Tony was a middle-aged man of Italian-American descent. I watched him limp toward me slowly as he leaned a little too heavily on his cane for support. He had a difficult time walking: his left leg was held relatively stiff and he struggled to avoid dragging his toes as he worked diligently to advance his hemiplegic extremity. His left arm was not faring much better. It hung limply at his side, obscenely lifeless. "My arm feels like a puppet on a string," he would say to me, "but there is no Gepetto to make this tired old body move."
Tony wasn't really that old. He had just retired from the railroad where he had worked for the last 35 years as a conductor. His only child was grown - a successful radiologist in the rural community where we lived. Tony and his wife had no real plans for retirement. They didn't have much of an opportunity to formulate plans before he had the stroke.
The stroke primarily affected Tony's left arm and leg. He was able to communicate well and there didn't seem to be any cognitive deficits. "At least I still have my noodle," Tony would say. Professionals use terms like 'intact cognitive skills,' but sometimes patients using colloquialisms can describe the situation quite well.
Whenever I asked Tony what his goals were he always told me the same thing: " I want to be well enough to go to the country club, play cards, and hang out with the boys." That meant walking better, using his left arm more, and not being dependent on others for eating and using the bathroom. Still, his goal seemed odd to me: Tony just did not seem like the country club type. I tried to discard my stereotypes and prejudices and I accepted what he told me.
He has goals to work on, I thought. And we embarked together on a process that would help him meet those goals.
With each day, Tony's hand continued to swell. The left arm was useless, and he regained no movement at all. His muscles continued to atrophy and there was no support to keep his arm well placed in the socket. This caused what we refer to as a 'shoulder subluxation.' This causes pain, and the pain is exacerbated by the swelling in the hand, and this contributes to an overall cycle of pain and lack of movement that is very difficult to overcome.
I always try to be honest with my patients. "Tony, I just don't know what I can do for this arm. The swelling is terrible, you don't seem to be able to move it at all, and all this is making the pain worse and worse." I felt as though I was letting him down.
"I think we need to try a poultice," he said to me one day. I had never seen him so serious before.
"A poultice?" I replied cluelessly. "What in the world is a poultice?" I was newly transplanted into the rural area and had no experience with such things.
"It's a mixture that you put on your arm and it will draw all the swelling out. My mom used them on us for bee stings all the time. I asked my son the big shot radiologist but he thinks I am crazy. Do you think I should try a poultice?"
"Well I think it might be a little out of my league, and I certainly don't have any poultice recipes, so I think you are on your own for this one."
Tony responded, "Well the one I remember best is the one that smelled the worst, but I know that my mom told me it was the most powerful one. Now my son tells me not to do it and that I am wasting my time. But I need to get equal parts of Pennsylvania crude oil - it has to be straight out of the well, you know - and mix it in a bag with fresh horse manure. Then I have to place it all over my arm and it will draw that swelling out. So can I do it?"
I mentally withdrew, but couldn't help noticing how badly he wanted to believe in this poultice. I could see that he believed in it. "I'll tell you what, Tony. You go try that poultice. Just wash your hands real well before you show up in my clinic again."
"Deal!" he said. He left my clinic that day a very happy man.
Tony kept his word, and I never saw or smelled any trace of his poultice when he came in for therapy. I also don't know where in the world he found Pennsylvania crude oil (straight out of the well, of course). There were still a few small derricks operating locally and I imagine he talked someone into helping him out.
His left arm didn't get much better in regard to movement. Some of the swelling went away over time, but I don't know if it was the poultice or the range of motion and massage.
I taught him how to dress himself using only one hand, and how to complete other important self care activities as well. I also purchased a card holder for him so that he had something to hold his cards when we played in the clinic. Tony loved coming to see me, and after my approval of his poultice ideas he developed a deep trust in my opinions.
One day he came to see me in my office and pronounced himself healed.
"I don't think I need to come to therapy any more," he stated. "This arm just isn't going to get any better, and I can't sit around waiting for it to happen. You helped me to learn how to do things without having to use it, and it is high time I just stopped waiting for everything to be the same again. You have done so much for me, and you even let me believe in my poultices. Will you just be my guest at the country club - just once - so I can thank you properly?"
I was so touched by his acceptance of his disability, and felt warmed by his kind words to me, so I accepted his invitation.
A couple days later I received a note from him in the mail, complete with directions to the Johnstown Country Club, located on Johnstown-Reynoldsville Road. I always chuckled at the lack of imagination when it came to naming rural roads - they always seem to be named after the two largest towns that the road connects.
Strange, I thought. I have traveled that road many times, and I just don't seem to remember any country club anywhere. I called Tony to be sure of the directions. "Oh it's there all right - don't you worry."
"How should I dress?" I asked, not wanting to be out of place when I arrived.
"Oh gosh, wear something comfortable," he replied. "What matters most is that we have a good time." Hm... 'casual country club' I imagined. It was enough to go on.
The day of our dinner soon arrived, and I made sure that I was dressed in a pair of casual slacks and a collared shirt and nice tie. I wore a sport jacket over it all, different color than the pants naturally. I was trying to be casual.
I followed the directions exactly, and they were quite accurate. However, I began to worry when I found myself on small dirt roads off of the main road. I saw no signs. No manicured lawn. No fountains or golf course or statues. But then I did see it: the Johnstown Country Club.
Tony was sitting out front, chomping on a cigar and playing cards on the front porch with a bunch of sloppily dressed retired gentlemen. It was little more than a hunting cabin. Off to the side was an open fire pit, busily manned by other friends of his that were cooking steaks and dousing the flames with their beer when the fire started to get a little out of control.
Tony, myself, and about a dozen or so of his buddies sat in that old dilapidated hunting shack on top of a mountain in the middle of nowhere (somewhere between Reynoldsville and Johnstown, I guess) - we ate steaks, drank beer, and played cards until it was dawn.
When the sun started to rise and the party started to break up they came up to me as a group and said, "Thanks for helping to get Tony back up here. It just hasn't been the same without him."
"Gentleman," I replied, "this is the finest country club that I have ever been to. This is also the only country club that I have ever been to." They laughed at this. " But I doubt that I will ever be in such fine company again in my life."
As I looked from face to face and watched them gather around their friend Tony I realized how young I was. And how wise they were.
Whenever I think about true healing I think of Tony, his friends, and that country club. I remember that healing is not about the swelling in a man's hand or the movement that he has in his shoulder. Rather, I think it is all about the things that a person believes in and what he does to find his way home again.