I swear that whenever one of my favorite patients discharges (because let's be honest, everyone has favorites even if it's a patient), another one miraculously appears. I evaled a gentleman yesterday who fell off his horse and fractured his ribs. I will name him Bud.
Bud is a gentleman in every sense of the word. In the two sessions I've worked with him, he's called me every nickname your father, boyfriend, grandfather, or husband has ever called you -sweetie, sweet pea, sweet thing, honey, hun, purdy lady, baby girl, babe, darlin. You name it, he's called me it. Sometimes I think it's because he can't quit remember my name just yet. But I think it's really because he's just a gentleman born and raised in the good ol' southern United States.
When I first met Bud, he told me he was originally from Texas. I told him my parents were moving to Austin in November. As soon as I said "Austin", Bud laughed, shook his head and said, "You gotta get down and dirty with it honey. 'AWE-stin'. Not that California talk you sayin there." As we walked to the gym from his room, he proceeded to teach me how to use "yall" and "yonder" in my sentences. I told the other therapists, "I'm learning how to speak Cowboy!" I'm sure Bud thinks I'm nuts.
When I told Bud I grew up in the Philippines, he blurted in his southern accent, "OH so you speak Filipinian!" I knew we were going to have a blast in therapy already. So far, all we have been working on is Bud's endurance. He is able to shower, dress himself, do his grooming and hygiene standing at the sink, etc. with only stand-by assistance. It just takes him forever to do it because he fatigues so easily. And on top of that, Bud does not understand the concept of pacing. So we've gone over energy conservation strategies on the first day after the shower and have been focusing on building his endurance for functional activities.Today, we did nothing but play cards in dynamic standing. Bud was able to stand for about 15 minutes tops (which is great) before having to sit down. The one problem is that Bud likes to work, work, work and doesn't initiate sitting down and taking a rest break. I constantly have to ask him, "Bud, how does your body feel right now? Are you doing ok standing there? Are you starting to get short of breath?" This is what we're working on. The good thing is that he's aware of this concern of mine and is trying to make these energy conservation strategies a new part of his routine.
So we played cards for a good part of our 60 minute treatment today. Bud loves playing cards, which makes it a great activity to use when working on standing tolerance and functional endurance. Bud taught me how to play 21, Poker, and Rummy. Rummy was my favorite. I would try to jump ahead and "hit" and "draw" when I wasn't suppose to and Bud would tell me to hold my horses and listen to his instructions because I was getting ahead of myself. Sometimes I felt like I was the patient. But I only jump ahead because I don't understand Bud half the time he's talking to me because of his heavy southern accent. At times it feels like he's eating his words under his moustache. So I ended up learning how to play Rummy from my next patient who also likes playing cards. When I went back to see Bud for the second half of our session in the afternoon, he commented on how fast I picked the game up.
Bud has already stated his goals for me (yes me, not him) while he is in our facility and when he gets discharged. He says, "Imma make a cowgirl outta you before I leave this place!" Here is his goal list for me, which isn't very client-centered considering all I want to be able to do is beat him at Rummy:
1. Learn how to ride a bull. If this were a real therapy goal, I would be discharged due to insurance reasons (because I would refuse therapy sessions until Medicare denies reimbursement for skilled services), or I would be discharged straight to the hospital for a fractured EVERYTHING.
2. Learn how to rope a calf. I think I would much rather pet the calf than rope it.
3. Get me a pair ah dem cowboy boots. This I don't mind.
4. Eat his buffalo chili. I don't know where he's planning on getting us buffalo meat for this cooking task. Other than that, I'm all about kitchen safety and self-feeding!
Wednesday, September 21, 2011
Friday, September 16, 2011
Group & Storytelling
At 6:45 AM, Thursday morning, I walked into the rehab gym with my sweats and O.T. softball shirt on (because it is sports day or physical health day or something like that) and the desire to curl up in bed because it is so cold and still dark outside and none of my current patient's appreciate 7:00 AM wake-up calls for therapy. So why the heck am I awake right now? But then one of our physical therapy assistants had a brilliant idea. We decided to group all our patients since the therapy department was in charge of doing some sort of sports activity with all the patients. We did not really think through this carefully because the two ideas we came up with were dodgeball or flash mob. Dodgeball was not going to work because we have three halls in our facility, not enough rubber balls or therapists to span the hallways, and many of our patients do not have the strength or range of motion to throw a ball very well. Flash mob was not going to work because the only dancer we have on our team is Andriana. And she already refused to chereograph any type of routine and we did not even have music planned that morning. So we decided to group our patients from 10:00-12:00 that morning and do fun sports-related activities. 10:00 AM would consist of two groups: the high-level OT group and the low-level PT group. At 11:00 AM, we would switch. We made sure each therapist had no more than 4 patients in each group so that we could bill for services. We printed handouts, came up with a rough outline of what we were to do, then did a couple individual treatments and caught up on paperwork.
At 10:00 AM, the CNAs brought all the patient's in one at a time. It was going to be a riot. Organized chaos. I was already getting sensory-overload. Our first group, the high-level patients, were a lot more energized. We did theraband exercises to work on bilateral upper extremity strength, balloon volleyball to work on range of motion, hot potato with weighted balls for core strengthening and sitting balance while weightshifting, and finally, a healthy aging discussion. It was fun. And our discussion was hilarious because we had patients who would not stop giving long, elaborate examples that, by the end of their story, I had no idea how it related to our topic.
Then we had our low-level group, who had just finished physical therapy. I realized that Frank, my patient with the amputated leg, got placed in the wrong group. Oh. No. Because as all the people in our low-level group needed several physical cues to do the theraband exercises, did not notice the balloon coming to them till it landed on their heads, and stared off into space when asked questions during discussion, Frank looked around wondering what was going on. I was doing the same. One of Andriana's patients fell asleep while doing the group exercises and almost slapped Frank with his theraband. Another patient with a very thick German accent was doing the exercises way too fast while yelling, "I need my oxygen! But I'm going to do these exercises anyway!" She started laughing and heeving -we had to physically take the theraband away from her. "Deep breaths through your nose, Marg. Smell the schnitzel!" Frank, who was sitting next to me as I talked about healthy aging, would smile and wink at me every time I looked over at him.
