Passive Listening and Therapist-Centered Care

She had 2 falls yesterday, after the surgeon had told her that she can start putting more weight on her foot; after a month of toe-touch weight bearing, the x-rays had (apparently) looked good. She denies any pain, which is (hopefully) a good thing, considering her hip has already dislocated twice in the last month.

“Did I dislocate again?” she asked.

“Did your hip have pain when you dislocated last time?” I asked.

“No,” she replied, “but it hurt like a mother fucker going back in.”

I asked her to lie on her back; she actively moved from sitting to supine independently, without difficulty. Upon assessment, her hips were not overtly asymmetrical; her motion was within restricted limits (considering her dislocation precautions) and she was still pain-free.  She actively flexed/extended her hip without pain, but when she fully extended her hips/knees I noticed the obvious, “When you went in for surgery, did you have a leg length difference?” I inquired.

“Oh sure, I had a shoe with a big honkin’ sole and everything,” she told me. Phew. “Do you mind if I see it?”

She didn’t and kindly directed me to where I would find the shoe on the floor in the other room. As I was scanning the room, looking for the shoe, she yelled from the other room, “I hate that thing.”

“I can imagine that you would,” I replied.

I brought the shoe out to the living room; it was still a pretty good match for her present leg length discrepancy post-op. I wondered aloud if, by trying to walk with a flat foot yesterday (without a lift) she was compromising her balance in a way that may have contributed to the falls. With my gaze focused on the knuckles of my thumbs over her medial malleoli, I said, “I’ll just ask that we try that shoe on for a second to see if it is still successful in evening out your leg length discrepancy.”

Then she wept…uncontrollably.

She really hated that shoe. I should have asked why.

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