After being discharged I began therapy as an outpatient. The prescription called for Speech, Occupational, and Physical Therapy five times per week. One of the therapists commented that she had never seen it written for so much before. The only barrier to this came from my insurance company, as there was a set limit to the number of therapy visits I could have covered. With this cap, I could theoretically only have two months of visits before I would be required to start paying out of pocket. Thus I had to space out my therapy sessions strategically so I wouldn’t reach that limit too quickly. Unfortunately, I did not plan well and reached my quota on therapy sessions sooner than I anticipated. I did, however, have the opportunity to experience each of these therapy modalities and have some thoughts on each.
———— Speech Therapy —————-
Outpatient speech therapy begins with the speech therapist conducting a battery of tests in an attempt to decipher first if therapy is needed, and if it were, what exercises would benefit the patient. Each session would begin with an impromptu conversation: “How was your weekend?” or, “What are your plans for the rest of the day?” These conversations served as more than just small talk. While I was responding the therapist would be closely listening to my every word. For example if I said, “my weekenghkthyd was great! I went to the beach.” She’d reply by saying, “no, no, say ‘weekend’ again.”
My first experience with outpatient Speech Therapy was with a great speech therapist who was unfortunately retiring. This was unfortunate for a couple of reasons: 1. Her impending retirement meant that I would no longer be the beneficiary of her expertise, and 2. She knew she was retiring and that any recovery I would have would take place both during as well as after her tenure. Thus it was only natural that some of the sessions seemed as though she was simply ‘going through the motions’. At the end of one of our sessions she said to me “Chris, next time you come, I’ll have a student with me. Would that be okay with you?” Before the tumor was discovered I was known in my residency program for getting good reviews from students—they considered me a good teacher. I like to think it was my attitude towards having them. While many of my colleagues see medical students as somewhat of a hindrance, I loved having students for many reasons: 1. Students often bring an eagerness and enthusiasm, which would not otherwise be part of the encounter. This is an eagerness not only to learn but to help as well. 2. Being with a student breaks up the monotony of the day. While seeing a patient is a privilege, it can become tedious at times—being with a student can help change this. 3. Lastly, I was in their shoes not too long ago. Being a medical student is tough in that as a student you’re in ‘no man’s land’. You cannot make significant decisions without a supervising physician. Patients often realize this and give you less respect. Also as a medical student you begin a new rotation every 4-6 weeks. This means working for a new supervising physician in a new locale every time you begin a new rotation. Imagine starting a new job every month, having to learn the nuances of the job as well as the quirks of each boss. It is for these reasons that I always welcome the opportunity to work with students. This time was no different. When my therapist asked me if it was okay if a student was present at the next sessions, I said “sure” before she could finish the question. This student was great, she revitalized our sessions with her eagerness to learn. I often wonder where she ended up landing work. My stint with Speech Therapy ended due to insurance limitations. I remember the therapist telling me, immediately after one of my Physical Therapy sessions, “Insurance won’t cover any more sessions. I’m sorry but you’re being discharged.”
Later the next year, after Sparrow hired a new Speech Therapist to replace the retiring one, I scheduled an appointment to see her. I had had several sessions with her when I was in the hospital, thus she knew of my deficits. Regardless of our past work together, an evaluation was still required, as it had been many months since I had been seen in Speech Therapy. However, because I was reaching my set limit of authorized therapy sessions, my insurance refused to cover any Speech sessions. I appealed their decision, but was again denied. This particular therapist was very compassionate, and I think more invested in my case because of her involvement during my hospitalization. Upon hearing of the denial of my coverage she actually gave me some home exercises to do and told me, “Chris, I had a cancellation in my schedule, after your physical therapy why don’t you stop by my office?” It turned out her cancellation ended up showing up and she told me that she would call me instead. About a month later as my wife found an old voice message from this therapist asking me to call her back. Ever since then I have been meaning to speak to her and thank her, and let her know of the delay in my receiving her message. It upsets me that she might think I received her message and ignored it, especially when I know she was really going out of her way to help me.
————– Physical Therapy —————
Video of me in a Physical Therapy session in June of 2013
Prior to being discharged from Sparrow, I inquired about recommended physical therapists in the area. Multiple therapists recommended the same therapist, a therapist in the Sparrow Health System named Cheris Grasse. Even before discharge, we promptly scheduled several sessions with her. From my first session I could tell that she lived up to the hype—she pushed me to my limits while also understanding my condition and the challenges it presented. She actually had her husband build me an agility ladder to use in our sessions. She is constantly thinking up new exercises for me to complete, and coming up with innovative ways to retrain my body. It’s gotten to the point that I refuse to work with other physical therapists. Nowadays, sessions with her typically begin on the treadmill followed by an exercise that she conjured up the night before. I have been seeing her since May of 2013, making it almost one year and a half. We have become close friends, and my only worry is that our friendship might cloud her treatment of me.
