04 March 2014

With Grief and Trembling

Yesterday morning, just before lunch, a patient was sent to see me.  Under the 'diagnosis' section of my referral form the doctor had written 'intention tremors significantly impairing function, cause unknown.'

Immediately my thoughts went to the overhaul of tests and months of treatment this gentleman would have received if we lived anywhere other than here . . . even after three years of this, I had to take a minute a grieve the imbalance between what could be and what is.  

This man came to me as a last hope, it helps no one if I say 'Well, since you can't spend weeks in a highly specialized neuro unit of a rehab hospital, I can do nothing for you.  Sorry.'  No . . . I was going to have to do something.

One thing I've learned working in this culture is that a broad question will get a broad answer and unless asked directly and pointedly, a Nigerien won't 'burden' someone with all the details.
The more I asked this man, the clearer it became that three years ago he had been in an accident . . . his obvious orthopedic injuries had been treated at a local hospital in the country bordering us to the south, but his slowed speech, decreased attention span, high rate of fatigue, decreased capacity for high level cognitive functions and severe intention tremors were never addressed.

As we talked, I found out that this man was greatly unlike the majority of the patients I see everyday.  He was university educated, had managed a bank in his home town, and has been grieving the loss of the life he loved everyday for the past three years.

Here he was, middle aged, a father of seven . . . who, in a country which does not provide unemployment benefits or social security, has lost his role as 'provider' . . . he is grieving his identity as working man with a prestigious job . . . trying to swallow the loss of independent mobility, needing to be held upright to stand or walk . . . and mourning the great loss of dignity that comes when a grown man cannot feed, bath or dress himself.

As I explored a few treatment options, his deficit of dignity was as palpable as his physical impairments.  And my heart was heavy for him.

It is not that my patients who live miles below the poverty line don't feel this too . . . I know they feel it . . . it's just that they don't normally show it.  But this man did.

Or maybe it's that I can't identify as well with an illiterate onion farmer who lives in a remote village.
Not that my heart isn't full of compassion for illiterate onion farmers . . . quite the contrary.  But those are the patients with whom I empathize . . . this was a man with whom I could identify . . . and in that moment I knew how deeply I would grieve if tomorrow something happened to me that prevented me from ever again being physically or cognitively able to be an Occupational Therapist.

I knew that we couldn't do much for him, but I had to do something . . . because I cannot imagine being out of options . . . I cannot imagine living at the mercy of others, helpless.

We started with walking.  He had a single-point cane that had once kept him mobile . . . but now the tremors were so bad it was impossible for him to line the cane up with the floor, let alone use it for support.  I asked why he still kept it with him, habit, he told me.  I suggested he use it to attack charging donkeys, he smiled and informed me they knew better than to head his way.

Knowing what I do about tremors and joint compression, I thought we'd give a walker a try . . . the hope was as he bore weight through his arms the shaking in his hands would chill out a bit.  He was skeptical, but I assured him I wouldn't let him hit the floor, unless I went first.

He took a deep breath and placed his complete trust in a process he knew very little about.

With B. to his left and me on the right, like a baby fawn he swayed into standing.  His knuckles turned a faint shade of white as he gripped the walker in front of him and allowed his upper body strength to bear down through his shoulders, elbows, wrists and hands.

As he leaned forward onto the walking frame, the trembling slowed and eventually stopped.  He pushed the walker forward and made his way across the the gym . . . independently!

His countenance beamed with renewed hope.

When he had returned to his chair, he said 'You know, I would really like to be able to feed myself again.  Is there anything you can do to help me?'
Giving the hand weight a try.

I poured him a plate of red sand, handed him a spoon, set out a cup on the table and offered for him to give scooping a try.

Sand went everywhere.

I cleaned it up and put it back in the dish.  This time, when I handed him the spoon, I first secured a blood pressure cuff--that we had recycled into a weight--around his wrist.

It was interesting, because both he and B. had experienced the reduction in the degree of his tremors with walking, but yet they both were unsure about this one.  My patient gave me a look that said 'Did you not SEE how badly this went the first time??' and the one from B. made it clear that I'd be cleaning it all up again when he was finished.
Scraps from our new therapy dept uniform stitched
into a wrist weight . . . complete with mini sand bags!
(yes, those are safety pins all over the fabric!!)

'Go ahead, give it a try,' I prodded.

He slowly lifted the spoon . . . .  'IT'S WORKING!' B. exclaimed his disbelief.

I won't lie, there was still sand on the table, but only a light dusting.  Clearly the weight was making a difference.

Not wanting to pawn off my used BP cuffs on this man, I went home and pulled out my little blue trusty sewing machine and whipped up a little something he could take with him.

This man had come to us desperate to receive his life back . . . hopefully a little bit of function will be a better consolation prize than the homemade wrist weight!


Robin said...

a great big WOW!!!!

Gloria said...

Deborah, that was wonderful. So happy for this man.