7. Liliana
7
LILIANA
“Hey, Lily. Whatcha working on?”
I close my laptop, wincing when I straighten my back for the first time in an hour. Apparently, I’ve been glued to my screen for my entire lunch break.
“Just reading over some case studies for Mr. Allen’s concussion,” I answer my coworker’s question. “He’s been struggling with the up and down motions since his fall, so I wanted to look up some other exercise options for him.”
She shoots me a perplexed look as she reaches for a coffee cup. “Didn’t you discharge Mr. Allen a month ago?”
I sniff. “Yeah. What’s your point?”
She huffs a laugh and shakes her head. “I’ve never seen someone go so above and beyond for their patients.” Quirking an eyebrow, she tacks on, “I bet he didn’t even tell you that himself. You called him to see how he was doing, didn’t you?”
I give her a flat stare in response.
Another chuckle, another shake of her head. “You are such an overachiever,” she says as she hits the button on the Keurig machine.
“Whatever,” I say with a sniff. “I like it when my patients make—and keep—their progress. Sue me.”
“I’m pretty sure the only way a patient could sue you was if you didn’t make them feel better,” she muses to herself as she mixes cream into her cup. Frowning, she looks up at me before asking, “Have you ever had a patient you didn’t successfully rehab? I know you’ve only had your license for two years, but proportionally, you’ve definitely had the most patients under your care.”
Sighing, I trace the logo on my water bottle, thoughts of Roman flashing through my mind. “No, I haven’t,” I admit. “Not yet, at least. Fingers crossed.”
She hums thoughtfully, studying me for another moment. Then she glances down at my computer.
“Guess I can’t tease you for doing your homework, then,” she comments as she turns back to her coffee. “Since it’s clearly paying off.”
My gaze also drops to my computer, my thoughts turning to the research I know I’ll need to do for Roman’s case. Something tells me the by-the-book tactics aren’t going to be enough to help him.
“Let’s just hope it continues to pay off,” I say with a sigh. “In the meantime, I think a cup of coffee might do me more good than the article I just read. Mind tossing another pod in there for me?”
By the time Roman’s appointment time rolls around, I’ve consumed two more coffees. I should’ve thought a little harder about taking on an extra patient at the end of my day—or at least bullied my boss a little for not giving me a heads-up about it before I said yes.
At 7 p.m., I walk into Roman’s exercise room. He’s early, and slightly less hungover, but he still looks just as unenthused as he did earlier this week.
I swallow the sigh that wants to escape. I need another cup of coffee.
With a smile pasted on my face, I greet him like I would any other patient. “Hi, Roman. It’s nice to see you again. How are you today?”
Unsurprisingly, that earns me a blank stare.
I let out an awkward cough and try again. “Do you need anything before we get started? Can I get you some water?”
“Let’s just get this over with,” he growls.
Swallowing another sigh, I grab the folder with his pertinent medical history. “Your file says you worked with an orthopedic therapist and…a few PTs.” I don’t think either of us misses the way I stumble over the word few . “So, I’m not going to start with the basics. I just want to evaluate where you’re at.”
“Doesn’t my chart already tell you that?”
Shrugging, I toss the folder onto a nearby chair. “We’re going to forget the chart. I want to see where you’re at.”
His voice takes on an edge. “So you want to waste my time.”
Aaaand that’s enough of that.
I lean back against a treatment table and fix him with an even stare. “With all due respect, you’re two years post-accident with an injury that your doctors said you could have rehabbed at least to the point of assisted walking. I don’t think I’m the one wasting time here.”
There’s a flicker of surprise in his brown eyes. Good. He’s going to have to get used to some tough love.
I gesture at the treatment table. “Should we get started?”
He aims a glare at me that’s reminiscent of a teenager not getting their way, but moves toward the table anyway.
Lily: 1 Roman: 0
When I take up my stance beside the table, he only appears confused for a second before he realizes I‘m not going to offer to help him get up on it.
“You’re seriously not going to ask if I need help?” he sneers. “What kind of physical therapist are you?”
