It doesn't feel real. In 5 minutes I'm packing up my desk and heading out the door. Beyond that door lies my future as an OT candidate (that's what they call us once we finish fieldwork, but before we take & pass the license exam). I leave behind my status as an OT student. Not that the learning stops here. The more I learn the more I realize how much there is to learn.
As with any huge transition comes the strange feelings, intense self analyzation. And I'm sure that's all coming, but right now I'm in the numb overwhelmed stage. Doesn't feel real. Maybe I'll be feeling it a bit more after a few cocktails- which is coming. Dinner, drinks, and karaoke tonight- to celebrate this monumental occasion! Party!
Well, here it is one last time...
Amanda LeBlanc Hamm, OTS
Friday, December 14, 2007
Thursday, November 29, 2007
2 Weeks Left!
How did it get to be the end of November with only two weeks remaining of this fieldwork? The old cliche definitely applies, "Time flies while you're having fun." I really have had a good time working in pediatrics. The children make me laugh and smile everyday, as well as the staff. No one takes themselves too seriously and why would we- we get to play all day!?! But of course you can't have all play and no work. We spend time writing daily notes, evaluations, and goals. This past week I spent hours researching spatial awareness for a presentation. Did you know that spatial reasoning occurs in the right superior temporal area of the brain? Well, you know.
Wednesday, November 7, 2007
treating the whole person... body and mind
Chris is an 8 year old boy, diagnosed with bipolar disorder at age 4. He's been medicated since the day of his diagnosis. Serious psychiatric meds on a developing brain, I'm no doctor... but this sounds a little dangerous. I'm not the only one with doubts; there's quite a bit of controversy surrounding the use of this label and treatment with preadolescent children. Experts now agree that bipolar can occur in children, but disagree about the defining symptoms and at what age they can appear.
The danger became evident last December as a young girl from Hull, MA died from an apparent overdose of Clonidine, a blood pressure med used to sedate hyperactive children. She was also taking Seroquel, an anti-psychotic, and Depakote, an anti-seizure med that helps regulate mood. Chris has been on all the same medications, but over the last year his parents have been exploring other options. Homeopathy has been successful in reducing the dosages required to control Chris's symptoms; they're progressively moving him off his meds.
Hypnotherapy has proved helpful in the past. Since the time he could make his needs known, Chris would only wear camouflage. When he was five someone recommended that he see a hypnotherapist. His mom laughed at the idea, but was willing to try anything... and it worked. During the session he began talking about his past life, being a solider in a war and dying in the battle. His mother couldn't believe it, but when it was done he no longer needed to wear camouflage.
So maybe there's more to treating people than diagnosing and medicating them. Modern medicine has brought many advances, but it's certainly not the end all be all. And with 36% of the US adult population using some form of complementary and alternative medicine (CAM), again, I'm not the only one who thinks this way.
About an hour ago I experienced a form of CAM for myself. CranioSacral Therapy (CST)is a gentle, hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system - comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. Using her hands, an OT here at my FW, released the "energy cyst" in my abdomen. I felt a deep pulsing there and then waves of heat rushing from my core down my legs. Weird, yes. Do I love it, yes. That's why in December I'll be attending a 4 day workshop on CranioSacral Therapy. More on all this then!
The danger became evident last December as a young girl from Hull, MA died from an apparent overdose of Clonidine, a blood pressure med used to sedate hyperactive children. She was also taking Seroquel, an anti-psychotic, and Depakote, an anti-seizure med that helps regulate mood. Chris has been on all the same medications, but over the last year his parents have been exploring other options. Homeopathy has been successful in reducing the dosages required to control Chris's symptoms; they're progressively moving him off his meds.
Hypnotherapy has proved helpful in the past. Since the time he could make his needs known, Chris would only wear camouflage. When he was five someone recommended that he see a hypnotherapist. His mom laughed at the idea, but was willing to try anything... and it worked. During the session he began talking about his past life, being a solider in a war and dying in the battle. His mother couldn't believe it, but when it was done he no longer needed to wear camouflage.
So maybe there's more to treating people than diagnosing and medicating them. Modern medicine has brought many advances, but it's certainly not the end all be all. And with 36% of the US adult population using some form of complementary and alternative medicine (CAM), again, I'm not the only one who thinks this way.
About an hour ago I experienced a form of CAM for myself. CranioSacral Therapy (CST)is a gentle, hands-on method of evaluating and enhancing the functioning of a physiological body system called the craniosacral system - comprised of the membranes and cerebrospinal fluid that surround and protect the brain and spinal cord. Using her hands, an OT here at my FW, released the "energy cyst" in my abdomen. I felt a deep pulsing there and then waves of heat rushing from my core down my legs. Weird, yes. Do I love it, yes. That's why in December I'll be attending a 4 day workshop on CranioSacral Therapy. More on all this then!
Thursday, October 25, 2007
here i am, but where am i going
Okay, I admit it’s been a while. And there’s a couple reasons..
1. The Red Sox made it to the World Series. And I’ve made it through some late nights watching them.
2. I’m still processing Sensory Integration Therapy. It’s kinda like doing brain surgery without ever cracking the skull. Pretty tricky stuff.
3. I’m deciding my fate as a future OT.
First point, the Red Sox are pretty unbelievable. Talk about a well integrated sensory system. Beckett’s perfected the pitching motor plan well enough to strike out the 1st 5 batters last night. He’s able to tune out the crowd, anticipate the batter’s swing style, and throw a killer fastball. Wonder if he had SI therapy as a child.
Secondly, forgive my ignorance, inexperience, or call it what you may, but I’m still grasping for a full concept of sensory integration therapy. I understand the theory, I think. But it’s so hard for me to see & understand the results of practice. I’d feel much better if there was a study out there that illustrated before treatment/ after tx pictures of the brain/spinal cord. SI treatment looks like play, in fact it should look like play. The more fun it is, the more effective it is. Jean Ayres, the queen of SI, stated herself… “The most effective therapy is often the least convincing to those not intimately involved in the child’s welfare.” A bit bold for my taste, but any other way of saying it might be a watered down truth.
And lastly, my career fate. Nearly halfway through my second fieldwork, it’s time to think about where I’ll be applying for my 1st job as an OTR/L. With two excellent, but very different fieldwork experiences exposing me to two very different pratice areas- long term acute care for adults & a private pediatric clinic… where will I end up? I wanted to avoid making this decision until later, but with an interview this Friday, seems I’ll have to make this decision sooner!
1. The Red Sox made it to the World Series. And I’ve made it through some late nights watching them.
2. I’m still processing Sensory Integration Therapy. It’s kinda like doing brain surgery without ever cracking the skull. Pretty tricky stuff.
3. I’m deciding my fate as a future OT.
First point, the Red Sox are pretty unbelievable. Talk about a well integrated sensory system. Beckett’s perfected the pitching motor plan well enough to strike out the 1st 5 batters last night. He’s able to tune out the crowd, anticipate the batter’s swing style, and throw a killer fastball. Wonder if he had SI therapy as a child.
Secondly, forgive my ignorance, inexperience, or call it what you may, but I’m still grasping for a full concept of sensory integration therapy. I understand the theory, I think. But it’s so hard for me to see & understand the results of practice. I’d feel much better if there was a study out there that illustrated before treatment/ after tx pictures of the brain/spinal cord. SI treatment looks like play, in fact it should look like play. The more fun it is, the more effective it is. Jean Ayres, the queen of SI, stated herself… “The most effective therapy is often the least convincing to those not intimately involved in the child’s welfare.” A bit bold for my taste, but any other way of saying it might be a watered down truth.
And lastly, my career fate. Nearly halfway through my second fieldwork, it’s time to think about where I’ll be applying for my 1st job as an OTR/L. With two excellent, but very different fieldwork experiences exposing me to two very different pratice areas- long term acute care for adults & a private pediatric clinic… where will I end up? I wanted to avoid making this decision until later, but with an interview this Friday, seems I’ll have to make this decision sooner!
Friday, October 5, 2007
Sensory 202: Let's Integrate!
Okay so we have 10 senses, so what? The so what is that our nervous systems have to constantly process this information- selecting, ignoring, and choosing an response. While it's something most of us do effectively, some people's nervous systems have differences that make even simple activities of daily life difficult, even impossible. As the nervous system develops it becomes more and more efficient. Children with developmental delays often have an immature nervous system. This makes their world look, feel, and sound a lot different. The resulting behaviors are often curious and misunderstood, but analysis through the lens of sensory integration theory may begin to unfold the mystery.
