The humanity in palliative care: a physical therapist’s perspective
– Ms. Gehna, Rishikesh
“Every life is precious and it’s worth cannot be measured”, was something I heard repeatedly during my childhood. This inspired and motivated me to choose the medical profession and become a physiotherapist. As I began working in the field, I started to wonder why humans prioritized everything; be it prioritization between a VIP and a commoner, prioritization between the old and the young, or prioritization even between a grave prognosis and a good prognosis. I now realize that just thinking about changing things isn’t the way out or a solution to reduce this act of prioritization and we must instead chip in with our contribution, big or small, towards achieving equity and equality.
Physical therapy is a branch in medical science that is aimed towards dealing with the identification and the maximization of movement potential within the spheres of promotion, prevention, rehabilitation and palliative care. Physical therapy in palliative care is still evolving with several not being fully aware of its benefits or what it really encompasses. Patients in palliative care often present with varying prognosis and represent a very diverse population. I was personally disappointed when I noticed the prioritization of patients based on their prognosis. Each time I was witness to this decision, the words ‘Every life is precious and it’s worth cannot be measured’, continued to resonate in my ears. You see, I was the primary care taker for my mother as she tried to maneuver her journey with cancer. It was during this journey that I shared with her, I actually realized that no matter what the prognosis is, every person has the right to lead a comfortable life, even if it is for just a few hours or a few days. I then realized how I, a physiotherapist, could contribute in some small way to reduce the gap in this prognostic-led differentiation. I can now say with conviction that physiotherapy can definitely offer comfort to even those patients who are terminally ill!
I share with you below, two illustrations of the positive role of physical therapy on the quality of life of two of my patients.
Positive story 1:
Dhruv (name changed), is a 17 year old boy, who was suffering from high grade malignant peripheral nerve sheath tumor. It was during Dhruv’s assessment and evaluation, that I enquired about when was the last time, he had walked or stood with support. I was baffled to hear that it was two to three months ago. Upon probing, I learnt that the lack of physiotherapeutic guidance coupled with his deterioration in his condition due to the tumor’s irritation of the nerve sheath led to various neurological symptoms such as weakness in both lower limbs, tingling sensations etc.
Even if a normal human being does not walk for two months, one can feel pain, uneasiness and weakness to stand again, and here, we had Druv, a patient with a malignant tumor. Our physiotherapy team immediately began the rehabilitation process with strengthening exercises of the bilateral lower limbs, which over a short period of time allowed him to sit on a chair with support. This small yet significant improvement, not only enhanced his activities of daily living but also gradually strengthened his lower limbs and boosted his self confidence. To our pleasant surprise, just within two weeks, Dhruv began walking with the help of a walker, all by himself! He began to even sit on a chair independently!
Timely and appropriate intervention of Physical therapy not only prevented complications such as bed sores, deep vein thrombosis or contractures for Dhruv, it also promoted independence in his Activities of Daily Living (ADLs) and thereby improved his quality of life. Seeing Dhruv’s smile provided immense satisfaction to the entire team as we were realized that we were able to add life to his days not days to his life.
Positive story 2:
I recently met Mrs Leelavati (name changed), a 75 year old woman, who had skeletal metastasis with a fractured femoral head and pelvis. Her primary tumor site was the right breast. During our initial meeting, I noticed that Mrs Leelavati was extremely dull and had lost all hope. During her very first physiotherapy session, I provided her bed mobility exercises and gentle lower limb exercises. We also began chatting as I listened to all her concerns. At our very second session, I noticed a drastic change in her aura and demeanor. A visibly excited Mrs. Leelavati went on to tell me, that she felt very comfortable post our first session and that she slept soundly for four hours; at a stretch and without pain. It was at that moment that I realized, that I had inadvertently embraced two roles during our previous interaction (which is quite common in resource constrained settings). My role as a physiotherapist allowed me to provide her with the bed mobility exercises which will prevent the development of bed sores; and my accidental role as a counsellor had created for her, an opportunity to share her feelings and concerns. I realized that our 15 minute session not only allowed her to get better physically but also emotionally and mentally, as she was able to share her thoughts, feel reassured and felt a sense of belongingness.
Mrs. Leelavati’s story to me, re-iterated the fact that the need for independence is second nature for us human beings; and that when this independence is hurdled by diseases, one goes through a lot of self doubt, disbelief and depression which may potentially hamper one’s ability to recover physically. Even a small amount of physical activity by experienced physiotherapists not only facilitates the improvement of the general condition of the patient but also leaves a lasting and a positive impact on one’s mental health.
It is therefore time that we approach our patients as a human being, rather than just a professional treating them as a physical body.
Palliative care therefore requires compassionate care and not just sympathy or empathy. Our profession provides us with the unique opportunity to combine humanity with our profession to actually create wonders. We must ensure that the patient’s comfort is always prioritized and that the true potential and role of physiotherapy in palliative care is not undermined and that physiotherapists be recognized as a critical team member in the multidisciplinary palliative care teams.
I also believe that research needs to be initiated and explored with those physiotherapists who are trained in palliative care and who are willing to add life to the days of these patients who live in despair and in need of support.
8th September is ear-marked globally as ‘World Physical Therapists Day’. It is a day to celebrate our physical therapists and a day to raise awareness about the crucial role physiotherapists play in keeping people fit and well. Let us leverage this day to thank our physical therapy colleagues for the chronic pain therapies they provide and for their contribution to the medical field as we continue to resonate the theme of this year’s World Hospice and Palliative Care Day, ‘Leaving no one behind – equity in access to Palliative Care’.
About the Author: Ms. Gehna, is a young physiotherapist, who is currently working at AIIMS, Rishikesh. She also volunteers at Ganga Prem Hospice, a non profit organization, that works for cancer patients