swung on the uneven parallel bars. We fell, and fell often. Lanky and awkward but unhindered by pain, and not yet stricken by the searing self-consciousness of adolescence, we were finding beauty in our moving bodies. My frame was ideal for gymnastics, my flexibility a plus when it came to the splits and backbends. I remember the momentary weightlessness I sensed as I mastered an aerial front walk-over, the brief suspension at the apex, the ecstatic reach of my body, the freedom of unfettered movement. That freedom is alive in me again in the water. It’s why I’m here, to feel alive, yes—to be conscious of my livingness.

On my first day of treatment, I found Mr. G. poorly positioned in bed, with his head flexed forward and his chin resting on the hard plastic collar of his tracheostomy. I plumped pillows to support his head and began our first session here, strengthening his neck so he could comfortably watch TV or make eye contact with his wife, who sat cross-legged on the couch, her slippered foot vibrating anxiously, studying us while chewing her nails. I began turning his head slowly left to right, up and down, inviting him to sense the subtle movements, to remember the possibility of control, coaxing him to help me when he could. Bending each finger, I determined places of constriction or ease. I helped him form a full fist and open it again, urging him along, “Open. Close. Open. Close.” I continued to his wrist, his elbow, his shoulder, counting through range of motion. Circling his arm through shoulder flexion, abduction and adduction, I created a shape that mimicked my swimming strokes. I knew what that movement felt like. I could recall its sensation even while at work. I wanted to superimpose this impression onto Mr. G. in hopes that it registered in his body, sparking a memory in his brain—reaching to put on a jacket or indulging in a contented yawn—and the process of healing could begin. Twenty-five minutes had passed. When I was done with the right arm, I began the same series of exercises on the left.  

Some days I’m uncertain of where the line lies between being alive and living. All my patients are alive; not all of them are living in the way that most of us would define it: breathing effortlessly, eating indulgently, moving freely, in control of our bodies. Most patients in this hospital are unable to stand and walk unassisted. They may be too weak to turn themselves in bed or even press a call light for help. They must pee and defecate in bed and are cleaned at the staff’s convenience. Many eat according to the settings on their feeding tubes. All are doubly imprisoned: inside their bodies by debility and inside a climate-controlled hospital room, its single window looking onto rows of blank windows and gray-streaked walls. 

I need a strong body for my job. I need a clear head. I am responsible for my patients’ safety and my own while I assist them to the edge of the bed or to tentatively stand and take a step. At any moment, they may buckle at the knees or become incontinent or suffer a sudden drop in blood pressure. Many days, I’m confronted with the fears and frustrations of patients and their families. I’ve sat at the edge of beds with grown men cracked open by grief, whose convulsive sobs nearly brought me to tears, made physically less than by their condition, dependent on others rather than being the stalwarts of their families. I’ve wiped their faces of tears and snot when they could not do it themselves. I’ve been moved to silence by my lack of words to comfort them, then yielded to silence because that’s what they need most, the comfort of a witness in their moment of despair. 

I’ve worked up to fifteen and twenty laps on my visits to the pool, moving from the breaststroke to the backstroke and sidestroke. I indulge in the sensations of suspension and effort the water brings, and I play inside these two poles, letting my arms and legs go limp, my body sink down, down, until only the oval of my face bobs above the water line. When the water begins to flood my face, I clammer to regain buoyancy. Other times I power through, catching the water’s silky tension, using it to propel me forward, finding more authority in each stroke. Water is a new medium in which to experience my body, in the way illness or disease can be for patients. It insists on a response: to surrender or confront.

It may take six, seven or more months before Mr. G regains function, if he ever does. If he can harness his cells’ deepest reserves to work like he’s never worked before, like his literal life depends on it. If he wishes to cross the nebulous border between being alive to living.

I hoist myself up the ladder and out of the pool, aware of gravity’s pull with each step. The Buddha man has left the cold plunge, and another woman sits with a towel over her shoulders. I step to the edge, acknowledge the woman with a smile and stand for a moment before stepping in. The initial shock is still there, but I’ve learned to counter the impulse to leave by breathing slowly, in through the nose and out through the mouth, the way I teach my patients, bringing the breath deep into the lungs to calm the nervous system.

I’d considered the cold plunge for weeks before I tried it. I researched its purported effects on the cardiovascular system, the tissues and joints. The jury’s out on the science behind its healing properties, but everyone who sinks into the frigid water swears by it. After a series of attempts, beginning with my feet, then moving to my knees, hips, and chest, I conquered its burn and reached the two-minute threshold, when the pain didn’t get better but didn’t get worse. I commanded my muscles to loosen their grip, even as I shook with cold. I’ve worked my way up to six minutes, which is how long I managed to stay in this time. Now, as I emerge, my skin is a pink cocoon, and tingling animates my entire body. I am whole, and aware of my wholeness for another day.