Go Stand

Ever since I was little, I was always so easy to please. I would get excited over the smallest things, maybe even just as much as things of greater importance. Well now that I am not so little anymore, nothing has really changed. Sometimes I think I need to not let my emotions get the best of me and be a little more, I don't know, withdrawn. But welcome to the life of an occupational therapist. Or any therapist for that matter. Where everyone's business unpurposefully becomes your business. And everyone's struggles become your struggles. And everyone's little successes become your own. If I didn't like connecting and helping people take more control over their own lives, then I would've chosen a different profession.

The other day I assisted my patient in a shower. He is slowly but steadily making progress in building endurance and strength in order to perform his morning ADL routine independently. We've been working on fine motor skills a lot because, for what seems like the longest time, he could not button his shirt on his own or fasten his belt. I've always encouraged him to try his hardest and when he gets to the point where I feel like he is getting so frustrated and mad at life, I intervene and do it  for him -telling him that we will try again tomorrow and that it's frustrating, I know, but I'm happy he tried his best for me. My patient is such a sweetheart. He takes a deep breath, sighs, and mumbles, "Ok". Well the other day, I handed him his shirt and told him, as I do every time, to try his best and I'll help if need be. He sat there for a minute so I went to grab my clipboard from his room, dreading the thought of having to document the same assistance level as I had the past few notes. When I got back, he got the first button on! He was working on the second. And pretty soon he was on the third, then the fourth. No rest breaks. No signs of fatigue or frustration. He finished in about 5 minutes but he got it done. Independently, too! I jumped up and down clapping and demanded a high-five. My patient laughed. I'm not sure if he was excited that he finally buttoned his shirt on his own or if he was just amused at how strange I was. Today I had the exact same reaction to my patient who donned his socks independently using his sock aid. He was a proud man, let me tell you. He told me his family came over to visit the night before and gathered around so he could demonstrate how to use the silly piece of adaptive equipment. That was a good moment.

I have also done a few more firsts these past two weeks. I did my first solo home evaluation. The facility driver took me and my patient to her daughter's house (where my patient will be discharged to) to assess safety and accessibility, and to give any recommendations for continual progress at home. We went through each room, laying out what daily tasks my patient would be participating in and how that may look like within this home environment. At the rehab facility, we get to work on so many things and train and educate patients on what to do once they go home. But it is so beneficial to actually observe and see the patient in their home environment because that is realistically what they will have to deal with once discharged. I thought that home eval went pretty well. The family was very supportive and accepting of my recommendations -which were not very many since their house is already really accessible.

I also got my very first shoulder case. She had a total left shoulder arthroplasty done and was admitted from the hospital on Monday. The doctor's orders say only pendulum exercises on her shoulder, and active movement allowed at her elbow, wrist, and fingers. Her sling can only be removed 3x/day and her surgical area must always be wrapped during showers. She is doing well and I'm pretty sure she will be discharged home some time next week, depending on what nursing and physical therapy agree upon. I remember when I first evaled her, I asked her to perform a sit to stand transfer for me as I searched for her walker. Well she had none. Duh. Her legs were just fine. I have been so used to patient's with hip and knee surgeries that I automatically think "Where's the walker?".

Last week I did my first group session with my friend/ex-classmate from grad school (we now joke at the fact that we are "colleagues/co-workers"). Our patients were ones who needed more functional transfer and proper body mechanics training. So we played "Go Fish", which actually turned into "Go Stand". We went around the table and every time someone did not have the card another patient asked for, they had to perform a sit to stand transfer and reach for a card from the deck. It was fun and the patient's enjoyed the company of others with the same diagnoses. Two of them now meet up in the dining room for meals instead of having them brought to their individual rooms.

I have also had to do a lot of research these past two weeks, which is fine with me because I like being able to explain why I'm doing what I'm doing and learning more in the process. I had a patient who had sensation problems in her right first and second digits so I taught her some desensitization techniques. I knew what to do, I just didn't quite know how to explain them in laymen's terms as to WHY they work. I have also had to research the rational behind pendulum exercises because there had to be a more in-depth explanation than simply regaining range of motion in the shoulder joint. But no. That's pretty much it. I have also had to explain to a patient the reason for continued skilled services and give my professional opinion as to why I think they are not safe to return home. That has been the hardest part so far because I understand that patients don't want to be here and want to sleep in their own bed and cook in their own kitchens and watch TV on their own living room couches. But if I don't keep my patients' best interest in mind, then I am not doing my job. And it will be most likely that patient's who are advised not to return home quite yet, fall and end up back where they started. Nonetheless, patient's leave when they want to leave, and refuse therapy when they want to refuse therapy. So all I can do is give them and their caregivers the best recommendations and home safety program I can so that returning to rehab is prevented.

