11 September 2013

The Gift of Stubbornness

When I was interviewing with SIM back in 2007, they asked me to go to a country I had never heard of and start a therapy department in a village-based hospital on the south side of the Sahara.  I wanted to say 'HECK NO!' but, all my inner people-pleaser could muster at the time was 'Uh . . . why would you want ME to go THERE??'

'Because you're stubborn.'

That was all the answer I was to receive . . . the quality that claimed the number one spot on my Top 10  List of Character Flaws was the entirety of their case.

'Um, isn't that usually in the weakness category . . . you know, What-I-Need-To-Work-On??'  I asked, trying to help them see the folly of what they were suggesting.

'Deb., what we hear in your story is that you are stubborn enough to stick it out in Galmi.'

Well, I don't know how right they were, but as of today, I'm still here.  Not convinced it's because of my mule-like tendencies . . . but I understand now what they were saying.

Stubbornness, when squandered, can be destructive . . . but when it begins to resemble determination, that's when miracles happen.

Let me introduce you to my new friend, L.

L. is 19 years old.  And a while back she had a high fever that left her severely handicapped.

Fast forward two years, and L. was wheeled into my gym.  Her family had heard that Galmi Hospital could help her, and they really wanted her to be able to sit up on her own and maybe do something with her hands.

As I read her short medical history and asked her parents a handful of questions, I sat in front of L., slumped in her wheelchair.

'Hi, how are you today?' I whispered to her as my assistant chatted up her mom hoping to get a little more insight into her story.  I placed my hand on her's as she slowly lifted her head to meet my gaze.

I smiled.

So did she.

As I began to evaluate her physical capacity I noticed that she was desperately trying to engage, despite the rapidity with which she fatigued.  Holding her head upright required all of her energy but she was going to maintain eye contact with me if it cost her everything.

The spark of stubborn determination was in her eyes . . . she hadn't given up, why should I??

'I know you live several hours away, and that you are probably not prepared to stay, but if you are willing, I will work with L. twice a day . . . we can do a one-week trial, if you don't see any progress, you can go home.  However, if you do, and you want to stay, I will continue to work with her until you can't stay any longer.'

L.'s smile widened, revealing all of her teeth as she laughed with joy.  Her father reluctantly agreed.

That afternoon L. came back . . . I transferred her to the treatment mat (thank God she's so skinny or we would have both ended up on the floor) where we began to work on unsupported static sitting balance and tolerance . . . which is really just fancy OT-speak for 'sitting up'.  But L. was too weak and couldn't do it on her own.

With a two year history of an 'anoxic brain injury' I should have known better than to expect any major results . . . we had long missed our 'window of prime opportunity' . . . was I just offering them false hope because I still wrestle with the reality of what I could do in the West and what I can do in Niger??  But then again, Galmi is a place where miracles happen.

Friday was more of the same . . . morning and afternoon, spending over an hour each session working to try to retrain her brain, even in the slightest way.  We stood in the parallel bars, we sat on the mat, we picked up pegs from a board, we even blew bubbles (hey!!  It's good for grasp-release, shoulder/elbow/wrist range-of-motion, respiratory function, core stability, sitting balance . . . the leading choice in low-tech Occupational Therapy sessions world-wide!!).

Around 10:30 on Monday morning, I came back down to the gym from the OR where I had made some plaster splints for a new severely burned patient.  L. was laying on the floor outside my door . . . and since so much of her life happens on the ground level, I took the opportunity to work on transfers.

I got down on the ground with her and pulled her into a low kneeling position.  Based on how our sessions had gone on Thursday and Friday, I expected her to be completely dependent.  Holding her in place, I put myself in the proper position.  Her mom and sister watched, unsure of what I might do next.  I grabbed her weak leg and pulled it forward, bending her hip and knee to ninety degrees of flexion.

'Okay, one-two-three and then we will stand' I said in Hausa . . . or at least, I think that's what I said.

L. slowly lifted her eyes to meet mine.  An enormous smile sprawled across her face.  I took that as my cue: 'Daya . . . biyu . . . UKU!!' I said as we began to stand.

And much to my surprise, she did her part!!

About halfway through our session, she needed to pee, so her mom and sister helped her with her toileting (hey now, fellow OT's, no judging . . . I know it's an ADL, but . . . well . . . it's just more culturally appropriate this way).  As they helped her back into the gym, one under her left arm, the other under the right, L. spoke up.

'I don't . . . want . . . to sit down,' she said.

'I don't understand,' I answered.

'I . . . want . . . to keep . . . standing!  I . . . want . . . to walk!!' she explained.

'Not yet.  We'll maybe get to that when you're stronger,' I insisted, not wanting her to fail too much too soon.

'NNNNO!' she fought back.  'I'm . . . going . . . to walk!'

There is a time to play the I'm-the-Therapist-So-We're-Doing-It-My-Way card . . . only this wasn't it.  I knew she wouldn't be able to 'walk', but she was not going to sit without trying first.

I went to the back room and pulled out a hemi-walker.

We made it seven steps before she was so exhausted her left knee crumpled beneath her.  As I lifted her into the wheelchair, I caught a glimpse of the enormous arc of joy spread out on her face.  Her eyes were glowing with triumph!  For the first time in two years, L. had walked!

She is one of the best parts of my day . . . she relinquishes everything she has in order to keep moving forward . . . and despite needing to be held up or dragged at times, she refuses to give up.

Watching her struggle with such seemingly 'simple' tasks, I cannot help but see parallels in my own life.  The Apostle Paul said it well when he recognized that it is through his inabilities that the Spirit of God takes over and makes the impossible come to fruition: For when I am weak, then I am strong.

How much I have to learn from my new friend who can barely form words or feed herself!


Heidi Hess said...

Deb, what a beautiful story! Thank you for sharing!

Elizabeth Kunkel said...

Oh I have missed a great post from you!!! This was beautiful!!! I will be praying for L!!

Katie said...

It's great to hear what's happening.
Sounds like you could really use a plinth. . . or a physio to help. . . .
The process continues.

Michelle said...

"Resiliency" is what I was told I had. Stubborness/resliency, potAEto/potAHto. Thank you for sharing this bright star with me. Regardless of what happens in the rest of our work, these smiles confirm just why we are here :)

Michelle said...

Resiliency/stubbornness, potAEto/potAHto. "Resiliency" was what I was told I had and would thus be able to make it. Thank you for sharing this star with me. Whatever else happens, it is these smiles that remind us of why we are here :)