Tag Archives: health

Ignatius the friendless fibroid

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Like me, Ignatius is a loner.

As I reported earlier, I decided to explore the possibility of a UFE, or uterine fibroid embolization, procedure. On Tuesday, July 22, I took the first step with an MRI scan and a consultation with Dr. V., an interventional radiologist.

Despite my best efforts to be late, I arrived a little early. After I’d been chided for standing in the wrong line (I was supposed to intuit the process) and after being asked for the insurance card I’d handed over three minutes earlier, I found myself with a pager. I wondered if I was in a hospital or the Cheesecake Factory.

I’d settled into a chair and cracked a book for the wait when it dawned on me I didn’t know where to go when called (in hindsight, it was very obvious, but I wasn’t thinking straight that morning), so I backtracked down the hall to the information desk. Just as I was asking, the pager buzzed and lit up impatiently. That was quick! Mr. Information told me to retreat the way I had come and to go to the double doors. “If you don’t respond to the pager, they call you, and then . . .”

I was slightly panicky because, according to the paperwork, I should have verified with the [new] insurer that the MRI scan had been pre-certified. Now they tell me. Or remind me. I think that I will never master the art of adulthood and responsibility, and wonder how many hundreds this particularly dimwitted oversight will cost me.

A young man, the first of many people whose names I didn’t catch or remember, told me how and where to undress and stash my stuff. When he called me, now fashionably dressed in matching back-and-front gowns and green booties. I called back for help. He found me wrestling with the locker key, which it turns out requires a token that had fallen to the floor. My blood was definitely bypassing my brain.

Next stop: Blood tests and IV needle. This MRI scan requires the use of contrast dye, which in turn requires healthy kidneys. I acknowledged that I’m not on dialysis (“that I know of”). After running my contribution through a desktop gizmo, the cheery nurse reported that my kidneys are “working well.” “Too well,” I muttered, as I was hit by another urge. (This proved to be a day of frequent urges.)
Next, I was taken to a waiting room where I had just about enough time to notice the House Beautiful pile before another woman came for me. I don’t think it was even 9:30 yet, and already I was in the MRI room.

She plugged in the IV tube, gave me a cool rush of saline, and told me what to expect:

  • The MRI scan would take 30–45 minutes.
  • I should lie as still as possible.
  • I would have a squeeze ball to alert her if I needed anything (I took this to mean, “If you become claustrophobic and panicky”).
  • She would be able to see and hear me (camera).
  • The table would move, but I shouldn’t.
  • During the scan, she would tell me through headphones to hold my breath until instructed to breathe again. Oh, the power!

I lay down on the table like a sacrifice as she and another woman put a heavy band across my mid-section, stuck a cap on my head, and propped my calves over a large pillow (even a sacrifice needs blood flow).

All set?

Let the games began.

I’d read that the technology has improved since my last MRI scan (of my head) and that the equipment is larger (obesity epidemic) and more open. Previously, I just fit, with my arms pinned to my side, my nose nearly touching the top, and no leverage to back out. It was like being in one of those coffins with the split top, only with the head covered and the legs exposed. I’m not particularly claustrophobic, but that time I did start feeling trapped and unable to escape at about the 25-minute mark.

By comparison, this was great. My forehead was sticking out one end so I could see a bit of the ceiling, I had room to move my arms (even if I couldn’t), and I didn’t feel like there was no way to get out without help in an emergency. (With a lot of effort, I think I could have backed out because more of my legs were free.) The squeeze ball nurse call is a bit of comfort, I suppose.

The hard part was holding my breath as many times as she asked me to, for up to 20–25 seconds. It wouldn’t be bad sitting up, but it’s a little problematic at my size in the prone position (one of the forms had a question about breathing issues lying down, but I didn’t think it would be one — but then I didn’t know about holding my breath). When I did hold my breath, loud, rhythmic sounds would kick in — not the same sound or rhythm, but different ones at different times. I distracted myself from the feeling I was suffocating myself by counting to the rhythm and trying to visualize it. The mind has many coping mechanisms, even for coping with something as unnatural as an MRI scan.

Finally, she told me that this was the last time I would have to hold my breath and that they were almost done. The timing was perfect, because I imagined I was feeling the effects of diminished oxygen.

