Two Week Notice

My last day at this facility is next Friday. I gave my two-weeks notice on Monday. I will be starting my new job with two of my ex-classmates from OT school on July 5th and I am super excited. If it came down to just my clients and the PTA I work with, I wouldn't even consider this opportunity. But as many of you know, there are several factors that make a therapist's job the way it is, and so let's just leave it at that. I know I am making the right choice and I am excited about this new opportunity.

All I can say is that I did not expect to bond with my clients in such a short time. I have already told those who remember who I am. For those that have severe dementia, resulting in poor short-term memory, I figured that there is no use introducing myself and building rapport (something I have to do at every visit) and then saying my goodbyes all in one session. I did not want to make them feel they were losing someone -for many of my clients, therapy sessions are the only visitations they have and they forward to it.

I have been putting off telling "Ernie". Ernie is very special to me and I am going to miss him the most out of anyone I work with. I guess the best decisions aren't always the easiest, but Ernie understands. He wheeled into the rehab gym today and asked, "You seeing me today?" We went for a walk outside and around the garden. He pointed out the different plants and he told me stories about how he used to harvest corn growing up. Then we went back to the gym to do some ther ex. Afterwards, we went to the dining room to get Ernie's beverage of choice (probably his only beverage of choice because he drinks it more than water) -diet coke, no ice. After our session, I walked Ernie back to his apartment, thinking to myself that today was the day to tell him of my leaving. I told Ernie what a great job he did today and he squeezed my hand. Before I could say anything else, Ernie said to me, "I always look forward to our time together". Oh crap. I thought I was going to cry. But I told Ernie then. Horrible timing, I know, but there will never be a perfect time with Ernie. I told him another opportunity came up that I had to take. He showed me the lip. I told him I would visit him. And he said I better. I am definitely planning on it.

Scheduling and Gardening

My schedule Monday morning looked a little something like this:

8:00 AM Lola - re-schedule (out smoking).
9:00 AM Tania - re-schedule (wants to smoke with Lola).

So I sat in the gym writing poetry (yes poetry) and munching on beef jerky because the computer did not work for me to actually be productive and get my weekly notes done. With that all said, let me tell you what I don't like.

I don't like scheduling my own clients. For one, you cannot really schedule effectively because they have a million other facility activities (which I am so glad they attend to stay active and involved), and second, even if I do schedule them, my clients forget 99% of the time who I even am and why they are having occupational therapy -let alone remember a therapy schedule. So I basically hang out in the therapy gym, waiting till I see them wheel by so I can chase them down. Or I'll visit their rooms hoping they are inside and not a grumpy case. I do enjoy my grumpy clients though!

The other day I heard one of my 93-year-old clients yell, as she was shuffling to the door with her walker to let me in, "Now what the hell are we doing today? That exercise shit?!" Wow. Those are the two descriptors I have ALWAYS thought of using when asked to describe OT -"exercise" and "shit". I have obviously not done my part. I used the time to do a little educating on what OT really was about. I was certain I would have to re-live that conversation at the beginning of our next session, and quite possibly for the weeks to come.

When Lola WASN'T smoking and decided to do therapy, we planted a patch of flowers outside her back door. I'm pretty sure I got more out of it then she did because I do not have the slightest clue how to plant anything in the ground, much less keep it alive. But Lola taught me. She showed me how, before you start digging blindly into the ground, you have to first shape it. So she got a knife, stabbed the ground (which eventually broke the knife), and traced a half moon from her wall. Then she poured water along the area she traced and asked for a shovel. I had none. "Well good lord, Katie. How are we gonna do this cognitive therapy without a shovel. Let's go." She clung to my arm and walked me down the hall. She stopped halfway and pointed through the glass window at some other resident's porch. Standing as clear as day against the wall was a shovel. "Come on". Lola snuck behind the back of the building, knocked on the porch sliding door, and when no one answered said, "Ok, we're taking it. I'll ask to borrow it later. And he'll say yes and it'll all be good." So we walked back to shovel out Lola's garden. As she was shoveling away, I thought to myself, "Is this even allowed? She's digging up the property, with a shovel that isn't even hers." I just hoped that whatever we were creating was going to look better than what it originally looked like.

