16 September 2014

Three Therapists in One: A New Meaning to the Holistic Approach

One of the hardest-but-at-the-same-time-best parts of my job, professionally speaking, is the necessity to be a full-service therapist.  That would be an OT, PT and Speech Therapist all rolled into one . . . although, I'm pretty sure that's not what they mean when they say OT comes from the 'holistic approach'.

My work with S. is the perfect example of this.

S. survived tetanus, a horrific disease that caused all of her muscles to become rigid, including those required for swallowing and breathing . . . two functions necessary for survival.  Which is why I was consulted: chest PT for her aspiration pneumonia and speech therapy for swallowing.

When I went to see her last Monday for our session, she told me that she didn't like me and I should just leave her to die.

Her mother had given up hope and was already beginning to grieve.  S. had lost her will to live and had resigned herself that healing was not possible.

She had survived tetanus . . . but I couldn't accept the thought of her starving or choking to death.

So we began working together several times a day . . . sitting up at the edge of the bed mostly.  She had very poor endurance, nearly no activity tolerance and was incapable of volitionally moving her own limbs . . . on top of that, she made it very clear how she felt about me.  

But we kept going.

Within a few days S. was able to move into a regular hospital bed.  I brought her a chair for the bedside so that we could keep her from spending all of her time laying down.  At first she was a dead-lift from the bed to the chair, and could only tolerate being upright for a few minutes . . . leaving her to sit in the chair wasn't an option, as our chairs are crap and the slightest nose or movement that would startle her would cause her whole body to extend rigidly like a board--hard to sit in a crappy chair if you can't bend in half.

Every morning she was the first patient I'd see--out of bed, into the chair.  I'd sit on a stool facing her, making sure she didn't lose her balance and we'd make funny faces at each other--I mean, do Speech Therapy exercises.

Over the week she was able to semi-wash herself and contribute a little more as she sat up in bed and moved to the chair.  She started to take a few side steps.  But the biggest improvement was her oral ability.

Swallowing is an essential part of life.  The swallowing mechanism isn't just for transporting food from the mouth to the stomach . . . if the system is impaired, it can have fatal consequences.  Swallowing is a protective response; it keeps saliva (and food/water/etc) from entering the lungs. IT IS A NECESSARY FUNCTION FOR LIVING!

Day after day, S. wiggled and contorted her lips and tongue . . . all the while begging that we remove the NGTube.  Whenever we came to the 'smile' exercise, she'd stretch her lips, but nothing that remotely resembled a smile.  I tried to make her laugh . . . nothing.  She simply would not enjoy anything about this process.

On Friday of last week, she refused to sit in the chair during our morning session.  Knowing she would do the same with her Speech Therapy if I forced the issue, I made her promise that we'd stand and move in the afternoon.

I returned a few hours later to find her already at the edge of the bed.  I got into position to help her transfer, counted to three and started to stand her up.  Only, S. didn't stand.  She didn't even make an attempt!

I leaned back, looked her in the eye and said 'You're going to make me work for this, aren't you?'

A great big you-better-believe-it smile spread across her face!

On Saturday, S. didn't want to do her Speech Therapy exercises.  There were too many people in the room, staring.  She was embarrassed.

I knew I had to act quick or I wasn't going to get her to work . . . so I decided to make her laugh.

'Okay, stick out your bottom lip and lift it over your top lip toward your nose,' I instructed.

'I can't,' she said stubbornly.

'Do you know why I can do that so much better than you?'

She furrowed her eyebrows at me.

'Because when God made me, He forgot to give me a top lip!  Watch this . . . now you see it, now you don't!'  (For you who don't know me personally, I have very thin lips, and when I smile the top one disappears.)

S. watched closely as I smiled, stretching my top lip so thin it was practically gone.  It was just what she needed to crack.

Laughter all around!

Yesterday we pulled her NGTube . . . since she was able to begin swallowing foods like guavasauce and tuwo (millet dumplings).  Today I've let her start sipping water and milk.

And then, this morning, another miracle happened.  S. sat herself up in bed!  But it gets even better!!  She then stood up and walked!!  With help of course, but she went ~10 feet, three times!  The whole patient ward cheered as she strutted her stuff!!  And then we had to celebrate with a little dance!

In one week, we went from 'I DON'T LIKE YOU . . . LET ME DIE!' to dancing down the aisle of the overflow medical ward!

And to think what we might actually be able to accomplish if we had real Physical Therapists and Speech and Language Pathologists!!

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