Expert Breakfast Report for March 20th 2024: Dr Carrie Falling, School of Physiotherapy. PART TWO

This continues Dr. Fallings story, the first part having been published roughly 7 days ago.

Recap. of Part 1

Raised in Alabama by parents who were both Engineers, Carrie Falling enjoys learning, exploring new experiences and what it is to be human. Following a BA in fine arts, she worked with a well-known artist in New York, with trips overseas that broadened her experience. She later became a Medical Receptionist, trained as a Medical Technician, then completed a course in Massage Therapy. Carrie worked a spell as a contractor for the US Army as a Senior Analyst supporting aircraft Engineers, which was followed by ten years running her own business in massage therapy. Considering the possibility of a fine arts Masters degree in the UK, she and her husband opted instead for New Zealand, where Carrie experienced First Year Health Sciences at Otago as a mature overseas student before embarking on Physiotherapy studies, and ended up teaching it.

Throughout her experiences Carrie highlighted the significance of exploration, empathy, and the power of connection in overcoming emotional challenges.

There followed questions on such matters as the most rewarding things about Physiotherapy, the most interesting place in the world she has visited and the idea of research into the beat way of giving Health knowledge to underserved communities.

Questions continued:

Q. Can you talk a little bit about the differences that you experienced in practising Physio on sports people, and practising Physio on people with chronic conditions?

A. First Dr Falling noted the unique nature of elite athletes in terms of finely tuned bodies. And even then, success is 80% mental, and 20% physical, giving a marked difference in personal performance depending on the state of their ‘head game’.

In Carrie’s experience working with both athletes and individuals with chronic conditions, showed little differences in the end. Working with athletes highlighted the precision and mental resilience required for peak performance. Sports physiotherapy often focuses on enhancing physical and mental abilities to optimise athletic performance. “Little changes make big differences to people.” On the other hand, treating individuals with chronic conditions requires a more holistic and patient-centred approach. In contrast to the athletes, these people often do not have all the physical resources that they may need. Yet it is amazing how resilient the human body is, and once again, their mental approach makes a huge difference. In either case her work was about providing them with the means to live the lives they wanted to live.

Chronic pain management and rehabilitation for individuals with chronic illnesses necessitate a comprehensive understanding of their unique needs and challenges. Both areas of physiotherapy present distinct challenges and rewards, and she feels both ultimately contributed to her growth and development as a Physiotherapist.

Q. I wondered if you were more grateful that you had come to Otago than AUT?

The answer was ‘Yes’ - in part because of the heat in Auckland. One cannot compare the schooling without experiencing both, “but I can tell you that the faculty and students I have met here in Otago are still my close friends after they graduated.”

Q. Why did you choose to come to New Zealand?

A. Her husband Mark is in the restaurant business, and he suggested Melbourne, but at the time they were living in Chicago, and Carrie did not fancy going to another big city, once again wanting to try something different. Also, part of it was a lifelong desire not to always choose the safe route – but to take chances and have adventures - not taking undue risks, but just enough for it to be exciting. “And it worked out!”

Q. You said Physio was your first choice, what was the driving factor for that?

A. “When I decided not to go for my MA, and I looked at my current life, I thought, ‘What are the things I like about what I do?’” That led to her thinking that she wanted to know more about the body and what was happening with her patients. And the closest to what she was doing, but had more capacity was Physiotherapy. “…and it would take way too long to be a doctor. So said the girl who has a PhD and has been in school for ever! I could totally have been a doctor… well, I am a doctor, but its a different kind. Actually, a PhD is the highest degree in the world , so my degree smokes a medical degree. It’s just the paychecks. . . . .but, never mind.”

Digestive Health Specialists

Q. Do you want to talk to us more about digestive health side of your work?

A. Apparently the person she was working with had been treating Carrie for some digestive problem, and “I found it quite interesting.” So, Carrie went to study it at the Loomis Institute. [The Loomis System advocates using whole food as a dietary mainstay in conjunction with exercise, adequate rest, clean air and water, and mental and emotional stability as a part of a total wellness program. There is also emphasis on the importance of proper digestion, absorption, assimilation, and elimination.- Ed.]

“I actually opened a practice here in Dunedin and I used to give public talks about it. A lot of what digestive health providers do is support people who aren’t diseased per se but are suffering from symptoms . . . For instance, heartburn is not a disease, it's a symptom. But it's a symptom of something that's not running properly. And so the question is, can we figure out what that might be? And so I treat anything from gastrointestinal kinds of issues, so constipation, heartburn, any of those kinds of things – to other issues like eczema and psoriasis.”

“One of the main things digestive health specialists do is to look at the nutrition going in and ask is: First, is enough nutrition going in? Are you able to break it down? Are you able to utilise what is coming out of your food? And if you aren’t, often what that ends up provoking is symptoms, not a disease.”

She noted that Nutrition is not taught extensively in medical curriculum. She joked, “it is often commonly a single lecture in one semester in Medicine. But, by definition, Medicine is the study of disease. “You often don’t get taught the study of prevention.”

Western Medicine Isn’t Everything

Q. You mentioned there was a hole in Western medicine. What's your sort of approach to remedying that? Do you take teachings and things from other medicines?

A. “ I do have a responsibility to the history of the discipline, but I sometimes talk about it in an irreverent kind of way. I strongly believe in Chinese medicine. I strongly believe in aspects of Ayurvedic medicine. I strongly believe in nutrition. I strongly believe in indigenous approaches to health and well-being. My father is indigenous. I'm indigenous. . . . I think Western medicine is one set of knowledge.  It's just an approach.  It’s very good - but it is by no means going to be able to be everything for everyone.”

At the same time, Dr Falling was clear on her obligation to teach students to prepare them for the Board of Physiotherapy qualifications, and that there was no way she could teach them something like Chinese Medicine - which takes many years of study.

