A cultural experience

I've been feeling like a bully recently to one of my patient on prac. This gentleman in his late 50s suffered a pontine infarct which gave him mild L sided weakness and a mild ataxic gait. He has no aphasia or perceptual deficits ,orientated to TPP and is independent on ambulation.

It all seemed straight forward when I read the notes and gathered what I'm going to do with him, until I met him. He showed severe depression and was crying in his room. He constantly repeated to me "why me, my mother/nephew/cousins died of stroke and now it's going to happen to me".

After the 1s treatment session which took ages because half the time I was trying to settle his emotions, he saw and felt some positive changes to his condition. In the next session, he all of a sudden became over confident in me as well as himself. When I took him for a walk to observe his gait, he decided, 'I'm going to get better now' and started to run without telling me. I literally had to physically restrain him and tell him "NO" like a child and yet he still struggled to continue. I never trusted him from that occasion on.

In the subsequent treatments, I made sure that specific instructions were given and that all boundaries are clear cut, but this patient still goes off on his own tangent and jeopardise his safety. His impulsive behaviour was getting to a point where I was reluctant to discharge him even though he was physically fit to go home with a HEP.

I couldn't figure out why the patient's behaving like this when I've explained infinite times about his condition, the likely prognosis and for him it was very positive after liasing with doctors. Until the OT came in and said he's Greek, which openned a whole new ballgame.

My patient's behaviour is perfectly normal for a man of his age from a greek background. He's the leader in his extended family. He doesn't want to be a burden on his family so therefore tries really hard in therapy and conseqently overestimates his abilities. Until he's tried it out for himself, he will persist. I suppose I'm generalising here a bit, but this was an interesting experience.