The magic of therapy based on sensory integration theory is providing the child with the type, amount, and intensity of sensory input so that their nervous systems begin to process and integrate this information more effectively, making learning possible.
One of my struggles with this theory is the social judgement which determines the appropriateness of certain behaviors in children today. Perhaps with today's standards, my mother would have determined me a candidate for this therapy. I couldn't stand any labels on my clothes, drank out of a bottle till I was five, and could only sleep after my dad tucked in my sheets so tight and put all my stuffed animals around me. Strange behaviors, sure. Sensory Processing Dysfunction, not quite because it didn't interupt my learning or everyday function. Or did it? What would I be doing different today if I had receiving treatment? What's normal anymore? And who's to judge?
The magic of therapy based on sensory integration theory is providing the child with the type, amount, and intensity of sensory input so that their nervous systems begin to process and integrate this information more effectively, making learning possible.
One of my struggles with this theory is the social judgement which determines the appropriateness of certain behaviors in children today. Perhaps with today's standards, my mother would have determined me a candidate for this therapy. I couldn't stand any labels on my clothes, drank out of a bottle till I was five, and could only sleep after my dad tucked in my sheets so tight and put all my stuffed animals around me. Strange behaviors, sure. Sensory Processing Dysfunction, not quite because it didn't interupt my learning or everyday function. Or did it? What would I be doing different today if I had receiving treatment? What's normal anymore? And who's to judge?
Wednesday, October 3, 2007
Sensory 101: The Hidden Senses (for non-OT folk)
Pop Quiz... How many senses do humans have? 5 right, wrong. You probably grew up hearing a lot about vision, hearing, taste, touch, and smell. But there are actually 5 more senses...6) Pain, 7) Temperature, 8) Visceral, 9) Proprioception, 10) Vestibular. I wonder if you've ever even heard of the last two (don't think I did before OT school.) But these two hidden senses are essential to our bodies functioning, movement, and learning.
Proprioception tells us where our bodies are in space, based on information detected in the muscles & joints. (Try to touch your finger to your nose with your eyes closed. Is your proprioceptive sense working?)
Your vestibular system provides the dominant input about our movement and orientation in space, based on receptors located in the inner ear. It is responsible for our ability to balance, to climb stairs, to walk easily, to adjust to changing levels, to react promptly, (recover our balance) when we step in a hole.
So be grateful, thank your hidden senses today! Tomorrow's lesson (Sensory 202) will focus on the integration of all these senses.
Proprioception tells us where our bodies are in space, based on information detected in the muscles & joints. (Try to touch your finger to your nose with your eyes closed. Is your proprioceptive sense working?)
Your vestibular system provides the dominant input about our movement and orientation in space, based on receptors located in the inner ear. It is responsible for our ability to balance, to climb stairs, to walk easily, to adjust to changing levels, to react promptly, (recover our balance) when we step in a hole.
So be grateful, thank your hidden senses today! Tomorrow's lesson (Sensory 202) will focus on the integration of all these senses.
Wednesday, September 26, 2007
Sensational Start at SI Clinic
Imagine spending your work day barefoot- jumping into a ball pit, swinging on a trapeze, climbing up a mountain of mats and then crashing into a giant stash of pillows. Yes, life is much different in the world of sensory integration (SI). Goodbye wiping butts, hello blowing bubbles. Instead running around a hospital to see 8-10 patients a day, I indulge in hour long sessions with 5-8 children per day. No foul smells, no obnoxious doctors, no 12 hour work days! I actually have time to read and observe. I can write this entry at work! Hallelujah! I love pediatrics!
However… I am once again learning a new vocabulary. Ideational praxia, gravitational insecurity, and vestibular discrimination are not terms that just roll off the tip of the tongue. And sure we went over these definitions in school, but actually observing a child and being able to identify them as such is a whole nother bag. But nonetheless I am excited to jump around, roll over, and crash into this bag!
However… I am once again learning a new vocabulary. Ideational praxia, gravitational insecurity, and vestibular discrimination are not terms that just roll off the tip of the tongue. And sure we went over these definitions in school, but actually observing a child and being able to identify them as such is a whole nother bag. But nonetheless I am excited to jump around, roll over, and crash into this bag!
Wednesday, September 5, 2007
After-thoughts
It's been a little over a week since fieldwork ended and while I thought I closed the door on this blog, I realized I still have a bit to share...
Goodbye Mr. Dilverman. On my last day, in an afternoon flurry of securing all my documentation and gaining some sense of closure, I missed saying goodbye to Mr. Dilverman. We had spent the last month together recovering from his quadruple coronary artery bypass surgery. He went from being completely dependent with most all his self care tasks to a near full return of his morning routine including washing up, getting dressed, and going to work. At 82, he still works as a certified public accountant. His last day at the hospital was my last day. And yet, I was so caught up that I missed saying goodbye.
It's hard letting go of patients. You build such a bond by performing such intimate, basic activities of life with them. It's unlike any other relationship. It's hard to gain a sense of closure when they leave unexpectedly due to some medical complication or even when it is expected, but you know you'll never see them again. What happened to all the people I met over the last three months? Where are they now? Who's helping them with their needs, if anyone? Again I'm feeling the bitterness of a disconnected health care system.
Thankfully, I've been working out my bitterness and post-fieldwork anxiety through a beautiful and healing book of stories by Rachel Naomi Remen, titled Kitchen Table Wisdom. Each two-three page story has been a solid dose for the soul. If I was a pharmacist for the soul, I'd prescribe it to everyone!
Goodbye Mr. Dilverman. On my last day, in an afternoon flurry of securing all my documentation and gaining some sense of closure, I missed saying goodbye to Mr. Dilverman. We had spent the last month together recovering from his quadruple coronary artery bypass surgery. He went from being completely dependent with most all his self care tasks to a near full return of his morning routine including washing up, getting dressed, and going to work. At 82, he still works as a certified public accountant. His last day at the hospital was my last day. And yet, I was so caught up that I missed saying goodbye.
It's hard letting go of patients. You build such a bond by performing such intimate, basic activities of life with them. It's unlike any other relationship. It's hard to gain a sense of closure when they leave unexpectedly due to some medical complication or even when it is expected, but you know you'll never see them again. What happened to all the people I met over the last three months? Where are they now? Who's helping them with their needs, if anyone? Again I'm feeling the bitterness of a disconnected health care system.
Thankfully, I've been working out my bitterness and post-fieldwork anxiety through a beautiful and healing book of stories by Rachel Naomi Remen, titled Kitchen Table Wisdom. Each two-three page story has been a solid dose for the soul. If I was a pharmacist for the soul, I'd prescribe it to everyone!
Thursday, August 23, 2007
Eve of the Last Day
Tis the eve of my last day of fieldwork. Can't believe how fast these past twelve weeks have flown by. Wish I had something real inspiring to say, but right now my brain is pretty shot. Ready for some time off. One month till I begin my second level II fieldwork at a private pediatric clinic.
I suppose if I was to something of worth right now, I'd talk about how much I've learned from everyone- from my supervisor and everyone in the dept to each patient. I'd probably mention how fulfilling it has been to have been such involved with so many strangers so intimately. Hmm, that sounds a little off. See my brain has "fallen out." Think what I'm trying to say is that there is something very powerful and moving in assisting people with their daily activities. Washing someone's feet, shaving a man's face, helping a woman don a bra... I will miss these unique moments of human connectedness. These moments are now "tattooed on the surface of my heart."
It's been real. See you in four weeks!
I suppose if I was to something of worth right now, I'd talk about how much I've learned from everyone- from my supervisor and everyone in the dept to each patient. I'd probably mention how fulfilling it has been to have been such involved with so many strangers so intimately. Hmm, that sounds a little off. See my brain has "fallen out." Think what I'm trying to say is that there is something very powerful and moving in assisting people with their daily activities. Washing someone's feet, shaving a man's face, helping a woman don a bra... I will miss these unique moments of human connectedness. These moments are now "tattooed on the surface of my heart."
It's been real. See you in four weeks!
