DRAFT: This module has unpublished changes.

Compassion/ caring:

 

In my second week, I had the opportunity to work with my first patient in the ICU. That being said, she did not present in the same way as many other people in the ICU. Firstly, she had no other lines or tubes than one peripheral intravenous line and telemetry. And according to her notes, nursing staff had noticed that her mobility was much different when she was being observed unbeknownst to her than when she was working with them. For example, when asked to demonstrate active hip flexion, she was not able to produce even a trace contraction. However, several minutes after that, she was observed walking to her bathroom with no assistive device. Overall, the phrase that kept repeating in her chart review was “poor performance based on minimal effort.”

It was apparent from the chart review and speaking to the nursing staff prior to performing her evaluation that the health care personnel who worked with her were frustrated with this patient. I heard the phrase “we can’t fix crazy” repeatedly over the next week that I worked with this patient, from assorted staff and therapists. It struck me over that time that even if this patient were “putting on an act” to get attention in the hospital, it was our task as her therapists to help her return to a level of mobility that would allow her to return home safely. And if that were the case, I didn’t see how making it apparent to the patient that we thought she was “malingering” and not genuinely needing skilled assistance would help her to make progress and return home any sooner.

So with my CI’s permission, I decided to use our treatment sessions as a combination of physical and emotional therapy, encouraging her to vent about the stressors in her life while performing transfers and ambulation. I praised her for improvements and good performance, and tried to redirect the conversation when the venting became overly negative. As we approached her discharge date, I began to speak with her about stress management in the forms of yoga, deep breathing, and mindfulness. We discussed at length how to fit these techniques into her day to day life to cope with the external stresses that were causing her to feel overwhelmed. She also received handouts and links to websites that described more mindfulness activities. I had deemed that as a web programmer, she was an appropriate patient to trust to navigate the internet on her own. In the end, she made tremendous progress on a daily basis and seemed to have a healthier and happier view on the whole episode of care by the end of our time together.

I am not able to say how she would have progressed if a different or more conflict based treatment approach had been taken, obviously. But in terms of this rotation, this was the first time that I felt that my handling of a patient’s treatment was superior to the care that they would have received if I had not been present. The experience has such an impact on my view of myself as an upcoming therapist that I chose to make “malingering vs. conversion disorder vs. CRPS” the subject of my in-service. I hope that I am able to briefly present on this topic in a way that can convince the therapists at St. Luke’s to take a positive, non-judgmental approach to their future interactions with patients who fall into any of these categories, without coming off accusatory. I imagine that in my future practice, I will continue to encounter patients whose external stressors are manifesting physically, and I feel more confident now in my ability to treat them and give them the tools to better manage future stresses.

DRAFT: This module has unpublished changes.