The whole process of digging and walking over to find (well, steal) a shovel, clean it, and return it took a whole hour. Before I knew it, I had my next appointment. So we called it a day and Lola instructed me on buying her a bag of potting soil so we could continue this project the next day. When the next day came around, Lola taught me to muddy-up the soil, scoop it out, place the potted plants that were broken apart at the roots, stabilize them with the mud, cover them with the potting soil, water them, and wala! She had a little flower patch outside her back door. I just had to take a picture of it:

At first I thought this activity was not going to be therapeutic in that I was probably the one needing some kind of gardening intervention. But the more I thought about it, the more therapeutic it became. Body mechanics, posturing and positioning, balance, sit to stand transfers, tool manipulation, reaching, weightshifting, strength and endurance -all obtained with a functional activity that addressed Lola's goals. So I was happy. But more importantly, Lola was happy. Because it was something that was meaningful to her.

Next week, Lola wants to finally do her laundry.

Quote of The Day

Today I came to the conclusion that if someone created a show called "Old Folks Say The Darndest Things" it'd be just as hilarious as the original.

This morning I visited my client "Nona" (Nona, who likes to sing her "Nona-Doe" song). She had the television on full-blast to one of those doctor talk shows and was sitting plopped in her automan with her legs dangling off the side of the arm rest. When I asked her what she was up to, she said in a very serious voice with her eyes still fixed on the television screen, "Shhh, they're talking about private parts, now we better listen."


"Lola" wheeled into the rehab gym this afternoon, asking me to help her patch some spongy-jelly-thingy on her spine because she felt like crap. If you know Lola, you learn not to ask certain questions and just go with it. As I was taping this spongy-jelly-thingy on her back, she asked me if I did anything fun over the weekend. I told her that my friends and I went dancing Friday night and how I used Saturday and Sunday to recover. She laughed and said she used to dance in the clubs when she was younger. Then she asked, "Meet a cute boy?" When I told her no, she blurted, "That's the problem with those men! They either think with their right head or they think with their WRONG head! Men and their two heads!"

Week two, check.

WOW do I have a lot of stories to tell you! I have met some of the most interesting people these past two weeks and have had some of the most interesting experiences. Let's hope I can remember them all.

My very first client ever (let's call him Ernie) has become very special to me in just my first two weeks that I have told myself, if I had ever been given the chance to experience having a grandfather, I would want him to be just like Ernie. Ernie is always smiling. And what I appreciate the most about him is that he tries to do whatever I ask of him, no complaints. And once he finishes the task, he either says "I did er!" or "I'm losing my britches!". He loves his diet coke so during our first treatment session, to work on increasing flexion in his shoulder, endurance in standing, and proper body mechanics, I had him stock his fridge with cans of soda. Boy was he a happy camper! Last week it was such a nice day outside that I decided to take him out and do transfer training under the sun. Ernie uses a powerchair. And he is FAST. On our way back, he sped a little too fast that he accidently went over the edge of the sidewalk, spinning in circles on the grass hill because of his delayed response to take his hand off his stirring stick. I almost had a heart attack and thought I was gonna get fired on week two. So I had Ernie do a sit to stand transfer right then and there -talk about therapy in a natural environment with realistic circumstances! Geez. With my help, Ernie shuffled to the wall of the apartment complex. As soon as he got there, I told him to stay put and don't move! I got his powerchair up and over the lip of the sidewalk and he successfully sat back in his chair. Heading back to his room, I noticed that Ernie eased up on his stirring stick. Phew.