Thursday, August 16, 2007
Flexing the Emotional Muscle
I've really toned up in the last few weeks and I'm not talking about my abs. (On the contrary, I've eaten my fair shair of treats during this fieldwork.) I'm actually refering to the intense emotional workout that I participate in routinely. Every day my ability to handle emotional stresses increases and although you cannot see this type of tone physically, I can certainly feel it. Midge brought this analogy to me the other day and it has helped to understand and accept the new "strength" that I've developed. Just as an athlete pushes their bodies to handle more and more physical stress- gaining strength and endurance, I have done so emotionally. I can handle more situations without breaking down emotionally, thus being able to provide more for my client. However, there is a danger, a risk of over-doing it. Becoming too tough, so that I cannot engage emotionally. I need to be strong enough to protect myself, but flexible enough to feel, empathize, and connect.
Today my strength was tested. One of my patients, with whom I really bonded, was sent out to a skilled nursing facility (SNF aka nursing home) to continue therapy and receiving medical care until he is ready to go home. But the idea of this didn't thrill him and the look in his eyes could have killed me. Not sure what it was, as we both knew it made sense, but the idea of not being able to return home was just devestating to the both of us. I shook his hand, gave him a hug, and ran out the room before he could see the tears in my eyes. Maybe it was the thought that if had a better team of doctors and therapists he could have done better. Maybe it was the thought that he should stay here until he can go home regardless of what his health insurance policy says. Maybe it was the thought that his daughter who has taken care of him for many years at home just can't do it anymore. Maybe it was the thought that he's a veteran, but not enough of one to receive benefits from the VA. Or maybe it was just that I saw a man who was facing the beginning of the end. Anyway you cut it, it hurts and like after a good workout, I'm a little sore.
PS- My bond with this patient really formed during the initial eval when I asked... "So are you right or left handed?" Considering that his right hand was missing (amputated from the elbow down due to an electrocution injury 35years ago), he's pretty much left-handed. We laughed.
Today my strength was tested. One of my patients, with whom I really bonded, was sent out to a skilled nursing facility (SNF aka nursing home) to continue therapy and receiving medical care until he is ready to go home. But the idea of this didn't thrill him and the look in his eyes could have killed me. Not sure what it was, as we both knew it made sense, but the idea of not being able to return home was just devestating to the both of us. I shook his hand, gave him a hug, and ran out the room before he could see the tears in my eyes. Maybe it was the thought that if had a better team of doctors and therapists he could have done better. Maybe it was the thought that he should stay here until he can go home regardless of what his health insurance policy says. Maybe it was the thought that his daughter who has taken care of him for many years at home just can't do it anymore. Maybe it was the thought that he's a veteran, but not enough of one to receive benefits from the VA. Or maybe it was just that I saw a man who was facing the beginning of the end. Anyway you cut it, it hurts and like after a good workout, I'm a little sore.
PS- My bond with this patient really formed during the initial eval when I asked... "So are you right or left handed?" Considering that his right hand was missing (amputated from the elbow down due to an electrocution injury 35years ago), he's pretty much left-handed. We laughed.
Tuesday, July 31, 2007
The Business of Making Simple Dreams Come True
"I used to dream of having a big house or fancy cars, now I just dream of having a shower!" Luckily for Mr. M, I was able to make his dream come true yesterday. A shower seems like such a simple act of everyday life, but it's not until you can't do it when you realize it's often that which matters most.
Update on my caseload... I'm currently on Week 9 out 12 and seeing 7 patients per day. Today 3 of my afternoon sessions were cancelled. Mr. G went out for an MRI in hopes that it will bring some answers to the intolerable pain radiating from the left side of his neck to his eye. Mrs. E was complaining of nausea when I walked into her room. Two minutes later I watched her lunch and 4 pills come back up and into a bucket I was holding. Mr. M once attempted to reschedule our session once again, complaining of fatigue after working out with physical therapy. I agreed to let him rest until the AM, but we had an intense discussion regarding the medical profession. Having had his 1st heart attack in 1984, he has had many years experience as a patient and feels "that he has been battling the health care system." His fight appears to be focused on all the external factors and what they have or haven't done for him. The doctors, the meds, the insurance companies. He feels misguided, mistreated, and even "bamboozled" by them.
On one hand, I agree with him. The health care business is just that, a business. A business that is overwhelmed and filled with bureaucracy and politics. And sometimes amongst this business individual patient care is compromised.
But on the other hand, who's body is it? Who's ultimately responsible for the care of oneself? You buddy! So instead of spending twenty minutes complaining about how the system is taking care of you- take care of yourself! Do your washing up and getting dressed with your OT! The ultimate problem is that many people don't realize that they have control over their health. Each moment you the choice of how to spend that moment. Many people just live their lives until a problem arises, then they see a doctor and look for the magic pill that will make them better. People would do better looking for the Transformers "AllSpark" or the fountain of youth!
Well that's enough ranting and raving for one night!
Update on my caseload... I'm currently on Week 9 out 12 and seeing 7 patients per day. Today 3 of my afternoon sessions were cancelled. Mr. G went out for an MRI in hopes that it will bring some answers to the intolerable pain radiating from the left side of his neck to his eye. Mrs. E was complaining of nausea when I walked into her room. Two minutes later I watched her lunch and 4 pills come back up and into a bucket I was holding. Mr. M once attempted to reschedule our session once again, complaining of fatigue after working out with physical therapy. I agreed to let him rest until the AM, but we had an intense discussion regarding the medical profession. Having had his 1st heart attack in 1984, he has had many years experience as a patient and feels "that he has been battling the health care system." His fight appears to be focused on all the external factors and what they have or haven't done for him. The doctors, the meds, the insurance companies. He feels misguided, mistreated, and even "bamboozled" by them.
On one hand, I agree with him. The health care business is just that, a business. A business that is overwhelmed and filled with bureaucracy and politics. And sometimes amongst this business individual patient care is compromised.
But on the other hand, who's body is it? Who's ultimately responsible for the care of oneself? You buddy! So instead of spending twenty minutes complaining about how the system is taking care of you- take care of yourself! Do your washing up and getting dressed with your OT! The ultimate problem is that many people don't realize that they have control over their health. Each moment you the choice of how to spend that moment. Many people just live their lives until a problem arises, then they see a doctor and look for the magic pill that will make them better. People would do better looking for the Transformers "AllSpark" or the fountain of youth!
Well that's enough ranting and raving for one night!
Wednesday, July 25, 2007
drowning in paperwork
I'm writing this with the hopes that in 5 years or less I'll be fondly reminiscing about my struggles through fieldwork and thinking how they made me "the OT I am today". Of course I at least tell myself that to get through the 11-12 hour days that leave me with half a brain left in my head. But ha- do not be fooled, this is not the woe is me entry- but a mere reflective piece on my time management skills, or lack there of.
Since OT is driven by science, I'll be taking the evidence based route. I have had a history of long days at school or doing homework, periods of endless work days, and neverending journeys to Barnes and Noble or the mall. I have never consistently worn a watch prior to fieldwork. Similar to my father, I often lose track of time when grossly immersed in something. I often be told, "I wear myself too thin. You can't burn the candle at both ends." It almost feels like I have to hurry up to slow down.
The evidence obviously reveals that I do have a weakness in the area of time management. But continuing the scientific theme, what could be the underlying cause to this impairment. Is it as simple as the learning curve? Is it developmental? Is it an inherited personality trait? Is it an inner drive to be the best damn OT I can be? Is it not enough coffee at the end of the day? Is it a combination of all of these?
Whatever it is I know it's definitely something for me to work on. My goal for tomorrow is to write up each note after each session!
(For those of you unfamiliar with work as an OT in a long term acute care hospital. Let me give you a quick schedule rundown... You see 7-10 patients per day for about 30-60 minutes each and after each treatment you are required to carefully document the session. In between seeing patients and writing daily notes- there comes team notes, initial evals, weekly evals, monthly evals, discharge evals, department meetings, inservices, and discussions with families, doctors, and other therapists. Phew! How to make it all happen in even 12 hours?!?)
Since OT is driven by science, I'll be taking the evidence based route. I have had a history of long days at school or doing homework, periods of endless work days, and neverending journeys to Barnes and Noble or the mall. I have never consistently worn a watch prior to fieldwork. Similar to my father, I often lose track of time when grossly immersed in something. I often be told, "I wear myself too thin. You can't burn the candle at both ends." It almost feels like I have to hurry up to slow down.
The evidence obviously reveals that I do have a weakness in the area of time management. But continuing the scientific theme, what could be the underlying cause to this impairment. Is it as simple as the learning curve? Is it developmental? Is it an inherited personality trait? Is it an inner drive to be the best damn OT I can be? Is it not enough coffee at the end of the day? Is it a combination of all of these?
