2006 Linda Crane LectureSources of Inspiration

Martha R. Hinman, PI EdDDepartment of Physical Therapy, Hardin-Simmons University, Abilene, TX

I would like to thank the mem-bers of the Cardiovascular and Pul-monary, Education, and PediatricsSections for giving me this oppor-tunity to share my thoughts withyou this afternoon, as well as myformer colleagues at the Univer-sity of Texas Medical Branch whonominated me for this honor. Asyou might imagine, I consider it aprivilege to be here today to paytribute to my friend and colleague,

Linda Crane. Linda and I worked together several years agoat the University of New England and we managed to keepin touch after we both departed Maine for warmer climates.Linda was a beloved friend and an unforgettable colleague,and I'm definitely a better person for having known her.

Once I found out that I would be delivering this year'smemorial lecture, I quickly realized that 1 didn't have aclue as to what I should talk about. I thought a lot aboutwhy we honor people like Linda—we have many au'ards,scholarships, and lectureships at the national, state, andlocal levels that are named for colleagues who have madesubstantial contributions to our profession and influencedour thinking and practice. So 1 began to wonder what itwas about these people that made them so inspirationalto us, and whether this was a characteristic that the rest ofus can learn. I discovered that I wasn't sure exactly whatit meant to be inspirational. My research instincts told meto go to the literature first and see what had been writ-ten about inspiration as it relates to health care. My firstmistake was to enter the word 'inspiration' into the searchengine because all the results related to articles on pulmo-nary function. So I tried again using the term 'Inspirational'and this narrowed the field down to almost nothing. At thatpoint I decided it would be appropriate to study this topicmore thoroughly from a physical therapy perspective andsee if I couldn't offer you some insights regarding the mean-ing and nature of this phenomenon. I had three questionsthat I wanted to answer:

• What is inspiration?• Where do we find it?• How does it at'fect what we do as

physical therapists?

What I will present this afternoon are the results of aqualitative study that triangulates data obtained from 3sources: the health care literature, personal interviews withphysical therapists, and a case study of Linda Crane based

on interviews with her family and close friends. AlthoughI have chosen not to contribute my own responses to thisdata collection, you will undoubtedly notice the influenceof one of my personal sources of inspiration in this presen-tation. And I will leave you with 3 principles that I havegleaned from my study that you can integrate into yourown lives and work if you want to be inspirational to oth-ers and exemplify what I will refer to later as a "Crane-ic"philosophy of life.

As I have already mentioned the concept of inspirationdoes not appear to have been studied much in the healthcare literature, but I have chosen a few articles to brieflyshare with you today. The first study was published in thenursing literature where inspiration has frequently beenrelated to the concept of hope. In this article, Cutcliffe'describes hope as something that allows us to experiencea higher quality of life and consider our future. He sug-gests that hope is something that requires nurturing which,in this study, was provided by nurses who were involvedin the caregiving process. He identifies and describes 4types of behaviors that these nurses used to inspire hopein their terminally ill patients. In summarizing his findings,he concludes that "the presence of another human beingwho conveys unconditional acceptance, tolerance andunderstanding should not be under-estimated in terms of itstherapeutic value and foundation for hope inspiration.'"

Another study that was published In the psychotherapyliterature focused more on how patients inspired clinicians.In this study, Kahn and Harkavy-Friedman' attempted todocument positive emotional, cognitive, or behavioralchanges that occurred in social workers as a result of work-ing with inspiring patients and examine how this inspira-tion affected the therapeutic relationship. Each clinicianwas asked to respond to a survey while thinking abouta patient that he or she considered to be inspirational.Frequently cited changes that occurred as a result of work-ing with these inspirational patients included: positiverole modeling for a personal or professional change, anincreased understanding of others and abandonment ofstereotypes, changing priorities or perspectives that madetheir own lives more pleasurable, acquisition of new inter-ests or activities, the ability to deal with own problems byidentifying with the patient's pathology, and an increasedspiritual awareness. Overall, the most inspiring characteris-tics of the patients described were their ability to overcomeor cope with adversity, their ability to make changes intheir lives, their courage and their persistence.

One other article represented a personal tribute to aBritish oncologist named Dr. Jimmy Ledingham.' It was

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written by one of his former medical interns. Dr. AlisonDouglas, who describes his inspiration in terms of theway he interacted with his patients and how he taught byexample. She says:

"I've been thinking about him and what he meant tome and his patients - how he related to the patient, to herhusband, to the nurses, and to me. He was so down toearth and cheerful but hugely supportive and so obviouslycapable, knowing what symptoms were most distressing,knowing when people needed to talk, trusting me to takeover."'

In summary, the common elements related to inspira-tional people that seem to emerge from the health care lit-erature include: (1) hopefuiness as a means of coping withadversity in life, (2) caring and empathy for others, and (3)positive role modeiing to help others internalize a certainvalue or behavior.

