More than arthritis.

"It's the little things. And the joy they bring."

~ India.Arie

"I can't wear my shoes." She patted the corners of her eyes and sighed when she said that. Her eyes glistened and her lips trembled as I sat across from her on a stool. "To someone else it may not seem like a big deal. But to me?" She shook her head and looked down at her feet. Now those tears had coalesced into pools in her eyes and had begun spilling down like tiny waterfalls.

This time she didn't even try to stop it.

She wasn't there for anything exotic. I mean, how much more "bread and butter" does it get than arthritis? And, no, not one of those inflammatory or autoimmune types, either. This was the regular, every day kind of degenerative joint disease that comes after people who have that not-so-rare combination of growing older and years of weight bearing.

Her knees and ankles were swollen. When I examined her legs, I could hear and feel the crepitus--which is really just a medical term describing that sensation in the joints that could be mistaken for a boot stepping into a bank of well-packed snow. Crunchy. Crackly. And, in her case, accompanied by fluid and pain.

But especially? All of it had robbed her of one of the most important parts of her quality of life: Her ability to wear her favorite shoes. So for her, this was about more than arthritis.

Much, much more.

"I'm sorry." That's all I could really think to say. I knew that there would be things we could do for the pain. And maybe even the swelling at some point. But she was caught between that tricky rock and that impassable hard place where her joint disease was bad enough to limit her every day activities but not quite to the point of needing joint replacements. Moreover, she had a few other health problems (as well as financial limitations) that would make a big surgery like knee arthroplasty a hell of a lot more than a notion and a scheduling issue.

Yeah.

So really? This just kind of sucked.

She lifted one of her feet and stared at the sneaker on it. "I've worn these for the last few months. Even when I have on a dress I have to wear something flat and cushioned like this." She shook her head and started to cry again. "I hate it. I hate that I can't wear my shoes."

I watched as her shoulders slumped and the corners of her mouth turned downward. Instinctively I reached for her hand and she allowed it. While holding her hand and passing her tissues, I sifted through my brain for something to say. But I didn't have any really good solutions so I just stayed quiet.

She slid her hand back and sighed. "I'm sorry."

"Don't be."

"I just. . . " She squeezed her eyes and fought back tears again.

"You know what? I understand." She looked up when I said that. "I mean. . . .I haven't had arthritis like you have had. But your feelings about the things that make you feel good, I do understand that."

My patient glanced at my feet and, for the first time, I saw a tiny smirk. "I see you're a heels girl."

I smiled. "I tell my residents and medical students that I was born feet first--and that the first thing the doctor saw was my three-inch heel." This made her chuckle.

"Do you wear heels like that even in the hospital?"

"I sure do. I mean, some really rare days I wear flats. But in heels I feel like myself. I'm a 5'6 girl who sees the world from 5'9" or higher." We both giggled at that.

"So you get it."

"I think I kind of do."

"My shoes are like . . . my thing, you know? I don't feel like me without them."

I twisted my mouth and nodded. I did get it. I thought about the day I broke down crying to Harry because I needed a haircut and couldn't work my schedule out to get it. For me, perhaps, my short hair is probably the equivalent of her shoes. Though I'll admit that being able to wear a nice heel is a close second.

"How can we be of support?"

She shrugged. "It sounds like we have a plan so far. And I guess I am going to work on losing a few more pounds so that, like you all said, I don't have so much pressure on my joints."

"The anti-inflammatory medicines can cut down some of the swelling, too. And if you change your mind about the steroid injections, that's another option."

"I'll think on it."

"Okay."

"Thanks for understanding."

"Thanks for being so honest. Besides. . .girlfriend, shoes are serious business!"

"What you sayin', girlfriend?"

She reached out and gave me a high five when she said that. Although I noticed her eyes glistening again when she did.

Yeah.

Today, I am reflecting on the little things. Though what they are and how they rank in importance varies for us all, there are so many seemingly small things that, if removed from our lives, might suddenly feel big. Like having legs that work and feet that can walk or even run. Like being able to step out in a sassy pair of high heels and feeling fierce when you do. Or being able to perfectly apply lipstick including lip pencil without even looking in a mirror. Maybe it's how I feel when my stylist Sakinah dusts my neck off after finishing her handiwork on my pixie haircut--which is very, very good and like I can do anything. Or even something as simple as having both of my hands able to type on this computer and share these thoughts. I'm thinking about all of it and allowing myself to feel grateful.

So today, with my patient and her collection of shoes on my mind, I am taking a mental inventory of those little things which really -- when I think of them -- aren't so little at all. Feeling grateful for all of these things.

And the joy they bring.

Yeah.

***

"Give me my guitar, give me a bright star
Give me some good news, give me some cute shoes
Give me Atlanta, give me Savannah
give me my peace of mind

Give me some Stevie, give me some Donny
Give me my daddy, give me my mommy
Pour me some sweet tea, spoonful of honey
I don't need no Hollywood . . ."

~ India.Arie

***
Happy Snowy Hump Day.

Now playing on my mental iPod. . . . . I can't get enough of Ms. India.Arie singing this song.