If you've just stumbled upon this post or clicked here via a different page and are curious about the back story, please see the following two posts for reference: The accident, The first 3 months. This blog post starts 3 months after my accident when I started thinking about starting to return to work. 

Where is my mind

There are certain things during a big recovery that starts to signal things are returning back ‘to normal.’ For me, one of those things was going back to work. I’d been having regular visits with my GP and had asked her time and time again when I could go back, but both of us were hesitant to set a date. Not because I didn’t want to work. But because it was still just so hard doing the day-to-day activities, and we weren’t sure how adding more to my week would change that. Finally, at the start of March, we set a plan. I’d take another two weeks of full leave, and then on March 21st, I’d go back quarter time (so about 9 hours a week). I let my boss know, and she helped schedule a meeting with my return-to-work consultant to help set up a plan for me to ease back into work.

Side note: I work as a Senior Learning Designer in higher education, so my job could be done from home, reducing the need to factor in commuting into the picture. Also, most of my job involves desk/computer work. So it requires a lot of mental load rather than physical, and I knew if I wasn't feeling super great I could always 'work from bed.' 

With nervous anticipation, I sat down on my first day back, logged in, and started going through what you’d normally face after months off: tonnes of emails, backlogs of meeting minute notes, changes in structure and who was doing what. All things I could chip away at that would keep me busy for that first week. I also had a single, hour-long staff meeting where I could say hi to everyone and let them know I was starting again, as well as a short meeting with my boss later in the week to catch up on how I was going. All in all, it seemed like a great plan.

Well, you know what they say about the best-laid plans of mice and men…

By the end of my work on Monday, I had done a total of three hours and I was absolutely exhausted. I made two hours on Tuesday, another hour on Wednesday, and by Thursday it was all I could do to make that meeting with my boss and not fall apart.

Never mind, I thought. The first week back was bound to be difficult. I’ll try again next week.

Week two… same thing. I worked a bit differently this week: half an hour here, then rest. Another half an hour there, and rest. It would take me most of the day to work 2-3 hours, but I could do it. Barely. After a week, at my next meeting with my return-to-work consultant, she expressed concern about coming back too fast and too soon.

The thought had crossed my mind a lot. Would it be better for me to stop work altogether and go on permanent disability? Max (my husband) and I had talked about this already, and he had said that it was an option that I’d be eligible for if I took another few weeks off of work. It was NOT where I wanted to be long-term. But I was very aware that my entire system was overloading every day, and I wasn’t able to do my physio work to the level I’d been doing it previously. The exhaustion was intense, and the mental fatigue and brain fog was impacting every part of my life. I didn’t have the energy to do physio AND work, so I was choosing work, with the thought that I’d be able to exercise afterwards. That just wasn’t happening, so everything started taking a nose-dive and spiralled downwards.

My GP expressed concern when I went and saw her after a week and a half of work, and she wouldn’t sign off any more time than the quarter-time I was on. And even then she said that she was apprehensive. I then broke down in frustrated tears in her office at my inability to think straight. To focus. To pay any attention to what was going on. Why couldn’t I work for even an hour at a time without being absolutely shattered, I cried? And finally, I said what had become a huge fear in my head: was there a chance that the teams at Bendigo Hospital and The Alfred had missed something crucial. My executive function was absolutely shot and I was constantly overwhelmed. Could I have brain damage?

No, she said. You don’t have brain damage. What you have is a body that is very busy fixing itself, and a mind that is super preoccupied with healing all the damage you have done. You aren’t working at full brain capacity. There’s too much damage and healing still for that. You have to be kinder to yourself and accept that this is where you are at. It won’t be forever. But it is where you are now.

I went home that night and really thought about what my options were. I didn’t want to stop work altogether. But I couldn’t keep going the way that I was without (most likely) major setbacks to my progress. There had to be a better way.

If I only had 10% of my brain to work with, how could I use that 10% to the best of my ability? How could I be more efficient with that small amount that wasn’t busy healing my body?

Saved by…. podcasts?

So if I couldn’t do my job AND do physio separately, could I somehow find a way to do them together? One of the parts of my job is keeping up with the latest developments and trends in my industry, which usually meant reading journal articles, news articles, and blog posts. But that meant sitting in front of the computer and reading, which I just wasn’t up to yet. What about if I could just listen to people talking about my industry? Listening to podcasts on Higher Education was something I’d done before my accident when I was commuting back and forth to work, could I do my morning walk while listening to podcasts?

Turns out I could. I couldn’t walk for a long time, but a good 30-minute walk while listening to a podcast turned out to be a perfect warm-up to the day. It was also a great way of distracting myself from the pain my body was in while walking, so it was super effective and efficient.

