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.
Saturday, May 17, 2008
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."
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