The Principle of Least Convenience

March had been a tough month due to a terminal brain cancer diagnosis, but April was in many ways tougher due to the after-effects of surgery. I could walk, but only with a walker — then just barely. Both my left leg and left arm were weak and imprecise. My right side had atrophied due to deconditioning. My balance was atrocious. My escapade in the hospital had left me with a profound fear of falling, casting a layer of existential dread onto major physical activities I tried. Even so I was determined to claw back all of the the abilities I'd lost.

My past experience with physical therapy (PT), both in the hospital and in an acute rehab unit (ARU), had convinced me that PT worked. Unfortunately, my discharge from the ARU meant that PT would become much less frequent. Clearly, it would be too little to get me to my goal. I had two options: hope for the best with the little that the hospital could offer; or take matters into my own hands. The choice was, if you'll pardon the pun, a no-brainer.

I concluded that PT would need to become an integral part of my daily life, not an add-on. I also concluded that I'd need a system to make this work. I would come to call it "The Principle of Least Convenience" (PLC).

The Principle of Least Convenience states that if there are two or more ways to do something, choose the least convenient. Let's say that I forget my reading glasses upstairs. I can either ask my wife to bring them down to me (convenient), or bring them down myself (inconvenient). PLC says I bring them down myself. Let's say I needed to take a drug with meals. I could either put the bottle of pills on the dining room table (convenient), or I could put the bottle in the bathroom and get a pill when needed (inconvenient). Easy, the pills go into the bathroom. Let's say I left my iPad near the living room chair where I last used it. I could either keep doing that (convenient) or put the iPad in its proper place — on my office desk — after every use (inconvenient). The PLC tells me to put the thing away when I'm done using it. The end result: hundreds of "unnecessary" trips up and down stairs and across the house.

I'm right handed, so it's most convenient to eat and drink with my right hand. Too bad. PLC says that even if everything I try to consume ends up on me or the floor, I eat and drink with the left hand only.

Under the PLC, literally everything becomes physical therapy. The affected side gets worked like never before.

Doing everything the hard way was exhausting, but effective. Not only was all the exercise building strength but all of the obstacle avoidance was building coordination. I could see and feel the improvement.

An important psychological side effect of the PLC is that it keeps the house demedicalized. Have you ever been in the house of someone who is chronically sick? These places often resemble hospital rooms with drugs, personal effects, and treatment paraphernalia strewn everywhere. This isn't always avoidable, but when it is I can't help but imagine the psychological toll this must take on the people involved. For this reason, I was determined to keep my house demedicalized, and was willing to go to great lengths to keep it that way. Following the PLC made it easy to detect when my inner schlub was winning. When the place started to look like my old hospital room, I knew I had given into temptation.

My biggest asset in all of this was learning to walk without a walker. It took about three weeks. I started by pushing the walker across a grassy field. After I felt comfortable with that, I walked into the middle of the field and let go of the walker. I struggled to keep balanced for about five seconds before grabbing back on. Then ten. Then a minute. Next, I took a small step from a standing position, then stood still. Then I took another step and stood still. And so on. If I ever were to fall, I knew I'd just hit soft grass. I never once did.

I should mention that prior to ditching the walker, I practiced regaining control of it from a position of lying flat on my back on the floor. Knowing I could do this was a big help in overcoming my fear of falling.

I didn't fully realize it in the beginning, but walking without a walker is a survival skill in a case like mine. Using a walker, both indoors and outdoors, is very hazardous. Outdoors I'd kick the walker as I became stronger, causing it to lurch forward. Or, my foot would land on top of a wheel, causing that foot to lurch forward. Decades after the Americans with Disabilities Act had become law, I found a lot of public places to be hostile to people using walkers. Within my own home, catching the walker on furniture or some other obstacle was a constant hazard, just as it was in the hospital.

But more than this, a walker teaches its user the wrong way to walk. Walking puts our entire bodies in motion: legs; arms; hips; abdomen; and neck. With a walker, only the legs move. As soon as I started walking without a walker, my body moved more fluidly. I felt much more comfortable and even safer. This, perhaps more than anything else I did, is what allowed me regain the strength and coordination I'd lost.

Before long, I was walking almost as well as I did the day I entered the ER room. My wife and I celebrated with a hike through the desert along a dry wash. I viewed the numerous changes of ground composition from sandy to rocky, the many uneven breaks in the underlying rock, and the many opportunities to stab myself on a cholla as coordination challenges with immediate feedback.

Another aspect of my recovery was re-teaching myself to touch type. Soon after my arrival home from the rehab unit, I was horrified to discover that for every two keystrokes made with my left hand there was at least one typo. This was far worse than I was doing before surgery. I use the term of "horror" deliberately. I write software and prose for a living. Not being able to touch type meant that either I'd never work again, or I'd need to find a different line of work.

My typing was so bad that I seriously considered using voice-to-text software. However, this violated the PLC. Speaking would have been much more convenient than typing, at least in the short term. Therefore, the path I took was to improve my touch typing. To help me re-train, I revisited touch-typing tutors, sampling about a dozen of them. The best by far was TypingClub. It's clearly geared toward kids, but I'm glad I didn't let that discourage me. I found the audio feedback when pressing keys and the video game-like progression of difficulty to be extremely helpful.

Prior to my arrival home, we'd installed some grab-on hardware onto the toilets. Within a day or two of having ditched the walker, the grab-ons were gone because they were not necessary. This was the last phase of de-medicalization.

It quickly became clear that implementing the PLC requires physical strength. It may not be obvious, but when you can't move very well, building strength is a terrible challenge. I knew I was weak because my first few attempts to restart my pre-diagnosis workout routine failed miserably. For some exercises, I couldn't complete a single repetition. It's an awful Catch-22 that I suspect has nabbed many people trying to recover abilities.

I hit this problem with push ups. I couldn't extend and hold my legs behind me. My arms were so weak from deconditioning that I could barely do just one half pushup. A half pushup is when you lie down on your belly and push up with both arms.

Fortunately, a half push up is all I needed to get going. I started with ons half pushup repetition. When that became easy I increased to five, then ten, and so on.

To deal with poor leg coordination, I began by trying to pose in the "up" position of a pushup, with both sets of toes on the ground, my body fully extended, both arms down, back straight, and both legs fully extended behind me. After several days, I could just barely hold that pose for about a second. The next session, I did my first full push up. Using this incremental approach over about two weeks, I worked my way back to a pre-diagnosis daily routine of 3 sets of 35 full push ups.

As I was doing all of this, I was struck by an idea I'd never even considered before: few things in life are as motivating or thrilling as winning back a lost ability. I'd return to this realization whenever my lizard brain told me that I was wasting my time and that I couldn't possibly accomplish the ridiculous goals I'd set.

My experience with push ups and ditching the walker led me to this PLC corollary: when doing the inconvenient thing is impossible, do as much of it as you can, then build from there. It's no accident that TypingClub, which I'd found so effective compared to the alternatives, also followed this principle by slowly working difficult keys into practice sessions.

Eventually, I'd re-gain almost all of my pre-surgery abilities thanks in no small part to the Principle of Least Convenience.