Friday, January 30, 2009
Interesting day...too bad I don't feel like writing about it right now, ha ha. But some key words to remind me when I do write. Severe dementia/delirium, catatonic to not, monopolizer, remember pop not 100%
ANYWAY........I'm tired, yo. Maybe I'll post later this weekend.
END OF WEEK FOUR! ONE THIRD THROUGH MY FINAL ROTATION! UM, I SHOULD PROBABLY START STUDYING FOR BOARDS - AND/OR FIND OUT WHEN THEY ARE - AND/OR START FIGURING OUT WHAT STATE I WANT TO LIVE IN/WORK IN...........just a thought.
Thursday, January 29, 2009
Wednesday, January 28, 2009
First of all, I prefer to say I observe/assist (either with verbal prompts or hands-on physical assistance), rather than "Watch" lol. That sounds creepy. I try and be as discrete as possible, I know nobody wants to be observed... although most of these people don't seem to care at all.
Second of all, there really is a link. Showering and dressing are both activities of daily life (ADLs). ADLs are often greatly impaired in people struggling with mental health issues,
whether it's dementia or major depression or a psychotic disorder or who knows what. People struggling with mental health are not functioning at top cognitive potential, and often
struggle with basic things such as remembering to wash all body parts, sequencing correctly, safety, etc. We can get a pretty good grasp of someone's cognitive functioning level by how they shower/dress. Do they forget to wash major parts of the body? Do they not notice their t-shirt is soiled or inside out? Things like that. Plus if we do some assessments near the beginning of their stay, and then again regularly through the rest of the stay, we often - hopefully - see an improvement in function that can be concretely graded.
So...showers DO have to do with mental health. :P
I couldn't have done anything without her there -and since outpatient is closed, she just has the ward, so I think she'll be okay (and she lives really close)...I just don't want her thinking I'm lazy!!!
I have her home phone number, but it's here at home. It never occurred to me I might be at work and need to call her at home. Now I know better.
ANYWAY....gonna go lie back down I guess. Hmm. b
Tuesday, January 27, 2009
Did a bathing ADL with a pt, my OT was there as well. This pt is high functioning and was standing up to remove clothing, the way most typical people do, I think. My OT kept telling her to sit down for safety and she wouldn't. But she was pretty steady and stubborn and just set in her ways. I tend to feel like they deserve some lee-way - like if I had some health issues and some aide was taking me to a special shower room with a shower chair, hand held attachment, nothing familar, etc, I'd probably do things a little differently than I do at home, that might seem unsafe or weird to someone watching. I dunno.
Did a geriatric depression scale scale with a lady who scored in severe depression range, no surprise. She seemed to need to talk -I spent a lot of time with her discussing coping skills and strategies, but I thought she might benefit from a chaplain (I see the chaplains come in sometimes). I asked my OT and she said go through the social worker, but the social worker (who is young and rather new) was like yeah, I didn't even think about asking the chaplains to come in for individual patients, go ahead. I think people who have worked there a while - and were trained by others there - tend to follow the same routine - while someone new and without a lot of constant supervision, just has to come up with own ideas...to me it's obvious, but I guess I have to be careful about not stepping on toes.
Speaking of the social worker, I've let her know we can contribute to the discussions on nursing home/AL/IL placement appropriateness, and so today I did the Cognitive Performance Task on a high functioning lady...took her out of the ward, my first experience doing it with my own patient. Her logic was skewed when explaining answers, and I think she "confabulated" the answer on finding the cost of a gallon of white paint....I was surprised she did rather poorly. I think she was smart enough to realize her performance on the test
was important so she was a little nervous.
It's AMAZING how much trouble people have with setting up new medications (part of that test).....they end up doing bizarre things like putting a few pills in a few days, seemingly at random, if they don't grasp the instructions. It's like they gamble maybe they got it right.
I gave the social worker a mini-tour of our area and walked her quickly through the 7 sub-tasks of the CPT...and gave her some papers on the level the pt was at, to share with family. Basically the social worker now knows we can be of help - she called today to ask about doing the test on another pt, and my OT was like well, guess you explained to her, and I was like yeah, maybe I created a monster! LOL. A good one. It's important, if OT is going to stay in the mental health arena, that other disciplines utilize us and know what we do!! It's a little sobering/scary though to have input...you have to be careful, safety-wise, as to what you recommend.
I interact a lot with nurses, aides, the social worker, some rec therapists, and of course patients. No speech or physical therapists work in the mental health units...which kinda sucks, because one of our patients who was walking when he got here (but weak) is no longer walking. I think if he had gotten regular PT he would have had a better chance.
I did two "creative-y" groups today...on was rather crappy, one was kinda interesting....I still have a lot of learning to do in terms of managing groups. When I took that group class, if some one had told me I'd end up running 2 groups a day for 3 months, I would have been like ha ha!! But here I am, sucking. lol
The first group was about ambiguous direction/problem-solving......the second group was called "Transformation" and it had to do with drawing past and present and future, and discussing things to do to help ensure the future as they depicted it.
One sharp lady drew an embryo for past, a stick lady for present, and a casket for future. She cackled about it, but when I asked her what she wanted to do before the casket, she got thoughtful and had several things she wanted to work on.
Another HILARIOUS old lady said she wanted to have "quar triplets" ...lots of babies.
Another lady drew a smiley face for past, sad face for present, and smiley face for future.
Another lady didn't draw anything, but verbally stated she would get better by eating right, taking vitamins, and "coming to groups"...lol. I liked that answer.
I did the MMSE on a pretty sharp guy who doesn't like the groups..and frankly he is so high level compared to most of them, that I don't blame him. He doesn't like the rec therapist at all. That almost made me happy, but not in a petty way. Let me explain...I really admire this rec therapist. She is loud and tough and really tries to get people to participate by being assertive. She is fun and good and I am "jealous" of her in the sense that I wish I had more of her strong personalit. On the other hand, some of the patients are put off by that apparently, and my quieter more lenient personality means they are more willing to do things because they don't feel I'm bullying.I know maybe some people think I'm too lenient or "soft" but I like to subscribe to the whole "more bees with honey" or whatever that expression is....flies with vinegar, I dunno. Whatev.
Ummmmmmmmmmmmmm what else. The social worker told me she likes that I seem to go above and beyond for patients, that I really care. That meant a lot to me because I do. I really, really, really care. Whether or not I do a good job or make a difference, I'm not sure sometimes, I feel I'm not very good, but I do care and I do try hard, so I'm glad that's apparent. I guess I wish I could get groups down...feel like my groups actually leave them going "Wow, that was helpful" versus leaving and going home and being like "I had to participate in the stupidest groups"....
I got exactly 20 units today...I'm less scared these days...except group is still no fun, lol. Gotta figure out how to make them FUN......and to steal a catch phrase....how to put that FUN in FUNctional.
I've got to figure out groups for tomorrow...I may do repeats...safety awareness and importance of exercise (which involves some exercise)...I think I have a whole new turn-over so it wouldn't be a repeat for anyone...hmmm.....I dunno.
