CELIA!!!!!!!!!!!!!!!!!!!!!!!!

I'm in Asheville, NC. Very nice. Tomorrow I get to see Celia for the first time in years...she lives nearby. Celia is the reason I am about to have my master's in occupational therapy. I did play therapy with her for YEARS while in undergrad. She was 5 when we started I think. I LOVE her and she always called me "Karen Dobyns my best friend" like that was my title, lol

 

Anyway...let's hope this video embeds right...this is like a 5 year old video, but you can at least kinda see her adorableness

 

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The end of fieldwork...

Well, I've finished my last rotation EVER...and turned in all my projects and PDEs....so while graduation isn't until May, I pretty much have my master's. Pretty exciting, a little scary too.

My last day had some great ups because of the staff although overall, it otherwise would have been a pretty crappy day. There were around 10 on the unit but only 3 of them were really mine...would be 4 but one was on hold for agressive behaviors. Of those three, only one was REALLY okay for OT...the other two were both obsessed with going home and so anxious about that that they weren't much for OT. Of course I don't blame them, but it makes it hard to be productive when you've only got one patient willing to cooperate.

The day started out with me getting to watch my OT do a craniosacral session on a lady with bad TMJ, pretty interesting. Also so relaxing I had trouble staying awake.
Then I went up to the unit and I could hear the screams before I even walked in. It was one of those days - like Thursday - where you really felt like you were in an insane asylum because several of the patients were nonstop screamers/yellers/criers. And any time you have a paranoid schizophrenic on the unit, you know it. Groups were a struggles since like I said, I only had one high-functioning patient. Also, I watched yet another patient throw her cup of ice water into the face/clothes of a staff member, this time a housekeeper. Poor lady. So two days in a row I watched this happen. Nothing you can do but shrug it off.

The rehab director (?) and my OT took me to a Thai restaurant for lunch which was so kind of them. They blocked off two sessions so we could do so. I enjoyed it a lot. I also got a card from the director, and the OT's husband (I've enjoyed getting to chat with him, a very nice guy!). Came back for a while longer on the unit. One of my favorite nurses walked in with cupcakes she had baked herself, for my departure!! A nurse and tech that weren't on my unit came down to say goodbye and the nurse gave me a card with several peoples writing in it. I also got a card from other nurses with signatures from nurses, the social worker, and even a case worker I didn't even know knew who I was, praising me. One of the phlebotomists and the housekeeper also came and hugged me and said goodbye, so I felt really loved to have gotten four cards, a lunch, and cupcakes, and tons of hugs and kind words. My OT said that the director had never taken any other student out for lunch and that the nurses/techs had never done something for an OT student before, so that made me really happy. She commented that I have a way of connecting with people. And yep, I have a LOT LOT LOT LOT LOT of flaws and I may not be so hot at OT, but my gift is (sometimes) connecting with people, which makes up for  a lot of my flaws. If my OT classmates read this most of them would probably laugh since I'm not alway so great at connecting with my own age group, they'll be like wha-wha-WHAT.

Oh! And the husband of one of the ladies with severe dementia, who I've spent some time with daily for the last few days during visiting hours, giving him handouts and stuff on caregiver stress, tips, etc, and even just sitting with him. He almost cried saying goodbye today, saying that even though he hadn't known me long I had made a big difference to him and that while he may not see me on this Earth again (he knows I'm maybe moving away), he knows he'll see me in Heaven. It sounds so GOOEY and DRAMATIC when I write it here, but it was sincere and sweet.

ANYWAY..........I was really pleased with how kind everyone was on my last day, and I was glad I didn't have to worry about units so much, I spent over an hour just chillin' with my highest functioning patient, she and I have become quite close over the last 3 weeks (most don't stay that long).

I got a comment recently from "BuckEyeBrit" that pointed out something I hadn't thought about. I had written about how a lot of patients see me as a granddaughter and hug me, are affectionate, etc, in ways they aren't with other staff. She pointed out that is a good use of therapeutic use of self - while a lot of times older patients see younger therapists as not possibly having a lot to offer due to lack of experience, coming across as a granddaughter fills them with some love and patience, lol.  Woo!

