The Burden of Practice

Perelandra - my oboe - is heavy. I think she may be the heaviest oboe out there. Sorry, old girl, but it's true - you are way harder to lift and hold for long periods of time than your Lorée, Fox, and Fossati counterparts. You have a big butt - er, bell.

I've always thought it interesting that two things that are so significant for me both have bells. Oboes, and stethoscopes. One for "speaking," the other for listening.

Anyway, those thumb hazards I mentioned before...well, it's official. I have it from one of my orthopedic surgery buddies at work. I have tendonitis (or is it tendinitis?). Probably from last week's Baroque Boot Camp.

I'm pretty sure of the exact muscle and tendon involved, too: it's no doubt my extensor carpi radialis longus. I have a very tender spot right between my thumb and my wrist where it attaches, and when I massage the muscle belly, it's like there's lactic acid squirting out into the surrounding tissues, burning with every rubbing motion.

I am feeling blue. I use my hands so much at work that I am reminded of my thumb problem almost every moment of the day. On top of that, I haven't been able to play for a week. And putting an elastic over my hair for a ponytail, so I can stuff it into an O.R. head cover, has been excruciating.

On the up-side, it's slowly getting better. Ibuprofen helps. But I may have to rebuild some music skills when I can get back to it.

"Practice" is of paramount importance to many aspects of my life. I practice medicine. I practice music. I practice (or try to practice) my faith. Practice: "to perform or work at repeatedly so as to become proficient." Important not only in the process of becoming what we want to become, but also in keeping alive what we've already learned. Without it, acquired skills fade, whether it's speaking a language or inserting an I.V.

But what about that well-known saying, "It's like riding a bike?" Is there a level of training so well-ingrained, so high, that even after a long period of disuse, a group of muscles and neurons can be recalled to a task and still "know" how to perform it well?

The marvelous thing about so-called "muscle memory" is this: it's a concrete example of the idea that experience - all experience - is learning, as far as our brains are concerned, and learning can occur so frequently and profoundly that it resculpts us physiologically - through our brain-muscle pathways, cells, neurotransmitters, even in the expression of our genes.

I imagine this applies not only to tasks but also to relationships. I am convinced that people who have been "trained" to receive abuse, over time, have catastrophically altered brain chemistries. I think in our strongest bonds we "teach" and "learn" in ways that truly transfigure our make-up - physical, mental, and spiritual - depending on what "lessons" repeatedly get transmitted.

As we shape what we practice, what we practice shapes us.

It's easy for me to see right in front of me what it is I'm teaching when I guide a paramedic student through an intubation. But what am I teaching my kids, my husband, myself? Is it all good? Sadly, I think not...I think there may sometimes be some spiritual lactic acid squirting out at those I love most...

I guess I need more mindfulness of each moment of teaching and learning. And more practice.

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For a thought-provoking and entertaining article about how the brain is "wired" and how its responses to the world / "self"-expression can be visualized, click here (hat tip to Dr. Deb for that one).

Update 7/23/08: I had our highly astute and skilled hand surgeon to take a look at my wrist. It's better after a week prescription strength ibuprofen, but it's still painful to do certain things. "My snuffbox hurts," I said to him. "Let's see if you have a positive Finkelstein's," he said. He took my thumb and yanked it down in the direction of my pinky. "Yee-OOOOOOWWWW!!!" I said, practically jumping off the stool I was sitting on. "Yup. That's a 2+ Finkelstein sign. You have de Quervain's. If it doesn't get better with the Motrin you might need a steroid injection." Painful as it was, it was kind of fun to just be able to walk up to a buddy at work and get a diagnosis between cases. Just as I was about to resume my oboe regimen...