A little while later I had a week where I listened to two podcasts, one that got me thinking, and the other that dramatically changed not just how I approached work, but also my life.

Podcast 1: Unraveling Faculty Burnout

Teaching in Higher Ed was one of my go-to podcasts, and this episode wasn’t necessarily one I was seeking out. It started playing while I was out on one of my walks, so I just stuck with it. A lot of the discussion resonated with where I’d been before as an academic but wasn’t necessarily where I was now. However, once they got into the podcast a lot of what they were saying really started hitting home. So much so that I actually stopped where I was, and just stood there, listening. Issues around perfectionism. About pulling away from connections because of the shame and embarrassment. About setting boundaries, being overwhelmed by emails, about not having to always be on.

Website link here, or search the title wherever you get your podcasts and music from. 

Perhaps I was already locked in this loop, I thought, where I had such high expectations of myself to ‘come back strong’ and ‘come back normal’ that I had left no room for any other options in the meantime. I wasn’t invincibly strong, and the way my brain was/wasn’t working was nowhere near my normal. I had relied (over-relied maybe?) on my brain capacity for so many years to think me out of situations that I was facing. Now, possibly for the first time ever, I was facing a situation where I couldn’t do this anymore.

I won’t say this was a mid-life crisis, but it was definitely one that shook me. My brain power has always been so integral to who I am as a person, that to no longer have it at my fingertips felt like I’d lost a huge part of me. No wonder I’d thought I had brain damage: for me, losing such a big part of my power felt like a massive change to my sense of self.

And the problem was that I’d set up my workspace exactly like I had before the accident. I was used to working with “19 tabs open” and the music going in the background. I was used to having emails and MS Team notifications pop up at any time, and I would switch between tasks with precision and efficiency, never dropping a beat, all the while being super effective at my job.

But now, just having two windows open, email, teams, and music playing were exhausting. Doing the same work in the same way but less often and for fewer hours wasn’t the way forward. And the perfectionist in me hadn’t fully recognised that I couldn’t just go back to “normal working Tiff for 9 hours a week” as I just couldn’t function this way.

Podcast 2: Brené with Dr. Amishi Jha on Finding Focus and Owning Your Attention

Yes, I’m a big Brené Brown fan. I’ve got a couple of her books, and I’d listened to a few of her pieces before and they always made me think (even if I wasn’t exactly thinking about what her podcast was on it triggered something). So when this one came up as a recommendation in my Spotify list I figured why not. It was a lot longer than the ones I usually had lined up, and it wasn’t specifically about Higher Education, but it was on attention and that was something that I was struggling with a lot.

The entire podcast is worth listening to, so much so that I listened to it twice, even going so far as to make Max listen to it with me on one of our walks so that he’d know what perspective I was now approaching my life with.

Website link here, or search the title where you usually get your podcasts and music. 

There are so many aspects Dr Amishi Jha’s work that really impacted the way I thought, but here are two thoughts that really kick-started my thinking:

1. There are three elements of attention: Your focal attention is like a flashlight, your alerting system is like a floodlight, and your executive function is like a juggler.
2. Multi-tasking is bullsh!t. There’s no such thing. It’s task switching, and doing this depletes our attention, which is a limited resource. The more switching, the faster the fuel runs out.

I thought back to the way I’d set up my work environment, and how my brain was coping in that space. My thoughts were constantly being hijacked by the pain I was in, which is akin to them grabbing the flashlight and pointing it directly at themselves like LOOK AT ME! Totally distracting, and an incredibly hard environment to function in. And because of that, I was constantly reacting to the floodlight of the pain that I was in and because of that, it felt like I was on high alert all the time, waiting for the next pain signal to strike.

Essentially being inside my head was like being in a rave: that flashlight was being pulled around so much by both internal factors (the pain and weird body sensations) and external factors (setting up my work how I had before the accident) that no wonder I couldn’t concentrate. It makes so much more sense now that I look back on it, but one of the problems with ‘habits’ is that they don’t always set you up for success, especially if “the way things have always been done” aren’t serving you anymore. And that juggler, or the executive functioning part of my brain? It had given up, dropped all the balls, and was rocking in the corner.

So if multitasking is actually task switching, and task switching is the part of the system that is the most vulnerable to fatigue, then I was essentially setting up my workspace to be super effective at tiring myself out.

Huh.

