No matter how much education one acquires, learning should never stop. Through many of you, I continue to grow and learn.
One day, a gentleman who was very active in our community, chose Red Cedar for his physical therapy services. Of all the types of doctors who refer, I was immediately struck by how this particular doctor thought about more than just his specialty. The doctor was a podiatrist, which isn't unusual, but he decided to refer the gentleman for services because the gentleman was having difficulty getting around his home and in Williamston. The difficulty in getting around had nothing to do with his feet! This gentleman was also undergoing dialysis a few times a week. So... he was weak.
By assuming, I cost this gentleman 4 weeks of his time. You all know I kick back and talk with you the first time I meet you. Of course, I'm sure you wonder why I ask so many questions... well, my brain is going a mile a minute trying to process and understand your situation AND understand what you need help with... to then figure out the little things I need to see or feel to then come up with a plan with you to help you get back to life. I can still remember touching upon the topic about dialysis with him. He seemed so confident when he said he was doing great with dialysis... and I dropped the ball and didn't ask anything further. I assumed he understood the dialysis treatments.
Well, after 4 weeks of treatment, sadly, he was worse on all the tests I used to note progress for him. I was dumbfounded! He attended... he worked hard... and no improvement, but worsening? I most definitely wasn't going to just give up. Something wasn't right. I went back to square one; did some deeper thinking and... decided I messed up when I just accepted he understood everything he needed to know about dialysis. I assumed... I could kick myself for assuming.
I contacted the nurses where he received dialysis and had them fax his before and after treatment numbers. They said the numbers on his report indicated he was "drinking himself to death." Okay, not literally "drinking" as in alcohol, but "drinking" as in too much fluid intake. That didn't make sense to me with what I knew about him. He really was someone who would implement change. I mean, he was instrumental in the Labor Day Bridge Walk in town; he really tried to get the community out and walking because walking is good for the heart!
So, I got online and did a bit of research to familiarize myself with the type of dialysis he was receiving and learned specifics on how he was to manage the situation at home. The next time I saw him, we sat down and had a lengthy discussion. He wasn't "drinking" himself to death... he was trying to combine the idea of getting nutrients WITH his fluid intake. He and his wife decided that soups would be a good "2 for 1" kind of deal. That was the issue - apparently, the nurses, when they educated him about fluid intake, didn't educate him on salt intake! Bingo... So... we talked about nutrition and how to stay within the dietary recommendations for someone on dialysis. Amazingly, once he changed his diet and substantially reduced salt, the numbers in the reports the dialysis nurses would send me were in a much more acceptable and normal range. He wasn't "drinking" himself to death at all - he just didn't have all the information he needed to manage his situation adequately.
Perceptions and assumptions. The nurses had the most erroneous perception of this gentleman. If they had only tried to really get to know him, they would have known he wasn't intentionally "drinking" himself to death by not listening to dietary advice. By assuming, I made an error believing he had a handle on the dialysis aspect of his condition and he was responding adequately to those treatments.
I will always remember Frank (page 4) and the lesson I learned from him. May he rest in peace.
2 comments:
Thank-you, I enjoyed the post. It's a good reminder that we need to stay diligent and will often need to look outside of our usual "scope of practice" to ensure people don't slip through the cracks. Because we get to spend so much more time getting to know people than other professions, we can often pick up on clues that are overlooked. It is good to see other therapists that feel it is our ethical responsibility to do all we can, even if it takes a lot more effort!
Thanks, Dave... my heart goes out to quite a few of the people I meet and treat. I try my best to assist in whatever manner I can. Sometimes, yes, I am outside of my comfort zone. In this particular situation, most definitely outside my comfort zone, but Frank needed someone to step up and have a talk with him. Sadly, it was a misinterpretation of information which could have been corrected sooner.
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