By Tim Wassberg, Vermont Maturity.
A mindset in any profession reflects in the logic of a situation but in health care, an aspect of emotional resonance mixed with experience always enters into the equation. Jeff Leake, a physical therapy assistant at VNA & Hospice of Southwest Region, has been helping patients for nearly 20 years but it reflects in knowing their story and seeing his own reflected back.
Leake grew up in Bennington and was part of a highly athletic, swimming family. He proudly states that they still have standing records at the Rec Center. His family owned a local dairy farm up in Woodford. His dad was also a national athlete in swimming. Leake says his dad always let he and his brother “do our own thing” but his mother was the one who pushed them as kids. She advocated in the state to get a good swimming program and make sure opportunities were there for those athletes. The hard part, he says, is that both his parents became sick when he was fairly young. His mom contracted terminal breast cancer. First diagnosed when she was 38, she got a double mastectomy but the cancer came back aggressively a couple years later. She eventually passed at 49 (around 1995). However, just after she had started to recover from the first onset, his dad found out that he had a brain tumor after he had suffered from a seizure. His dad received treatment but did come back post-op with some psyche issues “because they took a chunk of his brain out.” Leake said it really impacted who his dad was as an individual.
“So as a kid, you have these two parents who are sick, know they’re sick, but you’re still trying to do well in school, figure out college and do well in your sports.” He and his brother did have some family support and his grandfather lived in town. But this is a lot to go through at 16. Leake also needed to pitch in at the farm since there was still a heavy load there to take care of as a full working farm. ”My older brother would milk a little bit. I’d milk a little bit, but you still had to do the hay and do the feed and fill in some of those gaps.” Eventually, during that time, his mom passed away. “My dad had recovered from his basic meningeal with the brain tumor, but just as he recovered, my mom started going downhill again, and it was really terminal. And so she did have hospice come in and help out.”
Leake’s dad was working at the farm and his brain tumor was resolved but then he started complaining of carpel tunnel which ended up being Lou Gehrig’s disease. “Basically, mom got sick. Hospice was taking care of her. She passes. And then later that next year you get bang…Dad has a terminal neurological disease.“ His dad had to sell the farm in the mid-90s “when prices were awful.” But his dad simply said: “You got to keep moving forward.” His dad eventually did pass in September 2002. At that point, Leake was coming out of college with a degree in Exercise Science. He was just figuring out what he wanted to do.
Biking was a love that Leake embraced. He blew his shoulders out swimming in college so he could no longer do that competitively. At that point, mountain biking was just kind of starting in the area. “I liked mountain biking. Did some triathlons.” He raced a lot of cycle cross. John Goodrich, who ran the bike shop in Bennington, asked if he wanted to take it over but Leake said he just wanted to work. “So I worked there with him, and he kind of supported me.” As Leake and his wife-to-be got more serious, she told him, “Look, if we’re going to get serious, you need to get a job with insurance.’ Leake went and worked at the hospital in daycare with three- and four-year-olds, but after a while he said he realized “I got to figure my life out.” He went to Berkshire Community College which had a physical therapy assistant program. He did the program in two years, graduated and started his internship with a home care gig in North Adams.
The PTA he was shadowing told Leake: “With home care, you never know where you might go. You can go to the most desolate, poorest parts of the community, and you have to service them. And you can go to the houses that have millionaires…and they’re all the same. It’s about that care. You walk in and you’re in there providing a service.” Leake says, on some days, “you go in there thinking you are going to be a therapist. You’re doing physical therapy, but you’re also a nurse, you’re also a social worker, and you’re also just a set of ears, because you might be only person they see for months.”
Working at the VNA also keys into having good self-managing skills. “I’ve been lucky having good supervisors over the years,” Leake explains. “They teach you that you have to be flexible and know who your go-to people are.”
