THE FIRST DOOR

Barrett L. Dorko, P.T.

There is a three line poem by Nobel laureate Octavio Paz entitled "Boy and Top" that I often recite to my students;
		Each time he spins it,
		it lands precisely,
		at the center of the world.
I take a few moments at this point to ask them what the poet knows and how he knows it. Of course, no matter how gently I ask, many in the room will start to sweat. They are immediately transported to some english classroom in their past where poetry and it's interpretation was inpenatrable. They normally avoid it, and today, in a lesson supposedly about manual care, it has reared its ugly head just when they thought they were safe.

I really don't mean to upset them, but I feel that some really important points about my work can be stated very simply, with few words, and in a manner understood by both my patients and my colleagues. Poetry does this.

I tell them that, for me, the poet is making clear the attention and fascination the boy expresses toward his spinning top. The poet sees it in the boy's face.

I have written in the past of how successful management of many problems requires the therapist to navigate a series of doors largely controlled by the patient.* In manual care the second and third doors involve the skin and internal organs, but the first door is neither visible or palpable. It is opened, or may remain closed, as the end result of an interaction between the therapist and patient before any handling is done.

However the patient may arrive in our waiting room, there begins at that moment a watchful presence within them whose primary concern is easily put; "Am I welcomed here?"

Reception is not only the first thing noted, it is the longest and most prominently remembered part of their experience of care. The care itself actually pales in comparison when the patient is later questioned about their experience in your office. I'm often amazed when visiting other medical facilities at how this fact is ignored. Nothing seem more important to the receptionist than the paperwork before them, the ringing phone or their conversation with a co-worker. I often stand silently, waiting my turn, knowing I represent an interruption more than anything else. It's pathetic.

Although the therapist in many clinics may not control the attitude or behavior of the receptionist, they always have their own opportunity to deal with the patient's control of the first door, and by that I mean the entryway to their world. This precedes the effect of therapeutic handling. It's been my experience that unless the patient decides to let me through, it makes no difference how skillful my handling might be, it will have no effect.

Perhaps the key to this door can be found in Paz's description of the boy's admiration for the top. For as long as the top spins "the center of the world" exists where it lands, and for the boy nothing else could be more interesting. When it wobbles, he manipulates it again, and the repetitive play of the child makes sense when seen in this light.

Of course, it doesn't take much to openly admire a toy in this way. It will never reject you or leave in a fury if you can't get it to spin. The therapist must be more courageous than that.

Unless you take a moment to consider thoughtfully the gifts of healing and correction each patient brings with them, they won't feel welcomed and their first door will remain closed. I know that at times even my best efforts to do this are not enough, and that's just part of the deal for every clinician.

Ultimately, my willingness to make the patient the center for awhile is what makes the difference in my office. And I must remember to do this every time I begin care again.

*"The Second Door" and "The Third Door" by Barrett L. Dorko, P.T. Copies available from the author.