Coca Cola

I was asked to evaluate a woman in her mid-thirties who had fallen seven stories down a fire escape.

I was seven years into my career at this point and knew alcohol was surely involved. My burning question was whether the ex-boyfriend mentioned in her chart was involved.

Distancing herself from either root cause, she told me she had been born with neurological issues that made her “slow” and uncoordinated for most of her life and attributed her natural clumsiness to the fall.

Due to her injuries sustained in the fall, most of them inoperable, she was functionally paraplegic. Her arms and hands worked mostly within normal limits, but both legs were essentially immobile. She’d scream in pain if touched either foot or if the left knee was bent even minutely. Her chart read like someone had dropped an anatomy textbook down a staircase and fractured every page.

Toes.
Tibial plateau.
Distal femur.
Proximal femur.
Pelvis.
Lumbar spine.

Recalling this from memory alone I might be exaggerating, but only slightly. The list of fractures and derangements was at least seven lines long.

She was violently against participating in a physical therapy evaluation that day. She wanted to rest. She had been in the hospital for several weeks before being transferred to different facility, and now this one. I knew that as true as her pain may be, fear-avoidance was also at play. The lightest contact made her tense, gasp, or recoil. Her body had learned that touch meant pain, and honestly, I could not blame her.

I gathered this much in our first conversation. And also learned that she was Ukrainian and desperately wanted soda. Knowing the evaluation must be completed that day (for insurance purposes of course) I used that as my in.

She had not brought soda with her to the facility and I did not know how to get soda from the kitchen or who controlled the mysterious hospital beverage economy. The nurse nearest her door did not either. But she did promise to deliver pain medication.

I went to the vending machine with my phone’s Apple Pay. When I came back, we split a Coke and she told me about the “care” she had received in other facilities. She described being moved too quickly, handled too roughly, ignored when she said screamed in pain.

I listened and sipped.

I told her, “I am not going to hurt you. But moving may hurt.”

There is a difference and she knew it. But she did not care. She was tired of being in pain at all.

From what I could tell, her highest realistic level of mobility that day would be sitting at the edge of the bed unsupported. If I supported her legs and kept them from bending, she could use her arms to pivot and hold herself upright. Maybe.

With me alone, we were unsuccessful. She screamed and commanded me away from her bedside when I mistakenly left her left foot unsupported when focused on keeping her right knee straight. We had barely moved from original supine position.

“I’m really sorry. But we have to do some sort of movement today. I am going to come back with help,” I told her.

The help was the occupational therapist also assigned to her care. He had allegedly completed his evaluation of her the day prior and was to return today for treatment.

He was, as the department manager had described him to me, “the one we need to watch out for.”

He made “the most interesting man alive” jokes as if it were a clinical skill. No day was complete without him making unsolicited commentary on a woman’s body.

That being said, when he asked how old I was and whether I was married, I said:

“I don’t want to disclose my age. And yes, I’m married.”

And I believe the boundary landed.

When we entered the patient’s room together, he deferred to me. He let me lead without saying too much, and I appreciated that. Mostly. Because somehow, even while technically following my lead, he still found ways to speak to her in a tone that made me want to fold him into the fitted sheet.

I had worked hard to earn her trust. I needed her to listen to my instructions because moving her was not simple. It was not casual. It was not “let’s just see what happens.” Her legs had to be supported carefully. Her knees could not bend even slightly. Her pain was real, her fear was justified, and if she panicked halfway through, all of us were going down emotionally, spiritually, and possibly physically.

I described how I expected us to achieve the transfer. I explained how she should use her arms on the bedrails, how I would support her legs throughout, and how the OT would support her trunk and assist with pivoting her around. As if the soda had gone flat in her belly, she pushed back and said she could not and would not do what I asked. She said she would do it a different way.

The way she suggested would lead to her trunk rotating in opposite directions and make it easier for her to resist the transfer. I wanted her to reach and turn her shoulders towards the direction her legs would be going, and she wanted to reach towards the opposite edge of the bed.

“Then we should stop,” I said.

She looked shocked.

To be honest, so was I.

I continued, “If we cannot trust each other, then it is not safe for us to do this. You do not have to sit up today if it’s not going to be safe situation for all of us.”

The room changed. I could tell the OT was surprised. He later confessed as much in the hallway.

She stared at me, trying to decide whether I was bluffing.

I was not. I explained to her my concern. How she would have too much force going in the opposite direction of where we were trying to go.

And after a moment, she agreed. Her stance changed but her tone did not. I accepted the victory anyway.

We positioned ourselves carefully. I bent over and supported both of her legs, keeping them straight on pillow laid horizontally. She reached and used the bedrails as I had asked, lifting and pivoting her trunk gracefully with added support from the occupational therapist assisting at her shoulders.

Slowly, and with some wincing, she came upright. Her arms were trembling and her face was tight. My back screamed from holding her legs in position. The occupational therapist was, thankfully, useful and silent.

I instructed her to breathe in through her nose and out through her mouth, and she did it.

“Now relax your shoulders, we’ve got you.”

For about one full minute, she was sitting edge of bed. She was not a body that had fallen seven stories and into a hospital bed. She was a woman sitting upright. A woman who had made a choice to do so. A woman who had trusted us enough to try.

“This is it,” I told her. “This is the beginning.” She had done the first impossible thing.

We pivoted her safely back to supine and reinstalled her comforts and supportive pillows.

She was exhausted and we were sweating. I suggested that next time we split a Cokeafterthe session.