The Hip Chronicles, Part IX: In therapy

In my series, the RA Diaries, I’ve tried to write about the weird, the painful and even the comical parts of having a chronic illness. Very recently, I had what for many RA patients is a rite of passage: my first joint replacement. My new right hip, with its festive combination of titanium, cobalt and plastic polymer, is worth five times more than my car. And it will surely be a great source of amusement to TSA scanners worldwide, because on x-rays it looks like I’m packing some major heat.

Now, kind reader, let me tell you exactly how I went about getting my new hip. But be warned. It’s gonna get gross. And graphic. And, maybe once in a while, somewhat amusing. I hope you get something out of it. I’m certainly hoping I will.

“Your left leg doesn’t trust your right leg.”

I’m standing in my dining room, just a few feet from the Christmas tree. My physical therapist, Gaby, has been teaching me some balancing exercises. In this newest one, I’m supposed to put weight on my operated leg, then bend my left knee and move to the side, slowly. It’s a move half-way between ballet and tai chi.

But the left leg refuses to budge. I try to make it, using some Kreskin vibes and my best “Bitch, please” stare. No dice.

“You know, Gaby? You’re absolutely right.”

Not that I blame my left leg in the least. After all, it’s been taking up the slack for several years, and been let down repeatedly. Then, to add insult to injury, it got used as a pincushion by a gaggle of anesthesiologists. The bruises have only just cleared up. At this point, it would sooner trust Bernie Madoff with its 401 K (for all I know, my left leg may have a 401 K — it’s always been business savvy). Or agree to help that Nigerian prince who keeps e-mailing about his inheritance.

Gaby, however, is a pro when it comes to dealing with mistrustful limbs. She has years of experience, and even treated my surgeon, who’s had a major joint replaced too (“When I called him,” she told me on our first visit, “He said ‘I’m doing my exercises! I’m doing my exercises!’ I had to reassure him I was calling for orders for his patient, not to check up on him!”). It takes a few gentle words, and some firm maneuvering, and by the tenth rep, the knee is turning. Not joyfully, mind you, but at least it’s moving.

Gaby is my second at-home physical therapist. Before her, I had Isabella. The only reason I stopped working with Isabella is that I moved back home again, and was therefore out of her jurisdiction. But Isabella was amazing.

When I first met her, she scared me a little. She seemed right out of Central Casting, sporting the kind of look one would need to play the Intimidating Gym Teacher — solid, strong, uncompromising. She looked like she’d been playing rugby, or ice hockey, or every blood sport since birth (it turns out she’s really a swimmer) and always kicked some serious ass.

But in her case, there was neither bark nor bite. In the three weeks I worked with her, she not only got me off the walker and showed me how to get up from lower surfaces, she taught me exercises that help tone body parts I’d long given up as lost (firming your biceps with bent elbows and frozen wrists can seem impossible). And she had a great sense for when I was about to fade. I was really sorry to say goodbye to her.

But Gaby has been great as well, and I get to work with her another week before I go into the next phase — outpatient therapy. I hope those physical therapists will be as good. Sadly, that is not always the case.

As an RA patient, I’ve dealt with physical therapists off and on since childhood. When I was first diagnosed, I was enrolled in what my mother called “sick gymnastics.” Apart from hating the name (all I wanted was to be good at regular gymnastics), the therapists I worked with weren’t so great. The exercises they gave me made the RA worse, so I finally stopped going.

After my surgery, I encountered my first physical therapist in almost 30 years. Her name was Daisy, and she was very nice, even though she was dealing with me on that dreaded first day in the hospital, when I was tubed up and weak as water and crying constantly. I must’ve been a real treat, but she was patient and she was kind, and I will always be grateful for that.

I wish I could say the same about the next therapist I saw that day. Now, to be fair, Tasha was not a physical therapist but an occupational one. Occupational therapists help patients figure out how to do all those day-to-day things after surgery, like wash and eat and dress. I was actually quite eager to speak to an occupational therapist, given my concern about certain maneuvers. Occupational therapy also appealed to my practical side.

Unfortunately, Tasha and I got along about as well as, well, a Talib and a radical feminist.

Now, let me reiterate: my first day in the hospital after surgery ranks as one of the worst in my life. Personal worsts, that is — I don’t count natural disasters or terrorist actions here. Just more like hearing a loved one just died, or getting seriously injured, or getting some really bad news, like that you’re fired.

That first day was downright awful, and it started early, with an unsuccessful 6 a.m. blood draw. I’ve covered my history with phlebotomists here, so I won’t go over it again. But my first encounter with Tasha the occupational therapist couldn’t have had worse timing — she came in just as what felt like my last vein was being plumbed.

I was in no position to talk to her then, and asked her to please come back later. But she insisted, in a tone that brooked no denial, on setting a time. I agreed to 11-ish (it was about 7:30 at the time).

Again, I had not slept the night before, and by the time Tasha returned, I had had visits from my internist, my surgeon (and his entourage of residents), Daisy the physical therapist, a nutritionist, a janitor, a food service guy (my hospital had a beautifully written menu, but the food was still tasteless) and at least three nurses.

I had managed to get up and out of bed with Daisy, and even took a few steps. Unfortunately, the walker I was using was a standard one not suited for RA patients with weak arms. So every step was miserable.

The effort wore me out, and I was finally exhausted enough that I could sleep, even with the pressurized socks and the bright sunlight and sore throat that prevented me from swallowing the tasteless scrambled eggs and bitter lukewarm coffee.

