Deciding between can and should

Sam Clift posing for the camera. Photo provided by Sam Clift.
Sam Clift posing for the camera. Photo provided by Sam Clift.

By Cori Ritchey

After a tragic accident left Sam Clift missing a limb, inspiration from those around her helped choose her life’s path. But, when it comes to healthcare, the fear of safety has her second guessing trying new things in her career.

Nightmare became reality on a playground in 2004. At a July 4 party when she was 6 years old, Sam fell from a playset. Though gruesome, the compound fracture that came from the fall was nothing short of a normal childhood injury. Easily fixable with the proper care and a longer-than-comfortable episode in a cast. 

Sam’s family wrapped up her bleeding arm, fumbled her into the car, and drove her to the closest hospital. There, they stabilized, splinted, stitched, and casted her arm up. It was all very routine. After a few days, that started to change. Something about the pain in the cast seemed different than your typical broken bone and stitches pain.

They returned to the hospital, quickly learning that Sam had necrotizing fasciitis, a rare flesh-eating bacteria that was rapidly spreading up her arm, and could cause her death if it traveled any further. 

There was one option: amputation. She underwent surgery, and spent several weeks in the hospital recovering, and re-learning how to do life. 

Returning home proved just as difficult as being in the hospital for Sam. Being only six years old, she struggled to understand why she was not able to do all the things she was doing before. Everything felt harder; putting on clothes, playing with toys, eating.

“She would get frustrated about everything,” Sam’s father, Mike Clift said. “She had to learn how to do everything over again.”

Immediately after the surgery, Sam began occupational therapy. Occupational therapy is a branch of healthcare that is meant to teach people with physical or cognitive ability how to be independent in their own lives.

“We work on aspects of their day such as bathing, dressing, feeding, brushing your teeth and the skills needed to complete these tasks with as much independence as possible,” M.J. Weinman says, occupational therapist at Spaulding Rehabilitation Hospital in Charlestown, Massachusetts. “This can be working on using adaptive equipment, fine motor skills, cognitive skills, etc.”

For Sam, this learning experience started with practicing dressing, eating, and showering with her newly single limb. Lucky for her, she had the best example to learn from: her therapist.

Sam’s occupational therapist, Debra Letour, was also monobrachius – the fancy medical term for only having one arm. For her, it was congenital, meaning she was born with this defect.

For Sam, having Debra as a therapist meant there were no excuses. She couldn’t quit, because Debra was right there in front of her, showing her that everything was doable. Every skill, exercise, and drill Debra showed her with confidence and reassurance that a very normal life was not only possible, but probable.

“It took a long time, months, to get back to a normal life,” Sam’s father said. “Adapting every day.”

Sam, with the help of Debra, worked through her adaptations and was on track to a normal life. She did a few bouts with a prosthetic limb, but she discovered quickly that she felt like her natural body was good enough, and she never needed that form of assistance.

When she went to college, it was a no-brainer what she wanted to pursue as a career. Occupational therapy, and her therapist, saved her life. She was ready to help others through the same route that her therapist had. She was determined to not let her physical ability undermine what she was able to do in this career path.

In the field of occupational therapy, there are several disciplines to work in. A few of the most common are acute care, subacute rehabilitation, outpatient care, and psychiatric. 

While in graduate school, Sam completed her final training in psychiatric occupational therapy. 

“Occupational therapy in a mental health setting focused on establishing routines, coping strategies, routines, and understanding psychological influences on their daily activities,” Weinman says. “It encourages an individual’s return to meaningful occupations, such as school, participating with family or in a work environment successfully.”

Upon graduation, Sam took a job with the same psychiatric unit she completed her training at. “It almost felt like a necessity,” Sam says. 

The therapy discipline often qualifies the intensity of physical work the therapist must do.

In acute care, for example, patients are still hospitalized, and their injuries or ailments are still active and fresh. These patients may be non-ambulatory depending on their medical issues, and they are at the first level of care. Often, a therapist may need to assist them physically to be able to participate in the exercises the therapist has programmed for them. The same is true for a job in subacute rehabilitation, which is typically the next step down from hospitalization. 

Psychiatric therapy, on the other hand, Weinman says, is much less physically intensive. Sam felt like this was the best fit for her given her disability. Though she enjoyed her work in this setting, she feels as though she is limiting herself. 

She has recently quit her current job in psychiatric care due to issues with poor management, and she has reached a head on this internal debate – should she attempt to take a position in another setting to keep expanding her knowledge of her field? Or is the risk too great?

“I believe I can do anything I want, but in settings like acute care, I’m not sure that I should even if I can,” Sam says. 

Falls are a number one preventable cause of injury in hospitals. When patients are hospitalized, their physical ability to move around on their own is limited, especially if they are attached to different I.V. lines or other medical equipment. Often, medications they are taking can also make them dizzy or lightheaded, susceptible to passing out or losing their balance. 

An extra hand, in this case, can mean the difference between an accident and a safe therapy session. 

“In more involved settings, where an individual cannot transfer themselves or stand on their own, such as an inpatient hospital, patient safety and clinician safety is often a first thought,” Weinman says. 

This is where Sam’s self-consciousness comes into play. Even if she is able to handle the physical load with her one arm, is it smart for her, or her employer, to allow the risk that she might not be able to handle the patient in the event of an emergency? 

While Sam is not worried about getting hired into one of these positions, as there are laws and regulations protecting people from her from being discriminated against, she is worried about her own self-doubt. Is it right for her to put her patients in potential danger in order for her to broaden the horizons of her career? 

Growing up with her disability, Sam was certain there was nothing she couldn’t do. She learned a new and exciting way to do everything that would typically take two hands. She’s proved to herself that she is unstoppable when it comes to living in this new way. When starting this career, she says she never had any doubts about her ability to do the job back then. 

Now, as she gets older and looks to begin a new phase in her career, she is overcome by this new found fear. Her disability had not defined her in such a way before. As she takes the chance and applies to jobs in these different settings, she continues to fight the line between can and should. 

“I know I can do this, but is it safe for me to even try?” Sam says.