These articles led me to wonder about the people orthings that inspire us as physical therapists and how thesethings influence our personal and professional lives. Thus,in the next phase of my study 1 solicited thoughts oninspiration from 30 physical therapists who were in vari-ous stages of their career. My sample included 4 physicaltherapy students, 11 clinicians or administrators, 7 edu-cators, 3 individuals in APTA leadership positions, and5 retired therapists who lived in 15 different states. Theirages ranged from 23 to 75 and their years of experienceas physical therapists ranged from 3 to 52. I conductedpersonal or telephone interviews with these individualsusing a semi-structured questionnaire that consisted of thefollowing 6 questions:

• How would you define inspiration?• How does inspiration differ from motivation?• Can you share a personal story about someone

or something that has personally inspiredyou in some way?

• How did this inspiration affect your career/wori<as a physical therapist?

• Where do you seek or find inspiration now whenyou are facing a challenging situation orfeeiing "burnt out" (personaily or professionaliy) ?

• In what ways do you think physical therapistsinspire the people they work with (patients,students, colleagues)?

The transcribed interviews were manually coded andcategorized by myself and a colleague to identify com-mon themes surrounding the 3 research questions. Wethen came to consensus on these themes, further refinedthem, and cited examples of interviewee responses thatsupported each theme. These themes and the supportingdata were then sent to a third party for external audit andconfirmation.

You may recall that my first research question was"What is Inspiration?" Jhere is no doubt in my mind as tohow Linda would have answered this question. She wouldsimply have said that it was "the act of drawing air into thelungs" which is, in fact, one ofthe definitions you will findin Webster's dictionary.-*

The word root actually dates back to the 14"' century

Latin "inspirare" which means "to breathe or blow into orupon."^ Although this physiological definition may at firstappear to be somewhat restrictive, over time it has takenon a more spiritual or philosophical meaning. However,the analysis of my interview data suggests that inspirationmay be further defined as a multi-staged process that 1 willrefer to as the "3 Es."

The first "E" represents the process of enlightenmentwhich may be described as the initial awareness of some-thing—an idea, a thought, or a plan. The people I inter-viewed frequently described this phase of inspiration usingvarious references to light. Here are some of the responsesthese therapists gave:

"To me, it can be described as an 'ah ha' experi-ence or as a somewhat spiritual experience...a lightgoes on that is a beacon to guide me that somethingneeds to be created, an activity needs to be accom-plished, or a plan needs to be developed for a goalto be achieved."

"1 believe that inspiration is that part of the humanexperience where you feel some creative spark,something that goes beyond the ordinary, that opensup insights you wouldn't have otherwise have had."

"It comes to you. You kind of look at a problem andall of the sudden you see a possible solution...Youmay have this sudden burst of inspiration - youknow, the 'ah-ha' kind of thing...All of a sudden thelight goes on and you see."

The second "E" represents empowerment-thls is theaction stage. At this stage in the process the inspired persondiscovers his or her inner potential, realizes a hidden abil-ity, or is encouraged by another to tackle a task that he orshe had not previously felt capable of doing. Examples oftherapists' responses that characterize this stage of inspira-tion include the following:

"This feeling then becomes a moving factor to pushyou to heights that you would not have achievedwithout it. The inspired person wilt perform beyondexpectations and enjoy the maximal effort. Aninspiring activity would be one that gave you greatpleasure and took you to limits beyond your basicexpectations."

"I think inspiration is what spurs you on to be some-thing or to do something that really you want to do,but maybe you feel like you don't have the strengthto do or that you can't do on your own and then yousee something or you hear something and that makesyou realize that you can do it."

Many interviewees also characterized this stage withexamples of how physical therapists empower otherpeople, primarily patients, to accomplish their goals. Thistype of empowerment was often associated with providinghope as was previously described in the literature review.One therapist said:

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"Therapists who offer hope to patients inspire thosepatients to do better, to achieve more, and to recover.Therapists who are instructional and give knowledgeto patients make patients' lives better and in that wayprovide inspiration to take command of their ownlives and health care."

Clinicians described this means of empowerment usinga variety of metaphors. Examples of these include the fol-lowing:

"We give them the tools to do it on their own andthat is so empowering for people. And sometimes wedon't even realize how much impact we make."

"We provide people a place to come to - perhapsa sanctuary In the middle of their work day orwhatever - that exudes healing...We provide themknowledge, equipment, we provide them with asense of empowerment."

"PT can sometimes get you to make things easier, togive you a little bit better quality of life because youhave access to things and can be functional again...the whole PT profession is almost like a vehicle tohelp people to become whole again, to be happy, tonot be bitter, to look positively, to be lifted up."

The final "E" symbolizes the outcome of inspiration. Itis a sense of enrichment which seems to have a positiveand long-lasting effect on one's life. This enrichment phasewas characterized in several different ways including abroader or changed perspective, stronger interpersonalrelationships, enhanced meaning or passion for one'swork, and improved quality of life. Here's how one clini-cian explained it:

"llt's] when you have one of those occasions whereyou make a huge difference in someone's qualityof life - when whatever you do works. When thechoices you made were the right ones. It clicks - thetreatment fits the problem, the persons gets betterand their life is better and they are grateful to youthat you were able to solve their problem. That wiltfeed me for a month!"