This morning I woke Frank up at 8:00 AM to get him ready for his 10:30 AM doctor's appointment. He looked at me, closed his eyes, and sighed, "Oh it's you". I said, "Frank, we're going to do a shower for therapy today". His eyes opened wide up and he said, "I can't do therapy this morning. I have a doctor's appointment!" When I told him we had plenty of time and that I was helping him get ready for it, he said, "I look forward to the day that I can win an agrument with you." We laughed. I sat on the cushion by the window sill and told him I was going to let him get himself out of bed and into his wheelchair. If you have forgotten or haven't read my previous posts, Frank is almost 90 years old (probably one of our sharpest patients) and has had a right amputated leg for quite a few years. After a few attempts and sounds of intense effort coming from Frank's end to get him in a long-sitting position, I suggested raising the head of the bed to make the transfer less demanding because Frank's family told me that he will have a hospital bed at home when he discharges. Frank told me to just let HIM do it. I laughed. I can't take things personal with Frank because he knows me well and I know him. When he got to the edge of the bed from a supine position, I crouched down on the floor and looked up at him saying, "Take a rest break -that was a lot of work". Frank said, "Let me tell you story". Oh boy, here we go.
Frank told me that when he was younger and moving around pretty well with his amputated leg, he started volunteering at the Utah State Rehabilitation Center. He told me that there were several young kids with the same disability as him. He would show them how to get on and off chairs, move around, and do daily activities like nothing was different about him. Frank told me they would enthusiastically cheer after he did things but that when they tried it themselves, they struggled. Frank said that as he watched them struggle, he would cry like a baby. When the coordinator asked him if he could come help regularly because the kids loved watching him do what he could do, Frank told him that he could not let these kids see him crying just because they could not do the same things he could. He never went back again. The reason why Frank told me this story was not just because he was able to get to the edge of the bed without my help now, but because he said the group session yesterday reminded him of that experience. I thought to myself, Well that's because your occupational therapist is an idiot and did not realize you were placed in the low-level group. Frank said, "I watched those ladies yesterday and how they were trying so hard to do the activities and it took all of me to prevent myself from crying . . . I have a picture of Christ in my home and beside it is a quote: 'I never said it would be easy, I only said it would be worth it'. I will keep trying. I just hope it's worth it". Holding back tears, I told Frank it was so worth it. He smiled looking down at me and knodded, "Ok. Now let's go." He completed the transfer, with no help, both of us in silence.
At 10:00 AM, the CNAs brought all the patient's in one at a time. It was going to be a riot. Organized chaos. I was already getting sensory-overload. Our first group, the high-level patients, were a lot more energized. We did theraband exercises to work on bilateral upper extremity strength, balloon volleyball to work on range of motion, hot potato with weighted balls for core strengthening and sitting balance while weightshifting, and finally, a healthy aging discussion. It was fun. And our discussion was hilarious because we had patients who would not stop giving long, elaborate examples that, by the end of their story, I had no idea how it related to our topic.
Then we had our low-level group, who had just finished physical therapy. I realized that Frank, my patient with the amputated leg, got placed in the wrong group. Oh. No. Because as all the people in our low-level group needed several physical cues to do the theraband exercises, did not notice the balloon coming to them till it landed on their heads, and stared off into space when asked questions during discussion, Frank looked around wondering what was going on. I was doing the same. One of Andriana's patients fell asleep while doing the group exercises and almost slapped Frank with his theraband. Another patient with a very thick German accent was doing the exercises way too fast while yelling, "I need my oxygen! But I'm going to do these exercises anyway!" She started laughing and heeving -we had to physically take the theraband away from her. "Deep breaths through your nose, Marg. Smell the schnitzel!" Frank, who was sitting next to me as I talked about healthy aging, would smile and wink at me every time I looked over at him.
This morning I woke Frank up at 8:00 AM to get him ready for his 10:30 AM doctor's appointment. He looked at me, closed his eyes, and sighed, "Oh it's you". I said, "Frank, we're going to do a shower for therapy today". His eyes opened wide up and he said, "I can't do therapy this morning. I have a doctor's appointment!" When I told him we had plenty of time and that I was helping him get ready for it, he said, "I look forward to the day that I can win an agrument with you." We laughed. I sat on the cushion by the window sill and told him I was going to let him get himself out of bed and into his wheelchair. If you have forgotten or haven't read my previous posts, Frank is almost 90 years old (probably one of our sharpest patients) and has had a right amputated leg for quite a few years. After a few attempts and sounds of intense effort coming from Frank's end to get him in a long-sitting position, I suggested raising the head of the bed to make the transfer less demanding because Frank's family told me that he will have a hospital bed at home when he discharges. Frank told me to just let HIM do it. I laughed. I can't take things personal with Frank because he knows me well and I know him. When he got to the edge of the bed from a supine position, I crouched down on the floor and looked up at him saying, "Take a rest break -that was a lot of work". Frank said, "Let me tell you story". Oh boy, here we go.
Frank told me that when he was younger and moving around pretty well with his amputated leg, he started volunteering at the Utah State Rehabilitation Center. He told me that there were several young kids with the same disability as him. He would show them how to get on and off chairs, move around, and do daily activities like nothing was different about him. Frank told me they would enthusiastically cheer after he did things but that when they tried it themselves, they struggled. Frank said that as he watched them struggle, he would cry like a baby. When the coordinator asked him if he could come help regularly because the kids loved watching him do what he could do, Frank told him that he could not let these kids see him crying just because they could not do the same things he could. He never went back again. The reason why Frank told me this story was not just because he was able to get to the edge of the bed without my help now, but because he said the group session yesterday reminded him of that experience. I thought to myself, Well that's because your occupational therapist is an idiot and did not realize you were placed in the low-level group. Frank said, "I watched those ladies yesterday and how they were trying so hard to do the activities and it took all of me to prevent myself from crying . . . I have a picture of Christ in my home and beside it is a quote: 'I never said it would be easy, I only said it would be worth it'. I will keep trying. I just hope it's worth it". Holding back tears, I told Frank it was so worth it. He smiled looking down at me and knodded, "Ok. Now let's go." He completed the transfer, with no help, both of us in silence.
Monday, September 12, 2011
Bonding Time
One of my new patients has an amputated right leg. Now, like any professional in the health profession, whenever you receive orders for a complex case, the first thing you think of is how interesting it will be. What a great learning experience. In a way, that may seem a little selfish. But I'm sure we see it as a chance to provide skilled service to someone who really needs it. So when I met my new patient last week who had his right leg amputated, I was excited to start my eval and treatment.
Let me tell you, that was one of the most physically draining 75 minutes of therapy I have experienced. My patient, who I will call Frank, required moderate to maximum assistance for every transfer -to get out of his wheelchair, out of bed, on and off the toilet, on and off the shower chair. And we had to do all of that since he needed to use the toilet as soon as I walked in and since I told the CNA that I'd help him with his scheduled shower. After the draining task of showering himself, which many people take for granted until they can no longer do it independently, I had to call the CNA to help me lift Frank back to his wheelchair. Despite all this, I am finding that I really enjoy working with the physically challenging patients. Because the way I see it, there is really no other direction for them to go but up (at least that it what I hope for my patients even though it is not always the case). And when they do "go up" or make the slightest bit of progress, I get excited like a little girl opening presents on Christmas morning.
