Category Archives: Physical Therapy

Silent Sings the Sorrow

“Someone should bring in a tape recorder, and record your laugh.” He was smiling, a little lopsidedly, one hand limp in his lap, posture slumped, voice always quiet. Yes, he’d had a stroke. They guy I was working with–and, yes, laughing with–had been through two strokes. Both struggle with depression, but deal with it differently.

He thought my laugh should be recorded. But he also thought there was a cure for his weakness–a pill, a treatment, a doctor on the radio who was stronger than his 20-year-old sons now, a typewritten piece of paper advertising oxygen therapy. Anything. Something.

But not exercise.

He would come here. He would do what we said, here. He would talk and talk about how he used to be “strong like a bull.” Or the latest treatment that he thought would cure him. Did you do your exercises at home? No, it was too hot. His son was staying in the room he used to exercise in. He had no energy because of this hormone imbalance; once the pills came, everything would be better. Listen, you have to work your body to get it stronger. Nag, nag, nag.

He didn’t exercise.

He stayed a slumped old man, older than he should be because he couldn’t accept he wasn’t young anymore. That he had to work to get strong. “That’s how strong I was!” he would say. Yes. You were. Now you need to work hard to get stronger.

He wouldn’t. He was discharged today. What can you do for someone who wants to wait to get better? Wait to be younger? Wait to be happier?

The other one, the one I was laughing with? He was so depressed when he came. I made him laugh. I explained things, and he drank in the explanations like he was trekking through the Sahara. I gave him an inch and he took a mile. He started eating better, and gaining weight. He smiled more and harassed me, the other patients, the staff–anyone who got within yelling distance. He went from dragging his involved leg behind him and trying to use momentum to throw it forward and using a quad cane to being able to walk around the clinic with no asisstive device, placing his feet appropriately, walking for 12 minutes on the treadmill. He stood up straight and got his center of balance over his feet.

We talked about his goals. What else would he like to be able to do? What was giving him trouble? What should we shoot for? He couldn’t come up with much any more. You’re supposed to be happy, then, you know. To be done with therapy. To get on with life. To be better. Soon, I said, soon we will be done, and you can continue on your own.

He seems quieter now. More subdued. He doesn’t get after as many people. I surprise the laughs out of him; he doesn’t really mean to. Was I imagining it?

The secretary told me to today–Oh, the family wanted me to tell you. He isn’t eating right at home again, or something.

Why?

Why can’t you just get better? Why can’t you just stay happy? I know you’d like to be a working man yet, I know you hate that your job is being alive and walking, that you have to think so hard and concentrate so much on it. But why can’t you just get better and stay better?

This man I met this morning, he had a stroke, too. He only speaks Romanian. Or French or Spanish. Not English. His wife speaks English, mostly. She doesn’t quite understand that pronouns are gender specific, and that her husband is not a ‘she’. But we can communicate with her.

She says she will take him home. She is adamant she will take him home. She can do it. She describes in careful detail how she assists him with a stand-pivot transfer. Painstakingly, she describes it. Let’s practice, I say. She already knows how, she does it, she does it. Yes, before. Let’s watch you do it, to make sure it is the same. So that we know he can go home. Finally, something clicks. “A simulation!” she says. Yes, a simulation.

A simulation of what? A wife who won’t let go of her husband. She will fall, he will fall, they will fall together.

They do the stand-pivot. She is bending too much. She will hurt her back. He is too tall. He pulls on her shoulder.

She brushes off the pain. It was nothing, it was nothing. The wrong angle. It’s better at home. Let me take him home.

If you hurt yourself, who will take care of your husband? You must keep yourself safe. Lift carefully. Don’t bend your back.

Yes, yes, she says. Yes, yes, her mouth says. Let me take him home, her eyes say. Please, let me take my husband home.

I say I want a band-aid big enough to fix the whole world. In the back of my mind, I sort of hear that God kind of has a plan about that, in the person of His son. I guess sometimes it doesn’t seem ‘now’ enough. When you make people cry with pain. When they ask you if they’ll ever get better, and you wonder how to not lie and not kill hope in the same sentence. When people look at you, and their eyes say, “I’m glad you’re happy. I’m glad you think I’ve improved. I still feel like shit and I can’t do anything.”

I’m sorry. But I don’t know to help you anymore.

Thank you for the postcard!

