Thought that title would catch your eyes :)
On my cardio clinic we're dealing with a lot of people that are coming in with exacerbation of COPD, and stuff like end stage emphysema. So pretty much people that are really not well. A problem that I've been finding a bit hard to deal with is being in there with a patient and clearing their chest or what have you and knowing or at least feeling that your looking at a person that is on their way out. Or even worse patients that keep saying how they hope they don't wake up in the morning or that they wish they could die. Kinda hard to encourage someone that wants to be dead or someone that looks like they'll be dead in a matter of days.
A pt Claire and I went in to see the other day. Looked at his notes, he had a bad liver prognosis, but it didn't look too bad. So we go in with our happy faces on to get him up and out of bed. We get in there and he says 'I'm sure physio is good for you. But after just being told that there is nothing more they can do for you, and that you have 3 cancers eating away at your body, I don't feel like doing anything please.'
I think that physios by nature are very caring people who truly care about the what happens to their patients. Much like any other health care professional who's not in it for the money :)
So I guess my question is how do you do you present that caring side even when the patient is on their way out?
Ps 1 of my patients died today. Not while I was seeing him though. And another one who took for a walk liked like he was on his last leg when he sat down for a break, and was shaking and crying and not looking in a good way.
2 comments:
I agree with you Calvin that it’s a very difficult thing to try to motivate people who have just been told that their prognosis is not good. A patient on my ward was told last week that her cancer had spread and that there was nothing more the doctors could do. I can’t imagine the grief and the helplessness this patient must feel. She is a mother with a young family who now has to deal with all sorts of issues I can’t even begin to comprehend. In palliative care, all you can do is encourage physio treatment in the hopes that it will make her ADL’s easier, but if the patient chooses not to continue with treatment, in the end it is their decision. My patient chose to forgo physio treatment and discharged herself to spend her final days at home. Sometimes you have to try to put yourself in the patient’s position and think about what would be most important to you during the end of your life.
I feel that as a physio, you always need to present that caring side. On top of that, you also need to be very respectful of the patient’s wishes. I think our Curtin program was pretty good at teaching us to separate our true self and our physio self. Between 8am-4pm, Monday to Friday, I am being my physio myself. I try to act professionally at all times and always act in the best interest of the patient. I find that turning my ‘physio face’ on helps me not only with being a better physio, but also helps me to deal with the issue of death and dying. It allows me to distance myself and leave physio related problems in the hospital or clinic. If I was unable to do this, I would eventually be crippled by the accumulation of sorrow and suffering. I was fairly lucky in that I had mostly optimistic patients on my cardio placement (or perhaps this is possibly related to my positive outlook).
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