Because my last internship was at an outpatient neuro rehab facility, I have developed great interest in neuro rehab. Which is why everytime we get a new-admit slip placed on the rehab desk at work that reads "CVA", I ask to have that patient put on my schedule. My patient, who I'll call Kelly, got admitted last Friday, having had what the doctor believes was a stroke to the occipital portion of her brain. According to her chart, nothing has been accurately diagnosed yet. In this case, and in any other case, you treat whatever you see. My ex-fieldwork supervisor in neuro rehab told me on my internship that, because the symptoms patients present vary with every CVA, it is important to not just rely on what the book tells you the symptoms are, but to explore the patient in depth, and treat what you discover during the evaluation and throughout treatment.
So here's what I discovered about Kelly. She was very weak. She could perform a toilet and shower transfer with me simply guiding her at her hips, but at any given moment, may need maximum assistance from two people because she can have muscle spasms in her legs in a split second. She can be in the middle of drying herself while sitting on her shower chair, and then collapse onto you because everything around her starts to spin. That was a little scary. She wears a black eye patch with a garter strapped around her head because she has double vision, and in order to focus on something and see it accurately, she has to have one eye closed. She has difficulty and fatigues easily with circular and vertical eye movements. She has poor short-term memory and divided attention. She will be walking to get clean clothes out of her drawer, get there, and forget what she walked over there for. Or she'll attempt to don her jeans in the morning and forget to take her pajama bottoms off.
With every limitation Kelly has, she has a million strengths. She is highly motivated. She is willing to try anything and everything I ask her to. One morning she was so nauseated after breakfast and kept apologizing for having to re-schedule, almost in tears, because she really wanted to do therapy. She goes to the afternoon recreational activities in our facility -attempting to play Bingo and Keno even though she tells me it's frustrating at times. Kelly also has a lot of hobbies and a thirst for learning new ones. She loves brain-teaser activities that are perfect for working on improving short-term memory. She has amazing family support. The posters, cards, flowers, pirate hat to match her eye patch, Winnie the Pooh and Snoopie stuffed animal in her room say it all. And whenever I recommend getting a portable grab bar or a vision stick or large-print playing cards, her daughter, parents, or husband will have it for her the next day to show me in therapy.
I look forward to working with Kelly every day because she makes me do treatments that are different from the typical ones I do with our more common patients with orthopedic injuries. It allows me to pull from what I've learned on my internship and be creative to find ways for her to re-learn new things or compensate for skills that may be difficult to regain. I've done visuomotor exercises with Kelly with her vision stick from the home exercise program she was given upon discharge from the hospital. But then I thought of ways to vary the exercises and make them more functional. We've scanned and read through the grocery newspaper which I really liked not only because Kelly loves grocery shopping, but because it has a lot of contrasting color and bigger font that make it easier for Kelly to read and maintain visual focus. I've taped a vertical and horizontal list of letters and numbers to the wall and had Kelly read them up and down, side to side, with her head facing the front and only moving her eyes(alternating the patch). I explained to Kelly that when she is discharged, she will have to be able to read signs being out and about in the community. At times I'd take out the middle portion of the list so she would have to jump back and forth to the first letter/number on one side and then to the first letter/number on the other side. Not only is she again working on her eye movement, but she is also working on her short-term memory and divided attention, because as she is going from one letter/number, she has to remember where her placement was and where she left off. I've played the memory game with Kelly and emphasized the importance of repetition, repetition, repetition. The more she reminded herself over and over again of what picture was beneathe the cards, the easier it was for her to finish the game. I printed an article on activities for short-term memory (http://www.livestrong.com/article/187149-activities-for-short-term-memory/) in large font and had Kelly read it during one of our sessions while, at the same time, teaching her how to use a rular to mark her place or use her finger to jump from one word to the next. It's amazing how one simple compensatory strategy can help.
In the meantime, we've also worked together to build Kelly's strength for safe transfers and shower tasks. On Thursday, almost a week after she was admitted, she asked if she could attempt shaving her legs because she hadn't for three weeks now. Why not! She was in the shower for, not kidding, a good 30 minutes. Hunched down, reaching for her ankles with her razor, she started laughing. When I asked her what was funny, she said to me, "I'm just laughing at the little things that are making me so happy right now". I grabbed my clip board and wrote that special quote down, thinking to myself, "That's what OT is all about". After her shower, she pulled out a pair of new jeans out of her drawer. She told me they were new and she couldn't fit into them when she bought them. She told me she lost 20+ lbs since before the hospital and wanted to try them on. She pulled them up over her legs all on her own, saying, "They feel so nice against my smooth skin! Amazing the things we take for granted." She layed supine, sucked her stomach in, and buttoned them shut. They fit. She sat on the edge of her bed and said to me, "I will never take things for granted ever again. Never."