Kingdom Comes

When anger fills your heart
When in your pain and hurt
You find the strength to stop
You bless instead of curse

When doubting floods your soul
Though all things feel unjust
You open up your heart
You find a way to trust

That’s a little stone that’s a little mortar
That’s a little seed that’s a little water
In the hearts of the sons and the daughters
The kingdom’s coming

When fear engulfs your mind
Says you protect your own
You still extend your hand
You open up your home

When sorrow fills your life
When in your grief and pain
You choose again to rise
You choose to bless the name

That’s a little stone that’s a little mortar
That’s a little seed that’s a little water
In the hearts of the sons and the daughters
The kingdom’s coming

In the mundane tasks of living
In the pouring out and giving
In the waking up and trying
In the laying down and dying

That’s a little stone that’s a little mortar
That’s a little seed that’s a little water
In the hearts of the sons and the daughters
The kingdom’s coming

Sara Groves

We undervalue an encouraging word. Not in the getting, of course, but in the giving. How many times have you not even said anything, because there was nothing you could do? But an encouraging word is like a cup of cold water.

Someone thanked me today for a postcard. I stared at her stupidly, not remembering. . .and then, from the depths of mundane moments not worth recording, I managed to pull a brief flash of a picture. Generic, pre-printed, commercial post card with a form message on it. A blank space for a name, the secretary’s neat handwriting filling in names of patients no longer being treated. The few minutes found to look over the cards and scribble in brief messages to anyone I recognized. A sentence, maybe two. What did I even say? “Keep up the good work”? I don’t remember.

“Thanks for the postcard. It was very encouraging!”

She got cancer and had her lower leg amputated off.

I sent her a postcard.

What difference does it make?

Past, present, and a I guess maybe a little bit of the future.

PAST:

This morning I was standing there getting dress, and all of a sudden I was hit with a powerful flash-back from my time in school. I imagined myself in the early mornings at school, when I would get there far earlier than would ever seem reasonable, except for the fact that that was when my ride dropped me off. (Earliest class ever offered = 8 am; my arrival time? 7:10.) I heard the sounds of the empty building, saw the flickering light, and most of all, I smelled school. School has a very distinctive smell all its own, and even after the sights and sounds of school were shaken out of my fuzzy head, the smell lingered.

PRESENT: (ish)

As mentioned, I took my boards exam on Saturday. I couldn’t stand the suspense and decided to check and see if my pass/fail results had been posted online yet, even though I was told I wouldn’t be able to find out until Tuesday. So Sunday morning I tentatively logged on, and discovered that I had passed.

You may certainly go back and re-read that sentence, because I went and re-read the results about 5 times, just to make sure my eyes weren’t playing tricks on me. Then I went back later on in the day just to make sure they hadn’t changed their mind. Nope–still passed!

So I went work today and told my boss, the owner of the whole company, and she was so happy she hugged me, and spent the next 5 minutes exclaiming with delight and telling everyone she could. So, so, so happy I could come into work with a positive report.

Then I was slammed by a full schedule, my first ever on my own. It required three donuts, and I am very glad that someone brought them in, because I don’t know what I would have done without them. I think I did some pretty dang good therapy and made some very good calls, but I think my documentation for it sucked. Some day I would like to be able to do some awesome therapy AND uphold the other end of the book pretty well, but today did not seem to be that day.

And I am exhausted.

FUTURE:

Tomorrow I am going first to the hospital, where I will most likely also be thrown into the boiling water. Then I am going to the clinic, where I will probably be lightly charred. And finally, after lunch I will be shipped off to different branch, where goodness only knows what fate awaits me.

Don’t get me wrong–I like my job. But I am still so, so green at this that I feel more that I am being put into a large washing machine with the agitation cycle set for 10 hours than I feel like I am a competent clinician who is capable of conducting herself in a professional manner. I am pretty sure that if I make it through this week okay than I’ll be over the worst of it.

But I still hope there will be more donuts tomorrow.

If I took a picture, you’d think I’d photo-shopped it

This morning I drove into the rising sun, and this afternoon I drove into the setting sun. Not a proper sunrise and sunset (though that will be coming soon, I’m sure, with the shorter days), but just the right angle to be in your eyes the whole way through. Today it was a different small town. I am seeing so much of picturesque, quaint rural America lately that I feel like I ought to taking along a camera and doing some proper photo-shoots for magazines, post-cards, and people who don’t believe that it really exists. (It really does, people!!)

