15. Liliana
15
LILIANA
Grad school doesn’t prepare you for patients like Roman Ward.
I knew there were going to bumps in the road of his recovery. I may not have guessed that they would be this kind of bump, but the fact that his body reacted during a massage isn’t really a big surprise. It’s a common occurrence with SCI patients, both with the unexpected nature of it and the potential lack of sensation that lets them know it’s happening.
The bumps in the road aren’t the issue. It’s Roman’s reaction to them that I’m worried about.
Case in point…it’s been a week since I’ve seen him.
And I’ve been stressed the whole time. Even my brothers noticed something was off when I showed up to family dinner last weekend. I almost called Roman that night, too worried to go another day without checking on him, but…I couldn’t. Ethically, I probably could have, just as a simple check-in on a patient, but that’s not why I’d be calling. And on top of that, I wanted to give Roman a chance to solve things on his own. To come back to physical therapy because he wants to.
I’m one missed session away from showing up at his house and banging on his door when he finally appears in the clinic.
I do a triple take when I spot him. He looks tired, with dark bags under his eyes and a general weariness to his demeanor.
“Roman. You’re here.”
He doesn’t nod or respond with anything. I have a feeling today is going to be an appointment of few words.
For the first time, I’m flustered. I’m not sure the best way to handle this. It doesn’t matter that I haven’t been sleeping well with how much I’ve thought about what I’d say to Roman when he came back in, or that I’ve practiced a dozen different motivational speeches in the past week—right now, I’m terrified of doing or saying the wrong thing.
My hands are shaking as I hurry to put away my last patient’s notes that I was finishing up. “Um… just give me a second. I can be ready in a minute.”
He doesn’t answer. He just turns and heads toward the stretching area.
After I finish cleaning up and move over to where Roman has started his exercises, it takes me a few minutes to work up the nerve to speak again.
In the end, what comes out in a too-high voice is, “Did you have a good week?”
I wince as soon as the words are out. “I mean…what did you do this week?”
Once again, he ignores me.
Another minute of silence. More of me frowning and biting my bottom lip.
“Did you think any more about starting gait training?” I ask, my voice gentler this time.
At that, Roman lets go of the retraction band he was working with, making it go flying across the room. Then he’s pulling his wheelchair over so he can move to the weights area.
This is a quicker progression than we usually follow, but since I’m already paddling upstream with Roman, telling him what not to do probably won’t win me any favors right now. So I let him go, while keeping a close eye on him.
Now he’s on the leg extension machine working leg raises. I can see the way his jaw clenches after the first rep, and I know he’s feeling the weight of it. I can also see how that fact makes him angrier than he already is.
Somehow, with shaky legs and gritted teeth, he gets to eight reps. Then he drops the weight with a loud clang and exhales a heavy breath.
My concern only mounts. “Maybe you should go a little easier?—"
He locks his feet in for another set.
Six reps later, he drops the weight again, his chest heaving as he sucks in air. His legs are now shaking from the exertion, not just during the reps but after.
And yet, I still don’t say anything. It isn’t until he moves over to the free weights that I get seriously worried.
“I don’t think that’s a good idea, Roman.”
“Well, you don’t actually get a say,” he spits back. Leaning down to grab one of the dumbbells, he settles back in his seat and places the weight on his thigh. One of the ‘functional’ exercises we had just started doing was first pressing up onto his toes to work his calves, and then lifting his knee completely to work his quads. But we hadn’t gotten around to it yet, because working with free weights is a lot more dangerous than using the machines.
Roman sucks in a breath to prepare himself, then presses up on the ball of his right foot.
And then he does it again. And again, until his leg is shaking. On the fourth lift, I know he realizes that he’s grabbed a weight that’s too heavy.
Goddamnit. I want to snatch the weight out of his lap. I should . He’s going to seriously hurt himself if he keeps up with this. But I’m still a little shocked that he’s even here, and I’m so out of my element with his current emotional state. Plus, I know if I do grab it, he’s going to absolutely lose his shit with me.
As all these thoughts flip through my head, Roman is moving the dumbbell over to his left leg. Which is even worse news, because his left leg is still weaker than his right. He’s just setting himself up for failure.
He sucks in another determined breath, manages to press up on his foot one time, and then as I shoot forward to grab the weight—his pride be damned—I watch as his leg loses all strength in the muscles and goes crashing down, the dumbbell sliding out of his grip and onto his foot.
“Roman!” I shout, stomach sinking as I rush around to his front. “What the hell! Are you hurt?”
He’s panting, looking stunned by the last few seconds. Too overwhelmed to react.
As I start to untie the shoe that the weight dropped on, that gets him talking.
“Don’t ,” he bites out.
My brow furrows as I glare up at him. “I have to check. You may have broken something.”
“Wouldn’t matter. It’s not like I need the foot anyway.”
