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Reaction to Quiet by Susan Cain
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There is a reason I want to react to the books I just read. I mean ‘react’ instead of ‘review’. A book review is a nice way of summarizing the book’s content and purpose. It is usually objective; whereas a reaction is mostly subjective. Book reaction is how I feel towards the book as it applies to myself while reading it.
There is another reason.
I listened to (via Audible) Quiet by Cain many years ago, and now I don’t remember what it's all about except its topic about introversion. I don’t remember anything much beyond that. Honestly, it doesn’t matter if I remember a book or not after I read it as long as I felt ‘joy’ while reading it. Sometimes its ideas stay in my head subconsciously which may add a new dimension to how I perceive the world and the people in it like my patients.
A case in point is when I modify patient treatments based on where they are coming from mentally and behaviorally. I don’t subscribe to a universal approach, a ‘one size fits all’ in designing treatments for each patient. There are patients who would like to be let alone; others would prefer exclusive one-on-one treatment or encounter. There are patients who want to be in the midst of things, who get a kick when surrounded by crowds, vociferous, the center and life of the party, the ones we call social butterflies. This difference in personalities is more obvious in a facility where I still work a couple of hours a day. Not everyone there wants to mingle. Some prefer to be alone in their rooms, choosing when and where and who they want to engage with. There are some who love to congregate even when they don’t have a reason to. And there are those who would rather go to the activity room than work on their rehab (that gives me endless frustration.) Where did I get this idea of tailor-made approaches and treatments? I could have been influenced by this book although I don't remember all its content after I read it first years ago.
The differences between extroverts-introverts applies to me as well. My job requires me to be sociable and approachable. **And I think I am doing a good job on this because I suffer no hesitations and fears when I approach the people I treat. I spring up from my chair, confidently walk to the patient, introduce myself, talk about their rehab issue at hand while I act gregarious and in control.
To be honest, it is all an act. Maybe my experience taught me how to act and reading a book like Quiet taught me the reason why I act that way.
After I finish work, I seek out a place where I can be alone. It could be my room or a park that is as far away from everyone as possible. That is where my comfort zone is. At work I feel like an actor playing a part that I am good at. Alone, I feel like living my own true self. I used to be very worried about this. I thought I was antisocial or paranoid especially when I flare up in the face of overwhelming crowds competing for my attention and loudness that makes me raise my voice to be heard. This book tries to explain to me that I am simply an introvert.
The terms Introvert/Extrovert were coined by Carl Jung. Their definition most likely resulted from a shift from the age of Character to the age of Personality in human history.
There was a time in history when the value of a man relied on integrity, moral compass, honesty, heroism and nobility. Not sure when the value of having a ‘Personality' took over. I guess it started at a time when talking more and being friendly and sociable became necessary to succeed. I personally call it the Salesman’s Era. People needed to jump from person to person to sell a product (sales) and this required attractiveness, affability, coolness, confidence. The same attributes are important in (politics, leadership, business). Finally, this cult of Personality is the major way to accumulate (fame, power, wealth). The age of Personality ushered in the modern age as we know it now.
The age of Character (Remember old Abe Lincoln’s quiet demeanor and value and ‘honesty is the best policy’) did not draw a sharp line between human personality and character, it was character modeled after Christian tradition became paramount over anything else. Until we shifted into this age of Personality where being gregarious and sociable and a good talker, or ambitious, or aggressive or high achiever or the magnet of attraction. You see this in our society nowadays - the man who talks the most and the most ‘ambitious’ and the action-man is considered the smartest and the one who will succeed the most.
Especially in the Western culture, introversion is frowned upon. Silence is considered to be dull and boring and coward and guilty of something. Lacking friends and company may suggest that something is wrong with you. (Eastern culture is quite different. Asians tend to be more introspective; they aren’t inclined to rock the boat and give priority to the community values instead individualism. Being too loud and gregarious, at least during my youth when I grew up in the small-town Philippines, was looked down upon.)
Today, parents and teachers and even medical workers seem to think there is some pathology in their child or pupil or patient if he prefers to be alone or shows limited interest in play or groupings and focuses on what interests him most - it could be airplanes or drawing or tinkering or experiments. A parent would say this behavior is wrong and the child should mingle, mingle, mingle. The child needs to learn how to deal with other people. The child needs to suppress his preference for being alone and needs to exploit every opportunity of engaging with other children. A teacher would get alarmed if the pupil is turning into a loner and may even seek the help of a school psychologist to figure out what is wrong with him. And by the way, these introverted children are also deep thinkers, they do engage with others but on a limited basis because they want to go back to whatever interests them.
For PTs and other rehab workers, we become alarmed if a patient would rather stay in his room and have his treatment there. So, we get the patient out, stick them into what’s called activity room and have an activity director force on them what everybody does.
