Lessons from the Bedside: Physical Therapy and Change

"They are NOT getting me out of this bed. They just make my pain worse."

"Whew! That physical therapist worked me too hard."

"I'm just not up for occupational therapy today." (No matter that the patient was also "not up to it" yesterday, or the day before, or the day before that...)

If you're a nurse, you have no doubt witnessed these scenarios. Though it's easy for me to discount patients' complaints and reluctance to work with PT/OT, I have to admit, I have a lot in common with their attitude—especially when it comes to change.

Currently, I'm in the midst of quite a bit of change. I'm shifting careers, learning new skills in the writing world, and trying to keep up with an ever-changing healthcare system, all on the coattails of moving from Cambodia back to the United States and working through reentry. Change, like physical therapy, is difficult. As I've observed my patients in the hospital over the years, here's what I've learned about both change and physical therapy:

1. It's painful.

Some patients won't move their feet off the bed for PT/OT until they've had their pain medication. I don't really blame them. Retraining your body to stretch and move and function in a new way can be very, very painful. Change and transition can be the same: a season of retraining our bodies, minds, and spirits to try new things, form new habits, and leave the comfort zone of our beds (or homes, or jobs, or cities). Yet just like with therapy, increasing our activity in these uncomfortable areas only increases our strength and ability to thrive in new ways. It may be painful, but it's worth it.

Adobe stock photo

2. It's scary.

"Don't let me fall!!" patients will exclaim when they transfer to the chair or the bedside commode for the first time. Their legs are weak and shaky, or their balance causes them to sway. Yet the therapist is always there, providing support and holding onto them, a trustworthy safeguard even when patients doubt their abilities. Similarly, in times of transition I too am fearful, and I do my fair share of crying out to God, warning Him I'm losing my balance and am going down, fast! How often I forget He is there, holding onto me, supporting me, even if I don't believe He's strong enough to catch me. It can be terrifying to walk when we're weak because there is always the possibility we will fall, but when we take wobbly steps forward, we arrive to new and important places (like the bedside commode! Just kidding. Kind of.). It's scary, but it's worth it.

3. You'll want to quit.

To be honest, sometimes I have a hard time not judging patients for "being babies" about PT/OT.

"I can't go any farther," they state. Or, "I just can't go anymore. I just want to go back to the bed."

As the patient healthcare professionals they are, our physical and occupational therapists encourage the patients to keep going. They remind them of the benefits of therapy, and they point out how far the patients have already come. Still, some patients refuse to keep moving.

Unfortunately, with all my judging of patients, I am the same way when it comes to anything new. New location, new method of transportation, new routine, new job—anything new throws me for a loop, and like a grumpy old woman who's stuck in her ways, I sit and pout and complain that I can't go back to the way things were before. Even if "before" meant I was bed-bound and my muscles were atrophying.

Like most people, I enjoy comfort. Neither getting out of bed to retrain muscles to walk nor getting out of old routines to form new, healthier habits is comfortable. It's hard, and we'll want to quit, but it's worth it.

4. It's a process, and it takes perseverance.

I wish physical therapy only took one session to accomplish all its goals. I wish one day of accepting change completely reformatted my brain to eliminate all anxiety and stress about new things. However, both physical therapy and change involve growth, and growth is a process. Processes require time, and time requires perseverance.

Little by little, cell by cell, muscle fiber by muscle fiber and neuron pathway by neuron pathway, as we persevere our bodies and brains shift.  The old, unusable junk is broken down and rebuilt into a new, healthier, stronger version of ourselves. Over time, we find ourselves able to jump higher and run faster than we did before knee surgery; we find ourselves utilizing stronger character traits of leadership, servanthood, and compassion as we relate to and lead those around us. It doesn't happen overnight; it's a process, and it takes perseverance, but it's worth it.

5. It's possible.

Though I witness many people who, like me, grudgingly swing their legs out of bed to start therapy, I also watch incredibly motivated patients work day in and day out to regain their strength. These patients focus on the positive and rarely complain. Nothing can deter them from finding something to be grateful for—including the opportunity to participate in occupational and physical therapy. Each time a therapist knocks on the door, they never refuse to get up or tell the therapist to come back later. They are willing to move forward in their healing.

Change and growth, whether physical, mental, emotional or spiritual, inevitably involve pain, fear, exasperation, and teeth-gritting perseverance. Change is all of these things, but it's possible. And it's worth it.

"Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will." Romans 12:2 (NIV, bolding mine)

Lessons from the Bedside: Constipation, Oversharing, and Mental Health

No, not oversharing about constipation. As a nurse, is there ever oversharing about bowel movement woes? There's nothing like the feeling after a really good, healthy poop.

Several months ago, I was talking on the phone to a friend from nursing school and was explaining how it's been a long journey learning to process things with others instead of holing them up inside me like a squirrel hoarding nuts for the winter. 

"Sometimes," I told my friend, "I forget to process things and go back to shoving them deep inside and trying to forget about them. It's so unnatural for me to talk about everything and process it. Every time I go to counseling, I have to relearn to open up. The longer I go without consciously processing things, the harder it is to start again."

My friend graciously agreed, and then the perfect analogy popped into my head.

"It's like I get emotionally and mentally constipated," I decided. "And sometimes it gets so bad it's impacted, and I need an enema to get things going again..."

Too cute. I couldn't resist. (Stock photo from Adobe)

Thank God for nursing friends who, rather than being grossed out, laugh richly and loudly at these kinds of things. In fact, I'm pretty sure she even said she was a big fan of the analogy. Nursing friends. They are wonderful.

