"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!
Tuesday, July 31, 2007
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.
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