After completing a survey, dressing, and asking Mr. Information the way, I made it to the next stop: the heart/vein area, because, I suppose, that’s where most embolizations are performed. I checked in with my insurance card and received another pager, which buzzed and lit as soon as I had settled on a seat. Such efficiency!

I’m not sure who picked me up; she may have been one of those mentioned on Dr. V.’s Web site. She confirmed my information and left, to be succeeded by Dr. V.

Dr. V. asked about how and when I discovered Ignatius and the grief he gives me, and how much I know about UFE. He gave me a folder with more information. I asked if fibroids were causing my urinary problems. “I think so. Look at this,” he said, as we got down to the business of checking the bastard out.

It turns out ultrasounds aren’t very reliable for pinpointing fibroids. There, on the computer screen, was Ignatius, a single 13-centimeter fibroid perched on top of my uterus, not far from my spine. There were no others. Just Ignatius. His weight is pressing down, flattening (“pancaking,” as Dr. V. put it) the oval of my bladder so that it’s a little bubbled on one end. Dr. V. said, “Here’s a more dramatic view,” adding, “There’s not a lot of capacity there.” He can’t be sure, but agreed that Ignatius could be affecting my lower back.

The images were fascinating. How often do you get to see your own innards? There mine were — dominated by a chunk of slowly growing muscle tissue.

Dr. V. told me what to expect from the procedure, described the pain management options, and talked about the logistics. He was open about the risks, mentioning “death” first, and covering infection requiring hysterectomy, premature menopause, and so forth. He answered the questions I remembered to ask about UFE (I forgot several) and reminded me to read the material and the Web site. I asked him about particle migration, and he told me a joke about why doctors cost so much. I must have been distracted and not laughed, because he told me it was just a little joke, and the point is that, having performed more than 3,000 UFEs, they are experienced, and that a complication like that is usually the result of inexperience.

He thinks I’m a good candidate and that infection is unlikely because of Ignatius’s location. (Apparently, the combination of his size and location is a bit unusual. Typical.) I asked about the likelihood of recurrence given my age and proximity to perimenopause (I don’t think I’m quite there yet, but am probably close), and he said that Ignatius didn’t happen overnight — he’s been growing, in his estimation, at least 10 years. Ten years! 1998 was a bad year in many, many ways.
He told me to contact his patient access representative to schedule the UFE. I checked out then, hoping that the last person I talked to really did change my status on the printout from “self-insured.” Yikes.

I’m still mulling and still looking at discouraging photos, still thinking that my symptoms aren’t that bad, still thinking that it’s possible I could feel a lot better with a tamed and reduced Ignatius.
To celebrate surviving the MRI scan and the consultation, I splashed boiling water on my bare stomach above the navel and then did everything wrong, from not applying a cool cloth and then opening the blister to using antibiotic and an improper bandage. Now I have a lovely second-degree burn that, fortunately, is healing in spite of my ignorance.
And a little decision.

The plot to murder Ignatius, part two

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Before I left the gynecologist’s office, I made an appointment for an ultrasound for the next morning. Later it occurred to me that I hadn’t been told to drink lots of water beforehand. I was even more confused when the administrative assistant and the ultrasound technician both asked me if I needed to use the bathroom.

“Don’t you need the person to have a full bladder so you can see?” I asked the technician. I told her about my previous experiences.

“No, we don’t have to do it that way anymore,” she replied.

As she went about her preparations, the back of my mind mulled this. The technology hadn’t changed that much, so I was mystified by the change in direction. Hesitatingly, I asked what was different now that a full bladder is no longer required.

“With a vaginal ultrasound, a full bladder would just get in the way,” she explained.

A vaginal ultrasound? I’d never had one and wasn’t going to now, I thought, as I eyed a wand sticking up from the machine with suspicion.

I told her I wanted an abdominal ultrasound only.

“Well, that’s a problem because I won’t be able to see what I need,” she said, explaining why and adding a discreet reference to the size of my stomach.

“I won’t have it done.”

“I’m not comfortable doing an abdominal only because it’s not going to show what we need to see.”

“And I’m not comfortable with a vaginal ultrasound.”

After a few rounds, it became clear we had reached an impasse.

She paused in her preparations, and I could see her mentally weighing how to handle this. I couldn’t be talked or forced into a vaginal ultrasound, yet I wouldn’t there if the gynecologist hadn’t wanted a look. She sighed.

