Defining Moment Proposal Accepted A patient and his rehab team, wedded to a goal. By Matthew Ulmer, PT, DPT | May 2016 Listen to 'Defining Moment' "I want to get down on my knees this week and propose to my girlfriend," Trent announced. I was caught off-guard that Monday morning, and I wasn't sure the goal was achievable within the timeframe. Still, I didn't think twice about responding, "Sure! We'll figure it out." It was exactly what I love most about being a physical therapist (PT) in the inpatient acute care setting. We often help patients achieve things that seemed unlikely or impossible to them in the wake of catastrophic injury. I took Trent's statement as a challenge. I'd do everything I could to help make this happen. On September 26, 2015, Trent had been riding in a truck that left the road, rolled down an embankment and crashed into a ditch after the driver, Trent's friend, dozed off at the wheel. Trent's injuries were extensive. He was diagnosed with paraplegia as a result of an L1 burst fracture—a traumatic spinal injury. He also sustained fractures of the C4, C5, and C6 vertebrae, and underwent cervical fusion and open reduction internal fixation (ORIF) for left femoral, right ulnar, and right radius fractures. He spent about a month at a hospital in Des Moines, Iowa, before being transferred to our rehabilitation hospital in Lincoln, Nebraska. Trent still was in a lot of pain when he came to us. There was nothing typical about his case, even among patients with paraplegia. The multiple fractures, surgeries, and non-weight-bearing status of his right arm complicated his recovery—as did a brachial plexus injury we identified after admission, which affected left deltoid activation. But Trent was a determined patient from day 1, doing everything we asked and never doubting his own capacity for improvement. The initial plan of care focused on decreasing Trent's pain, improving his upright tolerance, and improving his sitting balance given the use of just 1 arm and no noted activation in his legs. We battled through significant nerve pain in Trent's hips and left leg. We tried to keep him focused on the fact that functional tasks would become easier once he was able to use his right arm. His spirits dipped at times, but he never gave in to despair. In fact, he was remarkably focused on envisioning a brighter future. The best illustration of that was the fact that he used a community therapy outing to a shopping mall as an opportunity to purchase a wedding ring for his girlfriend, Tasha, who had been by his side throughout his hospitalization and rehabilitation. That set in motion Trent's proposal announcement on that Monday morning. The next day, the members of Trent's rehab team—including his occupational therapist and me—led him through a trial run in the private treatment room where the proposal was to take place. We practiced the transfer from the wheelchair and the transition to the floor. Trent couldn't sustain the "classic" proposal position (1 knee on the floor) due to pain and hip-flexion range-of-motion restrictions, but he could sustain tall-kneeling (both knees on the floor) for the 10 to 15 minutes we estimated would be necessary for him to get into position and remain there until we got Tasha into the room. The proposal was that Friday, December 4. We were excited to have roles in this romantic story. And we wanted the room to look the part. After a few emails and phone calls, we'd secured enough LED candles and flowers to fill the room. Trent was stunned when he came through the door, repeatedly saying, "I can't believe you did all this for us!" We had brought together his family, several friends, and even the trauma nurse from Des Moines—a 3-hour drive away—who'd facilitated Trent's transition to our facility. When Tasha entered the room, her eyes immediately filled with tears of joy. "Look at this pretty room, and you on the floor!" she exclaimed, looking at Trent. I was right behind him, supporting his hips. To no one's surprise, Tasha said "Yes" when Trent proposed. It's late February as I write this. Trent's right arm at is full weight-bearing, and he's nearing the end of his stay with us. He has purchased a house where he and Tasha will live. They plan to pay down some expenses before they get married. Trent will continue his rehab as an outpatient. His prognosis is good. As his left shoulder continues to gain strength, he may be able to use a manual wheelchair. I expect him to regain some mobility in his legs. That will be a major focus of his continued therapy, with standing and walking being his ultimate goals. I became a PT because we have the opportunity to spend more time and develop closer relationships with patients than do professionals in the other medical fields. I get to interact with patients for 90 minutes a day, over the course of 2 or 3 months. I learn all about them and their families. I identify what challenges and motivates them. I see what makes them laugh, and what makes them cry. I have the privilege of helping them achieve things they never imagined they could when they were in intensive care, sometimes fighting for their lives. That day last December was one I'll always remember. As I stood behind Trent while he proposed to his future wife, I felt as if, together, we'd achieved something special. We'd literally gotten Trent in position to do something he hadn't thought possible a few months earlier. Matthew Ulmer, PT, DPT, is a physical therapist at Madonna Rehabilitation Hospital in Lincoln, Nebraska.