This ended up being longer than I thought...I felt like I didn't have much to say but apparently, lol, I did. Just a lot going through my head. I really want each patient to leave with skills they need to be successful and not come back as a frequent flier....I want each patient to feel they have some control and that people are listening to them...I want patients to feel like their therapy is helpful and promoting success....want want want.
Monday, January 26, 2009
One eval cancelled...heard an aide yelling for help in a bathroom...I unlocked the door as nurses came barreling in...patient had medical issues/was taken out of unit. Another one of my patients was also gone for medical issues over the weekend.
I did two groups today...with six people, my new record. I think I bored them, but I got a few ironic smiles even out of an acutely depressed patient.I didn't do my crayon group yet. Tomorrow, I think.
I'm quasi- proud of a few moments today...
One. Patient with aphasia spilled ice water on lap. I came across him in hall and saw the wetness/his cup of ice, although he didn't say anything. I told him I'd get him a towel and some water, and he started saying something. I started to move off and he got slightly agitated and clearly and loudly said WAIT! WAIT! I stood calmly in front of him for a minute, saying nothing. He just looked at me. Finally about a minute later when i sensed he was calmer, I said slowly and calmly, May I get you a towel? He nodded yes. When I got back, I said calmly, may I get you more water? He nodded yes. I'm proud I realized his agitation was coming from wanting some control and trouble processing, so I'm glad I did what I did, once I realized I was operating too fast for him. I was in a rush initially because stuff like that is a big productivity sucker - technically for stuff like that I should mention it to an aide, instead of doing it myself, because I'm solely based on billable units. But I think it's good to do it myself anyway for many reasons. It helps build a rappoire with the patients, it allows the aides/nurses to either see I'm helping them out and/or let them focus on more important stuff, and it means it gets done right away.
I went in to the activity/dining room to say hello and almost slipped because water had been spilled - there was one nurse in there on a 1:1 (ie one nurse for one patient, arms length at all times), so I let her know I'd be right back with a towel and to keep anyone from walking over there....went and got a towel. Then the lady sitting next to the spill asked for new socks because hers were wet. So I went and scanned her out new socks for her in the supply closet down the hall (not that big of a deal)..another productivity sucker, but all the patients (most of them were in there) saw I delivered on my promise. This lady has been especially hard to work with so it was good, I think. Plus I feel good I'm learning the ropes/know what's going on/can help out. I enjoy it.
On one eval I did today, the pt cried possibly four times in about 15 minutes. On another eval, you could just see the fog clouding her depressed brain...but I'm learning to go with the flow.
My friend Suzy took my cat to the vet today since he's been listless and extra sneezy. He got a steroid shot and he'll be on antibiotics. It was so helpful and kind of her to take him for me. My friend Arnie - her husband (the couple I'm staying with on this rotation) is dropping me off at work tomorrow, if we get the ice storm we're supposed to get. Hopefully we don't...ugh. But I'm lucky to have good friends.
Tomorrow night, if weather permits, we're going to a friend, Steve's, house...I wanted to go to gym...well see on weather...blah blah blah.......
Sunday, January 25, 2009
I want to do some involving artwork...but am limited as we have very few supplies and a lot of items are contraband, even if we did....I spoke with a good OT friend of mine about ideas.. she pointed out I need to be careful about not being too emotionally evocative as I don't have the training or experience to necessarily handle what happens...and also that I need to remember to stay OT based, not psych based, with goals/objectives. Good point. Thinking, thinking.
This week, I have one MAIN goal.
1) Be more relaxed/calm during group!! Not dread it so much!!
Friday, January 23, 2009
I went back to the office a while to do documentation and I was still feeling off. My OT and I had our weekly meeting. Overall I'm pretty much on schedule.
Went back to the unit and was able to do a new eval with a very high functioning lady...gave a lady a shower...I finally feel pretty comfortable dealing with shower time now. And then I also did two ADM Sticker Cards...actually, it was kinda funny...I sit in on the end of a rec therapy group and we were left with four high-functioners...I wanted to do ADM sticker placemat on one of htem, but the other three were bored, and all wanted to do it. Luckily there were plenty...so I passed them out. Then they were still bored...I got the tactile dominoes (big dominoes with textures instead of numbers, for low vision) although none of us know how to play dominoes right so we ended up kinda making silly patterns, stacking them up and knocking them down, making little structures/sculptures and figuring out what they could be...just playing around and laughing. I was relaxed and comfortable because it wasn't about insurance and billing and documentation...just about having a good time with some ladies.
Apparently I probably could have billed as a group since I did have 4 people and we spent easily 20+ minutes together, interacting with each other. But the point was that it was just a nice relaxed time, which is good for me - and them. It helps me learn to chill out and calm down and it gives them some "down" time or maybe "up" time depending on how you want to say it, lol.
I ended up with only 12 units for the day since there was no group, and because I really did have an off morning which is typically when you get the most units. Next week is WEEK FOUR...time kinda flies, although not really...I've been really trying hard to bring peace to myself because it SUCKS to wake up in the mornings in dread and nausea and anxiety. I'm trying to exercise 3-4x/wk, use my special blue light to help combat SAD, repeat calming words...I really hope after another week or so, I get to the point that groups don't bother me. I think the key is to bottle that relaxed comfortable feeling I had when I wasn't worrying about having to charge insurance, and try to bring that to groups...fun and relaxed. Easier said than done, but I can try.
I went to the gym and did a half-hearted workout afterwards..then came home and apparently slept from 630 to 9pm, HARD...they tried to wake me up and I was OUT. Now my tummy is full of pizza and cookies YUM FRIDAY NIGHTS and Lester is lying next to me. I think I'm going to re-go to bed in a minute, lol. I'm so exhausted.
Thursday, January 22, 2009
Did two groups....6 in first, 5 in one. First was a Social Bingo. Second involved an 50 Noodle Boosters article from AARP...brain stimulation!
SOCIAL BINGO was interesting because it involved things like giving compliments to people sitting near you
This one lady walked around the table (she should use a walker as she holds onto furniture, but that won't happen), to give a compliment to another lady (one who has dementia and isn't really with it). With tears in her eyes she told the lady she was special and beautiful. This other lady looked up at her tremulously and said faintly "Thank you".
I thought that was sweet.
Another compliment was made by a lady with depression to a man with dementia. She said "I love your beautiful white hair" and he said thanks, want to run your hand through it? She did, a faint smile on her lips.
One of the really flirtatious men always winks at me and sometimes I wink back and he'll say, do you have something in your eye? He always wants to marry people, I tell him I'm married. Anyway, this lady - one of our higher functioning ones - told me "I gave my heart to your boyfriend" lol.
Another man got transferred to an Assisted Living facility today - I'm not sure the facility realizes his level of need - based on our results he needs to be in a nursing home, but apparently this AL facility gives a lot of physical assistance. I hope he does okay. My guess is he'll end up frustrating the other much higher level residents, and/or getting frustrated himself. I won't be surprised if he ends up back here, although for his sake I hope not.
