The Reluctant Patient
A few weeks ago I wrote about my experiences with the rehab of a patient with a recent AKA. Having no prior experience with AKA therapy, even within my clinical affiliations, I have been following the primary PT's plan of care closely. As I discussed, this particular patient is extremely fearful and anxious regarding her new prosthesis.
The patient is elderly and is simply not interested in donning the prosthetic device for any reason. She finds it painful, heavy and "ugly." The prosthetist, PT and myself have carefully explained that she could wear her "new leg" with dresses to church or out to dinner with her family, basically only for aesthetic purposes. As the prosthetist mentioned, the prosthetic leg was made so she "can feel whole."
The patient's reluctance and anxiety has never wavered regarding donning the prosthetic. In every other aspect of therapy, she participates daily. Her effort and angst have been remarkably consistent. We recently took a step forward in her rehab, by having her don the prosthetic leg under her clothes each day for 10 to 20 minutes. As I feared, the patient was gasping for air and I spent the majority of the time attempting to alleviate her fears and offer encouragement.
I wheeled her in front of the therapy gym mirror so she could view her reflection with "two legs." She was underwhelmed to put it mildly, commenting that it was "too uncomfortable" and looked too bulky. Perhaps I imagined it, but I could have sworn there might have been a glint of pleasant surprise in her eye at first glance of her image.
I've considered that maybe we are forcing an issue that she is not prepared for emotionally or remotely interested in functionally. There have been days when I feel like the lines between "therapy" and "torment" have been a bit blurry. But I do understand this is a process, which can be painful and slow, yet could lead to a more fulfilling life and improved self-esteem for this patient. That's why for now I'm not giving up on her rehab and will keep that "glint" I witnessed as a sign of potential.