I work in hospital settings. Sometimes wacky stuff happens. Names and details have been altered to respect privacy.
Volume III: The Perils Of Upright
When a person has sustained a severe injury – I’m not talking torn ACL, I’m talking fractured spine – the rehab process is a long, difficult journey, to say the least. The physical pain and effort required to ‘get better’ can at times seem like nothing short of torture, and the potential lifestyle modifications related to one’s injury can appear to be insurmountable. The great Yogi Berra once said, “Baseball is ninety percent mental; the other half is physical.” Long-term rehabilitation is similar. With sounder math.
Even patients with the most positive of attitudes can have very dark days in the face of these heavy challenges. After days upon days of barely measurable improvement, virtually anyone in this situation would be asking, “What am I really working towards?” There needs to be a tangible payoff for it all to make sense. We as able-bodied, experienced clinicians can see the big picture, but for the person who lives in such a situation for twenty-four hours a day, the only thing that matters is realizing substantial results. In this respect, I often find that long-term rehab patients each have their own ‘aha moment’, the initial attainment of a specific skill where all the work they’ve put in finally makes sense and the endgame seems possible. And for many people, it boils down to one particular sequence – standing up and taking a step.
It seems so simple, almost trivial – for any healthy adult, standing up is something that we take for granted. We don’t even think about it, through no fault of our own. But standing is the gateway to walking, and walking means feeling normal again. It’s a pretty big frigging deal. And for someone who hasn’t done so in quite some time, it’s a bit of a process, with a few wildcards thrown in the mix.
There are a few preparations to be done in conjunction with a ‘first stand’ – clearing it with the attending physician (or if there are new residents in town, just telling them exactly what they should write on the order), monitoring vital signs, and educating the patient. Why do they need education? Because gravity is a mischievous little prankster, that’s why.
When a person’s body has spent a lot time without being up, other things have a tendency to go down. I’ve seen someone’s blood pressure plummet to 63/36 – for those of you not in the know, that’s what we in the biz call ‘barely alive’ – after which we had to basically turn him upside down to get the blood back to his brain. I’ve also seen a colleague’s student not check a full colostomy bag before helping a patient stand, leading to the accidental detachment of the bag and the equivalent of a bursting water balloon creating an explosion of fecal destruction on the hospital floor below. But for every one of these mishaps, there’s another patient experience resulting in tears of joy or an elated nearby family member. There’s a payoff.
I had a patient who had gone through an emergency abdominal surgery which had resulted in the complication of partial lower extremity paralysis. She started out with no functional strength in either of her legs, but after nearly a month of multiple therapies, she was ready to give standing a shot. We prepared accordingly, and when the moment came, she was phenomenal. We stood for a moment, her hands gripping the parallel bars, mine pulling on her gait belt, and after a few seconds, she began to laugh quietly. Then she gasped, and started giggling wildly. She was all smiles. Another success story, I thought to myself.
I asked her how she felt. And I will never forget what she said.
“I’m pooping, Drew. I’m pooping HARD.”
About Andrew Rose
Andrew Rose is a writer and editor for Rookerville. He also manages a travel blog for his friends and family. His book, “Seizure Salad”, is a work of fiction - not in that it is a tale of fantasy, but in that it does not actually exist.