Barrett L. Dorko, P.T.

          Ian has a Scottish brogue that immediately catches my ear and after awhile I ask him how long he's been in this country.

          "Twenty years," he says.

          It's the shortest possible answer he can give me without being openly rude, and nothing more is offered. His face is perfectly straight and the silence in the treatment room deepens as he holds himself perfectly still and at attention, though he is supine.

          A carpenter who suffered a fall, Ian hasn't worked for a couple of months. His shattered calcaneus was internally fixated and has healed well, but his gait is awful and he can't squat in the way he knows he must if he is ever to work again. He had to suggest to the surgeon that he get some therapy, and he tells me that this referral was an afterthought. "He never watched me walk," is all Ian says about this.

          In the book "The Wonderful Wizard of Oz", the Tin Man starts out as an ordinary woodcutter. One day he professes his love for a Munchkin maiden. Jealous of this girl's services, an old woman gets the Wicked Witch of the East to enchant his ax.

          The next time he goes to work, he cuts off his own leg. It is replaced with a tin replica, shiny and incapable of pain. In succession he cuts off his remaining limbs and head, each replaced with tin, and he continues to work.

          When he finally splits his own torso in two, the replacement part does not include a heart, and he says, "This was when I lost all my love for the Munchkin girl."

          During the course of his care, Ian carefully and slowly confides that he has had severe pain in his back for years. He says he wakens with numbness in his arm every morning, and that he hasn't mentioned this to the doctor.

          We finally talk of the underlying mechanisms that might account for this pain, and what can be done to enhance his movement and comfort when at rest. Like the Tin Man in the book, his movement returns. I act like Dorothy applying the oil and listening carefully to his story, spoken with hesitance and shortened even moreso with the clipped Scottish brogue.

          Ian has been repetitively hurt at work, patched up a bit and then sent right back to it. This final injury has enforced an immobility that has affected even his speech, and, he says, "My wife is ready to kill me, I've been at home so much."

          Seen any tin men recently? I know that there are plenty of tin women around as well.

          Although it might be assumed that all they need is to be oiled, it's obvious that movement is only one of their problems. I think you probably remember what the original tin man felt that he needed more than anything else.

          In the movie version of the story, the Wizard of Oz tells the Tin Man that he doesn't need a heart, but rather he needs something indicating that he is loved by others; a testimonial. Once it's hung on his chest, the Tin Man rejoices, and truly smiles for the first time.

          Maybe we should consider the power that caring might have on the tin men who come to us. Perhaps if the physician understood what the patient needed beyond surgery and time to heal, they wouldn't wait so long to offer therapy. I know that having to ask for care was very difficult for Ian, and he's got problems enough.

          As our time together passes, I watch my newest tin man soften, I hear more of that beautiful accent, and I finally see him truly smile.