I usually take a lot of time thinking about how to best position my patient and his environment (his wheelchair, the height of his bed, to recline or not to recline) so that he can safely perform whatever it is he needs to do in the easiest way possible. In working with Frank last week, he would discover easier ways to do things, and I would learn from him. When he'd ask me if he could do it a different way instead, I would tell him, "You can do whatever you feel works for YOU. I will give you my suggestions and if I feel your safety is at risk, then I will jump in." He likes that I listen to him. He told me once after his shower, "WE did pretty good!" I like that he includes me in his accomplishments.
There was one day that Frank did not want to participate in therapy. He layed in bed till 10:00 AM and the CNA came in to ask me if I could help him get up and dressed because she had been trying since 8:00. Well that was not going to happen. When Frank decides he doesn't want to do something, he DOESN'T want to do something. I learned later from his nurse that his family had just sold his home that he absolutely loves and will be moving in with his daughter when he gets discharged. He needed an anxiety pill. That broke my heart. I went in to see him and we talked for awhile. He told me he felt that if he layed in bed and rested that day, he would be emotionally and physically prepared for therapy the next day. I told him I was ok with that. I walked in at 9:00 AM the next morning and Frank was ready to go. He told me, "I am going to get out of this bed and into my wheelchair and you are just going to watch me because I did it all by myself last night". Uh, you did? That made me nervous. I stood there with my hands an inch away from Frank's skin and every time I slightly brushed him, he'd stop and tell me to back off. "I am just killing you right now, aren't I?" he said, laughing. "Yes, Frank. Yes you are." He made me so nervous, it took every ounce of me to stop myself from helping him. I trusted him, but I felt that if he accidently slipped, I would not be fast enough to catch him. "Can I AT LEAST put my arm under yours? I won't help. It'll just be there if you need a little oomph." "No." I wanted to pout and stomp my feet. Frank thought it was hysterical. But you know what? He was right. Given time, and excessive perspiration on my end, Frank carefully (and safely) made it to his chair with no help. He sat there with a big smile on his face. Awesome. He sang the whole time he was in the shower that morning.
Today, Frank made my Monday by telling me something I will always remember. I wrote it down as soon as he said it because I knew that if ever there was a day that I doubted myself or felt down in the dumps, I could read it and remember why I love doing what I do. Frank told me, "You are one of the highlights of my being here. We talk, we have conversation. You are not just my occupational therapist. You are also my shrink." I almost cried.
Let me tell you, that was one of the most physically draining 75 minutes of therapy I have experienced. My patient, who I will call Frank, required moderate to maximum assistance for every transfer -to get out of his wheelchair, out of bed, on and off the toilet, on and off the shower chair. And we had to do all of that since he needed to use the toilet as soon as I walked in and since I told the CNA that I'd help him with his scheduled shower. After the draining task of showering himself, which many people take for granted until they can no longer do it independently, I had to call the CNA to help me lift Frank back to his wheelchair. Despite all this, I am finding that I really enjoy working with the physically challenging patients. Because the way I see it, there is really no other direction for them to go but up (at least that it what I hope for my patients even though it is not always the case). And when they do "go up" or make the slightest bit of progress, I get excited like a little girl opening presents on Christmas morning.
I usually take a lot of time thinking about how to best position my patient and his environment (his wheelchair, the height of his bed, to recline or not to recline) so that he can safely perform whatever it is he needs to do in the easiest way possible. In working with Frank last week, he would discover easier ways to do things, and I would learn from him. When he'd ask me if he could do it a different way instead, I would tell him, "You can do whatever you feel works for YOU. I will give you my suggestions and if I feel your safety is at risk, then I will jump in." He likes that I listen to him. He told me once after his shower, "WE did pretty good!" I like that he includes me in his accomplishments.
There was one day that Frank did not want to participate in therapy. He layed in bed till 10:00 AM and the CNA came in to ask me if I could help him get up and dressed because she had been trying since 8:00. Well that was not going to happen. When Frank decides he doesn't want to do something, he DOESN'T want to do something. I learned later from his nurse that his family had just sold his home that he absolutely loves and will be moving in with his daughter when he gets discharged. He needed an anxiety pill. That broke my heart. I went in to see him and we talked for awhile. He told me he felt that if he layed in bed and rested that day, he would be emotionally and physically prepared for therapy the next day. I told him I was ok with that. I walked in at 9:00 AM the next morning and Frank was ready to go. He told me, "I am going to get out of this bed and into my wheelchair and you are just going to watch me because I did it all by myself last night". Uh, you did? That made me nervous. I stood there with my hands an inch away from Frank's skin and every time I slightly brushed him, he'd stop and tell me to back off. "I am just killing you right now, aren't I?" he said, laughing. "Yes, Frank. Yes you are." He made me so nervous, it took every ounce of me to stop myself from helping him. I trusted him, but I felt that if he accidently slipped, I would not be fast enough to catch him. "Can I AT LEAST put my arm under yours? I won't help. It'll just be there if you need a little oomph." "No." I wanted to pout and stomp my feet. Frank thought it was hysterical. But you know what? He was right. Given time, and excessive perspiration on my end, Frank carefully (and safely) made it to his chair with no help. He sat there with a big smile on his face. Awesome. He sang the whole time he was in the shower that morning.
Today, Frank made my Monday by telling me something I will always remember. I wrote it down as soon as he said it because I knew that if ever there was a day that I doubted myself or felt down in the dumps, I could read it and remember why I love doing what I do. Frank told me, "You are one of the highlights of my being here. We talk, we have conversation. You are not just my occupational therapist. You are also my shrink." I almost cried.
Monday, September 5, 2011
Elderly Children
I went into occupational therapy school dead-set on working with children and graduated, still with a passion for pediatrics, but with a new-found love for the adult population. Little did I know, my first (well, technically second) job would be with the geriatric population -the one population I said I'd never work with. But, to my surprise, after an exhausting weekend experience, I learned the many similarities between the pediatric and geriatric population. Let me tell you how my weekend went down.
It started at 1:00 in the afternoon -the time I was scheduled to watch a 6-year-old who I've known since she was 2, and a 3-year-old who I've known ever since the time their mother took a pregnancy test. I wasn't just there for the afternoon. Heck, I wasn't even there till late evening. I was there for the next 27 hours. I walked in with a venti skinny vanilla latte and their mother said to me, with a smile on her face, "If you need more, there's freshly ground beans in the freezer. Feel free to brew yourself a pot." I laughed but found out later that evening she was not joking.
