“Look at his hands. They’ve changed him. They’ve turned him into stone. Watch him work with that chisel and hammer. Twenty perfect blocks of stone every day. Nobody else can do it like him. He loves stone. That’s why they’re nice to him. He’s forgotten himself. He’s forgotten everything. . . why he’s here, where he comes from. That’s happening to me, John. I’ve forgotten why I’m here.”

Art piece chosen (play) – The Island by Athol Fugard & Dennis Walder, Scene 3, Page 220-221

The above extract had been taken from a scene in a South African play by Athol Fugard, The Island. The play revolves around two inmates, John and Winston who are being held on Robben Island during the Apartheid era. They spend their time in an endless cycle, working on a quarry daily, disconnected from the mainland by sea. This is alluded to in the title of my assignment ‘An Ocean Apart’. In the extract, Winston and John comment on another prisoner who has been stuck in the routine of prison life for so long that he eventually forfeits his own identity, becoming a mere vessel involved in the daily quarrying of stone on the island. The use of the extract above along with the title was inspired by an elderly male I treated on my general block who had dementia ,right arthroplasty, verbally unresponsive, completely blind in his right eye and only three percent vision in his left eye. I found this specific extract relevant due to the fact that it reflects the situation both I and my patient found ourselves in, one in which we are both prisoners, albeit in different ways. This reflection will explain the extract above, the relevance of the play script to the situation I found myself in, as well as discuss the ethical dilemmas I encountered while treating my patient.

According to the Health Professionals Council of South Africa (2008), a health care practitioner providing treatment has the responsibility to discuss it with the patient and obtain consent. Due to my patient’s condition, obtaining consent for treatment had been challenging. Just as the inmates in ‘The Island’ felt detached from the outside world, I too felt disconnected from my patient. The ocean in my instance being the gap in understanding between us. My patient’s mental condition and inability to articulate any words, his silence punctuated only by occasional grunts and moans presented a dilemma, in that his agency in making medical decisions was practically non-existent. Furthermore, he did not have any family members who supported him. Therefore, medical decisions were made by the multidisciplinary team at the facility. This can be compared to the prisoners in the play whose decision-making power in their own lives is minimal. In the extract, the words, “they’ve changed him,” indicates the lack of agency the prisoners have. Ultimately, the wardens decide on every aspect of the inmate’s lives, and in that way, their fate is placed solely in the hands of these wardens. Similarly, my patient’s future rested in the hands of the medical practitioners treating him.

Empathy can be defined as the ability to sense other people’s emotions, coupled with the ability to imagine what someone else might be thinking or feeling (Greater Good, 2019).I felt a sense of empathy towards my patient as he had been unable to communicate with me, he could not remember anything nor could he comprehend anything that was being said to him. Just as the inmates in the extract expressed a sense of hopeless, evident in their words of “They’ve turned him into stone…He’s forgotten himself. He’s forgotten everything. . . why he’s here, where he comes from.” Although this quote refers to a figurative loss of identity and memory, in the case of my patient who has dementia, a far more literal interpretation applies since memory loss is a natural consequence of his condition. However, the far more evident similarity between the prisoners in the play and my patient is in that they are both confined to a life behind bars. While in the play these bars are that of the prison cell, in my patient’s case, the bars are that of his own mind. He cannot escape from his condition even if he were to try.

As health care professionals, we are expected to deliver efficient health care while exercising compassion and understanding towards our patients. However, I found it difficult to maintain these qualities and became frustrated as my patient did not understand what I wanted him to do nor could he remember the exercises despite countless demonstrations. Additionally, he was unable to see me visually, and verbal communication proved impossible. These two lines from the extract above, “Watch him work with that chisel and hammer. Twenty perfect blocks of stone every day,” refers to the quarrying the prisoners are required to do every day. It reminds me of how I felt as a healthcare professional at the time. I knew what was required of me as a physiotherapist during the time spent with my patient and I enjoy my profession. However, it is almost as though I ‘chisel and hammer’ away aimlessly. I try my best at every treatment session, putting in the hours, the ‘twenty blocks of stone’ symbolizing this. However, in the same way that the prisoners do not reap the benefits of the quarrying that they do, I too feel as though the benefits of treating my patient is somewhat non-existent. In the extract it is mentioned that the work has “turned him (i.e. the prisoner) into stone,” and in many ways, the frustration resulting from what I perceived to be one failed treatment after the other hardened me, in a sense turning me into stone.

When treating a patient with dementia and a visual impairment, one needs to remember that we cannot change the person (Caregiver, 2016). The person has a brain disorder that has shaped who he has become and what works today, may not work tomorrow. Therefore, it is important to try a different sequence or approach and become flexible and creative in your treatment strategies (Caregiver, 2016). I have learnt that it is vital to adapt unique communication strategies to patients with dementia with the use of auditory, visual and tactile cues (Chavan, 2018). In particular, the use of art therapy.

This reflection enabled me to understand that as a health care professional, one’s disease and the effects thereof are beyond their control. It allowed me to reflect on my thought process, treatment approaches and the ethical principles when treating a patient with dementia and a visual impairment. In future, I will refrain from the mindset of ‘getting the job done’ and become more empathetic, supportive and compassionate towards my patients in order to improve patient interaction and quality of life.

References
Chavan, U. (2018). Physiotherapy in Dementia. Retrieved 17 August 2019, from https://crimsonpublishers.com/ggs/fulltext/GGS.000581.php

Caregiver (2016). Caregivers guide understanding dementia behaviours. Retrieved 17 August 2019, from https://www.caregiver.org/caregivers-guide-understanding-dementia-behaviors

Fugard, A., & Walder, D. (2000). Township plays (pp. 220-221). Oxford [u.a.]: Oxford University. Press.

Greater Good (2019). Definition of empathy. Retrieved 17 August 2019, from https://greatergood.berkeley.edu/topic/empathy/definition

Health Professionals Council of South Africa (2008). Guideline for good practice in health care professions: seeking patient’s informed consent: the ethical considerations (PDF) (pp. 5-6). Pretoria: The Health Professionals Council of South Africa. Retrieved from https://www.hpcsa.co.za/downloads/conduct_ethics/rules/generic_ethical_rules/booklet_9_informed_consent.pdf