Another therapist who has spent her entire PT careerworking with residents at a state school shared the follow-ing:

"They will just go out of their way to call you orcome up to you and just give you a hug...completelygenuine and selfless. So it's very rewarding to workwith them because they give you so much back - somuch more than we could ever give them...That'swhy I do my job - that's why 1 choose to work there.I know it's not glamorous. I know it doesn't pay aswell as some other places. But when I go home atthe end of the day, I know I made a difference andhopefully it will be positive."

Some therapists described the satisfaction they derived

from interactions with other colleagues. As one stated:"I'm so lucky that I have all these amazing rela-tionships to enrich my life. I go around and meetpeople and talk to people—connecting with peopleis extremely rejuvenating."

If we return to the physiological definition of inspirationI mentioned earlier, I think a strong analogy emerges. Thephysiological act of breathing begins with the inhalationof new air into the lungs, lust think for a moment aboutthe number of times you have been enlightened by a newthought, idea, or vision and referred to it as "a breathof fresh air." Next, the oxygen that is extracted from thebreathed air is used to energize and drive all of our otherphysiological processes - thus, it empowers our heart,brain, muscles, and every other vital part of the body.Finally, these physical and mental actions are transformedinto a variety of functional activities that enrich our livesand give them meaning. So if we stop breathing that air,we will literally die. Likewise, I would suggest that with-out inspiration, we are likely to experience a professionaldeath.

So if inspiration is indeed such a vital process, wheredo we find it? The responses provided by the therapists inthis study indicate that most people get their inspirationfrom 3 sources: other people, a spiritual entity, or intrinsi-cally from their nature of their work. Several categories ofpeople were identified as inspirational sources. The firstof these was family members and close friends. Severaltherapists described the inspiration they received from theirparents' optimism, perseverance, and encouragement:

"Well, in truth, the most inspirational person in mylife is my dad. It's hard to describe. He's a hero to mein many aspects. And I know many people feel thatwas about their parents, but he's a really remarkableman. Having to deal with many life tragedies andthe way he continued to look at the world in a verypositive way - he has been an inspiration to me mostof my life."

One retired therapist shared her mother's story andsaid:

"One of the things 1 always wanted to live up to wasmother's ability to meet life. She made mistakes. Shedidn't always do everything right - none of us do.But she had this ability not to complain about goodluck or bad luck, about the things that life brings youthat are positive or negative...It was the only life youhad and it's there for you to live and just do it to thebest of your ability - everyday."

A physical therapy student whose mother has multiplesclerosis said this:

"Here's my mom who is in pain from day to dayor weakness or whatever, and she's just telling meyou have to keep going on and keep doing it. Ithink she's probably my main inspiration for mostthings...because her attitude is 'no matter what'sgoing on, you can't keep worrying about tomorrow.'

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You have to just do what you can do today and that'sall you can do."

Others described inspirational qualities found in theirsiblings, spouse, or children. One dad said:

"You find a lot of things in children that really inspireyou without thinking they would, just the simple joythat they have and the smiles, giggles - all kinds ofthings that really inspire you."

Another therapist described the inspiration she receivedfrom her disabled brother:

"He's a couple of years older than me and he hashydrocephalus and cerebral palsy, and he hasworked five times as hard as anybody to accomplishnot as much as anybody else you know - I admirehim."

Another common category of people mentioned wasprofessional colleagues which included mentors, supervi-sors, educators, and students. In describing her efforts towrite her first book, one therapist cites the inspiration andsupport she received from her mentor:

"And she inspired me to not only do the work, sheinspired me to believe in myself and what I had tooffer... And Ishe] has supported me all along the waywith her feedback and important comments."

Another PT educator shared her stories of 3 differentsupervisors who enabled her to grow and develop at vari-ous stages of her career. In describing one of these indi-viduals she states:

"It's not what she says or what she does - I don'tknow what it is about her, but every time you go into meet with |her] and leave her office, you comeout feeling like you can conquer the world. Shemakes you a better person. She's always encouragingyou, never pushing. She allows people to develop atwhatever level they're comfortable at developing."

Another therapist described a clinical educator whotaught him many years ago how to care for polio patients:

"She organized our time there into eight-hour daysthat consisted of clinical and classroom time. Shetaught us functional anatomy in some of the lecturehours and she was a master at making anatomycome to life. Students would sit enthralled with herlectures and always be ready for more. Her concernfor patients was exceptional."

And a retired faculty member shared her secret sourceof inspiration:

"Whenever I felt myself dropping or draining or likeit was too much...I literally knew where the inspira-tion would be. I began it as a habit maybe 10 or 15years ago- it's never failed me and that is to go into aclassroom and sit down in the back and just literallyobserve the interaction of the teacher and the stu-dents... But watching those students always changed

me and it brought back to me the reason, really, thatI became a teacher."