Of course, Tasha woke me up. But that’s not why I soon dubbed her The Evil Occupational Therapist. It was the way she came in, and the first thing she said was “So you had JRA, and then it turned into RA!”

Huh. Thanks for rubbing it in?

She went on to tell me she could tell I was very tired, so we wouldn’t do too much, but how about if I sat up, and then we could try getting to the bathroom? Now, I was still on the catheter, so the idea of sitting on a toilet was not appealing. Getting up and trying the walker again was even less appealing.

But I gamely got into a sitting position, almost dislodging the IV my internist had told me earlier to “guard with your life.” (He didn’t want me to go through unnecessary pain either.) Tasha asked me some question, but I don’t remember what it was. I just started sobbing, crying so hard I couldn’t catch my breath. I was just so tired, and spacey, and I hadn’t eaten in 48 hours. And I worried I would never be able to do something as simple as sitting up by myself again. I knew I wasn’t rational, but I wasn’t in a rational place.

Still, I managed to apologize, between sobs, for my behavior.
“I’m not usually like this,” I gasped, wishing I had a tissue, but they were across the room.

But she didn’t hand me one. She just stared at me with stony eyes, the way some people stare at toddlers acting up in the supermarket checkout. She waited until my sobs had subsided, icy the whole time. Then she told me she really didn’t think I could go home after my hospital stay. A nursing home was likely my best bet.

I felt my despair turn into fury. Who the hell was she to judge me based on five minutes on the worst day of my life?

I told her I had no intention of going to such a place, because I found it depressing. That I had people who would be able to take care of me, that I had planned everything carefully. That I may have had RA my whole life, but I had still managed to be a newspaper editor and private pilot and generally independent human being, and I was not about to be treated as a lost cause.

And that if she really wanted to help me, she would tell me if there was some gadget out there that would help me wipe my own ass, since that was a bigger concern for me at that time than walking.

So yeah, things went downhill from there. To say we failed to establish rapport would be a gross understatement. After realizing a trip to the bathroom was out of the question, she half-assedly helped me back into bed. I asked if she would help me put the pressurized socks back on.

“You don’t need them,” she snapped. “Why don’t you give yourself a break?”

That didn’t sound right to me, since I was still barely able to move, and everyone from the surgeon to the internist had been going on about blood clots. But I was tired of her, and wanted her to leave, even though the room was cold and I could also have used help putting on a blanket.

She flounced off. Luckily, a nurse came in soon after, and I asked her about the socks.

“You definitely need them,” she told me, putting them back on. “That woman doesn’t know what she’s talking about.”

“Yeah, I didn’t like her,” I said.

Unfortunately, Tasha came back in just then, and must have heard me. That is probably why she pretty much threw a medical supplies catalog at me and flounced off again.

Needless to say, the encounter left me even more exhausted, and depressed, than before. Also, I suddenly started having intense pain. The medicine nurse, a very nice one named Liz, came in to help. Somehow, I managed not to cry this time, but I asked her if there was any way I could get another occupational therapist, since this one wasn’t going to work for me. She showed me the kindness and patience Tasha lacked, and promised to speak to Daisy, who happened to be Tasha’s boss.

Daisy came in later, and assured me I would get another therapist in a few days. I apologized for putting her to such trouble, and she said she understood — that sometimes, people just don’t have the right chemistry.

True to her word, I got not just another OT on Monday, but two. I was having a much, much better day that day, and both ladies were kind and patient, and taught me the fine art of getting my clothes on with a grabber.

But I hadn’t seen the last of Tasha, aka The Evil Occupational Therapist. I was released on Tuesday, but before I was to go, I had one last physical therapy session. The PT this time was named Lena, and she was terrific. She had asked my mother and husband to come to the session, so they could learn how to help me out of bed and up and down steps without railings.

I was making my way down the long hallway back to my room, this time with a modified walker. I was handling it like a champ, walking well (what a difference the right equipment can make). Then I saw Tasha out of the corner of my eye. I considered ignoring her, but decided to be an adult.

“Hi,” I said. “I’m having a better day today.”
She looked surprised, but whether that was because of my progress or my pleasant tone, I’m not sure.

Shortly after Lena left, while my mother and husband were helping me pack to leave, Tasha came in. She had been assigned to me one last time, but the vibe between us couldn’t have been more different. She was chastened (I imagine she got a reprimand), and I was non-lachrymose and magnanimous.

The delayed bathroom trip happened, and she also helped me stand at the sink and brush my teeth. We discussed assistive devices, and my husband was dispatched to buy them. She went out of her way to tell me she understood I was a competent, intelligent individual; I went out of my way to tell her how much I appreciated her help figuring out practical tasks. It was quite the love fest, and even if we didn’t part as friends, we parted in a friendly fashion.

I still don’t know what drove her to treat me the way she did that first time. Maybe she was being forced to work a weekend shift. Maybe she had just had a huge fight with her husband. Maybe I reminded her of someone she hated. Either way, it made me appreciate what a difference kindness and patience can make when you’re in a really bad place. And how much damage a bad therapist can do.

The vast majority of physical and occupational therapists I have worked with during the last two months have been great. I just hope that, as I graduate to the next level of therapy, that I get no more Tashas.

And if I do, expect to read about it here again.

All text copyrighted by A.K. Whitney, and cannot be used without permission.