Patient Emotions

A 67 year old patient presented to the ward during my neuro placement. This patient had the formal diagnosis of Motor Neurones Disease (MND) for two weeks, but had noticed rapid onset of symptoms since Christmas of the previous year. As you would be aware, MND is a progressive neurological disorder that destroys motor neurones, resulting in symptoms such as weakness and muscle wasting, fasciculations, spasticity/rigidity, overactive reflexes, and eventual death. As cognition remains intact, this prognosis would conjure many emotional issues, for both the patient and their family. Even I could not help but feel saddened for this lovely patient, as in a few months, they had moved from being a healthy, talkative, independent individual to someone that was unable to verbalise (now used a lightwriter) and required assistance in all aspects of daily life.
This patient was always compliant and willing to participate in physiotherapy, with maintenance of functional mobility being our joint focus. One morning I had wheeled this patient to the physiotherapy gym, aiming to practice sit to stand and bed mobility. Everything seemed to be going well- I was happy, the patient appeared happy and the exercises were progressing well. All of a sudden, the patient began to cry, with this cry quickly becoming a wail. I drew the curtains around the plinth, as not to disturb other patients. When asked what was wrong, the patient would not answer so I just held her hand and reassured that we would finish and return to her room. She seemed happy with this, and the tears soon stopped.
As I began to wheel her back to her room, she began to cry again, and appeared more visibly upset than before. So I stopped and sat down with the patient in the hallway. It really broke my heart to see someone so upset. As I asked again what was wrong, the patient began to inform me that they felt so helpless. They had deteriorated so quickly, and felt there was nothing that could be done to help. I found it really difficult to know what to say. I knew I couldn’t tell her “it will be ok” or “I’ll help you to get better”. We both knew she did not have many months to live. I struggled to hold back tears as I sat there with the patient, resting my hand on theirs. All I could say was “I’m sorry” and say that I was there to listen and help as much as I could.
It is really difficult to know how to handle these situations, and there is definitely no set recipe. I believe that as physios, especially as students, we become so focused on fixing and treating the problems, that we can forget the patient. It really doesn’t take much time from your day to stop and say to a patient “How are you really going?”; and if they ever begin to cry, all you can really do is try to find a quiet place, and lend a listening ear. Obviously, I didn’t get much treatment accomplished during the session, but I believe that the patient communicating with me was of much more benefit. These emotional issues can then be communicated to other appropriate health professionals.
It’s so easy to take life and our own health for granted, that we don’t always stop and think of the struggles that our patients must be facing. So try to take time during the day to think of how your patient may be feeling, as I think this will help you to develop a more holistic understanding and empathetic attitude towards the person. I know I will be.