Many individuals also shared inspirational stories ofpersons with disabilities or patients that they had treated.They frequently reflected on the inspiration provided bypeople with chronic or terminal illnesses who seem togive more to us than we can give to them. One particularstory reflected the total process of inspiration that I justdescribed--the enlightenment, the empowerment, and theenrichment. It was this therapist's first experience with anHIV patient who had a debilitating neuropathy. She talkedabout being a new graduate at the time who had no ideaabout what she should do for this patient. She explains:

"...But her biggest motivation was she wanted tocare for her child and she was willing to do what-ever it took to be ahle to take care of her little girlas long as she could. So I got involved in her treat-ment. I realized there was nothing in the literature- and so because she was motivated to take careof her little girl, I thought, 'By golly, it is my profes-sional responsibility to learn how to better treat thisperson as well as those to come.' [the enlighten-ment] So from that I became very interested in HIVand continue to be - it's really helped to chart thecourse of my professional career, [the empower-ment] Because I was interested in HIV and treatingthis one patient, 1 attended a course, I started lookinginto some research,...did my master's thesis relatedto that,...and pursued a PhD in infectious diseaseepidemiology because I felt like 1 needed to knowmore as a PT if I was going to be better able to treatthis population." [the enrichment]

Although less frequent, some interviewees cited famouspolitical, human rights, or spiritual leaders among thosewhom they found to be personally inspirational. For exam-ple, one therapist stated:

"In my life I have been inspired by the great peoplein history - Mahatma Ghandi, by Christ who ismy personal example, by Nelson Mandela, by thefounding fathers of this great nation of ours. I feelthat 1 have received inspiration reading their historiesand the things they overcame and the unusual think-ing that those people [had] - and the commitmentthat they had to their ideals and their goals."

The second major source of inspiration that was fre-quently mentioned was a spiritual one. Some therapistsgenerally referred to their sense of a greater being orpower, while others specifically described their faith inGod or Jesus as a source of spiritual strength. Here aresome examples:

"I believe that we're all a part of the same energy andthat energy courses through us. It is my work to tapinto it - kind of like tuning a radio. So 1 stop and Itune myself into the wisdom from beyond that flowsthrough all of us and then wait and listen. And usu-ally I get an inspiration of how to go forward."

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"You know, no matter what level - whether it's per-sonal or professional - I'm directed by God. So Iguess maybe that's where my inspiration ultimatelycomes from - 1 feel like wherever I am, it's where Iam supposed to be as long as I am depending uponGod and looking to Him tor guidance and realizingHe has a plan for my life."

In discussing the importance of role modeling, onetherapist said:

"A lot of people I respect are great role models, butto me, the oniy person who has ever truly inspiredme is lesus and His walk to serve other people. Andthat's been my goal... His genuine heartfelt attitudetoward serving other people is kind of what I havehopefully modeled my PT career after."

Finally, several interviewees mentioned that the natureot the work that physical therapists perform provides anintrinsic source of inspiration or selt-renewal. One PTeducator stated:

"You know, my career is inspiring to me. I love whatI'm doing. I absolutely love being in academics...I'm interested in research, I'm interested in becom-ing a dean, I'm interested in teaching, I'm interestedin mentoring new faculty and students, and collabo-rating with other institutions."

Another academic administrator voiced similar senti-ments when she said:

"PT is special in terms of the contact you have withthe patient. But what I've learned over time, which Idon't think I knew when I came into the profession,was the marvelous variety of opportunities that existin our profession...and the changes that will happenover the next 15 years will be remarkable - it won'tlook the same."

The final question I asked was "How does inspirationaffect Vi^hat we do as physical therapists^" Most of theresponses I received indicated that the inspirational sourceeither influenced their career path in some way or affectedtheir personal interactions with other people. Some thera-pists and students described people who first inspired themto pursue a career in physical therapy, while others focusedmore on individuals who had encouraged them to developor diversify their career through teaching, research, or writ-ing. Still others commented on people who had inspiredthem to take a leadership role or become an advocate forthe profession. Several people spoke of individuals, usu-ally someone with a disability, who initially inspired themto become a physical therapist. One therapist shared thestory of her father's burn injury when she was a teenager,and how his rehabilitation experience provided her initialexposure to the physical therapy profession. Another thera-pist spoke of a young boy that he met in high school whenhe volunteered for a week at a Lions Camp for childrenwith muscular dystrophy:

"Each child had an attendant, so it was a one-on-one

experience for every child or individual there andthere were probably 300 children... And I had neverdone anything in the way of helping people physi-cally handicapped, and / learned in one week fromhim what would influence the rest of my life."

Another interviewee described the simultaneous influ-ence of two events which prompted her to pursue a careerin physical therapy:

"Many years ago when I was a middle school stu-dent, I saw a movie that dealt with rehabilitation...\was very impressed with the significance and valueof the work and was inspired to pursue an educationin physical therapy. About the same time, a pastor inmy church reminded me that I was given many giftsand talents and he urged me not to 'hide those giftsand talents under a bushel.' His words ring true inmy ears and heart today, especially at those timeswhen it might be easier to slide by rather than torgeahead."

Others described professional mentors who inspiredthem to take their career to the next level. One educatordescribed the person who first inspired her to pursue ateaching career:

"Dr. P taught me the mechanics of how to be agood teacher. And I had been teaching before with-out know how and I hated it! And she gave me thetools.... And then teaching others how to teachbecame a real goal. She inspired me to teach clini-cal faculty and that's the first thing I did as a newtherapist."