Whatever it is I know it's definitely something for me to work on. My goal for tomorrow is to write up each note after each session!
(For those of you unfamiliar with work as an OT in a long term acute care hospital. Let me give you a quick schedule rundown... You see 7-10 patients per day for about 30-60 minutes each and after each treatment you are required to carefully document the session. In between seeing patients and writing daily notes- there comes team notes, initial evals, weekly evals, monthly evals, discharge evals, department meetings, inservices, and discussions with families, doctors, and other therapists. Phew! How to make it all happen in even 12 hours?!?)
Tuesday, July 17, 2007
all in a day's work
Just got home from grocery shopping. Signed my receipt, Amanda Hamm OTS. Just couldn't stop myself after signing notes all day long. Growing up I always wished to be famous and pictured myself signing autographs. Guess part of that dream came true.
Aside from writing and signing notes all day, it's funny to think about the day to day nuances of being an occupational therapist. For instance, all within the past week I have done or observed the following:
-given an 83 year old woman a mohawk
-patiently watched the same woman take 5 minutes to clasp her bra
-pantomimed wiping oneself
-been slightly responsible for flooding hallway
-taken patients to the beach and down a country road (all by visualization)
-held a bucket under a commode while someone "relieved themselves" into it
All in a day's (field) work I suppose. Ah, the joys of everyday living! Imagine how amazing it must feel to shower or step outside for the 1st time since being hospitalized. I feel so lucky and priveleged to be a part of these people's daily triumphs! (Even if it is holding the bucket under the commode as they go on it for the 1st time since their stroke!)
Aside from writing and signing notes all day, it's funny to think about the day to day nuances of being an occupational therapist. For instance, all within the past week I have done or observed the following:
-given an 83 year old woman a mohawk
-patiently watched the same woman take 5 minutes to clasp her bra
-pantomimed wiping oneself
-been slightly responsible for flooding hallway
-taken patients to the beach and down a country road (all by visualization)
-held a bucket under a commode while someone "relieved themselves" into it
All in a day's (field) work I suppose. Ah, the joys of everyday living! Imagine how amazing it must feel to shower or step outside for the 1st time since being hospitalized. I feel so lucky and priveleged to be a part of these people's daily triumphs! (Even if it is holding the bucket under the commode as they go on it for the 1st time since their stroke!)
Wednesday, July 11, 2007
this is like this, because that is like that
Got a lot on my mind during this week, Week 6, midterm week. I'm having a tough time pulling all my thoughts together, especially with Katie and Mr. Lambert watching Apocolypto in the background. (Looks like a good movie).
Maybe here's why I have a lot on my mind: Within the past 24 hours I've done 3 evaluations- one woman with severe bilateral lower leg cellulitis (she's left with 3 options at this point... continue to rot in excruciating pain, amputation, or maggots which eat away the dead skin and possibly allow her wounds to heal enabling her to walk again... hmm, which would you choose?). The second eval was a younger woman with severe, multiple, painful bloodclots in her calves. And the last was an older gentleman with diabetes who's left big toe was amputated after it was discovered that the bone was massively infected. Each patient has an interesting social history and possible psychiatric components to their diagnosis. Which I suppose shouldn't be shocking considering the mind is connected to the body. But the trouble is hospital care focuses on the body and the problem with the body, it's standard medical model. And even when focusing on the body, the medical model tends to divide up the body- treating the wound site, the fracture, the kidney. But then again, I suppose you have to start somewhere, make care manageable, progress measurable, and time billable. That's all well and good for the clinician, but does it really heal the patient?
I realize I'm coming down a bit harsh on a system that I've only been a working part of for 6 weeks now, but as I've mentioned earlier, I've spent many years on the other side of the fence. Growing up watching my family circulate through the health care system has deeply influenced my perspective. I've also spent a fair amount of time looking into the mind-body connection in health and am particularly interested in psychoneuroimmunology. Even the father of medicine knew it himself, "For this is the great error of our day that the physicians separate the soul from the body."
The holistic perspective drew me to the field of occupational therapy. The theories behind the practice are surely based on this, but it appears this all becomes a bit diluded in practice. And I understand why. To quote the great buddisht monk, Thich Nhat Hanh, "This is like this because that is like that." Everything is connected. Mind-Body. OT-Medical System. Question is: How to create healing within them all? Maybe my supervisor will have some answers.
Tomorrow I'll just start with teaching Mrs. E how to cope with her pain.
Maybe here's why I have a lot on my mind: Within the past 24 hours I've done 3 evaluations- one woman with severe bilateral lower leg cellulitis (she's left with 3 options at this point... continue to rot in excruciating pain, amputation, or maggots which eat away the dead skin and possibly allow her wounds to heal enabling her to walk again... hmm, which would you choose?). The second eval was a younger woman with severe, multiple, painful bloodclots in her calves. And the last was an older gentleman with diabetes who's left big toe was amputated after it was discovered that the bone was massively infected. Each patient has an interesting social history and possible psychiatric components to their diagnosis. Which I suppose shouldn't be shocking considering the mind is connected to the body. But the trouble is hospital care focuses on the body and the problem with the body, it's standard medical model. And even when focusing on the body, the medical model tends to divide up the body- treating the wound site, the fracture, the kidney. But then again, I suppose you have to start somewhere, make care manageable, progress measurable, and time billable. That's all well and good for the clinician, but does it really heal the patient?
I realize I'm coming down a bit harsh on a system that I've only been a working part of for 6 weeks now, but as I've mentioned earlier, I've spent many years on the other side of the fence. Growing up watching my family circulate through the health care system has deeply influenced my perspective. I've also spent a fair amount of time looking into the mind-body connection in health and am particularly interested in psychoneuroimmunology. Even the father of medicine knew it himself, "For this is the great error of our day that the physicians separate the soul from the body."
The holistic perspective drew me to the field of occupational therapy. The theories behind the practice are surely based on this, but it appears this all becomes a bit diluded in practice. And I understand why. To quote the great buddisht monk, Thich Nhat Hanh, "This is like this because that is like that." Everything is connected. Mind-Body. OT-Medical System. Question is: How to create healing within them all? Maybe my supervisor will have some answers.
Tomorrow I'll just start with teaching Mrs. E how to cope with her pain.
Thursday, July 5, 2007
return to innocence, return to life
"If you want then start to laugh. If you must then start to cry. Be yourself. Don't hide. Just believe in destiny." -Enigma, The Return to Innocence
I would have never believed it was possible- to see her pick up that quote and read it aloud. For weeks these quotes have been sitting in a basket at the nurse's station. And for weeks Mrs. F has been lying in bed, showing little signs of progress since her massive stroke which initially paralyzed and made her completely unaware of her left side. Every day we've been working on facilitating attention to and movement on that left side. Gains seemed minimal, halted by her disoriented, disinhibited, and fluctuating cognitive state. The first time I saw her move her left hand I felt as if I was witnessing a miracle. ("You wiggled your finger, that's wonderful."- Princess Bride Reference, anybody). Anyway, blood rushed through me and I was hooked, determined to bear witness to more miracles by this cackling toothless 83 year old woman.
Today many of my therapeutic dreams for Mrs. F came true. She remembered my name. She remembered her birthday. She told me her favorite TV shows- Texas Walker Ranger and Law and Order. She was able to stabilize a piece of paper and write with her right hand. She put a top on a marker using both hands. She picked out that quote from the basket and read it aloud! That was of course followed by, "I don't understand it." Well I don't either Mrs. F, but let's just keep trying and return to life.
I would have never believed it was possible- to see her pick up that quote and read it aloud. For weeks these quotes have been sitting in a basket at the nurse's station. And for weeks Mrs. F has been lying in bed, showing little signs of progress since her massive stroke which initially paralyzed and made her completely unaware of her left side. Every day we've been working on facilitating attention to and movement on that left side. Gains seemed minimal, halted by her disoriented, disinhibited, and fluctuating cognitive state. The first time I saw her move her left hand I felt as if I was witnessing a miracle. ("You wiggled your finger, that's wonderful."- Princess Bride Reference, anybody). Anyway, blood rushed through me and I was hooked, determined to bear witness to more miracles by this cackling toothless 83 year old woman.
