Wednesday, February 8, 2012

poem for a physical therapist's assistant

(Corrected 7 March 2012; please also see note at the bottom of the page)

The authorities who distribute resources in the USA are too cheap to allow my father regular visits by an actual physical therapist. Instead he is visited by a physical therapist's assistant. Then, less often, a physical therapist comes to check up on things.

This is exactly parallel to the processes I witnessed when I used to teach at USA-headquartered educational institutions in Europe. Written directions specified in detail what one was supposed to teach. This was supposed to maximize control from the home office. However, an unstated advantage was that it made it easy to replace people.

In truth, I did not follow that ridiculous detailed directions, and neither did my colleagues. Fortunately, administrators did not expect us to. However, there is a general desire by the people at the top to shrink what one knows, to limit the spread of knowledge. The less any given worker know, the better.

This reached megalomaniacal proportions at one Language School where I was employed. I actually saw a department head holding every little piece of unshared knowledge over the heads of other people as if she had a sword......

As for my father's PT assistant, I pointed out that if therapy is successful, my father will
be stronger. But, as their physical therapy does not cure his senility, and as his judgment
is very bad, successful physical therapy may be increasing his chances of falling. Her response was to say that she was only doing her job. What happened when she was not here is not part of her job. (So, implicitly, she is not going to think about it.)

How very capitalist, I thought to myself. First of all, people are more or less aggrieved by non-democratic working conditions, and so resent their jobs. (Not so, in her case, as far as I can tell.) But secondly, the limited narrow mind-set is oh so capitalist. EG: I only sell cars. I don't consider the consequences for the environment.

In any case, thinking about the words of my father's PT assistant......(admittedly, I did not hear them, but only my mother's version of them.....) I wrote the following lines:

Forgetting Nuremberg in 2012

The bombs fell.
I followed orders.
Someone died.
Who died?
I don't know.
I don't care.
I was only following orders.
It's not my job to think about the consequences of my actions.

Of course, there is a very practical problem here. My father wants to move around freely. And that's not surprising. I cannot always be at this side. Sometimes he wants to get up when no one is around. And sometimes he forgets to use his walker. One solution is to keep his walker nearby at all times. Practically that doesn't always work because it creates crowding.

However, I would have more respect for my father's helper if she had simply acknowledged the problem, rather than dismissing it as not part of her job description. That sort of laziness deserves no respect whatsoever.

Note added March 6:  The PT-assistant later made some attempt to give my father advice, so, to partially solve this problem.  She also did arrange exercises with the thought that she needed to think about what goes on when she is not here.  I discuss this fact in a later entry.  I leave this entry here as a record of what was going on (and going through my mind) at that point.  Moreover, I am speaking of general trends which persist even if one particular PTA made a correction on one day.

FURTHER COMMENT 2013:  PT'S have a very important role to play in the lives of the elderly.  When they fix mistakes, it is very important.---And when they fail to notice mistakes, that is also very important.

Now, in 2013, it seems that someone failed to notice that my mother was given the wrong walker--a walker too tall for her, which was forcing her to walk on her toes.
Please allow me to replay that: Normally we walk heel-ball-toe. My eighty-something mother was---because she was given the wrong walker--- walking toe-ball-heel. Now, that incorrect walking could have only aggravated whatever problems she had. She, too, was seeing physical therapists and physical therapists' assistants during that time. First, someone at a private company that contracts with Medicare gave her the wrong walker. Then two or more physical therapists who are paid through Medicare (though, they, too work for a private company) failed to notice that my mother's walker was too tall for her---and, probably aggravating the problem. Last of all, to add insult to injury, Medicare is too cheap to pay for another walker----even though the original walker which my mother was supplied through no fault of her own was the wrong one, and was probably undoing the beneficial effects of any therapy she was receiving.
But I wouldn't want to tar all physical therapists with the same brush. It was a PT who noticed the problem. But before he noticed it, my mother used the wrong walker for two years, and two or three other PT's didn't notice it. That's not a good track record. And, I am willing to believe that it has more to do with the system of medical care than the individual therapists. The system reflects the urbanization of the USA and the excessive use of the individually-piloted private vehicles. This sytem dictates that there cannot be a full-care health service in a given neighborhood. Instead, insanely, those who deliver care to the elderly must waste hours (and add to climate destruction) by travelling in their private vehicles from one end of the city to the other. Altogether an insane system, and insane society---not because individual Americans are insane--not even the PT's who failed to notice a problem. But, it is extremely important to recall the staggering inequality in the USA-- some individuals (aka the very wealthy) do benefit
much more than others from this insane system; they benefit much more than they deserve. And with their exorbitant wealth and power, generated by the existing insanity, they don't seem to be in a hurry to change anything.

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