I met two new PTAs today. . .one was the one that inadvertently got me a job, as she passed news of the opening on to her friend, who then passed it on to me. The other insisted she recognized me from somewhere, and come to think of it, she looked familiar to me too. We spent the whole morning trying to figure it out, and finally decided that it had been at the (local, small-town, entire community effort) craft fair a few weekends previous. I couldn’t place her booth exactly, and I struggle to believe out of the many people streaming past her she really remembered my face. Nonetheless, we were both definitely there.

Right now I am kind of feeling like the way things are right now is how I wished my clinical experiences would have been. I see a lot I can learn. I also feel pretty dang clueless (which I hate), but past clinical experiences have taught me that the first week is really the most acute phase of cluelessness. As long as I keep pushing myself through, I should feel a little (tiny) bit more settled by next week.

My school trip. . .

So we had a school trip to Atlantic City for a PT conference. I think I was the only one who found my course to be the real highlight of the trip, but that’s me!! Summary in lists:

Things that made me absurdly happy:

    The sign for the Children’s Hospital Of Philly, saying “Hope lives here. Right here.” I felt like maybe I should hang it over our doorway. Or on my forehead. Or something.

    The old architecture of Philly. People useta know how to build stuff.

    People singing along with the radio. Signing = happiness.

    Being on the beach. We weren’t there for long, but I discovered I really, really, really like the sight, sound and feels of the ocean. I need to go to the ocean again sometime.

    Someone else driving and the exceedingly low stress environment of people who weren’t stressed by traveling.

    Sleeping on the way home. Sleeping is always a good thing, but the more difficult the sleeping environment, the more irrationally pleased I am with myself for having accomplished it.

    Starbucks half-caf mocha frappicino. I don’t remember how much it cost, and I’m trying hard not to, but if you’re going to drink caffeine, that’s a pretty good way to do it. Even if it was more like a shake/smoothie/icy dessert.

    Cherry limeade. Among other attributes, it helped get rid of a lingering headache.

    The really, really, really dark curtains that made the bedroom darker than my room at home, even though Atlantic City never turns the lights off.

Things that annoyed me/made me unhappy:

    Fighting a headache the entire time. This led to me unilaterally decreeing to my roommates they had to be quiet for 5 minutes. Whispering was enforced for said amount of time.

    The peculiar habit of my roommates to sleep with the TV on. Seriously??? This totally obliterated the point of really, really, really dark curtains. I guess they still needed a night-light, or something, because it was BRIGHT. Either that or the modern person is so addicted to stimulation of sound and noise they can’t go without. However, it didn’t work at keeping them asleep, because they still woke up as soon as anything went bump in the night. (It’s a hotel full of people; of course things go bump in the night!)

    The fact that Atlantic City let it’s tallest buildings be built right on the ocean front. I know, I know, you get expensive shore frontage and you want to make the most of it. But, from a non-selfish point of view, it would make more sense to build progressively taller buildings the further you went inland so more people could get a shot at seeing the water. Instead, even though we were so close to the water we were practically sitting in it. . .all we saw was buildings. Gaudy, tacky buildings.

    Be dragged through a couple of casinos. I wanted to stay on the beach all evening, but I was out-voted. For some absurd reason, people wanted to walk through casinos even though we weren’t going to gamble. Casinos, generally speaking, ignite in me a general loathing for human-kind.

    Paying way more than was decent for crappy food. I decided just to pretend that everything I spent on food was really the $$ necessary to cover food AND transportation AND a place to sleep—wot a deal!!! (All the other stuff was actually paid for by club funds. Sans the 14 hundred million tolls.)

Peculiar things that may or may not have been mildly disturbing, but in any case I can’t quite figure out:

    The appeal of Atlantic City. Having already opined on the the merits of casinos, that leaves stores. The stores fall into two categories–the same ones we have here (payless shoe stores? Yankee candle?), and stores that are wwwaaaaaaaaayyyy out of normal mortal price range. The whole place struck me as tacky and un-noteworthy.

    When my roommates demanded to straighten my hair. I let them, because (1) it was temporary, and (2) it kept them quiet. (See above about managing headaches and roommates who are afraid of silence.) When they were done, they said it looked beautiful. I said I looked like Mrs. Munster.

    markymunster238

    Alternatively, I felt like maybe I should be singing “I’m here for the party” a la Gretchen Wilson:

    Gretchen-Wilson-sb09

    What do you think?

    wilson hat

    wilson

    The barely-speaking-english rickshaw people on the boardwalk. Um, the board walk is flat and the easiest walking in the world. Why would anyone have the need for riding in rickshaw? But people were. I found it demeaning, I think.

