Loss of Independence: A Wound That Heals With Time and Patience
by Bruce E. Ruben MD
"Any natural, normal human being, when faced with any kind of loss, will go from shock all the way through acceptance."
Life is a bunch of pivotal moments that move you on to the next phase. Like the moment you realize you're no longer a child. Or the moment it becomes clear that you have to change jobs. Later on, it's when you admit you can no longer maintain your home. And for many of us, there will be the moment you come to grips with the fact that you can no longer care for yourself without help.
When Assistance is Needed: Talking to Your Patient
In our outpatient wound care facility, we see the moment when when a patient reaches the point of requiring assistance play out enough to know that we can play an important role in helping them accept that next phase of their lives.
"So what if I didn't put the bandage on right. So what if it's going to take another week to heal. It's no big deal. Look, I've been caring for myself for 78 years. Believe me. I'm going to be fine. I bet I've healed a thousand sores in my life."
First, we understand that healing wounds is always a team effort and that the patient is always the central member of that team. Not only because we promote the patient-centered approach to health care, but also because no matter what we do in wound care, the patient has to do most of the work. And it's not easy. They have to take their medications on time, get their dressings changed, some may need IVs every day and they often have to adhere to mandatory dietary considerations such as taking in more protein to help heal their wounds.
Getting Patients to Collaborate on the Plan of Care
Healing requires a patient to buy in to the wound treatment plan 100% no matter how hard it will be for them to comply. Sometimes, it's an enormous challenge. Imagine asking an ischial wound patient with a fresh surgical flap to remain completely immobile, in bed, for four to six weeks. Would you be able to comply with that prescription? Frankly, I'm not so sure I would.
"I don't know why there's still swelling. But I did stop taking the water pill because it put me in the bathroom every five minutes. I was in there half the day! Plus, that pill was so small that I always forgot to take it. How about if I just drink less water?"
Patients need time in order to accept the reality that they can no longer do it all on their own. Like so many of the changes we experience in life, it takes time for our brains to process all the facts and feelings, especially for the elderly. They'll certainly need more time to adjust to the idea of a new normal simply because it will alter their precious routines.
Not surprisingly, there are specific, identifiable stages to this adjustment process, much like the grief stages Elisabeth Kubler-Ross described in her groundbreaking book, "On Death and Dying." It makes perfect sense because these patients are experiencing a death.
They're experiencing the death of their independence.
"Absolutely not! I do not need any strangers coming into my home and knowing my business. I'm still sharp as a tack, not like you say. I pay my bills. I pick up the house. I cook. I never needed help raising you four boys; I can certainly deal with a little sore! And stop talking to me like I'm a child. Stop 'handling' me!"
Listening to Our Wound Care Patients with Purpose
So what are our roles as wound care experts when patients wrestle with losing their independence? Naturally, our first role is to listen with a purpose. That doesn't mean listening just so they can vent, but to listen for something in particular. An example might be, "I'm going to listen for this patient to verbalize her true fears about losing her independence so she can move forward." With that context in mind, it's just a matter of asking the right questions and giving all the time they need to answer.
Ask the right questions and have the strength, patience and resolve to listen. It's not easy for us to put everything on pause temporarily since we're always so geared toward fixing things. We find it hard to accept that patients can often fix themselves mentally if we give them the mental space to do it. For both doctor and patient, it's quite powerful to see it happen.
"Okay, so maybe I do need some help. I'll do what I have to do. Just tell me. Please tell me, doctor, and be completely straight with me. Is this the beginning of the end for me? You figure it's downhill from here? I mean, really, is this thing ever going to heal or are we just kidding ourselves? I'll tell you the truth, I'm scared."
Fear is an interesting thing. When it finally gets verbalized, it's always followed by courage. And then with courage comes acceptance.
About the Author
Dr. Bruce Ruben is the Founder and Medical Director of Encompass HealthCare, located in West Bloomfield, Michigan. Encompass Healthcare is an outpatient facility featuring advanced wound care, IV antibiotic therapies, hyperbaric oxygen treatment, nutritional assessment, and other treatment modalities. Dr. Ruben is board certified in Internal Medicine, Infectious Disease, and in Undersea and Hyperbaric Medicine. He is a member of the Medical and Scientific Advisory Committee and National Spinal Cord Injury Association (NSCIA) board.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.