“Tell you what,” she said. “I’ll look to see how much water you need to drink, and we’ll try it.”

So she looked. And looked again. And kept looking without stopping to have me drink water.

“Can you see anything?” I asked.

“Yes. I can see your left ovary, which is good. Your uterus is so large that this is going to work out fine. The only thing that the vaginal ultrasound would have picked up that this can’t is your cervix, which your doctor can see during an exam.” She paused and said brightly, “See, the patient knows best!”

“I don’t know anything,” I said, “except that I wouldn’t like a vaginal ultrasound.”

She laughed. “No one likes it!”

She told me there are two fibroids to the left and either a third large one or a large cluster of several smaller ones. She gave me the measurements, which I was not in a position to write down. I remember, I think, three inches by four inches and four inches by four inches for two of them. Cumulatively, the measurements would be about 10 inches each way. She confirmed my doctor’s estimation that the uterus is the size of a 20-week pregnancy. With ruler in hand, I can see why that would be considered “enormous” or “huge” and how it might cause bladder and other discomfort. Next week the gynecologist will tell me what she thinks.

A UFE is starting to look like a possibility . . .

The plot to murder Ignatius, part one

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At last, after two missed appointments due to bad timing, I met my new gynecologist. Like many contemporary physicians, she has ditched the traditional unisex lab coat and practical shoes. She has opted to sport a dress and heels, both of which looked uncomfortable to me.

Her assistant performed the usual preliminaries (height, weight, blood pressure) and asked me if I wanted her to be present during the examination. I am not sure I understand why having Stranger 1 in the employ of Stranger 2 present while Stranger 2 examines me would be desired. Having one stranger checking out your nude, vulnerable body seems uncomfortable enough without a witness.

The doctor met with me in her office, which was decorated with appropriate texts (Complete Gynecology), family portraits and candids, and knickknacks. Despite the touches, it didn’t reveal any personality. Even the family photos could have been anyone’s family photos, a thought that makes me sad. On the surface at least, we are not as unique as we like to think.

She asked the usual questions, then the conversation turned to my primary interest — Ignatius and his fellow fibroids. Her recommendation is a uterine fibroid embolization, or UFE, in which “microspheres” are inserted via the femoral and uterine arteries to block or decrease the blood flow to the fibroids (a form of slow fibroid murder). While not a surgery, the procedure is not without risks, of course, which I have to weight against the discomfort to which I seem to have become accustomed. I could carry on without a UFE, although Ignatius and company are showing a disturbing tendency to grow. On the other hand, a number of women say that they felt immensely better within days of their UFE and that they are glad they had it performed. As Virgil says, something that large can’t feel right. And who doesn’t want to feel immensely better, especially when they have a vague feeling they don’t feel as well as they could?

Then we moved to the examination room and got down to business. At the sight of my scar, she expressed shock. “I thought you said you had an appendectomy? That’s a big scar!” (Curious, I later measured it; it’s about seven or eight inches long and one-eighth to one-quarter inch wide.) I explained my understanding of what happened, which is that my “hot potato” appendix was hiding demurely behind my bowel, necessitating a search-and-rescue party. Now even I wonder why it required an incision the length of two hands side by side.

Her first attempt with the pap smear was unsuccessful because the swab was too short, or, as she put it, “You have a long vagina,” which, I think, qualifies as one of those things one doesn’t need to know about one’s own anatomy.

She must have struck the proverbial pay dirt with the second attempt because for an eternity it felt like an enraged pit bull had a very sensitive internal part in the grip in the grip of its sharp teeth and powerful jaws. I bit my lip. I tried, unsuccessfully, to suppress groans and even a tear or two. Finally, the pit bull let go. I’m sure I would have remembered that much pain during previous samplings! I blame Ignatius.

After the breast exam, always fun when I’m in the throes of PMS, it didn’t take much effort for her to find my uterus, which is “huge.” (“Enormous” or “huge” — take your pick. I gather that it’s a bit larger than the norm.) Naturally, between the fat and the fibroids, she couldn’t feel my ovaries — they’ve been in hiding for several years. Clearly an ultrasound was in order.

Next: Fun with the ultrasound technician.