    The people on the trip (all over the age of 20) who took along stuffed animals. Um. . .okay.

    The appeal of trying to get tractor-trailer drivers to honk. The students in the car harassed the assistant teacher in the front seat to open her window and wave madly at the tractor-trailer we were passing. She complied; he didn’t even notice. She was charged to try again on the next one. He waved back. Students’ windows opened, arms were flailing, everyone was hooting and hollering. He honked the horn. Everyone was happy. Um, what?

    Dutifully trying a sip of someone’s margarita. It tasted like alcohol. Duh. No appeal there for me, thanks.

    The collection of “Miss America’s” shoes at the hotel. They looked like they had been made by a 6th grader with a hot glue gun and access to a dollar store.

Verdict? Atlantic City, thumbs down. Beach, thumbs up. Traveling–only if with people who like doing it and the opportunity to sleep on the way. Conferences? Thumbs down to the vendors. Two thumbs up to the teacher I had. Casinos? Two thumbs down.

That about covers it!

On Learning.

I found this while doing research for a school paper. It was non-applicable, but I was pleased to find someone else saying what I’ve often wanted to express. It is written to therapists on the topic of motor learning, but it is obviously much more applicable.

Learning is a process. We deny that process if we attempt to provide the solution. We must view learning as a process of coming to terms with a task in a self-referential fashion. It is the understanding of the all the elements involved in the task that enables the product (ie, the movement) to emerge.

Our goal, as facilitators of learning, is not to get the learner to perform a movement, but rather to facilitate the understandings that produce that movement. Our goal as therapists is to facilitate the learning process in a way that is suited to the unique characteristics of the learner and to respect the product for all it has to tell us. Too often we view the product as deficient and wrong, rather than as an evolving reflection of the learner’s current level of understanding and control. In this sense, it is never wrong. . .

With learning, there is a generalizability. With training, there is a memorization of solutions that are nongenerlizable and of limited value. If we teach solutions, rather than encouraging discovery and active generation of strategies, we short-change the learner. In order for the learner to become fully functional, he or she must engage in teh learning process autonomously–independent of us.

Our ultimate goal is to help the learner become autonomous as a learner, with teh most effective set of resources possible and with the means for self-enhancing those resources. We wish the learner to become a competent problem solver whose movements are effective in a achieving his or her goals. Our role then is to assist the learner in understanding, amassing, and refining the resources that serve as the “raw material” for skill expression and learning. We wish to assist the learner in the development of his or her abilities to both analyze tasks and develop effective, personally suited, cooperative relationships between the body and the environment for any task he or she may encounter. In essence, we wish to assist the learner in exerting control over the factors that influence the detailing and progressive refinement of movement–self-understanding, environmental understanding, and self-as-agent in teh environment for the task at hand.

Susan Higgens, “Motor Skill Acquisition.”Physical Therapy/Volume 71, Number 2/February 1991.

Is there something wrong with my head?

So there is this guy and his son coming in for therapy right now. They both got run over by a rototiller. The son got the tines chewing up his calf, and the dad got the frame smashed into his lower leg, breaking it. (The leg, not the frame.)

So. . . .is there something wrong with me that all I want to do is ask them “Forward-rotating or rear-rotating? What brand? What model? Were you happy with it before it ran you over?”

I really think the patients would be perfectly happy to discuss such details, but I think I would get some really funny looks from the therapists. Which might make it all that much more fun to do, come to think of it.

On the downside, one of the therapists wants to play match-making between me and the son. . .so maybe asking about the machine that ran him over would only be used as ammo to her cause. Hm.

Find Out

So today I found myself walking into the room of a patient who’d been cleared by the nurse to have physical therapy. Only I found the patient shaking and shivering violently from head to toe, pale, with bluish lips, asking for another blanket. So I grabbed two, and then asked him how long he’d been this way and if his nurse knew about it (about half an hour, and no). So I found myself asking for the nurse to come in, and I found her face to look rather surprised, confused and concerned. I found that his forehead was hot and dry, and that the nurse was having a hard time taking his blood pressure because of his shaking, and his O2 was not as high as it should be. And then I found another more experienced nurse had been fetched in, and that they were agreeing to call some sort of code. As I was led away from the room, I found doctors with defibrillators and respiratory doctors and all sorts of people making a deliberate walk toward the room.

