I always thought I could talk to anybody about anything. When I was little I even imagined I could talk my way out of a bad guy kidnapping me. (Never tried to test this one out). And especially the hard stuff, the personal stuff, the down and dirty, & wild and crazy. But not today. Today the patient that I've building a trusting relationship with for the past 3 months, told me he couldn't talk to me, "It's personal."
There's obviously more to the story and this patient's story is one of the tougher ones. 53 year old male with history of schizoaffective disorder (schizophrenia + bipolar) fell at his group home and developed shortness of breath and bilateral extremity weakness after a few days. He presented to the ER was intubated and sent for a CAT scan, which revealed a C4-5 fracture. Basically- he broke his neck during the fall and its amazing he's not paralyzed from the neck down. Doctors stabilized his head and neck with a halo and he transferred to our hospital for further medical management and rehab. During his 16 weeks in the halo, we were able to build a solid relationship- a true achievement for someone with his history of mental illness. I introduced him to the internet, we baked pies for the nurses, and exercised him back into shape. He told me stories of what it was like living with his disease- surviving 14 years of institutionalization. His parents came to visit him everyday through every hospitalization.
Symptoms of his schizoaffective disorder presented initially as emotional lability and difficulty with appropriate social engagement. Later on he developed episodes of mania- "I'm gonna sell my coin collection and go back to college, get my degree in writing!" and negative thoughts, talking and crying a lot over war and killing. At times he was difficult to redirect, often going off on tangents with thoughts that didn't really connect. Generally he was pretty easy to treat given his boundaries and I really felt like we were getting somewhere.
But once the halo came off, anxiety began to rise regarding his discharge plan. During those 16 weeks he was receiving nutrition via a feeding tube since he was unable to swallow with his neck immobilized. Once that was removed he had a swallow test performed by speech therapists to determine if he would be able to eat or drink anything. And here's when his behavior really began to fall apart... he failed the swallow test. No eating or drinking allowed, probably for the rest of his life. Worse, he won't be able to return to his group home because they won't take him with a g-tube. Stuck. And stuck with schizoaffective disorder. Who's to say how a person without this mental illness would behave? Hi, um yeah, you can't ever eat or drink again and you can't go back home.
Well needless to say, he may be leaving the hospital tonight via Section 12. He's been screaming profanities at the nurses, flooded the toilet, rummaged through his roommates belongings, and hiding scissors, drinks, and food. His affect looks entirely different- drawn, lost, and empty. "I can't talk about it Amanda, it's personal." Come on buddy, talk to me!
Thursday, December 18, 2008
Sunday, December 14, 2008
CODE D
It's not too often you hear this code in a hospital, but Friday, December 12th we entered disaster mode. After 2 days of serious rain and ice, three telephone poles came down in the middle of the entrance to the hospital. There's only one way in and out, and that road was blocked. No main power and no one in, no one out. The generators kicked in right away, so no one had to ambu the vent patients all day. Thank god. The road was cleared by 2:45pm, so luckily the 3-11 shift could come on. My day was pretty much business as usual, a lot quieter though with having to talk to my patients over the roommates blaring TV or interrupting families visiting. Unforgettable- CODE D, hopefully the first and last. I called my OT buddy Mike to tell him the story and he told me his "fire story." Basically a patient was about to be discharged to a long term psych facility, so he lit his hospital room a blaze. Mike ended up evacuating 123 patients out into the parking lot. Now that is crazy! See anything can happen on any given day. Gotta stay focused.
Sunday, November 30, 2008
i love my job.
"work is love made visible... and to love life through labor is to be intimate with life's inmost secret."
-taken from the prophet by kahlil gibran
-taken from the prophet by kahlil gibran
Monday, November 17, 2008
the art of listening
It's 11:38am, 22 minutes until lunch and my stomach is rumbling. I'm running late to my next treatment session which will be focusing on solving my patients insomnia. I've asked him to think about a good night sleep verse a bad night sleep and the type of day that leads up to each. Upon arriving to his room, I see that he's asleep. Seems silly to wake him to talk about his sleeping or lack thereof, however, allowing him to sleep through our therapy time won't really get to the bottom of his insomnia.
He awoke grouchy and slow moving. I knew we needed a quiet place to talk, despite the temptation of saving time by staying in his room and battling with the bells and beeps of the unit. He's not too thrilled either to be leaving now 10 minutes before lunch, but I have a hunch that this what we need to do.
So we pull up to a quiet section in the simulated living center, he's in his wheelchair and I'm sitting in the red restaurant booth. I ask, "Did you think about your sleep? What do you think makes the difference between a good night's sleep and a poor night's sleep?" He's missing his hearing aides, so I have to repeat the question. My patience is wearing thin. His response is slow and I'm holding myself back from giving him the answer. "Stress."
"There's a reason why I can't sleep at night. I can't turn off my mind. It runs through a million thoughts. You see I didn't really have a good life." He went on to tell me about his horrific childhood- stories of terrifying abuse. How his mother left him crying in a crib for 3 days until his grandmother found him with his head stuck between the rails of the crib. How his father stomped on all of their Christmas gifts one year for twenty minutes in a fit of rage. How his mother wrote him out of her will just weeks before her death after they had finally reunited and begun to stabilize their relationship. How his father convinced him to leave the Navy and come work for the family business, but then underpaid him so much that he could barely afford to put food on the table. It was sickening to hear, but I know that he had to tell me. I could tell by the sound of his voice that just by speaking these injustices out loud he was beginning to free himself of them. I could almost see the weight being lifted off his back.
I didn't offer him any advice. I merely listened and supported him through the telling. I offered him a place to be heard. And it was in hearing himself say something that I believe he really began to heal... "When I asked my mother, 'Why'd you do it?' She simply responded, 'I didn't know any better." He held back tears, obviously still hurt by her answer. Then later in the conversation he said to me, "I didn't lead a very good life myself. I drank. I divorced my wife. I cheated. I gambled. But now I think I'm ready to go back to the people I've hurt and tell them, 'I'm sorry but I just didn't know any better." I smiled and pointed out to him that that was exactly what his mother had said to him. The revelation shook him. He paused for a moment and it began to sink in. "Now can you forgive her?" I asked. "Yeah, I think I just did."
