Tuesday, October 28, 2014

Tough Love and a Cranky Old Man

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I met Huey when he attended his mom's care conference. Mom was the patient, and we were having a tough love talk with Huey and his wife about the fact that his 90-plus year old mom was cutting off all attempts to work with therapy, including treatments scheduled with the most skilled and motivating therapists. She would simply not engage! She wanted to die...

During the conversation about discharge planning from therapy, Huey began to talk about their home. Mom, Huey and his wife lived together in a home they had purchased within the last year that had multiple flights of stairs. Huey stated that even he was having trouble getting up and down the stairs. There was no way he and the wife could take care of Mom.

Aging in place is another topic for another day, isn't it? Suffice to say, it looked at that point nearly impossible that Mom would return home.

About two weeks after that care conference, the daily list of expected admissions included Huey's name. He had fallen down the steps in his house and broken his hip.
I'll keep the story short. Huey exhibited several weeks of behavior very similar to Mom. He was one of the more challenging patients I had seen in a while, demanding that he stay in bed, that people bring him the bed pan instead of getting up to go to the bathroom, and that he should not have to stay dressed during the day, preferring to lay unclothed in the bed with a light sheet over him and hitting the call light frequently.

We made slow but steady progress. He challenged most attempts to progress his independence. The first ripple occurred when he was repositioned into a new wheelchair without a legrest to encourage self propulsion with his non-affected leg. The second ripple turned into a small wave when he was encouraged to be on a schedule to be out of bed and sitting up to enhance his activity tolerance between therapy sessions. The last ripple caused a hurricane when, after he was independent enough to get in and out of bed with supervision, I discussed with him the need to pull the trapeze, which he had been using to go from supine to sit (laying down to sitting up).

It was if the world was collapsing. Huey was furious with me. It was at this point that I recognized that I would no longer be effective with him. I switched out with an equally strong OT who would continue the Plan of Care to get Huey as independent as he could be.

For weeks after this event, Huey glared at me when we passed in the halls. He was not one to forgive and forget. He did quickly, however, become modified independent getting in and out of bed with a quarter-rail and later progressed to independence without it.

Huey discharged home a couple weeks after Mom. Yes, Mom rallied and went home walking with a walker and modified independent going up and down stairs. When she returned with Huey's daughter to escort Huey home, she had progressed to a cane.


We don't always know what is going to happen with our patients.
Sometimes they surprise us!

Remember the CarFit event I mentioned a couple blog entries ago? Huey and his wife attended. It was quite a pleasant reunion of a number of rehab graduates. Huey came in to the rehab department after his CarFit Checklist was complete, said hello to his former therapists and grabbed some refreshments. As he walked out of the rehab department to get in his car, he turned to me. 

He gave me a hug, and his words surprised me,

"I can still remember how angry I was at you when you had that trapeze pulled." He started laughing. "I was furious! But I'll tell you what. There's no way I could be getting in and out of bed as well at home if you hadn't done what you did. I just want to say thank you."


Tough love can pay off.

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