A spinal cord injury is a life-altering event that has enormous, far-reaching effects not only on the person who sustained the injury but also has a profound impact on their families and friends.

During my clinical rotations, I have come across many patients who have sustained spinal cord injuries, traumatic and non-traumatic. Working at a facility such as the Western Cape Rehabilitation Centre one has access to amazing facilities to aid in the rehabilitation of such patients. The patients at such a facility have a great opportunity to return to their ‘normal’ lives and to participate in their daily routines. However, according to Maclachlan (2012) and Michell (2015), this goal of re-integration after a spinal cord injury is not always realised, particularly in South Africa. People who have sustained a spinal cord injury very often suffer from depression, become demotivated and struggle to find the will to try and carry out their normal activities of daily living or to adapt to their new circumstances (Maclachlan, 2012).

While on block at the WCRC I found it extremely difficult to motivate an SCI patient, especially those who have a high spinal cord lesion to try and accept their lives for what it now is and to push them to use what they have left in order to live a relatively normal life. I found it so difficult because I know, deep down that I would be inconsolable if the roles were reversed. I have always said that if I sustained a high spinal cord injury I would prefer to be euthanized, as I feel that I would be unable to do the things that make my life worth living. Not being able to go to the bathroom, clean myself, feed myself or change my own sitting or lying position does not equate to a good quality of life for me personally. And so knowing this, my own personal views, made it very difficult to cheer depressive patients up. I had a patient with a C4 complete injury, and it was evident that he no longer had a will to live, and one truly could not blame him. It is, however, my job to do everything in my power to help this person and motivate them, but it felt insincere and empty. If I were to sustain such an injury I am of the privileged minority that would be able to afford an electric wheelchair and would have every resource be made available to me. I would be more likely to find employment, as I have a secondary and tertiary education. According to Michell (2015) having 16 or more years of education (meaning one should have a tertiary education) puts one in a favourable position for finding employment post-SCI. Individuals with such qualifications will usually find themselves in more senior positions. This man, however, does not. His family will have to look after him, turn him every two hours and provide for him for the remainder of his life.

I had other patients who, on the other side of the spectrum, were ecstatic and so grateful for the rehabilitation they were receiving. An acute SCI patient that I encountered sustained a T6 complete injury and was a paraplegic. While in the acute setting he was under the impression that he was going to die, and that he would never see life outside of a hospital bed again. After I had spoken to him and explained that he is making a fast recovery in terms of his health and he would be receiving further rehabilitation at the WCRC he was moved to tears of joy. He understood that he would no longer be able to walk and that his life would have to change drastically. But that fact that he will be receiving the help he needs to teach him how to adapt and train him to use the rest of his body to gain independence in his ADLs was, for him, the greatest news he had ever heard. He said that he felt he had the opportunity to turn his life around, and had been given a second chance to become a better man.

This was after my experience at the WCRC and I was deeply moved by this gentleman. One could tell that although the road ahead for would be very difficult, that he would still be able to live a meaningful life, as he himself has determined what a meaningful means to him. For him, being able to go home, see his children grow up, be able to wheel himself outside and enjoy the day is meaningful to him. Being able to transfer himself from his wheelchair to his bed will make his life easier. Being able to visit his friends and tell his story makes his life meaningful.

Each of us determines what makes life worth living and what we accept as a good quality of life. For some, just being alive and having their basic needs tended to is enough. We as physiotherapists can do everything in our power to try and improve our patients’ quality of life; we work together with the multidisciplinary team to ensure our patients are getting the overall support that they require to overcome their traumatic, life-changing event. We cannot, however, force someone out of a depressive state, or make them accept the hand they have been dealt. This is something I have learnt to accept. What I would do if I were in their situation does not matter, and I can only act in the best interest of my patients. Nothing more and nothing less.

Resources

Maclachlan, M. (2012). The activity and participation profile of persons with traumatic spinal cord injury in the cape metropole, Western Cape, South Africa: a prospective, descriptive study [Masters. Stellenbosch : University of Stellenbosch .

Michell, L. (2015). Initial investigation into the factors related to employment of individuals living with a Spinal Cord Injury in a specific South African population. Johannesburg , South Africa : University of Witwatersrand.