By the end of it, he couldn't thank me enough and said he immediately felt much better. He admitted that at first he was annoyed at my insistence of going to another room, but he also admitted that now he thinks he was finally going to get a good night's sleep. When we got back to the room both the nurse and the respiratory therapist made remarks about how good he looked, "You must be close to going home?" "I am." He said as he winked at me.
He awoke grouchy and slow moving. I knew we needed a quiet place to talk, despite the temptation of saving time by staying in his room and battling with the bells and beeps of the unit. He's not too thrilled either to be leaving now 10 minutes before lunch, but I have a hunch that this what we need to do.
So we pull up to a quiet section in the simulated living center, he's in his wheelchair and I'm sitting in the red restaurant booth. I ask, "Did you think about your sleep? What do you think makes the difference between a good night's sleep and a poor night's sleep?" He's missing his hearing aides, so I have to repeat the question. My patience is wearing thin. His response is slow and I'm holding myself back from giving him the answer. "Stress."
"There's a reason why I can't sleep at night. I can't turn off my mind. It runs through a million thoughts. You see I didn't really have a good life." He went on to tell me about his horrific childhood- stories of terrifying abuse. How his mother left him crying in a crib for 3 days until his grandmother found him with his head stuck between the rails of the crib. How his father stomped on all of their Christmas gifts one year for twenty minutes in a fit of rage. How his mother wrote him out of her will just weeks before her death after they had finally reunited and begun to stabilize their relationship. How his father convinced him to leave the Navy and come work for the family business, but then underpaid him so much that he could barely afford to put food on the table. It was sickening to hear, but I know that he had to tell me. I could tell by the sound of his voice that just by speaking these injustices out loud he was beginning to free himself of them. I could almost see the weight being lifted off his back.
I didn't offer him any advice. I merely listened and supported him through the telling. I offered him a place to be heard. And it was in hearing himself say something that I believe he really began to heal... "When I asked my mother, 'Why'd you do it?' She simply responded, 'I didn't know any better." He held back tears, obviously still hurt by her answer. Then later in the conversation he said to me, "I didn't lead a very good life myself. I drank. I divorced my wife. I cheated. I gambled. But now I think I'm ready to go back to the people I've hurt and tell them, 'I'm sorry but I just didn't know any better." I smiled and pointed out to him that that was exactly what his mother had said to him. The revelation shook him. He paused for a moment and it began to sink in. "Now can you forgive her?" I asked. "Yeah, I think I just did."
By the end of it, he couldn't thank me enough and said he immediately felt much better. He admitted that at first he was annoyed at my insistence of going to another room, but he also admitted that now he thinks he was finally going to get a good night's sleep. When we got back to the room both the nurse and the respiratory therapist made remarks about how good he looked, "You must be close to going home?" "I am." He said as he winked at me.
Tuesday, September 16, 2008
the power of occupation
"I'm a little out of practice." Jim leaned over the side of the piano which he played and whispered this in my ear for the sixth time, unable to recall the five times earlier in which he did the same thing.
Jim is the reason why I'm coming out of a 3 month writing hiatus. He has reminded me of the power of occupation.
Jim is a bit out of practice. For the past month this 58 year old man has been at the hospital, lying in bed "recovering" from multible strokes affecting various areas of his brain. These include the cerebellum, disturbing his sense of balance; the temporal, disrupting his sense of time; the hippocampus and pre-frontal lobe, erasing the ability to form new memories; the hypothalamus, disabling him from regulating his emotions; and finally the occipital, destroying his vision. Basically, he is now blind, confused, unable to remember anything from one minute to the next, dizzy 24/7, and emotionally unstable. He says it feels like a nightmare, it IS a nightmare!
That's the bad news. The good news is... he can walk, talk, and remember how to do things like tie his shoes, get dressed, and play the piano. His strength, coordination, tone, and proprioception remain basically intact. So when I walked in yesterday and we sat up at the edge of the bed without crying or complaining of dizziness I knew we had a breakthrough moment. "Come on Jim, we're going to the piano."
Darlene, his girlfriend, mentioned briefly that he could play and we had tried once before but to no avail. Dizziness and headaches spun Jim into a panic attack and we had to head back to bed. But not this time. He sat on the bench and began to clumsily play a few chords. "It feels different. I can't see what I'm doing." I responded to Jim's anxiety with a calm voice, "Just close your eyes and keep doing it. Just let it flow out. Don't judge it." And suddenly it came out! It was beautiful. Beautiful melodious chords and rhythmns, classically composed. Just as I was nearly in tears, he leaned over and whispered to me, "Do you know what this song is called?" "Amanda." He remembered my name and I burst out crying!
For over an hour and half Jim played consistently, gathering a crowd of doctors, nurses, therapists, patients, and families. Dr. Wirtz, his primary physician, walked by, paused, then remarked, "Better than any medicine." It is the longest time he has sat upright and not cried or complained of dizziness or fear. A truly powerful example of the power of occupation.
"Man, through the use of the hands as they are energized by mind and will, can influence the state of his own health." Well said, Mary Reilly.
Jim is the reason why I'm coming out of a 3 month writing hiatus. He has reminded me of the power of occupation.
Jim is a bit out of practice. For the past month this 58 year old man has been at the hospital, lying in bed "recovering" from multible strokes affecting various areas of his brain. These include the cerebellum, disturbing his sense of balance; the temporal, disrupting his sense of time; the hippocampus and pre-frontal lobe, erasing the ability to form new memories; the hypothalamus, disabling him from regulating his emotions; and finally the occipital, destroying his vision. Basically, he is now blind, confused, unable to remember anything from one minute to the next, dizzy 24/7, and emotionally unstable. He says it feels like a nightmare, it IS a nightmare!
