Podcast: Listen to 'This Is Why'
For the past 11 years I've worked in the subacute inpatient rehabilitation setting at skilled nursing facilities (SNFs). I very much enjoy helping older adults regain function and mobility post-hospitalization for various conditions and injuries. My first love in physical therapy, however, was orthopedics. So, when a 23-year-old patient arrived at our facility earlier this year after an Achilles tendon-lengthening procedure to correct equinovarus contracture of her ankle, I relished the opportunity to again put on my sports medicine and orthopedic thinking caps and get to work.
This individual—I'll call her Noelle—nearly had died at age 20 when the motorcycle she was driving colliding with a pickup truck. She sustained many injuries, but foremost among them was a traumatic brain injury so severe that physicians had held out little hope of her survival, and had in fact spoken with her family about donating her organs. Before the crash, Noelle had been a straight-A student and a member of the National Honor Society member. She was a gifted musician and a natural leader, and was well on her way to a career in audio engineering and music production.
She has been non-ambulatory and essentially limited to her bed or a wheelchair for the past 2 years, requiring assistance for all transfers, toileting, and, until recently, nearly every activity of daily living.
During her 3 months at our facility, however, Noelle has progressed from being non-weight bearing in a posterior splint and needing assistance from 2 people for transfers, to being non-weight bearing in a short-leg cast, to being full weight bearing with ankle-foot orthoses (AFOs) and shoes. She has learned to ambulate with a walker (with stand-by assistance) and to transfer in her room with modified independence by using grab bars and bed canes. Her surgical wounds have healed and her surgeon has discharged her from his care. Noelle can now dress herself, put on her AFOs and shoes, and needs no assistance to use the bathroom.
While she hasn't yet become independently ambulatory, the potential exists for her eventually to rid herself of her wheelchair—and perhaps, one day, to be free of dependence on any assistive device in order to walk. She has show tremendous desire to progress, and has a strong will to reclaim her life as she had lived it up until the day of the accident.
I've had the honor and pleasure of having been Noelle's primary physical therapist (PT) at our facility. It's been so satisfying to witness her progress, see all the positive changes in her life, and know that I've helped her along the road toward recovery. Noelle's improvement allowed her mother recently to resume her job at her former employer, so now both mother and daughter are getting their lives back on track, and the family has an income stream it had lacked.
As I write these words, Noelle soon will be discharged to a group home, where she will live with other people who are recovering from brain injuries, will receive additional care, and can continue her quest to resume a fully independent life. While I no longer will be her primary PT, I'll be tracking her progress, keeping in touch, and sending positive thoughts her way.
My experience with Noelle these past few months has reinforced everything I love about being a PT. I entered the profession because I wanted to play an important role in empowering people to improve their lives. I wanted to help patients problem-solve around barriers, guide them as they regained function and ability, and, whenever possible, facilitate their move to the next setting, where they could continue to grow.
Don't misunderstand—I cherish my patients who are older adults, and I relish the opportunity I'm given to play a positive role in their lives. But so much of Noelle's life remains ahead of her, and her future looks notably brighter now than it did when she first arrived at our facility and came under my care. What difference-makers we can be! That's why I became a PT.
Tyler B. Smith, PT , is employed at Good Samaritan Society-Eugene Village in Eugene, Oregon.
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