Another one of my clients (let's call her Lola, just because) had recently had stomach surgery due to a hernia and is supposedly on 5-week bed rest. I say "supposedly" because I always find her wheeling around in her powerchair all slouched over with her pink baseball cap halfway on her head and tilted to the side with a huge mug of some apple-cider-vinegar concoction in her hand. She has a hoarse-sounding voice and she LOVES to talk (and at a hundred miles a minutes at that). And I love talking to her cause she always has so much to say. Every time I see her and ask how she's doing, she always lifts up her muumuu to reveal her bloated tummy and bandaged stitches. Now remember how I told you she's suppose to be on bed rest? Well one afternoon as I was doing paperwork in the gym, Lola walked in. Yes, WALKED in. I didn't notice that she had left her powerchair parking in the gym. I turn around and said, "Lola! What are you doing?!" She looked at me from under her baseball cap and said in her trucker voice, "I had to move my car to a different lot". "Lola! You DROVE your car?!". She froze and it was as if I could she her brain ticking. She got in her chair, wheeled to the doorway, turned her head around, and with a half grin on her face said, "No" and sped away. Oh Lola. Recently our treatment sessions have been home management activities -organizing her apartment. And since she's on bed rest, I've been trying to convince her to sit in bed so I could bring a few light things for her to sort through. Lola's apartment is a mess! She calls it her disorganized organization and it's so true. Because whenever I ask her for a medical phone number or some tape or her reacher, amidst all the clutter, she knows exactly where it is. "See that red box next to the pile of magazines behind the bin with the books under the table with all the clothes piled on top of them? That's where it's at my love". Oh Lola. Our last two sessions have consisted of creating a binder to organize all her phone numbers in. Lola writes numbers on pieces of paper and sticks them on her wall right by her bed. Her entire wall is a collage of papers with names and numbers. It's almost like a piece of artwork. So far we have organized about 50 numbers. About 200 more to go I would say.


Speaking of organizing, I walked into another one of my client's apartments today to find a massive amount of cassette tapes lying all over the floor of her bedroom. She told me she was trying to sort through them but that her back started aching and her arms started hurting from reaching. So we used our hour sorting through cassette tapes. Let's call this client of mine Tania. Tania really enjoys occupational therapy. She loves that we can do what is meaningful to her and that I can help her find ways to make it therapeutic. Because she was fatigued and sore in her legs from her PT session the day before, I figured I would ease up on her and have her sitting for this activity. I had her hold her box in her lap and reach for cassette tapes I would hold somewhat overhead. That way she was still working on gaining some shoulder flexion and sitting balance as well. I swear we sorted through 200 cassette tapes, all the while talking about our lives. She told me I reminded her of her granddaughter because when she used to visit her, they would work on getting stuff done but talk about their lives while doing it. I realized how she trully loved therapy when she got a phone call towards the end of our session. It was the front desk inviting her on one of the facility outings. She raised her voice, it took me off gaurd, "I am having therapy! Yes, ther-ah-pee. My arms and legs are much more important and I gotta get em fixed!". And she hung up the phone. She looked at me, rolled her eyes, and said that the only activities she attends at the facility are the trips to Walmart so she can buy her craft materials, and the wine and cheese-tasting event in the library that the director runs every month. I thought that was pretty awesome. Nothing like a group of elderly people with their wheelchairs and walkers, holding a shaking glass of wine and attempting to stab cheese cubes with itty-bitty toothpicks.

There was a time (during the course of my first two weeks) that I thought I was again gonna get fired. One morning I went to Tania's apartment for therapy and she asked me to sit out on her porch with her. So I go out there and sit across from her. She takes a lighter and shakily lights her cigarette that she is trying so hard to maintain between her lips. "Ummm.....", I think to myself. "Is this therapeutic? What were we taught to do in school when we came upon a situation like this?". I figured I'd just go with it. What the heck, I was still building rapport, right? Therapeutic relationship? Oh my gosh, what would my professors think of this? After a minute or two though I felt like I was going to pass out from just trying to breathe so I asked Tania if I could go back inside and look through her craft collection to think of ideas for therapy today. She had a wooden birdhouse to paint, those sun-catcher things that look like glass, puzzles, knitting kits.. I was so exited. When I went back out to call her in, I caught her hunched down with one hand on her hip, peering through the screen she had draped on the porch. I asked her what she was doing. She said, "The lady in that office right there always looks up here to see if I'm smoking on my porch." Holy shit! "Tania! You're not allowed to smoke?!" "Oh I can smoke. Just not on the porch. I've been caught twice. You get kicked out the fourth time. So I figured I'd wait to get caught the third time." Again, I thought I was going to get fired my second week. "Tania, let's just go paint or something, ok?" And we went back inside.

