Defining Moment Fulfillment at the Finish Line A patient's inspiring determination. By Julie Coté, PT, MPT | December 2017 Listen to 'Defining Moment' I'm reminded every day that life can change in a single moment, and that recovery requires persistence and courage. I've worked in an outpatient rehabilitation setting in Philadelphia for the past 16 years with young survivors of stroke, spinal cord injury, amputation, and unlikely accidents. Having previously worked in geriatric settings, this was a big adjustment. Being the last stop in the rehab continuum for a young clientele carries great responsibility. One of the hardest things about outpatient rehab is working with young patients who find themselves in catastrophic situations. How can we help them not only regain mobility but also connect the dots from their old life to a new one? How can we help them gain the skills to reclaim their roles as parents, young professionals, and athletes? Sometimes it seems that the nicest people are handed the most unfair circumstances. Living through the emotional journey with them can be a heavy burden for any caregiver. Yet we witness every day how the worst of situations can bring out the best in people—in the patients themselves and in their supportive family and friends. Thinking back, a particular patient provided the greatest inspiration on my career. Jessica Cappella, an intensive-care nurse, was in her mid-30s—my age at the time—and, like me, was a young mother. She was in the best shape of her life when she suddenly began to lose strength in both legs. As a neuro nurse, it hit close to home when a tumor was found on her spinal cord. She expected to wake from surgery with her mobility restored. Instead, her worst nightmare was realized. She couldn't move her right leg at all. She came to our facility in a manual wheelchair, able to walk only very short distances with a wide-based quad cane, and with the worst compensatory gait you could imagine. While she was fighting for her own recovery, she was caring for 2 sons, 1 of whom has a significant developmental disability. We worked for several months on ambulation, with bilateral forearm crutches and a long leg brace to give her a reciprocal gait pattern. Much to everyone's disappointment, however, her right leg remained very weak. Jess, who previously exercised almost daily, deeply missed working out as she had before her spinal cord injury. She grieved the many ways in which her life had changed. She was forced to resign from her beloved job because being on her feet for a full shift was physically challenging and produced significant low back pain. Fortunately, she had incredible support from her family and friends. Early in her therapy, either her parents or her in-laws accompanied her on visits and were there to cheer her on. Soon, she got back on the road again, with a left-sided driver's pedal, and was able to drive herself to physical therapy. A few years later, good friends gave her a completed entry form to the Queen of the Hill sprint triathlon as a Christmas gift. At that time, she thought they were kidding. She never dreamed she would be able to compete in any race, let alone a triathlon. The Queen of the Hill event, organized by the Mullica Hill Tri Club in southern New Jersey, provides a supportive environment for female athletes of all ages. Jess's girlfriends recognized that she needed to do something positive for herself. They not only helped her train but also entered themselves as a team in order to provide her with a buddy for each leg of the race—a quarter-mile swim, a 10-mile bike ride, and a 5-kilometer run. The plan was for her to complete the run in a sports wheelchair, which no participant in the Queen of the Hill had done before. Preparing for the event gave Jess a newfound focus, as it required both mental and physical stamina. Training 7 days a week not only was challenging, but it required a fair degree of problem-solving. Because her right leg provides her with little power, she placed a children's floatie on her right ankle so that her leg didn't sink as she swam. Her husband built an extended bike pedal to support her right leg and allow her to cycle primarily with the left one. Jess knew that the wheelchair portion of the race would be the most challenging for her, as she had tremendous back pain whenever she leaned forward to push. Accordingly, her best friend held an online fundraiser to buy Jess a new lightweight sports chair. Nothing makes a physical therapist's day like watching a former rehab patient transform into a strong, competitive athlete. On the day of the triathlon, there was no place I'd rather have been than on the sidelines, cheering Jess on. As she whizzed by me on her bike, I heard 1 of the course directors ask, "Hey, didn't we just see that girl on crutches?" That day, I met many of Jess's friends and family members, all wearing "Cappella's Crew'" T-shirts. The slogan on the back was "Could, Would, Should, DID." Even that all-caps "DID" was an understatement, given Jess's performance: She placed 27th out of 400 entrants, completing the event in 1:17:13 with the use of only 3 limbs! When she crossed the finish line, she beamed with pride and accomplishment. Her mother shed happy tears and mouthed the words, "She did it." Another friend exclaimed that "Beast" was the only word that adequately described Jess's tenacity. As physical therapists, we seldom witness the glory of what typically comes much later in our patients' recovery process, after our time with them has ended. The pride in Jessica's eyes as she crossed the finish line revealed a renewed individual and a stronger athlete, both physically and emotionally. Watching Jess complete that triathlon was the single proudest moment of my career—a remarkable reminder of what our patients can achieve. Julie Coté, PT, MPT, treats patients at Magee Riverfront, an outpatient rehabilitation facility in Philadelphia, Pennsylvania. She is a board-certified clinical specialist in orthopaedic physical therapy and a certified orthopaedic manual therapist.