Similarity #1 between children and the elderly: They value their independence.
But doesn't everyone? In my attempts to give the girls their independence, I let them pick out their daytime outfits in the morning. The 6-year-old did pretty well color-coordinating, but the 3-year-old came out of her room in her full-on fairy costume. Wings and everything. The whole shibang. Nonetheless, her dress was backwards and in my attempts to make her look somewhat appropriate for our walk with the family lab, she stomped and cried, "KAFWIN, LET ME DOOOO IT!" Until she took it off later on that day, she was knocking walls and counters with her wings.
Similarity #2: Despite the many times they will attempt to convince you otherwise, they require supervision.
Usually the girls spend a good 15 minutes in the tub playing together with their bath toys before getting ready for bed. Once the tub's filled and they're sitting safely in it, allowing them to play what they call "tidal wave" is a bad idea. I could hear them laughing as I washed the dishes in the kitchem and figured everything was fine. But when I walked in the bathroom after their 15 minutes was up, the tub was filled a quarter of the way up. And the other three-quarters was everywhere BUT in the tub. "Girls! What are you DOING?!" They looked up at me laughing -"We're playing 'tidal wave'!" Duh.
A few weeks ago at work I walked out of my patient's room and noticed my co-worker's patient attempting a wheelchair to bed transfer unsupervised. From our weekly meetings and the few times he's been put on my schedule, I knew he wasn't suppose to be doing functional transfers unsupervised. I jumped in right before he could face-plant off his wheelchair and asked him what he was doing. He said, "I'm trying to get back in bed!" Duh. I told him he was not suppose to get out of his chair or out of his bed unsupervised. I knew he understood me. Even though all he did in response to my 1-minute safety education was laugh.
Similarity #3: Sometimes there is just no reasoning with them and you have no choice but to pick your battles.
Come naptime, the 3-year-old stomped and cried yet again, not wanting to take her fairy costume off. Despite my reasoning that the wing's wires will poke her in her sleep and that the flower in the front of the dress will most likely fall off, she wanted to sleep in it "like Thumbellina". One thing was for sure. She was not taking that thing off. She stomped and cried and even though I absolutely refuse to give into fits and tantrums, I figured she was tired. And quite frankly, I was tired too. So like Thumbellina, she took her afternoon nap in her fairy dress. Wings and everything.
A couple weeks ago I had a patient who absolutely hated rehab. In fact, I was pretty convinced up until the day she was self-discharged that she hated the world. I spent the first 45 minutes of every 60-minute treatment session explaining to her WHY she was in rehab and why we were doing what we were doing. She would apologize to me at the end of the session and I would go home thinking we had built rapport and that they next day would be a different day. It was not. I went in her room at 7:00 AM one morning because she was upset with me the day before for walking in at 8:00 because she said she was waiting for me since 7:00. So there I was, standing over her bed, asking her if she was ready for therapy and all she did was yell, "It's 7:00 in the morning! Why are you here so damn early?!" I was a millimeter close from walking out of her room and putting her on someone else's schedule. When I told her, obviously frustrated, that she was upset with me the day before because I WASN'T in at 7:00, she got up and decided to "get it over with". I spent the next 60 minutes of the session in silence, while she jabbered away at how she hates rehab and did not understand why she was doing what she was doing. I explained it to her once more, giving her the benefit of the doubt. Maybe she has poor short-term memory. But she would not stop. So I picked my battles and did not argue with her. I was just there to help her with her self-care that morning and supervise her exercises. I left her room after the longest 60 minutes of my life.
Similarity #4: With some encouragement, sillyness, and a little give-and-take, they will do whatever you ask of them.
Sunday afternoon, the house was a disaster. There were crayons and papers scattered all over the floor, along with their stuffed animals. They were playing "school". I had just made them popcorn and under-estimated the size of the bowl the popcorn was flowing into. On top of that, the girl's drawers were opened and emptied out in their attempts to "independently" dress themselves. Now we all know, clean-up is never as fun as playing, no matter what the situation. Getting these girls to clean up was like pulling teeth. But the less I demanded and the more I encouraged, the more toys per minute they seemed to pick up. When I joined them and made it a game, they started picking up two toys at a time. And when I told them we were going to the dollar store afterwards, all the toys and clothes miraculously disappeared off the floor.
At work with my elderly patients, it is never suprising to get a patient who complains when you ask them to do something they find difficult or fatiguing in therapy. I find myself constantly saying, "You can totally do that!" or "How will you know till you try it!" When my patients are grumpy, I dish it back. And then they end up calling me a "happy booger" or a "cheery little one" and all is good. I have learned that if I respect what they ask, they have to respect what I ask. In other words, we meet eachother halfway. If they do a couple sit to stand transfers for me or attempt to put their pants on, I will go over handouts with them the last 10 minutes of our session so they can take a long rest break.
Similarity #5: Working with children and the elderly means there will be special moments that, as corny as it sounds, I will cherish forever.
Getting the girls in bed early so I can relax for the night means they will be up at the butt-crack of dawn the next morning. I pulled the covers off my head and found them standing in the doorway of my room, half asleep. I raised my arms up and we layed there together -me, the girls, and the lab. I looked at the clock on the nightstand. It was 6:50 AM. Holy crap. After 20 minutes, we went on a "pajama" walk with the dog. And that morning, we made chocolate chip cookies. I felt like a kid again.
Last week at work when I walked in my patient's room at 8:00 AM, she told me she was feeling so nauseated, she did not think she was up for a shower that morning. She is one who worries about her body odor due to her feeding tube inserted in her abdomen region, and unfortunately she had a doctor's appointment at 10:00. If this were a rare circumstance, I would've re-scheduled for later that day. But this patient of mine was always feeling nauseated and worried and sleepy. So I gave her a few minutes as I gathered a few things, came back, and encouraged her to attempt this shower no matter how long it took us within our 60-minute treatment session. When she got it done, her husband turned to me and said, "Thank you, Katharine. If it weren't for you, she wouldn't have gotten in the shower today". Appreciative family members always make my day.
So there you have it! The few similarities between children and the elderly that I have discovered this crazy 27-hour weekend.
It started at 1:00 in the afternoon -the time I was scheduled to watch a 6-year-old who I've known since she was 2, and a 3-year-old who I've known ever since the time their mother took a pregnancy test. I wasn't just there for the afternoon. Heck, I wasn't even there till late evening. I was there for the next 27 hours. I walked in with a venti skinny vanilla latte and their mother said to me, with a smile on her face, "If you need more, there's freshly ground beans in the freezer. Feel free to brew yourself a pot." I laughed but found out later that evening she was not joking.
Similarity #1 between children and the elderly: They value their independence.