Today many of my therapeutic dreams for Mrs. F came true. She remembered my name. She remembered her birthday. She told me her favorite TV shows- Texas Walker Ranger and Law and Order. She was able to stabilize a piece of paper and write with her right hand. She put a top on a marker using both hands. She picked out that quote from the basket and read it aloud! That was of course followed by, "I don't understand it." Well I don't either Mrs. F, but let's just keep trying and return to life.
Wednesday, July 4, 2007
Happy 4th! Midway through Week 5
It's been a rough and wild road, but I think I'm getting somewhere here. I know where to find the portable oxygen tanks. I know what a barium swallow video looks like. I know how to disconnect a feeding tube. I know who to ask for a neuro-opthamologist consult. I know what a neuro-op does (well, kinda). And I know that while I've learned a lot, I still have a lot to learn. Last Friday, I got solo hijacked by a patient's family... "do you work with Mrs. F?" I was so excited to say yes and to get a chance to speak with them. That was how I felt right up until they asked, "So why isn't she spending any time out of bed? It's she going to develop bedsores?" I know that this question is well within the realm of OT and that I should be able to answer it, but the words just didn't come and in that moment "I don't know" didn't seem like an acceptable answer. I wanted a response that would exude my intellect, impress them with the wealth of OT knowledge. I wanted to not sound like an idiot. But instead I panicked. In my head I thought, "Oh no! Why isn't she out of bed!?! Isn't she going to develop bedsores?" And the more I fumbled through an answer, the more the concerned family member felt anxious about the situation. Luckily at that point, the case manager with years experience, walked in to speak with the family. I fielded the question to her and she immediately answered with a soothing harmonious response. It was nearly perfect. We all released a huge sigh of relief. Then I realized that her answer was my answer. Mrs. F isn't ready to sit up and out of bed yet. Her body is not able to support her in that position. Her brain is having trouble telling her body what to do. She would fall over sitting upright in a wheelchair. I knew it! And I did say some of that, but I just couldn't deliver with the confidence and credibility that the case manager did. In the end, the family was satisfied. I spent some more time with them and even invited them to visit my next treatment session with Mrs. F. They came and it was a good educational session. Hopefully their carryover will benefit Mrs. F's recovery which is coming along very slowly, complicated by her hallucinations and delirious behavior. But man she is fun to work with!
A note on Sailor Jerry, aka Mr. P. Last Friday I went to check the boards and noticed his name was gone. Read the chart which was in the discharge pile at the nurse's station. Pt. administered 6 ml morphine IV. All comfort measured in place. Expired 13:30. Wife, daughters, and Dr. W present. So that's it. He was right, he was my 1st dying patient. I'll always remember him. May you rest in peace now Mr. P.
A note on Sailor Jerry, aka Mr. P. Last Friday I went to check the boards and noticed his name was gone. Read the chart which was in the discharge pile at the nurse's station. Pt. administered 6 ml morphine IV. All comfort measured in place. Expired 13:30. Wife, daughters, and Dr. W present. So that's it. He was right, he was my 1st dying patient. I'll always remember him. May you rest in peace now Mr. P.
Friday, June 22, 2007
i do all my own stunts
Week 3 wrapped today (that's right, a little hollywood lingo). After the past weekend's emotional breakdown, I had a physical one right in the middle of the week. Spent all day Wednesday in bed- reading and resting. It was actually quite restorative. I've never taken a day off like that. In school, you could always drag your way through the day, because at the end of it- it was about you. How much you learned, so if you had a cold and didn't gain quite as much, that only affected you. But on fieldwork and you're sick, you can't give proper care to your patients and what you might give them is a cold.
I've continued to draw a parallel between the patients and myself. This week I was evaluated the director of the OT dept. The purpose was to assess my clinical reasoning, which includes my observations and interpretations focused on one patient. Just a check-up really, to give a baseline of my clinical skills at this point. No pressure. And yet, performance anxiety swept over me. I tried to relax and do my best, but just the knowledge of someone taking note of my abilities and limitations somehow changed my experience and the way I behaved. Hmm... are you sensing the parallel yet? Everyday, I'm working with patients asking them to do challenging things. And they know I'm watching. Even though it's all towards their benefit, whether they know that or not, performance anxiety can creep in and change the output. For better or worse. Sometimes it can get the blood flowing and you can perform better than you would without someone there. But let's face it, you do act a little different when someone's watching you, especially if you know they're evaluating you.
ps- I do, do, all my own stunts, by the way. (Some more hollywood lingo and also a saying on sailor jerry's t-shirt).
I've continued to draw a parallel between the patients and myself. This week I was evaluated the director of the OT dept. The purpose was to assess my clinical reasoning, which includes my observations and interpretations focused on one patient. Just a check-up really, to give a baseline of my clinical skills at this point. No pressure. And yet, performance anxiety swept over me. I tried to relax and do my best, but just the knowledge of someone taking note of my abilities and limitations somehow changed my experience and the way I behaved. Hmm... are you sensing the parallel yet? Everyday, I'm working with patients asking them to do challenging things. And they know I'm watching. Even though it's all towards their benefit, whether they know that or not, performance anxiety can creep in and change the output. For better or worse. Sometimes it can get the blood flowing and you can perform better than you would without someone there. But let's face it, you do act a little different when someone's watching you, especially if you know they're evaluating you.
ps- I do, do, all my own stunts, by the way. (Some more hollywood lingo and also a saying on sailor jerry's t-shirt).
Tuesday, June 19, 2007
"I want to die."
"I want to die." No, not me. It's the man in room 456. He was my very first patient on fieldwork. He has a terrible pneumonia, which is complicating his prior existing conditions of chronic obstructive pulmonary disease (COPD), congestive heart failure, and very painful spinal compression fractures. For those of you who've been reading this blog since the beginning, he's the one with the sailor Jerry tattoos. Every morning for my 1st three days of fieldwork, I "wiped and diaped" this man. I postponed writing about this to preserve his dignity, but now I feel it adds to the understanding of why he feels ready to die. I can't imagine living in diapers in a world of pain.
"Honey, I'm the picture of health," his humor has kept him going and kept us going as well. But as the jokes fade and the moans and groins grow, I do not feel this friend will be with us much longer. I actually thought he had died last week... he was sent out acute and appeared in one of my dreams. So I thought, that's nice that he died and came to visit me in my sleep. But low and behold, a week later he was wheeled back in on a gurney. Now he's telling me "he's ready to go." And I wonder... is that the pain speaking or is that a 75 year old man in diapers who's been losing function and independence for years? The look in his eyes tells me the later, but who am I to make that call?
It was simpler 100 years ago, without a million drugs on the market to secure and prolong life. We didn't have to ask ourselves the questions that we have to ask today. The choice was not made by doctors, family, or therapists, but by the individuals body, mind, and will to survive. Today that part seems to play a smaller role. Yet, I suppose it doesn't have to if people would only realize that. Realize that there is choice, even at the end of life.
So, Mr. P, what'll it be?
"Honey, I'm the picture of health," his humor has kept him going and kept us going as well. But as the jokes fade and the moans and groins grow, I do not feel this friend will be with us much longer. I actually thought he had died last week... he was sent out acute and appeared in one of my dreams. So I thought, that's nice that he died and came to visit me in my sleep. But low and behold, a week later he was wheeled back in on a gurney. Now he's telling me "he's ready to go." And I wonder... is that the pain speaking or is that a 75 year old man in diapers who's been losing function and independence for years? The look in his eyes tells me the later, but who am I to make that call?
It was simpler 100 years ago, without a million drugs on the market to secure and prolong life. We didn't have to ask ourselves the questions that we have to ask today. The choice was not made by doctors, family, or therapists, but by the individuals body, mind, and will to survive. Today that part seems to play a smaller role. Yet, I suppose it doesn't have to if people would only realize that. Realize that there is choice, even at the end of life.
So, Mr. P, what'll it be?
Monday, June 18, 2007
Yerxa really knew her stuff!
This quotation caught my eye today. It seemed to be calling to me from the bulletin board in the OT Dept...
"We cannot really help clients unless we are there, that is we feel, we encounter, we take time, we listen and we are ourselves... Personal authenticity as an Occupational Therapy practitioner means that the therapist allows himself to feel real emotion with the client... Philosophically we do not see man as a "thing" but as a being whose choices allow him to discover and determine his own Being. Our media, our emphasis upon the client's potentials, the necessity for him to act and the mutuality of our relationship with him provide a milieu in which his suffering can be translated into the resolve to become his true self."
