Monthly Archives: June 2011

Licky’s preferred way of fishing. . .

They say this is in a “flooded drainage ditch”. I almost think that’s the most amazing part. . .

Learning Difficulties

This is a re-post of something I wrote about 2 years ago. It was brought to my mind this morning, so I thought I’d re-post it.

As an Aide, I don’t really get to participate in any of the treatments. You have to pay for a couple years of school for the privilege, which I haven’t done yet. I bring the patients back for their treatment. And yes, I can watch. And I am often the one who removes the heat packs or cold packs or the stim machines. But I rarely get involved in any of the actual treatment.

One of the rare exceptions happened a few weeks ago.

I was standing in the hall vaguely watching an exercise treatment in the hall and waiting for the next patient to arrive or for a mat to need to be cleaned. In the background, I could hear things going on in the “gym” where most Physical Therapy takes place. Suddenly, I focused in on one sound.

“Okay, Now Roll Back On The Ball.” Like that. Not quite loud, but certainly not quite patient either.

“Oh, okay.” Softly. Quietly.

“This Isn’t Difficult, Just Roll Back On The Ball, Like This.”

“Like this?” Timidly.

“No, Roll Back.”

It was obviously a nightmare, both for the patient and the Therapist Assistant. The patient was very soft-spoken, shy, and clearly of a different nationality. Which one, I didn’t know, and didn’t care, as people are all people. But she was obviously feeling embarrassed, confused and doing her very best to cooperate. The assistant was also doing her best, as she was trying to use multiple ways of explaining things—visually and verbally—but obviously did not have the mental flexibility to understand where the difficulty was. Although she was trying to be clear by speaking distinctly, it was only causing the patient to feel flustered. The assistant’s own frustration was also beginning to show, which only added to the patient’s discomfort. And all we really had here was a crisis of communication.

She was listening hard, she was trying to follow directions of the therapist assistant. But speaking more clearly doesn’t help people who don’t understand what the words are trying to communicate. Understanding the words is one thing; understanding syntax is another. The assistant was using almost slang syntax—to “roll back on the ball” meant to roll the ball forward while you laid back onto the ball. The patient was rolling the ball back, literally, which was what the assistant was saying, but was not what she meant.

Almost before I even knew it, I was down the hall and on the floor beside her, explaining the instructions with different words, guiding the ball with my hands, and speaking calmly and cheerfully. She responded instantly, and began to do much better. For the rest of the session, I “translated” the assistant for her, and everything went smoothly. Both the assistant and the patient seemed glad for the help.

For the last part of the session, she was to have heat treatment. I went to get her hot pack. She passed me on a trip to the restroom and thanked me profusely for my help. I said I was glad to; I could see both she and the therapist were having a difficult time.

I stepped into the hall, and the therapist approached me. She expressed her frustration at the patients inability to grasp it, how she needed constant cues, how she would tell her, over and over and over. Yes, I could see both of you where having a difficult time, I said. Yes, she agreed, we think she may have learning disabilities.

I don’t have a poker face, and I’m sure she saw my eyebrow shoot up. I don’t know if she knew what I was thinking, which was vaguely along the lines of “You’ve got to be kidding me. If she has learning difficulties than 98% of the people on the planet have learning difficulties. If the only people you count as normal are the ones who don’t need to be taught, maybe it’s a teaching disability.”

See, it’s kind of a pet issue of mine. It’s nothing personal against the assistant, who I know was doing her very best. It’s my own personal rebellion against The System that says all people can be taught the same. All people can’t be taught the same. People simply think in different methods and manners. I’ve seen it again and again throughout my life. Some people learn best by methods convoluted and incomprehensible to me; and some people I’ve been able to explain things to with the first words that pop out of my mouth. The insinuation that it’s always the student’s fault when The System doesn’t work leaves me indignant.

Teaching is truly a skill, and those that excel at it leave me in awe. It’s the hugely talented teachers who can get inside the head of seemingly any student and open up the doors. But why is it the student found lacking when “it doesn’t work”? Why not simply, “This isn’t a good match”? Or “I have difficulty understanding this student’s thought process”?

But I’m aware this is my own personal vendetta against the world at large, so I try to keep my indignant (and unhelpful) out-bursts to myself. I didn’t say anything, regardless of what my face said. The patient came back from the restroom. We went back to the booth, so we could set the patient up with a hot pack for her back.

“Do you want to lay on your back or your belly?” the therapist asked.

You could see the look of panic on the patient’s face as she tried to internally parse this. Do I want the heat on my back or my belly? Does lay on my back mean my back is facing up or down? What is she trying to ask me?

“Do You Want To Lay On Your Back Or Your Belly?” You could see the therapist thinking, c’mon, how how hard can this be? It’s just a simple question!

I rephrased it for her.

“Would you like to lay so that your back is facing the ceiling or so that your stomach is facing the ceiling?”

“So my stomach is facing the ceiling!” Her relief was evident, and her answer instantaneous, if still very soft spoken.

That simple change, that small clarification, was enough. She’s not stupid. She is just having difficulties communicating, difficulty understanding. I’ve heard people explain what goes through their heads when faced with seemingly simple questions. I’ve felt my face flush as people continue to repeat, over and over, the same instructions that I still don’t understand. I realize that if she doesn’t understand it the way it was phrased the first time, she needs to hear it a different way.

