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PTA Blog Talk

Everything Possible

Published February 29, 2012 11:16 PM by Jason Marketti
We were working on a patient who required extensive assist just to sit on the mat table. After about three weeks, she was able to sit up with a very minimal amount of tactile and verbal cues to self-correct to a midline position. She was getting stronger and making appropriate progress with all three disciplines in the therapy department.

Her family, who was very supportive, decided we were not doing enough for her and began a slow campaign to question the nurses about whether we knew what we were doing. Fortunately the nurses and therapy get along well enough to support one another when it comes to patient care and family members. The nurses assured the family we were good (the best in the area) but it did not seem to appease the family. The patient's husband finally asked, "Are the therapists doing everything possible to ensure my wife's recovery?"

There is only so much therapy can conquer when it comes to stroke rehab. Other factors weigh in, such as the extensiveness of the stroke, time elapsed between home and hospital, and the body's ability to recover after a brain injury. This did not seem to make a difference with the family. They wanted progress, and they wanted it now.

The family wanted therapy's estimation of discharge to home and questioned each one of us separately at different times about the progress she was making. Obviously the family was angry about the injury but to ask whether we were doing everything possible hit a nerve in me. Can a family really believe we would not do everything possible to get people well? Do they think we would not work hard with her and delay recovery? I wonder if they questioned the MD that way at the hospital. Probably not since she was not expected to live and now that the life-and-death situation is over they can focus on other aspects of her care, like why she is not improving faster.


Kubler-Ross' five stages of grief would seem to apply here. Anger is clearly identified by you, but there also seems to be a lot of denial on the part of the family mixed in with a little bargaining as well. "If mom just had a better rehab team then she would get better." The next stage is a tough one...depression. Once they realise that their anger won't change anything, their denial of the facts no longer holds water, and that, in fact, the therapy team is doing everything possible and a "better" team wouldn't make a difference, they will likely become depressed. Acceptance is still a long way away for this family.

It isn't easy, but try not to take their lashing out personally. It is a rotten process they're going through.

Dean Metz March 4, 2012 6:56 AM

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About this Blog

    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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