Recently on my neuro placement I had a patient who had suffered a massive stroke. As I was very inexperienced when I was given the patient, I expected to see significant gains in the patient over the course of the month that I was to treat him. However this was not the case and the patient remained completely dependent. After one month of treatment he still had absolutely no sitting balance and was unable to swallow. We spent countless treatment sessions trying to improve this sitting balance and left sided inattention that he displayed with little luck.
After a couple of weeks of treating the patient my thoughts began to change and I went from being very disappointed in the patient's progress to extremely excited whenever we noticed the slightest improvement. These improvements that we saw would be a tiny flicker of tone, a couple of clearly spoken words or a spontaneous turn of the patient's head to engage in an activity on the left.
It did become very clear that the patient would be eventually discharged to a nursing home as he was simply not showing enough improvement to warrant further rehabilitation. It became quite hard speaking to his family as they were always so excited about the patient's rehab and asking how long it would take for him to walk, etc. All we could do was constantly remind them that the patient was recovering a lot slower then we would expect and it would be a very long road to recovery if he ever got there.
I found it very hard to see the hope in his family's eyes slowly start to disappear over the month as mine had already done. In future I don't think I would approach the situation any differently however I would have the experience of dealing with such a patient and would not be so shocked if a patient didn't progress as I would expect. And I would just be as honest with family as i possibly could be.
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I think you did a great job Adam. You had the right attitude and you wanted this patient to recover and gain as much independance as possible and the best that you can do is the best that you can do... it's so disheartening when you realise that a patient you've worked so hard with is not going to recover as much as you'd hoped.
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