I started my career as a physiotherapist almost 40 years ago. Today I work with therapists and assistants who were not yet born when I graduated. The only constant over the years has been change;- employers, technology, practice, standards of care and more. I trained at a time when passive modalities were widely used. We spent hours in labs learning how to apply hot packs, set up shortwave diathermy, nerve stimulators, ultrasound and even microwave machines for deep heat. (Microwave ovens were not available for home use in the early 1970s.) We learned massage techniques and studied how to apply traction to the spine. We suspended limbs in slings that were clipped to wire cages to facilitate active assisted exercise. Hours were spent learning postural drainage and manual percussion. Physiotherapy developed as a profession during the world wars and polio epidemics of the 20th century and focused on massage, exercise, ice, moist heat and electrical modalities.
My first job was in a general hospital where therapists rotated to different areas of service every three months. The rotations included outpatients, rehabilitation which included stroke, spinal cord and amputee rehab, general medicine, orthopaedic surgery, chests, both medical and post surgical and intensive care, neurology and paediatrics. Service rotations are rare now but we gained experience in treating a wide variety of of conditions. In the mid-1970s we had no computers, MRI, CT scanners or diagnostic ultrasound. Joint replacements were not available at our hospital and patients with femoral fractures spent months in bed with their limbs in traction. Orthopaedic surgeons did meniscectomies, discotomies, osteotomies for knee arthritis and other surgeries which are seldom done any more. We worked under doctor’s orders and most treatments were conducted in a routine fashion without detailed assessment on our part. If the doctor ordered a hot pack, that is what the patient received.
Medicine has changed immensely in the last four decades and my practice includes many techniques unheard of when I was a student. Learning new treatment techniques is not as challenging as developing good clinical and patient assessment skills. Human motivation and behaviour must be understood to give effective treatment. I have worked in acute care hospitals, a rehabilitation hospital, home care, nursing homes, schools, research labs, and have found my career to be rewarding in every setting.
I still work full time and do not have a retirement date in mind. One of our gerontologists, a brilliant young doctor who is under 40 years old said to me this week, "Keep on working or you will decline." We must stay engaged and involved with life at every age.
Many patients have inspired me, some have saddened me, others have amused me. Their stories have become part of my life. The following accounts are based on true events but the identities of people involved must be protected. For that reason names, locations, and time may be altered. Here is the first instalment.
George- Never Too Old To Learn
Working as a home care physiotherapist was the most enjoyable job of my career in many ways. Self-scheduling, working from home, driving the open road and meeting a variety of interesting people were among the perks. I covered a section of a city and a large rural township where many older residents had long associations with the area.
I met George, an octogenarian, following his knee replacement surgery. Widowed after spending a number of years caring for his wife who suffered from Alzheimer’s disease, he enrolled at the local university and earned a geography degree. His field studies included a lot of leg work in the township and that pushed him to have his arthritic joint replaced.
The house was small but long windows brightened two walls of his living room. A computer was in the corner and a work table was strewn with papers and books. George had a full head of white hair, a strong stocky build and bowed legs from lateral compartment collapse of his knee joints. A collection of walking sticks stood in a barrel at the door, from strong knobby tree limbs to ornate carved and painted canes.
Physiotherapy visits included an assessment and a set of painful exercises. The only patients who are prepared for the pain of a knee replacement are those who have had one in the past. I helped George progress from a lift walker to a wheeled walker to a cane for walking and showed him how to descend and ascend his basement stairs After my work was done he shared his knowledge of the area often pulling out maps and books with enthusiasm. I learned about four nearby kames and came to understand how the many kettle lakes in the area were formed. A nearby moraine that filtered and balanced ground water was threatened by city expansion. He knew the name of the lake that once covered the area where we live and I understood why our property is largely sand and gravel.
George finished his therapy successfully and started working on his masters degree. I received a referral to see him the following year when he was 85 years old and recovering from his second knee replacement. He still had an infectious love of learning and showed me a special achievement award from the university.
I see older adults working on work puzzles and short games to maintain their mental abilities. I never met another senior who was a passionate university student participating in classes with people one third his age. The exercise he got on trails and fields also kept his mind and body fit. He never uttered a bitter word or complaint about past losses and regrets.
I remember George as I drive or walk in the region. Every hill and gully is unique and has its own history. Rivers cut through ancient glacial fields and change is never ending. He embraced change and forged new paths in old age, never too advanced in years to take up a new challenge.