Like bowel movements, everything in life flows a little easier when we regularly practice owning and processing emotions, events, and struggles in life. The longer we push the need aside, the tougher it is to begin. When I was a child, I spoke so few words I could remember everything I said to everyone and when I said it. Naturally, I figured everyone else was the same way and wondered why some people would tell me the same stories over and over again. I genuinely believed they were intentionally telling me the story for the fifth time because they thought I needed to hear it five times. I didn't realize until much later it was possible to talk so much you actually forgot what you said and to whom you said it! Though I have since conformed and routinely have more conversations than I can recall, it's still not my natural bent to process life out loud. It's taken a long, long time to develop this habit that's so easy for other.

Of note, conversely, some face the challenge of oversharing and lacking boundaries (the opposite of constipation would be "the runs"). This, as you can imagine, can get really messy, really fast. The nurses who are reading this know what I'm talking about. Sometimes we walk into rooms and have to wonder: "How in the world did they get stool in that spot??"

Sometimes, life gets a little crazy and our ability to process life gets put on hold. Traumas or deaths or major life events alter our habits, and in those times all we can do is lean on each other. We turn to each other the best we can, give supportive care, and clean up the messes as they come. From my own experience, I know we often feel ashamed and judged for our involuntary reactions when life overwhelms us. There was a season after returning from working in a Cambodian hospital I broke down every few hours and breaks between classes were spent in the nursing building's chapel crying. I was embarrassed, but I didn't have to be. Sometimes we lose control. It's temporary, and it's okay.

Unlike bowel movements, learning to share appropriately—enough, regularly, and with boundaries—is a trial and error process. It's one I'm constantly challenged by and one I think we will all continually be adjusting and tweaking throughout our lifetimes.

So I'll keep trying and tweaking. A little daily stool softener like Colace may resemble a phone call to my best friend or a journal entry spilling my thoughts. A little laxative like lactulose or milk of magnesia may take the form of a therapy session. A little antidiarrheal like Imodium may look like the restraint not to tell that person my deepest fears or post a blog about a wound that hasn't yet healed.

The analogies could keep going and going, but the main point is this: we all get a little constipated or have diarrhea mentally and emotionally, and this is okay. Health is the goal, because we all know it's true:

There's nothing like the feeling after a really good, healthy poop.

Lessons from the Bedside: Life After [a Patient's] Death

Recently I took care of a patient who died.

The patient went quickly and without pain, but for some reason the death shook me more than usual. The next day, I found out a different patient had decided to go hospice. At home in my bed, I cried as I thought about how I'd gotten to know these dear people, and how their lives had or were coming to an end. Not in a painful or sudden or traumatic way, but coming to an end nonetheless.

Admittedly, lately I've been working extra shifts at the hospital and have been slightly overwhelmed by nursing in general, and maybe that's why these deaths seemed to affect me more than usual. Saddened by the loss of life, I sat in my bed begging my body to fall asleep while tears slid down my face. Sickness, sickness, death, sickness. Though I love my patients dearly, I was worn out.

Stock photo from Adobe

All I wanted was to help people succeed. It's what gives me the most fulfillment and satisfaction in life. In high school, I played competitive soccer. I only scored once the entire time I played, and the one time was sort of a fluke! I didn't care, though. My favorite position was center mid-field, where I could receive the ball from our defense, take it up field, and set up a scoring opportunity for our forwards. I may have scored only one goal myself, but I couldn't keep track of my assists. When I could create space on the field and send the perfect pass—just the right position, speed, and timing—for a goal, I was just as thrilled as if I had scored myself. Their success was my success. Nothing brought me more joy.

These setups for success were the kind of work I wanted to do every day, and working in a hospital, staring sickness and death in the eye every day, felt like just the opposite.

These thoughts swirled in my brain the next day as I drove around town after dropping by the hospital to say goodbye to our now-hospice patient. I cried in the car, and I told God I was sad, and I questioned what role I had as a nurse in helping others succeed.

In the car at a stoplight, tears slipping down my face, I wondered. I wondered if I had a limited view of success. I wondered if to the patient and to God, success didn't mean staying on this earth. I wondered if it meant them crossing over into eternity and feeling His embrace. I wondered if being one of the last faces someone sees, one of the last hands they hold, one of the last voices to say a prayer for them on this earth—I wondered if this was helping them succeed in moving to the next place they were meant to be, the place we were really all made to be: the presence of the Most High God.

This realization crushed me. I wept like a baby at that stoplight, and I can't help but cry a little now as I remember that sweet moment. We can only see part of the soccer field, and perhaps sitting with someone at the end of life is akin to assisting them with the most epic goal of their existence, the moment they see God face to face.

To be frank, though this perspective helps me process the experiences of this week, it doesn't make death any easier. It doesn't mean I won't cry the next time I have a patient who dies or who make the difficult decision to go hospice. It's easy for others to remind me it's special and important work to care for people in their last months, days, and moments, just like it's easy for others to tell me my work as a bedside nurse is honorable and impactful. Speaking or hearing these words is not the same as living out the moments at the bedside. People like to say nursing is a calling, but even if it is a calling for some, it's still a job. There is still the wear and tear of cleanups, medications, assessments, the moment-by-moment deepening of relationship between nurse and patient in every interaction, and the moment-by-moment decisions and realizations a patient is declining. The sweetness of helping someone succeed does not remove the deep sorrow of death.

Yet, I am thankful there is sweetness and not only sorrow.

Today, I'll keep hoping. Hoping for what's to come, for the day we'll all be on the other side of death, when there will be no more sorrow, only the sweetness of the presence of Jesus. Yet until then, I'll keep praying, and I'll keep crying. And I'll keep doing my best to be a part of the setup for success.