That's the bad news. The good news is... he can walk, talk, and remember how to do things like tie his shoes, get dressed, and play the piano. His strength, coordination, tone, and proprioception remain basically intact. So when I walked in yesterday and we sat up at the edge of the bed without crying or complaining of dizziness I knew we had a breakthrough moment. "Come on Jim, we're going to the piano."
Darlene, his girlfriend, mentioned briefly that he could play and we had tried once before but to no avail. Dizziness and headaches spun Jim into a panic attack and we had to head back to bed. But not this time. He sat on the bench and began to clumsily play a few chords. "It feels different. I can't see what I'm doing." I responded to Jim's anxiety with a calm voice, "Just close your eyes and keep doing it. Just let it flow out. Don't judge it." And suddenly it came out! It was beautiful. Beautiful melodious chords and rhythmns, classically composed. Just as I was nearly in tears, he leaned over and whispered to me, "Do you know what this song is called?" "Amanda." He remembered my name and I burst out crying!
For over an hour and half Jim played consistently, gathering a crowd of doctors, nurses, therapists, patients, and families. Dr. Wirtz, his primary physician, walked by, paused, then remarked, "Better than any medicine." It is the longest time he has sat upright and not cried or complained of dizziness or fear. A truly powerful example of the power of occupation.
"Man, through the use of the hands as they are energized by mind and will, can influence the state of his own health." Well said, Mary Reilly.
Tuesday, June 10, 2008
Happy 1 Year Anniversary!
It's officially been one year and 6 days since I began this blog in June 2007. Looking back at some of my first entries, I realize how far I have come in one year. One of the greatest things I appreciate from my work is learning to shift gears quickly and be present in each moment for each patient. Taking care of the needs of one patient then moving on and taking care of the needs of the next patient. Moving through my day in a flow-like state, yet maintaining a mindful connection to the clock, paperwork, and equipment.
Perhaps I'll give you a snapshot of my day today to celebrate this anniversary! Began at 7:30am looking at the schedule, designing my dailty treatment plans, and reading through the charts for updated doctors orders and nursing notes. Then off to my first patient...
9:00-10:00 In to see a 78 year old woman admitted for failure to thrive secondary to small bowel obstruction, which began evident when she began vomiting fecal matter at home. Yes, it's possible. We sat at the edge of the bed for some ADL magic a la sponge bath and dressing into street clothes. Hopefully that does that does the trick!
10:00 Next off to Mrs. Pistol, a 76 year old woman who recently had a massive hemmorhage (stroke). She is the most pleasantly confused person I've ever met. If my brain ever bleeds (knock on wood) I hope to be as delightful as she. She has been making gains in terms of initiating and sequencing functional activities, but continues to require cueing throughout due to decreased attention and distracting hallucinations, which may be a side effect of Provigal, a medication used to increase alertness.
10:30 3rd patient of the day, Mrs. J another 76 year old woman, but with a very different situation. Within the last month she has survived a flatline via CPR and weaned off a vent, now ready to go home with supervision and minimal assistance only due to her fluctuating blood pressure. Orthostatic hypotension remains her primary limiting factor, meaning her BP dramatically drops when she stands, making her very weak. Luckily her spirits have not dropped along with it, she remains very positive and realistic through it all.
11:00 Off to see Mrs. G. A 78 year old female presented to us after breaking the proximal end of her femur (very close the the hip) and is having difficulty getting back on her feet. She's making gains, slowly but surely. But will she be able to go home as she's hoping to? Only time and her determination will tell.
11:30 Last patient before lunch, Mr. Lyon. An 82 year old going on 65 year old. This man truly does not look or act his age. He's always asleep when I go in and after waking him, he teasingly tells me to take a long walk off a short pier. Yet he's always up for whatever I have up my sleeve... be it doing some laundry to work on his balance and activity tolerance or playing catch to build up his endurance, he's willing and ready.
During the afternoon I revisted Mrs. G, Mrs. J, Mrs. Pistol, and Mr. Lyons. A little bit of cognitive assessment here some pacing and energy conservation teaching here and voila- there you have it... a day's done!
I'll admit it's been a while since I've written, I've just been overwhelmed with the thought of sitting down at the computer and thinking about work outside of work. I'm getting better at really leaving work at work. I still love it just the same, but am aware of the potential for burnout by bringing it home and chewing it all over again. Instead I've gotten into some really good reading... Waking by Matthew Sanford, Anatomy of the Spirit by Carolyn Myss, and Eat, Pray, Love by Elizabeth Gilbert. Also really deepening my yoga practice. Attended the Yoga Journal Conference and am looking into becoming certified as a yoga teacher. Om, baby, om.
Perhaps I'll give you a snapshot of my day today to celebrate this anniversary! Began at 7:30am looking at the schedule, designing my dailty treatment plans, and reading through the charts for updated doctors orders and nursing notes. Then off to my first patient...
9:00-10:00 In to see a 78 year old woman admitted for failure to thrive secondary to small bowel obstruction, which began evident when she began vomiting fecal matter at home. Yes, it's possible. We sat at the edge of the bed for some ADL magic a la sponge bath and dressing into street clothes. Hopefully that does that does the trick!
10:00 Next off to Mrs. Pistol, a 76 year old woman who recently had a massive hemmorhage (stroke). She is the most pleasantly confused person I've ever met. If my brain ever bleeds (knock on wood) I hope to be as delightful as she. She has been making gains in terms of initiating and sequencing functional activities, but continues to require cueing throughout due to decreased attention and distracting hallucinations, which may be a side effect of Provigal, a medication used to increase alertness.
10:30 3rd patient of the day, Mrs. J another 76 year old woman, but with a very different situation. Within the last month she has survived a flatline via CPR and weaned off a vent, now ready to go home with supervision and minimal assistance only due to her fluctuating blood pressure. Orthostatic hypotension remains her primary limiting factor, meaning her BP dramatically drops when she stands, making her very weak. Luckily her spirits have not dropped along with it, she remains very positive and realistic through it all.