Life with a night guard

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After a couple of false starts, I picked up my occlusal guard (night guard) on Tuesday. It’s thicker than I expected, but then perhaps that is what is needed when you can and do bite the enamel off your own teeth.

It snapped in neatly in front of the dental assistant. That night, without an audience, I struggled to get it into place, more or less — mostly less, because my entire mouth was sore Wednesday morning, plus the guard had popped out two or three times during the night.

I was more successful Wednesday night, during which the guard stayed in place. My teeth weren’t as sore in the morning, which I thought was a good sign — until I noticed dried blood in three or four places on the guard and tasted blood in my mouth. Of course, I began second guessing myself, as I did about the braces. Do I really need a night guard? Will it do my teeth more harm than good? Would I really have developed periodontal disease? Then each time I have a muscle spasm and my jaw clenches involuntarily and encounters the guard, I am reminded of how much force that muscle is capable of and what it’s like to wake up with the grit of one’s own enamel between one’s teeth.

It’s fascinating because it’s involuntary. When I wake up, the first thing I notice is that my jaw is forcing my teeth together, and as I try to relax those muscles consciously the pressure becomes slightly worse before the jaw finally lets go. I imagine that someday I will have to use my hands to persuade it to loosen its grip.

I’ve heard a couple of different versions of what the night guard does and how. One explanation is that the guard, worn over the lower teeth, prevents the joint from functioning fully, so the jaw simply can’t clamp as hard. I think this may be true for me. Although I can close my mouth, the jaw doesn’t seem to work very well. It did try this morning. I woke up and found myself attempting to break my teeth against the guard.

i have noticed one thing — that is, my jaw seems more relaxed and less likely to clench during the day. If you have never experienced an involuntarily clenching of your jaw while you’re awake, conscious, and in control (mostly), I can assure you it’s an odd, disconcerting, and painful sensation.

I am grateful that modern dentistry is helping me to treat this painful, damaging problem. I am not so grateful that the stress of modern living, where everything and nothing is important, is causing it.

With that said, I’m ready to try to relax this weekend, to focus on the meaningful to shrug off everything — and everyone — else.

Name my uterine fibroid

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Frustrated with being denied a pregnancy, my uterus has struck back by sprouting a fibroid. As if to prove its maternal ability to nourish and cherish, my uterus has not only produced a fibroid, but is growing it as well. I’m told that it has achieved the size of a 16-week pregnancy.
The truth is, I’m not sure what is going on in there. Two years ago, an ultrasound revealed “two fist-sized fibroids and numerous smaller ones.” At the time, I did not know what a fibroid was, let alone that my uterus was one of millions set on developing them.

After poring over many fibroid photos on the Internet, I must say that it’s a good thing fibroids are an internal condition because they have no aesthetic value at all, unless you are looking for something to inspire you with an alien monster design for your next straight-to-DVD bargain bin movie. They look like solid, smooth, shiny, red balls of muscles on steroids. They can be very small, or they can grow to the size of a watermelon or even larger. (Aside to my uterus: That is not a suggestion.) In some cases, they have even shared a womb with the baby for which the organ is designed. (Aside to my uterus: We won’t be attempting that.)

Two years ago, the gynecologist couldn’t be sure I had fibroids without an ultrasound. Today, even I can feel its hardness a little below my navel. It figures that the only hard muscular tissue my entire body sports would be in what should be the softest part of my belly.

So I have a fibroid, or two, or several. What is the next step? I’m supposed to schedule an appointment for another ultrasound, as I have an unfounded suspicion that my uterine rebellion is crowding my bladder and causing some issues. The mostly likely outcome is that I will ignore it; then, at menopause, it will shrink of its own accord if not provided with estrogen therapy. It’s not that big, and despite the bad behavior of my uterus I wish to keep it. We humans are fond of our body parts, even the non- and malfunctioning ones.

Gratitude

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I’m thankful for my:

  • wonderful parents, even if I didn’t appreciate them at the time. The older I get and the more I see, the more I appreciate them.
  • brother and his family. We complement each other well.
  • extended family. They help me keep much in perspective.
  • inspirations and everyone who has taught me something, from teachers and professors to family and friends, even some non-friends.
  • job. It’s not ideal, but it fuels most of my habits, like shelter, food, and books.
  • shelter. Moving has brought me to life, and I need to keep up that momentum.
  • health. I have my problems, some typical, some a little unusual, but none very serious.
  • freedom. Love it and guard it for few have so much, and it’s so easily compromised.
  • books and poetry. As the song says, they protect me.