On Friday, she mentioned she couldn't continue reading her novels on the kindle application on her iPad because the font was so small. So I saved the last 10 minutes in our therapy session to mess around with it. Surprisingly, my technologically-retarded self, discovered how to maximize the font. Kelly sighed and said wtih a big smile, "I can read now!" Next week, I'm going to print out large Sudoku sheets for her to work on since she told me she misses doing them. Then we are going to visit her home to give Kelly ideas on how to make her environment safer and more accessible. That should be a good session. And one to motivate her even more towards discharge.
Saturday, October 29, 2011
Friday, October 7, 2011
Room 104
I can't help but feel a sense of failure (even if it's slight) when a former patient of mine returns to our facility after a fall. I felt that for the first time on Wednesday morning. I was in room 104, doing a room treatment, when my patient's phone rang. It was not long until I realized that the person calling was someone my patient did not know. She said, "Here. Talk to my therapist" and handed me the phone. To my surprise, it was my ex-patient's daughter. That patient used to be in room 104 and was discharged a couple weeks ago. What her daughter told me broke my heart.
My patient fell on Saturday in the middle of the night, tripping over the wheel of her four-wheel walker as she was getting out of bed to go to the bathroom. She had not gotten out of bed since. It was already Wednesday. And according to her daughter, home health never arrived. First thing I asked was, "Did you take her to the hospital?" No. I was so confused. So I told her I'd see what I could do, never having this situation happen before, and that I was glad she called when she did. I talked to the physical therapist who also worked with this patient and our social worker, who was in charge of getting home health services set up prior to discharge. She took it from there and sent a home health nurse over to the house.
At 4:30, as I was getting ready to leave and was walking down the hall, I saw my patient's name outside one of the rooms. I stared at it for a second to make sure I was reading it correctly. Then I knocked, opened the door, and peeked inside. My patient (let's call her Connie) was attempting to sit up in bed with a big, gasping smile on her face. She opened her arms up to me. I made my way past her daughter, who was on the phone and ended up taking her call in the bathroom, and gave Connie a big hug. "What happened?!" I asked her. She told me how she fell and that she feels she has declined and has been depressed since she's been home and does not understand why. Then she hugged me again. I told her I was glad she was back under the circumstances and that we'll talk tomorrow and figure out what's been going on and how we can fix it. I told her, "You were READY to go home, Connie. In fact, you were more than ready." And she knew that.
When I first met Connie, she became very special to me right away. Connie used to be on hospice care, which was shocking to me. Because even though she fatigued easily when bending over to put her socks on and needed me guiding her into the shower, she had so much potential. With Connie's Rheumatoid Arthritis (RA), we adapted her writing utensils and found easier ways to allow her to open packages in the kitchen. With her Chronic Obstructive Pulmonary Disorder (COPD), we went over energy conservation strategies and did endurance training. With her decreased strength, we did bilateral upper extremity exercises and functional activities, keeping her RA precautions in mind. And with her depression, we talked. Mostly about family and baking and what she wishes she COULD do.
When her endurance finally picked up and her physical therapist gave me the go-ahead with walking long distances with her front-wheel walker, I planned a trip to the dollar store. When the facility driver and I went into her room to get her ready, she was sitting on the edge of the bed, with a big smile on her face, and a list of almost 20 items she wanted to purchase -all listed in her squiggly handwriting, that she told me she did with her adapted pen. Here's what she came up with:
3 birthday cards - one for my grandson, one for my sister, and one for my brother (this one has to be extra special).
Hairbrush
Hair color
Hair curlers (2 packs)
Hair spray
Mirror
Floss (2 packs)
Hot tamales
Pantyliners
Non-slip mat (The main reason we were going to the dollar store in the first place)
Mascara
Shades
Reading glasses
Small notebook
I wasn't sure if we could find all this stuff at the dollar store, but Connie reassured me we would. We got there and she looked like a kid in a candy store. On top of getting all the items on her list, she found more things she wanted. She demonstrated good endurance in walking for a long period of time, good safety with positioning her walker when reaching for items, and good fine motor skills as she manipulated her wallet and money. As we walked out, Connie said to me, "I haven't been taken to the store in 8 years". I felt happy and sorry for her all at the same time, I almost cried.
