At the beginning of every season of The Biggest Loser, I am skeptical that there will be visible changes in the contestants over the 16 weeks the show runs.  Each week, they look the same as the last, and the change is barely noticeable at best.  But by the end of the season, the results are remarkable.  They are different people.  Hard work, and the tincture of time, get them from point A to point B, but from the outside we barely notice the time has passed.

The same thing often happens with our patients that are around for a long time.  Every day, I come in and see them, and I see little changes... maybe.  Some days we move forward, some days backwards, some days not at all.  This is especially true on my new service, Physical Medicine and Rehabilitation.  Most of my patients are on the neuro rehab side; stroke and traumatic brain injury patients.  Their day consists of at least three hours of dedicated therapy (physical, occupational, and speech/language) to slowly creep towards their previous level of function.

When I started this rotation on Monday, I was given 5 patients to take care of.  Much to my surprise (and delight), one of the patients I was assigned was a patient I had taken care of for almost my entire month on the PICU.  He is a 16 year old kid who was in a serious car accident over two months ago.  He suffered a very serious brain injury, pelvic fractures, a humerus fracture, kidney laceration, and other internal injuries.  I took care of him for over three weeks on the PICU, where each day we crept along, adjusting his feedings and regulating his temperature and treating his fractures and hoping his brain would recover.  He progressed from being ventilated and unable to breath on his own to breathing on his own.  He progressed from not responding at all, to moving his right side a little, and occasionally following simple commands.  He moved from the PICU to the regular floor right before I left, but no one knew if he would have any meaningful recovery.  We took a lot of baby steps, and there was progress.  But it was very hard to see.

When I saw him in the rehab unit this week, just over a month after I had last seen him, he rolled out on his own in a wheelchair to tell us that Portugal was winning their world cup game.  He was awake, alert, able to carry on a normal conversation, able to make sarcastic comments and act like a normal 16 year old boy.  His legs were weak from not walking for two months, and his left side was weak from the brain injury.  His voice was hoarse from being intubated for so long.  He still has a ways to go before he completely better, but in the month that I didn't see his baby steps of progress, he was leaps and bounds above where he was when I last saw him.

On Monday, he stood for the first time since the accident.  On Tuesday, he walked.  On Wednesday, he walked outside, up hills and through grass, and we took away his wheelchair.  On Thursday, just over two months after the accident, he went home.  I remember the first few days I was taking care of him in the PICU, I didn't have a lot of hope that he would do well.  But the brain is a funny thing, and sometimes the tincture of time is the best medicine.  He did most of the work, wanting to get better and go home and be a kid.  And every day, he made progress that was barely noticeable to anyone.  But he came in one day, unconscious with scrambled eggs for a brain, and walked out with no help and an excellent prognosis.

I can't tell you how rewarding it was to see him again, better.  We plug along each day, hoping our work is doing something to help someone get from where they are to where they want to be.  But often, the progress isn't visible.  We spend a lot of time looking ahead to how we can make the next day better, and not much time looking back to see how far we've come. 

But sometimes, looking back is just the motivation we need to believe that working for tomorrow is worth it.

Keep plugging,
Kari