#33 上司の付箋
今から13年前，当時はまだ紙カルテを使用していました．
現代では，電子カルテの導入が進み，紙カルテを使用する医療機関は限定されるでしょう．
ある日のこと，
理学療法士として働き始めたばかりの1年目．
当時担当させていただいていたのは50歳代の男性患者さん．
脳梗塞により，性格変化と軽い麻痺がありました．
コミュニケーションは取れるし，歩くことだって自力でできる．
けど，ちょっとしたことで怒ったり，声を荒げるようなことがありました．その矛先は医療従事者だけでなく，同室にいる患者さんやその方の家族，友人にも向けられました．
これは脳梗塞の影響で生じることがある性格変化の一種です．
脳の機能局在によって，症状は実に様々です．
冗談も言い合えるような関係になった頃，ある学校から実習のために学生が来ました．
その学生は脳梗塞後のリハビリテーションを学びたいということで私の理学療法提供場面を見学するようになりました．
非常に明るく，笑顔の印象的なその学生は，勉強熱心で周囲のスタッフからも評判でした．
そんなある時，
理学療法を提供するリハビリテーションルームの一角でその学生が震えながらいつもの雰囲気とは明らかに異なる様子でした
そこには，ベッド上に仰向けに寝ているその患者さんがいました．
理学療法とは異なるリハビリテーション（作業療法）を実施している最中でした．
そこに作業療法士はおらず，二人だけ
思わず，「何かあった？」と学生に声をかけると，作り笑顔で「何もありません，普通ですので大丈夫です」と．
明らかに普通の様子ではないことはすぐにわかりました．
一方の患者さんに目を向けると，少しニヤつきながらこちらをみている．
「何かありました？」と問うも「いや，少し話してただけだよ」と．
明らかに二人の言動と雰囲気が一致していない．
その場に戻ってきた作業療法士の先輩に一言伝えてその学生を別場所に連れていきました．
そこで本当のことを教えてと問うと，作り笑顔から苦しさが滲み出ているような表情で「本当に何もありません」と．
何回か尋ねたところでようやく，
「実は，○○さん，私の股に杖を当ててきて．それも何度も．びっくりして何も言えなくて，でも怖くて何もできなくて」
つまり，担当の作業療法士がその場を一時的に離れたタイミングでその患者さんは学生に不適切な行動をとっていたのです．
相手は学生．
こちらは学生を保護する立場でもある．
ただ事ではないと思い，その作業療法が終わったタイミングで人気のいないところでその先輩に伝え，そして患者さんに聞きました．
聞いても，そんなことするわけないじゃんとニヤニヤ
あまりにも不誠実な対応に，
「冗談でもそうそういうことはしないで下さい」
と伝えると，その患者さんは激高．
いきなり大声をあげ，杖を振り回し，
「もうお前の顔なんか見たくない！！出てけ！！」
「お前みたいな新人，俺は本当についてない！！」
「さっさと担当変えろ！」
「お前はもういらない！！」
その後も怒りは収まらず，病棟に戻っても大声をあげ，続く激高．
その状況はすぐさまリハビリテーション科と病棟に共有．
学生には，謝罪をしたのち，その日は別の患者さんの見学に着くよう伝え，自分は上司に報告．
するとその上司はただただ笑ってるだけ．
「はいよー，大変だったな，了解了解」と
その後，病棟に行った際，生意気な振る舞いが多かった自分にフォローの言葉をかけてくれる先輩も看護師もおらず，むしろ冷ややかな目を集め，ステーションの端で報告書を作成．
書き終えた後，その患者さんの部屋へ行き，静かに様子を見ると，横になってテレビを見ている．
何も言葉をかけられず，そのまま部屋を後にし，院内の理学療法の勉強会に参加．
勉強会が終わり，カルテを書こうと再びステーションへ．
カルテを手にしていざ，書き始めようとページをめくるとピンク色の付箋が．．．
「お前はただまっすぐなだけ．時には正しいことが求められるとは限らないことだってある．
患者の身体を動かす前に心を動かせ」
学生保護を最優先にし，患者さんの症状の延長にあった行動を真正面から否定した自分．
事実を伝えるだけではダメだった．
脳梗塞．
男性．
怒りっぽい．
そうした特徴を総合的に，そして冷静に考えて発言するべきだった．
その後，この患者さんのもとへ謝りに行ったものの，担当変更という結果に．
事実上の担当者クビです．
しかし，この上司の行動は当時の自分にとってはものすごく強烈なインパクトを残した．
言葉を介さずにあえて付箋を使う．
そして，カルテに貼る．
言葉ではなくて、あえて付箋を使うことで言葉を実体化させてくれた．
なにより，自分のことを想って付箋にメッセージを書き，必ず目を通すであろうカルテに貼り，そのことは何も言わない．
ただ直接自分に言うことよりも付箋の方が言いやすかったかもしれないし，特別すごいことではないかもしれない．
だけど、当時の自分にとっては残してくれたメッセージのインパクトを大きく変える行動だった．
“患者の身体を動かす前に心を動かせ”
悪いことをした
そう思ってもらえるような対応をするべきだった．
悪いことをした．
申し訳ない
そういう気持ちになってもらうための言い方，伝え方，やり方があった
まずは心に働きかける
心が動けば身体が動く
まさに，その上司は私の心を動かしたのです．
そして今ではこの言葉を私が学生に伝えています
心が動き，行動が変わる
そんな敬愛してやまない上司の一言を紹介させていただきました．
English ver
Thirteen years ago, paper medical records were still being used. Today, with the introduction of electronic medical records, the number of medical institutions using paper charts is limited.