But it is also about reacting correctly in a situation: “Sometimes you walk into a house and the person’s complaining, and you realize, ‘Wow, something’s not right today.’ And then you triage. You’re in the home by yourself saying, ‘OK…this guy’s never stumbling around like this. Is it a stroke? Is it over-medication?’ And then you have to figure out, ‘What do I need to do?'” You are there as a physical therapist you have to interpret. “Their blood pressure is dropping, so you really have to put on the other side of the hat,” Leake explains. He recollects a gentleman years ago who had substance abuse issues as well as a seizure disorders. “He would over-medicate because it made him feel good.” Leake says the man was always good to him but, he explains that, with his seizures, the man would run out of medication because he would self manage “which you should never do.” Leake remembers knocking on the door. He gets in and the man’s standing there behind a couch. His speech is slurred. Usually the man would be making eggs and bacon. There is also coffee spilt on the floor. Leake asks him “What’s happening?” Leake says, at times, one had to act like a detective to see the details. He watched the man, checked his vital signs and got him walking but something was off. He told the man he needed to send him to the hospital because he couldn’t quite put his finger on what was wrong. The man didn’t want to go to the hospital but he had to go. “We ship him to the hospital, found out he had way too much Keppra [in his system], probably [from] self medicating. But he was at toxic levels. When he came home, he said, ‘Jeff, thanks so much for doing that.’”
And many people don’t have anyone. Leake says that is where Home Health steps in. He says he was explaining to a man the other day, that there are four worlds: There is the hospital, where the patient is there, hooked up to monitors and seen around the clock. There is the CLR or rehab center where people are seen on a regular basis. Sometimes they are monitored but, at other times, they are just in the room by themselves. Then there is Home Health. “We’re kind of that bridge between the doctors. Our goal is get you back into the community. If you had an adverse effect or a stroke, you do come home. You’ve been in rehab for six months. Our goal now is to get you so you can start doing what you want to do in the community.” The last world is outpatient through the doctors because “you have to go to them to get the care.” Leake says what is interesting about home care is that you see people sometimes at their worst. “But then you’re like, ‘OK…let’s get you up.’ And I’m then the first person that’s now stood you up after you’ve been in your bed for three weeks,” he explains. It is about that progression. “Now we have to get you down the steps to go to your doctor. ‘Let’s work on that.’ So you get to see that improvement.”
The differential to make is that these specific instances he speaks of are for people that are not terminal. This service is not hospice. This is the Visiting Nurses Association [VNA]. Their service is helping these clients make sight improvements to function. They might need to make those home modifications to stay in place at home. “And that’s where we have a great team. We have an OT who comes in, and says, ‘Let’s modify the showers. What do you need to manage your daily living life? Are there utensils you can use?’ The Occupational Therapist really works on that stuff, Leake adds.
Leake says some people are more aware of their limits than others. “But I think a lot of is education in what’s going on with your your illness.” It is also providing that interaction which is sometimes a key part of the visit. “I walk into houses going, ‘How’s your son doing? How’s your daughter doing?'” Leake explains. “Sometimes I will get a request for Jeff or Greg because they know us, and they know our reputations. I’ve seen my parents friends so you have that rapport. It’s about that personal connection with people.”
The reality is, as we age, we all slow down. “I’m going to the houses now of individuals I knew as kids. And you’re like, ‘This was a strong man, and now you see him, and he can barely stand up out of a chair.”
Leake says has met some interesting people. “You’re in their space. And sometimes, you stop for a second [and think about it].” One time he was looking at a painting on the wall and asked the client: “’Is this a real Picasso’ ‘Yes, it is’ ‘Why?’ ‘Because I always wanted a Picasso.’ ‘Okay, that makes sense.’ Other people have included veterans. “And you hear the stories. Some don’t want to talk. [Some do.] Sadly I miss some of those World War II guys, that have now passed, because they had some stories.” Leake says it really brings out, not just the microcosm of Bennington, but it creates a global picture. “You realize this person was at Normandy Beach. This person was in the Pacific, fighting the Japanese. This person was in tunnels in Vietnam, and is traumatized.” This also includes women. “I had no clue how much of the WASPs and all those female auxiliaries were around here. And you’re meeting them in their hundreds, and they’re showing you the pictures and the magazines. It’s such history lesson.