I really came to love my rotation...even when things were tough or stressful or a wee-bit scary...it turned into a wonderful experience. I learned a lot about mental health OT, a lot of assessments/evaluations, a lot about myself, a lot about interacting with all sorts of different people, etc. I stayed really late yesterday on my final day because I had procrastinated so much I still needed to finish a few things. I got there at 745am and left around 610pm. I got home with kind of an achey feeling. Glad to be done with school and fieldwork as it is a rite of passage, but sad to leave that place with all its wonderful people. I told them I have abandonment issues and would stay in touch, though, LOL.

I didn't end up going out dancing last night because I was so tired.. .it was my friend's ten year anniversary of her husband dying, and her current husband had a really hard day at work, so all 3 of us were sort of in a funk...a blah night. Oh well.

I'm just chillin' today...slept in late of course, did a tiny bit of errands...hanging on the sofa with my kitty now. I definitely feel like doing SOMETHING tonight, so maybe depending on their plans I'll go dancing tonight instead, or who knows what.

I need to get some stuff in preparation for going to a wedding Saturday of an OT classmate (congrats Kim) and also for being a bridesmaid in an upcoming OT classmates wedding (yay Allison)...and prep for some upcoming mini trips, looking at where I may end up.....who knows.

This got long so quickly, oops. Oh well. Anyway..........school as I know it is over....time to face boards, interviews, a real job, etc.

THE REAL WORLD BECKONS!!!

One day of final fieldwork remaining....nine months over!!

I HIT ONE HUNDRED THOUSAND PAGE VIEWS YESTERDAY......it only took me two years to do so :x Right now I'm getting anywhere from 4 to 6,000 page views a month, roughly.

===============

Today was "off". I spent an ENTIRE HOUR in traffic this morning (instead of typical twenty minute trip) because of a big accident/diversion. The two nurses on staff in my unit were both not normal nurses for that unit so they weren't entirely sure of what they were doing with the geri psych patients. (Well trained, well versed in psych, but not typically on geri psych and each unit runs a little differently) The sole tech was the only one I sometimes have trouble with. And there were lots of problem patients. Screamer/yeller/criers, agressive ones, etc. Today was one of the few times I really felt surrounded by crazy people.

I tried to do group and in the middle of the room were our two criers/screamers with bad dementia. I attempted to remove them from group as it was almost impossible to focus, but the tech refused, saying she had to watch them and the men. So I moved them to her side of the room and my OT patients to the other side, but it was still really bad. Then my supervisor comes up and is not pleased with what she sees. The tech tries to get her to keep them there too but she overrode the tech and took them out. I appreciated that but I know she probably wasn't happy with me. In hindsight I should have taken my own pts to the other room, but I guess it didn't just occur to me. When I had walked in for group I was overwhelmed by the high density of poorly functioning patients that were going to make group hard for me, and I guess I just didn't want to rock the boat with trying to move my patients out. I should have though, it was a stupid rookie mistake on my part and I should have known better by now.

We did my final evaluation today, I passed, and she said some nice things.

Tomorrow my OT supervisor and Rehab boss-dude are going to get Thai for lunch if it works out time-wise. Won't surprise me if it doesn't but it's a very nice thought and gesture.

Today, like I said, it was two nurses rather unused to the floor, me, a social worker and a tech. Of course maintenance workers, cafeteria workers, nursing supervisors, housekeepers, etc, are also coming through.
One of the patients was getting agressive and kept cornering me (and any staff) every time we walked into the hall. The nurse tried to give him something to calm him down, while he was standing next to me, and he threw the cup of water right into her face, over the nurse's station. She got covered in water of course. I guess better water than chocolate pudding or juice, but still. The nurses didn't do anything, just let him stalk off. I guess it was the best way to keep from him escalating, but wow. It was a little scary. Had he gotten really combative, it would have sucked. A lot.