I went home that morning and had a good look at what I was doing, and made major changes. First, I shut down any notifications while I was working (iPhone has a great feature on this too called focus). When I needed to concentrate, I’d turn off MS Teams and turn off emails. That meant no bings or dings would distract me while I was doing a task. I figured everyone could, and would, wait until I was done, and then I would check my emails when I was ready. Second, I started organising my week around blocks of tasks, rather than single tasks. So Monday became “Central Projects Afternoon,” Tuesday became “Program Design Day,” Wednesday became “Connected Classrooms Day,” and so on. Sometimes this would have to shift around, but I tried (and successfully managed) not to schedule any “Central” meetings in the middle of a “Program Design Day” which helped immensely. By the second week of this, I could not only focus for a small block of time but could actually start achieving hyperfocus, which for me meant my productivity shot up as well.

Mono-task. Not multi-task. It’s not possible all the time, and sometimes I had to have notifications on as I was waiting for an important call or message to come through. But I tell you what, I really notice a difference when I’m able to just focus on one thing.

I felt so amazing after listening to this podcast and changing my work set-up that at my next GP appointment three days later I asked her to bump my hours up to half-time for the next month. I had a couple weeks with bank holidays in them so knew I’d have a couple weeks of more flexibility, but after that, I knew I’d be ready. And I was right.

So then I thought if these changes can get me to this point, how do I make things better? How do I move forward? Is there a way of stopping my flashlight from behaving like it’s at a rave? Of helping my juggler off the floor in the corner and being useful again?

Mindfulness is the new black

Have you ever had it where two or three different people tell you the same thing independently of each other, and by the third or fourth time you hear it you actually start to listen?

That’s where I was at with mindfulness.

Taking a step back

One of the many things that helped (and scared) me as I went through recovery was reading all the things to find out what was going on. It’s my go-to when I don’t feel in control of things. The more you know and all that. Originally my google feed was full of questions, mostly how long does X take to heal and spinal surgery recovery time and what can you do after spinal surgery. After a while, the search became more specific. I learned more about what the difference between healing after elective surgery versus trauma meant in terms of healing time, and that terms like major trauma and polytrauma would give me a more accurate assessment, as would reading medical journals rather than WebMD google searches. Eventually, I started stumbling across resources that combined physical recovery with mental recovery and purchased a book that hasn’t left my bedside yet: The Body Keeps The Score by Bessel Van Der Kolk.

Bessel van der Kolk MD has spent his professional life studying how children and adults adapt to traumatic experiences. He translates emerging findings from neuroscience and attachment research to develop and study a range of effective treatments for traumatic stress and developmental trauma in children and adults.

https://www.besselvanderkolk.com/

When I first bought it, I read the first three chapters and then skipped ahead to the section on Paths to Recovery. Because let’s be honest, I haven’t really developed much patience… ever. And what I found out was really interesting.

Did you know that the rational, analytical part of your brain has no direct connection to your emotional brain, which is where a lot of trauma sits?

Me either.

However, your medial prefrontal cortex, or the centre of self-awareness, does connect, both to the emotional part of the brain and the rational part of the brain.

Go medial prefrontal cortex. So… what does this mean?

It means that, according to neuroscience research, I needed to make friends with what was going inside my body. Interoception. The core of recovery is self-awareness. So I needed to work on learning or re-learning in some cases, to know myself. Through breathing. And mindfulness.

Wait, what? I thought this was a science book?

Suspiciously I looked back at all the references he listed and started looking some of them up. Turns out there is a lot of research in this area, and it ties in really well to polyvagal theory and how to map your nervous system, which was something I’d been working on even before my accident (see more here). Hmm, maybe there was more to this than I thought.

Now stepping forward again

So while I’d had mindfulness as an option, I didn’t really explore it in any great depth, figuring that all the other things I was doing were enough at the time. I wrote in my previous blog about the pain meditations that I was doing to help, and I’d kept at them for quite a while, including some sleep meditations as I was really struggling to settle down at night. But it wasn’t until I had read about mindfulness in a few websites and articles, as well as listened to the Dr Amishi Jha podcast that it really hit me how important mindfulness was, and how much it could support not just my current recovery, but also help me long term. Well, what have I got to lose, I thought and purchased her book too (see here for more).

So… what is mindfulness?

Essentially, the concept behind mindfulness is to pay attention to the present moment (without telling a story or being emotional about it). So breath is often used as a grounding exercise to help focus on where you’re at. My first session I set the timer for 5 minutes, figuring that was a good place to start. I could pay attention to my breathing for that long, right?

However, after half a breath in I was already thinking about something else. Turns out that’s totally normal, and part of the process.