My approach to my therapy sessions mirrored my approach to my tennis training: work hard, and work smart. Sweat is the external manifestation of hard work. I often leave sessions dripping in sweat and because of this I’ve had many people in therapy tell me that they have noticed my hard work and are impressed by my work ethic. I am grateful to every person that took time out of their day to tell me such things, but in writing this I realize that my hard work is only half of the battle: Work hard and work smart. The idea of 10,000 hours as some magic number to attain excellence was popularized by author Malcolm Gladwell: it’s theorized by Gladwell and others, that in order to attain a high, elite level in any endeavor, at least 10,000 hours of practice is needed. He cites examples such as The Beatles, spending well over 10,000 hours together practicing music, Bill Gates spending over 10,000 hours in front of a computer screen in high school, or grand master chess players spending (you guessed it) over 10,000 hours playing chess. This idea was challenged by Daniel Goleman in his book Focus: The Hidden Driver of Excellence, in which he writes that
The “10,000-hour rule” — that this level of practice holds the secret to great success in any field — has become sacrosanct gospel, echoed on websites and recited as litany in high-performance workshops. The problem: it’s only half-true.
If you are a duffer at golf, say, and make the same mistakes every time you try a certain swing or putt, 10,000 hours of practicing that error will not improve your game. You’ll still be a duffer, albeit an older one.
I estimate that I have spent about 150 hours in physical therapy along with 450 or so hours in the gym working on rehabilitation. While this equates to a measly 600 hours focused on my physical rehabilitation, it is not the number of hours that worries me. As Goleman writes, simply reaching the 10,000-hour milestone is not enough; one has to spend the 10,000 hours practicing correctly. That has led me to wonder: what is the smart way to rehabilitate? In China, the main mode of recovery following a stroke or traumatic brain injury is acupuncture. Is acupuncture the answer? I’ve come to realize that the exercises I am doing are the correct ones, but it is my attitude that needs correcting. What do I mean by this? I am not sure if I 100% bought in that all this work, that all these different exercises would make a difference. I used to believe that time was a major player in my recovery. I realize that this is false thinking. Now I believe that every Physical Therapy session, every workout at the YMCA, every home session of oral exercises should receive not only 100% effort, but also 100% belief that it is making a difference.
Video of me in a Physical Therapy session in August of 2014
————– Occupational Therapy ————
I feel bad because I do not feel moved to describe my Occupational Therapy experience. The saying “No news is good news” holds true here. My occupational therapy sessions have been uneventful. I’ve come across many incredible Occupational Therapists during my recovery. At the moment, because of the aforementioned restrictions on the number of visits, I complete numerous home exercises. Occupational Therapy is tough to define because technically any activity that entails either tasks of daily living or work skills is considered Occupational Therapy. In fact, typing this would be considered Occupational therapy.
———- Thoughts on Therapy ———-
There have been times in my recovery that I questioned the difference and impact that therapy could have on my recovery. I now realize that even though I have completed every task asked of me in the various forms of therapy, this lack of 100% belief has held me back. I believe that this holds true in any endeavor we choose to undertake—if we hope to achieve our goal, then we must combine both 100% effort with 100% devotion and belief. Otherwise, we will invariably fall short of our expectations.
I am grateful to every therapist I have had the privilege of working with after my surgery. In the clinic I would often refer patients to therapy not really knowing what it was—to me it was a button I clicked. Now it means much more. Every patient I refer to therapy in the future will bring back a flood of memories and emotions of my recovery process, and will remind me of all the therapists towards whom I will always feel grateful.
 With any medical field, learning makes up a large chunk of the craft. This takes place through students—people in school in that particular field, who follow and observe more experienced clinicians. When a clinician has a student it is customary to ask the patient if they are okay with having a student.
 The time varies depending on the rotation you’re in. For example, a General Surgery is typically longer than a Psychiatry rotation.
 In medical school we are often warned against becoming friends with our patients fearing that friendship could be detrimental to patient care. My personal belief is that every case is different. In a diabetic whom you’re trying to improve their diet, yes I agree that friendship in this case may lessen your ability to get your point across. But in a 31 year old with several cerebellar signs after a brain tumor resection, I see no downside to such a friendship.
 I mentioned in an earlier post that I was a serious tennis player growing up, playing in high school, college, and some on the pro circuit.
 Goleman, Daniel “Focus: The Hidden Driver of Excellence” 2013, New York, Harper. Page 163