Likewise, this next person credits her former associatedean and another faculty member for inspiring her to writea textbook:

"And we had very few PT books...and so every sum-mer I would sit and I would write things to use inclass and finally she said, 'Why aren't you puttingthat into a book?' So she pushed me a little bit todo that And I had a colleague who was writing abook, so that said to me, 'Maybe I can do this.' I wasamazed that 1 could do it! It wasn't anything that Ihad thought that I could do."

Still others spoke of individuals who encouraged themto become an advocate for the profession and providedopportunities for leadership. One interviewee spoke of theinspiration he received from his political representative:

"Well my state legislator, who is now my congress-man, has always been an inspiration to me becausehe's a very good man, he's got very conservativevalues, and I just appreciate what he does becausehe always does it for the good of the people in hisdistrict, in the state, and in the country...It has mademe want to get involved in politics...because whatI want to do is to advance our profession...so thatwe can provide services to our patients. And it's thesame service to our patients that motivates PTs to get

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involved in advocacy. It's the same service that moti-vates most legislators, so it's a very similar thing."

When asked how or why therapists inspire those theywork with, several individuals commented that it's just"who we are." When I asked them to elaborate on what thismeant, 1 discovered a variety of common characteristics.The first of these was an altruistic attitude in which patientsfeel that they are genuinely being cared for. This, in turn,facilitates their rehabilitation. Here are a few representativecomments:

"There's something that's intangible, but real aboutthe community of physical therapy and just sort of agroup attitude. It must be connected with an innatedesire to help others. I mean because you can't getinto this field if you don't want to do that. So beingin a helping profession, for one thing, I think weavesthis common thread through this entire commu-nity.... it's just who we are."

"We get comment cards back from patients that havebeen discharged and mostly the comments we getback are not like 'Oh, this is the most talented PT I'veever seen.' It was things like 'They cared. They spenttime with me. They helped me.' You know, thingsthat were more emotional than physical. And 1 thinkthat's how we can motivate, inspire and encourageour patients is to be there cheering them on, to listen,encourage them, be honest - all that kind ot stuff."

This altruism is complemented by a positive attitude.This positivity is reflected by the PTs enthusiasm, opti-mism, and persistence which in turn motivates patientsor students to achieve their own goals. Here are someexamples:

"The willingness to try something before saying 'Ican't help' is characteristic of therapists throughoutour history. Polio taught us that there are many waysto do things. People who, by muscle test, shouldn'tbe able to walk found ways to walk with the help oftheir therapists who assisted them through improvis-ing... Therapists who offer hope to patients inspirethose patients to do better, to achieve more, and torecover."

"One of the things that I try to do is be a mentor forstudents. I also try to talk to students every oppor-tunity that I can get and go to their classes and talkwith them about what the APTA is doing, what theirstate chapter is doing, and to try to give them infor-mation and let them 5ee all the positive benefits thathave happened over the last 80 years as a result ofPT involvement."

The third common trait that was identified was thetherapist's ability to communicate compassion, empathy,and trust through closeness and touch.

"There's something extremely powerful, from myperspective, in touch and we get to do that. We get

to invade people's space. They let us do things tothem that they wouldn't let anybody else do...Wetake their clothes off and expose their bodies, andso they have trust. And I think there's not a lot oftrust out there, and so the people see the peoplebeing trusted. I think that's fairly impressive andimportant."

"We're licensed to touch people and that's a rarity intoday's society - to actually physically contact some-one with your hands and all of the physiological andemotional response that that feels good - even whenyou are putting your hand on someone's shoulder,or if your focus point is their knee, or wherever. Ithink that that inspires people to get more involvedin other people's lives."

The fourth characteristic was the knowledge and creativethinking that inspires innovative solutions to problems. Onetherapist shared her story as a volunteer PT for the TexasMarine Mammals Stranding Network. She described theprocess of diagnosing and treating a bottle-nosed dolphinwith pneumonia that had been subsequently injured by aboat propeller and attacked by a shark. She consulted hercollege roommate who is now a veterinarian and said:

"I learned that their anatomy is pretty close to oursin a lot of ways and used the palpation skills that wehave as PTs to realize that he was guarding."

She went on to describe how she was able to applyvarious modalities and manual stretching techniques toeventually help rehabilitate this wounded dolphin. Anothertherapist compared the process of patient evaluation to thatof solving a mystery:

"I've always felt like when 1 had a new patient, thatt was the prime character in a Nancy Drew mysteryand that this was a great mystery to be solved. Theygive you all these little clues that don't make anysense and you try to put them together. That wasalways the challenging, exciting, inspiring part ofthe job."

This same therapist went on to describe how she usedthis process as a clinical educator to inspire her students:

"1 think students are inspired by people who areturned on by what they do. If they're in a settingwhere therapy is done in a rote manner, then thereis no inspiration. But if they are in a setting wherethey really have some option to use their brain andcreativity and their imagination in doing what needsto be done, then they get to experience that sameexcitement when it works!"

The fifth characteristic was a holistic approach to patientcare. In speaking of his clinical instructor, one therapistrecalled:

"She taught techniques that were definitely patient-centered. She taught us to consider the wholepatient, not just the paralyzed part."

