A year ago, I was terrified of acute care physical therapy. I thought it would be gross (especially after one of my professors joked about patients pooping on my shoes…also, Foley Bags??? um…). I thought it would be boring (managing lines and leads? walking patients around the hallways?). I didn’t understand why DOCTORS of physical therapy needed. to be the ones mobilizing patients – that seemed so below our skill level, our diagnostic capacity – like, why couldn’t the nurses do it?
Last week, I had my second mini-clinical rotation on the acute care oncology floor at UNC Hospital (which is fancy AF, btw). I’d had fun back in November, and noticed then that all of our patients seemed happier after walking around. But I still wasn’t sold.
This week started out rough. On our first day, none of our patients were able to get out of bed. Both of the two patients assigned to me (We work in teams of four; each of my classmates and I are allowed to take the lead on eval/treatment for at least one patient per day) refused treatment. And so, as usual, we spent our lunch periods complaining about how this job was “beneath” us, how we weren’t getting to use any of our new manual therapy skills or our diagnostic brainpower.
And then finally, on Friday, I had an experience that was truly life-changing. We had a young man with lymphoma that had spread to his brain, and was presenting like a stroke. When we first met him on Monday, he had no volitional movement and couldn’t speak. By Wednesday, we got him sitting up (with max assist) and he had enough movement to fistbump my classmate and was able to tell us what time it was on the clock. By Friday, he was doing short arc quads (still with max assist to sit, but who cares), talking about his favorite NBA team, and asked us if he could stand up. He was still max assist with sitting, but we thought, “sure, why not – there are four of us, of course we can get him standing”.
And we did. This young man, who hadn’t left his bed since January, was standing. He still didn’t have a lot of speech, but you could see in his eyes what this meant to him. A group of physicians on rounds had stopped outside the door – I saw them approach, and then stop short of opening the door. Their eyes were all glued to us. And when we got him back in bed and found his caregiver to tell her what had just happened, she cried. I almost cried.
To the PTs and students out there….THIS is what it’s all about. YOUR CAREER IS ALL ABOUT HELPING PATIENTS GET THEIR LIVES BACK THROUGH MOVEMENT. Your patients don’t give a crap about your fancy manipulation techniques or that you got your DPT at Duke (or that you have a doctorate degree at all, tbh) or that you are better at musculoskeletal differential diagnosis than most physicians. People really do not care about that. YOUR PATIENTS WANT THEIR LIVES BACK. And nowhere is that more true in acute care, where your patient is a former student athlete that’s had everything taken from them by a disease that no one can predict or prevent….but truth be told, I don’t really think that most athletes care about that either. They just want their lives back. “People don’t care how much you know until they know how much you care”, after all.
We are trained to heal, protect, and build up our patients through movement. We have such a nuanced understanding of why movement is necessary, and we are acutely aware of how devastating a lack of mobility can be for most people. This is how we are trained. This is NOT how nurses, physicians, or PAs are trained – and that’s why it has to be us. We are the movement experts. That is the very definition of our profession (or it should be at least), and that’s why it’s SO important to have doctors of physical therapy serving in the hospital.
It’s not about your degree. It’s not about your fancy skills. It’s not about how well you professionally network, how big of a following you have, or whether you can distinguish patellofemoral pain syndrome from patellar tendinitis without imaging. It’s about your patient, and whether you’re guiding them towards their best possible life. In an athletic setting, sure, that might mean breaking out your best transverse abdominus exercises. In acute care, it probably just means getting a patient to stand up. That is no less important, and no less impactful. Is it less mentally challenging to you? probably. But it’s not about you. And if you can’t see that, you’re doing it wrong.