all in a days work

work can appear so random at times, for instance... today I helped someone get dressed, taught someone learn how to use a cell phone, cooked rice and beans aruban style, and gave a massage. And that's all in between reading charts, lab values, chasing down doctors, and speaking with family members about their loved ones. Man, no wonder why I'm exhausted at the end of the day!

can't fix 'em all

It's difficult to accept, but true. I'm not a super healer. I can't make it all better for everyone. Not to say that this was ever my assumption, but some days it's just more apparent than others. Like today, the look on Mrs.'s P's face said it all. Her husband sits in his hospital bed staring out the window to the right, unaware of the left side of the room. He needs two people to help him with washing in bed, someone to clean up his bottom several times a day as he cannot control his bowels, and someone to feed him. His mind is clear, he knows and is able to say where he is and what time it is. He knows he's impaired, but wants to get home so he can help his wife. He's concerned about her, asking her "Who's helping you take out the trash? I gotta get home so I can help you with the bills." She's called asking her husband for directions to her doctors office. They have no children and few friends have come to visit or show support. All they seem to have is each other and I'm witnessing the slow painful awakening that their lives are completely changed. I want to do more. I want to make it all better.

goodnight moon

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.

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!

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.

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

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.