Wonderland

Drink Me
My first patient today was a very large man. Not obese, mind you, just extremely tall. Like Yao or Shaq. His head is easily twice as big as my sweety's (in case you're wondering, my sweety has a big head), the footboard on the hospital bed had to be taken off so his feet wouldn't shove up against it, sitting in our largest power wheelchair his knees are still higher than his hips... and that's with the footplate off, feet on the floor. The hospital pants (one size fits all) barely cover his knees. Nothing in our donated clothing closet fits him. I have to use 2 hands to move one of his legs, when usually I can move both together with just one arm.

I found that I kept having to rethink the things I normally do for a patient to improve their mobility. Or not so much rethink them, but rethink how to achieve them. For example: when sitting at the edge of the bed one's feet should be flat on the floor to optimize balance and decrease risk for falls. This is a problem as most hospital beds are notoriously tall, out of habit I lower a bed almost all the way everytime I'm sitting someone up, it's a reflex. Wait, stop... raise it, raise it.... wow... okay, raise it some more. When the bed's right about at my hip, his feet are flat on the floor.

His hands are probably the most striking. Enormous paddles, he holds his 8 ounce milk carton delicately, with thumb and forefinger, the way I might hold a shot glass. He sees me staring and lets me place my palm against his to compare sizes. My fingertips barely reach to the base of his fingers. He laughs at the look on my face and has me measure my middle finger against his pinky- my longest finger is as long as the 2 end segments of his littlest finger.





Eat Me:
My next patient was a tiny woman in her 40's. Shy, quiet, earnest, she is not frail or bird-boned, just very small. I can't get the bed low enough for her feet to even touch the ground, let alone be flat on the floor. The hospital pants (one size fits all) have a third of their length rolled up so she can use them. Nothing in our donated clothing closet fits her.

Her tiny hands barely extend to the first knuckle of my fingers, and she uses both hands together to do things that most of us do one-handed: hold a cup, carry a shampoo bottle. She can't really carry multiple items easily, or gather the top of a sock into her hands so that she can put her toes right into the toe of the sock. She has a funny strategy of hitching her bottom up high on one side every time she sits, so that she'll be able to get it into the chair.

Steadying her, for balance, my hands engulf her shoulders, my palm takes up her whole belly.



Through the Looking Glass:
I realized that I have ways and means of doing things: moving a limb, threading a foot into a pants leg, steadying someone. I have done them so much that my body has a plan and a memory and it just gets going without a lot of instruction from me. These two patients were so surreal because my goals were the same as always, but my body didn't know how to do them. I had to plan and think over each movement. With the first guy I was tiny, I had to set everything up for maximum leverage. With the second patient I was gigantic, I had to scale way back on strength, speed, and contact area. And having them back to back was just plain trippy, I felt off-balance the whole morning.