noun  bri·co·lage \ˌbrē-kō-ˈläzh, ˌbri-\


1.  :  construction (as of a sculpture or a structure of ideas) achieved by using whatever comes to hand (Merriam-Webster)


A central concept in resiliency theory is the power of improvisation. My (new) favorite word for it is Bricolage. According to Wikipedia, Bricolage is ‘a French loanword that means the process of improvisation in a human endeavor. The word is derived from the French verb bricoler ("to tinker"), with the English term DIY ("Do-it-yourself") being the closest equivalent of the contemporary French usage.’


Bricoleurs, then, are men and women who not only make due with whatever is in front of them, but build great things using unfamiliar tools and a hodgepodge of unrelated, unexpected materials. The ultimate Bricoleur? My childhood hero MacGyver! Remember him? He could make a bomb out of a damp twig and a feather, a toaster oven out of a reed and some string. It didn’t matter where he was or what he found himself working with, he puttered about until he built something useful, something of value, something beautiful.


My most recent Bricoleur experience took place on the open plains of Omaha, Nebraska (Go Huskers!). Frankly, I’ve never thought of myself as an inpatient Physiatrist and I’ve certainly never thought of myself as a Midwesterner. But when the opportunity came to move to Omaha and work on a modern, purpose-built inpatient Physical Medicine and Rehabilitation unit for 3 months, I took it. ‘Why not?,’ I reasoned. If nothing else, I could finally get to the bottom on where exactly Omaha Steaks come from (like, the street/ranch address) and I might run into Warren Buffet at Starbucks (ideal outcomes: business advice or a selfie).


Never mind the fact that the contract started in the middle of a notoriously brutal Midwest winter, and that my tiny, Ghanaian-born Shih Tzu, Nina Simone, seems allergic to both cold and snow. Never mind the fact that the opportunity coincided with one of the ugliest, most polarizing, and faction-focused presidential elections in American history… A single black woman moving to a decidedly red state might not be the brightest political move of the century. Minor details, I decided, and we moved west.


Because everything was so new (pace of life, weather, professional environment, grocery stores), I had no choice but to open my heart and mind completely, to leave any and all expectations at home, follow my instincts and simply try to do my best with whatever I found. And I found truly unexpected tools in Omaha:


  • An unexpected physical facility: a sleek and modern, fully-kitted-out inpatient rehabilitation gym with all of the sparkling bells and whistles we Physical Medicine devotees drool over.
  • Unexpected (extraordinary) human resources: The largest therapy staff I have ever worked with – 5 full teams of physical, occupational, speech, and recreational therapists, in addition to therapy aids, therapy students, a full complement of nurses, nursing students, social workers, social work students, case managers, medical students, and administrators, about 50 people in circulation, on any given day.
  • Unexpected inspiration: the patients on the 36-bed unit were nothing short of angels. Most were in their 7th, 8th and 9th decades of life, born and bred in the Heartland, and clear about their values. Even after having suffered significant life interruptions, from catastrophic strokes to severe motor vehicle traumas, the single most important factor that portended an efficient, optimal and often surprisingly rapid recovery for each and every patient was personal connection.


No matter the diagnosis, in the setting of a good medical treatment plan, my patients who had created and continued to find deep meaning in core familial relationships (from grand children to neighbors), those who talked about closeness to and positive anticipation of sharing time with loved ones (many of whom I met and became close to), simply did better. And (perhaps not surprisingly), my Heartland patients were incredibly open-hearted towards me! Differing political perspectives and life experiences aside, I was floored and encouraged by their embrace, typified by their comments on my last day of work. So it turns out my leadership style and clinical practice ethos are all right. That hasn’t always seemed true.


It’s like this: the way I work is aligned with my personality and values (I’m a bit of a mastery- compassion-, and justice-driven caretaker). This style can seem “soft” to some, isn’t always valued and can even be considered a weakness in hard-nosed, rigid ,exclusively data- and book-fact-driven academic environments. But in Omaha, everything was so different – the city, the roads, my apartment, my staff, my boss, my patients, my cold-gear, that there was no room for pretense, I had to just be completely myself, vulnerable and compassionate, curious and warm. And my patients were both receptive to and appreciative of the personal connection I made with them – because it resonated with their core personal values.


From the affluent business owner with a stroke who told me: “doc, you’re a real diamond,” to the young rapper with a traumatic femur fracture who said “know that you make a difference,” to the gentle-spirited octogenarian with a rare muscle disease who said, “go out there and knock ‘em dead darlin,’ and know that I love you,” my patients in an inpatient rehabilitation unit in the middle of nowhere taught me a clear and unanticipated lesson about family, love and life. The talented, cohesive, dedicated and huge (!!!) therapy, nursing and management staff beautifully exemplified the same, by warmly welcoming me, an outsider, into their (professional) family.


French social anthropologist Claude Lévi-Strauss said that the artist "shapes the beautiful and useful out of the dump heap of human life." Lévi-Strauss compared this artistic process to the work of a handyman who solves technical or mechanical problems with whatever materials are available. Bricolage made its way from French to English during the 1960s, and it is now used for everything from the creative uses of leftovers ("culinary bricolage") to the cobbling together of disparate computer parts ("technical bricolage").........” to the practice of inpatient medicine in the Heartland by an outpatient Physiatrist from the city.