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)

To Hell with Politics, and Happy Nurses Day!

It was a long day at work. Thirteen hours later, my apartment remained just as I’d left it. I placed my empty water bottle and coffee cup on the table and sat down for a moment. A quick scroll through my emails and social media quickly overwhelmed me with news and opinions about the new healthcare bill. Pros, cons, and mostly anger. 

I searched for an unbiased report and skimmed a couple articles. So many opinions. So many numbers. So much money. So much talk.

Votes. Parties. Critics. Supporters. Right. Wrong. Pushing. Blocking. Winning, but someone always losing.

It made my head swirl. As I read, I thought of different people I knew who would be affected—and how they would be affected. I thought of friends and family and patients. There was no perfect win-win situation.

“To hell with politics!” I finally said aloud as I tossed my phone down and stood up to head for the shower. 

When I walked into the bathroom, the sight in the mirror made me smile and then shake my head. My hair was flying in a hundred directions due to repeatedly donning isolation gowns and an N95, a special mask for airborne diseases. I was a mess!

As I pulled my hair out of a ponytail, I thought again of all the politics surrounding healthcare. I looked again at my reflection in the mirror. I was a mess, but it didn’t matter. I care about healthcare laws, but I care more about people. Isn’t this where my mind had naturally wandered when I read these articles, to real live people and how they would fare with these changes?

Today is National Nurses Day. This is what nurses are about: people.

Adobe stock photo

We care about people. We care about people with no insurance and people with insurance, people receiving Medicaid or Medicare and people paying out of pocket. We care about people who are black, white, green, and blue. We care about people who are Democrats and Republicans and everything in between. We care about people who are born in our country and those who came here later in life. We care about people when they take their first breath and when they take their last. Short, tall, heavy, light; two legs, one leg, no legs, five legs! We care about people.

Because we care about people, we care for people when they are sick. This is what sets nurses apart.

In order to care for people, we set our differences aside and form a team (a family, really) that will do whatever it takes to help people recover: dress wounds, give medications, wipe bottoms, start IVs, perform CPR, call doctors, answer phones, and so much more.

Certainly, we have strong political beliefs and opinions, and we know money is a factor. But if we were called today and told, “A disaster has struck and you will not be paid, but people are dying,” our hospitals would be overflowing with help. With nurses. 

As nurses, we care about you! Truly, nursing is an amazing profession. Each nurse makes dozens of sacrifices each shift to care for our patients and for each other. It's quite normal to sacrifice our comfort, our lunch (half) hour, holidays with family, and even our bladders' urges to pee. We do not do what we do for attention or applause (we often encounter more poop than thank-you’s), but we do appreciate knowing others care about us, too! 

To all my nursing friends, thank you. You are brilliant, humble humans. Even though I hope I never have to care for you in the hospital, I care about you!

This National Nurses Week (May 6-12), we invite you to celebrate nurses with us! Take time to thank a nurse or tell them how much you appreciate what they do.

However, regardless of whether or not you appreciate a nurse this week, we still care about you. We will still care for you. It’s who we are as nurses. It’s what we’re about.

Happy National Nurses Day & Nurses Week, friends!

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.

Beyond the Smiles (Part II)

(For Part I, click here.) 

I remember him laying there. The bare white mattress in the Emergency Ward. The blanket stained with sweat and dirt wrapped around his waist. His ribs protruding from his thin, malnourished frame.

I remember him turning onto his side, obviously in pain. I remember his mother standing at the bedside, anxiety and fear written clearly across her face.

A group of American healthcare workers, part of a medical mission team I was working with, flocked around him and hooked up an ancient ECG machine to confirm a diagnosis of pericarditis—a diagnosis for which nothing more could be done in this rural Cambodian hospital. 

As they gathered around the bed adjusting ECG leads and talking among themselves, I stood in the back. Listening, observing, and praying.

I took in a deep breath, and I let it out. This young man was dying. There was nothing we could do about it. With all our knowledge, with all our experience, with all our compassion and good intentions, there was nothing we could do to prevent this man’s suffering and death. 

There was a time when seeing a patient like this young man broke me. It led me on a journey of desperate brokenness and incredible healing. It led me to face truths concerning what I believed about God and myself. Ultimately, it led me to rest in knowing I don’t have to be enough.

This time, as I stood near the patient's bed, everything was different. Outwardly, I was surrounded by Americans, and I was grateful to be with so many whose education and experience exceeded mine. Things had shifted inwardly, too; I found I had courage to reach out to this patient in a way I was too timid to do before but was incredibly important.

When I close my eyes, I am back in the hot, humid, Cambodian Emergency Ward. I breathe in deep, and I choose to rest in this truth: I don’t have to be enough, for Christ is enough. When I stop worrying about how much I can’t do because I am not enough, I hear Jesus’ quiet invitation to sit in His presence, even in the midst of such deep suffering. And I accept. 

I sit in His presence and bring this young man to Him, praying he would know the peace of Jesus’ presence, too. I sit in His presence and bring myself and my broken heart to Him, finding space to grieve and freedom to be sad because when I’m with Jesus, the lie that “I have to be the strong one” crumbles. Jesus is the strong one. I never have to act like I have it all together—because I don’t. Jesus knows this. He's okay with this.

The Americans clear out, and it’s just my dad and me left. With the help of our friend and translator, Dad explains why the American team is there, to teach and work with the local doctors. The patient’s mother looks up tearfully and asks if her son will live.

All our knowledge, all our diagnostic powers, all our education and good intentions—it means nothing in this moment. We have nothing to offer this woman and her son. Nothing except Jesus. So we ask if we can pray, and I reach out my hand to touch this patient’s dirt-smeared blanket and lift him up to Jesus.

And I know in all our heartbreak, in all their heartbreak, Jesus is enough, and He is with us. 

His presence is so strong. It always is, if we'll just acknowledge it. If we'll just accept His invitation and stop our striving to be everything, fix everything, and know everything. Perhaps this is the most important thing I’ve learned about poverty in the past few years. Poverty and suffering highlight our sense of helplessness, and so often our response is to push this uncomfortable feeling down and ignore it or to grit our teeth and take it upon ourselves to eliminate disparities. Yet I’ve found no freedom there. 

No, freedom is found in Jesus' presence, in trust. It's found in trusting God is enough, trusting He cares and is big enough for all the hurts in the world and my grief over poverty and suffering and death, and trusting God is, indeed, good.

He is good. Even when everything around us seems to be wrong and impossible and heart-wrenching and clouded with evil. He is, indeed, good, and He is enough.