And then we went to a different floor, because rehab doesn’t work with people like that. And then I found myself crying and being led by two therapists into a room to be myself until I could pull myself together, and then I found out that I still see my grandfather in every dying man I see.

And sometimes I wonder how long it will be that way.

I fact-check everybody

So today I overheard a student asking the teacher about a muscle behind the knee. She (the teacher) said it was anconeus. I said I thought it was popliteus, which looks almost exactly like anconeus, but anconeus is at the elbow. So she looked it up. And I was right, and she said so. And the class said, “Of course she’s right!” Like the poor teacher just didn’t yet realize that I knew everything. Well, now she does. She very humbly said she would ask me any time she needed to know what a muscle was. And the class was like, “Yeah, that’s what we do, too.”

Sometimes I wonder how I got here.

We also got to listen to some gruesome stories, like a diabetic patient who got a cat scratch. It scabbed over, so she thought it was healing, but she kept having calf pain. By the time she went to the doctors, the hidden infection had destroyed muscle right to the bone, up and down her leg. They patched her up, but she still had a chunk of her leg missing due to an infection she didn’t know she had.

Also about blisters that are infected on the inside, and eat you away to the bone.

Also about working with pediatric burn patients, and how you have to work at stretching out their scar tissue so they can heal (functionally), except that it’s super painful, so that even though they’re drugged up on morphine they scream and scream in pain while you work on them.

And grade 4 pressure sores, which means down to the bone, that can develop if a patient is not repositioned for merely ONE SHIFT. A grade 2 pressure sore—a blister—can take about 2 hours. It left me amazed that Grandpa didn’t have more problems with pressure sores.

We are all nervous about our practical exams, because they’re pass/fail. . . and you have to nail almost everything, exactly, in order to pass. It’s just—-stressful.

Semester II, Week 1: Thursday

Amusingly, today I, the shortest person in class, worked with The Guy From The Bronx, arguably the tallest guy in class. We were in the Intro to Rehab lab, and we were supposed to do such things as practice educating people on the proper way to lift things by themselves, lift things with another person, do laundry with a bad back, and reach for things that are high up.

If you will realize that, when we are both standing on the ground speaking to one another, I will get a crik in my neck, you will have a better visual of how absurd it would be to pair us up carrying an object. I believe the teacher was pleased to see that we correctly addressed the situation on our own. How could we not? I’ve been the short one almost every single time I’ve helped carry something.

Then we get to the laundry, where we presume I have a bad back. He correctly shows me how to load the washer, and how to move laundry from the washer to the dryer. Then we get to getting the clothes out of the dryer, and shows me how to squat down and keep my back straight.

“But,” I say, “How about reaching the clothes in the very back of the dryer? How do I do that without bending my back?”

He got a rather confused look on his face. He squatted down and tried for himself. It was easy for him, naturally; he probably could have reached the back of the dryer from several feet back. Finally, flummoxed, he asked, “How can you not reach the back of the dryer?” (I would have to kneel on the floor, as opposed to squatting, in order to reach the back.)

When it came to the item on the high shelf, we were supposed to talk about using a step-stool. “Not,” the teacher cautioned, “climbing on the counter.”

“But,” I said, “My brother always says it didn’t hurt him the last time!!”

I addressed my deficiency in height by requesting he get the item down for me. The lab Assistant agreed that was a perfectly viable solution. Next I was supposed to teach him. If I had him climb on the stool, his head would have gone through the ceiling. I recommended he didn’t. The lab Assistant agreed that was good advice. Next, we examined what would happen if I did use the step-stool. If I went on tip-toes and my fingertips could only just reach the counter, I could reach the object. Otherwise, not. He recommended I not store things on the top shelf. The lab Assistant concurred.

When it came to turning patients during bed mobility practice, I was referred to by the teacher as tiny and petite. Petite I can swallow. Tiny made me laugh. Nonetheless, my handicapped length proved to be a hurdle there, as well, because although strength is generally not an issue for me, there were some actions that simply required more length. Helping someone sit up, for example. One arm is supposed to scoop the patient’s leg of the bed while the other arm goes underneath the patients armpit to lift them up. I can’t have an arm here and an arm there at the same time; it required helping someone sit up to be a two-person job.