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