Skin Diver

The first time I meet a patient a lot of information comes at me very fast. How they walk, their posture, how they carry each part of their body, scars, skin, facial expressions, evenness of movement, which way they lean (away from their pain}, skeletal alignment, condition of their skin, the emotions they wear on their face, how they smell, the energy they put out or pull from me, areas of weakness, strength, and pain all rush at me as I introduce myself and reach out to shake their hand for the first time.

When I examine them, I work first with my eyes, then my hands, then my ears. My mother always asked me, "Why don't you ever listen?" I don't know, Mom. I do listen. But until I absorb something with my eyes, and then examine it with my hands to know what I think, I cannot really hear what you say. It's like my occipital and parietal lobes have to tell my temporal lobe what is coming. I don't just picture them naked. I picture them without skin. I have to dive beneath the surface, layer by layer, to help them sort out their pain. They know they hurt. It's my job to tell them why, and how to stop it. Every time I am successful at that, I hear a little voice in my head that says, "This is why you are here." I always laugh when people say, "What do you want to be when you grow up?" I tell them, "I am grown up. I am what I want to be." I want everyone in the world to have that great feeling.

It's a luxury to be able to have longer treatment sessions with my patients, and ultimately it's why I picked physical therapy school over medical school. I wanted to spend more time with my patients, I find it more satisfying. Hands on is what I am about, and no one else gives that. One of my beloved professors, a genius at manual therapy and reduction of musculoskeletal chronic pain always said, "If your hands aren't on the patient, why the hell are you there? Shut your mouth, open your eyes, and feel." Often I am surprised at what I find no one has bothered to explain to them before. With the typical contact time for patient visits dwindling by the day and required paperwork increasing exponentially, I have to fight to keep my hands where they should be: on the patient, and I have to fight for enough quality time in a patient encounter to really understand what is happening and why. When my father was diagnosed with Parkinson's disease in his mid-forties, it took the neurologists five years to make the final diagnosis. Five years of 15-minute patient encounters. Kind of makes me wish that one person had taken 45 whole minutes and gotten it right the first time.

Today, as everyday, so many satisfactory moments. When one of my patients, a beautiful, beautiful woman with a diagnosis that makes me weep for the finality of it and want to believe in Angels in America, told me today, "You always shake my hand, today I want a hug. You are the only person I know who actually listens to me." I heard what I always hear at these moments. This is why I am here. See Mom, I do so listen.