That same week we baked sugar cookies in the kitchen in the rehab gym. Connie told me she used to bake all the time but that she stopped because it became too difficult for her with her RA and COPD. But there she was! In control. Opening packages with minimal assistance and adaptive strategies, obtaining everything she needed, stirring ingredients in standing, managing the oven, and washing dishes. We stood there and ate a cookie (or two) before I walked her back to her room.
The following week, Connie told me she needed a smaller pair of black sweat pants because she had lost a lot of weight. She wanted to go to Ross for their Senior-20%-off-Tuesday. I scheduled it with the driver, which almost became a disaster because I wrote it on the Wednesday calendar by accident. Connie said if we couldn't go, she would've cried. Connie would've hated me (well, not really). The driver, by luck, showed up to her room at the perfect time to replace her oxygen tank and was greeted with Connie asking, "Ready to take me?" Luckily, he had no appointments scheduled and we were able to make it to Ross for our therapy session. She bought a pair of black sweats, a bunch of socks, and a cute turqoise blouse that I picked out for her. The only thing that she didn't find that was on her list was a wallet. She did amazingly well considering how huge Ross was. The only little scare we ran into was when we were in the dressing room and she told me that she was having BM accidents lately. Luckily, she did not have one under my watch, on a community outing nonetheless!
And now here she was. Back in transitional rehab because of falling at home. In a way I felt responsible because she was my patient and my job was to keep her safe. But when I told the physical therapist the situation and how I randomly, but thankfully, received a phone call in room 104 that morning, he told me we did our part. She was more than ready to go home. Among all the patients I've had, she's been able to do the most -bake, go on outings, walk through an entire store and try on clothing.. There was nothing more we could've done as a team.
I missed Connie so much when she left. In fact, I considered doing PRN work in home health to possibly be her home health therapist. But that was just a thought. I know I say this a lot in my posts, but I had a true bond with Connie. I am not happy of course about the circumstances, but I am glad that she is back in an environment where she can get the skilled service and support she needs to get back to where she was the day she left. It seemed as if Connie was excited to be back. She hugged me again for a third time before I told her I had to go clock out because I was done working for the day and that I would see her tomorrow. As I walked out the door, Connie called out, "I love you, hun".
Today, I saw her for a 70-minute treatment session. She was in the gym, just finishing up her physical therapy session, when she whispered that she'd like to start our session in her room because she wanted to talk to me. In her room, she told me she wanted to get out of bed since Saturday but her daughter told her not to because she didn't want her to fall. She told me all her frustrations and hurtful feelings towards her family. All I could do was listen. Then, as she sat on the toilet, she broke down into tears and said, "I just wish somebody wanted me". My heart broke once again and I felt for her. There I was, hugging my patient who was sitting on the toilet thinking, "I don't know how sanitary this is but I don't give a crap" (no pun intended).
My patient fell on Saturday in the middle of the night, tripping over the wheel of her four-wheel walker as she was getting out of bed to go to the bathroom. She had not gotten out of bed since. It was already Wednesday. And according to her daughter, home health never arrived. First thing I asked was, "Did you take her to the hospital?" No. I was so confused. So I told her I'd see what I could do, never having this situation happen before, and that I was glad she called when she did. I talked to the physical therapist who also worked with this patient and our social worker, who was in charge of getting home health services set up prior to discharge. She took it from there and sent a home health nurse over to the house.
At 4:30, as I was getting ready to leave and was walking down the hall, I saw my patient's name outside one of the rooms. I stared at it for a second to make sure I was reading it correctly. Then I knocked, opened the door, and peeked inside. My patient (let's call her Connie) was attempting to sit up in bed with a big, gasping smile on her face. She opened her arms up to me. I made my way past her daughter, who was on the phone and ended up taking her call in the bathroom, and gave Connie a big hug. "What happened?!" I asked her. She told me how she fell and that she feels she has declined and has been depressed since she's been home and does not understand why. Then she hugged me again. I told her I was glad she was back under the circumstances and that we'll talk tomorrow and figure out what's been going on and how we can fix it. I told her, "You were READY to go home, Connie. In fact, you were more than ready." And she knew that.
When I first met Connie, she became very special to me right away. Connie used to be on hospice care, which was shocking to me. Because even though she fatigued easily when bending over to put her socks on and needed me guiding her into the shower, she had so much potential. With Connie's Rheumatoid Arthritis (RA), we adapted her writing utensils and found easier ways to allow her to open packages in the kitchen. With her Chronic Obstructive Pulmonary Disorder (COPD), we went over energy conservation strategies and did endurance training. With her decreased strength, we did bilateral upper extremity exercises and functional activities, keeping her RA precautions in mind. And with her depression, we talked. Mostly about family and baking and what she wishes she COULD do.
