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Teaching and Learning Moments

Standing Up Tall

So, Conan MPH

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doi: 10.1097/ACM.0000000000002577
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Lauren screamed. One second … two seconds … three seconds passed. A nearby patient, stretching his legs with green resistance bands, turned towards the commotion.

For the first time in years, Lauren’s 19-year-old feet were supporting her body weight, and only by yelling could she endure the pain of her progress. She was strapped in a harness that helped bear some of her weight; her electric wheelchair was off to the side, abandoned. Born with arthrogryposis, her mobility had been severely limited. After a life-changing surgery to straighten her ankles, she was finally ready to strengthen her feet. Three weeks into my physical medicine and rehabilitation rotation, I was there for her journey and tasked with monitoring the stopwatch tracking her progress.

I stood in the middle of a large physical therapy room. Santa Claus Is Coming to Town played in the background, a gentle reminder that Thanksgiving was officially over. A whisper of aloe-scented cleaning solution lingered. One patient was using a machine with electrical sensors that moved his arms around as if they were pedaling a bicycle. Another patient took meticulous steps, his hands resting on balance beams for support, with trainers trailing behind.

Lauren slumped into the harness, inhaling a much-deserved breath of air. I paused the stopwatch. “How long was that?” she asked, lifting her head up. “Six seconds!” I replied, showing her the flashing digits on the screen.

Lauren seemed uneasy. “So, do you think I will be able to walk again?” I hesitated. More than anything, I wanted to tell her yes, to give her hope, to validate her progress.

I thought of Chris, formerly a soccer player, now a paraplegic. He walked using a futuristic exoskeleton, which used sensors to free him from the confines of his wheelchair. I wanted to give that same feeling of independence to every patient. I wanted to assure Lauren that she too would get stronger, that one day she could stand as tall as she wanted. I imagined her standing on tippy toes, arms outstretched, reaching for the box of spaghetti hibernating in the back of the pantry. She was looking to me for a response. What if I told her the wrong answer?

“It’s hard to say,” I finally replied. “But the team thinks that this therapy will help you walk. We’ll be here for you.” At that moment in the physical therapy room, it was the best I could offer. Lauren stared off silently—it was probably not what she wanted to hear. I imagined her telling herself she could become anything she wanted if only she could walk. Maybe she wanted to work for the U.S. Postal Service delivering mail like I once did.

My encounter with Lauren taught me that one of the challenges in medicine is finding the right balance between being realistic and being hopeful. Like many patients, Lauren’s path to recovery was not straightforward. It was difficult to know whether she would be able to walk in the future. Nevertheless, I felt it was important to let her know that she was not alone on her journey.

What Lauren said next stuck with me: “Let’s do that again.” Maybe offering emotional support struck the right balance for her. Perhaps empowering patients with realistic short-term goals can create the hope they need to overcome moments of setback and disappointment. As a future physician, I aspire to bridge the gap between honesty and hope to give patients like Lauren the fortitude to recover.

In the meantime, the stopwatch in my hand read 00:00, ready for Lauren’s feet to touch the ground again.

Copyright © 2018 by the Association of American Medical Colleges