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Finally, we seem to he inspired to place a high value onpersonal relationships. In sharing her story of her father'sinspiration, one therapist said:

"What it has done is definitely emphasize to me theimportance of relationships. You know, to me, teach-ing is a sacred relationship between the learner andthe teacher. And I have a much deeper appreciationfor the importance of connecting with people."

Another person nicely summed up all ot' these charac-teristics in her general description of physical therapists:

"If I think about PTs that I've been around over theyears - and students right on up to practitioners- it is the wonderful character of these people. Theirlack of guile, their straight-forward manner, theirconstructivism, the positive nature they have, theirkindness as you observe them with other clients andwith other people...They seem to show good will,and I think they have strength of character. The thingsthat I would admire and hope to be, I see in PTs. Andso I think that they're wonderful role modeis... AndI think that that ability to be that kind of person per-mits other people to open themselves to the therapistand to be inspired."

My final data source came from several individuals whowere close to Linda Crane including her mother, friends,and professional colleagues. I questioned them about thethings that they believed had inspired Linda, the thingsthat she was passionate about, and why they thought shewas so inspirational to others. The responses that I receivedvalidated the themes that were derived from the therapists'interviews li.e., the three "Es" - enlightenment, empower-ment, and enrichment). Thus, Linda's life and career servedas my case study on inspiration.

Aithough no one could say with any certainty whathad initially inspired Linda to become a physical therapist,several described her as a "person of faith." She was notoniy enlightened by her spiritual beliefs, but aiso by herunending thirst for knowiedge and her intense desire to usethat knowiedge to make a difference in other people's lives.in other words, siie had faith in what she could accom-piish if she equipped herself with the right knowledge andskills. At my university, our mission statement includesthe phrase, "an education enlightened by faith." I beiieveLinda must have had a similar motto for her own life.But to translate this motto into "Seussical" terms, I thinkyou couid best describe it as her "yearning for learning."Everyone i interviewed commented on this characteristicand used a variety of adjectives to describe Linda includ-ing "intellectual," "cerebral," and "curious." We hear a lottoday about the need for evidence-based practice in physi-cal therapy, but I'm here to tell you that Linda Crane wasway ahead of curve on that concept. As one of her closefriends observed:

"There were a lot of unanswered questions andLinda wanted answers. And I think she wanted reli-able answers if she was going to practice somethingor initiate something."

Ol course it was not enough for Linda to learn what sheneeded to know to be an effective therapist - she felt anintense need to share her enthusiasm for learning with oth-ers. A former classmate recalled how excited Linda used toget when she had the opportunity to tutor other students.She also mentioned that Linda never hesitated to offersuggestions to her professors about ways that they mighthave taught something better. For those of us who workedwith Linda, this is not hard to imagine! She finally got theopportunity to formally share her knowledge and expertisewith others through her teaching and writing.

Figure 1.

Another former classmate described Linda's experiencewith chest physical therapy during one of her clinical affili-ations in New York and how this affected her career path:

"But 1 don't know what came first - her desire to bein chest PT or that affiliation that really just took heroff on a path in her life that was so important, andshe was just great at it. And maybe because it wasso new and most people didn't know much aboutit - that really inspired her to learn more becausethere wasn't a lot. And then when she went on towrite books and edit books, you know, she justnever stopped wanting to learn and to share herknowledge."

I personaliy remember one time when I was sitting in onone of Linda's classes, and it was after lunch when studentsoften find it particularly difficult to pay attention to a lec-turer. Anyway, several of them began to yawn, and none ofthem were very subtle about it. But Linda, being the eternaloptimist that she was, did not let this i:)other her. Insteadshe began to compliment the students who were yawningbecause they were obviously trying to increase tiie oxygensupply to their brains so they could pay attention to theimportant information that she was imparting to them! Atleast her comments got their attention, and their laughterundoubtedly had some additional physiologicai benefits!

Although we tend to focus on Linda's knowiedge and

90 Cardiopulmonary Physical Therapy lournal V o M 7 * No 2 •)une200(»

expertise in cardiopulmonary physical therapy, her yearn-ing for learning went beyond the professional domain. Shewanted to explore the world, she wanted to learn aboutart and birds, and she had a natural curiosity about peopleand who they were. One friend recalled a time when Lindajoined their family for a visit to her grandmother's house:

"Well, she dove right in and she felt my grandmotherout and said, 'Well, tell me the story about this andthat.' And we tound out stuff as a result of her ques-tions...that just never came up. But due to a ques-tion she had, or her curiosity, she would just find outthings that most people wouldn't be interested in."

As I further examined the information from the peopleI interviewed, I sought to identify the ways in which Lindawas empowered to deal with the many adversities that lifethrew her way. She had survived personal losses due to fireand hurricane, had coped with several professional disap-pointments, and of course, finally faced her ultimate chal-lenge with cancer. As an individual dealing with a terminalillness, Linda was described by everyone as a person whowas filled with optimism and empowered hy hope. Youmight say she had a "hopeful heart."

As one friend recalled:

"She was going to be in the survivor statistics andthere was no denying that to her. I'm sad that shewasn't, but certainly that she survived as long as shedid with her cancer was because she was positive-besides being knowledgeable. She knew the impor-tance of being positive."