For some reason, his question breaks through every barrier I have, reverting me back to the eighteen-year-old girl who decided on this career because she wanted to help people.
“The kind who’s going to get you walking,” I say softly.
I can’t tell from his expression if he believes me, but at least he moves to climb out of his chair.
I’m watching him closely as he does it. He might think I’m being an asshole who’s just trying to make him work, but this first session is critical for me. It’s as much of an evaluation as he’ll let me conduct without asking him a million questions that he’s answered before. With Roman, I’ll need to rely heavily on what his body is showing me he can do.
Sure enough, by the time he’s lifted himself out of his chair and onto the table, I can already tell he favors his right side. Roman has an incomplete spinal cord injury, which means not every neural pathway between his brain and spine were damaged in his accident. For the ones that were spared, there’s still a connection, and some sensation. It’s those neural pathways that we need to retrain to recover the functions that he lost.
I just need to figure out where they are and which movements he’s capable of.
“Can you flex the toes on your right foot?” I ask, ignoring Roman’s still-intact glare.
After a moment, there’s movement in his right toes.
“And your left?”
Less movement there.
“Can you contract your left quad and pull your leg up?”
No movement, but I also notice out of the corner of my eye that Roman’s gaze has intensified.
“And your right?”
Some movement.
For the next ten minutes, I go through two dozen exercises with him, trying to identify where he has feeling and where he has nothing. By minute six, I’m feeling slightly frustrated.
The problem is, I can’t tell if his muscles are actually weak or if he’s just not trying. Or if his muscles are weak because he hasn’t been trying.
For the most part, physical therapy comes down to simple exercises and repetition. There’s no big secret to rehabbing an injury beyond identifying how best to do that, and most of my sessions with patients are spent in the gym doing countless reps of basic exercises that they’ve already heard of, just with lower weight or intensity.
For a man like Roman, I can only imagine what it feels like going from putting a hundred pounds on the leg extension machine to struggling to even lift your foot up. Part of me doesn’t even blame him for losing motivation. I see every day how much of an ego-crush physical therapy can be. There’s a reason we heavily suggest counseling for our patients.
Grabbing a thin resistance band, I wrap it around his socked foot and hand the other end to him. “We’re going to use the bands for some strength training. Do you currently do any exercises at home?”
“Does exercising my thumbs on a video game controller count?”
This time, I release the sigh I’ve been holding back. “No, that does not count. Alright, we’ll keep it simple today, then. I’ll write the exercises down so you can do them at home between appointments, too.”
It doesn’t take me long to confirm he’s not going to do them at home. He’s not even doing them here .
Roman doesn’t technically defy my instructions, but he’s clearly not trying. Even when he does an exercise correctly, and I expect it to boost his morale, all he does is double down on his non-reaction. I get more blank stares in one hour with him than I did with all six of my other patients today.
And that’s not even taking into consideration the motions he can’t do. I half-expect him to throw the resistance band across the room every time we discover one of those. When it happens, I see Roman grit his teeth and put even less effort in. It’s like he feels more comfortable blaming the failure he is feeling on a lack of effort instead of on his body.
By the time our hour is up, I have no idea who’s more exhausted: me or him. Honestly, it might be a tie.
“Alright, that’s enough for today,” I tell him, taking the band from his hands. “Do you have one of these at home?”
He nods, albeit reluctantly, so who knows if he’s being honest.
“If I tell you to do the exercises we just did daily, will you do them?”
A muscle twitches in his jaw. “Sure, Doc.”
I frown at that. I haven’t had someone call me “Doc” since…
My eyes narrow as I study Roman, trying to see if he does remember me. But his face remains impassive, and after a moment, I decide it was just a coincidence.
“Do you need help getting back into your chair?” I ask instead.
Anger transforms his expression— at me? Or something else?
“No,” he spits out. Then, with the practiced movements of someone desperate to be independent, he pulls himself up into his wheelchair.
“See you on Saturday at four?” I ask.
But he’s already leaving.
This might be harder than I thought it was going to be.