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.
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!
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