Medically Sound Coaching

2

July 2, 2010 by David Gillaspie

FOR PARKINSON’S

My oldest son Tyler saw my approach to dealing with his grandfather’s Parkinson’s and called it ‘not medically sound’ in his comments in the Portland Tribune,

http://portlandtribune.com/opinion/story.php?story_id=127793319710667100

 He couldn’t be more correct.

He reminded me of the scene in Shawshank Redemption where the old-timer told the new guy ‘you either get busy living, or get busy dying.’

The medically sound approach to my father in law landed him in the hospital where the doctor, under my direct questioning, guessed he might have a couple of days to live.  

I brought him home for those two days.

On the second day we got busy living; our own Training Day.

Over our years together, the family grew closer.  My mother in law, raised and educated in England, gave every detail the thrice-over; my wife, a practicing naturopathic physician, kept an eye on the bigger issues; my two sons bore witness to my Parkinson’s coaching tactics and got a few coaching moments of their own for better and worse.

What is the sound medical approach for a Parkinson’s patient as far down the line as Grandpa Ken?  This example, and others to follow, come from home-care agencies we interviewed for some of that important respite care, and home visit nurses.

For the uninitiated, respite care is like a relief pitcher in baseball, the guy who comes in when the starting pitcher tires.  Except the starting pitcher takes four days off between starts. 

Not the family caregiver with a chocolate whistle.

The home care representative shows up to do an overview of the home situation before sending a worker.  So far so good.  The first rep came in, saw Ken’s condition, and said they couldn’t legally work with someone so infirm. 

Infirm?  That’s not a word we used around Ken.  He didn’t need to think he was infirm.  I got him out of the infirmary to avoid the whole ‘you are too infirm’ conversation.  Ken was convinced he wasn’t as sick as he was, so I coached him up for the home care rep.

He was sitting in his Big Chair, the one that lifts off the ground so those too weak to stand on their own can get up.  We didn’t use the lift option, just the leg raiser and tilt back parts. 

“Let’s save the lift for when you need it.  You’re not that weak,” I told him. 

While the home care person watched, I took each of his legs and did ten reps of high knee, followed by range-of-motion arm lifts. 

“Okay, we’re warmed up.  You never do this unless you’re warmed up.  A high jumper would tear himself in half if he tried jumping eight feet without a warm-up.  Isn’t that right?  Now we’re going to stand up.  Look at me; show me the game-face.  Nod if you can hear me: You can do this.  Ready?  Let’s go.”

I’d give the old man a few dekes on the stand up.  The first one being I wasn’t set to help him, the second being he started too fast, the third being I tweaked my back so he’d have to make a big effort.

By the fourth time Ken was ready to quit screwing around and jump up.  He was peaked to go.  I watched the home care lady writing in her evaluation notebook.

By using the wrestling equivalent of double under-hooks, I helped Ken to his feet and got his hands clamped onto his walker.

“This lady wants to see how we do, Ken.  Let’s take a lap on the clock, hit the bed to show her how we get in and out, then back here.  Deal?”

He nodded.  Somewhere in the day a Parkinson’s guy has said all he wants to say, but that doesn’t mean he’s checked out.  If you find a way to engage them, they will show a sign. 

We took a lap in PR time, got in and out of bed with a wrestling technique similar to a cradle, which is always sweet, and made it back to the chair. 

“Look at you, Ken.  No one can do that for you.  That’s all you.  You hit the physical therapy, took time off your personal record, and charged right through.  You could have done ten up and downs on the bed and gone for more, but we’re taking it easy.  For now.  We’ll hit it harder a little later.  Take a breather and we’ll get back to it.” 

Kenny looked all fired up.  He looked like Muhammad Ali vs Floyd Patterson.  Instead of asking “What’s my name” of the man who insisted on calling him Cassius Clay, Ken had a look that said, “See that?”

The home care lady saw it, all right.  I stood beside Ken’s Big Chair with the kind of smile you see on Little League dads whose kid just turned a double play as slick as Tinker to Evers to Chance.

The home care lady said she could not provide a respite worker; that she wouldn’t subject any of her employees to the sort of routine I just did with Grandpa Ken.

“This is an extremely unstable man and by insisting he perform for you, you put him at grave risk of falling.  He needs to be confined to best rest for his own well-being.  I won’t report you, but you ought to think about your motives before you do this stunt again,” she said.

I thanked her for her time and walked her to the door, telling her she was an expert in such matters and that I would heed her advice.  Experts like others to heed their words.

Then I went back to Ken and evaluated the home care recon lady. 

“Did you like her?  She seemed nice, but she looked like she’ll be using a walker in about three years.  She’ll need a neck brace to hold up her big head on that skinny neck.  Listen Ken, you’re in better shape than she is.  I think we shamed her.  I walked her to the door because I didn’t want her taking a dive in front of you.  I’ll bet she uses extra light pens to write with because a normal one weighs too much. 

“What do we think of people who’d rather leave you in bed than figure out a way to get up and get around?  What do we say to people who think everyone else is as lame as they are?  We say fu-fu-fu-fu-fu….”

Ken turned his head toward me and said, “Forget ‘em.”

“Gimme five on that.”

2 thoughts on “Medically Sound Coaching

  1. David Gillaspie says:

    Thanks Mike, from the sound of your comment we agree that making a world for someone who has lost theirs through debilitating circumstances goes beyond medicine. Turning a new world into a reality worth living is the biggest difference maker.

    Dave

  2. Brit Miller says:

    A theme that needs addressing in some cases too. What’s better for an patient nearing the end of their time. Self respect, or a nurse treating the patient like an infant, or an object to keep up her mortality rates? Some cases you read of are truly saddening.

    Anyway, a very well written piece. You have a fan.

    All the best, Mike.

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