Goodbyes

I usually don't like saying goodbye to people. But at my job, discharge (upon therapist recommendations, of course) is always a good thing. I like to tell my patients, "I've enjoyed working with you, but I hope to never see you in this environment ever again".

I have a patient who is going to be going home on Wednesday. She had back surgery recently and also presents with cognitive problems, which makes recalling (and following) her back precautions next to impossible. She would impulsively twist to reach for a pillow, bend to put her socks on or pick something off the floor.. And I'd find myself telling her, "No- Stop- Wait- Don't do that-", as if I were babysitting a 2-year-old. At one point she didn't even remember having precautions. And when I attached the tab alarm to her, so that nursing staff would be called if she ever attempts getting out of bed unsupervised, I caught her taking it off and hiding it under her pillow when she thought I wasn't looking. I have caught her performing wheelchair-to-bed transfers all alone in her room (brakes unlocked I might add) as I was leaving another patient's room across from hers. I have told her time and time again to use her call button before doing that, but of course when you think you don't actually have precautions, why on earth would you need to call for assistance with anything? Good grief.

I figured that the best thing I could do was have her remember her precautions. She has horrible macular degeneration so posters with big contrasting letters was not an option. So that idea got scrapped pretty quick. Plan B. She did have a talking clock that I've noticed around her neck. Her friend gave it to her on her second day at the facility. With time, she was able to remember and initiate using it to tell the time without asking me. This told me that, with repetition and practice, there was hope that she could remember her back precautions.

I began each session asking her what her three precautions were. BLTs. No bending, no lifting, no twisting. She told me, "That is not going to stick out in my mind because I don't eat BLT sandwiches". She'd remember 2/3 after about a couple minutes of staring at the ceiling. Then I would have her repeat them in her head as I left her room to grab towels for her shower or theraband for her exercises. I'd come back and she'd remember, once again, 2/3. We'd start an activity and before any sort of movement, I'd ask her again. Or on the way back to her room from the gym or before out session ended. 2/3. Then one morning, I went to see her and, when asked what her precautions were and expecting the same 2/3 answer, she told me all three! I jumped for joy, I was so happy! Now the trick was getting her to actually follow them. But we were making progress. Baby steps. This was good.

She could now verbally tell me her precautions, but her impulsivity would always get the best of her. I told her that before she even attempts to move, she needed to stop and say her precautions outloud. This took time and there were days when she would get overwhelmed and emotional and all we'd do was sit together with her rubbing my forarm gently to calm herself down. She told me she just really missed her home. So what did I do? I scheduled a home evaluation.

I love doing home evaluations because, not only does it allow me to assess my patient's home safety and give my recommendations to allow for easy access, but it let's my patient be back in their natural environment and have something to look forward to. There's nothing like home. I scheduled it with her daughter who picked up my patient -sitting all ready to go in her wheelchair and oversized neon green shades nonetheless. I helped her with a car transfer and followed them to my patient's home sweet home. I could see how happy my patient was to step foot into her front doors (Well, back doors. Her front steps didn't have any railings and I absolutely refused to put myself in a situation where there'd be a chance for me to fill out another stupid incident report). We stayed no more than 30 minutes. We went over a few functional transfers -in and out of the shower, on and off the toilet, in and out of bed.. I gave my recommendations for adaptive equipment and things I'd re-organize in the home to make it easier and safer for my patient. The next day, the PT told me she had an amazing session with my patient -she remembered all three precautions, showed more energy, more strength and endurance... She told me she thinks seeing her home and knowing that's where she will be discharging to has picked up her spirits. I couldn't agree more.

I saw her in the afternoon that same day. When I told her I'd be taking her to the gym, she scooted over to the head of the bed to reach for her vaseline. Now I know this may sound a little strange but that was the best thing EVER. And I'll explain why. My patient would continuously twist her entire trunk (BIG no no) to get her vaseline on the night stand at the head of the bed. I always asked her, "What could you have done differently so that you're not twisting?" We'd talk about moving her entire body over, asking for help, using her reacher... The fact that she moved her entire body to get her vaseline that day was a HUGE accomplishment in my eyes. It told me she's remembering SOMETHING. I have no idea what and it could have been mere coincidence. But I'll take it. I was so happy and she was so proud of herself.

So she leaves on Wednesday. She will have 24-hour supervision, which is what her PT and myself have recommended, and home health services for continued therapy. She told me last week during her shower, "What would I do without you?" and I told her, "You're doing all the work. I'm just watching you do it." She took my forarm and started rubbing it gently. I am going to miss her.