A patient that I have been working with for several weeks started suddenly cancelling her appointments over and over. I knew that she was missing some appointments due to Thanksgiving, but she was cancelling more than what we had discussed. I spoke with our receptionist and she relayed that when the patient called to cancel she mentioned that she was overcome with grief as she had recently lost her son. She had never spoken to anyone about it.

As her next appointment approached, I wondered if she would show up and how I would bring up her son’s passing or if I even should. This pt is dealing with what seems like classic hip OA, but has mentioned several times how she feels that she should be healing faster. I’ve done my best to reassure her that this is a process and that while her symptoms may not completely go away, hopefully we can get to the point where they are minimal and not debilitating. Now, having learned this extra layer into her life, I began to wonder the impact it was having in terms of increased overall stress. Not only did this patient have to quit her job as a housekeeper because she was in too much pain, but she was dealing with immense grief of losing her son.

The patient did arrive for her next appointment and she filled me in on all that had happened since I had seen her last. I listened patiently, all the while thinking about her son and wondering if she would bring it up. She finished her update and I moved on to remeasuring her hip IR without any mention of her son. As I was finishing telling her that her ROM had decreased, she said, “I’ve been wondering.. and you would know about this more than I would but I know that stress can manifest in different parts of our body…” She went on to explain that she had lost her son this year and that she has been very stressed with the holiday season coming up. She explained that thanksgiving held so many reminders of him as she cooked his favorite foods and she was anticipating it being just as hard with the rest of the holidays coming up.

I was relieved that the patient brought this up on her own and that I could reassure her that absolutely stress plays a role in symptoms and pain. I told her that she should not be discouraged if she feels that she is hurting more or feeling worse during this next month or so. We also talked about strategies; I indicated that if she notices her pain increasing this holiday season that she should try to acknowledge it, remember that we have a plan and are actively working to make her better, and then she should try to let it go and not perseverate on the increased pain. I was nervous to approach this with the patient and thought about it throughout the session before bringing it up. I did not want her to think that I was telling her just to ignore her symptoms, but I didn’t want her to be so focused on her pain when she is already dealing with so much else. I reiterated that this was “easier said than done” and that it might be helpful to try and have “different buckets” that when she is feeling overwhelmed with feelings she can put her “hip pain bucket” away and focus on other emotions.

I’m hopeful that this resonated with the patient, but it will definitely be interesting to see how she progresses. I’d love to hear if others have has experiences like this or what their thoughts are.