When her endurance finally picked up and her physical therapist gave me the go-ahead with walking long distances with her front-wheel walker, I planned a trip to the dollar store. When the facility driver and I went into her room to get her ready, she was sitting on the edge of the bed, with a big smile on her face, and a list of almost 20 items she wanted to purchase -all listed in her squiggly handwriting, that she told me she did with her adapted pen. Here's what she came up with:
3 birthday cards - one for my grandson, one for my sister, and one for my brother (this one has to be extra special).
Hairbrush
Hair color
Hair curlers (2 packs)
Hair spray
Mirror
Floss (2 packs)
Hot tamales
Pantyliners
Non-slip mat (The main reason we were going to the dollar store in the first place)
Mascara
Shades
Reading glasses
Small notebook
I wasn't sure if we could find all this stuff at the dollar store, but Connie reassured me we would. We got there and she looked like a kid in a candy store. On top of getting all the items on her list, she found more things she wanted. She demonstrated good endurance in walking for a long period of time, good safety with positioning her walker when reaching for items, and good fine motor skills as she manipulated her wallet and money. As we walked out, Connie said to me, "I haven't been taken to the store in 8 years". I felt happy and sorry for her all at the same time, I almost cried.
That same week we baked sugar cookies in the kitchen in the rehab gym. Connie told me she used to bake all the time but that she stopped because it became too difficult for her with her RA and COPD. But there she was! In control. Opening packages with minimal assistance and adaptive strategies, obtaining everything she needed, stirring ingredients in standing, managing the oven, and washing dishes. We stood there and ate a cookie (or two) before I walked her back to her room.
The following week, Connie told me she needed a smaller pair of black sweat pants because she had lost a lot of weight. She wanted to go to Ross for their Senior-20%-off-Tuesday. I scheduled it with the driver, which almost became a disaster because I wrote it on the Wednesday calendar by accident. Connie said if we couldn't go, she would've cried. Connie would've hated me (well, not really). The driver, by luck, showed up to her room at the perfect time to replace her oxygen tank and was greeted with Connie asking, "Ready to take me?" Luckily, he had no appointments scheduled and we were able to make it to Ross for our therapy session. She bought a pair of black sweats, a bunch of socks, and a cute turqoise blouse that I picked out for her. The only thing that she didn't find that was on her list was a wallet. She did amazingly well considering how huge Ross was. The only little scare we ran into was when we were in the dressing room and she told me that she was having BM accidents lately. Luckily, she did not have one under my watch, on a community outing nonetheless!
And now here she was. Back in transitional rehab because of falling at home. In a way I felt responsible because she was my patient and my job was to keep her safe. But when I told the physical therapist the situation and how I randomly, but thankfully, received a phone call in room 104 that morning, he told me we did our part. She was more than ready to go home. Among all the patients I've had, she's been able to do the most -bake, go on outings, walk through an entire store and try on clothing.. There was nothing more we could've done as a team.
I missed Connie so much when she left. In fact, I considered doing PRN work in home health to possibly be her home health therapist. But that was just a thought. I know I say this a lot in my posts, but I had a true bond with Connie. I am not happy of course about the circumstances, but I am glad that she is back in an environment where she can get the skilled service and support she needs to get back to where she was the day she left. It seemed as if Connie was excited to be back. She hugged me again for a third time before I told her I had to go clock out because I was done working for the day and that I would see her tomorrow. As I walked out the door, Connie called out, "I love you, hun".
Today, I saw her for a 70-minute treatment session. She was in the gym, just finishing up her physical therapy session, when she whispered that she'd like to start our session in her room because she wanted to talk to me. In her room, she told me she wanted to get out of bed since Saturday but her daughter told her not to because she didn't want her to fall. She told me all her frustrations and hurtful feelings towards her family. All I could do was listen. Then, as she sat on the toilet, she broke down into tears and said, "I just wish somebody wanted me". My heart broke once again and I felt for her. There I was, hugging my patient who was sitting on the toilet thinking, "I don't know how sanitary this is but I don't give a crap" (no pun intended).
Thursday, October 6, 2011
I Can Use a Wrench!
Yesterday, I decided to play the role of handyman. Considering the only tools I know how to use are crochet and knitting needles, I think I did a pretty good job and I am proud enough to write a post entirely on my experience fixing my patient's wheelchair brakes!