11:00 Off to see Mrs. G. A 78 year old female presented to us after breaking the proximal end of her femur (very close the the hip) and is having difficulty getting back on her feet. She's making gains, slowly but surely. But will she be able to go home as she's hoping to? Only time and her determination will tell.
11:30 Last patient before lunch, Mr. Lyon. An 82 year old going on 65 year old. This man truly does not look or act his age. He's always asleep when I go in and after waking him, he teasingly tells me to take a long walk off a short pier. Yet he's always up for whatever I have up my sleeve... be it doing some laundry to work on his balance and activity tolerance or playing catch to build up his endurance, he's willing and ready.
During the afternoon I revisted Mrs. G, Mrs. J, Mrs. Pistol, and Mr. Lyons. A little bit of cognitive assessment here some pacing and energy conservation teaching here and voila- there you have it... a day's done!
I'll admit it's been a while since I've written, I've just been overwhelmed with the thought of sitting down at the computer and thinking about work outside of work. I'm getting better at really leaving work at work. I still love it just the same, but am aware of the potential for burnout by bringing it home and chewing it all over again. Instead I've gotten into some really good reading... Waking by Matthew Sanford, Anatomy of the Spirit by Carolyn Myss, and Eat, Pray, Love by Elizabeth Gilbert. Also really deepening my yoga practice. Attended the Yoga Journal Conference and am looking into becoming certified as a yoga teacher. Om, baby, om.
Saturday, May 17, 2008
"i know too much"
How often does this happen? The eval begins and you conversation with the patient goes like this, "Show me supination. Okay good, do you have any external rotation in your shoulder. Hmm, how's your proprioception?" Never, right? We're constantly translating for patients... but not with this one.
Introduce Bill. Bill's a 47 year old male- very athletic, musician, gymnast coach, father, husband, and CLINICAL SPECIALIST PHYSICAL THERAPIST! He knows the lingo. He knows the hospital course. He knows the long road he has ahead of him.
I am so glad to be walking this road with him.
Introduce Bill. Bill's a 47 year old male- very athletic, musician, gymnast coach, father, husband, and CLINICAL SPECIALIST PHYSICAL THERAPIST! He knows the lingo. He knows the hospital course. He knows the long road he has ahead of him.
I am so glad to be walking this road with him.
Wednesday, April 9, 2008
exhausted
I'm babysitting, the kids just all settled in bed, finally. While giving the youngest of the three his bath, I realized this was the 6th person that I've bathed today! Began with a 72 year old woman and ended with a 2 year old. And now one more bath to go- mine!
Wednesday, April 2, 2008
Pressure Drop
On the way to work today I listened to this song- Pressure Drop by Toots & the Maytals (the guys who invented the word reggae, literally) and little did I know I was about to witness pressure drop in a whole other way.
At approximately 2:00pm I went in to check on Mr. D for our afternoon therapy session. His breathing was heavy, labored- even a little more than usual for him. He appeared anxious, attempting to get out of bed. I checked with the nurse, she said the PA had just been in 15 minutes earlier to examine him and okayed him. I checked his vitals- O2 Sat 86%, HR 138, BP-116/70. Desaturating to 86 on 2 liters of oxygen while lying in bed and elevated resting heart rate- two major red flags! "Get the PA back in here now!" The secretaries paged the PA out of meeting, we checked him out together. We asked him if he was in pain- "No" he responded, then attempted to get out of bed again. She agreed that his situation was worsening. "Let's get respiratory in here." She ran out to call his MD, I stayed with him. I held his hands. He began to gasp for air and looking up and off to the right. "Call a code!" CODE BLUE ROOM 334B. CODE BLUE ROOM 334B, 3A North.
Everything began to fall away. Every PA and doc in the house came running. CPR began, but he never regained a pulse. That was it. He was gone.
And so was I, somewhere between witnessing the present situation and flashing back to the last time I saw a full code in a hospital. Suddenly I was 15 again, watching my mom slip away. As Mr. D's family came rushing in- screaming & in panic mode, I lost it. Midge and Joan walked me down to the hall to the OT office, their hands on my back, supporting me. I flashed to walking down the aisle at my mom's funeral, with gentle loving hands supporting me, ushering me, comforting me. I settled down into the present moment again with a cup of tea and some humor- a powerful combination. Then went for a walk with my supervisor. The fresh air and kind words of advice helped, "This may take to you to a deep dark place, but allow yourself to go there and come back. Refill the well. Take the time." I needed to hear that.
Before I left for the day, I met with the family. I let them know his last words, his show of strength in attempting to get out of bed, his feeling of no pain, and that he was with someone who really cared about him before he passed.
Rest in peace, Mr. D.
At approximately 2:00pm I went in to check on Mr. D for our afternoon therapy session. His breathing was heavy, labored- even a little more than usual for him. He appeared anxious, attempting to get out of bed. I checked with the nurse, she said the PA had just been in 15 minutes earlier to examine him and okayed him. I checked his vitals- O2 Sat 86%, HR 138, BP-116/70. Desaturating to 86 on 2 liters of oxygen while lying in bed and elevated resting heart rate- two major red flags! "Get the PA back in here now!" The secretaries paged the PA out of meeting, we checked him out together. We asked him if he was in pain- "No" he responded, then attempted to get out of bed again. She agreed that his situation was worsening. "Let's get respiratory in here." She ran out to call his MD, I stayed with him. I held his hands. He began to gasp for air and looking up and off to the right. "Call a code!" CODE BLUE ROOM 334B. CODE BLUE ROOM 334B, 3A North.
Everything began to fall away. Every PA and doc in the house came running. CPR began, but he never regained a pulse. That was it. He was gone.
