Commentary: Unenviable

After my recent posting, Unenviable, a conversation began on Facebook that I wanted to share here. Perhaps it might add additional perspective to my initial posting.

JD: This woman could be dying of inter-spousal stress infliction. On top of the aorta problem I mean..

AR: So could he, JD.

JJ: Maybe, but she’s the one who weighs 84 pounds. And had to go to hospital.

AR: Yeah, I get that, but what is the dynamic that leads to resolution. People get tired and we start to pick what team jersey to wear and it doesn’t lead to resolution.. It is a huge part of chronic conditions and is essential to moving forward.If you pick sides, life is easier, but not more effective. What they don’t need is more tears.

HS: I can’t think of a single excuse to yell at another human like that. Or any thing.

This is the type of dialogue that I was hoping would be elicited from the posting. Much of the sentiment expressed was very much in-line with my own natural thoughts the day that Lydia went to the hospital. The following is my own response in the conversation.

 I appreciate the dialogue regarding this interaction. And while I agree with HS that I (personally) can’t think of an ‘excuse’ to yell at someone like that, under those circumstances – I tried not to pass judgement (in the home, or in the posting).

I was in the home for Lydia, so she is my one and only concern, whether I agree with her or not. In this instance, I HAD to call 9-1-1 (by policy), but I knew she wouldn’t go – after all, she had already refused to go to the hospital the week before. So despite my desire to be a ‘good libertarian’ and do what SHE wanted, I knew what was in her best interest and sat down to convince her that what I was going to have to do (as yet unbeknownst to her) was something that she wanted and needed. I was thrilled when my poor-man’s version of motivational interviewing had paid off – (1) there is nothing worse that wasting tax-payers dollars to bring out the EMTs when the patient has already stated that they won’t leave but I have to call anyway due to policies designed to cover the agency’s ass and (2) she REALLY needed to go (more than I knew at that time).

The husband was upstairs when the decision was made; their daughter had walked upstairs to inform him that he was going to have to go to the hospital with his wife. It was then that he came down and said all that has been written. Some thoughts:

(a) This is a lower-middle class family – a sometimes gruff blue-collar group who has lived and worked hard – the use of ‘fuckin‘ as an adjective is quite possibly used between the 2 parties in good times and in bad. I try not to judge the use of ‘fuck‘ more than I do ‘ain’t‘- regardless of context (this is, of course, difficult).

(b) If we look at most of the phrasing, without the cursing and with a pet name thrown in, he might be trying to motivate and compel her to get better: “Come on, hon, get up! This is ridiculous, show us what you can really do. You need to be stronger, sweetie. You need to stop trying to have everyone else get you better. You were just at the hospital – you are fine!” Maybe he just really loves her and it pains him to see her this way. Maybe he doesn’t have the skills or capacity to convey that to her. I don’t know. I may doubt it, but I don’t know.

(c) It seems that he is struggling to say something that might motivate her while coming to grips with his own frustrations: “You keep doing this to us. You keep wasting our time with this…You were just at the hospital – you are fine!

So maybe you had a man’s gruff, unrefined vernacular coupled with his love for – and desire to motivate – his wife while simultaneously being unable to filter his own thoughts/emotions in a stressful time – mashed together with no medical knowledge of how quickly a change of condition can present.

Or maybe he is a fucking asshole…of course, that is likely a false dichotomy and the truth lies somewhere in between. Perhaps, if I had observed their marriage before now, I would know better; for now it is just fuel for thought.

The other thing that keeps going through my head (as I also mentioned to a reader on Facebook) is the potential similarities between Lydia’s experience and the patient who might be receiving outpatient PT for chronic low back pain who has been on disability for 3 years. Might the stresses be similar at his/her home? What kind of support system is in place after they leave the clinic, with its environment that has (hopefully) been so carefully crafted to optimize benefit for the patient?

Most teachers understand that they only have influence over a child 6-7 hours per day, 5 days per week, for less than 9 months per year (in the US). They understand that no matter what they do in the school, the child is going to shaped most by what happens the other 18 hours of the day, not the time spent in school. How many therapists consider their own influence as realistically when they send their patients home after a bi-weekly 30-minute therapy visit?

What would a single consultative home visit provide the clinician that a visit to the clinic can’t? What if the entire family and support system for the patient were included in that single consultation, outlining a plan, collaboratively, to provide the patient with a realistic support system that will work for all family/friends who share their time together the other 167 hours of the week that the patient isn’t in the clinic?

In thinking back to Lydia, I wonder what may have happened if I had asked the husband (who, I hadn’t yet met, and wasn’t even aware if he was/wasn’t home) to come down while Lydia and I were discussing the ambulance. Would he have responded differently? Would she have decided differently? Would she be dead, or alive? Did I ‘wrong’ the husband in some way by unintentionally not involving him, making him feel like he had diminishing control? Might some of his frustrations with me been re-directed at her. As it was, the stakes were high for Lydia; I am just glad that things worked out…

…but I can’t stop thinking about that day. It has a lot to teach me.

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