The first time I had met with P., he was new that day to the rehab unit. The ambulance transferring him to our unit had scarcely left the drive, on the way back to the University Hospital, when I assured myself my plan was on point. No one had taught me this, but I knew I had to imprint on this guy.
I needed to be the first therapist with whom this patient could bond. And now I was here for the initial bonding experience. Through review of P.'s record, I could flesh out his story to decide on a tentative plan with P., his family and support system.
"P. my name is C. I am a speech therapist. It's good to meet you. You are at our rehab center. I'm here to help you anyway I can"...and then I sat back and listened.
P. had been shot in a drive-by assault, some six weeks prior to the day he had entered acute rehab. The trajectory of a single bullet, entering his right forehead, had at high speed dug deep into his midbrain, with a cavity swelling then imploding around that missile. Brain tissue density did indeed change the bullet trajectory, so that the bullet exit wound was found through cerebellar tissue at the lower left cranium.
"P., with what happened to you, I have seen in your chart that you do not talk. You are able to concentrate on a person, when that person touches your arm or shoulder. You don't swallow your own saliva without coughing, so there is a tube in your stomach so that you can be fed".
While the abrupt trauma to P.'s nervous system had brought about his coma and near herniation of his brain stem, - what had been turned off, at the neuropsychological level, were consciousness, alertness, attention, speech, expressive language, and all the higher cortical functions - what make you an adult...they're turned off, for awhile.
P. had been found on an urban street corner by the EMT's, not five minutes after the gunshot had been documented on high- sensitivity audio police surveillance. He was known to the city's police; not having completed high school or a GED, his job had been on the streets. The state had begun to pick up the tab for his highly complex medical care through Medicaid. Acute rehab was intended to get P. more mobile, more independent for ADL, and communicative.
"OK P., it's time now to help you get better. I can't guarantee we will reach a certain goal, but we are going to try to help you swallow better. Here -here is a cotton swab, with some lemon ice coating it....I'm rubbing your lips with it. As the President says, we'll see what happens".
I am always open to pleasant surprises...but after doing this kind of work for over 35 years, the odds for P. having a future in competitive employment is extremely low. P.'s need for long term complex medical care seems to be high intensity and long-term. As of our first day, the social worker says no one had yet been arrested for this shooting. Why did we have to have this case?
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