grumpy sometimes means going bad

I had two occasions where the attitude of the patient was more important than I thought in signalling their failing or recovering health. With the first on my rural placement, I had been treating the male patient from day one post-op laparotomy. Routine chest treatment. When I arrived post op day 2 the patient was irritable, grumpy and even borderline insulting with his negativity. I got the hint that today and right now would not be a good time to work with him as he was sullen and uncooperative. I was more affected by his complete turn of character than what it may have meant. It was so unlike him. An hour later he was in AF and rushed to ED. Perhaps his bad attitude was a signal that he was feeling more unwell and that was a flag I could have picked up on.

The second patient turned during a session. A post-CVA with significant expressive aphasia and apraxia, I was targeting his balance. Previously all physiotherapy had been focused on his ailing chest. So we were doing new and exciting things. Suddenly he began to get very distressed in tandem stance, saying he had had enough and was scared. He seemed very distressed. Flushed, not making eye contact, gasping and trembling. I was very concerned that I had pushed him too far too early. We stopped and sat down to rest. Then he suddenly stood up and indicated he needed to go to the toilet immediately! He was not about to wait for the portable oxygen he would need. My supervisor and I speculated later that perhaps with this apraxia and expressive aphasia that he perhaps was not realising that he needed to go earlier to prepare, and that his distress may have been related to this biological confusion. Either way, it was important to pay attention to. From then on I would prepare with taking an oxygen tank in with me incase he again needed to quickly go (which did happen again). His uncharacteristic change of attitude and irritable distress was very relevant.

These two encounters have taught me not to over look how a patient is feeling and reacting to treatment. Often we feel we have to push them on for their own good, and if we don't get to see our patient because of their attitude that it isn't good enough. But honestly, sometimes their grumpiness is a sign of sudden deteriorating health or distress to do with another problem unrelated to our physiotherapy. This is especially true if the patient is normally cooperative with you. Knowing your patient's personality and moods can really help with picking up on important signs regarding their health!