But doesn't everyone? In my attempts to give the girls their independence, I let them pick out their daytime outfits in the morning. The 6-year-old did pretty well color-coordinating, but the 3-year-old came out of her room in her full-on fairy costume. Wings and everything. The whole shibang. Nonetheless, her dress was backwards and in my attempts to make her look somewhat appropriate for our walk with the family lab, she stomped and cried, "KAFWIN, LET ME DOOOO IT!" Until she took it off later on that day, she was knocking walls and counters with her wings. With one of my patients, adaptive equipment is not an option. Despite my countless explanations that it actually helps him be more independent till he can do things on his own without it (put socks on by yourself with your sock aid, reach for something out of your closet with your reacher without asking for assistance, pull your shirt down behind you with your dressing stick), he saw it as a label that he was incapable. And that was fine. People view adaptive equipment in different ways. For him, being independent was being INDEPENDENT. Not independent with modifications.
Similarity #2: Despite the many times they will attempt to convince you otherwise, they require supervision.
Usually the girls spend a good 15 minutes in the tub playing together with their bath toys before getting ready for bed. Once the tub's filled and they're sitting safely in it, allowing them to play what they call "tidal wave" is a bad idea. I could hear them laughing as I washed the dishes in the kitchem and figured everything was fine. But when I walked in the bathroom after their 15 minutes was up, the tub was filled a quarter of the way up. And the other three-quarters was everywhere BUT in the tub. "Girls! What are you DOING?!" They looked up at me laughing -"We're playing 'tidal wave'!" Duh.
A few weeks ago at work I walked out of my patient's room and noticed my co-worker's patient attempting a wheelchair to bed transfer unsupervised. From our weekly meetings and the few times he's been put on my schedule, I knew he wasn't suppose to be doing functional transfers unsupervised. I jumped in right before he could face-plant off his wheelchair and asked him what he was doing. He said, "I'm trying to get back in bed!" Duh. I told him he was not suppose to get out of his chair or out of his bed unsupervised. I knew he understood me. Even though all he did in response to my 1-minute safety education was laugh.
Similarity #3: Sometimes there is just no reasoning with them and you have no choice but to pick your battles.
Come naptime, the 3-year-old stomped and cried yet again, not wanting to take her fairy costume off. Despite my reasoning that the wing's wires will poke her in her sleep and that the flower in the front of the dress will most likely fall off, she wanted to sleep in it "like Thumbellina". One thing was for sure. She was not taking that thing off. She stomped and cried and even though I absolutely refuse to give into fits and tantrums, I figured she was tired. And quite frankly, I was tired too. So like Thumbellina, she took her afternoon nap in her fairy dress. Wings and everything.
A couple weeks ago I had a patient who absolutely hated rehab. In fact, I was pretty convinced up until the day she was self-discharged that she hated the world. I spent the first 45 minutes of every 60-minute treatment session explaining to her WHY she was in rehab and why we were doing what we were doing. She would apologize to me at the end of the session and I would go home thinking we had built rapport and that they next day would be a different day. It was not. I went in her room at 7:00 AM one morning because she was upset with me the day before for walking in at 8:00 because she said she was waiting for me since 7:00. So there I was, standing over her bed, asking her if she was ready for therapy and all she did was yell, "It's 7:00 in the morning! Why are you here so damn early?!" I was a millimeter close from walking out of her room and putting her on someone else's schedule. When I told her, obviously frustrated, that she was upset with me the day before because I WASN'T in at 7:00, she got up and decided to "get it over with". I spent the next 60 minutes of the session in silence, while she jabbered away at how she hates rehab and did not understand why she was doing what she was doing. I explained it to her once more, giving her the benefit of the doubt. Maybe she has poor short-term memory. But she would not stop. So I picked my battles and did not argue with her. I was just there to help her with her self-care that morning and supervise her exercises. I left her room after the longest 60 minutes of my life.
Similarity #4: With some encouragement, sillyness, and a little give-and-take, they will do whatever you ask of them.
Sunday afternoon, the house was a disaster. There were crayons and papers scattered all over the floor, along with their stuffed animals. They were playing "school". I had just made them popcorn and under-estimated the size of the bowl the popcorn was flowing into. On top of that, the girl's drawers were opened and emptied out in their attempts to "independently" dress themselves. Now we all know, clean-up is never as fun as playing, no matter what the situation. Getting these girls to clean up was like pulling teeth. But the less I demanded and the more I encouraged, the more toys per minute they seemed to pick up. When I joined them and made it a game, they started picking up two toys at a time. And when I told them we were going to the dollar store afterwards, all the toys and clothes miraculously disappeared off the floor.
At work with my elderly patients, it is never suprising to get a patient who complains when you ask them to do something they find difficult or fatiguing in therapy. I find myself constantly saying, "You can totally do that!" or "How will you know till you try it!" When my patients are grumpy, I dish it back. And then they end up calling me a "happy booger" or a "cheery little one" and all is good. I have learned that if I respect what they ask, they have to respect what I ask. In other words, we meet eachother halfway. If they do a couple sit to stand transfers for me or attempt to put their pants on, I will go over handouts with them the last 10 minutes of our session so they can take a long rest break.
Similarity #5: Working with children and the elderly means there will be special moments that, as corny as it sounds, I will cherish forever.
Getting the girls in bed early so I can relax for the night means they will be up at the butt-crack of dawn the next morning. I pulled the covers off my head and found them standing in the doorway of my room, half asleep. I raised my arms up and we layed there together -me, the girls, and the lab. I looked at the clock on the nightstand. It was 6:50 AM. Holy crap. After 20 minutes, we went on a "pajama" walk with the dog. And that morning, we made chocolate chip cookies. I felt like a kid again.
Last week at work when I walked in my patient's room at 8:00 AM, she told me she was feeling so nauseated, she did not think she was up for a shower that morning. She is one who worries about her body odor due to her feeding tube inserted in her abdomen region, and unfortunately she had a doctor's appointment at 10:00. If this were a rare circumstance, I would've re-scheduled for later that day. But this patient of mine was always feeling nauseated and worried and sleepy. So I gave her a few minutes as I gathered a few things, came back, and encouraged her to attempt this shower no matter how long it took us within our 60-minute treatment session. When she got it done, her husband turned to me and said, "Thank you, Katharine. If it weren't for you, she wouldn't have gotten in the shower today". Appreciative family members always make my day.
So there you have it! The few similarities between children and the elderly that I have discovered this crazy 27-hour weekend.
