Top of the World!

whiteIn the final scene of the 1949 classic crime drama, White Heat, the psychotic mother fixated killer, Cody Jarrett, played by Jimmy Cagney, realizes that he’s doomed. His plan to rob the payroll of a chemical plant has gone bad. A trusted gang member, an FBI plant, has tipped off the police who now are lying in wait for him. Vowing not to be taken alive, Jarrett climbs the tower of a gigantic fuel storage tank. Just before blasting a hole in the tank and sending himself to the great beyond, Jarrett looks up to the sky, smiles and yells out to his departed mother, “Finally made it ma—top of the world!”

I often get puzzled looks after I tell people that I’m a homecare physical therapist. Many believe that I go to homes to give “workouts”. Nothing could be further from the truth. Most of my patients are elderly and have just come back from hospitalizations. They display varying degrees of debilitation. There is a main diagnosis (the reason for the hospital admission), but often there is a host of other problems that the medical community refers to as “co-morbidities”. For instance, an individual admitted for kidney failure may also be suffering from diabetes, heart disease, and a long list of other maladies. This is certainly not your squat thrust and push up population.

Bob was one of my “typical” patients. His primary diagnosis was coronary artery disease, but among his co- morbidities were diabetes, high blood pressure, congestive heart failure, and a past coronary artery bypass. While hospitalized, he had an episode of respiratory failure that put him into a coma for a few days. To make matters worse, he came home with bedsores and a gastrointestinal infection.

His legs were extremely swollen with fluid, and he became short of breath rather easily, both problems often the consequences of a weakened heart. Poor leg strength and balance necessitated the use of a rolling walker to get around his spacious home. A thick cushion placed on the seat of his favorite chair enabled him to come to standing without assistance. He was confined to the ground floor of his of his split level home because he didn’t have the strength and endurance to make the trek up twelve steps. Bob desperately wanted to climb those stairs in order to sleep in his own bed, instead of the uncomfortable hospital bed on the ground floor, and operate his model trains.

Bob was 70, extremely intelligent, and a former history professor. During my first visit his daughter warned me that he was an incessant talker. I came to find out that he had a story for EVERY piece of furniture, painting and knick knack in his home. He displayed an uncanny ability to start a conversation on a particular subject and then seamlessly veer you on to a side road, and then another, and another….. He would eventually lead me back to the main highway, but the “trip” was extremely arduous. I was usually unsuccessful at trying to gently deflect the “dissertations”, in order to get on with the business at hand. My tai chi experience didn’t help. I really wanted to resort to a more external approach, such as, “STOP IT ALREADY—YOU’RE DRIVING ME CRAZY!”, but after all, I am a professional. Eventually I learned to listen patiently. It was like dealing with the Borg—resistance was futile. I had been assimilated.

I had to decide how to rehabilitate Bob. I needed to keep things simple in light of his fragile condition. Based on what Bob wanted to accomplish, I started him on a gentle Yi Quan /Zhan Zhuang regimen. I had to “sell” him on this approach, because he had had previous experiences with physical therapy and I was sure that this would be entirely new to him. I told Bob that many martial artists use standing postures as a means of improving leg strength and balance, and this was just what he needed. He immediately saw the logic of this and didn’t require any convincing.

Bob began to stand like a tree and Santi-ercise , initially holding the postures for 30 seconds—better too little than too much—at first.. I threw the homecare version of a horse stance into the mix by having Bob hold a quarter to half squat position with his back flat against a wall, initially for 10 seconds. He took to this enthusiastically. His wife told me that she would catch him in mini Yi Quan sessions throughout the day.

I forgot to mention that Bob’s wife ran a daycare center out of their home. Quite frequently some adorable waif would run by, stop dead in his/her tracks, trying to figure out what “Grandpa Bob” was doing. We also received some curious looks from the waifs’ parents at pickup time.

Bob gradually increased the duration of his postures and as expected, “discoursed” the entire time. I didn’t object, this wasn’t the time or place for traditionalism .After a while I added some more “Yi” to his Quan in order to get his motor cortex humming, and most importantly, to cut the chatter.

Bob showed steady gains. He progressed from a walker, to a cane, and finally to complete independence. He no longer needed the cushion to come to standing from his chair. The last challenge was the stairs. He had railing on one side along half the length of the stairs. I told him that he would need a full length rail on the opposite wall in order to have a realistic chance of succeeding. Within a few days, the rail was in place. The plan was to have Bob use the rail and a wide four pronged cane to climb the first six steps. From that point he could discard the cane and use the two rails. We spent a few days doing only three steps. Then we progressed to six. The day finally came to attempt the full flight. I practically glued myself to him, but did not physically assist. Bob slowly and steadily climbed the twelve steps. In a room straight ahead was model train heaven. Bob went into action. His trains roared around the tracks with sound effects, smoke, and bright lights. Bob’s wife finally realized where we were and what he had accomplished. She smiled at us from the foot of the stairs. I looked down at her, smiled and just couldn’t resist. I yelled, “Finally made it ma—top of the world!” Without missing a beat Bob proceeded to give me an extensive critique of White Heat and Jimmy Cagney.

Some things never change.

Gary Shapiro, married with two children,  is a former USAF navigator. He has been practicing Tai Chi for as long as he’s been a physical therapist- about 25 yrs- and is interested in applying the practical aspects of Tai Chi to benefit those with which he works.

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