She was definitely known for her dogged determinationwhich reminds me of this little Seuss character with theclub who was so determined to arrive at his destination inSolla Sollew, no matter how many obstacles he encoun-tered along the way.'' And here we see a determined Lindawith her club!

But hope was not just something that manifested itself atthe end of Linda's life.Her hopefulness andoptimism also energizedher work as a physi-cal therapist and gaveher a passion for herprofession. She dem-onstrated more than a'can do' attitude-herswas a 'must do' atti-tude! She never backeddown from her con-victions that we mustdo everything we canas physical therapiststo improve the heaithcare of our society andeducation of our profes-sion. She modeled thisempowerment through

Figure 2. her clinical practice as

a cardiopulmonary specialist, her leadership roles inthe APTA, her teaching in entry-level physical therapistprograms, and her research agenda. Her enthusiasm andpersistence seemed to have no bounds. As one close frienddescribed Linda:

"She did it - yes, and you'd better join her! The powerof positive thinking was very strong in Linda and shewas a doer. You know, when she put her mind up tosomething - whether it was writing a book or teach-ing a class - she gave 125%. It was going to be thebest job that she could possibly do."

Obviously, one of things Linda is best remembered for isher advocacy for our profession, which was not unlike theLorax who you see here as he staunchly defends the Truf-fula trees in his forest.' People like Linda and Scott Irwinwere among the visionaries in our profession who did carea whole lot and their caring has rnade a difference.

Finally, we can say that Linda's life was enriched bylove, and she had manyloves! First and foremost,she loved people. If youwere fortunate enoughto have Linda Crane asa friend, then you werefortunate enough. Sheembraced her friendshipsand invested time inmaking them meaningfulexperiences. Of courseshe was very close toher family as well as her

AmericanPhysicn! Therop'Assocf.ition

Figure 3.

god-daughter, Amanda,who remembered Lindaas "her best aunt - theone who understood herbest and the one who

really loved and supported her." Fveryone I interviewedalso commented on how much Linda loved children:

"She loved connecting with them. She was some-body who kids felt very comfortable around. Andthat was something that always, I thought for some-one who was single who didn't have children, thatthat was a really neat quality about her. And in a lotof ways, she was childlike."

She also loved animals, particularly her own pets.Linda's mother talked about Linda's childhood love forher dog, Dixie, as well as the cats that shared her homelater as an adult. They were a great source of comfort andcompanionship for Linda. One friend talked about Linda'ssuppressed immune system following her stem cell therapyand how she was not supposed to handle her cats:

"I don't think she could have survived without a caton her lap when she was home...She could not havea day pass without touching her cat."

As you might imagine, several of the people I inter-viewed also admitted that they had a secret desire to be

Vol I 7 • No 2 • lune 2006 CArdiopulmonary Physical Therapy lournal 91

reincarnated as one of Linda's cats!Finally, it must be said that Linda ioved an adventure.

Her friends found a variety of ways to describe Linda'senergy including her "gusto," her "vim and vigor," andher "zest and zing!" When i asked her mother to describeLinda's approach to iife, she simply said "Weil, I thinkshe just jumped right in with two feet." You might say thatLinda had a flair for fun. Whether it was taking a trip, piay-ing blackjack in the casinos, dressing up for Halloween,going to the theatre, vacationing at the beach, or enjoyinga party-she wasn't going to miss it! i can personally recall

one particular partythat occurred rightafter Linda was recog-nized as one of the firstclinical specialists inphysical therapy. Shehad to return to Maineright away to teach hercourse and was notable to celebrate withthe others who stayedin New Orleans. Shewas obviously disap-pointed so I suggestedthat we have ourown celebration andoffered to host a partyat my house after workthe next day. i wouldprovide the food and

Linda would bring the champagne - it seemed like a goodplan. Although we invited a few others to join us, it endedup being one of those parties where no one showed up.But Linda was not about to let the lack of people ruin hercelebration, i don't recall just how much we ate or drankby ourselves, but I will tell you that 1 found numerouschampagne corks in my front yard well into tiie next springafter all the snow melted! So it was a memorable party, andI treasure the fact that i had the opportunity to share it withher. i am sure that many of you have your own stories andmemories of Linda to share. I beiieve those are her gifts tous-the ways in which she enriched our lives.

As I was preparing this lecture, 1 frequently found myselfstaring at a plaque that 1 have sitting on my desk at workand i finally realized how well its message reflected Linda'sapproach to life. So i now refer to it as the "Crane-ic"phi-losophy on life, it consists of 2 brief quotes. The first is i)yWinston Churchill which reads, "Never, never give up"The second is by Dr. Seuss which says - "Never, nevergrow up."

Linda iived an inspirational iife because she was enlight-ened hy FAITH, empowered by HOPE, and enriched byLOVE. And before you accuse me of plagiarism, let meacknowledge that these three words were the same onesused by the apostie Paul neariy 2000 years ago in his inspi-rational message to the people of Corintii. And I quote: "So

Figure 4.