Tuesday, August 30, 2011
Baby Steps -Part III
**Must read Part I and II to fully understand the magnitude of this post**
11am. I walked into Kate's room, fully gowned, masked, and gloved to take on Kate's long-term goal -the shower. She told me she was sore and paying for what she did yesterday, but she was ready to do it. She mummbled, "I can do it. I can do it. I can do it", took a deep breath, and stood up from the edge of the bed with her walker. And just as I was in the process of getting her wheelchair positioned to wheel her to the bathroom, I looked up at her and said, "Can you WALK to the shower?" She looked ahead of her to the bathroom and said, "Well I walked to the commode and back yesterday, so I should be able to". She was able to all right -with me following behind her with her chair, praying her knees wouldn't buckle. With some cuing on hand and feet placement, Kate was IN the shower. Standing. Once she sat down, I started frantically laying towels on the floor to soak up excess water, saying repeatedly, "This is great. Kate, this is awesome. This is so great. Oh my gosh I am so excited." Kate just sat there, not saying a word. I looked up at her and asked, "Aren't you excited about this?!" She smiled and said, "Oh I may not look excited, but I am WAY excited. I cannot believe I just did that". She went to town with her washcloth, and I helped her with her feet, back, and peri area -all the while mummbling the same this-is-great-this-is-awesome-oh-my-gosh-this-is-so-great rant the entire time. I almost cried, I was so happy. After she dried off, got dressed in her gown, and sat back in her wheelchair, I told her, "This is one of those amazing moments that I will remember as a new grad for the rest of my career, Kate." It was the best shower ever. And I wasn't even the one taking a shower.
11am. I walked into Kate's room, fully gowned, masked, and gloved to take on Kate's long-term goal -the shower. She told me she was sore and paying for what she did yesterday, but she was ready to do it. She mummbled, "I can do it. I can do it. I can do it", took a deep breath, and stood up from the edge of the bed with her walker. And just as I was in the process of getting her wheelchair positioned to wheel her to the bathroom, I looked up at her and said, "Can you WALK to the shower?" She looked ahead of her to the bathroom and said, "Well I walked to the commode and back yesterday, so I should be able to". She was able to all right -with me following behind her with her chair, praying her knees wouldn't buckle. With some cuing on hand and feet placement, Kate was IN the shower. Standing. Once she sat down, I started frantically laying towels on the floor to soak up excess water, saying repeatedly, "This is great. Kate, this is awesome. This is so great. Oh my gosh I am so excited." Kate just sat there, not saying a word. I looked up at her and asked, "Aren't you excited about this?!" She smiled and said, "Oh I may not look excited, but I am WAY excited. I cannot believe I just did that". She went to town with her washcloth, and I helped her with her feet, back, and peri area -all the while mummbling the same this-is-great-this-is-awesome-oh-my-gosh-this-is-so-great rant the entire time. I almost cried, I was so happy. After she dried off, got dressed in her gown, and sat back in her wheelchair, I told her, "This is one of those amazing moments that I will remember as a new grad for the rest of my career, Kate." It was the best shower ever. And I wasn't even the one taking a shower.
Monday, August 29, 2011
Baby Steps -Part II
**Make sure to read Part I before reading this post. It'll make everything make so much more sense.**
I came to work excited to see what Kate could accomplish today, and left work with her exceeding all my expectations. She was all ready for me when I poked my head in her room at 11am, despite laying supine in bed, staring at the ceiling. I gave her my game plan. We were going to bust out a tricep workout with her sitting on the edge of the bed, she was going to comb her hair since she looked like she just got electricuted, then we were going to have her attempt standing with the wheelchair backed up in front of her so she could hold onto the handles as if it were her walker. Kate fears using her walker to stand because she feels like it will slide out from under her. So we were going to adapt with what we had and ease her into it. Baby steps.
Without me saying a word, she lowered the head of her bed, scooted up to the top of it while laying supine (something she needed max assist x2 with when I first met her), log-rolled with use of the hand rail, and pushed herself up into a sitting position at the edge of the bed as she swung her legs over. I knew it was going to be a great session already. I asked how she felt today and she said, "I am excited to see what new things I can do". So I handed her her theraband and she started on her tricep exercises. She asked me how many she had to do. I told her since she looked pumped today I wanted her to do as many reps as she could till she felt a burn. Then we'd stop, take a breather, and do the same amount of reps two more times. She was up for it and she did them like a pro. We did a few more exercises with dumb bells (1 lb heavier than last week) since she was pretty much being a rockstar. After that, she combed her hair and I pulled it up into a pony tail for her.
Then it was time to stand. I backed the wheelchair in front of her so she could hold onto the handles. With the brakes locked, I leaned into the front of her chair with one knee on the seat and my hands planted on her arm rests to make sure it was stabilized. I must admit, I was a little scared considering it was just us two in the room and she told me her emergency call-button was apparently not working. But I knew she could do it. I wouldn't have asked her to if I didn't feel she could. I told her to take her time -she took a couple deep breaths with her eyes closed, and up she went. Once she was up, she looked at me and smiled. She sat back down and said, "I want to try it with the walker". Sweet. It took her a few seconds to get her mind in gear, but I knew that once she did it a few times, she'd be one step away from conquering her fear of falling when using the darn thing. She did it and I was so proud of her.
On top of all this, she said she wanted to stay standing for four whole minutes. She made it to three and a half when she told me she had to pee. Now typically, she'd be in bed, flat on her back. And all I'd have her do is roll to the side so I could stick her bed pan under her. But she was already standing so I asked if she felt like she could walk to her commode, which sat right outside her bathroom door (about 20 small steps). She said, "Might as well". I followed right behind her with her wheelchair and told her that if she felt like her knees were going to give way, to fall BACK. Not forward. Or better yet, just don't fall at all.
She got to the commode, pivoted, sat on it, realized she wasn't entirely on it, did a partial-stand, and re-adjusted. I may or may not have done a little victory dance. She looked up at me and said, "I did it!". Yes, she did. If she didn't have C. diff, I would've hugged her. On top of all that, she was able to get off the commode, and walk back and get herself into bed at the end of our session. That called for a high five. I told her how proud I was of her as I was leaving work today since her room is one of the last ones on the way out. She was sitting up in her wheelchair, watching television. I told her, "No more bed baths, my friend. Tomorrow you're getting in the shower." She was stoked.
I came to work excited to see what Kate could accomplish today, and left work with her exceeding all my expectations. She was all ready for me when I poked my head in her room at 11am, despite laying supine in bed, staring at the ceiling. I gave her my game plan. We were going to bust out a tricep workout with her sitting on the edge of the bed, she was going to comb her hair since she looked like she just got electricuted, then we were going to have her attempt standing with the wheelchair backed up in front of her so she could hold onto the handles as if it were her walker. Kate fears using her walker to stand because she feels like it will slide out from under her. So we were going to adapt with what we had and ease her into it. Baby steps.
