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Typical Day

Xena Ratched loves her job as a physical therapist, and she loves her hours: four days a week, 10 hours a day. It's hard work, but she's up and out late Thursday for a wonderful three-day weekend.

It's 6.45am, and the hum of her Prius calms her as she speeds off to a clinic where she is the chief PT, specializing in orthopedic manual therapy. She's the bone and muscle gal to her staff.

Minutes later, she's opening the clinic office, seeing to it that all rooms are spic-and-span clean and ready for patients.

"Morning, Xena!" That's Clinton Lee, her assistant. Clinton and his ear buds are one and same, and he cranks up the sound on his iPhone so loud that Xena can hear the tinny echoes of Coldplay.

"Mornin' Clinton." But he doesn't hear her—he's too busy humming—off-key—the tune of the hit "Yellow."

"Clinton!!!!" Xena wags a finger at him as he pulls the ear buds out of his ears.

"You'll go deaf if you keep up this nonsense. Fine example you're setting for our patients, you doin' dumb stuff like blasting out your eardrums."

Clinton's shame-faced and gives her a "yes-boss" mumble of contrition.

The rest of the staff wanders in one by one: Matt and Tadd Smith, the twins; they're bone and muscle folks, too. They're a great team.

Xena downs her fifth cup of coffee of the day (bad habit, she should cut down, she tells herself). Her 8am patient is hobbling toward her, grinning from ear to ear. Brad Crowley is a man with a cervical and mid-back problem, which keeps him in near-constant, low-grade pain. That's too bad for a guy who has everything—great job, perfect family, mega income. At least he can afford therapy out of pocket. For that alone Xena loves him—she doesn't have to wrestle with insurance companies on his account.

"Xena, my lovely. How is my queen of pain doing this morning?" He slowly lowers himself onto the PT table.

Xena gave him a warm smile. He's such a charming rake that she feels slightly guilty that many of the techniques make him twist and turn in pain.

Xena starts in with soft tissue work, loosening Brad's restricted muscles. She zaps the area with ultrasound to improve the give of connective tissue. At this stage, Brad is very quiet, livid with pain. But he's stoic and doesn't scream or curse at Xena, as many of her other patients do, regularly. She ends the ordeal after 30 minutes and lets him rest. Then, it's time to review his home exercises tailored to improve mobility of this neck and trunk area. As they discuss the plan, Brad keeps nodding and smiling. Xena knows his mannerisms well. He's been her patient for more than six months, and when he nods, that means he's not going to follow through with the exercise regimen. Progress is measured in baby steps. Xena keeps telling herself this. She ends the session with passive stretching of his pelvic muscles. The session ends, and Brad hobbles off.

The next three sessions go quickly. The 9am patient complains of pain, and Xena increases her meds. The 10 a.m. patient needs soft tissue work. The 11am is in so much pain that Xena can hardly touch her; not a good sign, time to contact a doctor.

Finally it's noon, and Xena goes to her tiny office, locking door behind her. It's break time—sort of. Xena stares down the mountains of insurance claim forms that clutter her desk. She knows they aren't going anywhere. Pulling out a sandwich and Diet Coke from her backpack, Xena sits down and, between bites of a salami-and-cheese-on-rye and swigs of chemical Coke, she reads form after form after form.

She loves 80 percent of her job, which involves working with patients and staff in happy harmony (usually). It's that final 20 percent that's threatening to push her over the edge, into battiness. To Xena, insurance companies exist to make rules just so they can change them and befuddle everyone who deals with them. Xena crumples one in-triplicate form. She's annoyed. Company X's rules—last month—said it was okay to reimburse patients for 10 visits; this month, it reduced the number to two. Company Y limits visits to two now; last year, it was 10.

The hour passes quickly—much too quickly, in Xena's humble opinion.

The next three hours a blur. Patients with aching necks, spinal malformations, raw nerves—and all in need of the soothing balm of physical therapy. Xena works hard, and it is hard work, but she wouldn't be doing anything else. She's helping people regain their health and mobility. She can put up with the ill tempers of patients who feel they're pushed beyond their limits of enduring pain as Xena prods and pummels their bodies.

It’s 4pm, her last hour, and Xena takes the time to pay the clinic's bills and start her patient progress notes for the doctors. As she enters the data on her laptop, she plans what she'll do for the rest of the evening. Go home, feed her dog, a big black lab, kick back with a cup of herb tea, and catch up on the current literature on PT innovations. Xena sighs. Many accuse her of not having a life outside of her job. "Not true," she thinks. Her life is her job, and there's a heck of a lot less pain in the world because of her.

So there!