It's interesting to hear how nurses talk amongst themselves about doctor decisions. The nurses spend all day with patients, the docs come in for rounds maybe once a day and spend at most a few minutes with their patients...sometimes the doctors make rather poor choices, I think. I dunno.
I need to figure out two groups for tomorrow, I bettr get crackalackin. One last stupid thing though
So when I fill out times in documentation, you have to do like 0834, not 834...four digits, not three. And if you do it with three digits it will bring up a box that says HHMM and I used to think that was so cute as if it were saying HMMMM!! Fix it!! Finally I realized it was saying HHMM as in hour hour minute minute. I liked it better as the concept of Hmmm!! Oh well.
Wednesday, January 21, 2009
This is fun, but ultimately disgusting. It is a good idea to get permission from the parents of students competing, as it will likely result in vomiting. So why is it on this list? Well, it really is a fun competition to do during a service. Have four or five students volunteer to compete during a youth service or activity. At the start of service give each student a gallon of milk. Throughout the service the students chug the milk to see who can finish the entire jug first. It is a good idea to have garbage cans on hand.
While all of these games can be fun, do you have more ideas you'd like to share. E-mail your ideas to your Christian Teens Guide. I'll put them together in more articles to share with other youth groups!
Four short stories.
1) Geriatric Depression Scale with severely depressed lady. She has had some SI - suicidal ideations - and poignantly explained the problem that "my body wants to live, but my brain wants to die"....
2) Our guy we d/ced from OT for being too low level - brain injury issues - very adamantly and clearly wanted me to come over to him today (I was across the table from him, talking to another patient)- I tentatively did so - and he promptly pointed to my half-open pants zipper. His aide died laughing and I was like AHAHAHAHA noooooooooo. I thanked him of course and fixed myself up!!
3) Newest sentence creation during MMSE: "I want to be your friend forever".
4) Discussing leisure activities during group, and new learning opportunities. Lady states she wants to learn to write more like doctors....I was like (thinking) hmm, working on making your handwriting MORE illegible, great idea. And yes, she literally meant the handwriting.
Okay...I'm back to being behind on things big time...online and off...I still haven't done Christmas cards to Norwegian friends/family, written thank you cards from Christmas, written some 3 or 4 month old blog entries (oopsies), and then of course I'm almost 200 emails behind. Maybe it's time to break it down and make some short term goals. For now I gotta go figure out what to do for group tomorrow. Love ya my blogging peeps
Tuesday, January 20, 2009
But really, that's just a disturbing blip in the radar, not necessarily the reason I don't want to blog. But I know if I don't, by tomorrow the new day will erase today and I'll have lost all my stories of the day.
Let's say. Today I got 20 productivity units and wrote um, at least 15 notes. 2 evals, 4 cogs, 1 ADL, 8 group notes, etc.
Abbreviations I'm about to use a thousand times explained quick and dirty and possibly slightly wrongly:
MMSE, Mini Mental State Exam: common questionnaire for dementia
ACL: Allen's Cognitive Levels, used to determine how much cognitive assistance a person needs
LACLS: a leather lacing task to test cognitive levels, related to ACL
My supervisor had an empty morning so was with me 8am-11am.
First: did MMSE/LACLS on a man who is very low level, just to confirm he is too low level for OT (at least for our purposes in this particular ward, nobody is too low level for OT), with documented proof, so we can discharge him.
Second: Gave a newly-frequent-flier lady a shower. My first time. I stood in the shower with her - her on a shower chair - and was in charge of the hand held attachment. She is graded
on her bathing/dressing using cognitive levels. For example she perseverated on certain areas and forgot to deal with others until cued. Man, elderly diabetics tend to have really scary feet.
Third: Did an eval. Lady slow to process, very depressed. Didn't particularly care but was cooperative.
Fourth: Watched my OT run a group on self-care using a Self-Care modified Bingo.
Fifth: Ran my group on importance of exercise as important component to healthy lifestyle - not in those words. Did chair exercises.
Sixth: Oh lordie, I'm forgetting.
We discharged one lady because she would ALWAYS sleep - and then an hour later, I go up and she is sitting there, bored in the hallway, wanting something to read. guess if she is awake again tomorrow, we'll re-instate her.
I did another eval on a lady who, apparently, pre-hospital, would try to get the plastic off food by using a lighter, lol. She apparently told this one aide
who she finds particularly pushy, "Go away, you bitch".......which isn't so bad. I mean, in the sense that sometimes they REALLY curse you out. One curse word is like, nothing, lol.
Some of these ladies seem pretty calm and cooperative and high-functioning and I'm like, hmm, do they really belong here?And then I stick around on the ward and start to hear them scream and cry and I'm like um, yes, I guess so, lol. Although truthfully I think a stay in a psychiatric ward could make someone a little crazy get a little more crazy. The change in routine, the loss of control, it's not cool!!!
I asked one lady during exercise group what she did for exercise and she said "breathe". Loved that answer.
Ok I guess this got long. I ended up at work 745 to 445, 20 minute lunch........documentation took longer than I expected so I left 30 minutes late. I guess I'll eventually learn how to handle it all.
Okay I'm going to go back to reading the year of living biblically now. and ignoring all the thank you notes, and 160+ emails, and 40+ Facebook msgs, that I'm behind on, lol. Oopsie doopsies. Maybe tomorrow.
Joke as reward for getting this far:
What kind of key doesn't open a door?
a MON key
Monday, January 19, 2009
I did a chart review, then an evaluation with supervision...we did the LACLS on a lady with SI "suicidal ideations" and she got frustrated with the lacing task (after the 2nd demonstration of the whipstitch) and she said "Please don't make me upset" in a wavering voice, so we stopped. By then we had her score anyways.
My OT ran groups today - I've told her several times I still feel the need to observe how she handles problem behaviors. She did one on roles/self-awareness, and one on logical thinking/sequencing, through a functional task - ie planning dream vacations.
The paranoid schizophrenic lady was not in a good mood this morning but then a switch flipped and she was pleasant and I was able to do an ADM placemat with her and she did a horrible job but enjoyed the process. I think she would definitely enjoy little arts and crafts activities.
Another man who is low functioning compared to the rest of the unit, and has aphasia, was having a rough day today. He can normally feed himself after set-up, but today he kept his eyes closed most of the time, kept using an imaginary fork instead of the real one, missing his plate, missing his mouth, etc. The aide was sitting with him and I was observing because I was going to do a few things with him. Finally the aide was like, he isn't normally like this, I guess I'm going to have to feed him. I was like how about I take over, so I could do a feeding ADL unit with him by helping him feed himself. That's an intimate act when you're providing a lot of help. Later on, he put his head down on the table and wept. He cries a lot. I felt so sorry for him. I rubbed his back awhile. While being mindful of his arms in case he decided to fling his arms out in anger, as he tends to get agitated.
On another man, I did the ADM tile trivet task, and he didn't particularly have interest in it, but he described his approach as that of a job. Pretty good attitude and insight for someone who functions at a relatively low level.
