the challenge of letting go
I’m finding a new challenge as I’ve seen the same patients for over a month now. I’m wondering when and how I discharge them from their current PT plan of care.
So many of their issues are chronic. And while it would be helpful to continue seeing them for months on end, there is a growing line of new patients being referred from the doctors.
And some are doing well and reporting being able to do 150 burpees, 100 pushups and squats in one exercise bout. But yet, they still report knee pain and buckling going up stairs. There are 42 steps just to get down to the yard (and then back up), not counting any stairs they encounter to get to their housing units. Some units are 6 stories.
Some of them are good with just knowing what is going on and this reduces their fear enough to continue on their own. They are woefully uneducated about the body and so any pop, click, shift that they senes means that something is terribly broken within them. So some education goes a long way to reduce the fear and to normalize their situation.
I’ve started to experience the many that decide that they’re doing just fine and no longer need PT after about 6 visits. Here 6 visits would be 6 weeks. They say, they enjoy coming but don’t want to waste my time. They’re doing their exercises, their pain is less and/or they’re able to do their work.
This hardly ever happens on the outside. It’s kind of refreshing to have them take ownership of their home program and realize it’s on them to keep going.
Others tell me they “like coming here”–meaning to the PT office. Who wouldn’t in their situation. It’s got a nice view of the water and the surrounding mountains. It’s a safe space. They get to use equipment they don’t have access to.
I have a guilt that when I discharge them, that I’m shutting them off from that access to feel good in a place where little is in their control.
But on the other side, some are trying to prolong out a “disability” so they can get benefits like a “lower bunk chrono”–a lower bunk assignment , a special wedge pillow, or to prevent them from being transferred to another facility. Some tell me outright their intention. But most I can see through by their words and actions. And my human side, says, who can blame them for wanting to be comfortable.
So when it comes time to discharge them and let them go for this round of care, it will have to be well intentioned, swift and leave them little space to argue or refute. I will then be part of the system which leaves them little control over their choices.
And then again, they can always ask the doctor for another round of care. And around we go in a place where time is abundant and resources are sparse.
**just to note, I’ll be leaving out the name of the institution that I work at. It’s a state prison for reference. Images are not from the prison as no devices are allowed in.
Prison PT 
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