I started with the analogy that Dr Amishi Jha used in her book, called “find your flashlight.” As I described it earlier, my flashlight was so active that it was like being at a rave (or disco, pick whatever metaphor works best for you). When my mind wandered away from my breath and I thought about something else (let’s say donuts…) I went aha! My flashlight is looking at donuts. Cool. Let’s move away from those and back to my breath. So instead of getting cross at myself for not being able to focus (which I’ll admit that I did for quite a while, old habits of perfectionism are hard to break) I found what I was paying attention to, and gently shifted it back.

Kind of like training a toddler. Eventually, it got easier, but there were a lot of tantrums along the way. And at the end of the day, a toddler is still a toddler. But training is possible…. but not unless you actually start. And really, with all the physical training I was doing in my recovery, why would I leave the superpower that is my brain behind?

There was a simple activity profile on my watch called Breathwork that I find really helpful for my mindfulness practice. And, because everything is about logical efficiency, I do it while resting on my physio table and stretching out my neck and back. The way the activity is set up is for “Box Breathing” or “Fourfold Breath,” which helps you work toward a “4:4:4:4” breathing pattern — 4-second inhale, 4-second hold, 4-second exhale, 4-second hold. My watch does a small vibration each time I need to change my breathing, which helps in two ways. One, it reminds me when I need to inhale, hold, or exhale, without me having to devote a lot of mental attention to it. Two, it helps me pull my attention back to my breath when my mind drifts off, which is all the time. And three, it was a relatively simple habit to form: my back is hurting as I’ve been at the desk too long/walking too much/riding my bike, I need to lie down. While I’m here, I’ll hit the breathe profile and do mindfulness for 15 minutes a day.

(okay, and four, it uploaded it as an activity to Strava, which meant I could set a goal each week and track how I was progressing. Know thyself. For me, this worked as motivation to keep at it and keep consistent, even if I didn’t make the activity public or push the activity to my feed. I knew I was doing it, and that was enough). I did accumulate a lot of ‘yoga’ in my monthly update though. Go me.)

Yes, it was nearly impossible when I started. See the previous commentary on the rave that was my attention system. No, I’m not ‘good at it,’ but I’m better at it than I was weeks ago when I started. It’s a bit of a mind-mess starting up really. You want to be good at mindfulness and make healthy behaviour changes, but it’s so difficult when you might give up and throw it all away, but you really need to do it in order to get better at it. Let’s just say if my pain-ravaged, traumatised body with its rave-like attentional flashlight can start, keep going, get consistent, and be better at mindfulness, you can too.

But does it really make any difference?

The short and emphatic answer is yes. It has quite literally changed my life. I’m far more present in my life, and not only that, but it’s easier for me to recognise when I’m NOT being present. Did you know that “research shows we are missing 50% of our lives… because we aren’t paying attention” (PeakMind). Well, I’m working on getting some of my life back. When I’m spending time on a task, with my family, eating donuts, I’m now actually doing just that, instead of mostly thinking of what I need to do next and how busy/tired/stressed/sore I am, or what I should/could be doing instead. Those things are still there, but I actually am better at noticing when my mind starts drifting off, and I can more intentionally pull it back. There are many more reasons that it changed me, but they are harder to articulate as it starts to get more meta.

You’ll notice that I don’t practice mindfulness while I’m doing other things, such as walking or riding my bike. For me, this is more meditation than mindfulness. I can’t seem to really be mindful while I’m walking, as I need to focus on… well, what I’m trying to focus on, which is my internal thinking, rather than paying attention to the broader external world around me. I mean, I suppose you could do both, but for me, it’s easier to ‘train my toddler brain’ when I’m at home in a controlled and quiet space and can really watch what it’s doing, rather than while I’m out walking or hiking and my toddler is running free. Walking is for mind-wandering, podcasts, and getting my brain and body warmed up, hiking is for strength work, nature, and taking photographs, and stretching my back and neck is for mindfulness. Personal choice I guess.

Where I’m at now

I’ve been working a flexible 0.7 fraction (meaning I can put in the hours whenever I feel good – more hours on a good day, fewer hours on a bad day or when I have medical appointments or other commitments) since early May, and this has been a good balance for me. At the moment, putting in solid hours of focused work is where I’m at. And the truth is that more hours of work do not necessarily equate to more productivity. In fact:

… the average employee stays productive for less than three hours a day, regardless of how much time they stay in the office.

https://socapglobal.com/2019/09/the-average-worker-is-only-productive-for-about-3-hours-a-day/

I’ve tried a few times to work some back-to-back longer days, but body my body and brain have said this isn’t a good strategy yet, so I’m sticking where I’m at and listening to my brain and my body. It’s taking a lot of time and an absolute ton of work, but I’m feeling a lot more confident about getting back to full-time later in the year. And I had colleagues start asking for me to be on their team and help them out, which for me shows that I’m being useful again. A good place to be, and not somewhere I ever thought I’d get to after only 6 weeks back at work.

