Written by: Yaffa Liebermann PT,GCS,CEO
Treating in My Hometown:
I went to work in a national institute at an outpatient center in Kfar-Ata, the village where I grew up. It was heartwarming to treat my schoolteacher, the bookstore owner where I used to buy all my textbooks, and patients with different religions and beliefs. The schoolteacher was frightening in middle school, and some children were very happy when he had sciatica and became mellow. I was blessed as a PT to help him in his advanced age in reducing his pain by performing back mobilization and giving him exercise instructions.
Change in Weather Affects the Joints:
The village was located over a hill and on an even ground. On the days where the weather changed from dry to rainy and there was a drop in temperature, 4 out of 10 patients would enter the room with the announcement, “Today all my joints are aching.” The conclusion is that when so many people from different heights and locations suffer from discomfort at the same time it means that there is a relationship between the weather and the body. This was an observation made in the clinic. Today scientific studies state that, “as barometric pressure drops right before the weather changes, this lower air pressure now pushes less against one’s body. This allows tissues to expand, which then places pressure on joints and causes pain to be perceived.”
Getting the Most of the Equipment We Had:
We worked with a few good machines like the short waves, hot packs, and ultrasound. As well as two beds with iron nets above them that hooks and springs that allowed for greater flexibility and strengthening. For knee mobilization and hamstring strengthening, the patient would sit at the edge of the bed and push down a spring from the top of the bed, for quadriceps would be to lift up ankle weights and most importantly weight bearing exercises.
Rewards and Fulfillment of Being A Help:
A woman underwent knee surgery and suffered from a stiff and swollen knee. We worked for some time for 3x a week. During the last treatment she came to me with a small glass art piece and said: “you helped me so much that I needed to thank you. I went to a glass artist and he made it for you,” and has hanged in my kitchen window for the last 50 years and I remember her every time I am in the kitchen.
Therapists love and remember their patients and their picture surfaces on different occasions throughout our lives.
Relationship between PT and PTA:
I had the pleasure of learning how to work with a PTA in the outpatient center. I found that it was very important to inform the PTA of the finding, limitations, difficulties, goals, and plan of care. I would watch from a distance as the PTA’s delivered treatment. Once I learned to trust and let them treat the way they choose, as long as they follow the guideline of the profession. I wanted the PTAs to be creative and think about appropriate movement and to see that the patient moves in the right direction. I let them develop rapport and relationships with the patient because it is so important for the healing process. It created a mutual respect and good atmosphere in the department. A place that we would love to go to work and welcome patients in a good atmosphere that would stimulate them to thrive and perform exercises well.
Caregiver Involvement in the Recovery Process:
The patient is an individual who has lived his life in a certain way before he experienced an accident and consequently came to rehab for professional help. If the patient is escorted by a caregiver to the room for the PT evaluation, and he/she is the one who takes the leading role in answering the questions, the PT should listen to the caregiver and not insist on hearing the patient. It is important to keep the dynamics between the two and become favored by both of them.
The PT will have enough opportunities to build up the professional relationship and trust from the patient in the following therapeutic sessions. It is important to build trust between PT and the caregiver so they can stimulate the healing process of the patient during treatment and after discharge from therapy.
Worker’s Compensation Patients:
When a patient was evaluated under worker’s comp. I had goals that sometimes were not reached. Some of them did not progress as expected. Since every patient matters to me, it made me very frustrated and I lost the belief in my ability to treat. Only after talking with my coworkers did I learn about the lawsuit behind each case. “Your patient will not progress until the lawsuit is settled.” I wish they told us in school.
In a hospital I treated another patient who was playing but not performing exercises. It was Friday and I reached the end of my patience in trying to encourage him to exercise. I said to him, “Here comes the weekend and you have to decide the way you will continue. If you want to do exercises, I am with you. If you want to play- go ahead come to the gym do your exercises but I will not expect any progress”. On Monday he was very cooperative and was discharged from the hospital ready to go back to work soon after. Sometimes we have to face the patient and be honest with him and let them decide on how to proceed.
1970 – Two Months In Bazel, Switzerland at A Psychiatric Hospital:
We went to Switzerland for two months in the summer, I looked at an advertisement in a PT magazine and found a job in a psychiatric institute for the summer. This was a workplace that left a lasting impression on my life. Till this day, I cannot have a rocking chair in my home since it reminds me of a patient who sat in a rocking chair staring blankly into the horizon. It was great to eat breakfast with the group in the department: to talk, to bring up difficulties with patients, to give advice, to listen to good ideas and create a good team. I knew Yiddish, which is similar to German and Swiss language and with about 100 or more words I was able to communicate well. It appeared that they understood me.
Some of the patients behaved strange and some were in deep trouble. I was not prepared to treat psychiatric patients that shared their problems with me, that were really everyday issues.
One of the best activities we were able to do – was group exercises. I was able to conduct a group. It was so rewarding to see all of them moving according to my demonstration. They understood my guidance during the individual treatment and got stronger.
As Physical therapists we can provide our skill anywhere in the world without full control of the language.
What a great profession.