Happy Thanksgiving. May we gain more in all things than we lose.

Dentures no more

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I went to a dentist about 15 years ago, who told me I had some new cavities and that he was going to use Novocain. I told him that I’d never had Novocain, and he said I had to be lying, given the number and type of cavities I had.

But it was true. In the 1960s, it was not unheard of for dentists to drill into children and teenagers without using anesthetic. It could be the reason so many people supposedly stopped going to dentists or were afraid to go in the first place, after hearing horror stories of primitive treatment and assuming not much had changed in the last 30 years.

My first experience with Novocain was not positive. My face swelled for two or three days, so I thought I had had an allergic reaction. Later, an endodontist told me that the dentist had possibly broken a blood vessel, but that an allergy to Novocain would be rare. I don’t know, but my current dentist also uses Novocain. A few years ago she told me that it wasn’t an option for at least one tooth because of how deep the cavity was. Because I could feel pain even under the Novocain, I concede that she was right.

Why the interest in dentistry? A month or so ago, the orthodontist’s assistant removed my upper braces and made a mold of my teeth, then gave me a retainer a week later with the instructions to rinse them in Efferdent or a similar cleaner. I didn’t think much of it until I was in Walgreens looking for Efferdent, and couldn’t find it at first. Eventually I located it on the bottom shelf, underneath all the whitening and brightening toothpastes. Bottom-shelf products are the ones that move slowly. Of course — how many people have dentures compared to how many have a need for whiter and brighter real teeth?1

This prompted me to think how different today’s generation is from mine and that of my parents. Both of my parents had full upper and lower plates. If I remember right, my dad’s teeth were removed courtesy of the U.S. Army Air Force. I’ve seen one photo of him smiling with his natural teeth, and it wasn’t pretty. They grew up in an era when the water wasn’t fluoridated, and country kids brushed, if at all, with baking soda. His youngest sister, however, did manage to keep most of her teeth.

My brother and I have many, many cavities, plus he had a root canal or two in his twenties. His are probably due to genetics because he took care of his teeth, while mine are due to poor dental hygiene. I didn’t want to brush when I was a child, and my parents didn’t push it. I can’t remember when I did start brushing regularly, but it was late in adolescence and then only once a day. No flossing. Surprisingly, I did not have bad breath, but I did get cavities. Now, of course, with braces, I brush and rinse twice a day and floss at night; gums deteriorate pretty quickly under braces if you aren’t fastidious, I quickly found out.

Most of the younger people I know are surprised to learn I have fillings because they have few if any. At first, this surprised me. I always believed that cavities were inevitable, that hygiene only staved them off or minimized them. Apparently, however, a combination of good genes and dental hygiene can actually mean a cavity-free existence. What’s it like never to have know the grating sound and feel of a drill chipping away at your teeth?

At this rate of progress, soon there will be a day when Efferdent will be needed only for retainers, mouth guards, and similar appliances. Dentures no more.

Ears askew

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I haven’t gotten new glasses in three years because I haven’t had any problems, but recently I decided to because I didn’t like the frames, and the lenses were losing the coating and getting scratched. Plus, it was time.

And once again the new glasses are crooked. They feel crooked and look crooked.

And once again I have enough confidence in the optician to think it’s not really him.

So, at age 44, it finally occurred to me — my ears are uneven. My left ear is a bit above the right. Not noticeably, but enough to make glasses feel and look just a bit askew. I think it gives me headaches.

And then I remember this entry, “I am an owl,” only I didn’t think I meant it quite so literally.

I like the new glasses better; the thinner frames are more feminine. The lenses keep getting thinner and thinner (therefore, lighter and lighter), so they are more comfortable. Not to mention expensive. Ah, well. At least I can still see. For now.

What do we want to be today?

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On his former bulletin board, Bensozia, John says, “I think something about the technology [IVF] just scares people, and so they invent weird reasons to oppose it.”