ANYWAY......I just turned in my professional development evaluations and I have two projects to complete tonight. I don't want to but I have no choice lol, considering tomorrow is my last day of fieldwork. Hard to believe. 5 years of college, almost 3 years of a master's program, plus a semester off here and there, and now I'm 26 and a half and just now starting a career.

Someone emailed me recently saying they looked forward to hearing about dealing with NBCOT, interviews, job searchs, etc...and I was like yeah...wow...I'm transitioning from student to practitioner and that's a whole nuther journey!! Kinda silly to make it sound like thats a revelation, but it is!
Hmm, guess my address "otstudents" is about to be a misgnomer.

I'll get you, my pretty...

Conversation of the Day:

Patient: "You're a very pretty girl."
Me: Why thanks! ::smiles::
Patient, indignantly: Do you think you'd be as pretty if your head was cut off?!
Me, smile fading: No, probably not.

I love you I love you I love you

Today, three different patients told me they love me!  Awww!!

Can't think of too much special about today besides the love fest. Things were a little chaotic this morning- we have several patients with pretty severe dementia who were agitated and calling out and "responding to internal stimuli", so that made life kinda difficult.

I told my supervisor today - you know, I am sorry I always come back to the office late from the unit. I know it messes you up having to sign them the next day, and it messes me up too since I have to stay late, but I have a REALLY HARD time leaving my patients in the afternoon. So it's not that I can't manage my time effectively, it's that I choose not to.

AAHAHAHA It's true...I look at my watch and I know I should go soon, but there is always one last thing to help a patient with...then another last thing...then a family member to speak to...then another thing...and then OOPS...and what is probably the worst is that I'm typically there about 30+ minutes after my last billable unit...so it's not even that it's counted towards productivity!!

Oh well. If I'm going to suck at managing my time, I guess it's good that it's by choice and for the reason of wanting to help patients, and not just because I sit around twiddling my thumbs.

I'm working on my professional development evaluations right now, I'm maybe half-ish finished. They are due Friday. I also finished my final fieldwork questions. I have a big ol' long form of questions to fill out though, and still need to work on a few other projects for my supervisor!!

Four days left to go of my psychosocial OT Level II fieldwork...then DONE, baby

Gonna be quick. Lots to do in next four days, project wise...then lots to do after that for other things, ie finding a cool job. LOL.

Still working on professional development evaluations, OPPM grid, nursing cheat sheet, therapeutic exercises, functional maintenance, observation of ACL levels, final questions, and a few other random things due by end of this week.

My back is really hurting this afternoon...it could be for several interesting reasons...from standing up in church for several hours on Sunday (an Antioch orthodox church, very interesting experience), but possibly from dealing with an angry patient today...I was running on adrenaline and didn't use proper lifting technique I bet when assisting staff with stuff related to him.

Today was the closest I've seen to being in person live at the start of a possible combative patient code (where its announced overhead throughout the hospital so we can get more people for backup/help). The patient was already being supervised quite closely but he bam, got angry. I was in a patient's room, prepping her for a shower, when I heard lots of commotion in the hall, yells and thuds and all that. I told her I'd be right back, closed her door, and flew out to the hall to see how I could help. I helped with moving some of the things out of the way and re-righting a wheelchair, but it was heavier than normal ones and I think I bent way badly and didn't start feeling it until later when the adrenaline wore off.

They got things semi under control so I went back into room to finish helping my lady. Then we hear more commotion, I leave her again. Then come back, we start to leave and then the commotion starts up right outside her door, so we sat on a bed and waited for it to finish up. No way was I taking a lady with a walker into the midst of that. It actually messed up my productivity some since we were kinda trapped!

You know, a person's protective instinct should be taking care of self, but I think it's innate to help the vulnerable first, even when its a stranger. Like, I know its my job to help my patients before myself, in case of a problem, yet technically, if things got bad, I could be like screw this! I'm getting out of here! and bolt, to protect myself. Yet today, even though I'm a big ol' scaredy-cat, when this guy was acting up, had he come into her room, I would have done anything and everything in my power, to keep him away from my patient. That has nothing to do with knowing its my job - just a strong instinct to protect the vulnerable. I guess everyone must have that, maybe its evolutionary...lol.