With a growl of frustration, I straighten to stand before him, planting my hands on my hips. “What is wrong with you today?”
He holds my eyes in challenge but doesn’t answer.
But something in his defensive expression makes me soften, and I remind myself that he’s struggling with a big hurdle in his recovery.
“Is this because of last week?” I ask, pushing through my hesitance around the subject. “Because you know that doesn’t mean anything to me. I know with your injury?—”
The reminder of our last session makes his face instantly blaze with visible humiliation. He spins away from me and starts to move in the opposite direction.
“Roman, come on , you can’t let something like that stop your recovery.” When I jump in front of him, and he brakes so he doesn’t hit me.
“If you care about my recovery at all, ” he says with his jaw clenched, “you’ll never mention last week ever again.”
Swallowing thickly, I nod. “Okay. I understand... But only if you don’t let it affect your sessions. You can’t do what you just did, it’s dangerous.”
“You don’t get to set my limits, Liliana,” he spits, trying to get around me.
I hold my ground, determined to have this conversation.
“Isn’t it against your physical therapist oath to hold your patients’ disabilities against them?” He gestures to his wheelchair and lack of mobility.
“No,” I snap without a second thought. “And even if it was, I’d still use whatever cheat method I could to get you to talk to me.”
“I don’t want to fucking talk to you,” he barks.
“Too fucking bad,” I bark back. “Clearly, it’s affecting your therapy. We can’t work on your recovery until we move past whatever this is.”
He looks away, an angry scowl on his face. It’s the first time in weeks that he’s thrown what can only be called a temper tantrum.
“Did you honestly think this recovery process wouldn’t come with hiccups?” I ask, holding firm in my stance and my confrontation. This feels like a make-or-break moment. “Did you think it was just a matter of lifting a bunch of weights, of committing to some walking exercises, and that was it?”
His frown deepening tells me I nailed it.
“It’s hard work, Roman. There are going to be hiccups. But you know what? Hiccups mean progress. And you should know better than anyone that progress isn’t linear.”
His Adam’s apple bobs, and it’s the first time his expression softens. A little bit of that anger and embarrassment fade, to be replaced by pain.
But he’s still scowling, still unable to let himself get past this particular hurdle. So I try the tactic that has been the only thing to work with him thus far: tough love.
I glare down at him, even though he’s still not looking at me. “So, if you could kindly get the fuck over yourself, we could just treat this as one of those totally normal, part-of-the-process speed bumps, and get back to your recovery.”
Roman finally looks at me again, a hundred emotions swirling in his eyes but with astonishment at the forefront. I just wait it out.
Finally, he murmurs, “Damn, Liliana. That was brutal, even for you.”
I let out a huff and drop my hands to my sides, feeling suddenly exhausted. “Sorry,” I grumble. “You had me at my wit’s end.”
“Apparently,” he returns dryly.
Then I watch as my words really sink in, as he takes them to heart and finally accepts them.
“You’re right,” he sighs, looking uncharacteristically sheepish. “I’m sorry. I guess…I was riding the self-pity a little hard.”
“A little?” I ask with a snort.
“Okay, fine. I’ve been an unbearable prick with it lately.”
I sniff. “You said it, not me.”
He shakes his head, the tiniest smile peeking out that might as well be bright enough to light up the entire room with the way it hits me in the chest.
“You should tell the board about your therapy strategies,” he says. “I’ve never had a therapist talk to me the way you do, and yet I’ve made more progress in the past two months than anywhere else. Clearly, you’ve revolutionized patient care.”
“Well, in that case, I’d like to continue that progress.” I can’t help glaring at him as I add, “So, can we get back to your therapy? Please?”
He nods, seemingly just as mentally exhausted as me, but at least he’s here. At least he’s willing to move on.
“Good. Before we do anything, I’m going to check your foot to make sure you didn’t bruise or fracture anything—and FYI, you better hope you didn’t.” The more I go on, the more my tone hardens to one of taking no shit. “Then we’re going to use the rest of the session for stretching and a massage so I can evaluate how much progress we’ve lost in the past week. And if you get an erection, we’re both going to ignore it, and I’m going to see you right back here on Monday night. Capisce?”
“Jesus, Lily,” Roman says with a wince, swiping a hand down his face. “Seriously? Could you not?”
But I’m not backing down from this. This last week can’t happen again.
In a move I’ve never ever used before but that feels suddenly right to break the tension of this moment, I extend my pinky to Roman. “Pinky promise right now, or I’m transferring you to a different physical therapist.”
His eyes widen before he smooths the expression. “I really hate you right now.”
I keep my pinky extended. “I hate you back, so that’s okay.”
He glares for another moment, then quickly reaches forward to roughly entwine our pinkies together. “You are certifiable,” he grumbles.
I hold on to his finger, ignoring the spark that shoots up my arm at the contact. “Whatever it takes to get you to your feet, Roman.”