Coping with the Death of a Patient

Q. Have you had patients who have died while being treated by you, and, if so, how do you cope with that?

A. “Oh, it’s hard. I’ve had patients die when I was in hospitals. I’ve had patients that I have worked with for a long time with Parkinson’s and die. I’ve had patients not survive surgery, and patients that have died of cancer . . . It’s never easy. Some are harder than others because I have developed a personal relationship with them as well, and so, you know, you go into the stairwell and sob . . . So you just hopefully cry for a while. But I also know that, irrespective of health, we are not solving immortality . . . Everybody dies. That is not within my control . . . It’s my personal faith that, if it’s your time to go, it doesn’t matter what I do. I do what I can to the best of what I can. When I’ve had closer relationships, I’ve gone and talked to some people just to get some help and just to process and grieve through that. But I have got it really clear in my head about what I am doing. And I am here to see people. And if my patients can feel seen by me and if I can help them in any way that I can, I've done what I could do in this space . . . I'm a pretty sensitive person. And I hide behind humour a lot. So, I spent a lot of time crying in the stairwells. “

Dr Falling then noted that there are jobs with more frequent exposure to death, such as in intensive care, high dependency units and emergency. “I know some people who have changed because of that.”

Q. Do you have any more travel plans at the moment?

A. “Yes, I had planned" . . . but Covid was creating problems. “ The plan was to go to Saudi Arabia.:" Two of her fellow Ph.D. students were from Jeddah, and Carrie still intends to go there with them. But she has just seen a documentary on Iceland, and would love to go there and knit on one of the volcanos. “I got my office mate involved. I think he's going to come with me. I'm such a travel junkie.”

India Revisited

Carrie was asked again about the python, and I have incorporated her answer to that in the earlier section on this snake. “It wasn't even the best story from that trip to India. It was the most ridiculous trip ever. So much fun. “

For one thing they somehow arrived a day early, and nearly could not find a hotel. “Thank goodness my husband didn’t go. So, travel with your best friend, so your spouse doesn’t yell at you!”

Q. A lot of the Physios I have spoken to say they treat the patient as very much part of a the team that provides care for them. How do you cope when there's a barrier in communication and the patient isn’t getting what they want out of the care?

A. My priority and obligation, first and foremost, is always the patient. And I advocate for the patient hard. I have loudly disagreed with other providers in the team, people who are way above my pay grade before. And actually, they think they're above my pay grade more than I think they are. But I loudly disagreed with consultants in neurology. Oh, I did it as a student, even. I’ve sat in team meetings, where decisions were being made that in my opinion were unbelievably wrong about somebody who was not going to be independent going home . . . I do think it's worth asking yourself what's the most productive way of having that conversation. If you are disrespectful and are a woman, you may alienate them . . . But no, it's about the patient. And I will advocate for them every day. It's not about the other providers. It's not about the health system. It's not about anyone. It's about that patient getting what they need.”

Q. And when there are issues such as they have a goal for themselves that it's going to be probably near impossible to hit, how do you have that conversation or how do you work to make it as close to what they want as possible?

A. This is the problem of unrealistic goals, and is asked a lot by Physio students. For example, someone who has had a stroke with accompanying neuronal death. Carrie said that her experience is that deep down, many patients know their goals might be unrealistic. She gave an example of someone who had been in a wheelchair for 20 years: “They know they're never going to walk again. And what they're communicating to you actually isn't about what’s a realistic goal for them. They're trying to have a conversation and grieve and to talk about this loss in their life. And so, it's trying to recognise what that conversation actually is about  . . . that it's actually not about them trying to achieve that goal that they know is unrealistic.” Then you need to talk to them about that. She described her conversation about someone who had had a stroke and said he wanted to play the guitar again: "And we had to sit and have that conversation about, ‘Oh, so what did you use to play? And, you know, tell me about that. Do you still have your guitar? Do you have it out? Do you even see it? Can you play it?’ You know, I just try to be in the space with them and let them talk.”

Other times, in the acute phase of a stroke, the patient may in fact recover - or may not. “So, if I'm not really sure they’re going to recover their ability to write, for instance, because it's a pretty fine motor skill, I'll acknowledge that and say, okay, well, in order to write, what we need to be able to do is reach and pick up a pen, like this. So, let's work on that.

So I acknowledge that that's their goal, and then I break it down in little steps and try to give them a target to get there. And what ends up happening is people become reconciled to the fact that that may not be realistic. The only other answer I have to that is I had a teenage basketball player here in New Zealand, who had enough skill to go play college sports in the States. She had the most insane knee. Patella was like floating around. It was literally the ugliest knee I've ever seen. She sustained quite a few injuries. And during her pursuit of her basketball dream, she had joined a cross-country track team.

“And I thought to myself, ‘So, what do you want to do on a bad knee? Of course, let's go running. Perfect!’. Like WHAT are you doing?” And so I probably had the wrong approach because I think I came down on her too hard. And she's the happiest girl ever, and she went out crying. I was like, oh, I got that wrong.

I said, ‘if you want to be able to walk when you're my age, you are going to have to stop it because you are ruining that knee. And why are you running cross-country when you want to play professional basketball in the States? So, you need to stop doing that!’

So I definitely didn’t get my response to that situation right, I'm not saying I got that one right, but she wanted to be able to do a lot of things that on that knee was completely unrealistic for her targeted goals. And so, it required taking a step back and reflecting what the reality of her knee was. So, you need a different approach at different times, and I have gotten it right sometimes and wildly wrong at others.

*Note re Question Time - I was not always able to hear exactly what the questioner said, so in some cases, the ‘question’ has been constructed in part from the answer elicited. - JPX

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Posted: Sunday April 7, 2024