Society has created technology, and technology has recreated society, a society where “no” is not an acceptable answer. Whether the question is as simple as, “Can I get that proposal by the end of the day?” or as complex as, “Is there any drug, treatment, or procedure that will stem my illness and prolong my life?,” the answer must never be in the negative. As the second Star Trek movie emphasized, “There are always alternatives.” If there are no alternatives, they must or will be invented. Treatment for cancer is simply an interim step; the demand is for a cure.

As for the proposal, once it could be sent overnight via FedEx, with harried office workers straining to meet the 9 p.m. pickup. Now they can email it, which means great pressure, especially when technological solutions tend make every decision maker even more of a procrastinator. But the answer is still never, “No.”

We cannot accept “no“ from nature, either. Everything that she throws at us that we don‘t like is a “problem“ to be “fixed,“ according to our industrial age-inspired ideology. If the human machine is broken, if it can‘t conceive, for example, and if it can‘t be repaired, then another mechanical solution must be found. Grief, loss, helplessness — these are seen as negative emotions to be avoided or subverted. But how can we feel joy without feeling grief? How can we understand the depths of love without experiencing the pain of rejection? How can anyone grasp the highs without the lows? Is a flat-line existence of comfort, complacency, and getting everything you want living?

Is that why reality TV is popular? People with carefully regimented, controlled lives seek out the avarice, bitterness, and bitchiness that lie behind reality TV. On weekends, some — seemingly a growing number — of thrill seekers pursue extreme sports like ultramarathon running in the desert or activities that are as dangerous as possible, like rock climbing, bungee jumping, or whitewater rafting. Anything to feel a rush, to feel alive.

Maybe we could feel alive if we stop treating life as a problem to be fixed and our bodies as machines to be repaired, if we could accept real pain (not the manufactured kind) and death as readily as we accept joy and life, appreciate shadow as much as light. If we could understand ourselves as living organisms. The more we aspire to some kind of unnatural perfection, the more we soil our home, the more problems we create, the more we feel thwarted, and the more we want and expect.

Obviously, most of us take advantage of medical technology, me included. Knowing where the lines should be drawn — or if the lines should be drawn at all — is a question that can’t be answered to everyone’s satisfaction.

We are like children in the universe, children whose intellect exceeds our wisdom by far, with the gap growing imperceptibly every day. As Frankenstein learned, simply because a thing can be done does not mean that it should be done.

When you can’t accept “no” as an answer, when you can’t accept that there may be limits to science and technology, even to the human mind and the prescience of its wisdom, you deny one of the things that make us human, an evolving organism. And that may be what is frightening. If we can’t let ourselves be human, what do we want to be?

Reinventing work

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Our status, our position, is not determined by the work we do outside but by the work in our hearts and how we assist others. The effort to recognize and speak the truth is the greatest work that any of us can do.

Dhyani Ywanoo

We may be forced to take a job serving food at a fast-food place for $4.25 an hour in order to pay our bills, but work is something else. Work comes from inside out; work is the expression of our soul, our inner being. It is unique to the individual; it is creative. Work is an expression of the Spirit at work in the world through us. Work is that which puts us in touch with others, not so much at the level of personal interaction, but at the level of service in the community.

Matthew Fox, The Reinvention of Work: A New Vision of Livelihood for Our Time

I think I’m going to like The Reinvention of Work. Like The Goddess Within by the Woolgers, it was written in another decade and predicts a movement that shows no signs of occurring today; in other words, it appears to be wishful thinking. It’s also insightful and thought provoking about why there should be such a movement and how it could benefit each of us and the community (world and local) in which we live.

In his introduction, Fox talks about “jobs” versus “work.” To put it much too simply, a job is something you have so you can pay the bills, while work is something that feeds the spirit and benefits the community.

There are two perspectives from which I see this. The first is based on a holistic wellness initiative we have undertaken at work that focuses on the six dimensions of wellness:

• Emotional • Mental • Occupational • Physical • Social • Spiritual

To be well and to live well, one needs to balance the six dimensions as much as possible. We all know someone who can run marathons and compete in triathlons but who pays no attention to their emotional or spiritual needs. Or someone who loves their job and works 70 hours a week but who is socially unfulfilled or who eats poorly and exercises little. Do we all know someone, or anyone, whose life is reasonably balanced emotionally, mentally, occupationally, physically, socially, and spiritually? Do we know someone, or many, who feels discontent about an aspect of life that they can’t identify or who is depressed, lonely, and frustrated, and unsure why?

