We interviewed Darryl De Souza, physiotherapist and therapy lead within the early intervention team.
Listen to Darryl's story
Link: https://youtu.be/dNb6fFDD4CY
Q. Darryl, what’s your role in our hospitals?
I’ve been working at CUH for around 13 years and I’m now the clinical lead for therapy within the early intervention team. We’re a unique and diverse team of different professions, such as occupational therapists and physiotherapists, who work with patients to prevent problems, or to tackle them head-on when they do, before problems get worse. That might be through assessing their mobility and function, loaning equipment to help with everyday living, or signposting and referring to helpful services in the community.
The aim is to help our patients retain their independence and avoid admission to hospital when it’s not necessary.
I recently also setup a service based in the accident and emergency department (A&E), where we see lots of different issues, all set against the backdrop of the pressures of a fast-moving A&E.
Q. What does a usual day look like?
No two days are the same, and no other clinical area that I’ve worked in before prepares you fully for the challenge and sense of reward you get helping patients when they suddenly find themselves injured.
We get to see a wide range of injuries, from a young person involved in a road traffic collision, to a frail individual who has fallen and sustained a fracture. You work alongside a highly skilled team of doctors and nurses to provide joined-up care and fast decision-making.
We want to help our patients get to the right place for them, whether that’s back to their home or to the wards for further care from our inpatient teams. Within therapy, our focus is very much on getting patients home where possible and also empowering our patients to understand and manage their injury effectively.
They often need an additional level of support, which can come from a range of sources; from social care, outpatient clinics, voluntary services, local village initiatives, or friends and family. It’s about helping patients to make the most of what they can do, and supporting them through the complexity of healthcare systems, so they can successfully link into what they need.
Q. Tell us about a case that really stands out to you?
An interesting case was a patient I met in A&E following a flare up of functional neurological disorder (FND), a condition when there’s a problem with the functioning of the nervous system and how the brain and body sends or receives signals.
In this case it had resulted in the patient waking up to find she had left-sided weakness. FND is a debilitating and poorly understood condition, which can have a tremendous impact on how well a person can function. With no specific cause for their problem, patients can experience an array of symptoms from pain, headaches and weakness, to visual loss. It can be very frightening for patients and often has very negative consequences on their lives.
Physiotherapists and occupational therapists are highly skilled in managing FND. The nature of our work is that we can help to optimise function, teach adaptive strategies and empower patients to manage their condition.
We have strong communication skills in listening and establishing a rapport, and we also think about how biological, psychological, and social factors can work together to have an effect. We want to find the best way to talk to a patient so we can understand things in the past and present that might be perpetuating their symptoms. It all starts with an honest and empathetic conversation.
Taking the time to allow this particular patient to talk so I could understand what she really needed was key. I established that her problems could be managed through a pain clinic with input from a pain specialist physiotherapist. After finding and liaising with her local services, she was given an appointment.
We could then shift our focus to helping her regain her walking and function through normal moving and repetition.
The patient was discharged from one of our short-stay wards the day after her admission. She had regained her ability to walk and was beginning to do more for herself on the ward, and by the time she was discharged she also had a management plan that she was positive about.
I’m occasionally able to follow up patients by phone, so I phoned the patient over the next few days to see how she was doing, and make sure that our plans were progressing. She continued to do well and progress her walking and function – she felt empowered to manage her condition, which made all the difference.
Q. What do you enjoy most about your role?
Therapy in A&E is such a valuable and important service. We can work with patients really quickly to unpick problems and resolve them, so they can get home to friends and family as soon as possible. This gives our patients much better outcomes and also helps them to avoid staying in hospital when they don’t need to.
Non-urgent advice: From the patient’s perspective
The symptoms I experience can present in many different forms and are very much like other biological, neurological illnesses such as M.S, stroke and Parkinson’s. On this particular occasion it presented as a stroke. Waking to find that I had lost the full function of my left side, as you can imagine, was very frightening. I quickly realised that I was unable to move, walk or put any weight onto my left leg or use my left arm, I also had reduced sight in my left eye.
Coming into Addenbrooke’s, initially it was suspected that I may have had a stroke. Once this was investigated and it was found to be the FND that had flared and I was relapsing, I was relieved, but then worried due to what I know can be a lack of awareness around my condition. I was so glad to meet Darryl as he understood immediately and really put me at ease in a stressful situation.
My husband and I spoke with Darryl at length about my past history and the situation that had brought me into hospital. We also talked about the impact FND has had on my quality of life and the daily difficulties I face making adaptations so I can carry on as best as I can. This simple conversation was so helpful and the start of Darryl and his team of colleagues supporting me before I was discharged.
Darryl directed us to some relevant community sources, which he took the time to source for me, and found the pain clinic at Bury St Edmunds, where Darryl liaised with the physio team.
When we met Darryl, I didn’t have the use of my left side and was unable to walk or even stand. He spent a lot of time with me, encouraging my left leg to engage, and on the second day Darryl gave me the support and time to get my left leg moving enough, so when I was discharged I was at least able to take some steps with the aid of a walking stick.
Darryl helped me a lot, simply by being understanding and supportive. He also offered solutions that helped me to prepare for being discharged and also meant it was easier for my husband to aid me.
I really felt Darryl went the extra mile to make sure that I had resources in place to aid my recovery. He took extra time to talk to me and hear my experiences so far, asking what he could do to help me.
My condition continually throws obstacles in my path, meaning I have to make constant adjustments. I battle day to day and will continue to, as I have a positive mind-set and will not let it defeat me.
Darryl and his team completely understood my situation and that made a huge difference to me – I’m truly thankful.