And so was I, somewhere between witnessing the present situation and flashing back to the last time I saw a full code in a hospital. Suddenly I was 15 again, watching my mom slip away. As Mr. D's family came rushing in- screaming & in panic mode, I lost it. Midge and Joan walked me down to the hall to the OT office, their hands on my back, supporting me. I flashed to walking down the aisle at my mom's funeral, with gentle loving hands supporting me, ushering me, comforting me. I settled down into the present moment again with a cup of tea and some humor- a powerful combination. Then went for a walk with my supervisor. The fresh air and kind words of advice helped, "This may take to you to a deep dark place, but allow yourself to go there and come back. Refill the well. Take the time." I needed to hear that.
Before I left for the day, I met with the family. I let them know his last words, his show of strength in attempting to get out of bed, his feeling of no pain, and that he was with someone who really cared about him before he passed.
Rest in peace, Mr. D.
Thursday, March 20, 2008
VIP?
This week I've had the pleasure of treating a VIP. A Very Important Patient, as noted this means that this persons requires excellent patient care, customer service, and top medical attention. These patients and their families should expect to be kept fully informed, receive immediate attention when their call lights are pressed, and benefit from exceptional therapy. Wait a minute. Shouldn't all patients be receiving this level of care? Shouldn't all patients share these expectations?
Sunday, March 9, 2008
sick.
Ms. A is a 26 y/o female presenting with a productive cough, fatigue, muscle ache, fever, and nasal congestion. This is no patient. This is me. Sick. I have no time for this. I've got my board exam next Saturday, this was my weekend to study! I have no sick time at work (that doesn't start until 6 months after your start date). And I have some sick patients to attend to! How inconvient!
Yesterday I couldn't move. I laid in bed, attempting to reposition myself every two hours to avoid pressure ulcers and keeping my head and chest elevated 30% to avoid a pneumonia. I pressed the call bell and no one came. Luckily I made it to the bathroom without falling and no nurse caught me sneaking around without my walker. I'd hate for them to throw a posey vest on me. Thank god that OT didn't come around and ask me to get up and go brush my teeth or fold someone else's laundry! Although I would have appreciated an OT helping me figure out a study plan for the week. Setting myself up so I'd feel confident about the board exam. Yeah, that would have been helpful.
Yesterday I couldn't move. I laid in bed, attempting to reposition myself every two hours to avoid pressure ulcers and keeping my head and chest elevated 30% to avoid a pneumonia. I pressed the call bell and no one came. Luckily I made it to the bathroom without falling and no nurse caught me sneaking around without my walker. I'd hate for them to throw a posey vest on me. Thank god that OT didn't come around and ask me to get up and go brush my teeth or fold someone else's laundry! Although I would have appreciated an OT helping me figure out a study plan for the week. Setting myself up so I'd feel confident about the board exam. Yeah, that would have been helpful.
Thursday, March 6, 2008
you tube, i tube, we all tube
Introducing Mr. W, 71 year old male status post left below the knee amputation secondary to diabetes, peripheral vascular disease. Initially attempted to save the left leg (right leg amputated in 2004 for reasons as stated) via a bypass of the femoral artery in the leg, however, during surgery he had a heart attack, requiring a coronary artery bypass graft.
So now introduce me, a first-year therapist who's never worked with a person with bilateral lower extremity amputations, nevermind one who's had a heart attack and major heart surgery. But this is the beauty of this work... our lives collide and we try to make the best of it.
After the initial evaluation I went home and hit the books looking for treatment ideas, goals, and some idea of what the heck to do with this man. The notes and pictures gave me very vague impressions, I needed more. I needed an image, a moving image to see how this guy might be moving around in the next few months/ years. He asked me if he'd ever play golf again... "Umm, sure?"
Then it hit me, "YOU TUBE!" Type in amputee and golf and BAM- there's a person in action at the driving range! And yes, with bilateral lower extremity amputations. Voila- introduce possiblity, nice to meet you!
Disclaimer- I do take potential with a grain of salt and didn't rush off and tell this man he'd be golfing in no time. But I can confidently say that it's been done before and that might be all it takes.
Happy Birthday Mom!
So now introduce me, a first-year therapist who's never worked with a person with bilateral lower extremity amputations, nevermind one who's had a heart attack and major heart surgery. But this is the beauty of this work... our lives collide and we try to make the best of it.
After the initial evaluation I went home and hit the books looking for treatment ideas, goals, and some idea of what the heck to do with this man. The notes and pictures gave me very vague impressions, I needed more. I needed an image, a moving image to see how this guy might be moving around in the next few months/ years. He asked me if he'd ever play golf again... "Umm, sure?"
Then it hit me, "YOU TUBE!" Type in amputee and golf and BAM- there's a person in action at the driving range! And yes, with bilateral lower extremity amputations. Voila- introduce possiblity, nice to meet you!
Disclaimer- I do take potential with a grain of salt and didn't rush off and tell this man he'd be golfing in no time. But I can confidently say that it's been done before and that might be all it takes.
Happy Birthday Mom!
Monday, March 3, 2008
jedi mind tricks
There comes a point when you have to pick an area in which to base your OT practice. Generally speaking, these are mental health, physical dysfunction, or pediatrics. But really the decision is more about setting than population as crossover is inevitable. Until the people in psychiatric hospitals cease becoming physically ill and the people in for "physical rehab" stop having underlying psychiatric diagnoses, the divide will never be clear. Damn that mind body connection.
