Letting go

To me the hardest part of being a physiotherapist is the fact that your patient can die at any moment. You meet different types of patients, each with their own history, social struggles and personal difficulties. Being a physiotherapist does not mean you only provide physiotherapy to each patient. You build a relationship of trust between you and your patient. You become their ear to listen to all their difficulties, their shoulders to carry them through their hardship and their friend to love and care for them. In some cases you have the privilege to make an immense change in their life and in other cases you stand next to them while they take their last breath.

My patient, a 56 year old male with a history of alcohol abuse, was admitted with severe paralysis of all his extremities. Initially the medical team thought he had a CVA, but the patient got weaker by the day. Eventually tests indicated that he had stage 4 brain and lung cancer. The patient was then placed under palliative care and all medical interventions were ceased. By that time I already formed such a close relationship with him. His whole face brightened up when I arrived each day. The majority of the time he was feeling too weak to do anything. He however enjoyed to sit over the edge of the bed, but he was unable to do it independently. Each time when he saw my face he immediately asked if I am going to help him to sit again. To me sitting is such a ordinary thing, but for my patient it meant the world to him.

The following song reminded me so much of my patient:

According to Huffman and Stern (2003) competence, concern, comfort and communication are essential characteristics to care for a terminally ill patient. Competent health care practitioners make use of their skills to aid in pain control, to treat the patient’s co-morbidities as well as to treat their psychiatric conditions in order to comfort their patients (Huffman & Stern, 2003). According to Ellershaw (2003) health care practitioners should do regular observations to ensure good symptom control maintenance such as pain and agitation. Empathy and connection between the health care practitioner and the patient is necessary to provide good care, to soothe, and to improve the live of the patient (Huffman & Stern, 2003). In cases where physical discomfort are present it can lead to psychological distress and it can influence the patient’s grief process (Huffman & Stern, 2003). Thus it is crucial to control the patient’s pain in order to comfort them. Therapeutic communication can be done by the health care practitioner by listening to the patient’s life story such as their accomplishments, interests, regrets, hopes, the people in their life, and the details of their spiritual life (Huffman & Stern, 2003).

As stated in the above video I too felt helpless when I treated my patient. I felt as if I am sitting next to him and waiting for him to take his last breath. I did not want to stop seeing him, but I was also afraid to say goodbye. According to HPCSA (2008) one should show compassion and respect towards your patient.The patient had such a huge impact on my life and initially I really struggled to cope with the fact that he is busy dying. When searching for literature regarding this dilemma it is clear that a health care practitioner should not become too attached to their patients. However, this is easier said than done. In this case I went out of my way to take care of this patient, to clean him, to feed him and to listen to his stories. I felt that I need to be there for him, seeing that his family does not want him anymore. After three weeks of seeing him everyday, he sadly passed away. The cancer won the battle and I had to accept it and move on. This case made me realize that I will need to be less attached with my patients. I need to accept that I am there as a physiotherapist only. Each patient will form a memory in my head and each memory will make my life as a physiotherapist unforgettable.

“There is no death, only a change of worlds”.



Ellershaw, J. (2003). Care of the dying patient: the last hours or days of life * Commentary: a “good death” is possible in the NHS. BMJ, 326(7379), 30-34. doi:10.1136/bmj.326.7379.30

HPCSA. (2008, May). General ethical guidelines for health care professions. Retrieved September 29, 2016, fromhttp://www.hpcsa.co.za/downloads/conduct_ethics/rules/generic_ethical_rules/booklet_1_guidelines_good_prac.pdf

Huffman, J. C., & Stern, T. A. (2003). Compassionate Care of the Terminally Ill. The Primary Care Companion to The Journal of Clinical Psychiatry, 05(03), 131-136. doi:10.4088/pcc.v05n0305

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4 Replies to “Letting go”

  1. Hi Carika,

    Wow! Your post really touched my heart. I can relate to your post, as I have the same problem of becoming attached to patients. Although, I believe it is not always a problem, because patients appreciate having people like us in their lives, who can they be happy with, because a lot of the time they do not have anyone. So well done for sticking by this patient’s side till the end.

    There is good additional reading present, and I commend you for that. Although, I feel you could have been more reflective in your evidence section, and relate your experience to the evidence. Your in text referencing and reference list is correct, well done, as well as it supports your claims. It followed a good structure, but slight changes can be made to the spelling and grammar (try reading your post out aloud before submitting). Your argument is good, and you had good evidence to back it up, although I feel you could have added more media such as images to engage the reader. Your videos were very interesting, and I am glad you related it to your topic and thought out of the box. Well done!

    All the best 🙂


  2. Hi Carika,

    As someone who struggles to relate to a topic like this I thoroughly enjoyed the read. This post gave me a perspective in to how other people view a situation like this as I have not seen a palliative care patient yet over the last two years, it will be interesting to see how I cope with it. I wholeheartedly agree with being there to listen to a patient and comfort them as necessary however I think one should stray away from the sadness of the situation and realize the privilege it is to make a profound difference in someone’s life.

    I think your grammar was very good, the post was laid out in an easy to read manner and followed good flow, except in one instance. The “literature review section” seems to stand on it’s own to fill a space, incorporating the literature review in short sections in to the entire blog post would make the linking of thoughts to literature more clear. I enjoyed your use of media, I actually played the song while reading which was pleasant.

    Lastly I feel you did well showing a different view you could have when in that situation again in the future that may reduce impact on you, allowing you to cope better. I hope that you remember this person and their impact on your working life as a good learning experience and in a positive memory, as I am sure this person would have wanted.


  3. One of the most admirable qualities for me in a health professional is the ability to care, i personally haven’t been involved in palliative care but i have dealt with grief and patients dealing with death. This used to make me uncomfortable as an ethical dilemma i figured the key is empathy. I really enjoyed your post as it was sincere and honest, the use of a song also made me reflect on how i am constantly being reminded of patients from watching videos and the more we care about patients the more we can effectively empathize with them and still provide the best care we can as health professionals. Well written and thought provoking.


  4. Hi Carika. Thanks for a lovely post. I got a very real sense of the relationship you had with your patient and appreciated your honest reflection. The video of Zach that you included was very uplifting and it seems that it could have taken your post in a different direction entirely. I thought you were going to talk about how *more* connection with patients is possible (and necessary?), rather than less. If I compare it to my own experiences, I could make the argument that every student I see is going to “leave” after a short period, so it makes no sense to get to know them. But I think the opposite is actually true. I want deeper and more meaningful connections with students *because* our time is limited. It’s a slightly different perspective on how we think about working with our patients.


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