Everyone, no matter what strata they are in, “they’re people with a story. And I think, for me, that’s how I kind of approach the houses and asking those questions. You can always talk about the famous people and the people who met famous people, But sometimes you don’t hear about the gentleman who went to Normandy, and his brother was in the first wave, and he was in the second wave. And you go, ‘How’d that make you feel?’ You step back from your therapy of walking this guy. ‘Your brother was hitting the beach.’ And he’s like, ‘It was awful. The only thing you think about is, ‘Is my brother alive? And you go, ‘Man’, and it kind of hits you.”
There is a very thin line at times between what Leake does and hospice which is a different team. “There’s a thin line. And it’s always hard having that discussion saying, ‘Hey, have you considered hospice?’ and having had both parents go through it, I don’t mind talking about it, and I’ll put the card down.” He says they can get a nurse to come in, and explain the program to the patient.
It differs of course from person to person. It just doesn’t happen to the old but also for terminal cases.
He’s heard stories of say a 30-year-old woman who had terminal brain cancer who also has young kids in the house, “much like my mom…and she would fight tooth and nail for every moment with her kids.” Leake says that is the part that just tears you up inside “because they’re not going easy but you got to let them do it, even though the doctors say, ‘There’s nothing more we can do.'” But those kind of cases go into hospice for comfort care and they meet the qualifications.”
But there are others where it is about finding the right end of life. Leake recounts the story of a woman who had congestive heart failure and atrial fibrillation. “We’re in for there for therapy, and we’re walking her at first hundreds of feet outside, and then it becomes less and less where it got to the point where we’re setting up chairs every five feet, just so she can go from the recliner to the bathroom.” At a certain point, a PT might say “I’m not rehabilitating you. I will make a referral to hospice.'” What hospice, Leake says, basically means is that “I’m not going to treat my disease. I’m not going to go to the hospital, and say, ‘Fix me.’ The doctor might say we’re going to take off your medications and let nature take its course.”
This specific woman was a huge advocate in the South during Civil Rights. She was a southern white lady who did the marches in Montgomery. It was 2008 and she was seeing the nominees in Obama and Hillary Clinton. “She’s like ‘This is it, Jeff’ ‘What’s it?’ We have a black man and a woman running for president. I’m voting for one of those two in November.” He says, at this point, she was not in hospice but said “I got to make it to Election Day because I need to see a Black man win the election.” He says Election Day comes around and she votes. “She’s like, ‘Now I can die.'” He says, she was in hospice at this point. Her doctor told her, once she goes off her cardiac meds, she wouldn’t live long. Inauguration Day comes around. Leake says she is still in therapy, doing transfers, and he is making sure she is safe and okay. “And this is where therapy changes. In hospice, we’re looking at safety. ‘Can we keep you comfortable,” he explains. “We make it through Inauguration Day with this woman and she says, ‘I never thought I’d see the Inauguration Day of a Black man.’ And she kept joking, ‘I can die anytime now.’ And the doctor said, ‘Well, I don’t know what’s keeping her alive.'” Leake says she made it 100 days and eventually did pass in March.” It shows the resilience of the human spirit but also the importance of the mind in the final proceedings.
But it also comes back to connection. “I think the big thing is sometimes we feel isolated,” Leake explains. “Sometimes you don’t realize there really is a community out there. You might not know they’re there, but they’re there.” He says it can be as simple as a social worker pulling in a private duty person to support a family. Sometimes, he says, he will see former patients at the gas station or the Hawkins House. A guy in a car passing will say “Jeff…how are you doing?” Leake will walk over and start chitchatting. He says it is great to see these people back in the community. He remembers seeing a patient who, six months before, was completely bed-bound and bilateral, with broken legs. “I say to him ‘You’re back…how are you doing?’ ‘Good,’ ‘When you getting back on that motorcycle?’ The man walks outside and says, “Here’s my new motorcycle.’ Sweet. Those are the fun things.”
To learn more about VNA & Hospice of Bennington, visit vermontvisitingnurses.org.
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