After the Fall: Occupational Therapy

"Good Morning! My name is Erica, and I will be your Occupational Therapist while you are here on the rehab unit."

These are the first words I say to her as I gather up a basin of soapy water, a washcloth, and a toothbrush. As I place the items on her bedside table, I am inevitably greeted with the same reply I have heard countless times:

"You want me to wash myself-"

It is certainly a rude awakening, and I am aware of this. After all, she doesn't know the benefits of being woken up an hour before her alarm clock would usually sound. She doesn't understand that this place is different than the hospital; I want to show her how to regain control in her daily routines. Before she was injured, she did not give a second thought to taking a shower or putting on her shoes. But now- She has to rely on us. I can only imagine how helpless that must make her feel. At the same time, however, I know she also fears the day when we will no longer be available to help her.

She begins to wash, gingerly at first. I tell her about life in the rehab hospital. Here, she will learn to do everything for herself again. She will be expected to attend all of her therapy sessions, and to participate at her maximum capacity. Three hours of therapy every day would be grueling for any one of us; for her it seems impossible. She can barely sit on the side of the bed without getting nauseous.

I tell her it will pass, that her body will get used to this again. She doesn't believe me.

"My mother will help me get dressed at home."

I want to scream every time someone says this to me. But I smile, and gently remind her that her mother works full-time, and that she is here to learn to do these things again, on her own. She has already finished most of her bathing without realizing it, and I help her with her feet. I always help with the feet and the back on the first day. After today, she will be on her own: I provide a long-handled sponge for this task.

I help her with her clothes, assuring her that with time and training she will find this task much less exhausting. She heartily disagrees, but I do not force the issue. We will have many weeks to fight this battle. Instead, I focus on teaching her to slide her body across a board into her newly issued wheelchair. She needs a lot of help, and I break a sweat.

"When can I go back to bed-"

Typical.

Time passes, and little by little she begins to trust me. I make sure I never promise anything I cannot deliver, or I will shatter the tentative relationship we have built. She is progressing, but not as quickly as I had hoped. She is fearful and emotional. Every day she cries. I try to be supportive, but part of me is annoyed that she can't move past her accident. I understand trauma, being close to it every day. But I don't understand the need to fixate on the terrible event. It is hard for me to hold my tongue, and not to tell her she is lucky to be alive. Right now, she only cares about not being able to walk. I think that is selfish, but I don't say anything. I complain to the social worker instead, who says he will talk to her.

She is getting her shirt on by herself now, but I get no thanks for teaching her that. Instead, she gets mad at me for making her get on to the bedside commode.

"Just give me the bedpan."

I hate bedpans. If someone ever wanted to torture me, they could lock me in a room filled with nothing but rows upon rows of bedpans, with dozens people crying out "Erica, I need the bedpan! Hurry!"

I firmly tell her she must get onto the commode. She reluctantly concedes, but refuses to help pull down her pants. I consider this a victory.

"This commode hurts my back."

I offer her a pillow. She sneers.

There are times when I wonder if I am too harsh, and there are other times when I understand why parents say things like "someday you will understand." Because one day, she will. It just won't be today.

A few weeks in, she can pull her pants up and down with support, and she is using the commode regularly without complaint. I'm proud of her. Until, the new CNA comes to ask me if I can help her get the patient out of the bed. Apparently, she was told that she cannot stand without two helpers.

I storm into the room, and her eyes get wide.

"I only told her that because I didn't think she was trained!"

She knows I have caught her, and I win again.

Another week goes by, and she can dress herself on the side of the bed if I bring her clothing to her and allow her breaks to rest. By the end, she is tired. She asks me to help her with her socks, just for today. I help her, because she has done well. She smiles.

Her mother comes for training, and we all pile into the shower room together. Out of habit, I start to help her wash her back, but she is already doing it herself. I look at her mother, who echoes my surprised expression. I realize that she almost doesn't need me anymore, and I feel a bit sad.

She is ready to leave, six weeks after the day she arrived.

On her first day, she could barely tolerate sitting in her wheelchair through breakfast. And now- She is wheeling herself down the hall, giddily shouting goodbyes to the rest of the patients. She gives me a hug and thanks me for my efforts. I am so proud of her. She wheels into the elevator with her mother, and then she is gone.

Part of me is thrilled at the prospect of not starting each workday with an argument. But another part of me misses her feistiness already. The rest of my patients, so easygoing and cooperative, are almost boring by comparison.

I complain, but part of me likes the fight. It makes the end result that much more fulfilling.