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  • Lezlie Sterling / lsterling@sacbee.com

    Joyce Mikal-Flynn teaches at California State University, Sacramento. After her 1990 heart attack she had to relearn just about everything. “When I had my event, the thing that drove me nuts was everybody telling me what I could not do,” she said.

  • Lezlie Sterling / lsterling@sacbee.com

    Joyce Mikal-Flynn teaches a class called the Brain and Gender at California State University, Sacramento More 23 years after being clinically dead, the professor and nurse practitioner is living her life to the fullest.

  • Lezlie Sterling / lsterling@sacbee.com

    Mikal-Flynn shows her book, “Turning Tragedy into Triumph: Metahabilitation: A Contemporary Model for Rehabilition.”

More Information

  • A new take on rehab

    California State University, Sacramento, professor and nurse practitioner Joyce Mikal-Flynn’s book, “Turning Tragedy into Triumph: Metahabilitation: A Contemporary Model for Rehabilition,” can be purchased at www.metahab.com.

  • Six concepts of metahabilitation

    1. Major traumas, personal life crises and catastrophic events all disrupt an individual’s status quo. Adjustments of biological homeostasis and self-concept are required in order to effectively address the disequilibrium.

    2. Such profound existential experiences provide human beings opportunities for significant physical, intellectual and spiritual growth and development.

    3. Human beings possess the ability to adapt and ultimately become stronger when faced with severe disruption or danger to their homeostasis.

    4. Humans have the potential and capacity for this resilience.

    5. Evidence of it is found extensively in the evolutionary, biophysical world.

    6. Human beings innately are or can become goal-oriented, possessing an awareness of their power to influence events, seek meaning and creatively reconstruct the future.

    Source: www.metahab.com

Nurse practitioner champions a new model of mind-based rehab

Published: Thursday, Sep. 26, 2013 - 12:00 am
Last Modified: Thursday, Sep. 26, 2013 - 12:20 am

She sometimes refers to her death, euphemistically, as “The Event.”

She speaks of it matter-of-factly, almost clinically, devoid of freighted emotion one might expect from a woman whose heart stopped for 22 minutes one afternoon 23 years ago on the deck of a Sacramento swimming pool, and whose resuscitation and arduous rehabilitation changed her life in so many ways.

Then again, Joyce Mikal-Flynn hardly qualifies as typical.

Even before the 1990 heart attack that has defined her life and given her renewed purpose, she had been a classic outlier. Driven and intense, totally Type A+, Mikal-Flynn was a nurse practitioner with a thriving practice, a triathlete who was pushed and pushed back in competition with legendary pro Sally Edwards, a doting young mother of three and spouse to a high-profile corporate husband. She neither had the time nor inclination to wallow in maudlin emotions.

Post-“Event,” she eventually used her inner-Ironwoman will to defy the odds — and most doctors’ expectations — to rebuild her life, synapse by firing synapse, step by halting step, thought by positive thought. She arrived, ultimately, at a higher existential plane where her “new-normal” life is richer and fuller than before.

Not only is she back practicing her profession — as well as teaching nursing as a tenured professor at California State University, Sacramento — and running marathons and sending her three children off into adulthood, Mikal-Flynn has developed a new approach to rehabilitation.

Based on her experience and those of other survivors of life-altering accidents or illnesses, her concept of “metahabilitation” promises nothing less than turning “devastation and disempowerment into self-actualization,” and showing those whose corporeal selves may have atrophied that their emotional or spiritual growth can blossom if approached in the right manner.

Her self-published book, “Turning Tragedy into Triumph,” (JMF Co., $16.50, 148 pages) details her story and those of six others who, due to accident or illness, saw their worlds come crashing down — careers and marriages ended, senses of identity obliterated, once-ordinary daily routines turned monumentally difficult — but refused to succumb. Using her medical background to buttress her personal experience, Mikal-Flynn has sought in the book to teach doctors and occupational therapists that rehabilitation alone is not enough, that a psychic transformation can go hand-in-hand with levels of physical recovery.

“Here’s the deal,” Mikal-Flynn said, starting with one of her pet phrases, “the thing that drives me crazy is physicians and other health-care people taking away that sense of hope. Who knows what you’re going to do, post-accident? I don’t know. You have to instill hope. There’s a hope of your life being a wonderful life. There is that hope. Sometimes, these people that I wrote about hung onto the thinnest thread of that hope. And look where it got them — to huge growth experiences.”

Of course, Mikal-Flynn, 58, concedes that her story is atypical. One of her cardiologists, Dr. Roger Van Winkle, once told her “You are the luckiest person I have ever met. I have never met anyone who had that much CPR and is alive and sitting up speaking to me.”

But rather than considering herself an exception among near-death cohorts, Mikal-Flynn sees her ordeal as an example of how she forced herself to “shake off my ego and resentment, and move forward.”

When asked how, as she writes, people can find meaning in their suffering, Mikal-Flynn leans in and puffs her lips to blow her brown bangs back into place.

“Listen,” she said, “There are only two ways to deal with this: One is to sink into that despair and desperation — and I can understand why you’d do that. The other one is to say, ‘I don’t know why all this happened but somewhere along the line, if I work with what I have to do — the basics: getting up, getting out — then I can start coming out on the other side.’

“I do not minimize people’s pain. These things are not fun and I’d never challenge somebody on it and (say) ‘You just need to get over it.’ No, no, no. But you need to grow as a result (of the event). Here’s the deal: I’m so tired of motivation. People tell me, ‘Joyce, your story’s motivational,’ but motivational stories are a dime a dozen. What I want to do is to say, ‘(My) story is just to allow you to see possibilities. Because just hearing a motivational story is not enough. If it was, everybody would be (cured). I never sit around telling somebody, ‘This is the best thing that could happen to you.’”

