By Keenan Whitesides, PT, DPT, NCS
I would imagine most therapists have had a patient like Ms. G. After suffering a stroke, she slipped into the hospital without insurance, without a supportive family, seemingly without hope. She was outwardly defiant and refused to work with most of the staff. With her, something always ranked 9/10 for pain. But I liked her immediately. I admired her spunk, the absolute vigor with which she asserted her authority, and her affinity for off-color jokes. Luckily, she seemed to like me too. She stood 4’10 when she wasn’t hunched over her walker and I stand just shy of 6 feet. We were an amusing duo as we trekked through the hospital. Although I easily towered a foot over her frail frame, there was no question as to who was in charge of the operation: she was.
As the weeks of her treatment went by, her hardened exterior started to melt; she became a different person. As she shuffled down the hall, still dragging her left foot behind her despite my endless barrage of cues to pick it up, she smiled at the other patients and offered them words of encouragement: “If I can do it so can you” and “One day you’ll be walking just like me.” Certainly a special experience to witness, this weathered woman who confessed she smoked and drank so much of her life away, reawakened with a sense of purpose and interest in helping the people around her.
Her stay was complicated: she had family that wanted her placed in a nursing home, friends that insisted she would be well cared for at the motel she had previously inhabited, and her in the center, unsure of her best option. We discussed this daily on our bouts through the hallways as she wavered between her safety and her independence. As a result of the stroke that had brought her to the hospital, she had pronounced difficulty with divided attention, consistently running into things when someone called her name, or when she was trying to eavesdrop on a nearby conversation. I had nightmares of her attempting to cross a street, shuffling behind her rolling walker and making it almost across only to be distracted by a nearby conversation as the light began to change.
She was fiercely social—she knew the names of everyone on the floor and addressed each one as we passed them each morning. After her initial period of rehabilitation, she was moved to an independent apartment to practice living on her own. As each therapist dropped her off at her room, like clockwork she would propel herself with her tiny feet that barely touched the floor in her wheelchair to the lobby, where she could chat with patients and their families and sneak a cup of coffee that hadn’t been treated with thickener.
As her discharge date grew closer, she became more insistent upon returning to her motel room, convinced that she had no need for a nursing home and anxious to return to her circle of friends. We worked tirelessly on safety, challenging her in different environments, throwing in every distraction I could think of that she may face when she returned to the “real world” outside our comfortably contrived rehabilitation hospital. Her walking speed improved, she no longer sat down precariously on the edge of chairs, and she was able to climb stairs on her own. On the day before she was scheduled to leave, as we concluded our final session together, she sat on the edge of the treatment mat with her feet dangling and looked me in the eye. She made me a slew of promises: that she would walk every day, that she would do her exercises—“even those damned squats that I hate”—and that she would stop smoking and drinking.
Before I gave her a hug that would mark the end of our time together, I asked her the question that had been gnawing at me since we started: why was she so willing to listen to me? After all, I was merely a student, and she had refused the help of so many others. Without hesitation and in a style perfectly in line with her personality she said simply, “because you never told me what to do—you gave me time to figure it out.” I thought back to our initial treatments, the mind-numbing minutes I spent watching her try to stand up with her seatbelt fastened or her wheelchair brakes unlocked as I gently asked her if there was anything she had forgotten to do. I remembered the circles we walked around her floor as she looked for the elevators and realized it all had a purpose. In those failures, she had learned to rely on herself.
I admit I was not always consciously aware of my reluctance to offer assistance, but Ms. G. taught me that maybe I should be. If our goal truly is to return our patients to their previous lifestyle, then we must prepare them to be self-sufficient. As a student I often find myself being especially verbose with my instructions, eager to ensure that patients receive all the information they could possibly need. It took a Ms. G. to teach me that sometimes the best instruction comes from knowing when to say nothing at all.