Here's a case to illustrate the point above... last Friday, I took Mr. L to the giftshop to pick up a newspaper and to see how he manages his rolling walker in a store, how he interacts with the people in the store, and if his neuromuscular endurance is enough to support his weight for standing and walking 50ft. (See a simple trip to the giftshop to the average mind is actually a world of analytical opportunity to the OT mind.) Mr. L is recovering from sepsis, an infection which nearly killed him and created a change in his mental status, which has allegedly returned to baseline. After picking up the paper, we headed back to the unit or at least attempted to head back to the unit, when he insisted that I leave him in the lobby unattended. After explaining the policy and need to return the unit, I got this response, "I'm sick of this micky mouse bullsh%t! I'm a retired trial lawyer of 25 years and I won't be pushed around by you! YOU have ruined my day!" This harrassment continued for about 2 minutes as I wheeled him back to the unit, all the while I practiced my best de-esculating tone and unconditional regard, "I understand you are feeling upset about this Mr. L, but we need to get back for your meds and to check in with your nurse. Perhaps they can bring you back out to the lobby." His verbal abuse included irrationality and delusions such as, "I spoke with someone in administration and they said it was okay for me to do this. I had this all set up. I'm a well man and can sit out there if I want to."
My head began to spin as Dr. Yoda entered the scene, "What seems to be the problem Mr. L?" As he explained his anger peaked, "I'm leaving" and he attempted to stand without checking the wheelchair brakes. I saw it coming and caught him just in time. He sat and shrugged it off, "You know I used to represent hospitals and doctors like you." Dr. Yoda replied, "Than you must clearly understand our position and realize the potential liability. You must then understand that if you fell in the lobby unattended I could loose my license. You must realize that these policies are established to protect you." Mr. L went on for a bit more about this place being very Mickey Mouse, but his tone was defeated. An hour later he apologized to Dr. Yoda and asked that he pass that onto the rest of the staff.
Afterwards I spoke with Dr. Yoda. He explained that his ability to think clearly in this tense situation came from working in inpatient psych and from studying Aikido. Aikido techniques are normally performed by "blending" with the motion of the attacker, rather than directly opposing the attack. The aikidoka (aikido practitioner) redirects the attacker's momentum, using minimum effort, with various types of throws or joint locks. He recommended I read, "Giving In to Getting Your Way" by Terry Dobbs. Midge suggested this was all a bit like "Jedi Mind Tricks."
Here's a case to illustrate the point above... last Friday, I took Mr. L to the giftshop to pick up a newspaper and to see how he manages his rolling walker in a store, how he interacts with the people in the store, and if his neuromuscular endurance is enough to support his weight for standing and walking 50ft. (See a simple trip to the giftshop to the average mind is actually a world of analytical opportunity to the OT mind.) Mr. L is recovering from sepsis, an infection which nearly killed him and created a change in his mental status, which has allegedly returned to baseline. After picking up the paper, we headed back to the unit or at least attempted to head back to the unit, when he insisted that I leave him in the lobby unattended. After explaining the policy and need to return the unit, I got this response, "I'm sick of this micky mouse bullsh%t! I'm a retired trial lawyer of 25 years and I won't be pushed around by you! YOU have ruined my day!" This harrassment continued for about 2 minutes as I wheeled him back to the unit, all the while I practiced my best de-esculating tone and unconditional regard, "I understand you are feeling upset about this Mr. L, but we need to get back for your meds and to check in with your nurse. Perhaps they can bring you back out to the lobby." His verbal abuse included irrationality and delusions such as, "I spoke with someone in administration and they said it was okay for me to do this. I had this all set up. I'm a well man and can sit out there if I want to."
My head began to spin as Dr. Yoda entered the scene, "What seems to be the problem Mr. L?" As he explained his anger peaked, "I'm leaving" and he attempted to stand without checking the wheelchair brakes. I saw it coming and caught him just in time. He sat and shrugged it off, "You know I used to represent hospitals and doctors like you." Dr. Yoda replied, "Than you must clearly understand our position and realize the potential liability. You must then understand that if you fell in the lobby unattended I could loose my license. You must realize that these policies are established to protect you." Mr. L went on for a bit more about this place being very Mickey Mouse, but his tone was defeated. An hour later he apologized to Dr. Yoda and asked that he pass that onto the rest of the staff.
Afterwards I spoke with Dr. Yoda. He explained that his ability to think clearly in this tense situation came from working in inpatient psych and from studying Aikido. Aikido techniques are normally performed by "blending" with the motion of the attacker, rather than directly opposing the attack. The aikidoka (aikido practitioner) redirects the attacker's momentum, using minimum effort, with various types of throws or joint locks. He recommended I read, "Giving In to Getting Your Way" by Terry Dobbs. Midge suggested this was all a bit like "Jedi Mind Tricks."
Thursday, February 21, 2008
in the weeds
On busy days, I feel like I'm back in the restuarant business, waiting tables. Same paranoid thoughts, slightly different objects. Here's what I mean...
"Did I get table 12 their ketchup? Oh shoot I forgot the napkins."
"Did I get room 202 their commode? Oh shoot I forgot the oxygen tank."
"Did I get table 12 their ketchup? Oh shoot I forgot the napkins."
"Did I get room 202 their commode? Oh shoot I forgot the oxygen tank."
Tuesday, February 19, 2008
it is what it is
It is what it is. The statement can imply complacency, acceptance, helplessness, and/or indifference, among many other meanings. In recent weeks I've tuned into the use of this morphic phrase and have begun to use as a mantra for myself, though not sure which meaning I aim to imply. Last week this phrase was the latest buzz in the Roger Clemens congressional hearings to determine whether or not he took steriods. His comment, "It is what it is," skirts politely around the truth, dismissively leaving it up to your own judgement.
Today in the family sitting area, I overheard one daughter say to her sister regarding their globally aphasic mother, "It is what it is." Their smiles following this statement implied acceptance.
Ah, acceptance. Coping with an illness isn't much different from coping with any other difficulty in life that requires acceptance, patience, and maybe even a little bit of faith. Faith that in the end everything will work out okay. Midge had yet another great metaphor today, "a pilot once told me... when flying you have to know where you are going and set the controls to move towards that destination, but always know that the flight is weather dependent and may cause you to shift course." When flying through life this may not be as clear, but I suppose...
It is what it is.
Today in the family sitting area, I overheard one daughter say to her sister regarding their globally aphasic mother, "It is what it is." Their smiles following this statement implied acceptance.