One day, one year after I started working as a physical therapist
I had just started working as a physical therapist in my first year. At the time, I was in charge of a male patient in his 50s. Due to a stroke, he had a personality change and mild paralysis. He was able to communicate and even walk on his own. However, he sometimes became angry or raised his voice over the slightest thing. This was not only directed at the medical staff, but also at the patient in the same room, his family, and friends. This is a type of personality change that can occur as a result of a stroke. Depending on the functional localization of the brain, the symptoms can vary greatly. When we were able to joke around with each other, a student from a school came to our office for a practical training. The student wanted to learn about post-stroke rehabilitation, so he began to observe my physical therapy sessions.
The student was very bright, had a big smile on his face, was eager to learn, and was well received by the surrounding staff.
One day, I found him shivering in a corner of the rehabilitation room where I was providing physical therapy. There was a patient lying on his back on a bed. The patient was in the middle of rehabilitation (occupational therapy), which is different from physical therapy. There was no occupational therapist there, just the two of us.
I asked the student, “What's wrong? I asked the student, “What's wrong?” He smiled and said, “Nothing, it's normal, I'm fine. It was immediately clear that this was not a normal situation.
I turned to the patient on the other hand, who was looking at me with a slight grin on his face. Is there something wrong? But he says, “No, we were just talking a little.
Obviously, their behavior and mood did not match. I told the senior occupational therapist who came back and took the student to another place.
When I asked him to tell me the truth there, he said, “There's really nothing,” with a look of bitterness seeping through his fake smile. After asking several times, he finally said
After asking several times, he finally said, “Actually, Mr. XX put his cane on my crotch ... . repeatedly. I was so surprised that I couldn't say anything, but I was too scared to do anything.
In other words, the patient was behaving inappropriately toward the student when the occupational therapist temporarily left the scene. The patient was a student. I was in a position to protect the student. I knew it was something out of the ordinary, so I told the senior staff member and asked the patient about it when the occupational therapy session was over in an out-of-the-way place. When I asked him about it, he grinned and said he would never do such a thing and was so insincere that I told him, “Please don't do that, even as a joke.
When I told him, “Please don't do that, even as a joke,” he became furious. He suddenly shouted, waved his cane around, and said, “I don't want to see you anymore!
I don't want to see your face anymore! Get out! I really don't have any luck with newcomers like you! Get your ass out of here! I don't need you anymore!
The anger did not subside after that, and even after returning to the ward, he continued to yell and continue to be furious. The situation was immediately shared with the rehabilitation department and the ward.
After apologizing to the student, I told him to go observe another patient that day and reported the situation to my supervisor. I reported the situation to my supervisor, who simply laughed. He just laughed at me and said, “Yes, that was a tough day, I understand.
Later, when I went to the ward, there were no senior staff or nurses to give me any follow-up words for my often cocky behavior, and instead, I was coldly watched as I wrote my report at the end of the station. After finishing the report, I went to the patient's room and quietly checked on him, and found him lying down watching TV. Without being able to say a word, I left the room and attended a physical therapy workshop at the hospital.
After the study session, I went back to the station to write his chart. I picked up the chart and turned the page to start writing, only to find a pink sticky note....
You're just being straight. Sometimes the right thing is not always required. Move your heart before you move your patient's body.”
I was the one who put the protection of the students first, and denied the patient's behavior that was an extension of his symptoms.
It was not enough to simply tell the truth. Cerebral infarction. Male. Anger. I should have considered these characteristics comprehensively and calmly before making my statement.
Afterwards, I went to the patient to apologize, but the result was that I was reassigned. In effect, the person in charge was fired.
However, the boss's action had a very strong impact on me at the time.
He dared to use sticky notes without words. He would post them on medical records.
“Move the patient's mind before you move his/her body.
I should have responded in a way that made them feel that they had done something wrong. I did a bad thing. There was a way to make them feel sorry, a way to communicate, a way to do that.
Work on the mind first, and when the mind moves, the body moves.
That's exactly how my boss moved my heart.
And now I pass these words on to my students
Move your mind and change your behavior.
I would like to share with you the words of my beloved boss.