Even as a seasoned physical therapist, the struggle is real for me. At times I cannot find the right words. The right words mean that I connected and was effective in how my message was received.

At times this struggle weighs on me.

How is it that of all the professionals that a patient with terminal cancer visits, the most difficult conversation I’ve ever had somehow got dumped into my lap? I will admit, I often times will go along with a patient’s wishes. Most that I am working with really want to just get through their day and want physical therapy services for strengthening and to reduce fatigue levels. When someone has cancer, there are good days and bad days. My role is to accommodate and think on my feet.

The patients who are terminal, determined to continue services and grab hold of the life they have left are the ones who pull at my heart.

I was angry that I, as a physical therapist, was the person who took the time to have one of the most difficult conversations with a patient.

One particular day, when he arrived, he was short of breath. He hadn’t been to that extreme level of dyspnea the week prior. His oxygen saturation was 70%. He had increased confusion over the weekend. He wasn’t going to let this lung tumor stop him from exercising. Somehow I found the words to not only convey that he could no longer attend services – along with why. Somehow I found the words that I considered effective messaging.

I gently let him know that he would not be able to physically go on his planned Alaskan cruise. I answered tough questions and let him know that the next couple of weeks, his goal of having dinner with his family would be limited to him staying in his home with every gathering versus at a restaurant.

I took time to convey to him what his family would experience comparing hospice care to no care. To look him in the eyes and stay strong and firm as I talked to him about end of life decisions was one of the most difficult things I had ever done.

He passed away 3 days after that tough conversation.

When I brought pie to the family to offer my condolences, his wife hugged me and thanked me. She said the night after I spoke to him, she had the best conversation with her husband. He made the choice to initiate hospice services. She said that no one else spoke to him as I did and she and the family appreciated it more than I’d ever know. To this day, I don’t know where the words came or why it was me that was able to help him in those last days of his life.

As I continue to grow and mature professionally, I fight some of the true, deep down feelings within me.

I want to scream at a particular patient, “you are blaming and choosing to be a victim versus assuming responsibility.” Everyone is dealing with something – that something can be physical or mental.

I honestly can’t imagine what inclusion body myositis feels like. I know I am not to have a highly focused approach to the involved muscle groups. I also know that I need to be aware of fatigue levels. I know when there is not an active, acute process the person should be able to maintain some functional ability. One of the important objective measures is for me to know CPK values. I am at a loss of words with how to help change strong attitudes – no matter how much I point out the positive movement patterns or negate a false blame, my messaging is not effective.

“Your foot doesn’t ‘stick’ on the treadmill. This isn’t a foot issue. You aren’t using your right hip to help lift your left foot off the ground when you walk with your walker which makes your left foot stick.”

I think I’ve discussed an unfit walker height more numerous times than a broken record.

None of my messaging has been effective. I can feel my next upcoming tough conversation: “how do you want to move around 3 months from now? Are you thinking you’d like to continue with this walker? Do you believe you can see yourself with a taller walker that fits you better? Do you see yourself in a wheelchair?”

Honestly, it feels there is a disconnect in my relationship with this patient. He is not in an acute phase, his function is declining, he inconsistently performs an evidence based home exercise program, he chooses to have his wife wait on him (and maybe she allows it), he won’t get a taller walker, and even though I see improvement of gait while he is on the treadmill (21″ step length and reasonable control of side to side center of mass movement) the movement pattern does not carry over into daily life. As I said, the struggle is real.

Effective messaging is helpful in more ways than one: educating, decision-making, motivating, mutual understanding, empowering and connecting with patients. Every patient needs to hear the spoken words that fits their thought processes, readiness, emotional status and personality, not only that, but the timing of when the words are spoken are just as important.

Does anyone else have effective messaging struggles?