On my last prac I treated a patient (Mrs S) following a fall at her hostel. She had advancing dementia. Previously she had been mobilising independently at her hostel. She was required to walk 50m independently to return to the hostel. As a result my treatment was based on walking to meet this goal.
The first 2 days, despite some difficulty transferring, she managed to between 30 and 50m with her 4WW and some assistance. Things were looking to be improving and I felt that in about a week or two with some intense physiotherapy, she might be able to get to the magic 50m mark. However after the weekend things had started to go backwards. She wasn’t able to mobilise at the standard she had been. Despite my best efforts to continue her mobility, as the week passed she progressively declined to a stage where she required hoist transfers, appeared asleep most of the time and resisted all oral intake and medications. During the final stages Mrs S was in bed all the time, shaking and on doses of morphine as requested by family to keep her comfortable, which also knocked her out fairly well. Finally she was transferred to a nursing home for what I would assume to be palliative care.
It was annoying for me, to have had her going along the right track and a few days later for her to revert to total dependence. I was getting frustrated about her lack of progress, despite my best interventions and trying to think of what I could be missing (in terms of my intervention) to get her back on track. Toward the end of her stay however, it was clear that she probably wouldn’t get better and that her time (to pass away) was soon.
I think that whilst in university we are totally focused on learning specific techniques to rehabilitate a patient back to their previous functional ability. From this experience it is clear to me that there will be patients, in any area, that will just not get better regardless of our efforts. At the same time, as a physiotherapist, being able to distance myself emotionally from any given circumstance is going to be important throughout my career. I believe that this situation had the potential to play on my mind outside of working hours – luckily, I found that it didn’t.
2 comments:
I agree.
I had a similar case like yours in my last placement.
The patient (late 80's) admitted hospital due to pneumonia on top of COPD and asthma, and he was middle stage of dimentia. This patient was not exactly my patient and I was following one of the fill-in physio on the day. The physio knew this patient from a week before and I was told that he was doing really good in terms of gait (~50m w/ WZF) and exercises.
As soon as we walked into his room, I was told he looked totally different person compare to him before. He looked uncomfortably lying in his bed shaking whole body and we were told not to touch him at all with unclear voice. There were two family members beside his bed giving us anxious look, like 'why trying to get him up?'. We were informed by them that he was like this since 1/7 ago. The physio explained what we were trying to do, but they were still unhappy. I hardly could believe what happened to him in one day. In shortly, he ended up in high-care facility.
I think we all need to understand that it happens sometimes no matter how well our patients are doing with our interventions. At the same time, it is still hard to accept the reality as well.
I had a similar experience on my 1st placement which was gerontology.
Although we identify problems and aim at treating them the best we can sometimes despite our best efforts patients don't seem to respond which can be frustrating.
If we are doing all we can to try and assist someone and they are not improving due to some kind of factor(s) i think we just need to identify these type of patients and not think it's due to some kind of inadequate treatment. If we are doing everything in our power to help i think that's all we can do.
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