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No Place to Cry

Tracing the patient’s bridge to ability

The New Physician December 2007
I didn’t expect much from my visit to Gaylord Hospital in Wallingford, Connecticut. Then a second-year, I was driving south along country roads from the University of Connecticut School of Medicine to tour a facility dedicated to rehabilitation, the next step for some of our patients. Unlike my school’s John Dempsey Hospital, there was no striking monolith on the horizon to guide me or clarify my impressions.

I envisioned what amounted to a nursing home on steroids. Somehow the concept of rehabilitation, rather than abbreviated transition, was lost on me.

At the entrance, the blank expression and outstretched leg of a man in a wheelchair didn’t do much to reverse my expectations. Only when I walked into the warmth of the hospital from the sunshine outside did I whisper, “Wow.” The place was considerably more positive than I had expected it to be.

From my previous experiences in primary care and emergency medicine, the epilogue to a hospital stay was often unknown to me. Certainly there were other hospitals, but in my myopic view, they were all acute-care facilities, serving to fix a life-threatening problem or allow some recovery following surgery; regaining strength and ability was a personal task left for the home.

I would need to create a new classification in my head: an amalgam of trained health care workers and hospital beds, summer camp activities to pass the time, and busy gymnasiums mixing physical therapy and preparation for daily life, nursery school revisited. Though it was easy to smile at the pretend supermarket shelves and plastic produce, hidden behind the counter lay the painful efforts of countless patients to regain the cognitive and physical capacity to go grocery shopping. To me, the empty cardboard boxes represented childhood games of pretend. For the patients, the boxes represented challenges, pain and memories of a former life.

Nonetheless, the hospital was not a place to dwell on one’s disabilities. I was struck that very few of the patients could actually be found in their rooms. With wide doors to accommodate wheelchairs, handrails along the walls and ramps throughout, nearly the whole facility was easily accessible for most patients. They filled the in- and outpatient gymnasiums, sat in small groups in hallway alcoves for speech therapy, discussed their progress individually with health care providers or listened intently to instructions on how to paddle a kayak in the hospital’s swimming pool. Even the patients who chose to paint or sketch between scheduled sessions were focused on creation rather than limitation. All of this served to rebuild the spirit, a vital ingredient in one’s path to recovery.

On the one hand, I felt guilty to breeze through the halls as a walking, talking young man. But one patient privately explained that no comparisons were drawn between those who could and those who could not. It was an individual journey, with individual milestones, and the hospital’s staff served to facilitate this.

This patient-mentor, a 60-year-old man with malignant glioma, told me that once he overcame his self-pity, he became obstinate in his efforts to function independently. Only if he emerged from his room with a shirt stuck around his neck and his arm in the air would he ask for help dressing himself. Following him to his physical therapy appointment at the pool, I awkwardly tried not to offer help unless asked. It was hard not to instinctively give him a boost as he moved from his wheelchair to the seat that would lower him into the water, but he needed the chance to take ownership of his body. Neither his left-sided hemiplegia nor an upcoming third round of chemotherapy robbed him of his ability to go into town with some of the other patients or prepare dinner with them.

The hospital’s mission statement spoke of preserving or even enhancing health and function. Behind this ideal, however, was a business. Gaylord had to market itself to discharge coordinators at Yale and other Connecticut hospitals. Despite our health center’s own financial woes, I had never superimposed the idea of a “business” on the institution of a hospital: People just went when they were sick; no marketing was involved. This hospital’s goal was clearly to better health, but in the countryside, it needed to reach out to stay alive. The physiatrists at Gaylord were keenly aware of what was needed to maintain hospital licensure and keep the facility growing.

Hospital stays—as dictated by licensure rather than insurance companies—ranged between 14 and 25 days, so patients’ conditions must be neither immediately correctable nor impossible to solve. Only through misdiagnosis would a patient stay long-term. The time frame encouraged the admission of stroke and brain injury patients or those with pulmonary problems over those with musculoskeletal complaints better suited to outpatient care.

After a few previous episodes of cerebral hemorrhage, my patient-mentor was quite familiar with Gaylord and the premise of recovery. He praised the staff for their attention and optimism, citing that this stay left him feeling better than before his last crisis. He lived in the “cottage house,” a co-op dormitory that meant greater independence but ostensibly less privacy from the other residents. His only complaint: There was nowhere to just sit down and cry. Despite this, having a body of others supporting him, without making comparisons to themselves or others, makes a substantial contribution to the healing process. The collective group body could do everything, even when his own could not.

The hospital was a new beginning for some and a continuation of care for others, but never was it an end point. There was life after rehab. You just had to rise up and greet it.
Benjamin Silverberg is a third-year at the University of Connecticut School of Medicine.