Tuesday, February 02, 2016

One of those patient encounters you never forget

The time: afternoon, typical work day, 1994. I had opened my first ever solo practice a few months earlier. It was autumn. My practice was still slow, still building. Even when it was busy, I had it organized so that I only ever saw one person at a time. This was completely against all ordinary practice in PT at the time, in that province.
The place: my work space, a quiet large airy office, upstairs in a busy funky artsy retail neighbourhood in Vancouver. It was a large room with a desk at one end and a screened off treatment bed closer to the windows, which faced west.
Dappled afternoon light beamed in.
For a change.
I mean, it was Vancouver. The only time the sun ever comes out there, usually, is just for a few hours before it slides into the ocean for the night.
The guy: He was a Middle Eastern refugee, sent by a doctor. I actually can remember his name, which is unusual for me and an indication of how our encounter left a groove deep in my brain, but to protect his identity I won't reveal it. He was in his thirties. I can't imagine what he'd been through in his life. We never got into it.
His situation: He could speak English very well. He had been in the country for only a few months. He told me he had arm pain, so bad he couldn't move it. He was visibly anxious and cradled his left arm carefully with his right. He said that a couple weeks earlier he was getting off a bus through the rear door. The bus driver had closed the door on his arm, and then started to drive off. He was dragged a few feet. Ever since then, he had not been able to move his arm, or sleep very well, because, pain. The doctor had told him nothing was broken inside his arm. The doctor had told him to come to see me. Earlier that year I had visited doctors and told them I was a manual physiotherapist who treated pain. The doctor who had sent him had taken a chance. A welcome chance, because I needed referrals.
The treatment: I did not have the faintest clue what to do. I told him I wouldn't hurt him, that I wanted to feel his arm. Assessing it was impossible, as he could not move it voluntarily. He was apprehensive, but agreed. I invited him to lie down on his back on the table. I carefully slid my hands under and around his arm. I don't even know what I thought I would accomplish. I guess I must have been thinking I would assess to see if he had passive range available. But before I could even start, the guy started sobbing. Out loud. Hard. Body shaking. Head lifting. Abs contracting. I froze, his arm still suspended by my hands, not even off the table yet. Everything in his body shook violently with his sobs, yet his arm stayed perfectly still, and I stood perfectly still, holding it gently, trying to figure out if I was hurting him somehow, and deciding no, I was not, best to wait until the storm cleared.
He went on with this for what seemed like an hour, but was probably just a couple minutes.
He stopped sobbing just as abruptly as he had begun. He looked surprised, and said, it feels better.
Really? I asked? Really, he said. He sat up, and, remarkably to me, moved his arm all around as though he had never had any pain at all. He smiled. Thank you, he said. For what? I wondered to myself, as I smiled back.
That was it.
Aftermath: I saw him about a year later as we crossed the same street in different directions. He recognized me, smiled and moved his arm all around at me. I smiled back.
It was the easiest treatment I ever gave but has been the absolute hardest to figure out. And it's been 22 years. Clearly all the drama, pain, angst and all its resolution was inside his own nervous system. My role was so vanishingly small it amounted to nothing.
Probably all we ever are is catalyst no matter how we like to imagine we possess technical prowess and skill. When kindling is ready to burn it practically self-ignites. When it's wet, it needs to be blown on for awhile. And lots of manual therapy is nothing but a lot of hot air.

1 comment:

Amitava said...

Wonderful example of how much of manual therapy (and human interaction) remain a mystery, and how we tarnish it with fantastical explanations.