Figure 5.

now faith, hope, and love abide, these three; but the great-est of these is love." (I Corinthians 13:13)"

So here is my take-home message from this study oninspiration that I believe represents a consensus of whatI found in the health care literature, my interviews withtherapists, and through Linda's example. It consists of 3very simple principles that you can apply to your life andwork whether you are a student, a new graduate, or aseasoned professional. This first principle is: Share yourselfwith others. All of us have beliefs, ideas, and dreams thatmay enlighten others, but only if we are willing to sharethem. You never know when you might create a spark insomeone else's life. But silence is like darkness-it providesno vision. If Linda had not spoken out on the things shebeiieved in, we wouid not be iiere today remembering hermany contributions. In describing another inspirationalcolleague, one therapist said:

"She loved to tell what she knew to other people.She was not at all selfish with the lessons she hadlearned."

The second principle is: Be an encourager. Encour-agement gives us hope, and hope is what empowers us.it allows peopie to tap their inner potentiai so they canachieve their goals or meet unexpected challenges. As oneclinician stated:

"The only way you can ever gain that foothold andgain their [patients'! trust in order to work closelyis to be an encourager and let them know that youreaily are vested in their outcome."

The final principle is: Love what you do. Love will notonly enrich your life, but wiil enrich the lives of thosearound you. Many peopie that I interviewed describedinspiration as something very deep and heart-felt. And toparaphrase one therapist:

"How can you encourage a patient or student to fol-low the physicai therapy path if you yourself aren'tin love with what you do?"

i think that is a very good question. I believe that if youfail to iove, you fail to live. Thus, we would do well to think

92 Cardiopulmonary Physical Therapy lournal Vol 17 • No 2 •June 2006

of inspiration as one of our vital signs. It is what energizesus to take action, and it renews us when we get burnt out.It changes us forever. And the people or things that inspireus are never forgotten.

Before I leave you with one last glimpse of the "Crane-ic philosophy of life," 1 hope you will allow rTio to take afew moments to thank the people who helped me preparethis message. First, I want to acknowledge everyone whoshared their thoughts, stories, and memories, some ofwhich were deeply moving and inspirational to me on apersonal level. I would also like to thank two of my col-leagues, Dr. lanelle O'Connell and Dr. Cecilia Grahamwho assisted me with the study design and data analysis.To my husband, Pete, I would like to say thank you for allthe time you gave me to work on this when I know youwould rather have been doing a lot of other things! And,by now you surely have guessed one of my own sources ofpersonal inspiration, the writings of Mr. Ted Geisel, betterknown as the good "Dr. Seuss." My very first Seuss story,Creen Eggs and Ham, taught me the importance of notbeing afraid to try something new, and that has inspired meto tackle projects like this one.'^

Finally I want to thank Linda for her friendship andinspiration which continues to re-kindle our spirits todayeven though she is no longer with us. I will leave you nowwith one final reflection on this inspirational woman. Soonafter Linda's death. Lee Ann Womack released a song enti-tled, "/ Hope You Dance."'" Those of you who are familiarwith the lyrics to this song will probably agree that it toorepresents a "Crane-ic" philosophy on lite. So I'd like toshare the words of this song with you now, as I think Lindaexperienced them.

/ hope you never lose your sense of wonder,You get your fill to eat but always keep that hungerMay you never take one single breath for granted,God forbid love ever leave you empty-handed.I hope you still feel small when you stand besidethe ocean,Whenever one door closes, I hope one more opens.Promise me that you'll give faith a fighting chance,And when you get the choice to sit il out ordance.../ hope you dance.... I hope you dance!

I hope you never fear those mountains in thedistance.Never settle for the path of least resistance.Living might mean taking chances but they'reworth takingLoving might be a mistake but it's worth making.Don't let some hell-bent heart leave you bitter.When you come close to selling out, reconsider.Give the heavens above more than just apassing glance.And when you get the choice to sit it out ordance...Dance... I hope you dance!

Figure 6.

I know that Linda danced every time she got thechance, and I am quite certain that she would want us todo the same. So thank you again for coming and takingthis time to help me remember her - / hope you too havebeen inspired!

REFERENCES1. Cutcliffe |R. How do nurses inspire and instill hope in

terminally ill HIV patients? j Adv Nurs. 199.5;22:888-895.

2. Kahn WL, Harkavy-Friedman |M. Change in the thera-pist: the role of patient-induced inspiration. Am j Psy-chother. 1997;51:403-413.

3. Douglas A. A lesson learnt: an inspirational teacher. BrMed j. 1999;319:889.

4. Merriam-Webster Online. Available at: http://www.m-w.com/dictionary.htm. Accessed November 18, 2005.

5. Online Etymology Dictionary. Available at: http://www.etymonline.com. Accessed November 18, 2005.

6. Dr. Seuss. / Had Trouble In Getting To Solla Sollew. NewYork, NY: Random House; 1965.

7. Dr. Seuss. The Lorax. New York, NY: Random House;1971.

8. The Holy Bible (English Standard Version). Wheaton, 111:Crossway Bibles; 2001.

9. Dr. Seuss. Green Eggs & Ham. New York, NY: RandomHouse; 1960.

10. Sillers T, Sanders MD. / Hope you Dance. Recordedby Leann Womack, Nashville, Tenn: MCA Records;2000.

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