I was working with one of my patients, doing a room treatment, when I noticed her wheelchair moved as she performed a sit-to-stand transfer. This surprised me at first because for one, I did not want her to fall, and second, she has always been my A-patient when it came to safety during functional transfers. Lord help me if I had to document that she all of a sudden had poor safety awareness. I checked her brakes and they were locked. But they were loose and just barely touched the wheel. She told me the PRN physical therapy assistant noticed it yesterday and that someone would tighten them today. I had her sit on the edge of the bed and looked at the clock. We had 10 minutes left. Now in 10 minutes, could I really figure out how to fix this thing? Why not. The physical therapist taught me how to do it my second week on the job when my patient's brakes were loose. But it took me a good 20 minutes to get it done because saying "yes, I can do that" after being shown how, does not necessarily mean, "yes I can do that" once you try it yourself. But I figured I had to figure it out eventually. And my patient cannot go through the rest of the day with loose brakes.
So I went to the gym, grabbed the toolbox, went back to my patient's room, gave her some theraband to do her exercises with in the meantime as she watched me.. layed out the tools on her floor, tipped her wheelchair on it's side, and crouched down. I told my patient, "So here's the thing. I know what I'm SUPPOSED to do-", as I pointed to the nut and bolt I was suppose to take apart, "-I just don't know if I remember what I'm suppose to do it WITH", as I held up the different little hollow cylindrical silver thingys. "I REALLY don't wanna have to call Jason" (her PT). But after a couple minutes of being unproductive, I had to give in.
Jason was sitting at the computer. I grabbed him and off we went back to her room. He laughed at all the tools on the floor. Once he picked out the tools I was suppose to use, I was good to go. I fixed the first wheel and clapped once it locked tightly into the wheel. Then I flipped the chair over and started unscrewing the other. When I was close to finishing, the nut got stuck in the cylindrical silver thingy. Panic. My patient laughed. I was glad to provide entertainment as she was doing her exercises on the edge of the bed. "I am NOT calling Jason back here. You cannot tell him this happened." We laughed. I figured out that if I attached it back onto the chair, it stabilized the nut well enough for me to unscrew it from the other side. I got it! Done! I was so excited and proud of myself. There's a first time for everything.
I was working with one of my patients, doing a room treatment, when I noticed her wheelchair moved as she performed a sit-to-stand transfer. This surprised me at first because for one, I did not want her to fall, and second, she has always been my A-patient when it came to safety during functional transfers. Lord help me if I had to document that she all of a sudden had poor safety awareness. I checked her brakes and they were locked. But they were loose and just barely touched the wheel. She told me the PRN physical therapy assistant noticed it yesterday and that someone would tighten them today. I had her sit on the edge of the bed and looked at the clock. We had 10 minutes left. Now in 10 minutes, could I really figure out how to fix this thing? Why not. The physical therapist taught me how to do it my second week on the job when my patient's brakes were loose. But it took me a good 20 minutes to get it done because saying "yes, I can do that" after being shown how, does not necessarily mean, "yes I can do that" once you try it yourself. But I figured I had to figure it out eventually. And my patient cannot go through the rest of the day with loose brakes.
So I went to the gym, grabbed the toolbox, went back to my patient's room, gave her some theraband to do her exercises with in the meantime as she watched me.. layed out the tools on her floor, tipped her wheelchair on it's side, and crouched down. I told my patient, "So here's the thing. I know what I'm SUPPOSED to do-", as I pointed to the nut and bolt I was suppose to take apart, "-I just don't know if I remember what I'm suppose to do it WITH", as I held up the different little hollow cylindrical silver thingys. "I REALLY don't wanna have to call Jason" (her PT). But after a couple minutes of being unproductive, I had to give in.
Jason was sitting at the computer. I grabbed him and off we went back to her room. He laughed at all the tools on the floor. Once he picked out the tools I was suppose to use, I was good to go. I fixed the first wheel and clapped once it locked tightly into the wheel. Then I flipped the chair over and started unscrewing the other. When I was close to finishing, the nut got stuck in the cylindrical silver thingy. Panic. My patient laughed. I was glad to provide entertainment as she was doing her exercises on the edge of the bed. "I am NOT calling Jason back here. You cannot tell him this happened." We laughed. I figured out that if I attached it back onto the chair, it stabilized the nut well enough for me to unscrew it from the other side. I got it! Done! I was so excited and proud of myself. There's a first time for everything.
Wednesday, September 21, 2011
A Little Bit of Rummy & A Touch of Cowboy
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!
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!
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.
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