 |
| Accepting what is, July 2010 |
Joy hates me. I can tell by the evil stink-eye she gives me when I walk by her and the other patients smoking under the NO SMOKING sign at the entrance of the hospital. She had a massive stroke on the left side of her brain and likely has some brain damage that decreases her ability to suppress noxious emotions. This is the little voice in our heads that keep us from telling the loudmouth repair man that he has an stupid haircut and his breath smells like regurgitated herring. The pickled kind.
It's also possible that she is scared out of her wits and anger is her fight or flight way of dealing with it. In any case, Joy has me struggling tonight. I decided to try the tough guy routine today and confront her anger with some Bruce Willis. She has a profound aphasia with some automatic speech and it seems like she understands me (she won't let me test her, but she responds appropriately to most of what I say to her). Her reaction to my clinical schtick was to tell me to f**k off (swearing is often the only thing that works well with aphasia) and then she rolled her wheelchair towards me in a threatening manner. I stared her down and was glad that I chose her paralyzed side to sit on so she couldn't reach out and smack me. I told her how awesome her speech was when she told me to f**k off and maybe we could do some therapy to help her say more things ... nicer things. She backed off with the wheelchair, but she didn't fall for my cheap praise. I won the pissing contest, but I lost any chance for us to find a way to work together.
She asked me to leave with a sweeping gesture towards the door. I told her I wasn't going to because she was in MY hospital and I had a job to do. If she was at home then she could tell me leave. I made a point of staying in her room and looking at her photo album as if I was enjoying a pleasant visit with an unwell aunt. I was really telling her I didn't care about her and her wishes. I was treating her like a prisoner and not a patient. I was telling her I was there to help with my words, but my actions were those of a bully telling her she has not only lost her speech, language, arm, and leg, but she has also lost the right to be respected as a person. She doesn't want therapy -- even if she needs it terribly -- and I can't bully her into working with me. What am I going to do? Show her pictures of food and withhold her cigarettes until she points to them on command?
Dominance is not the way to effective therapy. Collaboration is. I should have to let her come to me and if she didn't ... well, it wasn't meant to happen.
As a professional health-care giver we want to help our clients. ALL of them must be cured. And if someone doesn't want our help, then we often believe we have to find a way to cajole, trick, or ... bully them into doing what we want them to do. The myth is that there is a therapy trick to make every client comply with our wishes.
After ten years of practice I think I finally understand (and accept) that I'm not going to help them all and it's not because I'm lacking skill or special goodness. I can only do what I can do. That doesn't mean I won't keep sharpening my clinical skills and making a sincere effort, I just won't push past the place where pushing won't help. "Never say never" is a cliché for failing empires.
-----
4 comments:
You cannot help anyone who does not wish to help themselves. Whether she is too proud to let you in or she has resigned herself to her fate, the choice rests with her. You can only do your best to reach out to her.
Well said, well thought, well done. It's good to hear from you.
Two stories come to mind after reading this excellent post.
Pam,a lady I live with,who is nearly 90yrs old,very ' with it ' mentally,still drives and hosts diner parties,is terrified of having a stroke.Pam has made me a witness to a document expressing her wish,that in the event she suffers a stroke,all treatment be withheld.In fact this request covers all serious illnesses,as she does not want to be kept alive.
A copy of this document is in her medical notes,held by our GP.This document was drawn up when she was only in her 60s,she is adamant that these wishes are upheld.
The second story is about Kate,a lady in her 70s,she did not have a stroke,but suffered dementia.
Kate,swore like a trooper at us and physically attacked us on a daily basis.
Kate was an addict to snuff,the Matron would buy tins of snuff and keep it in the office,the staff had
a key and could use the snuff as a bribe to get kate bathed,dressed,fed,etc.It was the only thing that would make her comply to what was required of her,if we did not have it she would bite and scratch us.
As mere humans ,however well intentioned,we can only help where help is needed or wanted.Your difficulty is that you do not know if your help is wanted or not,this lady is unable to communicate sensibly,because of her stroke,she may be like Aunty Pam,or she could just be stubborn ,like Kate.
Good luck,you sound as if you need it.
i think you're right to say that you can't help everyone - but that doesn't mean you shouldn't try
Maybe you could try a subtler approach - less direct?
Post a Comment