Without me saying a word, she lowered the head of her bed, scooted up to the top of it while laying supine (something she needed max assist x2 with when I first met her), log-rolled with use of the hand rail, and pushed herself up into a sitting position at the edge of the bed as she swung her legs over. I knew it was going to be a great session already. I asked how she felt today and she said, "I am excited to see what new things I can do". So I handed her her theraband and she started on her tricep exercises. She asked me how many she had to do. I told her since she looked pumped today I wanted her to do as many reps as she could till she felt a burn. Then we'd stop, take a breather, and do the same amount of reps two more times. She was up for it and she did them like a pro. We did a few more exercises with dumb bells (1 lb heavier than last week) since she was pretty much being a rockstar. After that, she combed her hair and I pulled it up into a pony tail for her.
Then it was time to stand. I backed the wheelchair in front of her so she could hold onto the handles. With the brakes locked, I leaned into the front of her chair with one knee on the seat and my hands planted on her arm rests to make sure it was stabilized. I must admit, I was a little scared considering it was just us two in the room and she told me her emergency call-button was apparently not working. But I knew she could do it. I wouldn't have asked her to if I didn't feel she could. I told her to take her time -she took a couple deep breaths with her eyes closed, and up she went. Once she was up, she looked at me and smiled. She sat back down and said, "I want to try it with the walker". Sweet. It took her a few seconds to get her mind in gear, but I knew that once she did it a few times, she'd be one step away from conquering her fear of falling when using the darn thing. She did it and I was so proud of her.
On top of all this, she said she wanted to stay standing for four whole minutes. She made it to three and a half when she told me she had to pee. Now typically, she'd be in bed, flat on her back. And all I'd have her do is roll to the side so I could stick her bed pan under her. But she was already standing so I asked if she felt like she could walk to her commode, which sat right outside her bathroom door (about 20 small steps). She said, "Might as well". I followed right behind her with her wheelchair and told her that if she felt like her knees were going to give way, to fall BACK. Not forward. Or better yet, just don't fall at all.
She got to the commode, pivoted, sat on it, realized she wasn't entirely on it, did a partial-stand, and re-adjusted. I may or may not have done a little victory dance. She looked up at me and said, "I did it!". Yes, she did. If she didn't have C. diff, I would've hugged her. On top of all that, she was able to get off the commode, and walk back and get herself into bed at the end of our session. That called for a high five. I told her how proud I was of her as I was leaving work today since her room is one of the last ones on the way out. She was sitting up in her wheelchair, watching television. I told her, "No more bed baths, my friend. Tomorrow you're getting in the shower." She was stoked.
Saturday, August 27, 2011
Baby Steps -Part I
I always end up with the patients who have some kind of virus that requires contact isolation precautions -meaning I treat them in their room, doors shut, fully gowned and gloved and masked and dying of heat. On Monday I evaled a new patient, who I will call Kate, who had these same precautions. Kate is in her late thirties, morbidly obese, and was diagnosed with Clostridium difficile, otherwise known as C. diff. C. diff is an infection of the colon that occurs primarily with people who have been using antibiotics.
Typically when we get a new admit, they are scheduled for a 15-min occupational therapy and physical therapy evaluation, followed by 60 minutes of treatment for each discipline. Sometimes if admits arrive later in the day, we do the 15-min eval and treat the following day. But I like to do the whole 75 minutes because I feel that the 15-min eval time does not give me a clear picture of what my patient can do in terms of their daily tasks. With the 60-min treatment following the eval, I get to see their bed mobility, how they transfer out of their wheelchair with their walker, on and off the toilet, toilet hygiene, how they manage and don their clothes, how they transfer in and out of the shower, can they reach their feet and lower back to wash, can they locate their grooming materials while standing at the sink, can they balance well when reaching for things at the sink, put their pants on over their toes, pull them up in standing, how is their safety awareness?, are they impulsive, distractible, inattentive... At the same time, I get to converse with them and build rapport for a whole 75 minutes. I leave the eval having a pretty good sense of what they can accomplish. With a 15-min eval, I am in and out and my documentation sucks for whoever has to read it the following day.
So with Kate, I did the whole 75-min treatment, which was definitely needed. Because, due to Kate's generalized muscle weakness, she needed a bed bath. And half the time she was crying so we had to stop and give her room to breathe. Kate was, for the most part, max assist x2 -me and the CNA (my new bestfriend). I gave her a washcloth and had her do what she could on her own, which was wiping her face and chest. With what seems like the simplest task, Kate needed rest breaks. In the middle of it all, Kate needed to use the bed pan. I thought to myself how I'd feel if I were laying flat in a bed, unable to move my legs more than an inch, with two people completely gowned and masked hovering over me, helping me with the most intimate of tasks. Oh how we take things for granted. I told Kate that I hated being fully gowned. She told me she didn't blame me and that her son even refuses to visit her because it's such a pain to get all gowned up. I said, "That's not what I meant. I feel very impersonal in this. Like I'm here to conduct experients on my patients". We laughed.
Despite Kate's situation, she was a very pleasant lady. Our long-term goal was to get her in the shower. But first we had to get her to transfer safely into her wheelchair. The physical therapy assistant (PTA) and I did a lot of collarborating this week. Whenever she'd come back to the gym from her room, I'd chase after her and ask her how Kate did. There was always progress being made. She was able to get Kate up in a static standing position for one minute. Her main problem was pushing herself up from the bed with her arms. Her triceps were so weak and she had so much weight to carry. So we started with tricep exercises with her semi-reclined in bed. Then we progressed to her holding herself up in bed with her elbows locked and pumping herself up and down as best she could (even if it was just a centimeter) during bed mobility tasks. Kate broke down once during that session because she said her son came in to celebrate his birthday with her but she couldn't do anything for him. She couldn't be a mom. But that motivated her even more to continue with her exercises.
When I walked by her room the other day, one of the CNAs was getting all gowned up to go in. Kate's door was slightly open and I could see her sitting in her wheelchair, watching tv -her hair braided back. I stopped in the hall and called her name. She had a BIG smile on her face and we waved at eachother. She said in her cute, nasally voice, "Hello world! ..I'm suppose to say that to everyone who sees me today sitting in my chair". I loved it. And I told her I liked her hair. She stayed in that chair for 5 and a half hours, which I think was a little too much after being in supine for so long, because the next day she was worn out.