Hmmm...one thing I'm encountering is how to make it clear OT is awesome...at times. I don't feel particularly awesome sitting there watching someone place tiles. And the aide who was watching was like, not impressed, thinking, OTs make so much more money and they just sit there and watch a person place tiles? I showed her some of the paperwork/explanations of the ACL/ADM because I *promise* you she was thinking OTs had the easiest job in the world. And maybe sometimes we do. I think aides have a much harder job than therapists...paid very little to deal with a lot of crap, literally and figuratively.
And the same for rec therapy - I try to explain to the rec therapy students, when they asked, about OT groups etc, and they seem to think I'm basically doing the same thing as them. And maybe I kind of am - there is some overlap at times - but OT has much more of a focus on functional outcome....I dunno. It's not that I want to feel superior to aides or rec therapy students because they all serve vital functions and I admire them - but OT is ideally much much much more than the little bits they see me doing, and I hate for them to get their opinion of OT by watching me sit by a dude placing tiles.
Okay, I can't think of anything else to say now. Oh yeah, it snowed a lot of the morning. Only four more days left of Week 3...lol
Sunday, January 18, 2009
One of my men with dementia who is very self confident (I think to hide insecurity though), seemed MORE so than normal during group Friday...he would say confidently, I can do anything, I can do everything, I am unique because I pick things up so fast....sometimes I think I am the Lord himself". It was interesting because I was having him do a placemat copy and he did a HORRENDOUS job but seemed to think it was perfect. I didn't ruin his illusion, lol.
That seemed like a slight escalation in behavior so I let the nurse know he was being rather grandiose at a higher level than before. That was before lunch. After lunch, I came back, and he had had a mini outburst, ranting and preaching to another patient, and had to be sedated. Guess he'll still be there Monday, lol.
I went back in the afternoon thinking I'd fill up, but two people were leaving, a few I had already seen in the morning or had an issue, one was heavily sedated, one was a paranoid schizophrenic who was having issues, and three were heavily asleep. I feel like waking up a strange lady to say, hey, I have some questions about depression for you, is kinda counter-productive. Yeah, if it's a depressed person sleeping the day away, that's one thing. But if it's a 92 year old taking an afternoon nap, I hate to disturb the person. Anyway.
The paranoid schizophrenic (look at my poor, poor use of person first language) was sitting in the hallway in a disheveled gown and as I'd walk by she would look at me until I got near, then she'd very blatantly snap her head away. At one point, having exhausted other options, I tried to talk to her (since she is one of our OT patients) and she snapped "I don't want to talk to you". I said "Okay, just checking in" and kept walking, lol. Her behavior was odd enough that it wasn't her being irritable, it was her having active symptoms, so I wasn't going to mess with her.
Joanne Cash (Johnny Cash's sister) came in to sing again. She does gospelly stuff. One of my men with dementia came in and was like Wow, is that a wig!? (she has black and white crazy hair). She said no, it's all mine, do you want to feel it? Or something along those lines. He ran his hands all through her hair and commented "That's more than a handful." After she was done singing, he asked again if he could touch her hair. She said no, once was enough. LOL. She was pretty cool in how she dealt with him. It's really nice of her to sing to them. I like watching the patients sing and immerse themselves into the experience.
I did group afterward - 4 in first group, 5 in second. One was on compensating for memory deficits....
Me: What would you do if somebody gave you a phone number and you didn't have a pen? (thinking they'd say repeat it a lot)
Lady: I'd say call back or tell me later after I get a pen!
Me: ::asks same question to man in wheelchair::
Him: "I'd say, go get me a pen so I can write that down!"
The second was supposed to be on anger management, but I made a split-second decision to do it on support systems/discharge planning instead, based on the group and that multiple patients in it were leaving that day.
The shining moment of the day, though, had to do with a one-on-one session.
That morning, I spoke with a man who was leaving that day after being there about a week. He said he was feeling anxious and he didn't know why really. We discussed how change can be scary, even if it's good change, because it means a change in routine, and some unknown factors. He acknowledged he was going to have a new room at his old nursing home and how that was a little disconcerting as well, etc. I think he hadn't been able to fully "get" his anxiety considering it's supposedly a good thing to leave a hospital, until we talked. We also spoke a little about relaxation - deep breaths, calming the mind etc, and he mentioned he wanted to try yoga. ANYWAY, I wasn't sure if what I had just done was billable or not since all we did was chat, but my OT confirmed it was, as long as the outcome is measurable, ie, identify 1-2 coping strategies for anxiety. So....I haven't been fond of what I've been doing in the ward (seems like I do very little therapeutically, mostly just evals and/or confirmatory diagnostic tools), BUT, one-on-one discussions of how to cope with anxiety, depression, etc, is right up my alley, so that might be the one thing that helps me like the rotation.
The way I know (or at least strongly suspect) I actually made a difference for him? He was in my group on discharge planning a few hours later. He basically said word for word what we had discussed earlier about change being hard whether it was good or bad, but he had made it his "own" words.
ANYWAY...those were the highlights of Friday.
I had a fun weekend - details later - but I was bummed tonight knowing I have the start of a new week tomorrow! Oh well, I guess I'll get through Week 3. I'm going to try and go to the gym 4 out of the 5 days, wish me luck.
Lester is curled up next to me with his little tongue protruding, sooo cute.
Thursday, January 15, 2009
It was really cool. We heard some crazy stories about a code that involved a man smeared in feces (they had to take him down regardless and all got covered in poo), stuff like that. Overall it was awesome...considering we were in training 730am to 415pm, it went pretty fast.
We were checked off on everything - we all took turns being both patients/staff in all of the holds, so we all took each other down. Pretty cool. The holds work around maximum leverage more so than strength. It was good basic self-defense stuff to learn although it was "clean" - ie no fighting back, just getting out of the way and calming/restraining patient safely.
Tomorrow I probably hold two groups and then do evals, etc. Almost end of week 2, 10 weeks to go. It was a beautiful, beautiful thing to have two days without worries about group...only 100 groups to go...2 a day, 5 days a week, x 10!!!!!!! :O
Wednesday, January 14, 2009
Tuesday, January 13, 2009
Note to Cookie Gimp: Yep, it was you I was talking about the other day!!
What else. Oh yeah, the big event of the day. I was doing group and one member with dementia was monpolizing things big time - I kept trying to redirect him, tell him to stop, but he is hard of hearing and adamant, so it's a bad combo. Another member, who has had multiple strokes and is not very physically functional and has trouble speaking, got really angry at this monopolizing member, and started yelling, banging the table, and cursing, etc, telling him to shut up. Some nurses/aides came in and calmed down the angry guy. The monopolozing guy kept apologizing but kept talking at the same time about his rough life. They kept trying to get monopolizing guy to be quiet so that angry guy would clam down. One of the aides said something along the lines of "Stop talking sir, we've all had a rough life, we don't want to hear it." I was like UM. Not to say I have a better way of dealing with it, but that doesn't seem like something you say to people in a psych hospital or who are getting therapy!! Angry guy left and so did another little lady with dementia who always dissapears during such events. So group was a bust more or less. Oh well. It kind of freaked me out when he was getting so angry. Good thing I have behavioral training tomorrow, lol.
