Thirty Minutes At A Time

[Barrett Dorko]

It’s been a quiet week in Cuyahoga Falls…

I live my clinical life 30 minutes at a time. If I’m lucky enough (and, believe me, it’s luck) to have several patients in a row these sessions melt one into the other, mildly punctuated with greetings and goodbyes and a changing of the sheets. During the course of most sessions I am fairly quiet and my patients learn soon enough that I’m unresponsive to small talk or stories involving their pathetic lives. I know that sounds harsh, but I mean just that.

During those thirty minutes my patients come to understand that, for me, very little else exists aside from their response to my handling and my assessment of their understanding. I watch their faces for signs of comprehension and insist they offer them verbally if I can’t see them there. Once they know what I want they usually cooperate and we meet as close to their complaint and ability to make sense of things as I can get. Many students ask me what they can hope to do with their patients that lack the cognitive ability they’d prefer. I say, “Of course, you have to go where the patient is before you attempt to pull them toward you.” They nod, but I’m pretty sure some of them wonder what on earth I mean by that.

For thirty minutes I circle my patients as they stand or move about the plinth as they lie there. Because I offer them virtually nothing physical to resist they are left with only themselves to consider and express. My job is to accurately interpret what they feel and to follow manually the movements they perform spontaneously. Many of these movements are invisible but I can palpate them. I can even see them. (See A Sense of Things (http://www.barrettdorko.com/articles/a_sense_of_things.htm)) I’ve done this for thirty minutes at a time tens of thousands of times and have never witnessed the same sequence of response precisely repeated. Not once. This uniqueness is what keeps me awake, and, despite the sameness of my actions and questioning, I maintain my wonder and respect for our individual and powerful ability to get better.

For thirty minutes my patients live in a place they’ve never known in adulthood. I tell them that outside of the treatment room it seems that the culture provides little more than a corset but between my hands it is a support, and they agree. For thirty minutes their instincts become evident and rise to the surface with movement that has long since been suppressed in favor of pleasing appearance and the advantages of disappearance in the crowd that surrounds us. For thirty minutes they learn to trust themselves and act accordingly, perhaps for the first time in memory.

For me these thirty minutes are equally therapeutic. I’ve learned that the best kind of manual care teaches me more about who I am and what I might learn in the presence of my patients. No classroom can compare to this. For thirty minutes at a time I am being therapeutic and, in a very real sense, I am being treated.

I will admit that I need this, and I think many of us do.

For thirty minutes at a time I actually get it.

[Diane]

I hadn't read that essay in quite awhile Barrett. It is full of good composting.

When patients ask me how I do what I do (which is close to what you do) I answer something like; if blind people can learn to read Braille, sighted people can close their eyes and focus on the feel of small bumps and textures of skin.. by paying attention to these bumps and their behaviors, the whole thing can eventually turn into a symbolic language (just like Braille) informing the hands kinesthetically, can even take over the visual cortex and become visible images.. do you know how many receptors there are in hands? Hands take up a huge amount of hard drive in the sensory/motor cortex.. there are 32 different areas that process vision.. processing is bound to bleed over into each other eventually..

Way less elegant way of explaining/interpreting what Ramachandran has to say about synthesesia, than your essay.. but it gets me through the day (one-hour blocks of time instead of thiry-minute chunks) and fields questions from people who are checking me out "philosophically" .

[Barrett Dorko]

Below these posts you'll find a link provided by Bernard to a column I wrote in the summer of '04. I had begun to spend a few hours each day working in a skilled nursing facility and decided to write about that as truthfully as I could. The column's title was "Time for Louise" and it describes something I began to realize while evaluating a woman with severe Alheimer's as her husband watched. It says in part:

"Louise’s husband is a benign presence but because he’s there so solid and watchful in the doorway I feel myself slow down. I begin to appreciate my patient’s apparent comfort and the consequences of good care for someone who needs it so much. He forces me to take more time and I use this to more carefully assess not only the patient but also her situation. I do a better job, and while I work I think a bit more about my own immobility in the orthopedic community. As I shift a bit more each day toward another way of being a therapist I wonder about the losses I’ve yet to experience.

I need to remember that I’ve been offered the gift of time. I should accept this gratefully and use it to appreciate what I still have, and to say goodbye to the things I’m going to lose."

I know that the thirty minutes I've decided to take with each patient is simply unavailable to therapists any longer but I wanted to make this point here - all you really need to sense another's nonconscious activity (or your own) is about 3 seconds. This is what I heard Berta Bobath herself say in '73. If you can't sense things after that you need to listen elsewhere, but quitting before 3 seconds has elapsed is a mistake. In Mind Time Libet explains why that is but that's worthy of a thread all its own.

The problem in today's clinic is that 3 seconds of "doing nothing" after touch is initiated is still too long a time to wait.

To me, this is one of the tragedies of modern practice.

[gary s]

Barrett,
Thank you. Every now and then I need a booster shot. Happy Father's Day.

[Baecker]

hi,

i like to ask you a few questions about sc. i hope you don't mind.

do the patients know they are getting this kind of treatment?

what do you tell the patient prior of using sc? do you tell them about ideomotion or do they spontaneous move themselves?

is your clinic booked out? i hope you don't mind this question. i am asking because you are saying its luck to have several patients in a row.

[Barrett Dorko]

Baecker,

Question #1 - Of course.

#2 - I don't have a script. Do you? I've explained what I say in numerous essays.

#3 - Ideomotion is explained. Simple Contact reveals its presence. Their motion is active.

#4 - No.