28 June 2011

Hands-On (Family) Education

I used to treat a lot of stroke patients during my former life in Philadelphia.  Here, I’ve had one or two.  I see fewer stroke patients here mainly because most of the time the patient doesn’t come to the hospital for a few days or weeks since the onset of symptoms.  And at that point they are considered ‘medically stable’ and are not admitted, but rather sent home with bloodpressure meds.
On the off chance that I am asked to see a patient who’s had a stroke, it’s mainly for family education.  You know, some exercises the family can do with the patient . . . encouraging the patient to use what functional capacity they have . . . safe transfers . . . etc.  It’s often 15 minutes with the family in the doctors’ office.

But today was way more fun than usual.
I was working in the OR office with R. on her typing skills when a nurse came hunting for me.  He had a patient he wanted me to see.  His friend’s father-in-law had suffered a stroke and they wanted help.  The friend is a nurse in a town about an hour from here, so his French was beautiful and he seemed to understand everything I was suggesting.  When I showed them upper-body PNF patterns to do, he even practiced a few times to make sure he got them right.
Just before they were about to leave I had an epiphany: this man lives on the floor.  
‘Does he have a bed?’ I asked.  
‘Oh yes.’  
‘A real bed, that’s high?’  
‘Well, it’s a mattress on the floor.’  
Ah-ha!  I thought.  ‘And a table with chairs?’  
‘So he sits on the floor to eat his meals.’  
‘Yes, on a mat.’  
‘And is there a couch?’  
‘So he sits with his family and friends on a mat on the floor?’  
‘So, it would probably be a good idea for you to know how to help him get up from the floor.’ 
‘Oh, we know how to do that.  We can just pull him up.’  
‘That’s not good for him or you.  Let me show you an easier way.’  
And I said a quick prayer before we started to make sure it really was going to be easier.
I also prayed that my wrap-around zunni would sprout into pants . . . but when that answer quickly came back as a resounding ‘NO!’ I ran to the OR to grab a pair of the scrubs the men wear.  I was sure to choose an extra baggy pair . . . no need to push the envelope too far, all at once.
When I came back into my office wearing pants I could read the looks of worry and regret on all four of the Nigerien faces . . . they were definitely wishing that they had bolted when they could.  Me, I was just happy to have found a good excuse to wear pants in the hospital.
I told them I would show them twice what the old man would do, then twice what the family would do, then they would get to try.
I dropped onto the mattress and began explaining where he should put his hands . . . then knees . . . then roll this way . . . then this hand goes here . . . and that leg goes there . . . and then . . . up we go.  It was like a one-man game of twister.  Only minus the colored dots.  
I demonstrated again, then had the son-in-law get to the floor.  I moved him through the different positions . . . help him place his hands on the floor . . . roll him to his knees by guiding gently on his right shoulder blade and pulling slightly on his left hip . . . have him grab your right shoulder with his left hand, then pull his left knee into a ‘kneeling’ position . . . stand up.  We did this twice and everyone was impressed with how simple it was.
‘But we’re both able-bodied . . . it’s going to be a lot different with your father-in-law.’  He didn’t believe me.
We gently helped the old man to the mattress on the floor.  It took three tries to move him into an ‘all-fours’ position.  The process of getting him into that little-league-baseball-take-a-knee-photo-pose was WAY more complicated.
After half a dozen attempts, I moved in to help the son-in-law.  I imagine from the bird’s-eye-view we all looked as though we were involved in a group-hug-type embrace.  With each try, the old man giggled harder and harder.  Surely this was a first for him.
‘No . . . like this . . . yeah . . . there . . . no . . . your hand has to go here . . . and his leg . . . THERE! . . . and . . . wait . . . nope . . . not there . . . over here . . . and . . . it will be MUCH easier . . . if you . . . and . . .’
As I was mid command-giving-en français I caught a glimpse of something out of the corner of my eye.  I looked up.  There in the doorway were four nurses, staring at me as if I was a side-show.  By the time the old man was back on his feet, there were another three behind them trying to catch a glimpse of the action.  
I’m not sure what was more entertaining . . . watching this family learn how to stand their now-disabled patriarch up from the floor . . . or me, barking my botched French, bear-hugging two Nigerien men, all while wearing dark-jade-green MCHammer pants.


Barb said...

Miss you, Deb!  I will definitely have to spend more time in the hospital watching you, the humor of which sounds very energizing!  After all, laughter is healthy, and we must get that however we can!!!  I admire you and on behalf of the people, I am thankful you are there!  See ya soon!

Deb. said...

You know, I am looking for an assistant!! :)

Seth Montgomery said...

how about an out of practice colleague?

Deb. said...

PT's like riding a bike!

Seth Montgomery said...

that's what they tell me.