I checked in with the angry guy later, he had calmed down, he was angry about the monopilizing (how many ways can I spell this wrong in one post?) not only for himself but also for my sake. I think I'll learn some assertiveness over the next few months, since I'm supposed to be doing two groups a day!!!!! Augh!!!!!!!!
Do you know the scenes in the movie Superstar where Mary Katherine Gallagher is like flirting with a stop sign/flagpole/tree? I think Lester is flirting with a table pole. He just stuck his nose against it.
Today and yesterday my OT has been more with me, watching me do evals to point out stuff, helping me with the single cordovan stitch on ACLS (I still freeze but I'm almost there!!)...we started out the morning with bathing I've never seen shower ADLs before. There is a special bathroom with a shower chair, hand held shower attachment, etc.
My OT basically holds the shower attachment to minimize how wet she gets, and then the person gets scored via ACL scoring and FIM scores for their bathing and undressing/dressing. You think, how do you score a person on bathing?!! But think about all the tiny steps involved in bathing - soaping up hidden areas, remembering a washcloth, being safe, washing off soup, using enough soup, etc.
I did a few MMSEs, a few ADM placemats ....
You learn to just nod and go along with things. Like on the MMSE when you ask orientation questions and they tell you it's February, Fall, Thursday, etc, you just keep going with the poker face...Today's MMSE sentence by a lady with COPD who was very gravvelly sounding: "I wish I had a cigarette". I added some exclamation points to that one for her ;)
I'm still a little conflicted sometimes regarding "getting the productivity units" versus whether I think the person is genuinely going to benefit from my intervention. Also, because I all too familiarly know the overwhelming desire to crawl back into bed with depression/anxiety, I feel bad for the ones who want to go back to bed because the nurses/aides/doctors want them up out of bed as much as possible. I know in reality it's best for them to stay up, not be isolated, etc, but I really "feel" their desire to just be alone/go to bed!! One lady today was having an anxiety attack and begged me to stay with her (I had gone in to chek to see if she would come to group, she was in bed crying). In retrospect I wish really bad I had stayed with her and worked on some relaxation techniques, but my other patients were waiting for group to start, so I couldn't. Ugh!
Tomorrow morning and Thursday morning I have behavioral health related training - I don't know how long it will last but I'm hoping a long time - anything to keep me out of the ward!
It's only day 7...I sincerely hope I'll eventually get the hang of things to the point I no longer dread each day. I'm really quite a passive person even in all my activity - I'd much prefer to be a zombie rather than do things like literally JOG to the ward for an eval (my supervisor has long legs!!!). She LOVES her productivity units with a passion, lol. She has the sin of productivity gluttony. She never stops for a break, and I think she's had an actual 30 minute lunch like once.
Today she had to go off premises for a while and it was like time for lunch and she was going to be back in say 45 minutes, and she wanted to make sure I had plenty to do, and I was like yeah and rattled off a bunch of stuff, and then I was thinking...if I'm lucky I've been taking a 20 minute lunch, and there is no such thing as a "break" for her. So I did take like 20 minutes for lunch and felt guilty lol.
I guess it sounds like the above is complaining, but it's more a combination of sharing/awe. She's certainly energetic. I just have my winter zombie blues so her level of energy is pretty amazing to me. Oh and today I got off on time!! Wow!!!!!!!
Okay, this is really long...oh well, I don't care. If you got this far, you are way too nice.
I went to bed at 9pm, I had all I could tolerate in the waking world. Right now it's 7am, I need to leave in 5 minutes, I'm anxious and nauseated. The thought of another long day....I'm hoping if I blog out my thoughts for the extra 5 mins I have, it will help.
It also doesn't help Lester hasn't been feeling so good, he's been acting extra oddly which always worries me.
Today we start out with ADLs - we are giving one lady, one man, a shower. Then I'm doing the CPT on one of my OT's neuro patients (since I'm learning it). Then I have two groups for an hour. There is at least one eval to do today maybe more if any orders came overnight. And then ACLS and MMSE on 3 people, ADMs and/or GDS on others. We'll see how
much of that gets done.
Ok, I better go start defrosting the car. Send calming thoughts my way.
Friday, January 9, 2009
Inpatient Geriatric Psych Ward: Census: 6
Today I did:
Two 25-minute groups of 4-5 patients: 8 notes
Two evaluations: 2 notes
One ADM Placemat/Geriatric Depression Scale: 1 note
One ADM: 1 note -
One ACLS: 1 note -
Total: 13 notes.
Productivity units: 17 (20 is ideal minimum).
My supervisor also had her neuro day patients, so we actually got 32 units for the day since my productivity goes under her. I also semi helped do the travel task of the CPT, and a cooking task of scrambling eggs, with a neuro patient, to gain some experience with both the CPT and using cooking for treatment. My OT was present/helped with this as it was her patient. My OT does do fine motor tasks with patients like pegboards etc, but is otherwise the most occupation-based therapist I've seen - she does a lot of cooking tasks, making the bed, dressing, typing, etc.
My OT kept getting called away when joining me, so I did most things by myself. She was present as an observer/SLIGHT participant for my groups, and did the cordovan stitch for an ACLS. The rest? All me.
She signed those 13 notes at the end of the day - made a few suggestions and a few small changes, but not much.
I got there at 7:45am, left at 5:30pm as she signed my last note. I had a 15 minute lunch - ie heated up the lunch, ate it as quickly as I could. No other real breaks - maybe 2 minutes here and there.
In other words: on the last day of my FIRST week, I basically carried a full caseload by myself. Of course I bounced off ideas on my supervisor, asked questions, etc, but I'd say that's a lot to do on week 1!!
Topics of my two Life Skills groups: First: identifying safety hazards around the house, how to remove them. 2nd: Somewhat of a stretch, but self-awareness - thinking about happy moments of the past and laughter, and what about the situation made it so happy, and what people could do now to help promote a positive mental state, ie be with friends, garden, etc.
One of my favorite moments of day:
Male patient with severe dementia: I don't remember. I'm 88, you see.
Me: You don't look a day over 87!
Patient: ::genuinely laughs:::
Also, one of my patients who was psychotic kept hearing things in his head...including calypso music! You try interpreting the word "calypso" from someone with dysarthria!!
Oh! And want to hear something funny???!! Apparently Johnny Cash's sister, Joanne Cash, performs for the patients, ie mini concerts (meaning a microphone/CD, into the little room), which is so sweet. But I saw the lady downstairs beforehand and she has such funky hair (a la Cruella DeVil), I was like WHO is that. Well I found out soon, when the rec therapist brought her in. She was awesome. She sang a lot of gospel. Isn't that the nicest thing? I think that is so wonderful and the patients loved it.
Week 1 down, 11 to go. I think I can handle it...
Sorry this is so disjointed...