Quote of the day: 

Occupational therapy assistance says to nurse administering pills to patient undergoing therapy in the gym: "If you make him nauseated, I'll kill you."

Rehab Planking

In getting through my week, I have realized how important it is to not only document my experiences with being a new occupational therapist, but to write down some of the funny comments that come out of people's mouths. Because these are the kinds of things that will help get me through the day when things aren't as amusing. So here we go:

80ish-yr-old patient during a cooking activity: You pinched my boob!
COTA: Sorry, I didn' realize they were down there.
Patient: Oh yeah, they're down there alright. Like lemons in socks.

Me: Did your wife leave?
Patient: Yeah. And frankly I don't give a damn if she ever comes back.
*awkward silence*
Patient: She ticks me off.

Me: You didn't shower yet this morning did you?
Male patient: No. I told the nurse you had first dibs on me. I don't know what it is with you and watching me shower.

Me, walking in my patient's room: MORNING!!
Patient: Oh no.  

PT: I like planking. Wow that sounds dirty.

Patient sitting in gym across from another patient: WHAT'S WRONG WITH YOU?!

Patient during fine motor activity: Now when am I ever going to use PEGS? I don't have PEGS!

Patient sitting up in bed: I'm pooped.

Me: You POOPED?!

Patient: Oh god I hope not.

Patient: I finished the plane while you were gone. In standing, too! I won't mind if you document that I did even though you weren't really here.

Me: Uh, no.

The New Job

I'm on my second week at my new job and I love it. I love how fast-paced it is, how many resources are available, how we can do community outings with patients, the mentorship, and the entire rehab team. I am especially excited to be working with two of my ex-classmates from grad school. I am excited to learn and grow together. I found this one and only picture of us three together. Now looking at this picture, how can rehab NOT be fun?! Apparently the staff outside the rehab team call us the triplets since no one can quite get our names straight just yet.

The setting is definitely challenging, but I have learned so much within the first week and a half. This setting feels like a mixture of a whole bunch of settings. It feels like acute rehab in that we work on ADLs in patient's rooms, it feels like inpatient rehab with our gym to bring our patient's to, and it feels like outpatient rehab with our community outings and home evaluations. I am never bored or complain that the day is dragging.

My schedule pretty much starts at 6:45 AM. I get the list of patients that I need to see. I visit my patient's rooms to schedule when to see them that day and then I start my treatments at about 7:00 AM (if I'm lucky and fast enough). Treatment usually involves assisting patient's with showering, dressing, transfers on and off the toilet -that sort of thing. If a patient does not need a shower that day or has been showered already by a CNA at the crack of dawn, we usually go into the gym to work on endurance in standing while doing a functional activity in dynamic standing. That could be anything -a puzzle, a board game, cooking in the kitchen, theraputty exercises. Or we'll do bilateral upper extremity exercises with theraband, weights, the machines -depending on the patient's goals, of course. Then there's always energy conservation or home safety education with patient's and families. I'll take a 30-minute lunch break, catch up on paperwork, see one or two patients more, finish my paperwork (daily notes, weekly progress notes, eval reports, discharge reports), bill, and clock out. Some times we'll get new admits around noon. If that's the case, then I'll do an eval for fifteen minutes. I go home, get to bed some time between 9:00 and 9:30, and start my day all over again.

