There was a conversation I avoided for months because I knew it was going to be really hard for one of my patients to hear.
She was an older transfemoral amputee who really believed the prosthesis was going to give her some version of her old life back.
She wasn't expecting to hike a mountain or run a 5K. She just wanted to get around her house, stand in the kitchen, walk a little with a walker, and do normal everyday stuff.
The problem was, she had a lot working against her. She was significantly overweight, very deconditioned, and her sound-side leg was in rough shape. Even before the amputation, she wasn't getting around all that well.
Nonetheless, she got a prosthesis and we worked really hard. At her best, we were taking maybe 5-10 small steps with pretty significant assistance, and even that wasn't what I would call safe.
Then she had to go through some revision surgeries on her residual limb, which kept her out of the prosthesis for quite a while. Her limb swelled, the socket stopped fitting, we remade it, and by the time her limb was ready to tolerate a prosthesis again, we were close to a year into this whole process and still didn't have a socket that fit.
Meanwhile, she was getting more deconditioned, but in her mind the plan hadn't really changed. Once she got the prosthesis, she was going to put it on and start walking around the house. Almost as if she had forgotten how difficult it had been just to stand with it or take a few steps.
At some point, I realized we couldn't keep pretending the prosthesis was the only thing standing between her and walking again.
I think everybody involved kind of knew it. Nobody wanted to say it.
Which I completely understood, because on top of everything else, her husband of more than 50 years had just passed away. She was very fragile emotionally and mentally.
Awesome time for me to tell her the prosthesis might not do what she thought it would.
And trust me, I delayed this as long as I could, until I finally realized the timing was never going to be right.
I had the closest relationship with her, so I figured if somebody was going to have that conversation, it was probably best coming from someone she knew cared about her as a person.
Instead of simply telling her, "I don't think a prosthesis is going to work for you," I laid out the physical things she needed to be able to do before it made sense for us to go through the process of getting another one.
These weren't arbitrary hoops. They were the things she needed in order to have a realistic chance of using the prosthesis successfully. This couldn't just be a couple visits with me each week and some exercises at home. This was likely going to be the hardest physical feat she'd ever taken on, and she was going to need to do it in her mid-70s.
If she was on board, I would help her every step of the way. But the ownership had to be hers.
As expected, she didn't take the conversation very well, and later told me she cried for several days and felt like I had betrayed her.
I'm not sure anybody gets good at conversations like that, unless you're an a-hole who enjoys crushing people's hopes and dreams.
It's much easier to avoid them. Keep saying, "Let's keep working on it" and kick the can down the road.
But that's not good care either.
Neither is walking in cold and telling someone, "You'll never walk again," like it's an absolute fact. Those people have a special place in...well, you know what I mean.
There has to be something in the middle.
Be honest enough to say the hard thing, but human enough to remember what it means to the person hearing it.