★ It's Probably the Weather

Conversation I had in the not-so-distant past with a patient who I thought would be amenable to therapy:

Phil: So how long have you lived here?
Patient: Too long. I have to get out of here.
Phil: Oh? You don't like it anymore?
Patient: Nope. I've had pneumonia four times in the last five months. This weather is killing me.

The pneumonia was actually aspiration-related, and was evidently recurrent. Given how cognizant this patient was, overall, I suspected even that it was primarily silent aspiration. Short of the recurrence of illness, as well as the associated deep, wet cough, this patient had managed to fly under the radar of bedside swallow studies for quite some time.

Rapport was established easily, and I enjoyed the initial eval and first session. By the second session, however, the patient was extremely upset with me. I had referred the patient for a video swallow study, as I needed further information in order to see how further therapy should proceed.

The patient felt everything was fine, and became increasingly agitated with each passing session, to the point that the video swallow study appointment had to be cancelled due to abject refusal, and the patient sought discharge from the facility by the end of the week.

I had spent the week wracking my brain, trying to figure out how to convince this patient that this problem would not go away. I took it very personally that the patient would not cooperate.

It wasn't until well after the fact, post-discharge, that I was finally able to let go. It's easy to forget sometimes that despite all we do, people have the ability, and the right, to make choices about their life.

To my patient, eating was important, and acknowledging that there was a problem was simply not an option. It could be said that blaming the weather was this patient's form of denial, and it might be true. As I've thought it over, with each passing month, I've taken it to mean something different. Perhaps this patient wanted to remain as active as possible, and considered any form of therapy to be something that stood in the way. Perhaps it was fatigue. It could be anything, but in the end, it matters little.

Some patients appreciate what we have to offer, and others may not. It takes time to realize we can't be everything to everyone, and that's okay. The best we can do is to reach out to one and all, and hope that they reach back.