I want to emphasize though that there is a difference between introversion and pathological personality disorder that mimics introversion. A person who used to be the life of a party becoming suddenly aloof might need a psych evaluation. A child who used to be happy and friendly suddenly becoming afraid, especially of being touched, might require some kind of investigation as to why. Or a child overly obsessed with gaming that makes him miss showers and meals and sleep, well, that can be pathological and dangerous.
But if a person is naturally a loner since birth, or an adult who prefers to stay in the shed to work on his personal projects instead of attending a party, or a student who wants to be in the library working on extra computer projects or writing or blogging or designing something of his interest, that is most likely stemming from his introversion. (I know this because I am one).
I have always had difficulty understanding why I am different from the more sociable people around me, for evading and politely refusing to join their party. This is a source of constant guilt. The trouble is, when I force myself to join, I get so bored because I cannot handle small talk. I do respond to how’s the weather and current politics but that is my extent. Outside of that, I tend to withdraw to a corner plotting my escape route to spend my alone time productively somewhere and that makes my sociable company worried about me being left out. I used to have a lot of extroverted friends (ok, maybe 4) who I joined in going out to different bars in Fort Lauderdale decades ago. I hated it in my deepest core.
My Friends: Let’s go to the bars!
Me: Oh yeah!
Once we were in the bar.
My friends: Ok, let’s mingle.
Me: O yeah! (But I start getting nervous.)
My friends disappear and fly like bees chatting with anyone who wants to chat with them.
Me: Oh God, when can we go home? (I stay in my corner.)
My friends notice me being alone with a beer as old as two hours.
My Friends: C’mon, mingle, mingle, mingle. Are you turning that beer into an aquarium?
Me: I will mingle, soon…. Are we done yet? I feel sleepy.
My Friends: Excuse me? We barely scratched the surface of our night out.
Me: (I really get nervous now.) Can you, maybe drop me home and you can go on your way to the other bars?
My Friends: You can f---ng go home yourself.(They sound pissed off).
Me: I am gonna die now. And I stay ‘still’ in my corner sulking the whole time.
Luckily, I managed to extricate myself from all that. There are people who thrive being around other people. It is the ‘high’ they seek out. There is nothing wrong with that. They are extroverted. But there are introverts who are equally alright. The trouble is - they often clash. A typical example would be a couple with one being extrovert and the other introvert. If the extroverted husband plans on having his friends and family over frequently because this is the highlight of his day while the introverted wife wants to settle in her room to enjoy her reading and spending time alone with her husband and children intimately, then there would be a problem. Unless they compromise like planning on having the wife settle down in a separate space enjoying a more intimate conversation with one or two of the guests instead of being forced, while the husband getting settled in the midst of the guests ‘entertaining’, that might work.
Why introversion works for me.
When Leonardo lived, he also thought the way I think today. Life is fleeting and we start preparing for death the moment we’re born. Despite all our dreams of being remembered, we will succumb to obscurity unless you are Leonardo da Vinci himself.
This idea hits my brain oftentimes. There is no point in getting obsessed with certain things. Most especially, there is no need for material accumulation at the expense of spiritual gains. Majority of us would die and be delegated to oblivion, no matter how many billions or how famous or powerful we are. We will all be deleted.
So what is the point of life but to enjoy it at its best? Enjoying life is not the way we usually associate it with, it is not a one-size-fits-all enjoyment. Each of us has our unique way to enjoy it - one may enjoy it through accumulation of the material, or collection of social networks, or being close with the family, or being alone, or becoming well-traveled. Most recently it seems people are enjoying media platforms like tik tok, reels, getting many hits and likes. There are those who enjoy spirituality, or politics or intellectual quests.
Each individual has a personal way to enjoy life which is worthy of respect and acceptance by others. I cannot, for example, impose my way to joy as the universal way or I will face the wrath of people who hate what I prefer to do for enjoyment. I cannot say reading a book is more enjoyable than going to parties or traveling. Party people and travelers will have a problem with me on that.
Now that I am in my 60s I am inclined to do things in solitude. It is clear to me that my way is a solitary, almost hermetic lifestyle. I am a certified introvert. I don’t intentionally push people away, mind you, I can still function in social circles and even play the role of the life of a party if I need to. I had a day off yesterday and I planned to stay home with my current book to read and I ended up dealing with my property manager, inspecting the work of people who prepared my rental unit for showing. And then in the afternoon I was asked to help in the interview of a tenant ( by another landlord) and I was good with all of that. But I immediately got back to my quiet room in between all these tasks where I felt most comfortable.
Other people look forward to their free days with friends, going out, eating out, partying or attending a concert or spending time with family etc and those are priceless enjoyment as well. I spend mine differently. There is no right or wrong way to enjoy one’s life.