Ah, acceptance. Coping with an illness isn't much different from coping with any other difficulty in life that requires acceptance, patience, and maybe even a little bit of faith. Faith that in the end everything will work out okay. Midge had yet another great metaphor today, "a pilot once told me... when flying you have to know where you are going and set the controls to move towards that destination, but always know that the flight is weather dependent and may cause you to shift course." When flying through life this may not be as clear, but I suppose...
It is what it is.
Monday, February 4, 2008
unspeakable difficulty
"Mommy you have to listen to Amanda. You have to do exactly as she says. We're all trying to help you here. We are a team. Amanda is a trained professional. Trust me. Trust her." I squatted next to the bed on the right as Janet, Mrs. Summer's daughter, squatted on her left and pleaded with her. "I want to take you home Mommy. You have to try. It's like I tell my children, you don't have to be the best, but you have to try. You can do this." Mrs. Summer's lips curled up on the left side into a smile. The right side of her face remained drooped, a result of the stroke that also left her speechless, literally. So I'm unable to ask her why after four days of working together, she's suddenly pulling away from me. Shaking off my hand, turning her eyes away, and attempted to utter some words of rejection. Is it frustration, confusion, anger, fear? Most likely a combination, but without the ability to verbally express herself we are left with a great distance of misunderstanding between us.
Wednesday, January 30, 2008
the rapport whore strikes again- day 3!
Day 3 and lots to report. My caseload has increased to 7 treatment sessions today! My first patient, the woman post stroke with right sided hemiplegia, aphasia (inability to process language, for more click http://www.aphasia.org/), and apraxia (difficulty controlling movements) is really coming along! Today she smiled at herself in the mirror and began using her left hand to clean her face. Ahh, the simple sweet power of intrinsically motivated occupation. Later in the day she sat unsupported at the edge of the bed for 30 minutes- I was completely amazed! Then she began to attempt to tell us something, "I want to bathe in the water." She became frustrated with our inability to comprehend and then the ah-ha moment! As we attempted to transfer her to the wheelchair I noticed signs that she had a little accident. The poor woman had gone to the bathroom and then sat in it while she tried to explain to us the situation. It all came together!
More excitement happened after lunch while I was covering a patient for another therapist. This 62 year old woman who was being treated for COPD exacerbation did not look thrilled to see me. She had just cut her chin while shaving the tiny hairs on her chin and was now lying flat on her back attempting to reach the tissues by her bedside without sucess. However, through the session she began to unfold and we really connected in a very therapeutic way. You see, I am a rapport whore. I love it and will pretty much do anything to get it. And the payoff was tremendous- by the end she was sitting up in her chair and looked like a different woman. "Wow, you just got me to do a bunch of things that I thought I'd never be able to do or want to do." As Midge would say, "That's stealth OT." As it actually so happened Midge was treating the patient in the next bed. After I left, my patient pulled Midge aside and mentioned how she'd been listening to Midge as she worked with her neighbor (see Midge is fun to listen to with her British accent). Then she said, "You know, it's funny, if that girl (me) had a British accent, I think you'd sound exactly the same. Your treatment styles are so similar." HA!
Lastly I finished up my eval with a 72 year old man, recently diagnosed with myelodysplastic syndrome with pancytopenia. Hmm, don't worry- i had to look this one up too! It's a blood disorder in which there is a dysfunction in the production of blood cells, thus a shortage of red & white cells and platlets. It is treatable with drugs and transfusions, but can lead to leukemia. Hopefully all will go well for Mr. W, in the meantime I hope to establish some rapport.
More excitement happened after lunch while I was covering a patient for another therapist. This 62 year old woman who was being treated for COPD exacerbation did not look thrilled to see me. She had just cut her chin while shaving the tiny hairs on her chin and was now lying flat on her back attempting to reach the tissues by her bedside without sucess. However, through the session she began to unfold and we really connected in a very therapeutic way. You see, I am a rapport whore. I love it and will pretty much do anything to get it. And the payoff was tremendous- by the end she was sitting up in her chair and looked like a different woman. "Wow, you just got me to do a bunch of things that I thought I'd never be able to do or want to do." As Midge would say, "That's stealth OT." As it actually so happened Midge was treating the patient in the next bed. After I left, my patient pulled Midge aside and mentioned how she'd been listening to Midge as she worked with her neighbor (see Midge is fun to listen to with her British accent). Then she said, "You know, it's funny, if that girl (me) had a British accent, I think you'd sound exactly the same. Your treatment styles are so similar." HA!
Lastly I finished up my eval with a 72 year old man, recently diagnosed with myelodysplastic syndrome with pancytopenia. Hmm, don't worry- i had to look this one up too! It's a blood disorder in which there is a dysfunction in the production of blood cells, thus a shortage of red & white cells and platlets. It is treatable with drugs and transfusions, but can lead to leukemia. Hopefully all will go well for Mr. W, in the meantime I hope to establish some rapport.
Monday, January 28, 2008
my first day!
the wait is over and the work has begun. today began my career. i can now walk into a room and introduce myself as an occupational therapist. it has the similiar feel to driving a car all by yourself for the first time. and i'm sure over the years it will become as routine as driving a car, but hopefully a very exiting hot car- like a 1972 Ferrari 365 GTB (which sold for 13.7 million in 2005- i've recently gotten into watching vintage car auctions).
anyway, back to the matter at hand- my first day. well first things first, the commute- can't get much better than living 1.3 miles from work. the car didn't even have a chance to warm up on the way there. then generally my day went like this... started out with basic orientation bruhaha, then human resource paperwork, and then my first patient (who was too tired to actually do therapy- dialysis is such a drain!) after lunch i became familiar with our computer based eval then put to use with my first official eval as an OT! very interesting case, which i'm too tired to go into, but i'm sure you'll hear details later. basically we've got a elderly woman post stroke who cannot speak, but can follow simple directions so she has some receptive language capabilities (in layman's terms).