Thursday, January 8, 2009
What do you do when a very old man with dementia is inappropriate towards women, expecting sexual favors (confusing them with his passed wife, at times)? Honestly my instinct is to recommend paying someone to cuddle with him since that's probably the only thing he can really handle anyway, but I know that's not exactly kosher and I'm not sure how you'd do it..."Excuse me, Escort Services? Yes, I'd like to use y'all, but not for any home runs, ya know what I'm saying?"
I wonder how many escorts specialize in geriatric services...ie cuddling and minor intimacy. Hmm. Yo Escort Services who have Google Alerts: Think about it!!! Geriatric Specialties!! You're welcome.
I was asked by the man's daughter how to handle this situation, and I told her I'd look into it and get back to her. Anybody have good ideas?!! I might post this on the OT mental health listserv, but first I should probably check some literature and the archives too, as I know this is a relatively common issue....the whole retrogenesis thing I guess.
Okay I'm jumping in the shower and heading to bed! Those of you who just started a new fieldwork (apparently January 5th was a big start day), I/we would LOVE to hear from y'all if you have anything to share, whether good, bad, stories, facts, thoughts, whatev.
AOTA! Check it out!!
My name is "Jane Doe" and I regularly read your blog! I wanted to say that I love the blog as it opened up my eyes to OT and I learned a lot about the profession. Your blog is one of the reasons I am applying to OT school because it gave me a perspective of OT from a student's view! I am actually in the process of applying to a master of OT program in "Doeland"(I am from "Dooda") and I was wondering if you can give me some tips.
I have to submit an essay discussing OT as part of my application and it's due this Friday! and I am freaking out...one of the question is to describe a trend in health care and how OT is positioned to play a leadership role. I was thinking of maybe discussing the switch in healthcare to health promotion and disease prevention but I am a little unclear on how OTs can play a role in this.
If you can give me any tips I would really appreciate it!
Thanks and keep up the great work on the BLOG!
Anyway, I should introduce myself- my name's Alece and I'm 2nd year MOT student at the University of Washington (in Seattle). I've been reading your blog for a long time now (since April 2008) and admire your dedication.
I am very interested in political advocacy at the state level, and for my Master's Project I've just launched a blog about OT advocacy in WA State- you might enjoy checking it out: www.otadvocacy.com
I watched a cooking task this morning - a lady who had to make scrambled eggs - and it's a miracle she didn't burn herself, she was sooo unsafe. It was my OT's neuro patient, but she wanted me to watch because I could potentially bring patients down to the kitchen for cooking tasks.
I am very proud of myself because today I went and hung out with our four patients (about to be six) + some other random patients, in a big room, for a little while, before group...instead of cowering in the nurse's area.
The first group was on discharge planning/importance of support systems. The second group was on identifying leisure activities/why they are important.
I really like watching Margaret run groups because I learn a lot about dealing with problem behaviors. I tend to be too nice - doh.
I don't necessary feel like I've been thrown to the sharks, but at least the dolphins. It's only the end of week 1 and I've done two LACLS, like 5 MMSE, lots of chart reviews, and 1.25 evals, as well as written up at least 2 evals, several cog notes, and lots of group notes. I know it's my last rotation and I've already had 6 months, but it's a very different setting!
I'm starting to finally grasp the paperwork and how the system runs - I have to understand the big picture and the step-by-step process, in order to be able to problem-solve.
My favorite quote of the day was when I asked the man with severe dementia why he was here, and he said "You tell me and then we'll both know!"
Who knew Baby Jesus had hypotonia!
Day 3 over!
So...I struggled last night and this morning with dread over going to work. I'm a creature of habit, I don't like unpredictability, I don't like not feeling competent, blah blah. But I swallowed it!! My OT had a packed schedule with her neuro day program, so she sent me to the gero inpatient ward to do a chart review, and then I came back. I practiced the LACLS and made myself a cheat sheet of what to say and did some other reading, while she saw her patients.
She had this one patient in a wheelchair attempt to take his jacket off one-armed (since his other arm had no function from a stroke), by using a pulling/shaking method, and WOW, it was hard to watch. He was struggling and getting frustrated and she was skilfully helping him, but after about a minute I was (internally) like OH PLEASE FOR THE LOVE OF GOD LET ME HELP. And you know, my OT training teaches me that its important for him to do it by himself independently, and then my "gimp" perspective taught to me over the year from my "gimp" friend, makes me wonder, Why?? If it doesn't really bother him to get help getting his jacket off, why bother frustrating him so much doing it one-handed? It was painful to watch him struggle!! My OT, btw, has awesome knowledge and skills. She has done a ton of continuing education and loves alternative therapies and is very smart and talented at OT-osity.
Then when it was time for the eval I did the chart review on, she had to do something really quick, so I went up to start. I wheeled the lady to her room - she had severe depression/anxiety - and she cried a lot. And when asked why she was there, her answer was "My stupid husband brought me here thinking it was an emergency room". I feel so sorry for these people who just feel utterly betrayed and lost. She kept saying she just couldn't stand to be alone anymore, and crying. I just wanted to throw my clipboard of evaluation questions down and give her a hug!! I started asking questions and then my OT came in and finished up, then I did the MMSE with her - her short term memory was horrid, so she scored pretty badly. The doctors LOVE the MMSE and so when I went to turn it in (they do most of their stuff via paper charts!!), they had me give it directly to the doctor who had that lady's chart, and he was really nice. He apparently worked with the people who developed the MMSE so he gave me some cool information on it, and pointed out it's a great tool to use repeatedly (ie every few days), to determine whether a person has delirium versus dementia. Oh. And her sentence creation? Was "Love is God's greatest gift".
I think of everything, the sentence people write on the MMSE, is most revealing. Breaks my heart. Think about it. You ask them, off-guard, to write you a sentence, about anything, and that which is most important to them, is what flows out of their fingers. The lonely lady craves love. The euphoric lady is, uh, euphoric (Euphoric Lady is Euphoric, Sarah), and the lady with circular logic/dementia just wants to be understood.
Lady with dementia: "Please understand"
Lady with euphoria: "I am a happy person and I love everyone"
Lady with fear of being alone: "Love is God's greatest gift"
I also got to give the LACLS for the first time, to an older hearing impaired man. I did the running stitch and whipstitch, then my OT took over for the single cordovan stitch, I'm not quite there yet (but probably will be tomorrow)!! Poor man could not untwist the lace for the life of him.
The coolest part of the day was unfortunately not directly related to my rotation. I joined the psychologist for his group in the stress disorders unit (I was with him Monday morning as well). I LOVE that unit because most of them aren't that dangerous or unpredictable, or at least less aggressive. You have a lot of sad people there, but not people ranting and raving and screaming and tearing off their clothes. It's subdued. The group was very small. One of them discussed some very painful memories, the other one was just very very sad and quiet. One lady kept picking at her clothes as if not sure what to do, I wanted to give her a Tangle toy to hold onto! I contributed a tiny bit to this session. I REALLY REALLY REALLY would like to work with this population of people debilitated by depression/anxiety. I have so many ideas for things I would do with these people. I realized that this morning that when I enter the gero inpatient psych ward, I'm scared and/or saddened, and don't feel like I have much to offer besides compassion...but when I am with these people with depression/anxiety, my soul shouts and sings with ideas of things to do. I'm thinking that maybe, when the gero ward is quiet, if my OT is busy, that I would be allowed to do some non-billable work in the stress disorder unit....doing a lot of activities that focus on soul-searching through (mildly) creative outlets.
