On a cob web afternoon,
In a room full of emptiness
By a freeway I confess
I was lost in the pages of a book full of death;
Reading how we’ll die alone.
And if we’re good we’ll lay to rest,
Anywhere we want to go.

In your house I long to be;
Room by room patiently,
I’ll wait for you there like a stone.
I’ll wait for you there alone.

Extract of lyrics from the song “Like a Stone” by Audioslave.

The first two lines of an old favourite song of mine set the tone and scene of a certain hospital ward during my second block of clinical rotations. The lyrics bleed loneliness and regret –feelings that one particular patient of mine could identify with. More so, the narrator of the song highlights his feelings about death and the afterlife further on in the song. This too is something my patient had been close to due to both internal and external conflicts that had recently occurred in his life. My patient had been referred to see a physiotherapist as a day-1 post-operative below knee amputation due to dry gangrene in his left leg as a result of his poorly managed type two diabetes.

My patient was polite and quiet during our first few sessions. I wasn’t yet aware of the similarities in my patient’s life and the song I have chosen for this assignment. My patient and I engaged in small talk during treatment times. It was strictly professional. My patient then had to go for another operation for an above knee amputation on the same leg due to the onset of infection. Our sessions together changed drastically after his second operation. His cooperation and effort put into sessions declined. I must admit this became frustrating as his assigned physiotherapist, and I did not look forward to attending to him anymore. His reluctance to fully engage and participate during treatment felt as if I was wasting both mine and his time. This led me to schedule his treatment session for the very last possible moment during my clinical hours. This continued until one session when he absolutely refused treatment and would not get out of bed. I tried explaining that I was only trying to help, but he continued to ignore me. It was only then that I acknowledged what a difficult time he must be having, after going through two major surgeries, and that I would understand if he didn’t feel like any physiotherapy for the day. He then asked me something that day that changed change my perspective on treatment moving forward.

His question to me was, “Can we just talk today? There is a ‘therapist’ in ‘physiotherapist’ after all.”

My demeanour and approach changed afterwards. I took a good portion of our session that day to just talk, and more importantly, listen to what my patient had to say. He opened up about recent events in his life. His son was murdered about two months prior to his operation in what was thought to be gang related. My patient added that taunting messages were sent to him after his son’s murder by the same gang members who wanted to further their victim’s family’s pain. This caused great distress in my patient’s life and he admitted these events led him to neglect his health and chronic diabetic medication, something he now deeply regrets. He since became overwhelmed with emotion and began to shed tears, revealing something even more shocking: this was the first time he had cried since the murder of his son. I felt grateful that he felt he could trust me enough with such a personal story, and I was happy I played some part in the processing of his grief. Then we continued on with our treatment plan for the remainder of our time. My patient was genuinely grateful for the first time after our session ended. We made so much more progress together after I had acknowledged his feelings and saw him more than just “Patient X who is day-4 post-op AKA”.

One study notes that patient-centred care, which follows a biopsychosocial perspective, involves understanding the patient’s experience of illness, sharing power and responsibility between the physician and the patient, and developing a relationship based on care, sensitivity, empathy, self-awareness and attention to emotional cues (Pinto, Ferreira & Oliveira, 2012). On hindsight, I did not approach my treatment with this mindsight and ignored multiple emotional cues. This study also notes that the nature of most interventions within physiotherapy is long-term, thus the patient’s adherence to long-term treatment interventions is vital to achieve clinical efficiency. The article concludes in saying that a good therapeutic alliance may help patients to adhere and fully engage in their rehabilitation. I found this very relatable and believe that if I had not allowed my patient to simply talk with his “therapist”, he would not have been discharged to the rehabilitation centre while mobilising independently with a walking frame as well as being more hopeful.

I do believe that both my patient and I worked together to clear his room from the cobwebs and emptiness. This experience has drastically shaped my treatment approach moving forward as a physiotherapy student.

References

Audioslave. (2009). Youtube. Retrieved from

Pinto, R., Ferreira, M., Oliveira, V., Franco, M., Adams, R., Maher, C., & Ferreira, P. (2012). Patient-centred communication is associated with positive therapeutic alliance: a systemic review. Journal of Physiotherapy, 77-87.