I had an extra good time with the nurses/techs today...there was random (nonballroom) dancing involved, in the nurses station, lol. Just quickly, I swear patients weren't being ignored. :)

Ummmmmmm.........nothing else too special. I'm really enjoying my rotation these days...not to say there aren't moments of dread or stress, but in general, I feel empowered to help make a difference in their lives during their stay, and that's a good feeling. Blah blah blah, good night...better go work on my projects.

Well ma'am, his arm strength looks fine

An evaluation I did yesterday asked for upper arm strength:

"Unable to determine, although since patient was throwing chairs, it appears within functional limits"

almost done with fieldwork...

So somehow today I ended up doing the sticky chicken dance for some patients.

I spend a lot of time just hanging out with my patients...no billing or productivity, just hanging.

Today I had 3 "with it" patients in the day room at the big table, and one lady with bad Alzheimers at another little table.

One of my patients asked if I'd clean the table they were sitting at, as it was really sticky. I started cleaning it and commenting on how it really was quite sticky. The lady with Alzheimers somehow started bringing up chickens and somehow we ended up on the idea of sticky chickens and how that could be a dance. I got up and hopped around like a chicken, saying that was my chicken dance, and then stuck my feet on the floor and twisted around like a chicken, doing the sticky chicken dance. My three patients were HOWLING with laughter. It was a completely ludicrous thing to do a sticky chicken dance, totally silly...but we had fun!

I was talking to an OT student in the class below me, Shari, on Facebook a few minutes ago. She is rightfully overwhelmed/scared at the prospect of starting fieldwork soon. I was telling her that it's so much less scary than it sounds....it all falls into place. Not to say there is never stress or yuckiness, but that overall its a pretty good experience...and encouraged her, on her upcoming geriatric Level I fieldwork (a two week fieldwork to gain some exposure), to do her best to spend some informal time with patients....ie, go sit in a day room at a table with some of them while they are hanging out or having a snack or whatever. I told her she'd learn a lot just by watching them interact with each other, seeing how staff redirects them, and having conversations with them.

I think my best times with my patients are in the afternoons around 3pm...its quieter and calmer (to some extent) and I end up just chillin' with them in the day room, depending on what's going on...I frequently am bad about losing productivity/billable units, because I feel like just sitting with them and chatting, is more therapeutic than me taking one of them off for some cognitive assessment. But I think those times are the most enjoyable, most bonding, situations.

I think being a young girl helps automatically with bonding because the ladies see me as a granddaughter...a lot of them will kiss my hand or rub my hand against their face, kiss my cheek, or put their arm around me, in a way they wouldn't even attempt with the rest of staff...just affection the way they would give one of their own. I rub their backs a lot, or stroke their hair...or sit and hold their hand a while. It's therapeutic! I'm just rambling. I should go to sleep. Soon.

I did the Cognitive Assessment of Minnesota (CAM) today on a neuro dude for my supervisor (as a competency thing). It's like 45 minutes and it looks at all sort of stuff, like attention span, orientation, memory, sequencing, visual attention, concrete problem solving, abstract reasoning, blah blah. I really enjoyed it! It's not perfect or anything but it can help you kinda target deficits in certain areas, it's not that hard to give, and it makes you feel like a therapist, lol.

One more day....and then only ONE WEEK LEFT OF FIELDWORK...NINE LONG MONTHS, DONE!

Fieldwork scared me so much.......I worried about it from like day one of school. . I had to cope with the extra struggle of depression/anxiety on and off throughout it...but I made it. And if I can get through it...anyone can. You don't have to be the smartest or the best....just motivated...clearly trying hard.

Okay bedtime.

The best moment of the day...

A little old man peeking his head out a doorway in the hall, beckoning to me. I come close enough to see he has on his normal shirt but his pants are off, he is only wearing white boxers.