She had the energy the next day to go from supine to sitting on the edge of the bed. But when I got the CNA to help me assist her to do a partial-stand-pivot transfer, Kate freaked out. With time, we attempted it twice, but there was no way I was going to risk her falling on her face and going back to square one. So we decided to do a bed bath with her sitting on the edge of the bed. I gave her a couple washcloths and told her to go to work, and I'd be there to help with what she couldn't do. She was able to wash down to the top of her feet, part of her peri area, her chest and armpits, and her face. She was doing great. She combed her hair and I braided it. She put her gown on and rolled back in bed, lifting her legs up with just a few verbal cues on hand placement. I raised the head of her bed and then, out of nowhere, Kate started crying. I asked what she was so sad about. And she said, "I feel like I disappointed you. We were so excited to get in the shower today and I thought today was the day that I could do it". I told her, "Kate! I am going to tell you FIVE things that you did GREAT today". Here was my list that I pointed out to her (literally):
1. You got yourself up to the edge of the bed, where you sat with no assistance for about 30 minutes.
2. You washed your own legs and feet! Remember how I had to do that for you with you laying flat in bed the other day?
3. You washed part of your privates! How awesome is that?! (We laughed)
4. You got yourself back in bed with NO help from me to get your feet up.
5. Your hair's all combed! Granted I did the braiding. But I couldn't have done it if you hadn't have combed it! (We laughed again).
I told her that yes, she may not have gotten in the shower today, but to put her focus on what she COULD do today that she COULDN'T do yesterday. It all brings her one step closer to reaching her goal of getting in the shower. Baby steps. She was getting there.
I am hoping that once she is able to safely transfer to her wheelchair and her C. diff sample comes back negative, I can take her on an outing to the store. That was her long-long-LONG term goal. And I really want to make it happen to lift up her spirits. I told her yesterday how proud I was of her and that I was looking forward to seeing what we could do Monday. She was all smiles.
Typically when we get a new admit, they are scheduled for a 15-min occupational therapy and physical therapy evaluation, followed by 60 minutes of treatment for each discipline. Sometimes if admits arrive later in the day, we do the 15-min eval and treat the following day. But I like to do the whole 75 minutes because I feel that the 15-min eval time does not give me a clear picture of what my patient can do in terms of their daily tasks. With the 60-min treatment following the eval, I get to see their bed mobility, how they transfer out of their wheelchair with their walker, on and off the toilet, toilet hygiene, how they manage and don their clothes, how they transfer in and out of the shower, can they reach their feet and lower back to wash, can they locate their grooming materials while standing at the sink, can they balance well when reaching for things at the sink, put their pants on over their toes, pull them up in standing, how is their safety awareness?, are they impulsive, distractible, inattentive... At the same time, I get to converse with them and build rapport for a whole 75 minutes. I leave the eval having a pretty good sense of what they can accomplish. With a 15-min eval, I am in and out and my documentation sucks for whoever has to read it the following day.
So with Kate, I did the whole 75-min treatment, which was definitely needed. Because, due to Kate's generalized muscle weakness, she needed a bed bath. And half the time she was crying so we had to stop and give her room to breathe. Kate was, for the most part, max assist x2 -me and the CNA (my new bestfriend). I gave her a washcloth and had her do what she could on her own, which was wiping her face and chest. With what seems like the simplest task, Kate needed rest breaks. In the middle of it all, Kate needed to use the bed pan. I thought to myself how I'd feel if I were laying flat in a bed, unable to move my legs more than an inch, with two people completely gowned and masked hovering over me, helping me with the most intimate of tasks. Oh how we take things for granted. I told Kate that I hated being fully gowned. She told me she didn't blame me and that her son even refuses to visit her because it's such a pain to get all gowned up. I said, "That's not what I meant. I feel very impersonal in this. Like I'm here to conduct experients on my patients". We laughed.
Despite Kate's situation, she was a very pleasant lady. Our long-term goal was to get her in the shower. But first we had to get her to transfer safely into her wheelchair. The physical therapy assistant (PTA) and I did a lot of collarborating this week. Whenever she'd come back to the gym from her room, I'd chase after her and ask her how Kate did. There was always progress being made. She was able to get Kate up in a static standing position for one minute. Her main problem was pushing herself up from the bed with her arms. Her triceps were so weak and she had so much weight to carry. So we started with tricep exercises with her semi-reclined in bed. Then we progressed to her holding herself up in bed with her elbows locked and pumping herself up and down as best she could (even if it was just a centimeter) during bed mobility tasks. Kate broke down once during that session because she said her son came in to celebrate his birthday with her but she couldn't do anything for him. She couldn't be a mom. But that motivated her even more to continue with her exercises.
When I walked by her room the other day, one of the CNAs was getting all gowned up to go in. Kate's door was slightly open and I could see her sitting in her wheelchair, watching tv -her hair braided back. I stopped in the hall and called her name. She had a BIG smile on her face and we waved at eachother. She said in her cute, nasally voice, "Hello world! ..I'm suppose to say that to everyone who sees me today sitting in my chair". I loved it. And I told her I liked her hair. She stayed in that chair for 5 and a half hours, which I think was a little too much after being in supine for so long, because the next day she was worn out.
She had the energy the next day to go from supine to sitting on the edge of the bed. But when I got the CNA to help me assist her to do a partial-stand-pivot transfer, Kate freaked out. With time, we attempted it twice, but there was no way I was going to risk her falling on her face and going back to square one. So we decided to do a bed bath with her sitting on the edge of the bed. I gave her a couple washcloths and told her to go to work, and I'd be there to help with what she couldn't do. She was able to wash down to the top of her feet, part of her peri area, her chest and armpits, and her face. She was doing great. She combed her hair and I braided it. She put her gown on and rolled back in bed, lifting her legs up with just a few verbal cues on hand placement. I raised the head of her bed and then, out of nowhere, Kate started crying. I asked what she was so sad about. And she said, "I feel like I disappointed you. We were so excited to get in the shower today and I thought today was the day that I could do it". I told her, "Kate! I am going to tell you FIVE things that you did GREAT today". Here was my list that I pointed out to her (literally):
1. You got yourself up to the edge of the bed, where you sat with no assistance for about 30 minutes.
2. You washed your own legs and feet! Remember how I had to do that for you with you laying flat in bed the other day?
3. You washed part of your privates! How awesome is that?! (We laughed)
4. You got yourself back in bed with NO help from me to get your feet up.
5. Your hair's all combed! Granted I did the braiding. But I couldn't have done it if you hadn't have combed it! (We laughed again).
I told her that yes, she may not have gotten in the shower today, but to put her focus on what she COULD do today that she COULDN'T do yesterday. It all brings her one step closer to reaching her goal of getting in the shower. Baby steps. She was getting there.
I am hoping that once she is able to safely transfer to her wheelchair and her C. diff sample comes back negative, I can take her on an outing to the store. That was her long-long-LONG term goal. And I really want to make it happen to lift up her spirits. I told her yesterday how proud I was of her and that I was looking forward to seeing what we could do Monday. She was all smiles.
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