But who takes care of you?
“…But who takes care of you?”
Driving on I-10 in the middle of the Coachella Valley can be tricky at times. Combine the iffy driving skills of hundreds of snowbirds with intermittent sand storms, and it’s a recipe for a lot of near misses. After nearly being sideswiped by a Cadillac just before my intended exit, I thought, “If that car would have hit me, I wouldn’t have to go to work.”
The Life I Chose…
It wasn’t until months later that I realized how disturbing that thought was. I was on my way to work at a busy physical therapy clinic, already dreading the stress of the impending day, and counting down until quitting time before I even parked my car. I knew that once I stepped into the clinic, I would be on the go for the next ten hours, seeing anywhere from 15-25 patients during that time. Then I would head home to complete the day’s documentation, which would be an additional two to five hours of work from my couch. Faxes would be sent to doctors’ offices at 11:00 PM, just before I got ready for bed and prepared to do it all again the next day.
My next patient arrived five minutes late, and I thought, “Crap, he’s here.” I was almost disappointed that this young man, an 18-year-old, paralyzed by a gunshot wound, came through the door in his wheelchair. All he wanted was to stand up without help; he was relying on me to teach him to do this, and he had become a burden to me. Intellectually, I was disgusted with myself for thinking this, but my body was tired, and my emotions drained. I felt I had nothing left to give.
Before leaving for work that morning, I spent two hours studying for a specialist exam, something to set me apart from other physical therapists. I wanted to be the best therapist to my patients that I could be. They deserved that.
Taking Care of Others…
A physical therapist is the person who knows why a patient is in the clinic. The referral might indicate the patient is in physical therapy because of knee pain, back pain, post-operative care, deconditioning, or paralysis, but those are not the true reasons someone is in therapy. One patient is here because his pain prohibits him from going for his evening walk. The patient on the treatment table next to him is here because he is injured and can’t work, rendering him unable to provide for his family. Whatever the case may be, a patient seeks help because something fundamental has changed in his life, and he wants to fix it. I’m the one who is going to do that for him, to allow him to return to life as though the injury never happened. I’m not going to do this once. I’m going to do the best I can in the short time I have with my patient, then I’m going to move on to the next one. I have at least twenty more injured or ill people counting on me. They are no less important than the person who is in front of me right now.
If I didn’t keep my hefty caseload happy, the patients would not come back; if I did not complete my documentation in a very specific and timely way, the clinic would not receive reimbursement from insurance companies. Both had the potential to bring reprimands from my manager, disguised as “constructive criticism.” The conversations always circled the subject of the bottom line: something that financially benefited my manager but professionally burdened me.
…Under Pressure
I felt the pressure building in my chest. My eyes got hot. I had chest pain and became lightheaded. My ears were ringing. “What is going on?” I asked myself. Patients were talking to me, but I could not make sense of it. I forgot my new patient’s face, not realizing she’s here to see me. I tried to regroup because I had much work to do. Patients needed me. Co-workers needed me; they were just as busy. I could not take a break, lest they label me as lazy. My thoughts raced; “I have to get out of here.” The urge to run hit me, but I was too exhausted to move.
Finally, on a Saturday morning after I finished working out, I had the first of what I would come to know as “melt downs.” I began to study for my exam, and my brain slammed on the brakes. I felt pressure building in my chest and head, and I cried for over an hour, physically unable to do anything else. I knew that this wasn’t me; I have never been a crier. I was used to having a lot on my plate.
When I Can’t Take Care of Myself…
I knew that I had been losing weight by the way my clothes fit, but I didn’t know the extent. I got on the scale the following Monday before work, and saw I had lost nearly twenty pounds in three weeks without trying. I tried to convince myself for the next two weeks that I was okay, but the chest pain, fatigue, lightheadedness, and concentration problems persisted. I developed daily headaches and nightly heartburn. I noticed rashes on my stomach and back. My normally patient demeanor was gone; I overheard co-workers saying, “Don’t mess with Claire.” I was so irritable I could not hold a conversation. I had about two melt downs every month. I was ashamed to tell my manager that I need help.
I’m the one who’s supposed to do the helping.
I don’t know what made the light bulb go off, but thankfully it did. I made a doctor’s appointment. My doctor explained to me that I had developed severe anxiety and had likely been depressed for months to this point. She prescribed an antidepressant, placed her hand on mine and said, “It does get better.” Two months later, I began seeing a therapist specializing in anxiety and depression.
In an effort to regain my physical and mental health, I reduced my schedule to thirty-two hours per week while studying for my specialist exam, explaining my situation to my manager. This came at a cost; the manager continued to pack my schedule with over 40 hours’ worth of patients and I sacrificed vacation time. But I began to recover.
…The Slow, Agonizing Ascent
After I took my test, I was sitting outside of the center and realized, “I actually don’t have a headache. I’m getting better.” Taking stock of my symptoms, I realized that it had been weeks since I had heart burn, and my rashes were gone. I was still 15 pounds lighter than my normal weight, but my appetite was good. I was still tired all of the time, but I was sleeping well. I felt ready to return to my “normal” life.
I returned to a full time schedule for a month before I had a full-blown melt down at work. While I thought I had regained control of the situation, I didn’t realize it was only a matter of time until it happened again. I had to leave the clinic during lunch and cried for the entire hour. Afterwards, I could not force myself back into the clinic. An aide treated my first afternoon patients while I regained composure.
I realized I could not do my job like this. Something had to change. This was the first time I had suffered from anxiety or depression. I had never considered myself to be susceptible to mental illness, but I am human like everyone else. Working in an overburdened health care system forced me to realize that. Just like my patients, I too am deserving of help.
So I Become the Patient…
I deliberately sought out a new job with less stringent productivity demands, located closer to my family and friends. Explaining to my patients that I was leaving was difficult; but to be the physical therapist patients deserve, I had to change my environment. Though I still have my “bad days” with anxiety, I am no longer suffering from physical illness and I do not have “melt downs.” I attend therapy weekly and have learned to tell my anxiety, “bring it on, I can handle this.”
Caring for others is a highly rewarding job, but it comes at a cost. Those of us who work in health care have to remember that we are human, just like our patients, and we have to seek help for ourselves when something is wrong. If we do not do this, we cannot be the clinicians our patients deserve, nor can we be the spouse, parent, child, or friend our loved ones deserve. In the current health care culture, switching from the role of caretaker to patient is difficult, but we have to allow ourselves this vulnerability. To improve our situation, we have to seek support and ask ourselves, “Who takes care of us?” Our need is just as great as that of the patient sitting in front of us.
Claire Kopko
Claire Kopko lives in Ohio with her husband, Nick. She is a physical therapist at a large children's hospital. She enjoys powerlifting, Olympic weightlifting, hiking, traveling, and reading. Claire's struggle with anxiety and depression began long ago, but only recently has she really learned to embrace it as a part of herself. In fact, it has helped her learn more about herself and how to better reach people in her personal and professional life.
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