I let him know I'll get some help for him, since he isn't one of my patients and I know he is a handful.

I let the staff know. The next thing I know, I look down the hall and there he is, his head peeking out again, this time twirling white boxers in his extended hand...clearly tantalizing us!

Most staff are in the hallway by this time and three of them snap on their blue gloves and head down the hall to him to work their magic. LOL. I turned around to go find a patient, shaking my head at the absurdity....and love for my job LOL.

Do I look like the kind of girl who carries a knife?

Pt who is pleasant but very garbled ("word salad") was sitting next to me while I worked with another pt. She likes reading things and was glancing at my clipboard, so I handed her a blank SLUMS (its a one page cognitive assessment that asks basic questions) to look at and write on. She read the question out loud, "How much do you have left?" without reading the line above it which had to do with spending money. She answered, "Well, all of it! They ain't taken nothing!"

I also wrote  "Patient X is so nice" for her to read, she read out loud "Patient X is fifty nice"...apparently I need to work on my handwriting, LOL.

She also said things (without pausing, like it all flows together appropriately) like "The bedtime has the stitching. There were three babies. Bob got shot in the head. Were you there yesterday? You are going to be my daughter in law soon. I saw that the money was there. Let me find the papers. Oh, there were snakes."

I conversed with her randomly for easily 20+ minutes. Another pt, who is higher functioning and listening, was asking me later if I was telling the truth/understanding, because I'd respond to things she was saying, like "Wow. Really? Yes. I remember." stuff like that.

Another pt was confused and trying to get off his seat-belt on his wheelchair. We didn't want him to because then he wears himself out walking and ends up needing a sedative to stop since he'll go to the point of falling down from exhaustion (a relatively common problem for some patients with dementia). He couldn't remember how to use the contraption at all and was fiddling with the belt part. He asked me, "Do you have a knife?" I said, "Mr X! Do I look like the kind of girl who carries a knife?" Mr X said "Well, scissors then". I said "Miss Y [the tech] is looking for some scissors for you." We had to keep kinda re-directing him by telling him we were checking on it, etc.

I recently had a pt who wasn't able to really follow anything verbal, but would imitate actions (like if I spread my hands out while talking, she'd do it too), and we were having a lull in group due to some interruption, like a nursing giving meds, so I started vogue-ing, and she joined me since she was imitating me, and then the lady with schizophrenia joined in for fun, etc...so we had a little Vogue pause. LOL

I really do crack me up...lol. Not in a way that makes fun of the patients, I just have fun WITH the patients...ya gotta laugh so you don't cry, right?

Well, I just did the CAM on my friend Suzy....a cognitive assessment. It took about 45 minutes. I wanted to practice since I'm doing it tomorrow on a real patient. It's got a lot of components to it, from explaining proverbs to making plans to reading, doing math, sequencing, mental manipulation, memory, etc. She felt stupid on some parts, but honestly it was all I could do to keep up with some of the sequential matching, so I felt stupid too, LOL.

Lester the lion kitty is so cute, I could croak with love. Hey I better go shower. Good night.

7 days left of occupational therapy fieldwork, but who is counting?

"I don't like sex, do you? I just pretend..." - gotta love hearing that from someone in their 70s, lol. I said "me too!!" ahahhahaaha

--------------

Lady who rarely makes sense, blabbering, a few weeks ago: "Blah blah blah making no sense, They say he is gay but I don't think so... blah blah blah making no sense."

A week later: lady's son walks in, gayest guy EVER.........ahahaahahhahaa


------------------

Had crappy groups today. Everyone was extra distracted, there were disruptive patients, a lot of interruptions......it was all I could do to keep things going at all. We had a new patient today who is pretty with it and I was like DUDE......I'm sorry. It's not normally quite this chaotic.

-----------

Nothing else to share. I need to look through the CAM today as I'm giving it tomorrow. I think its the Cognitive Assessment of Minnesota, not sure.

Need to work on some forms, PDEs, questions, projects, etc....

