The Extraordinary in the Ordinary

Abstract

As I meet with many of our colleagues in different parts of the country, I hear accounts about their clinical practice, their research, their teaching, and their learning. Although these colleagues often express their joy in the science and art of what we do and the hope that we can provide to those we care for, I sometimes hear comments about how elements of what they do seem ordinary. One such comment came after an account of a colleague's work with a patient with a rare protein receptor deficiency resulting in serious myopathy. The patient's muscle wasting was severe—estimated at 25 pounds of muscle in one month—and the patient's creatine kinase levels were consistently above 60,000 units per liter, far above what we know to be the norm of predictably under 200 units per liter. While working on the root cause of the pathology, the patient's neurologist was in a quandary about how to manage the myopathy. In consulting with the physical therapist, the neurologist said simply, “Will you see this patient? I am not sure what you can do, but you are our best option right now.” The physical therapist explained to me that the examination seemed routine, and there was nothing particularly unusual about the interventions of strengthening, aerobic conditioning, and functional activities that she chose to use with the patient. This physical therapist further described to me the need for her to take charge of a bigger picture of care and how that action led to a wheelchair evaluation and fitting, a nutrition consult, and the call for some additional nursing care. What was the result of this colleague's action? The patient is now out of the power chair, is walking, and is back to work at about 85% of pre-episode levels. This physical therapist told me …