I think that Fox would agree that part of our “inner work” is to identify the dimensions of wellness in which we are strong and those to which we need to pay more (or any) attention. This requires us to believe that whole wellness is important for more than our health and longevity. After all, many of us don’t pay attention to our health until it changes significantly. Even then, after of diagnosis of high blood pressure, high cholesterol, or diabetes, it’s a struggle to change our habits. And life expectancy is a mystery over which we have limited control. Conditions such as depression seem to play a greater role in determining life expectancy than one might assume.

No, wellness is not just about health and life span — it’s about quality of life. That means much more than staying physically healthy, maintaining a good weight, adhering to a sensible diet, making an effort to prevent disease, and the like. It means more than brushing after every meal and getting X minutes of aerobic exercise every week. It means paying attention to yourself as a whole person. If work makes us “ornery, angry, frustrated, violent, hateful, and humiliated” (Studs Terkel), then we need to reevaluate our level of occupational wellness, to “reinvent work.”

It seems to me that the occupational dimension of wellness has a disproportionate influence on the others, as work is essential to the human soul. If you are occupationally well, I imagine you are likelier to be well in most of the other dimensions.

The second perspective is based on some changes we have undergone at my own workplace to streamline work flow and improve time lines. These ends are good. Certainly, when there is a smooth process in place and it is followed, and when roles are well defined, work can be a lot less stressful. If you don’t know what’s expected of you and when, you feel lost and without purpose. You won’t know if you’re doing the right thing, how it fits in with what others are doing, or how you are being evaluated. And — this is critical — you may not even understand the purpose of your work, the proverbial “big picture.” If you don’t know that the bolts you drive into metal all day hold critical parts of the vehicle together, or even that you are part of building a vehicle, how satisfied and rewarded can you feel?

We’ve always had “tasking” meetings, during which we discuss what we are working on. I hate the name “tasking” because it metaphorically reduces our work, in Fox’s sense, to “tasks,” which to me evokes routine things that need to be done but that in and of themselves bring no joy — vacuuming, paying bills, cleaning the litter box — things that you have to do so that you can do what you really want to do, the kind of things that your parents told you that you had to before you could go outside to play. “Make your bed first” or “Help with the dishes.”

Now, there may be people who enjoy tasks, and tasks that promote a larger goal can be very fulfilling on a certain level — as long as you are conscious of the goal and your progress toward it. Clearing and cleaning a particularly cluttered space can be purifying. Vacuuming before a party may feel wonderful because you realise your guests will see a carpet and a home that suddenly looks like new. The drudgery of washing windows may be made bearable by the crispness of the view through the clean glass. Although these are tasks, they have tangible, desirable ends that feel good, once you’ve overcome the inertia to start them.

To me, however, our “tasks” don’t feel like that. Part of it is because they drag on for a long time, and during most of that time I have no control over anything that I’ve contributed. The time between the completion of my initial “task” (writing) to the final production can span several weeks, even months.

But mainly I think it’s because we’ve reduced our work, which is creative and has an end that is beneficial to our constituency, to “jobs” contained in “job jackets” that outline our “tasks.” It seems to me that the concept of the “job jacket,” which apparently comes from advertising agencies, inhibits the spiritual aspect of work.

We are handed folders with a list of assigned tasks and dates, complete our task, and pass them on to the next bee. From my perspective, it seems dehumanizing and isolating, similar to the earlier example of putting a bolt in a car part all day. It’s the white-collar version of a production line. The process itself stifles the creativity and the collaboration that most people say they crave.

Ironically, it is, at least at this point, not efficient. Deadlines are missed, and there is no one person who manages them or the projects. Rather, we have turned that function over to project management software, which is time consuming to use. Instead of utilizing our abilities and experience, along with face-to-face communications, to manage our own selves, our own time, and our own projects, we are reduced to having the people who use the software change dates and times and letting the software tell them what we should be doing, how much time we have to do it, and when it should be done.

Men were once enslaved by their animals and crops (hunting and agriculture), then by machines (industry). Now we are letting a different kind of machine make our decisions and manage our lives. How can this possibly nourish the spirit and empower the mind?

Let’s reinvent work. Let’s make it something to be cherished and enjoyed, not dreaded.