Hmmm, nothing new

Um...doing groups, doing showers, doing evals...people hearing voices, people crying, same ol, same ol.

Nothing really to share for last few days...oh I spent an hour+ helping my OT move offices....kinda prepping for my departure soon by getting stuff done with help now. Have a bunch of projects to work on. Blah blah blah.

More soon I guess :)

WAIT! AM I DREAMING? IT GETS BETTER

I read further down!!!!!!!!!!  Two mentions of OT in one article! Two bad they confuse things slightly by using both SPD/SID. Anyway, YAY!!!!!

http://www.uexpress.com/dearabby/

DEAR ABBY: Last year my 8-year-old son was exhibiting symptoms of ADD/ADHD -- constantly losing things, fidgeting, lack of concentration, along with a wide range of other annoying behaviors. He was hospitalized and referred to occupational therapy by a therapist who recognized his symptoms as being part of Sensory Integration Disorder.

I am happy to tell you that after almost a year of OT, we have discovered ways to make his life easier by understanding what sensory input he needs. Being able to fulfill my son's sensory needs has helped with his clumsiness, forgetfulness and lack of attention, and he no longer displays signs of ADHD. Such a simple remedy to a very troublesome problem. There is hope. -- A MOTHER IN BEND, ORE.

OT IN DEAR ABBY!!

http://www.uexpress.com/dearabby/

FINALLY! A DEAR ABBY INVOLVING OCCUPATIONAL THERAPY!!!

DEAR ABBY: I am an occupational therapist, and it sounds like this young man could have Sensory Processing Disorder. It is common for people with this disorder to have difficulty grading their movements, i.e., using too much force, slamming doors instead of closing them. They also have difficulty recognizing personal space.

I suggest that the mother have her son evaluated by an occupational therapist who specializes in sensory integration. If he has SPD, their lives will change dramatically through intervention and education. -- THERAPIST IN WINTER GARDEN, FLA.

Yay!

Two weeks left.

Ten business days left of my final fieldwork. Nine months of fieldwork about to be over.

Lots to do in that time period.

I've once again gotten my email down to under 50 e-mails, and only about six of them are from January...so I'm doing better to not be more than about six weeks behind, LOL. I won't think about the 62+ inbox messages on Facebook.

Twenty groups to go......way better than the 120 I started out with.

Life's about to change pretty drastically, in two weeks. Will be travelling a lot in April/May, hunting for a job, but really looking for a new place to move to. I'm pretty sure - 99% sure - Memphis is out of the question, it's time for a change. Certain places in Tennessee, North Carolina, and California are in my radar, although I've gotten some good job advice (which I'll share soon) that is making me thing about a few other options. Who knows.

Hmmmmmmmmmmmmm...........

popsicles, dancing, friends...and two weeks of final fieldwork left.

went dancing at dancing party last night (fri) with a friend who is a pediatric nurse practioner. Did push-pull swing, basic rumba (sp?), etc. Fun. Then went to Brentwood to see my OT friend Kerri and her husband. Spent day with them - today I went with them and a friend and we got popsciles at La Pelates? Petales? I got a Mexican caramel one...they got chocolate rose petal, pineapple kiwi, something. All they have are cool flavors of popsciles. Why can't I spell that. Popsicle. There. Okay, we also went to a random scooter store, and then we went to Opry Mills - giant mall - which was packed. Came back to house and was exhausted - was supposed to go to a bday party but I hit my max and had a headache, so stayed home....friend Christa from Memphis came here this weekend too. Tomorrow in morning I'm headed back to hotel for a few more hours before they go home. I might go to hot yoga tomorrow night if my other friends go, we'll see. Fun weekend so far, I enjoyed it, although I get fatigued way too easily for a 26 year old!! In the next two weeks I need to finish my professional development evaluation, do a huge fieldwork questionairre, answer a page of "final" questions, and do about four mini projects for my OT. Only ten more days of fieldwork and then I'm done - 9 months worth of fieldwork. Hard to believe. It's been really rough for me - I'm such an academic type (not that you would guess it based on the misspellings in this post), at least in the sense that I do best with tests and knowlege - the practical aspect, the applying of knowledge, the stress of being extroverted all day and dealing with utterly new surroundings every few months - that's all been REALLY REALLY REALLY REALLY a huge challenge for a scaredycat introvert like me. Can't believe it's almost over. Wow.