Proving doctors wrong

But, in a way, it was for Mikal-Flynn. Two years after “The Event,” through rigorous occupational therapy and counseling, she regained all her cognitive functions and proved wrong the cardiologist who told her she’d never run again.

Saddled with aphasia, she basically had to relearn the language and, as her husband, Terry, noted, “figure out how to run the microwave oven again.” She battled depression, too, once flirting with suicidal thoughts. She would, early on, take walks around the block and forget where home was. Her kids were on their own when having to construct their Sutter’s Fort fourth-grade projects; mom was just trying to remember their middle names.

So Mikal-Flynn, when she later returned to earn her doctorate at St. Mary’s College in Moraga, remembered her initial struggle and the “turning point,” a moment of clarity when she decided to fight to embrace her new life rather then morosely accept its perceived limitations. Much like Elizabeth Kubler-Ross’ stages of death, Mikal-Flynn developed a six-stage model of rehabilitation: acute recovery; the turning point; the treatments; acceptance and adaptation, regeneration; and taking on the future. She even copyrighted the term “metahabilitation.” Meta, she said, because it goes above and beyond a simple return to normalcy that rehabilitation promises.

Then, she set out to interview others like her who had taken the same path after catastrophe. Among the six survivors profiled in the book are “Jerry,” a dentist who was paralyzed due to an air embolism while diving and lost his practice; “Dominic,” a college rugby player paralyzed in a car accident; and Connie, a mountain climber who suffered major head trauma in a 30-foot fall.

After varying periods of grieving the loss of much of their physical capabilities, the subjects whom Mikal-Flynn interviewed set about re-evaluating their lives in terms of not what they no longer could do but what possible new opportunities arose as a result of their catastrophic accidents or illness. Jerry the dentist, for instance, became an expert witness in civil and criminal trials involving dentistry after losing his practice. He also defied doctors’ expectations by learning to walk again, albeit haltingly and with crutches, after years of dedicated therapy. Dominic the rugby player has started a foundation to help other ex-athletes “transition” to para-sports.

What Mikal-Flynn calls “transforming consciousness” others might simply call a positive attitude that led them to recover mentally and, sometimes even physically, when they could have easily succumbed to reduced expectations. By whatever term, their stories reinforce the book’s thesis that the established medical model for rehabilitation often does not aim high enough in dealing with patients and their levels of recovery.

“When I had my event, the thing that drove me nuts was everybody telling me what I could not do,” she said. “Nobody said, ‘OK, for (driven) people like you, here’s what we’ll do.’”

She acknowledges that her “metahabilitation” stance has drawn criticism from some doctors, who believe it gives some patients false hope, and from some patients who may think they are “failures” if they don’t succeed in reaching a certain plane of consciousness.

But Dr. Dean Elias, Mikal-Flynn’s dissertation adviser at St. Mary’s, defended the research and concept of “metahabilitation.” Her results may be anecdotal — but, my, what compelling anecdotes.

“All these people she talked to had a transformation of consciousness,” Elias said. “They became different in a way that was more participatory in the whole of life. They gained a sense of their own agency. I think the medical establishment is doing what it gets paid to do, which is to keep things normal. She has discovered something that seems abnormal but in a very positive way.”

Far from being Pollyanna-ish, Mikal-Flynn said she simply would like caregivers to focus on what the patient confined to a wheelchair or dealing with severe cognitive damage can do and tell them.

“What’s going to happen in the future, we don’t know,” she said.

She laughs and tells the story about herself from when she had newly awakened from her coma in the hospital and confronted in the hospital corridor that cardiologist who told her she’d never run again. She told the doctor, “You don’t know me. ... I will come through this. You don’t know who you are talking to,” then turned on her heels and got lost on the way back to bed. The doctor said, loud enough for Mikal-Flynn to hear, “Wow, she’s yelling at me and she cannot even find her room.”

Grieving essential

... for a while

It does, she admits, take a certain kind of doggedness of spirit to embrace “metahabilitation.”

One thing Mikal-Flynn discovered in her interviews is that people needed time to grieve for their previous selves. Dominic the rugby player, for instance, mourned the loss of movement in his legs for weeks before he vowed to pursue other goals.

“I say to them: ‘It’s an absolute necessity to grieve the life you knew. But we’re going to come back and get you because we can’t let you stay there. You have to get angry, scared of everything you have to do. That’s a natural response to trauma, but now you have an opportunity to move forward, and let’s look at how you want that to look like.’”

Mikal-Flynn presents such a strong, impenetrable presence that it’s difficult to believe she, too, dealt with depression. Her husband, Terry, recounts some dark days.

“She was really, well, there’s no other way to say it: She was really pissed off about what happened to her,” he said. “Here she was this accomplished nurse practitioner who’d done some pretty amazing athletic things, but he couldn’t remember when the kids’ birthdays were.

“It really upset her when people would say to her, ‘Oh, God must have bigger plans for you.’ She was like, ‘Come on, really?’ But she had a breakthrough one night when she finally said, ‘I can’t live like this anymore.’”

And so began her “metahabilitation.” And, true to her book’s thesis, she’s found her life fuller than before “The Event.” She, of course, wouldn’t wish a 22-minute heart stoppage on anyone, but in the fullness of time, it has benefited her.

“People tell me I’m, I don’t know, ‘softer’ now?” she said. “I was kind of hard-edged before.

“Here’s the thing: I’ve always been a very driven person. But this has given me insights into my own life and what works and what might work with other people.

“I’m just trying to get people like I was away from the (culture of) victimhood.”


Call The Bee’s Sam McManis, (916) 321-1145. Follow him on Twitter @SamMcManis

Read more articles by Sam McManis



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