2-19-2022 The magic of a compassionate physical therapist

(Tricia)

On Tuesday, I received an email from the social worker at NHC. She wanted to let me know that Linda was once again refusing therapy. If Linda refuses therapy too many times, the social worker told me, the insurance company will no longer cover the cost of the skilled nursing care or therapy. So, she wanted to ask me "if I had any suggestions."

When this same thing happened last fall, I told them, repeatedly, what my suggestion is: Let me know the window of time when they will be working with Linda. If their PTs would just provide me with a schedule for Linda's therapy sessions, I could be there to persuade Linda to participate. However, getting the facility's PT to set actual windows of time for therapy, which seems so simple to me, was almost impossible last fall. Even a two-hour window would be fine.

When I told the social worker this on Tuesday, she gave me a time for the next day and said that the PT working with Linda would set out a schedule for the following week. The PT did arrive at Linda's room at the specified time, and we did, with great effort, get Linda through her therapy. But the PT did not provide a schedule for the week as was promised. Just as before, I'm having to ask her to set a time on a day-by-day basis. This wouldn't be so bad except that, each time I ask, it's clear from the PT's blank stare that committing to even the loosest schedule is the last thing she wants to do.

At one point, I was talking to a nurse who told me that this is the only facility she has ever worked in that didn't have a PT schedule for residents. She said that other facilities set schedules mainly so that the nurses would know when to administer pain medications. That's not a thing, apparently, at this NHC location.

This week, I was there for four physical therapy sessions with Linda. Three of these sessions have been with NHC's in-house therapists, and the therapy has been brutal, to put it bluntly. When the therapists came to Linda's room, I had to beg Linda to do the therapy. And, while she eventually agreed to go down to the therapy room, she was begging at every moment to stop. They ran her through rote set of exercises, regardless of whether she is up to them. They didn't really ask, at any point, what she would like to do or kind of movement would feel better for her. The worst part was when they stood her up to take steps with her walker, as they supported her on either side. They forced her forward, even as she cried in pain and begged them to let her sit down.

I tried to encourage her through these sessions, thinking that this must be how physical therapy was done. But on Thursday, there was another resident in the room while Linda was getting her therapy. As they were walking Linda across the room and she was yelling in pain, he looked right at me with a horrified look on his face, as if to say, "And you're letting this happen?" I didn't blame him. I was wondering at every stage whether this was the right thing to do. In the end, I was trusting that they knew what they were doing.

That changed completely today, however, after I saw a different therapist in action. When I arrived, Linda was slumped in her chair, looking despondent. She said she was in pain, so I asked the nurse to give her pain medication. About 20 minutes later, a PT whom I'd never seen before came in and introduced herself--the regular therapists weren't there today, and this therapist was filling in. And, today, I saw how therapy should be done. 

This woman was so gentle with Linda. She talked with Linda about her own kids and asked Linda whether she had ever had a dog. She kept Linda distracted and talking and laughing, even as she moved the injured leg up and down--something that had caused Linda to wince in pain just the day before. Rather than forcing Linda to stand up and walk, she let Linda take the lead. She allowed her to gently walk her way forward in the wheelchair, and to push against her with the injured leg. 

Linda responded to this approach beautifully. More than anything, this therapist talked to Linda rather than at or around her as the other two therapists tend to do.

When the session was over, Linda seemed like a completely different person. She was calm and smiling. She told me that she was surprised at "how much benefit could be had from such aesthetic moments." This time, even with her "creative" use of language, I knew what she was trying to say! I too was so surprised at what a difference that therapist's gentle touch had made.

I now have a completely different view of what physical therapy can be and what kind of therapy Linda needs.  The problem: This magical PT only comes in occasionally, and the two "brute force" therapists are the only other options at that facility. But I learned a lot today, so one way or another, they're going to have to change their approach. I truly wish I hadn't let the other sessions happen as they did, and that I had seen sooner that PT could be done in a much softer, more compassionate way.