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MONDAY MORNING brought me two new patient referrals to go along with my regular home healthcare visits. Both new patients needed wheelchairs and were ready for physical therapy. While they seemed similar at first glance, once I got to know them, I discovered that they couldn't have been more different.
Mrs. M, an 80-year-old widow, was staying with her daughter while she recovered from knee surgery. When I arrived at her home, she was sitting in a wheelchair. The sparkle in her blue eyes belied the fact that she'd recently had surgery to repair a comminuted patellar fracture.
I introduced myself and put my hand on her shoulder. "How does it feel to be out of the rehab center?" I asked.
Mrs. M covered my hand with her fingers. "I'm tired, honey, but ready to work."
I told her a physical therapist would visit her 3 days a week and set up an exercise program. "That's what I want," she said. "To get back home to my old life."
I smiled. "You have a good attitude. It'll help."
She pointed to a photograph on her dresser. "Those are my kids. The two in the middle live across the country. Elaine and Denise live here in town. The grandkids visit a lot."
Physical assessment demonstrated bilateral lower-extremity weakness and limited range of motion in the affected knee, but she had normal muscle strength in her upper extremities.
My next visit was to Mr. W, 78, who was diagnosed with Parkinson disease (PD) and had recently injured his hip and back in a fall. A wealthy businessman, Mr. W was lying in bed watching TV as I entered the bedroom of his sprawling ranch home.
"Good morning, Mr. W." I extended my hand toward his, noting his gaunt unshaven face and thinning gray hair. A wheelchair occupied one corner of the room.
Mr. W kept his eyes on the Today show. "Not much good about it," he bellowed.
The tremor, rigidity, bradykinesia, and postural instability caused by PD could make rehab challenging.
"I'm going to cancel your agency after today," he said. "I don't need rehab. I have lots of money and can afford to pay for anything I want. That includes someone to push me around in a chair. Rehab is for the birds.
"Until last week, I worked half days in the office. A chauffeur drove me; now he'll take me in a wheelchair. I'll buy a van with a lift. I'm not going to live forever. Why not make the rest of my life easy?"
"Strengthening your muscles will help you walk better and stay independent," I said. "If you don't rehab those muscles now, you'll lose function. It won't be easy to get your strength back later. Give it your best effort for 3 weeks. Then decide."
Mr. W frowned. "You sound like my doctor. But all right."
The following week, I spoke with Mr. W's aide, who told me he was refusing to do his range-of-motion exercises or use his walker. Two days later I made a shared home visit with the physical therapist. Mr. W asked to end the session after 15 minutes.
He turned around in his wheelchair to face me. "I've finished everything in my life worth finishing. I pay for what I need."
My eyes met his. "Some things money just can't buy," I said.
"There's nothing in this world worth having that can't be bought," he replied.
"Let's talk about that," I said. But Mr. W was already wheeling himself out of the room.
As I left Mr. W's house to visit Mrs. M, I thought, Why can't he be more like Mrs. M? She was now walking with a quad cane. If he'd follow his therapist's treatment plan, he'd be up and about too.
Mrs. M moved her arms up and down as she talked with me. "I can't wait to get home. My house is waiting. Lived there 53 years, raised the kids there, and stayed on after my husband died. I miss my kitchen and can still bake the best pies in the world."
"If you go home too soon," I said, "You could have a setback."
"I don't believe in 'ifs'," she replied. "They don't get you anywhere. I learned that when that drunk driver slammed into my car and crushed my knee. If only I'd left the house five minutes earlier...if only this, if only that. All hogwash excuses. Let's practice stair walking. The therapist says once I master steps, I can go home."
Two weeks later Mr. W's aide phoned the agency to tell me that Mr. W had fallen, so I added his name to my afternoon schedule. He was sitting in his wheelchair when I arrived. I noted no injuries from his fall, but after that day, he began to follow the therapist's directions. Three weeks later, his balance and lower-leg strength had improved enough that he could use a walker. "How am I doing?" he asked.
"Wonderful," I said. "There's a big difference from the first day we met."
"The therapist wants me to work on stair climbing, but I don't want to," he said. "I rarely go down to the basement."
"But steps can be found in the most unexpected places," I replied.
"I decide what I need to learn, not you," he snapped. Yet he held on to the basement banister and placed his right leg on the step. "You don't know what it's like to be in my shoes."
"Tell me," I said.
Mr. W took a deep breath. "I'm a failure as a father. When my son used to visit, he'd always ask for money. Never worked a full day in his life, and he's 49. I have more cash than I'll ever spend, and it was simpler to hand the money over. He hasn't visited since I stopped working."
Mr. W took a deep breath. "I want to apologize for the way I talked to you in the beginning. It's been a tough year."
Mr. W sighed. "Since my wife died, I've been a mess. Never thought I'd miss her. We fought so much, mostly over little things. She died of an aneurysm. She was fine when we went to bed. At 4 a.m., she was dead." He wiped his eyes with his shirt-sleeve. "We don't know what we have until we lose it. A good woman's one thing money can't buy. My son's love is another. Add doing things for myself to that list."
Suddenly I realized I'd made a mistake in measuring his progress against Mrs. M, who had a supportive and caring family. Mr. W had to work through his grief and life losses in his own way and at his own pace. My job was to support him on his journey.
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