I am often consulted by physical therapists and PT assistants regarding patient treatments, difficult patient situations and ethical dilemmas in practice, to name a few scenarios. At times, I find myself arbitrating a disagreement between therapists who cannot agree on treatment philosophies.
A nursing home administrator once told me, “Sometimes I long for a day that I will not be asked to make a decision or recommend a course of action to resolve an issue. It’s mentally fatiguing.” Although I don’t necessarily share the sentiment, as I am thankful that my viewpoint and opinions are valued by my colleagues, the nursing home administrator’s comment made me more conscious of those moments when I’m not asked for my point of view. These are the quiet moments when I could just listen from the sideline and reflect on conversations occurring around me.
One of these opportunities to listen came as I completed some paperwork and overheard a conversation between two PTs at a hospital facility.
Jeff, the PT assigned to work in the hospital’s sub-acute floor, was a bit teary-eyed as he spoke about a patient with whom he had worked several times. Jeff was sad to witness the deterioration in the patient’s cognitive functions. Her mental and physical states regressed due to Alzheimer’s disease. He reflected on how a year ago his patient could still recognize him. They would talk about her family — especially the grandkids, her future vacation plans, her past life and current hobbies. But that was no longer the case; the patient did not recognize him or her family members. Her personality had changed from being socially engaged to being quiet and withdrawn. She would not initiate any activity, unless prompted. At times, Jeff and the nursing staff would find her wandering the hallways as if in a daze. Jeff questioned if this is a quality life worth living.
Sancho, on the other hand, shared his anguish about working with a patient in the ICU. The patient had been comatose for four weeks and showed only minimal reflex reactions since his head injury. His muscles were beginning to show signs of atrophy and soft tissue structures around his joints were starting to get tight. Sancho was hopeful his patient would emerge from this state, but he also was aware of the cognitive and physical deficits that come with head injuries. He knew his patient would no longer be person he once was, and he questioned whether his patient could return to his career as a bank executive. Sancho doubted whether his patient would be able to care for his family and his 4-year-old child, even if he emerged from the coma and completed his rehabilitation.
Similar to Jeff, Sancho questioned if the patient’s current comatose state and the uncertainty of what may come amounted to a quality life worth living.
As I completed my paperwork and prepared to leave, I had the feeling Jeff and Sancho wanted me to weigh in on their conversation – but they did not ask. At that moment, I felt like the nursing home administrator who once told me, “Sometimes, I long for a day that I will not be asked to make a decision or recommend a course of action to resolve an issue. It’s mentally fatiguing.”
But as I walked away, I could not stop myself from having an internal conversation, questioning what I learned while listening from the sideline. Then, it came to me: As PTs, we are fortunate to be part of our patients’ emotional experiences — grief, happiness, losses, progress. Our interactions with them give us the opportunity to understand the depth and breadth of human triumphs and sufferings and to know the difference. Above all, the connections that we develop with them help us to search for the definition of a quality life. Perhaps, in our discovery, we can help our patients and their families to redefine it and find a new meaning to life that is worth fighting and living for.