She started crying sitting at the edge of the bed combing her hair. I sat next to her, hiding my own tears. Such a simple task, now such an achievement. No one would have imagined this 38 year old woman's life being turned upside down the way it has been over the last two months. On January 18th 2009, she gave birth to her second child, a perfectly healthy baby boy. Then after two weeks of being home with her growing family, she started to not feel well. Her doctor recommended that she go to the hospital, just to get checked out. A few days later she was comatose, vented, on dialysis, and receiving final blessings from family and friends as she went into multi-organ failure due to a pneumonia and sepsis.
After swift medical interventions including a course of IV antibiotics, she began winning the uphill battle- her lungs and kidneys returned to function and she became stable enough to be transfered to our hospital for rehabilitation. Initially she needed all of our help to bring her sitting to the edge of the bed, the next day she needed half help, and by day 3 she was sitting up on her own! Sure signs of her body's resiliency, but emotionally she was struggling. Imagine being away from your newborn for over one month!
So we began the "books on tape" project, (can't take credit for this one, thanks Colleen!), voice recording my patient's voice reading stories and special messages to her children. Her family at home then included this into their bedtime routine so they could be used to hearing their mother's voice. Like brushing your hair, reading a bedtime story has never carried so much meaning.
Monday, April 6, 2009
Thursday, December 18, 2008
talk to me
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!
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!
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.
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