Obvious Acute Trauma
We must not Rolf anybody who has recently been severely injured. If any part of the client’s body is severely bruised or swollen, bandaged or has recently been put in a cast, the body is healing. The client does not need the strong input of a Rolfing session. It is reasonable to wait until the person is available, until she is able to be up and about with little or moderate pain only (refer yourselves to my article on pain in the March 1994 issue of Rolf Lines).
Not So Obvious Acute Trauma
I suppose that your clients like you. I also suppose that you clients trust you. It is not too far fetched to imagine that a client would show up soon after a major accident for her regular appointment, thinking that though her car was badly damaged, she is just a little shaken and worried but basically O.K. It may thus be possible that a client who is really but not perceivably injured would come to your practice. Since we are not usually trained to examine people for possible subtle but dangerous injuries, we could be fooled by normal appearances and commit irreparable damage.
One day I picked up an adorable very, very old lady who had just fallen right in front of me and had badly hit the back of her head against the sidewalk. She did not feel pain and was not confused, as far as I could see, but she had a rapidly growing bump on her head (was it just a hematoma or a more severe intracranial blood vessel damage?). I offered to call help, to drive her to the hospital, to drive her to her doctor, to drive her home… She just allowed me to walk her home saying, “Honey, the hospital is the last place I will ever go!” …I knew what she meant. All I could do was ring her neighbor’s doorbell and let it be known that the lady really needed to be checked on. A few days later I found out that she did have to see her doctor that day. Her response to her injury is a classical example of denial. I’m sure you have heard about it.
So what would you do if you had such a customer come into your office? You would get a detailed history of the incident or injury and take notes. You would be or act calm and observe your client for signs of shock. Shock almost always indicates acute injury.
The Most Obvious Signs of Shock Are:
– The person is noticeably agitated and frazzled, talks loud and fast, does not sit down, breathes rapidly, looks scared but may try to laugh it off or minimize what happened (chronic Machismo may be a complicating factor and is rampant in both genders).
– Her story does not make complete sense, she may not remember everything that happened.
– One of her pupils is noticeably more dilated than the other or both of her pupils are widely dilated even in bright light.
– She is cold (feel the arm or the hand) and clammy, or there is visible sweat on a cool day.
– She is pale and has bluish lips (a dark colored or black person may look gray around the mouth).
– She is very thirsty and feels a little nauseous.
– If you feel the pulse it will be abnormally fast and may feel weak.
By now your own pulse should have risen significantly. Do not let the person assure you that she is well because she is not.
The Best Course of Action Is The following:
Make the client lie down, give her a blanket, elevate the feet slightly, help her loosen her belt or clothing, open the window, do not touch her and do not give her anything to drink (or eat). Sometimes people will become very anxious or even belligerent and will not comply. You should be firm and insist. You should reassure the client, leave the room for a few seconds and call an ambulance or have your secretary do it.
Some people go into shock with very minor injuries or even no injury at all. It may happen because they just barely avoided a potentially deadly accident or because of any other sever emotional shock like learning the horrible news of the sudden death of a loved one. Whatever happened to your client is irrelevant if you see the signs of shock. You must act quickly because untreated shock can be fatal.
In 1852, shock was defined as “a rude unhinging of the machinery of life”. Shock is the collapse and progressive failure of the cardiovascular system which brings oxygen and glucose to the cells of the body via the blood. The cells most sensitive to the lack of oxygen are the heart, the brain, and the lungs, and they can be irreparably damaged in just 46 minutes. Some degree of shock occurs from all injuries. All depends on the stability of the nervous system of the person. Most at risk are the elderly, infants and people who already suffer from chronic diseases of the major vital organs.
If people are strong, the signs of shock may recede gradually, but since we are not trained in emergency medicine we are not able to monitor such progress. So, let’s play it safe (as they say in the U.S. of A.): Even if you do not think that the client has been injured, do send her home if she comes to your office the day a serious accident happened.
If your client comes to see you a week or a few days after an accident with significant car damage, shattered skis, bicycle bent into a pretzel, possible sever impact but no scratches on her skin, ask the following questions:
Are there any recent changes in the freedom of movement of your eyes (make them look to the extremes of all directions of the visual field)?
Has there been any recent ringing in your ears, any noticeable loss of hearing?
Did you vomit after the accident without having an upset stomach?
Do you remember all the events concerning the accident?
Have you experienced any change in balance or gait?
Have you had a fever after the accident?
Can you move your back and neck as usual without any new pain or restrictions?
Is there any unknown discomfort in your abdomen?
Is there any numbness or tingling in your extremities?
A positive answer to any of these questions indicates potentially serious damage to cranial or peripheral nerves or blood vessels and your client should be examined by a doctor ASAP.
If the client is well, you may seem a little nutty. Big deal! But if she is injured, she will come to really appreciate that you look out for her welfare … and last but not least, by doing so you will have acted to keep your heart open and CYA.
Detailed facts are taken from Brunt Q. Haven and Keith J. Karren: Pre-hospital Emergency Care and Crisis Intervention.
The choice of the feminine pronoun is not meant to exclude men, since they are persons too. It is just to contribute my part to the rectification of a long standing historical imbalance and avoid stylistic clumsiness.