Anyway......just a random little blurb...maybe more tomorrow. Yeah, I'm still way behind on e-mail and facebook. Yeah, I still plan to get to it soon. :)

Is it bad when the patients tell me I'm crazy? lol

I only got a few hours sleep last night - my new meds cause some sleep disturbances - and so on days like this with little sleep, I strive to overcompensate and typically end up more
extroverted/loud on those days. Our second group today had a big crowd and I was being really silly with them (we were playing a social interaction bingo that has you compliment people,applaud people, give hugs, etc). I had the entire room cracking up pretty regularly (apparently I'm pretty funny to people with dementia and the like) and one of the patients, who I've had relatively normal conversations with, chose that he would ONLY answer questions with "You're so crazy!", gazing at me with a smile on his face. I'd be like Mr X, tell us your favorite memory. Mr X: You're so crazy!!!

I chose to take it as a compliment because I think he meant it more bemusedly than negatively.

And apparently even old people love fart jokes. I was standing up, facilitating the game, when all of a sudden there was this incredibly long, low noise...honestly at first it sounded like
someone's stomach was having serious trouble. I turned around in circles several times, trying to figure out what it was, and then realized it was construction noise. I exclaimed (without thinking) "Wow!! I thought that sound was coming from someone in here!! I was thinking maybe somebody ate too many beans!"  and they all burst into hysterical laughter. I guess the noise was low enough that even the hearing impaired ones heard it and all originally had a similar thought? I dunno.

I think I AM a little crazy. That's okay!

I've said it before, I'll say it again...when it comes to groups, especially lower-functioning ones, I think smiles and laughter can be the most important part of the session.

I did four evals today...one of which needed to be done ASAP. I won't go into the gory details - I'm sure I'll bring it up in a few weeks or something in more detail of the yucky parts- don't want to mess with HIPAA fate - but let's just say it was the most disturbing and revolting eval I've ever done, period, and it was all I could do, literally, to not vomit, while doing it. I thought I was going to be sick several times because of how disgusting the behaviors were. It was the kind of thing where had it not been needed ASAP to confirm something, I would have taken one look and said "Not appropriate right now, I'll come back later....and by later I mean never" lol.

Thank God I have an awesome poker face when things get really bad. :)

Yeah...time for bed.

moar funny pictures


This is what happens when you can't sleep at 1am.

I'll probably regret sharing this but hey, humor is important and that's important to show in my professional development evaluation, so hmmm

My friend said something that jogged this memory of a recent event.

There's a lady on my unit whose family came to visit her. This little lady is sweet as can be, although often "confused".

Me: Ms X! I see your family came to visit, how nice.

Ms X: Yes, this is my daughter :::points to (very obviously) a son::

Me: ::looks at the man:: Gosh Ms X, your daughter sure is ugly!

Ms X and son: :::start laughing:::


*Before I get hate mail - I knew this lady well enough to know she would catch the mistake and find it funny.
**Before I get hate mail anyways, yes I still sometimes say inappropriate things without thinking, I'm working on it and overall am doing better. :P

Burning songs...hmmm

So, I was watching Desperate Housewives on my laptop with my earbuds in, and IT SHOCKED ME!! Like literally, the earbuds buzzed in my ear and tingled and HURT with shock. Ouch.

Right now I'm burning a CD from my iTunes of old songs...like Fred Astaire, Mitch Miller, Frank Sinatra, etc..to give to the geriatric unit I am in. I might ask the social worker - who apparently gets to order stuff for the unit - to get some old CD compilations to play. Hmmmmm. Ideally they'd take a page from Alzheimer Day Centers and get some reminiscing books as well.

Ta da

HA HA HA HA HA!!!!!!!!!!