Let me just tell you that yes we are taught about hallucinations in school, but by golly, how interesting it is to actually witness it in the living flesh. Another one of my clients (let's call her Edna) sees her children in the room with us while we're doing therapy. She's one of my tough ones and I need to do more research so if anyone has any treatment ideas, please throw them out there! One time we were sitting and talking when she suddenly she burst out yelling at my stomach. She screamed, "God damnit!! Stop it!! Cut it out!!" She said that her 25-yr-old daughter was running around and around and around me. Then she would scream again at her. I must've had the most shocked look on my face because Edna looked at me and said, "I know it sounds crazy but I see them and they don't talk and it's so frustrating and nerve-wracking." I told her I didn't think she was crazy and that I believe she sees things. I thought to myself, well at least she has good insight into her hallucinations. She said she's gone to the doctor, got perscriptions, but nothing has worked. She said if I can help her with her hallucinations that would be wonderful. All I could think of was distracting her with meaningful activity, but how can I do that when there's some girl running around me as we DO therapy?! On top of hallucinating, Edna has severe macular degeneration. She holds her arms out and looks not quite in my eyes and yells, "I can't SEE!". She has difficulty finding her self-care belongings on the sink, which makes her pretty dependent with self-care tasks. We agreed upon organizing that sink counter for our first session -getting rid of items she rarely uses that just serve as visual distraction, marking spots on the counter to return her items to (more for the nursing staff because Edna says everything gets out of place after they help her with her self-care), and sticking familiar material on certain bottles that have similar shapes so that she can recognize them (for e.g., sticking velcro around her lotion bottles and furry cloth around her powders). If anyone has any other ideas, please spill! As I was leaving that eval that day, I found another lady gripping onto one of the corners of the third floor hallway. She was crying and so I thought maybe she was lost and couldn't find her room. When I asked her if she needed any help, she said her husband was being revived by the doctors and she pointed down the hall. I looked down the hall with my mouth agape. There was no one there. As I asked her what room number she lives at so I could coax her into going back, she snapped, "Shut up!". So I backed of and found a nurse to help her back to her room. You learn to not take things personal at this facility.


If there is one thing I have realized when scheduling my clients, it is that some people are just not morning people and some are just not afternoon people. One lady (let's call her Sue) is someone I normally see in the morning so I can help her with her ADLs (and emptying her purse to find her toothbrush. She hides it in there because she thinks someone else tries to use it. On top of having her toothbrush in her purse, I have also found silverware and table clothes from the main dining room). Well, I had a busy morning that day so I decided to visit her after lunch one day. As I was doing paperwork in the gym, I saw Sue walk by with her walker, heading back to her room. She had her clothes on from yesterday with her night gown draped OVER her clothes. Sweet, time for a dressing intervention! I got up and followed her. When I asked Sue if I could see her that afternoon, she forgot that she even was having therapy. So I had to go into the the shpeal of why I was seeing her, which I've realized I've had to do on several occasions at this facility. She agreed to do therapy in her room. So I followed her. A second later (literally a second), she turned around and said, "Why are you following me?" Oh no, here we go again. I said, "To do therapy with you. Where are you going?" I guess that ticked her off cause she yelled, "That's none of your business!" I was stunned. She looked like she was going to eat me alive with her eyes. So I said, "Alright Sue. I just have one more visit with you for the week so let's just re-schedule for tomorrow, ok?" And she said "Yeah today is my rest day" and zoomed off. The next day, I woke her up, we did ADLs, and before I left she told me I was her favorite "helper". I got to the gym and wrote in big letters on my schedule, "SUE - MORNINGS ONLY".