You know how Care Bears are like CARE BEAR POWER or whatever, and then like their stomach shines with this huge light that focuses on the person/thing, and changes it? I want to be like SEROTONIN POWER and have my necklace burst into this spotlight and infuse them with happy chemicals and thoughts.
Ok....my posts have gotten back to being really really long, but it helps me to spill it out. Tomorrow I may do an evaluation, MMSE, and LACLS with supervision...ie the whole tamale!! And maybe some ADLs...
After work I hit the Curves gym and have been hanging out with my friend I'm living with!! Lester the Lion Kitty is curled up next to me. I just talked to Brooke who is at John Hopkins and she loves it so far (although she's only been in orientation but it's obviously an awesome place). Also talked to another good friend for a catch-up chat and that was also awesome. Now I'm going to hang out some more and go to bed. YAY for being ridiculously overdetailed.
Tuesday, January 6, 2009
Last night I took an anti anxiety pill to help rid of my jangles, and went to bed early. I woke up about an hour later because I had this really bad dream where my beloved Lester the Lion kitty was eaten by a dog. I cried!! I've had a lot of dreams lately where I'm just really uneasy and scared. I guess just reflecting all the changes I've had lately in my life! Anyway. The problem with that pill is that it helps at the time, but when I wake up in the morning, I feel rather sad and broken. So that's not cool. I woke up this morning and I was like, I'm not sure I can handle this. I'm not sure I can do this fieldwork (or any new fieldwork). Rough. I consoled myself with the knowledge that if I do break down, I'm in the perfect place. LOL.
Went to work, and it turns out there was orientation issues, and that I was supposed to have gone to the main campus Monday morning, and I need to go right that moment. I volunteer to look up directions on Google Map, but my OT wants to draw me a map to go the back roads as it is easier. It looks pretty straight-forward so I agree to try her way. Unfortunately one of the roads had an issue and I had to get directions in a Walgreens, but I did eventually get there, in the rain.
The fieldwork coordinator there (not just for OT, she has 500+ students) was quite kind as apparently the mistakes were on both sides, not just mine. She let me get my TB test there instead of finding the health department, and we're working on the CPR card thing. Of all the stuff stolen from my car that night in October, I never thought my CPR card would end up causing me more grief than all my financial cards!!
I went back to my hospital using yet another way - I had now gotten directions from 3 different people and all of them had said something that wasn't quite right, lol.
The rest of the day was a combination of interesting, a little scary, busy, and slightly confidence-increasing.
We did a group with 3 old ladies - one we had evaluated, two that would be evaluated later in the day. One lady, let's call her Jane, kept insisting "I'm not crazy!" and she was rather euphoric and motor-mouthed and restless. The other two ladies were rather quiet. Euphoric Jane cracked me up, she kept talking about how much she loves belly-dancing. One of the quiet ones, when asked about things she values, said "My kids and my clothes". The first group was on self-awareness, by answering questions about valued things/events, and the second one was using big pictures and discussing emotions displayed in the pictures (ie happy child, sad person, etc).
The lady that was so agitated yesterday - screaming and cursing - was mild mannered today.
Later on we did several evaluations.
1) A lady who talked/processed sooooo slowly and was very Alice in Wonderland, using circular answers "That is the answer to which the answer is asked", kinda stuff. She could not remember the state she was in at all, or county, or town. She scored in moderate dementia range using the mental status MMSE questions. She did poorly on the leather lacing assessment. She also didn't handle imitating a placemat very well. This is one of the confidence boosters today - realizing the ADM craft placemat wasn't so hard and I wouldn't have to struggle to learn it.
I was the one who gave the MMSE with my supervisor sitting next to me. Pretty cool. Her "sentence" that she had to write (without any suggestions on what to write) was "Please understand". It kinda gave me chills - considering the way she spoke so slowly and circular-ly.
2) The euphoric lady. She was living alone up until this hospitalization. Hard to imagine her being safe. Euphoria is hilarious. Her sentence was "I am a very happy person and I love everyone". I did her MMSE as well.
3) This was awesome. We went back to do the evaluation on one of our earlier pleasant quiet ladies, and she was NOT in a good mood. She kept saying SHUT UP and NO. My OT was trying nicely to get her to participate - and she was having none of it. She finally said "If you don't go away I'll throw my coffee in your face!". My OT didn't flinch, she stayed calm.
I did a few mini chart reviews - learned that the Axis I diagnosis is what we have to use - did my two MMSEs - and learned how to enter in the info/notes for a group therapy session, into the computer. They still mostly use paper charts and their computer system is like DINOSAUR DOSsey, with like, using the function keys and arrows to get around, a TOTAL pain in the butt. It doesn't even word wrap!! Shockingly old school.
I need to practice the ACLS some more...that single cordovan stitch is going to be the death of me. And I'm not the only one. I know lots of other students who struggle with it.
It's really interesting to me to see how people can be logical and smart in some ways, and then utterly incompetent in other ways, in these settings...the brain is so complicated!!! Spoken like a true neuroscience major.
ANYWAY....this was a little disjointed, but whatev. I wrote it with lots of distractions. After work I went to the gym. I think physical exercise at the gym is going to be my saving grace for getting through this fieldwork with my mental health intact. That and wonderful friends. And SEROTONIN! Come on you little serotonies!! Work harder!! Be fruitful and multiply and stuff!
Monday, January 5, 2009
These two videos were made while in OT school, when we learned them during lab. Now I'll be doing it on real people!!!
Yes, I know there are some mistakes in both videos...we were students just trying to get SOMETHING out there.
Pointing out errors to be helpful is great. If you want to be critical though, just make your own, better, video, so we can benefit from your awesomeness, okay?
ANYWAY! I'm going to watch these videos to refresh my memory, then go to bed,and hope tomorrow is a little less overwhelming!!
I met up with my supervisor around 8amish, read student manual binders for about an hour and a half until I was utterly overwhelmed, then joined a psychologist while he went and did a group in the inpatient ward that deals with stress disorders. It was an initial group and it was interesting. One lady there was complaining about how she couldn't have her makeup - she had the good point that they kept saying you should do things to make yourself feel better, but makeup would make her feel better! LOL! You aren't even allowed conditioner or face soap or anything. You get a baby Johnson's shampoo and Dial soup. Wow. Anyways, all these people were pretty high-functioning overall...able to interact, crack jokes, use words like "acrimonious",...lol.
