Where I work, everyone wants to walk. But those who want to walk the most are the ones who, for reasons of illness, progressive degenerative disease or injury, can no longer walk.
I remember asking a young paraplegic client of mine if he ever dreamed about walking. "All the time.", he said. He also kept up to date on the latest research in spinal cord injuries and knew exactly how much it would cost to get the latest walking devices such as Rewalk. What's a mere $70 000 if it means you can walk again?
There are huge physiological and psychological benefits to walking, to any weight bearing activity really. Sometimes though, the damage to the neurological system is too severe, and the connections between motor cortex and muscles are no longer viable. In spite of this, there is often a discrepancy between what the clinician knows (prognosis) and what the patient believes (hope). The physiotherapy evaluation then becomes confrontational as we ask the client to perform certain functional movements, only to have them realize they are no longer able to.
After thirty years in the field, I can usually predict what the outcome is going to be. Then there are those times I am proven wrong. In this context, I love being wrong, being put in my place by a universe that knows better than me. Miracles, albeit small ones, can and do occur and clients who were slated to spend the rest of their days wheelchair-bound rise up to pat me on the head. Yep, once in a while the complacency of experience is humbled by a little upheaval.
Last week, one of those very miracles stood up for the first time since her stroke three years ago, from the geriatric chair she is mechanically lifted into everyday. She then walked with a walker at least three meters down the hallway of the private residence where she lives. The first thing she said when she looked over at me was,"Gee, I feel so tall!". On the other side, her devoted husband couldn't stop beaming and kissing her. Her private caregiver filmed the whole thing from behind (thankfully cutting off the back of my bad hair day). And the staff of the residence cheered her on. It was the kind of moment you live for as a physiotherapist, the convergence of an entire career into that one incredible feat. There was joy, there was gratitude, and there was reverence for the powers that be, the ones that allowed the damaged neurones to find their way again.
Accepting the prognosis may make it easier for some to cope. It certainly relieves the discomfort of healthcare workers faced with the sometimes unrealistic and cost-inefficient demands of clients. I mean, facts are science, right? Facts and truth. Yet there is also hope, and hope is something I refuse to take away from my clients, especially when it's the only thing getting them through the day. Because of that hope (I give credit where it's due), the universe occasionally offers up a big fat juicy miracle. And when it does, I bow in awe to its magnificence.