"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
Sunday, November 30, 2008
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.
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