If Sue is not an afternoon person, then Dana (fictitious name yet again) is not a morning person. We went for a walk outside one morning and she looked like she couldn't wait for me to leave her alone. As we were going up a hill, her walker got stuck in a crack so I helped her re-position it. She stopped, took a deep breath, and said, "Just let me do it". When I let go, she rolled her eyes. The next day I saw her in the afternoon and she was a lot more pleasant. I learned with her that sometimes, in order to even be successful with therapy, you have to just take your time and talk and listen. Dana told me she had a cat that she loved dearly but stayed with her sister now because her apartment just wasn't big enough for her. I asked if she had any pictures and she brought out an album of old photos from when she first got her. We spent the first 30 minutes of my visit flipping through it and she would tell me stories for each page and I would tell her stories about my dog. We laughed a lot. I left realizing we bonded and intervention wouldn’t be so bad from that point forward. Baby steps.

I have also now learned a song that I will remember forever. The lady I learned it from (let's call her Nona Doe) told me her brothers sang it to her growing up. Well it goes like this: "Nona Doe, a bag of bones, a belly full of fat. And when she cries, she shuts her eyes, now what do you think of that?" Every time I see Nona and say, "Hi Nona Doe!", she continues with the song. It's pretty entertaining. Nona has dementia. At times she thinks she has a roommate. Other times, I'll ask her what she's up to when she's in the lobby and she'll say she's downtown about to go home. Despite this, she is the most pleasant lady. She does everything I ask of her and is very chipper doing it.

For the most part, my clients love that I am a new grad and that they are my first clients. One lady who is not my client but keeps coming into the gym asking if I could be her OT told me on my second day, “You know how sometimes you feel like you’ve known someone forever? Well that’s how I feel with you.” I was gonna cry.  I have client's call me Kathy, Katie, sweetie, honey, dear, love.. And then I have a client who tells his little harmless poodle to bite me because he doesn't want to do his strengthening exercises. Sometimes I feel like I don't really know what I'm doing, but that's ok. Sometimes I'll ask my client's what they want to work on next time I visit. One wants to paint her wooden bird house. Another wants to learn to use her microwave even though she can't see the buttons so that she can make tea. And another wants to simply organize all the junk on her dining table. My job is to make it therapeutic, which is the fun part. At the end of the day, I don't care about the marketing or business aspect of outpatient settings. All I care about is providing skilled service to my clients. I love writing MOT, OTR/L after my name. And I love calling the doctors and families and introducing myself as an occupational therapist. It is surreal and I'm doing it! I am finally here!

Holy Shiz!

I have survived my first two weeks of my first full-time job (ever) as an occupational therapist! After my first day, I thought to myself, "What the heck am I doing?!" I came home bawling -my mother thought I got fired. And I thought to myself, this is no longer grad school. So suck it up, Katharine. I am no longer gonna have someone grading my treatment ideas or giving me a schedule of what I need to get done during the semester. I will no longer be in a classroom with the same 26 amazing people I have been with for the last 3 years -some of whom have become my bestfriends. Man do I suck at change. But as the days went on, and I started to get to know my clients, I realized that this change will be good. I am at a stage in my life that is so new and exciting. So I thought what better way to document every step of the way with my very first blog! I figured it could be a place for people to swap treatment ideas, or learn more about occupational therapy, or to simply read about some fun and interesting experiences. So welcome! And enjoy!

P.S. - In keeping with confidentiality, I will not be telling you what facility I am working at. What I can tell you is that it is an assisted living facility and my clients range between the ages of 55 to 93. If you asked me my first day of grad school where I wanted to work, this setting and population would be the last one on my list. Who would've guessed it? And since many of you already know where I work anyway, I will not be mentioning room numbers, only floors. And all names will be fictitious -although I do wish I could tell you because the names of my clients have so much personality in itself! But I would like to keep my job, and not to mention the respect of my clients. So there goes it.