Routine (I)

It’s a common observation that autistic people prefer routine. For me in my daily life, that’s not so applicable in the way you might think.

I’m not disciplined enough to have the stereotypical timetabled routine which stipulates I must wake up at this time and eat by breakfast at that time; routine for me is more evident in the way I do things, rather than at what time I do them. I have a set route that I drive to work – there are actually alternate ways which would get me there quicker and involve fewer traffic lights – but I like the route I like.

For a long time, I had a set parking space in the car park, if I arrived at work and there was someone already in my parking space then I could venture to the parking space on either side without too much mental pushback.

I have a specific Tesco store I shop in, and a set route I take around the store. I really struggle to adapt if I am forced to shop in a different branch and I have been known to shout across ASDA that I can’t find where they hide the bread/milk/cheese. If you’re looking for an entertaining trip out, try making me do a food shop in Lidl or Aldi – suddenly all of the effort I put into masking just falls away.

When I run a bath, the order is: i) wash bath ii) wash bath mat, 1) bath salts 2) hot water 3) bubble bath 4) cold water 5) bath bomb – if I don’t have any of the first four elements, then it’s a shower for me! (I prefer to have, but can live without, a bath bomb). When I’m in the bath (or shower) I have my routine: apply shampoo – exfoliate face – rinse shampoo – apply conditioner – face mask – wait 10 minutes – rinse face – rinse hair – apply hair mask – etc. etc. When I get out of the bath (or shower) I dry my feet before I dry any other part of my body; thinking about it, I dry and dress from the bottom up.

I get into bed at 9pm (6:15pm on a work-night) cleanse my face, study a chapter of the Bible, apply moisturiser, read some of a book, put The Big Bang Theory on the TV, then I’m ready to snuggle down and go to sleep.

You see, it’s not the day itself which is structured, but the activities within that day. I could go to Tesco before I bathe, or bathe before I go to Tesco. But I will always bathe the same way, and go to Tesco the same way. I’m a big advocate of the nap, it’s not rare for me to put my pyjamas back on mid-day and get back into bed for a couple of hours.

My attitude towards routine changes when I go to work. At work, I need my day to be structured around time. The ward environment I find pretty chaotic, lots of people come and go; with so much distraction, I need to be solely focused on my own activities. If I allowed myself to become distracted by every sight, sound, smell, or strange person that my autistic brain wants me to be distracted by, I would spend much of my shift hiding in the store-cupboard. Having set times for certain tasks allows me to focus away from the things that bring me discomfort and focus on my job. Plus, the patients expect consistent care, eyebrows may be raised if all my colleagues have completed their morning meds round at 8am, and it isn’t until 10am when I decide to bring around the paracetamol and Oramorph for the poor souls who find themselves in my care. I often have a lot of things I am expected to do in a relatively short space of time, to ensure I get all the aspects of my nursing care in, I must designate a time for each.

From the start of my nursing career, I really struggled to remember to ensure the patients had had a wash in the morning. It is customary for the patients to be washed at the start of the day, usually between 8am-11am. This doesn’t stick in my brain because in my schema it doesn’t make sense. I mean, sure, I get that the risk of HCAI is there, but other than that I can’t really find a reason as to why every patient must have a full top-to-toe wash, every day. I have no shame in admitting that bar my face and teeth, I don’t wash every day - certainly not every morning; I actually prefer to bathe at the end of the day rather than the beginning (unless I’m working, in which case I will shower before and after every shift). So, the notion that every patient must wash every morning, is a difficult one for me to grasp, and if I didn’t have an hour in the morning designated to washing, it wouldn’t occur to me to make sure it was done. I do know nurses who would lose their minds if a patient of theirs opted out of having a wash in the morning; for me generally it’s not such a huge problem. What about the patient with incontinence...? I hear you cry.. Well, wouldn’t you just wash them appropriately after every episode of incontinence? I could probably do a whole separate reflection on the hospital-washing-ritual alone, maybe I’ll save that for when I start running out of ideas.

Largely, I have very little control over the day-to-day happenings of the ward, having a timed structure to my day helps me to retain the illusion of having some form of control over what the day will bring. I’m lucky enough to work in a team where if there is an unexpected event – usually in the form of a deteriorating patient – I have colleagues who will do my meds for me, or do my washes whilst I’m indisposed. It’s rare that I end up falling behind.

I don’t know how much of my routine is autism driven, and how much is an innate human instinct to be a creature of habit. I like to think I maintain a fairly healthy balance of 50-50. None was so poignant an example of how much humans love routine than all the pomp and ceremony that was witnessed splashed over the TV screens after the death of Queen Elizabeth II. We all sat and watched nearly two weeks of what I would describe as royal titting about (I suppose that’s what happens when you leave neurotypicals in charge of the routine). What I will stress though is the comfort that comes from doing things in a way in which I enjoy and feel comfortable with.