(Photo by Stewart Black via Flickr)

If sheer cussed independence were enough to overcome all ills, rural people could stop worrying about how hard it is to access medical services in our communities. But sooner or later, most of us will have our independence challenged by injury, illness or aging. Where we live becomes a huge factor in how we respond. And sometimes it takes sheer cussed determination and good neighbors to help us get back on our feet. 

Physical therapy, occupational therapy, cardiac rehab, balance therapy, speech therapy — all  these services are probably available in your community. Under some circumstances, they may be available in your own home. For many people in rural areas, reaching these services might take a longer journey than the 52-mile round trip required where I live. More than 40% of rural residents spend more than 30 minutes traveling to rehab, compared to 25.3% of urban residents. And the distance is an even greater obstacle when you can’t drive yourself. 

In 1997, I fell on the ice and tore my rotator cuff. When the doctor recommended physical therapy, I said I didn’t have time. PT sounded too much like jury duty — an inconvenience to be avoided if at all possible. I did the home exercises diligently, my shoulder improved, and I carried on with cussed independence. 

Then the next year I was hit by a drunk driver. It was not convenient, but I had no choice, so I did months of physical therapy. Neighbors drove me so my husband could work. That’s when I learned what a difference there is between doing some exercises on my own versus having a physical therapist guide my rehabilitation. And those professionals have tools and techniques to help manage pain and inflammation that would not be available to me otherwise, unless I become a professional athlete. 

Since then, I’ve seen my husband through PT before and after shoulder surgery. My dad did balance therapy twice, which I’m convinced is the only reason he didn’t have a major fall until a few months before he died last year. When he fell and broke his hip, I learned a lot more about occupational therapy, which he did along with PT in an inpatient rehab facility. My aunt did time in an inpatient facility after a stroke last year. There, she got the trifecta of therapies: PT, OT, and speech therapy. Now she can not only speak at a normal rate, she can sing in church again. 

I wish my mom had gone to rehab — inpatient or outpatient — after a brain bleed. That happened back when my parents lived in rural Indiana. Mom never even told us until years later that her doctors wanted her to do rehab. That’s right: Pure cussed independence runs in the family. She didn’t do any kind of therapy and was brilliant at masking her struggles. I didn’t know she had trouble writing until I asked her to pipe a frosting name on a birthday cake. 

Sometimes you have no choice. Two friends who live alone in small towns planned hip replacement surgeries last year. Both knew they would not be going home until after rehab. End of story. They prepared their homes before surgery for the challenges they would face during recovery, and made plans that involved family, friends and neighbors once they returned home. 

(Photo provided by author)

Unfortunately, it’s hard to plan for the cardiac crisis or fall that lays one low.  

Last year as fire department volunteers carried an injured neighbor out of the woods, we knew the injury was bad. It had to be, because that friend has enough pure cussed toughness to be in my family, yet he had his daughter call for help. Despite his pain, our friend cracked jokes while we hauled him on a stretcher up a steep slope then bounced him out of the woods on a rescue sled pulled by an ATV. He had to know he was facing surgery, since he heard the bone snap. One wrong step can mean months of recovery. That’s physical recovery. Financial recovery from lost work and extra expenses might take even longer. 

We all have bills to pay, families to care for, co-workers and customers who depend on us. It’s hard to commit to rehabilitation therapies when you don’t know anything about them except they involve being away from home or making many long trips to town. If you don’t know someone who has benefitted, it’s hard to imagine why you should. Or how you will get there if you can’t drive yourself. 

It might help if we try channeling our pure cussedness into mental preparation. When the unthinkable happens to my family, I’m going to ask questions like this: 

  • What are my options? Inpatient, outpatient, visiting nurses and other services might be available. When you’re sick or hurt, it’s easy to miss references to other options, so it never hurts to ask. And you may discover new home-based “telerehab” options are being introduced in your area. 
  • What would be required of me and my family — both medically and financially? For example, Medicare might pick up most of the cost of an inpatient rehab stay, but only if the patient actively participates in therapies.  How long might rehab take? Expect initial visits to take longer because each specialist does specific assessments to help determine your needs.  
  • Is it something you want to do? When my dad broke his hip, he just wasn’t sure he wanted to do rehab. So we asked for appointments to discuss his concerns. Two social workers, a geriatric care specialist, a hospice nurse, his doctor, and a family friend who is a physical therapist all told him his pain would be worse without therapy, and he would probably be discharged to a nursing home where he would be bedridden. Once he had that information, he was ready to commit to rehab. 

 Once you make a commitment, here are a few things to keep in mind: 

  • Be clear about your goals and communicate them to your therapists. They can’t read minds, and you may see different specialists at different visits who don’t know all you have said to your regular therapist. 
  • If you don’t understand something, say so. It’s their job to explain.  
  • Don’t think you can fool them. They can tell if you don’t do assigned exercises between visits. They can also tell if you do. And they might be able to reduce your trips to town if they know you’re doing the work. That is, if you ask. 
  • Be realistic. When PT adds another set of exercises to what you are already doing, ask if there are any you can discontinue. Outpatient therapists especially may lose track of the amount of time everything takes or neglect to add in the travel time. They just want what’s best for you, and utter exhaustion isn’t it — especially if you’re still working or are a family caregiver. 

 Even with specialized rehabilitation services, it helps to throw some sheer, cussed determination into the mix. But that doesn’t mean you have to do it all on your own. Be honest with family, friends and neighbors about what you need, and grant them the blessing of letting them help.  

 In a study of stroke survivors in Appalachia, one patient who identified herself as an independent individual said this: 

 “I prided myself on my ability to take care of myself … And now all of the sudden I cannot even fold sheets because my right hand doesn’t work… I am learning to ask for help. I read somewhere that if you don’t ask for help, you are prideful. It hit me in the gut. I couldn’t believe it at first, but now I can see that.” 

 Donna Kallner is a fiber artist from rural northern Wisconsin whose new year’s resolution was to use the exercise bike in her living room for more than drying laundry. 

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