Routine (II) and Reasoning

I have already chatted a little bit about routine. I seem to have pretty much covered the ‘what?’, but not really the ‘why?’. A series of sudden changes going on at work of late have got me reflecting upon the reason why my behaviour deteriorates when I feel that the control I have over life is lost. I could at least do myself the service of trying to explain why things are the way they are, and what goes on in my head when things do not quite go to plan. I must specify before I go on though, that often it is not the change itself that causes me so much distress, it is usually the suddenness of that change that is the problem.

As a ward nurse in an acute area, things are chronically changing. Some may diagnose it as recurrent acute on chronic change, like the cogs are turning harmoniously but several times an hour there’s a jolt as they skip ahead. Nursing does not lend itself kindly to autistics in this way, the hospital ward is a hive of general uncertainty and unexpected alteration.

I have the type of personality where I have to have knowledge, I spend a lot of my time home-schooling myself. An autism OT once made the observation that rather than having a stereotypical special interest as many autistics have, mine is self-education. When change happens – and I’m speaking more so of sudden change rather than a planned alteration – I treat this as knowledge I don’t have, and gaps in my knowledge do make me very anxious.

Think of it like this:

I have had patients return from theatre after a lap appendix, decline paracetamol, and discharge just hours later. I have also known patients to return from theatre less an appendix, but sporting a fentanyl-PCA, IV para and tramadol, and still screaming in agony (which admittedly happens less often but happens none-the-less). It’s the same procedure, for the same problem, perhaps even similar levels of pain, but for whatever reason some people just do not tolerate it as well as what others do. That is really the only way I can think of to explain it. I can be forced to undergo the same change, at the same time, in the same way as my colleagues, and I will absolutely be demanding a PCA, IV analgesia, and remain shouting about my displeasure regardless – perhaps not as metaphorically as you might hope.

So, what is that feeling that I’m so distressed by? Cast your mind back to your first day in a new job, or a new placement. Those first-day nerves are there, you feel sick, not slept – terrified you will balls it up from the off. That same sort of feeling, although amplified within me, is comparable to the feeling I get when struck with sudden change, and much like the patient with the f-PCA, I do not handle it well. It takes me a little while to build up a new routine, and if I am suddenly cast into the realm of doing things differently, those neural pathways simply are not there. It all requires a lot of planning in my head.

If I am building myself a new routine: I need to troubleshoot my options; work out specifically why this change is happening; foretell any problems I may run into; ask questions (and get answers); decide upon the best course of action to take; work out how I am going to do that; figure how this new thing will fit into my pre-existing schema; then start to try it out. There is an awful lot of effort that goes into doing something new, it all must be done in a controlled and logical way so that I can ensure efficiency. If change is so sudden that I am not given the opportunity to think it through fully, the whole system short-circuits. Essentially if the process happens too quickly for me, I’ll shut down. I am so ridiculously stubborn*. I’ll start firing questions, most of which may seem ridiculous and things that I don’t really need to know, but when stuck in a situation where I’m not being allowed to process in my own time, all of a sudden my brain becomes a mess of trying to process too many eventualities at once. I liken autistic overwhelm to be like the tabs running on a computer. I’ve worked out that at any one time I’ll have probably somewhere between five and ten tabs open in my brain, I’ll flick between them with somewhat ease. But all of a sudden I have to do something differently, and this forces open an extra twenty tabs that I look at concurrently. On a computer, if you had >30 tabs running all at once, it may slow down the functioning. This is exactly what happens in my brain, and if the situation doesn’t resolve, I’ll crash.

It is rare that I am able to suddenly adapt to new ways of doing things. Sometimes if there is a really good reason for change it’s easier, often that really good reason doesn’t exist.

So how do I avoid all of the drama? I think most people who know me know that I’m a creature of routine, and the way I do things is very much the right way in my head. Largely, I just need time. Amoeba did not evolve into man in the space of a day, it took time. If I am in receipt of a decent explanation as to why things are happening, I will adapt.. not change.. just adapt.

*I absolutely will not be forced to do something I don’t want to do.