the highlight of today was the surprise visit of a gentleman who wandered into the gym. he was a former patient who had returned for a stroke support meeting and wanted to thank his therapists 5 years since his stroke. "i took my first steps right here!" his enthusiasm and gratitude was the perfect blessing for my first day. hope that 5 years from now i can drive to work in my 1972 Ferrari and be greeted by such inspiration. fuel in the tank.
anyway, back to the matter at hand- my first day. well first things first, the commute- can't get much better than living 1.3 miles from work. the car didn't even have a chance to warm up on the way there. then generally my day went like this... started out with basic orientation bruhaha, then human resource paperwork, and then my first patient (who was too tired to actually do therapy- dialysis is such a drain!) after lunch i became familiar with our computer based eval then put to use with my first official eval as an OT! very interesting case, which i'm too tired to go into, but i'm sure you'll hear details later. basically we've got a elderly woman post stroke who cannot speak, but can follow simple directions so she has some receptive language capabilities (in layman's terms).
the highlight of today was the surprise visit of a gentleman who wandered into the gym. he was a former patient who had returned for a stroke support meeting and wanted to thank his therapists 5 years since his stroke. "i took my first steps right here!" his enthusiasm and gratitude was the perfect blessing for my first day. hope that 5 years from now i can drive to work in my 1972 Ferrari and be greeted by such inspiration. fuel in the tank.
Thursday, January 17, 2008
still waiting
i've color coordinated my closet. i've made it to yoga or to the gym every day. i've slept 8 hours every night. i've listened to NPR morning edition 4 days in a row. i'm organized, well rested, and all updated on politics. enough is enough people! put me to work!
every day i wait by the computer or the mailbox, just hoping that something might appear. it's really enough to make you crazy. i can't plan out my week. heck, i can't plan out the next day until 6pm and i'm sure nothing else is coming in the mail. my anxiety is peaking.
of course i'm not the only one who's life this delayed piece of paper is tragically ruining (slight dramatization). the effect is magnified by the thousands, seriously. i'm not carrying a caseload, therefore, every one has to cover for me. this means each therapist is probably seeing 10-12 patients daily, ultimately leading to burnout. the patients' care could be affected, which could impact their families lives. And what about the lives of the burnout therapists' families! it's one giant mess i tell ya.
but i'll also tell you this- my empathy meter is sharply rising. this is exactly (or closely) how patients must feel. waiting to hear from the doctor about their test results. waiting for the foley to come out. waiting to know if they're going home or to a nursing home. and of course they may also be sweating their impact on others lives- physically, mentally, and financially.
okay so now that i've learned that lesson and my empathy meter is at 99%, can i start work now?
every day i wait by the computer or the mailbox, just hoping that something might appear. it's really enough to make you crazy. i can't plan out my week. heck, i can't plan out the next day until 6pm and i'm sure nothing else is coming in the mail. my anxiety is peaking.
of course i'm not the only one who's life this delayed piece of paper is tragically ruining (slight dramatization). the effect is magnified by the thousands, seriously. i'm not carrying a caseload, therefore, every one has to cover for me. this means each therapist is probably seeing 10-12 patients daily, ultimately leading to burnout. the patients' care could be affected, which could impact their families lives. And what about the lives of the burnout therapists' families! it's one giant mess i tell ya.
but i'll also tell you this- my empathy meter is sharply rising. this is exactly (or closely) how patients must feel. waiting to hear from the doctor about their test results. waiting for the foley to come out. waiting to know if they're going home or to a nursing home. and of course they may also be sweating their impact on others lives- physically, mentally, and financially.
okay so now that i've learned that lesson and my empathy meter is at 99%, can i start work now?
Monday, January 14, 2008
waiting
If you are an OT student, reading this post could save you much anxiety. Well, at least help you anticipate the anxiety. Okay, actually this may prematurely create anxiety and probably shouldn't be read at all. But let me just tell you- going through the licensing process is long, tedious, and confusing! Here's been my experience so far... Finished fieldwork Dec. 14th, NBCOT closed Dec 15th (until Jan 3rd)! Meaning no online applications, no processing of paperwork, nothing. I setup my start date at my new job for Jan. 14th (today), but am still awaiting the arrival of my temp license which was held-up due to NBCOT's convenient 3 week closure. So basically I may be missing out on a week's pay and this month's orientation because someone hasn't gotten to my file yet which is just sitting on their next. Not that I'm placing blame, directly, I understand that Sally the assistant has 45 other files to review, but are they all supposed to start work today? My guess is no.
Phew. Needed to get that out. It's just so frustrating- checking my email every hour of every day to see if I've gotten the temp license numbers and not knowing when I'll actually start, could be tomorrow, could be next week. But I suppose things could be worse. I'm not totally strapped for cash (thanks to the $8 million in student loans) and I do get some extra days off. Good practice in learning to enjoy the moment and attempting to appreciate this current state of limbo.
Phew. Needed to get that out. It's just so frustrating- checking my email every hour of every day to see if I've gotten the temp license numbers and not knowing when I'll actually start, could be tomorrow, could be next week. But I suppose things could be worse. I'm not totally strapped for cash (thanks to the $8 million in student loans) and I do get some extra days off. Good practice in learning to enjoy the moment and attempting to appreciate this current state of limbo.
Friday, January 4, 2008
life in the off season
i'm into week 3 now of my month off between the end of fieldwork and the start of my career. next week i hope to sit for the exam. yikes! i've put in a little study time (2 hours) but hope to really crunch it out in the next few days, in between unloading boxes of course. i'm moving tomorrow!
life is really about to change. new year. new place. new career. new body (i'm in the middle of a major detox after the holidays). but same old blog. have no fear, this nonsense is going to continue right through 2008!
life is really about to change. new year. new place. new career. new body (i'm in the middle of a major detox after the holidays). but same old blog. have no fear, this nonsense is going to continue right through 2008!
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