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?

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.

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!

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."

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."

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.

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.