So far I have had some pretty good experiences. My first ever patient with an orthopedic injury happened to be a simultaneous bilateral total knee arthroplasty. Yes, SIMULTANEOUS. Both knees. Toe-touch weightbearing on the right, weightbearing as tolerated on the left. I walked in, planning to evaluate for fifteen minutes and then treat for another sixty, but walked out a little short on my time because of my patient's pain level. We agreed on a treatment session at 7:00 AM the following day once his pain is properly managed. I prepared that night, thinking of how to exactly assist this patient in transfers from his bed to his wheelchair to the toilet to the shower. I'm surprised I didn't wake up at two in the morning re-thinking the scenario in my head. When I walked in that morning, the CNA tracked me down and told me he was waiting up in his bed for me. Here we go! Every transfer was going successfully with assistance from one of the CNAs, up until we got the patient out of the shower in his wheeling shower chair to the side of the bed. He looked at me and said, "I don't know how you expect me to do this transfer. I have never tried standing up from a surface as low as this." Well, shit. I stood there thinking I need to figure this out QUICK, I have to make it seem like I know what I'm talking about, and I need to actually KNOW what I'm talking about so that he doesn't fall flat on his face and traumatize me from bilateral knee patients for the rest of my life. So I figured, ok, it's all about body mechanics. I had him scoot to the edge of the chair, bring both legs out straight as far as he could, push off of the shower chair arm rests (that would NOT come off, which is why we did not do a sliding board transfer onto his bed. That would have been nice), grab a hold of his walker and push down into it to lift himself up after the CNA and I pulled him up far enough under his armpits with max assistance. From a standing position, we did a pivot, raised his bed to his butt, and had him ease onto the edge of the bed. Success! He looked at me and said, "That went a lot smoother than I thought". I think I gained his respect that day. Before I left, he asked me what my name was since I did not have a name tag yet. I told him Katharine. He said, "Can I call you Kathy?" That was fine with me. Since that day, he has been making slow but steady progress. He performs his transfers with contact gaurd assistance now, some times stand by assistance. Today, after working out in the gym, showering, donning his very uncoorperative ted hose, and discussing potential adaptive equipment he may need at home, he was ready to transfer from his wheelchair to the bed and call it a day. I bent down to help lift his legs, but he put his hand out and said proudly, "Nope nope! Just watch!" He did the transfer on his own. I was so excited for him! Then he asked if he could go home Saturday. Aw crap. Double shit. In our meeting yesterday we decided he needed another week. I did not tell him that because I was advised not to just yet, but I did tell him that I felt Saturday is too early and that I want him to be 100% safe in being alone at home. He wasn't happy. But he didn't give me a hard time about it. Thank goodness.

For The Birds

Lola, Tania, and I used this last week of mine to really get the most important things done. For Lola, it was arranging the corner of her apartment that was crammed with so much stuff that she couldn't get to her birds to feed them. And for Tania, it was painting her birdhouse.

Before Lola and I started, she wanted me to help put her pain patches on. She turned around, hunched over, and blurted, "Put it above my crackademia". Then she laughed, turned around, and said, "The crackademia. What's that mean? Phobia of the butt crack!" This was going to be fun.

This was the task at hand: Lola wanted to remove the big file cabinet sitting under her book shelf sitting under her two bird cages. She wanted to replace it with her chested drawers and bring the file cabinet out to the dumpster. The first thing to do was to figure out how to even start. There was no room in that little corner of hers or anywhere else for that matter. Lola's apartment was full of clutter and she was the first to admit it. We stood there, staring at everything, when Lola said, "I have a dream. As soon as we get our shit together, the dream will come true". We ended up piling things on top of more things and inching our way around the furniture -with me all the while demonstrating and teaching Lola about good body mechanics. With Lola's impulsive tendencies, I had to stop her many times because she would pull instead of push, or not bend her knees, or lift boxes away from her body, or not initiate rest breaks when she was clearly fatigued and out of breath. It took a good hour and a half to get the job done, to sweep all the bird seed away (until Lola knocked over the cup she swept the seed into and had to start all over again), find a dollie in the building, and wheel the file cabinet to the dumpster. Lola was so happy she gave me the biggest hug as she said, "Thank you, baby girl. You're my girl."


From the first day I met Tania, I couldn't help but notice her wooden birdhouse on top of her kitchen shelf. When I asked her about it, she told me she always wanted to paint it but couldn't open her paint bottles. So that's what we did on my last visit with her. She's been doing so well with her theraputty exercises -doing them at home twice a day when not even asked of her. I can tell because when I have her demo them to me, she knows exactly how to do them and it almost looks as if she's using a less resistant putty than she started out with. Tania was now able to open her paint bottles by herself.


Tania's stroke affected her fine motor coordination but not as severely as I have seen in past clients on fieldwork. The great thing is that, even though Tania stopped arts and crafts after her stroke, she still loves the thought of doing them and using her hands as much as possible, which gives her excellent rehab potential.  Tania was able to paint her birdhouse on our last visit in about fifty minutes. It was slow, but she got it done. She told me, "When I do crafts, I get lost. I can go on for hours." I told her I was the same way. We cleaned up together -Tania putting the caps back on the paint bottles, rinsing out the brushes, crumpling the newspaper to throw away, walking to and from the sink and trash can and table. It was all great therapy and she knew it. I was so proud of her. She listens and follows-through with everything asked of her -a therapist's perfect client. The past few days she's been walking by the gym using her walker instead of her powerchair. She's been walking faster and appears more stable. The PT assistant says she's been making so much progress. I told Tania I was so excited for her and that I can only do so much in outpatient therapy. Progress is seen when clients carry out and follow through at home. Tania does just that.