‘I Can't Wait Until I Can Walk Again'
Last Saturday, one of my patients at the SNF was a woman with left femoral neck and humeral shaft fractures. She'd undergone an ORIF to repair the hip and the arm was immobilized. She was NWB on both extremities. Like many of our patients, this was not a small woman. She was limited by bilateral knee arthritis and admitted she didn't walk much before she fell.
Her first words to me were, "I can't wait until I can walk again. I need to get home as soon as possible." I got her into her wheelchair with a slide board using one of my feet to prevent her from leaning on the left leg. I did most of the work. She couldn't have stood in the parallel bars even if I had let her weight-bear through her left leg. Nonetheless she believes she is going home in a week or two because she will then be ambulatory.
I hear those kinds of things all the time from my stroke patients. They have an excuse. Their cognition is impaired. Some right MCA stroke patients truly believe they have no deficits. With the exception of her one delusion, this woman was cognitively intact. I don't understand how she could think she'd be able to go home in a few weeks. I doubt she'll even be able to stand until her weight-bearing is increased.
Selective hearing only explains so much. Doctors aren't known for always explaining things clearly either. Even so, she must have slept through the conversation. She isn't alone in her delusion. I've had others say similar things when it was obvious walking wasn't going to happen anytime soon. I don't understand what part of the brain fails to make the connection. Sometimes the CNAs allow patients to do things they shouldn't because it makes the transfer easier, which might create a misconception. This woman couldn't do that if for no other reason than it would hurt too much.
Do people really lack that much insight into their limitations? How can someone who wasn't active before believe she is going to hop up and move along without effort? Remember we're not talking brain injuries here. This is similar to the patients I've had who complained that they walked into the hospital before the surgery, so why can't they walk now? I've had patients who were surprised they had pain after surgery. Does someone really have to spell it out for them?
I suspect this woman will figure it out after a few more therapy sessions. Or someone will get her to understand how long the recovery is going to be. I wonder if what I refer to as her delusion is really the normal response and I'm just jaded because I see this all the time. I wish someone would explain it to me.