Thursday, June 17, 2010

The Memorable Patient (Elise)

Every patient I meet in the hospital is unique. They each have their own story, their own goals. Every day, I am handed a challenge: find a way to gain a person's trust during (perhaps) the most traumatic time of their life. This is no easy task. Some days, it comes naturally-- other days, it can be an overwhelming challenge.

Today, I think to myself: What is the key to a meaningful patient-therapist relationship? If I think back to the patients who stand out to me most over my past 3 years as a PT, many fond faces come to mind. What are the characteristics of these patients that link them together as some of the most rewarding people I have had the pleasure to work with?

Sarah: A sweet, slightly overweight woman in her early 70s. From the moment I met her, her quiet voice and gentle laugh struck me. When I introduced myself, she asked me about how my day was going. It caught me off guard. It was clear she wanted to get to know me as person before she would work with me. She even asked about my family. Sarah was clear in her goal: go back home independently. "I never needed help before and I don't want to need help now. Look at me! Someone had to just take me to the bathroom. It's so humiliating." In therapy we worked hard: I acknowledged her desire for independence and acknowledged my desire to push her a little more each day in therapy. Always with a laugh, she'd say: "You want me to try what?!" And that's how we'd spend time together every day for a month: laughing, chatting about home, and walking... farther and farther.

Max: An athletic, tall man in his late 60s. Recovering from an aneurysm rupture, he was very confused and agitated the first time I met him. In fact, he was a bit scary. Because the aneurysm was in the area of his brain which affects the ability to understand spoken/written communication, he could not understand me and spoke in jibberish. On top of this, he was angry/agitated (which is common with brain injury because the brain does not know how to regulate all of the stimuli in the environment). The only way I could work with him was by letting him move around/explore his environment, and by using subtle non-verbals (hand on shoulder or reassuring smile). It was not pre-planned therapy; it was whatever Max was willing to do that day. His brain was healing quickly, though, and every day he started following simple commands more and communicating more. The most memorable day was a week later when I brought him outside to the basketball court. I had learned that he loved sports from his sister. When I handed Max the basketball, I saw a whole different side of him-- calm, smiling, dribbling the ball, and shooting baskets. Yes, he required help- but he started interacting and responding more. An hour later, when we got back to the room, he said to me "I loved this." Three words that couldn't have meant more-- words that showed that I had found a way to show him that I was trying to help.

Maria: A hard-working, friendly woman in her early 50s. She had a long list of medical problems: fibromyalgia, gall bladder flare-ups, uterine fibroids, and (most recently) a stroke. Maria had a lot on her plate- but always arrived to therapy early and with a smile on her face. Her determination was evident every day. But, I soon came to realize that she was having a hard time adjusting to her change in status. "At night, I cry sometimes," she finally told me one day. I reacted by reassuring her that it was okay to be upset, but that she had great potential to make continued gains. Together, we just sat and talked. Emotional support was going to be almost more important than physical improvement. This was a woman who had a lot of medical barriers that could have stood in her way-- but made the most of every day to improve her condition.

For me, each of these patients had certain qualities that made our relationships meaningful. With Sarah, it was her gentle nature, her bright spirit, and our mutual interest in one another's lives. For Max, it was meeting the challenge to communicate without words. For Maria, it was the importance of listening to one another. The patients whom I've learned the most from have been those who have challenged me to establish rapport, to think critically about their clinical picture, and to find a way to build their trust. But most of all, the most memorable patients are those who have overcome devastating injuries and strive each day to live life to the fullest. For them, I have only the deepest respect and admiration. I often ponder if I would respond to illness/injury the same way. At the end of the day, I feel privileged to have worked with these inspiring people as their therapist.

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