Wait, isn’t this a cycling blog…?

Yes well. It’s really a holistic approach now as I progress through my recovery. As I mentioned, when I went back to work my levels of exercise dropped as I wasn’t able to do everything. So I wasn’t riding. At all. The pain in my back and neck while sitting in a chair at my desk put me in no position to be able to get on a bike, so that took a backseat for a while. Yes, it bothered me and made me upset, but that was the only way I could go back to work. I’ll also admit that I lost a lot of motivation to ride, both with the pain as well as the exhaustion, and I just didn’t feel like I had that extra oomph that it normally took to get me on the bike. So I spent my energy differently for a bit.

When I did feel ready to ride again I took a different approach. Trying to do “training” wasn’t all that exciting, and I couldn’t “just go ride my bike” even if I wanted to. A friend of mine suggested looking at Fulgaz as an option, which initially scared me a lot. It’s more realistic than the other apps, and I was worried that it would trigger some PTSD issues, so to be honest I avoided it as I didn’t feel ready to deal with the ramifications if it all went pear-shaped.

By the end of April, I’d had three weeks off the bike and was ready to try again. I loaded up the app, set my screen up, and set up contingency plans in case anything went wrong and I had any triggers. In good news, all the work I’d been doing with getting outside into nature, psych visits, and mindfulness had strengthened my mind and I had no PTSD triggers during the first ride. On the second ride, I purposefully chose a course that had a lot of trees and went again. Still good. And from that point onwards, I actually wanted to get on the bike and ride, rather than feeling like I “had to because I was a cyclist and I thought people expected me to do it” which was an amazing change.

By the end of May, I’d put more time and distance on the board than I had in December before my accident, while also increasing my work hours up to half time. I managed over a few weeks to increase my time on the bike to a four+ hour ride that included virtual hills (and a real coffee break), and while I didn’t feel like dancing afterwards, I didn’t completely collapse so I counted that as a win.

So where am I at now after attacking my recovery hard, and smart, for three months? My brain and body team (psychologist, physiotherapist, osteopath, sports massage therapist) are all so excited by what I’ve accomplished. I might not be breaking any records (though you never know… not that it’s a competition), but I am in a place no one could have predicted when I first got out of the hospital less than 6 months ago.

The fear isn’t as strong now, and neither is the pain, but they are both still present on a daily basis. Mornings are still difficult, as in my dreams I’m not injured but then I wake up to pain and a body that still doesn’t feel like mine, so it’s a hard transition each and every day. The exhaustion still kicks in if I push myself too hard, but I’m much better at reading the signals early and making conscious choices about what to do about it (push through and face the consequences, or ease off knowing I’ll feel better for it, but also facing the reality of having to cancel plans, or not do what I wanted to do).

Now that the pain is more manageable and not as overwhelming (most days) I’m getting more accurate signals of what’s going on in my body, though they aren’t altogether that great. On good days I’m just generally sore and tired. On bad days I have some pretty acute pain in the back of my shoulder that still feels like I’m getting stabbed, and my sternum still hurts all the time. And every time I try and stretch by arching my back, I get a digging-in feeling lower in my spine that stops me from moving. It feels like my body is fighting the internal fixation and is not happy about it, which means I’m not super happy about it either. Yes, I can cope, after all, I have pretty high efficacy for pain, but it’s not where I want to be. The advice from my body team is to take the implants out, but the surgeon said a few months back that we won’t talk about this until my 12-month appointment, so we wait.

I was hoping to end this 6-month blog update with some news from the surgeon, but after waiting 2.5 hours for a telehealth appointment I found out that they’ve rescheduled me to the middle of July.

So I guess the update, for now, is that I’m doing really well. I’ve got near full neck movement back, and I’ve even started running as I’m able to absorb the impact and pain now. I still don’t have the all-clear from the surgeon to get back on the bike outdoors, though he did originally say “after 6 months” so maybe I’ll take him at his word on that one. The road to recovery progresses, though there do look like there are a few bumps coming up in the road as we wait to find out what all the pain still means.

*NB: Although I am a doctor I am not that kind of doctor nor am I your doctor. All content and information on this blog are for informational, educational, and entertainment purposes only. It should not be relied on as health or personal advice. As always, donuts are not a substitute for therapy. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or a medical condition. If you are struggling, please reach out to your GP, and/or see https://www.healthdirect.gov.au/mental-health-helplines for options.