Even though this group was basically an initial hi, don't stop making your meds after you leave, kinda group, they all clamored to tell their stories, although sometimes indirectly, like..."What do you think it does when your mother tells you, when you're still a child, that she was molested?" Etc. They all mostly had problems with depression, anxiety, a few bipolars, a few DID (dissociative identity disorder)...honestly, considering my own background with depression/anxiety/panic attacks, and their high levels of function overall, it was a little hard for me to be present. I could see how precarious the slope is, to ending up inpatient. The psychologist kept discussing serotonin, which I wear around my neck (www.madewithmolecules.com), and I could feel it practically burning into my skin!
My OT supervisor also showed me the gero inpatient ward I'd be in - although sometimes if another ward has a low census, they temporarily combine them or something, so there were lots of young people there...including one lady who looked like an Amy Winehouse, screaming and cursing and trying to get out...my OT was just showing me around cool as a cucumber as this lady ranted and raved in the halls, not more than a few feet from us. She oddly seemed to ignore us. When it was time to leave the locked ward, the supervisor had me slip through quickly, since this lady was trying to leave. "I need to leave. I need to go to a hospital that will actually help me."
Those were my two forays into the inpatient psych areas...the rest of the day was a combination of reading through mind-numbing huge manuals, and getting to see a few outpatient treatments with my OT, specifically a few that used assessments I'd be using - I got to see the Cognitive Performance Task - CPT - done, as well as the MMSE. The man on the MMSE scored in the moderate dementia range, answering with confidence that it was 2008, that it was Fall, etc (while also knowing it was January 5th).
For the lady who she did the CPT on - she did quite well. She scored slightly lower on the "shop" task because she "bought" a belt before checking the wallet to see how much money she had. The "phone" task was interesting as she really had to call a store and ask about a gallon of paint, which is a little flustering. I was thinking they'd have to be careful on this one not to let the patient call a big hardware chain that would make you navigate a menu to get to a person. They do account for that in the test though. Pretty interesting. The lady would think out loud, and for example on the medication task, she'd be like "Hmm...this says take as needed...normally at home I don't put those in the boxes if it says that, but I guess I could put one in a day...what do you think?" Therapist, noncomitally: "Whatever you think is best.". Luckily she always self-corrected her mistakes, but it was a little slow-going. The only sub-task she really did poorly on was the "travel" one, following a very basic map.
There was/is a little confusion over orientation - I did get my ID badge today at least. And I was shown around some. My OT seems interesting and nice and so do her PT/ST colleagues. Here's the big scary issue. THE HOSPITAL IS A GHOST TOWN! They're closing down wings, laying off therapists and support staff, left and right. Maybe I misunderstood, but my OT was saying they had like THIRTY OTs a few years ago, and now it's down to four OTs. Today I saw one PT, one PTA, and one ST, and then just my OT. Maybe she meant, actually, that there were like 30 therapists total, and only 4 now...hence the four therapists I met today. I'll ask for clarification. Regardless, there is no receptionist, and there are all these massive rooms/wings that are filled with AWESOME rehab equpiment, that are just dead/quiet. We stopped through the Independent Village that they boast about on their website, that has like a fake little grocery store, gas station, fake ATM, etc...it is SO COOL, it is like every OT's DREAM for functional, occupation-based treatment...and it's DEAD. Dead because it's isolated now (it was attached to the rehab area which is defunct), and it would be unsafe for a single therapist to take a patient to an isolated area, far away from any help. Seriously, a little chilling, to walk into these rooms strewn with rehab equipment. And this little village BROKE MY HEART. Such a beautiful, perfect, stunning, amazing, coolest thing I've ever seen. And yet empty. What this also means is that my OT has a lot on her plate - she runs the neuro day patient program, AND she has to do support staff functions that normally a receptionist/admin person would handle, and she is the only therapist I know of so far....today I ate lunch alone because they had a meeting through lunchtime. Not a big deal, just very different from my last two rotations. I think I'm going to have to be creative about my learning since it looks like basically I'll get to watch my OT do things a few times, then I'll be on my own from then on out...of course getting in my necessary supervisory hours, etc, but I won't be working side-by-side with any therapists.
They use the Allen's Level stuff a LOT - some of the RTI, ADM crafts, and then the CPT. Also the MMSE and ACLS. So this will be a great learning experience! I feel confident I can administer the MMSE, and the CPT is relatively straight forward once you learn some of the nuances with lower functioning patients. The ADM crafts and ACLS (leather lacing) are going to be hard for me because I have such major issues with visual perception and therefore struggle mightily to do these types of tasks.
Okay...this is my longest post in a long time. Basically, I'm feeling somewhat scared and overwhelmed, but I think that's normal for the first day/week of a fieldwork, and I think I can handle it, I just need to keep a lid on my panic!! Hey, if I do go postal, I'll be in the right place, lol.
I've gotten some sweet blog comments lately - thank you.
Sunday, January 4, 2009
Okay, I'm going to try and go to bed soon. Wish me luck on my first day. And I seriously seriously seriously seriously am getting my act together so I think I'll FINALLY catch up on emails, Facebook, blog entries, questions, etc, SOON!!!!!
Saturday, January 3, 2009
"A Poem for Karen
Three months went by so fast...
Hard to believe so much time has passed!
Karen's leaving us, it's such a pity.
At least she still has Lester the Lion Kitty.
I've never met him, but I know he's famous.
He's on YouTube, where his name is
Well-known to all who read her Blog!
(some say Karen should have bought a dog)
So it's Goodbye to our dear student
(When in Nashville, please be prudent!)
And remember your friends at "Hospital"
(X, Y, Juliet and was there a fourth...?
Have a great Christmas back in La Jolla
And think of Juliet when you see a sequoia."
Here was my poetic response:
"A Poem for Juliet
You are not
the only one who can
write a poem.
But I cannot rhyme
Thyme; lime; chyme;
Creativity flows out as rhymes
So instead I cheat
Using little sentences
To make it look
as if I am
I wanted you to know
that you are like
Not morbidly woodenly obese
Or exceptionally tall
But you have a majestic presence
Powerful and graceful
An experience that cannot be forgotten."
I'm actually a little "off" in entirety regarding this fieldwork. I didn't contact them until rather late and there's an issue with the CPR card (which was stolen since it was in my wallet when my car got broken into in late October) - I'm getting a replacement card but it won't be there by Monday, that's for sure. This fieldwork site is going to be like YOU SUCK and I'm going to break down and be like I'm sorry! I'm sorry!
Ok just kidding. Kind of. That reminds me, I need to print out my online orientation test. And like, take it first. LOL. Guess I'll do that now.
I joined the Curves gym here and I'm working on getting healthier...hmmm. Have been sleeping a lot, healing from my sinus infection...so don't have a lot of fascinating stories to tell...of course I could tell my old stories and I will, but not yet, because um, I still don't feel much like it.
By the way, my high maintenance low-level obese patient that I did a lot of co-treats with PT, who would rarely even open her eyes even though she was fairly young (but had terminal illness)...I found her in the obituaries. (We had discharged her because she wasn't wanting to do anything anymore...can't really blame her.) Ouch.