-Elizabeth Yerxa (1967 Slagle Lecture)
I really couldn't say it any better myself. This brought a lot of clarity and comfort to my distress with Mt. Emotion. My supervisor also helped me to process and more deeply understand my feelings at this time. I don't want to speak too highly of her, because I know she reads this, but she really is a terrific OT and teacher. (She is also apparently a very talented artist... once painted a picture on a cake for the Queen of England!)
"We cannot really help clients unless we are there, that is we feel, we encounter, we take time, we listen and we are ourselves... Personal authenticity as an Occupational Therapy practitioner means that the therapist allows himself to feel real emotion with the client... Philosophically we do not see man as a "thing" but as a being whose choices allow him to discover and determine his own Being. Our media, our emphasis upon the client's potentials, the necessity for him to act and the mutuality of our relationship with him provide a milieu in which his suffering can be translated into the resolve to become his true self."
-Elizabeth Yerxa (1967 Slagle Lecture)
I really couldn't say it any better myself. This brought a lot of clarity and comfort to my distress with Mt. Emotion. My supervisor also helped me to process and more deeply understand my feelings at this time. I don't want to speak too highly of her, because I know she reads this, but she really is a terrific OT and teacher. (She is also apparently a very talented artist... once painted a picture on a cake for the Queen of England!)
Sunday, June 17, 2007
Mt. Emotion
This week I learned and my Nana reminded me, "You gotta take the bad with the good." It's been a really good first two weeks. I'm learning so much (developing my 3D holographosensosurround system), meeting incredible people, and really feel connected to this work. It has been a wonderful learning experience. The bad, well, that took shape in the form of an near emotional breakdown driving home from the hospital on Friday. I knew it was coming. I'm just glad I made it to the end of week two and into the car. I cried harder than I've cried in a long long time. And it felt great. I needed to release all the feelings that were being stired up. The first week I felt fine because everything was so new and I was just overwhelmed by everything. This past week, I began to focus on some of the people on our (my) caseload. Writing treatment plans and wondering about their stories, brought up a few of my own life stories. Feeling them again was an intense, confusing, and empowering.
Being in a hospital for me is a strange and yet comfortable place. I spent many days as a child visiting family inside of the NYC hospitals. I've watched a woman die inside of a hospital ER. Three years ago, I spent a few nights sleeping next to my cousin in the ICU. All of these experiences have shaped the way I see and feel when I step into my fieldwork site. Right now those impressions are all very raw. I feel very connected to the patient and family perspective and am finding some uneasiness shifting over to the other side, the provider side. I also feel proud and honored to be on the other side. Sort of feels like reaching the summit of a rough and challenging climb. I know there's still much more to climb, but for now after an intense week and relaxing weekend I'll just enjoy life as it is.
Being in a hospital for me is a strange and yet comfortable place. I spent many days as a child visiting family inside of the NYC hospitals. I've watched a woman die inside of a hospital ER. Three years ago, I spent a few nights sleeping next to my cousin in the ICU. All of these experiences have shaped the way I see and feel when I step into my fieldwork site. Right now those impressions are all very raw. I feel very connected to the patient and family perspective and am finding some uneasiness shifting over to the other side, the provider side. I also feel proud and honored to be on the other side. Sort of feels like reaching the summit of a rough and challenging climb. I know there's still much more to climb, but for now after an intense week and relaxing weekend I'll just enjoy life as it is.
Wednesday, June 13, 2007
shifting focus
My first encounter with flaccidity. I'll never forget it. The way his arm laid heavy and motionless in my hands, unable to move it if he tried. A massive stroke paralyzed the entire right side of this man's 83 year old body. His wife died only a few weeks ago and he was discovered on the floor by his daughter, who has mental retardation, and her aide. I wonder if she even realized what had happened when she saw him on the floor. I wonder if he now lies in the bed just wishing to let go of this life and join his wife. I wonder if I'll be able to see him tomorrow and set all these thoughts aside so that I can act professionally and move him towards "his goals." Unable to speak, we have to make certain assumptions as to what these should be- sit on the edge of the bed for 1 minute with minimum support, find a way to communicate, transfer to a wheel chair with moderate assistance.
I've always been a big picture thinker. In the past two weeks I've been absorbing all of these parts and have been trying to connect the dots. Trying to make sense of it all. Problem is... shifting focus back to the parts and not just their connection. For example, I need to stop wondering if Mrs. P will ever drive again and remember to bring an oxygen tank with me to her session. It's all the fine details that make a session flow smoothly (or somewhat smoothly). The locks on the wheelchair, the foley, the oxygen cord, the hearing aides, the magnifying glass with the glasses, and the bed alarm. Not to say that the big picture is lost during this. Both the details and big picture need constant attention. My supervisor calls it "hypertasking." Organizing oneself to remember all the little details, the time, the purpose of the session, and thinking about what's next. It's certainly a lot to juggle. But hopefully after some practice, I will be more able to function in this hospital circus.
I've always been a big picture thinker. In the past two weeks I've been absorbing all of these parts and have been trying to connect the dots. Trying to make sense of it all. Problem is... shifting focus back to the parts and not just their connection. For example, I need to stop wondering if Mrs. P will ever drive again and remember to bring an oxygen tank with me to her session. It's all the fine details that make a session flow smoothly (or somewhat smoothly). The locks on the wheelchair, the foley, the oxygen cord, the hearing aides, the magnifying glass with the glasses, and the bed alarm. Not to say that the big picture is lost during this. Both the details and big picture need constant attention. My supervisor calls it "hypertasking." Organizing oneself to remember all the little details, the time, the purpose of the session, and thinking about what's next. It's certainly a lot to juggle. But hopefully after some practice, I will be more able to function in this hospital circus.
Monday, June 11, 2007
Week 2
Week 2 begins and at the end of the day, I realized a tell-tale sign that my brain is slightly overwhelmed. I haven't touched the car radio since starting fieldwork. My heads so full processing all this new information that by the end of the day, I can't listen to anything. Silence has been a critical part of my day. That's one thing you definitely don't get in the hospital. It's always buzzing with some action at the nurse's station, alarms from machines, visitors coming in and out, and carts of food trays, meds, and other medical parapanliea wheeling about. Just about every patient seems tired and it's no wonder why. It's seems nearly impossible to get some solid rest. I suppose there are a few things you must give up when entering the hospital... privacy, homecooked food, and peace and quiet. But I guess it's trade off, in return you get 24-7 medical care and rehabilitation services. And I suppose for people that need to be in a hospital, it's worth the trade.
Everyday in fieldwork is a challenge, just as everyday as a patient in rehab is a challenge. Once you accomplish one step, the therapist just adds another step. At the beginning of my first week I was mostly observing and learning my way around. Midway through the week, I was writing progress notes in the charts, and towards the end of the week I was planning treatment sessions. This week I'm leading sessions for two of "my" patients. Of course, my supervisor is present for the treatment sessions and helps me to plan and process my observations into a progress note, but little by little I'm becoming a "trained professional." Gotta run and write some treatment plans (in peace and quiet)!
Everyday in fieldwork is a challenge, just as everyday as a patient in rehab is a challenge. Once you accomplish one step, the therapist just adds another step. At the beginning of my first week I was mostly observing and learning my way around. Midway through the week, I was writing progress notes in the charts, and towards the end of the week I was planning treatment sessions. This week I'm leading sessions for two of "my" patients. Of course, my supervisor is present for the treatment sessions and helps me to plan and process my observations into a progress note, but little by little I'm becoming a "trained professional." Gotta run and write some treatment plans (in peace and quiet)!
Thursday, June 7, 2007
STAND BACK, I'm a trained professional?
Leaving classes this became our mantra, "STAND BACK... I'm a trained professional." And while we said it with a grain of salt, I never fully realized how BIG that piece of salt really is. There's so much I don't know! I feel like I'm in 3rd grade math class during the first week, looking through the last few chapter of my textbook thinking, "Holy cow, how will I ever learn all this?" My only vote of confidence is that by the end of the year, I could do long division and all those crazy word problems in the back of the book. So I'm not panicing yet and feeling pretty comfortable with not knowing everything just yet. It's just at this point I'm not sure who I'm relating more- the patients or the therapists. "You want me to do what!" "I can't do that." But the amazing thing will be that in a few weeks, we'll all be able to do it, especially with such great teachers around.