My problems occur when I assume my way is wrong, like I HAVE to go to parties, to socialize, to travel, to be in a crowd, drink in a bar, accumulate as many friends as I can etc when my heart is not into all that. Worst case scenario is to fake your lifestyle just to meet the social quota of the society. It is also wrong to change your lifestyle just because people around you point out your inadequacy or failure or your loneliness stemming from your affinity to isolation and solitude.
For me, physical lifestyle is not as valuable as personal values. There are universal values that supersedes any lifestyle I choose. Being kind and generous and noble and honest is important no matter whether I were an introvert or extrovert.
So - my fellow seniors, don't feel inadequate if you are introverted. You are not alone. Instead of moping and feeling bad for shying away from others, if you would rather be gardening or walking or learning some new tricks or journalling or reading or tinkering with something that piques your interest, Go for it. Don't worry being left out. In my 60s I don't give a rat's ass if people would say, 'He is not one of us' pertaining to my love of solitude LOL.
Stroke Part 5 : The Bleeding Pipe
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When it comes to hemorrhagic(bleeding) stroke, there is the good news and the bad. The bad news: It is a very critical (life threatening) condition. The bleeding will build up in a contained structure (brain and skull) leading to high intracranial pressure which can suppress the overall structure of the brain leading to its lack of oxygen and demise. During my clinician days, the first rule of stroke alert is an immediate CT scan to check the brain. If bleeding ( as opposed to clogging or blocking) is present, the size of the bleed is measured ( through CT and MRI). If it is very large or it causes a midline shift, which means the pressure is shifting the position of the brain, a neurosurgical intervention is emergent.
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[from PubMed]
Treatment of hemorrhagic stroke focuses on controlling the bleeding and reducing pressure in your brain caused by the excess fluid.
After a hemorrhagic stroke, surgery through the skull (craniotomy) might be required to remove the blood and relieve pressure on the brain if the area of bleeding is large enough. Surgery may also be used to repair blood vessel problems associated with hemorrhagic strokes. Your physician may recommend one of these procedures if an aneurysm, arteriovenous malformation (AVM) or other type of blood vessel problem caused your hemorrhagic stroke:
- Surgical clipping. A surgeon places a tiny clamp at the base of the aneurysm, to stop blood flow to it. This clamp can keep the aneurysm from bursting, or it can keep an aneurysm that has recently hemorrhaged from bleeding again.
- Surgical AVM removal. Surgeons may remove a smaller AVM if it’s located in an accessible area of your brain. This eliminates the risk of rupture and lowers the risk of hemorrhagic stroke. However, it’s not always possible to remove an AVM if:
- It is located deep within the brain.
- It is simply too large.
- Its removal would cause too much of an impact on brain function.
[from PubMed]
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If an aneurysm is likely to rupture, a variety of surgical procedures can divert blood flow away from the aneurysm and repair the affected blood vessel, including microsurgical clipping, artery bypass and occlusion, flow diversion with stents and endovascular coiling.
The most common symptom of brain aneurysm is a headache so unexpected, worse than a migraine. I had patients describing it as the most painful headache they have experienced.
Now the good news: Sometimes the bleed is so small that the Neurologist will just let it be reabsorbed until it eventually disappears. This is the best outcome scenario. The other good news: bleeding stroke though critical in the acute phase usually shows a rather better outcome in recovery with less disability and shorter recovery period as opposed to infarction.
***How about a clogged (infarction) stroke? There is a surgical hope for people with clogged (infarct) strokes as well. Besides the tPA during the first 3 hours that can potentially reverse it; there is also a neurological procedure called thrombectomy.
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Thrombectomy is a medical procedure used to treat some cases of ischaemic stroke. This type of stroke is caused by a blood clot blocking blood flow to part of the brain and accounts for around 85% of strokes.
Thrombectomy is a treatment to remove the blood clot. It should be carried out within the first six hours of a stroke starting to be most effective. If you experience stroke symptoms, it’s important to get to the hospital as quickly as possible for treatment and to see if you’re eligible for the procedure.
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In conclusion, there are different causes for stroke and they can be minimized by lifestyle changes. Let me repeat the keyword ‘minimized’ here, not a complete immunity. Anybody, including myself can have a stroke for any possible unknown cause. Anybody can have afib without knowing it, can have high blood pressure without knowing it, can have genetically weak blood vessels that can balloon and rupture without knowing it, can develop a blood clot in the leg without knowing it.
