Abstract
“I think you need, for your own peace of mind…” I paused, choosing my words carefully, “to try to let that go, to focus on just getting better.”
“I know that. But you don't understand what it is like, to not feel safe in your own home.”
That was a good point, one that I could use. “In that case, maybe we should think about some other place, some place where you can feel safe.…” I stopped short of saying “skilled nursing facility” or “nursing home,” knowing the response those words would evoke.
“I just need a little bit more time, to get my strength back. I'm doing exercises every day in the bed. Look.” She pumped her ankles under the blanket several times, her feet rippling the surface of the covers. That was the most physical activity I had seen from her in five days of lying in the bed.
“Mrs. Hanson, I don't think that is enough; I think you need to work with the therapists when they come around. You need to get out of bed and walk to get stronger.”
Her face darkened. “I don't like that woman. She threatened me. She told me that if I don't get out of bed she'll send me to a nursing home.”
I sincerely doubted that the exchange was as simple as Mrs. Hanson portrayed it, but the sad fact was, that simple mantra—refuse to get out of bed and you'll get sent to a nursing home—was probably correct. I knew this after working for several years as a therapist myself before deciding to go to medical school. Talking to Mrs. Hanson felt like old times: matching wits with the slightly irrational. I knew the rules well. My advantage was obvious: I was young and fresh and did this every day. Her advantage was that, well, she was not always limited by the laws of reason. Then again, all I had at stake was a little pride and the need to be able to tell myself at the end of the day that I tried to do the right thing. For her, her whole livelihood was at stake: losing the battle of wits meant losing her home, her friends, and her independence.
Discrediting the person I had just placed on a pedestal was a clever strategy, but I was not ready to relinquish that point so easily. “There are other therapists,” I said. “We can find one who is a better fit for you.”
“Listen,” she said, looking at me patiently, “it is just really hard for me to trust anyone right now, knowing that someone tried to murder me, and I don't even know why.”
The claim of attempted murder, supported only by a video that had never been seen by anyone else, was a stretch, but within her rights, as one not bound by the laws of reason. For myself, wishing to remain aligned with reality, I believed what seemed most plausible: that before the fall she was living on a knife's edge, slowly losing her physical and mental capacity, until one day she lost her balance or tripped on a throw rug, fell hard, and could not get up for several days. Her son found her on the floor, in her own urine and feces, unable to recall what had happened. It was only after several days in the hospital that she began to reference a videotape, one a neighbor was supposedly recording for her grandchildren, that showed definitive proof that she was pushed. Time and time again, she told me, there was a man in the video, and he never once looked at the camera. Why else would he do that, unless he was up to no good? I was impressed that her fictionalized evidence also included a certain undertone of malice. I figured it was only a matter of time before the man in the video began to develop a back story, as well.
“Mrs. Hanson,” I said, “I really cannot imagine what you went through, lying there on the floor for days, not able to get up. But you are here now, and you need to take advantage of the people who are here to help you. The way I see it, you have two challenges right now: to build up your physical strength, and to build up your courage. If you are going to return home, you need to be strong enough to get around, and to have confidence that you can take care of yourself.” I liked my closing argument; even on her terms, I had proven what was necessary. I was winning the battle of wits.
“You don't understand,” she said, sadly. “You are just like everyone else. You just want to tell me what I have to do. Well, I've made my own decisions my whole life, and I'm going to keep making my own decisions. I just need a little bit more time here, to rest in bed, and get my strength back. Then I'll get up and walk around on my own, like I did before. Then everything will be back to normal.”
For a moment I wanted to keep arguing with her, to state my points again, take her by the arms and say, “Look how much sense I'm making!” Then that moment passed, and I knew that she was right. Not about getting stronger, or things going back to the way they had been, but about everyone trying to tell her what to do. I was guilty of it. The therapist, the intern, the resident, and even our attending were guilty of it, too. But most of all, the realities of life were guilty of crowding in on her, making her decisions for her, taking away her home, her friends, and her independence.
“You don't understand,” she said again, with tears in her eyes, “it wasn't my fault. The video shows: I was pushed.”