Wednesday, June 6, 2007
Progress Note
OTS arrived 30 minutes early to assess daily schedule and plan tx. Performed 8 ADL, 5 Fx'l Mobility, and 2 Cognitive units. Was able to assist during MAX/MOD txfers bed-WC using RW and gait belt. OTS reported large appetite and demonstrated I feeding skills. Cognition appears intact, but needed MOD v/c to perform assists and take the lead in instructing patients. Documenting seems to be improving, although terminology and phrasing is poor. Will continue to work on tx planning and observation skills.
-Amanda L. Hamm, OTS
-Amanda L. Hamm, OTS
Tuesday, June 5, 2007
DAY 2
Learning a new skill is always a bit tricky. As I'm watching patients learn basic life skills like going to the bathroom, I'm learning a lot of new skills too. Therapists make documenting, treatment planning, and performing assesments look so easy. Patients probably feel the same way about watching me move around the room, so easy. I'll be trying to remember that through the next 3 months. Looking forward to watching the patients (and myself) progress!
Monday, June 4, 2007
First Day
Besides the beginning (spilling green drink all over my brand new and finely pressed srubs) and the end (temporarily forgetting my locker combination) it was a good first day! Pouring outside, so a great day to be inside hard at work (or inside reading a book- which Midge reminded me I should choose to think about the first one).
We started the day with 2 very interesting patients in the morning- a koran war vet with sailor jerry tattoos and a troubling case of COPD. His O2 levels are poor, even with a nasal cannula, which limits his activity tolerance. In other words, his difficulty breathing is preventing him from doing everyday activities like washing up, going to the bathroom, sitting up for long periods. His fear of falling may be contributing to his self-limiting attitude. He spoke highly of his wife, married for 53 years. She comes to visit him everyday, but they don't watch red sox games in the same room at home. Strange. So, obviously he has a lot to work on and I have a lot to figure out- like what will we do tomorrow in therapy and why different rooms to watch the game at home?!?
Our second patient is a friendly older woman who recently experienced a left CVA (stroke). We saw her twice today and she did much better in the afternoon. The morning we spent 20 minutes on the throne (I didn't quite realize how much toileting is really involved in OT!). But this afternoon we went to the kitchen and she put away some dishes in the upper cabinets. Definitely a good scene for the OT version of ER. "Put the dish in the cabinet." "Fantastic, you put the dish in the cabinet!"
The rest of our afternoon involved an 83 year old woman recovering from a major motor vehicle accident. Her mutible fractures including her ribs are causing a lot of pain and interfering with her ability to function indepently, which she had been prior to the accident. She just transferred here from B&W in Boston. She is depressed and I'm hoping that a few successful ADLs will help brighten up her week!
Our final patient for the day was on another unit, the vent unit. She's been trying to wean off the vent, but has a lot of anxiety over doing so. Midge has been working with her on breathing and relaxation techniques to improve her feeling of control of her breathe. Her shortness of breathe is more perceived than actual, as her O2 levels remained high and steady throughout the session.
So now I'm going to be thinking about treatment planning for these fine folks. It wild to imagine that I'm now a real part of their care. As I left the building, I thought about how fortunate I am to be able to walk out the door to my car, open the door, get inside, close the door, and drive home. I never really thought about how much all of that required until I saw people today who were not able to do such ordinary tasks. It's sort of like Joni Mitchell said, "Don't it always seem to go, that you don't know what you've got till it's gone." I love being in a profession that teaches me to appreciate the little things in life. The ordinary is extraordinary.
We started the day with 2 very interesting patients in the morning- a koran war vet with sailor jerry tattoos and a troubling case of COPD. His O2 levels are poor, even with a nasal cannula, which limits his activity tolerance. In other words, his difficulty breathing is preventing him from doing everyday activities like washing up, going to the bathroom, sitting up for long periods. His fear of falling may be contributing to his self-limiting attitude. He spoke highly of his wife, married for 53 years. She comes to visit him everyday, but they don't watch red sox games in the same room at home. Strange. So, obviously he has a lot to work on and I have a lot to figure out- like what will we do tomorrow in therapy and why different rooms to watch the game at home?!?
Our second patient is a friendly older woman who recently experienced a left CVA (stroke). We saw her twice today and she did much better in the afternoon. The morning we spent 20 minutes on the throne (I didn't quite realize how much toileting is really involved in OT!). But this afternoon we went to the kitchen and she put away some dishes in the upper cabinets. Definitely a good scene for the OT version of ER. "Put the dish in the cabinet." "Fantastic, you put the dish in the cabinet!"
The rest of our afternoon involved an 83 year old woman recovering from a major motor vehicle accident. Her mutible fractures including her ribs are causing a lot of pain and interfering with her ability to function indepently, which she had been prior to the accident. She just transferred here from B&W in Boston. She is depressed and I'm hoping that a few successful ADLs will help brighten up her week!
Our final patient for the day was on another unit, the vent unit. She's been trying to wean off the vent, but has a lot of anxiety over doing so. Midge has been working with her on breathing and relaxation techniques to improve her feeling of control of her breathe. Her shortness of breathe is more perceived than actual, as her O2 levels remained high and steady throughout the session.
So now I'm going to be thinking about treatment planning for these fine folks. It wild to imagine that I'm now a real part of their care. As I left the building, I thought about how fortunate I am to be able to walk out the door to my car, open the door, get inside, close the door, and drive home. I never really thought about how much all of that required until I saw people today who were not able to do such ordinary tasks. It's sort of like Joni Mitchell said, "Don't it always seem to go, that you don't know what you've got till it's gone." I love being in a profession that teaches me to appreciate the little things in life. The ordinary is extraordinary.
Sunday, June 3, 2007
OT Defined (by Tufts Best)
Occupational therapy is the practice of helping people use ordinary
activities to enhance function in their daily lives.
– Sharan Schwartzberg
Occupational therapy maximizes the fit between clients' attributes and abilities, their physical and social environments, and the structure and complexity of the tasks they perform, with the objective of helping clients achieve healthy, competent, and satisfying engagement in their valued activities and roles.
– Linda Tickle-Degnen
The essence of occupational therapy is found in the appreciation of
occupation as both a means and an end. Therapists use the activities
that have meaning in an individual's life, to help them recuperate
and/or perform other meaningful occupations better.
– Scott Trudeau
O.T. is a health profession that helps people successfully accomplish important daily activities, those that may be difficult to do because of any physical, mental, emotional or environmental challenge.
– Deborah Rochman
"I was once skiing in the American Birkebeiner cross country ski marathon wearing a Tufts windshell. A man, with apparent unlimited ability to both ski fast and talk volumes, skiied up next to me and asked 'Did you go to Tufts? What did you study there?' ....and I looked ahead and saw that the firetower hills were approaching. I had a crisis of confidence in my ability to ski those hills and even greater doubt about my ability to fend off the inevitable 'what is occupational therapy' question. I took a deep breath and said 'physical therapy' ....and then I paid for this lie because the man said 'Really, that's great, my best friend is an OT'
– Janet Curran-Brooks
"Occupational therapists assist people in selecting and balancing meaningful life activities to enhance their health and well-being."
– Mary Evenson
"Occupational therapy is diverse field that assesses how people function in
their daily lives and then works with the individual to remediate or
compensates for deficits that may be limiting their performance - including,
but not limited to; cognitive skills, upper extremity function, developmental
challenges, and other sensorimotor or psychosocial components of function."
– Monica Pessina
Occupational therapy is a profession that assists individuals of all ages and their families with participating in activities and life situations (i.e., "occupations") that are important and needed for health, development, daily life functioning, enjoyment, and overall quality of life. Occupational therapists 1) teach individuals how to perform or participate in activities using specialized or adaptive methods, devices or equipment; 2) use interventions that address the personal or environmental factors that hinder or support individuals' participation such as strengths or difficulties in physical, cognitive or psychological functioning, and physical, social or attitudinal barriers or facilitators of participation; 3) design equipment or modify the environment to promote optimim participation; and 4) collaborate and consult with stakeholders that can ultimately affect individuals' participation in the activities and life situations that are important to them. Stakeholders can include individuals recieving services, their families, interdisciplinary professionals, administrators, 3rd party payers, government officials, and policy makers.
– Gary Bedell
"Helping people live full and productive lives"
– Diana Bailey
"Occupational therapy helps people regain, develop, and build skills for independent functioning, health and well-being."
– AOTA Conference
activities to enhance function in their daily lives.
