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 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?

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!)

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.

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.

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)!

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.

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

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!

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.

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