How My Life Was Changed by Rats, Underwear, and Human Nakedness
My experience of being a physical therapist to the rich and poor.
My 30-year physical therapy career has been with inpatient rehab and in homes. I often work with patients whose lives are suddenly unhinged — a newlywed has paralysis after being hit riding a bike, a young mother becomes unable to care for her children due to a brain hemorrhage, a young woman who jumped off a building in a suicide attempt now has multi-traumas, an elderly person falls and breaks bones, an athlete with a head injury learns to use a wheelchair, amputations from wars, accidents, and severe diabetes, arm injuries from domestic violence, young and middle-aged adults with ALS, MS, and a rare virus brain infection causing loss of standing balance, strokes with an inability to communicate, fractured bones due to a fall while intoxicated, and end of life support.
It involves teaching not only the patients but their families, friends, and caregivers how to assist with their mobility and exercise program (i.e., in and out of bed to a wheelchair, or walk to the toilet safely, climb 45 steps out of an apartment to be able to see their doctor or to get some fresh air).
I have worked with hundreds and thousands of patients. These are a fraction of the examples of my journey.
In the last fifteen years going to patients’ homes, I have been to buildings where rats have run up to me (I restrained my scream and the residents assured me that this rat comes this time every day and not to worry!), roaches on pillows, things that move in hung plastic bags (who knows what was in there!) to mobile homes, nursing homes, those that resemble the Hoarder show ( i.e., decades-old yellow frayed newspaper stacked to the ceilings, layers and layers of empty canned goods stacked on a dining table, dozens of empty shampoo bottles on the bed, hundreds of empty soda cans littering the floor, unusable appliances and hundreds of used takeout boxes spread out on the kitchen table as if that was lunch), to stately and majestic mansions with more than a dozen bedrooms, homes with personal drivers, gardeners, cooks, and housekeepers in uniforms.
Some one-room apartments were so small that I had only a standing space of 3'x3' to work with a patient since their essentials occupied most of their home — one was so small that I did PT right outside my client’s door because I could not even walk in. Some were mammoth homes where I became lost in the meandering halls to teach my patients endurance walking.
What I have observed is that — no matter where and how we live, how rich or poor, how old or young we are, no matter our ethnicity, sex, religion, or education— pain, emotional suffering, and tragedy are inevitable to all of us.
Those with financial resources may pay for their care, but the rich do not always progress faster without dedicated devotion, love, and support of loved ones or their community.
The low income (barring those who do not have basic shelter, food, or safety) actually thrive sometimes better than the middle or high-income patients — even as some of them live in an 8'x10' room with one small window that offers only views of their pinned clothing, translucent thin underwear drying out on tattered ropes, with wobbly dented pots and pans on a makeshift table, and ingenious creative storage of most of their worldly possessions wrapped in brown paper or plastic bags on an upper bunk bed.
They improve not only because they are tenacious people and work hard with me, but also because they have people they can count on consistently who show up and who are deeply connected to them.
That is a huge part of their success: They seem to be happy people.
I don’t mean that if you have many visitors and sleuth of paid help, it will necessarily restore your function better — it’s the quality of the relationships that matters. You can still be lonely with many people around you who are unreliable or who don’t understand you. I have noticed anecdotally early in my career that social isolation commensurates with slower or lack of return in physical function and movement.
Our society dictates that only family can serve to be the patient’s caregivers. Yet, I have witnessed many alternatives that are very loving, such as neighbors, partners, church/faith members, community members, and sometimes simply a good friend.
Sometimes they provide better care and loving support than family. I was always bothered when a discharge planner or social worker asked my patient, “Do you have a family member picking you up?” or “Do you have any children picking you up?”
Such questions are packed with assumptions. It’s assuming everyone has or wants children. It’s assuming that one is close to their family or has family that lives close by. I once had a patient who was abused by their parents, so they had not contacted their family since they were teenagers.
I also notice that patients with very little disposable income are the most generous people, much more so than the well-to-do. They have not forgotten what it is like to be without. With meager means, they are the ones who offer me what little they have, be it their last orange or their best dry scallop in a used jam jar, or a lai see (a five-dollar bill in a bright red envelope: symbol of good luck), a family heirloom, their own painting, meals, a sweater they knitted, or an offer of tea or coffee.
And oh, they give so much so willingly to their neighbors, friends, and even strangers when they have so little, unlike the wealthy who can afford to be charitable. Generosity oozes out from them, and they are also liberal with gratefulness and appreciation. Their grateful attitude also seems to help them return to their function faster than those who guard their resources and paucity of gratitude.
I have noticed that many who are very well-educated and well-off view therapy as what is entitled to them. And often, they spend a lot of time scrutinizing what is due to them and want to maintain their position of power. (Granted, there can be medical staff who perform less than the standard of care. I am not referring to those — they are not the norm). Of course, it’s our job to provide competent medical care regardless of the patient’s attitude. I am talking about a spiritual loss, the greedy spirit, which is detrimental to one’s well-being.
People often ask me why I became a physical therapist. Sure, it is gratifying to help patients walk again and sometimes even return to normal life.
But really, I have been the recipient of a great honor to be so intimately involved in peoples’ lives — physically and mentally, in the heart-to-hearts and in such close vis-a-vis conversations, I get to be deeply connected to others in their vulnerabilities and in their nakedness.
I am eternally grateful to have been privileged to hear my patients’ stories and witness their great acts of courage in the midst of physical and emotional pain.
I have been trusted to be their “ secret holders,” hearing personal stories and family secrets they had not told anyone for decades as we worked together in quadricep sets or took breaks from the stairs training.
I have also worked with belligerent, capricious, narcissistic, malicious patients, but unexpectedly they have taught me compassion, hope, and patience.
I think about what might have happened to my patients in their life experiences, or in utero, or with their ancestors to cause them to be unkind. I know that even the most unpleasant patient can change, albeit a little, with compassion and patience. What hope in humanity!
What a humbling experience to have been bestowed with this journey: bearing witness as my patients battle their inner demons, self-criticism, despair, failures, and insurmountable environmental and systematic barriers.
I cheer alongside their fierce commitment to getting better despite colossal pain, watch another human’s acrobatic tumble and grit, model their somersault of resilience, behold herculean tender caregiving with so much love and support that I wonder if that is what heaven will be like. One of the greatest rewards in my life is that my patients allow me a seat in their private cinematic screenings.