When her timer went off, I went to collect the hot pack and let her know she could go home. She thanked me again for helping. I’m sure I said you’re welcome; I know I mentioned I could see the therapist was having trouble explaining it. I asked her when her next appointment was. She said Monday, and I said that was too bad, I wouldn’t be there, because I worked at a different location on Mondays. She asked me if I did the same work there, or something different. We chatted a bit as I walked her out of the gym.

I did miss her next appointment. I hoped they had been patient, I hoped they had explained themselves well. I know it can be difficult, but I wanted things to go well for her.

When I saw her name in the appointment book a week or so later, I know my face lit up. I kept my eye out for her, but I was busy when she showed up. Her Physical Therapist took her back, so I didn’t get to talk to her then. I was pleased to see that her therapist was the most soft-spoken of them all, and perhaps the most patient, though I couldn’t help but wonder how well she can explain.

But I couldn’t keep half on eye on them to make sure everything was okay, because the therapist pulled the curtain. She knew the patient was shy and self-conscious, and felt it would be better if the patient wasn’t feeling exposed, and that was probably a good thing.

She again went to the restroom right before her heat treatment (it’s a good idea; nothing like laying there with a full bladder wondering how long until your time is up. It’s kind of the opposite of relaxing). I talked to the therapist; how was it going? I don’t know; she hardly said a word the whole time. She needs constant cues; she just doesn’t get it.

I am confounded. Why do people harp on the constant part of constant cues? Maybe they’re simply be the WRONG cues, in which case it doesn’t matter how constantly you give them. And I can hardly be surprised that she clams right up. You feel so dumb when everyone acts like something should be obvious and you don’t understand what they are trying to say. I didn’t think this was hard to relate to; I didn’t think this was hard to understand. Why are they having such difficulties working with her?

I again got to talk to her when I took her off heat treatment. I asked her how it was going. She said she wasn’t having much luck, and it was still hurting her just the same. It made it hard for her to do things. Physical therapy didn’t seem to be helping. She talked easily; there was no fear or confusion.

I felt so bad for her. I wanted to help her, I wanted her to keep coming so I could explain it to her; I wanted it to work for her, wanted her to stop hurting. Whether her therapist or therapist assistant knew it or not, she was my patient now. I was going to take care of her.

This morning I found out she was shot and killed last Friday while studying to be a U.S. citizen.

Do you know horror? I don’t know horror very well. I didn’t know horror last Friday, when I knew it was happening. It was no one I knew, in a part of town I didn’t know. I couldn’t relate to the horror of the other people in the hospital, when we knew it was going on. Not that I didn’t understand it. I just didn’t feel it.

I felt it now, and on top of that I felt the horror of my own words, “It’s just doesn’t feel that personal to me. It might as well be happening in Australia.” That horror spread and stayed with me as I read a piece in the paper on one of the victims. In it, it said “The point is, she was real and not some strange-looking letters on a list that are difficult to relate to.” And I had thought last Friday, “Why is our hospital refusing to let it’s staff go home? It’s only a few casualties, only a dozen dead.”

Only?

“I can still see her pull her braid down and shake her beautiful hair loose and smile, with those shining eyes. I can hear that infectious laughter. . .” the article said. Me, too. Kind of. I never saw my patient pull her hair loose, I never heard her laugh—but I saw her smile and her shining eyes. I can see my patient as clearly in my mind now as that author could see her friend. She was small—as short as me, but much more frail and delicate. She was the kind of person who should be kept some place safe–not some place dangerous, where she could get hurt. But she had been some place safe. It was supposed to be safe.

When did I last see her? The day before? The morning of? I can’t remember. But she wasn’t supposed to be dead, she was supposed to be coming back. So I could help her, so she could get better, not get dead.

She wasn’t sick. She didn’t have a car accident. She didn’t linger, and give us all some warning she wasn’t going to be hanging around. She was murdered while minding her own business in a civics class.

I’m not confused by it, and I wasn’t on Friday, either. I understand, to some measure. I knew it was a horrible thing last Friday, and I knew that people died last Friday. But last Friday I wasn’t really horrified.

Today I’m horrified.

At my patient being killed. And at myself, for not being horrified last Friday.

I only saw her twice, I didn’t really know her. So I should have been just as horrified at the other 13, because I didn’t know them either. I should have been horrified last Friday, before I knew she had died. They were all important people, even if I didn’t know them. And you can’t really use the word “only” in the same sentence with the word “died”.

I shouldn’t have said it might as well be in Australia. My patient would have been my patient if she was right next to me or if she was in Antarctica. I shouldn’t have laughed, in my mind, at the people who said “This never happens around here!” On Friday I thought, “What is so special about here? Human nature is the same wherever you go!” Today I find myself wondering, “How about that patient? Is he coming back in here alive?” Or considering that if this was “some place else”, this wouldn’t have been the first time someone I “knew” had just been murdered. Would it be happening more often? Just because it wasn’t that way “before” doesn’t mean it will stay that way.

I was happier when they were just numbers. I was happier when there wasn’t names. But it is better for me that there is at least one face, one name, one person in the midst of all of these blathering reports. One thing that makes it real, not a story. One thing that makes me care, makes me want to cry. There are people out there crying right now, and I shouldn’t be able to dismiss them out of my mind by telling myself it was only about a dozen people and really not that big of a deal. It should be a big deal when someone dies, and I shouldn’t be so calloused I can’t feel it when they do.

Sometimes you just wonder why it’s so hard to learn.

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