– Sharan Schwartzberg
Occupational therapy maximizes the fit between clients' attributes and abilities, their physical and social environments, and the structure and complexity of the tasks they perform, with the objective of helping clients achieve healthy, competent, and satisfying engagement in their valued activities and roles.
– Linda Tickle-Degnen
The essence of occupational therapy is found in the appreciation of
occupation as both a means and an end. Therapists use the activities
that have meaning in an individual's life, to help them recuperate
and/or perform other meaningful occupations better.
– Scott Trudeau
O.T. is a health profession that helps people successfully accomplish important daily activities, those that may be difficult to do because of any physical, mental, emotional or environmental challenge.
– Deborah Rochman
"I was once skiing in the American Birkebeiner cross country ski marathon wearing a Tufts windshell. A man, with apparent unlimited ability to both ski fast and talk volumes, skiied up next to me and asked 'Did you go to Tufts? What did you study there?' ....and I looked ahead and saw that the firetower hills were approaching. I had a crisis of confidence in my ability to ski those hills and even greater doubt about my ability to fend off the inevitable 'what is occupational therapy' question. I took a deep breath and said 'physical therapy' ....and then I paid for this lie because the man said 'Really, that's great, my best friend is an OT'
– Janet Curran-Brooks
"Occupational therapists assist people in selecting and balancing meaningful life activities to enhance their health and well-being."
– Mary Evenson
"Occupational therapy is diverse field that assesses how people function in
their daily lives and then works with the individual to remediate or
compensates for deficits that may be limiting their performance - including,
but not limited to; cognitive skills, upper extremity function, developmental
challenges, and other sensorimotor or psychosocial components of function."
– Monica Pessina
Occupational therapy is a profession that assists individuals of all ages and their families with participating in activities and life situations (i.e., "occupations") that are important and needed for health, development, daily life functioning, enjoyment, and overall quality of life. Occupational therapists 1) teach individuals how to perform or participate in activities using specialized or adaptive methods, devices or equipment; 2) use interventions that address the personal or environmental factors that hinder or support individuals' participation such as strengths or difficulties in physical, cognitive or psychological functioning, and physical, social or attitudinal barriers or facilitators of participation; 3) design equipment or modify the environment to promote optimim participation; and 4) collaborate and consult with stakeholders that can ultimately affect individuals' participation in the activities and life situations that are important to them. Stakeholders can include individuals recieving services, their families, interdisciplinary professionals, administrators, 3rd party payers, government officials, and policy makers.
– Gary Bedell
"Helping people live full and productive lives"
– Diana Bailey
"Occupational therapy helps people regain, develop, and build skills for independent functioning, health and well-being."
– AOTA Conference
Thursday, May 31, 2007
Stepping Stones
(1st a little disclaimer- In school we had to write A LOT of reflection papers. Funny that I just can't seem to get enough!)
In just 4 days now, I will be meeting people in the hospital immediately following their stroke or traumatic brain injury. Today I had the opportunity to meet people several years post their injury. They showed me the incredible potential for recovery and growth, which I would have never have known.
This all came about by one of my mentors, Barb. She is the program coordinator for Stepping Stones, a community based brain injury rehab center in Portsmouth, NH. It's located in the back of an industrial park, very wooded area, and in a beautiful building. 11 non-profits share the space, which includes a huge gym, several garden spaces, a movie room, and cafeteria. The rooms are open, spacious, and full of light from giant windows.
I sat in on an afternoon group on stigma. I was surprised at the openness, focus, and patience of each member as they each shared their thoughts. Everyone in the group seemed fully present. The group leaders provided a safe and comfortable environment which allowed for this to be a powerful experience.
I found myself relating and connecting to their stories. For although we've never shared the same experiences, they've elicited the same human emotions. Anger. Fear. Confusion. Love. Compassion. Triumph. Joy. I listened to one patient express her frustration of not being understood at the grocery store. Another man shared how he used humor. What a powerful tool in tranforming potentially hurtful and anger provoking situations! And while I don't have a brain injury, I've certainly felt the gammit of emotions and used humor as my shield.
Many members spoke about their desire to regain lost occupations such a driving and working. At one point I was nearly brought to tears as he discussed the unconditional love of his wife and caregiver, "We said for better or worse and well, this is the worst and she stands by me." As he spoke, another member smiled at his wife and caretaker and then reached for her hand. You could sense the intimate bond between them. Between a determined man who found difficulty in putting together several words and his wife who loved him just the same. I realized that these people are struggling to do what most people still struggle to do... to accept and love themselves as they are, to express themselves, and to grow a little each day.
A few notes that I walked away with on stigma. Stigmas are held in the minds of other people and institutions. They are a part of our culture. 99% of what people see is behind their eyes. So, how do you change other people's perceptions? How can you affect that 99%? How can you best teach communities so that they understand? How can you tip the culture into letting go of stereotypes? More questions than answers, but isn't that always the way?
At the end of the day, I felt the gestalt effect of my two years of learning at BSOT take hold. I can't pinpoint a certain class/lecture that prepared me for today- it just all came together. I hope this continues and builds for the months and years to come.
"Never cheat somebody on hope. You never really know how far they can go."
-Barb Kresge
In just 4 days now, I will be meeting people in the hospital immediately following their stroke or traumatic brain injury. Today I had the opportunity to meet people several years post their injury. They showed me the incredible potential for recovery and growth, which I would have never have known.
This all came about by one of my mentors, Barb. She is the program coordinator for Stepping Stones, a community based brain injury rehab center in Portsmouth, NH. It's located in the back of an industrial park, very wooded area, and in a beautiful building. 11 non-profits share the space, which includes a huge gym, several garden spaces, a movie room, and cafeteria. The rooms are open, spacious, and full of light from giant windows.
I sat in on an afternoon group on stigma. I was surprised at the openness, focus, and patience of each member as they each shared their thoughts. Everyone in the group seemed fully present. The group leaders provided a safe and comfortable environment which allowed for this to be a powerful experience.
I found myself relating and connecting to their stories. For although we've never shared the same experiences, they've elicited the same human emotions. Anger. Fear. Confusion. Love. Compassion. Triumph. Joy. I listened to one patient express her frustration of not being understood at the grocery store. Another man shared how he used humor. What a powerful tool in tranforming potentially hurtful and anger provoking situations! And while I don't have a brain injury, I've certainly felt the gammit of emotions and used humor as my shield.
Many members spoke about their desire to regain lost occupations such a driving and working. At one point I was nearly brought to tears as he discussed the unconditional love of his wife and caregiver, "We said for better or worse and well, this is the worst and she stands by me." As he spoke, another member smiled at his wife and caretaker and then reached for her hand. You could sense the intimate bond between them. Between a determined man who found difficulty in putting together several words and his wife who loved him just the same. I realized that these people are struggling to do what most people still struggle to do... to accept and love themselves as they are, to express themselves, and to grow a little each day.
A few notes that I walked away with on stigma. Stigmas are held in the minds of other people and institutions. They are a part of our culture. 99% of what people see is behind their eyes. So, how do you change other people's perceptions? How can you affect that 99%? How can you best teach communities so that they understand? How can you tip the culture into letting go of stereotypes? More questions than answers, but isn't that always the way?
At the end of the day, I felt the gestalt effect of my two years of learning at BSOT take hold. I can't pinpoint a certain class/lecture that prepared me for today- it just all came together. I hope this continues and builds for the months and years to come.
"Never cheat somebody on hope. You never really know how far they can go."
-Barb Kresge
Monday, May 21, 2007
Graduation Saga
The grand finale felt more like the grand fiasco. I was sick as a dog (what does that cliche even really mean?), it poured nearly all day, and one of my closest friends and classmates could not partake in the ceremony. Plus my family was in town meeting my boyfriend's family, yikes! (all went well though). It was all a bit much for me and I found myself fighting to enjoy the moment. There were some great ones though like all of Katie's speech and when Andrea gave me Sharan's flowers! Also I couldn't stop staring at Sharon Ray, the woman had the biggest smile of anyone I'd ever seen. I'm home now for a week and then will be back in Boston for a week preparing for fieldwork which starts June 4th. Can't wait for that to begin!
"learning to be an OT"
I orginally titled this blog "learning to be an OT." But then I realized that to become an occupational therapist seems like more than just "learning" to be one. That is a piece of it, of course, but the change seems much more holistic and transcendant than just cognitive learning. I'm dedicating this blog to that process.
Subscribe to:
Posts (Atom)