I used to work in the acute phase of stroke during my clinician days. I start moving the patient when appropriate as determined by the Stroke Team (yes, advanced hospitals certified as Comprehensive Stroke Centers have Stoke Teams). My role was the least glamorous. Under close monitoring, I get you up, transfer you to a chair, gradually walk you until ready for home or rehab or an SNF. There are lots of cases whose strokes get reversed and they go home. There are those who might need a short term rehab to facilitate going home. There are those who may need long term care and they are transferred to Nursing Homes. And then, there are cases called ‘stroke in evolution’ that I pay very close attention to. These are strokes that are still in progress and it is a must to monitor things like increased confusion, increased drowsiness or seizures. And immediately alert the Stroke Team again if needed.
But I am not here to blog about how I manage patients with stroke. There are many Doctors and Therapists and Nurses who deal with the medical and recovery aspects of Stroke. Each of these members have their own specialties and sub-specialties. I am limiting myself to basic information that may help a layman in understanding what stroke is and how to manage one’s lifestyle to minimize the risk of having it.
Evidence-based lifestyle changes can help. The first rule is a regular check up, like a car, to see abnormalities in the system whether it is in the blood pressure, blood sugar, bad cholesterol and well, lets face it, body weight. Obesity is not a good protection from stroke. If blood work finds abnormalities in any of the tests, by all means take the prescribed medications.
The next rule is lifestyle. We may not be able to control the medical factors that predisposes somebody to stroke - old age, heart diseases, blood vessel diseases, diabetes, kidney diseases - but there are factors we can control.
Stop smoking, avoid abusing alcohol, avoid eating bad food that worsens blood pressure (high salt), or diabetes (high sugar and carbohydrates).
Work on proper nutrition and diet, exercise, reduce stress (that can increase BP, sugar) and when it comes to stress, it can be physical and mental or both.
Physical stress refers to any activity that is inappropriate for one’s age, An example is assuming you can still do (in your 50s) what you used to do in your twenties whether it is sports or gym work-out or running marathons. It is more prudent to scale the exercise down as you get older, (not to avoid exercising completely) but scaling it down. Physical stress can also be environmental. Too much air pollution, super hot weather (heat wave), overworking no matter how much you love your work, chasing after cars and trains and any form of transport because you are late or in a hurry, climbing multiple stairs when the elevator is not working, deciding to play golf with old buddies out on a whim and you play the whole day ( I had a stroke patient who did just that), trying to show off with the ladies that you are super macho by lifting some heavy loads too much for your strength. There are lots of things you need to reconsider when you turn over 50 or 60 to prevent stroke.
And then, there is the mental stress. Avoid toxic relationships or engagements whether it is with family (spouse or children or relatives) even with your ex-friends and neighbors. If someone triggers anxiety or anger or fear inside you, avoid that person. That holds true with situations. If you are stressed out because you are forced to do something you don’t want to do - an introvert who is thrusted to a noisy party or an extrovert being imprisoned in a lonely isolation - please be nice to yourself and leave. Working relationships that make you squirm or pause for fight or flight reaction is not healthy either Sometimes, social media can be toxic. If you are dealing with toxic FB friends who have all the time in the world to judge or bully or harass you, learn to turn off your screen or phone to ignore them.
There is a time to plant and a time to harvest, a time to work and a time to rest. Being over 50 is probably the peak of one’s life. This is the age you’ve earned what you worked hard for. You are respected for your experience, trusted by most for being reliable and your confidence is more secure because you’ve been there and done that.
The 60s however is the laurel of your life. There are no more heavy responsibilities if you have played your cards right during your working years. This is the decade of winding down. Mortgage has been paid, the kids are no longer dependent on you, gone are the challenges and struggles to support your family and you are done trying to prove your worth. You are sure of yourself without a care about what others think about you. You do what pleases you and damn the bitter enemies LOL. You probably have set the bar lower when it comes to finding love and social connections. Me? I personally don’t even care if I were treated non-existent by the world around me. I don’t mind not getting second looks. This is the age you can enjoy life fully provided you are prepared for it properly. You may have a steady income, like social security, that you worked hard for. Some may even have over-saved and accumulated wealth through proper investments, so now they have more money than what they need. They travel, go to expensive restaurants, watch movies, hang out with old friends, spend time in bingo or cruise ships, they deserve it.
And then there are people like me who are closet introverts. I will talk more about introverts when I review the book ‘Quiet’ by Susan ___ in my next book review.
- Reaction to the book 'The Beginning of Infinity (part 2)
- Book Reaction: The Beginning of Infinity(part1)
- Stroke Part 4: The good, the bad, and the bad (Cholesterol)
- Let's Take a Walk on the Wild Side
- Stroke Part 3: Burst vs Clogged Pipe
- Stroke Part 2: The Plumbing System
- CardioVascular for Seniors
- Stroke Part 1
- Balance Reinforcement Exercises
- Dementia Part 2
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