That was AWESOME.

I've recently taught Lester the Lion Kitty to stand up for his treats....because it's cute mostly, but also because it seems to help him get it far enough in his mouth since he isn't the greatest eater with his smooshy face. ANYWAY....my friend Suzy kindly took him to the vet for me today and I met her there, since I really wanted Lester to get seen asap for his bad sinus infection or whatever. Okay, anyway again, he has to take antibiotics for a while. Of course no cat likes taking pills. But I held it up like a tiny treat and he stood up for it, I threw it in his mouth like a treat and gulp! It went down, no fuss at all! No torture! Of course I praised him to the skies with a few real treats, but was that not awesome. To have a kitty stand up for his drug! Ha ha! Ha ha!! HA HA HA HA HA!!!!!!!!!!!!!! HA HA HA HA!!!!!!!!!!!!!!!!

Okay moving on. Today was a semi stressful day...cursing angry unsteady lady causing issues and rattling other patients. I did four evals and two groups. Groups were a struggle because of two quite disruptive patients making it hard. At least I got 20 units for first time in a while. I would have had more but I ended up doing some non-billable helping.

Some of our patients are sweet and pleasant and just not suitable for OT - solely because my supervisor wants them to be at least at a 3.2 level to take them on in this unit...and that apparently pisses off some of the nurses because, I guess, they think anyone who isn't absolutely 100% insane, should get OT. It's a great thought, but with one OT running things (especially when there is no student), there has to be some kind of cut-off because otherwise it's just too much work for one person.

Relatively short post today...nothing too incredibly exciting, just difficult dealing with a few disruptive patients that have a domino effect of upsetting everyone, especially the most "cured" ones ready to go home.

I now have 7 patients...so maybe tomorrow's group will be big. Hmmm, what to do, what to do. Several of them have severe visual impairments so don't want it to be too visual. Blah blah blah, the end.

The carnival is up!!! With an update

The blog carnival went up today...time got away from me so I didn't submit in time. I feel bad. Check it out and read all the great OT submissions at

http://e-nableot.blogspot.com/2009/03/occupational-therapy-blog-carnival_09.html

This would have been my submission:

Private Parts & Body Fluids: Things you have to learn the hard way in fieldwork

It is my belief that OT schools should have at least a class or two (maybe a panel with some fieldwork students or new grads) on some of the um, not so much fun, aspects of OT that might come up in practice. Just to be slightly less surprised when those things happen. For example, it turns out a lot of lower-functioning people, once placed on a shower chair (with the hole), often end up having a bowel movement in the shower. Nobody told me this. I had a patient with problems functioning physically and mentally, surprise me by leaving a large mess on the shower floor, at the beginning of the shower. Trying to keep him calm and safe while dealing with the mess, was a little overwhelming. That's just one of those things you're never told about! I just wouldn't have thought about my patients pooping in the shower. Until it happened. Several times.

1) Hopefully by the time you have completed all your observation hours to get into OT school, you realize this, but toileting, depending on the setting, can and does take up quite a bit of time, especially in geriatric settings. You might have to help wipe. You might have to help change diapers, help change soiled clothing from accidents, deal with underwear, incontinence pads, diapers, etc. And if you ever want to think "I'm only going to sit him down for 30 seconds without anything on, surely he won't have an accident in that 30 seconds" - you are wrong. I speak from recent experience.

2) Women's issues - menstruation in younger women, urinary incontinence in older women - pads, pads, pads. You might be putting the pads in yourself or helping fix a mistake. I recently had to fix an urinary incontinence pad while the lady was wearing it. It had bunched up while pulling up her underwear. Because standing up/sitting down was so fatiguing for her and we had already done it multiple times, the safest option by far was just for me to fix it while it was on her. With her permission of course. But as I stood there, fixing it, I marveled at the idea that I was doing something like that. I never would have thought that was part of the job description...and/or at least thought, "that will never happen to me". Guess what, it does.

3) Some people are private - but many are happy to whip out all their bits and do whatever they need to do. You'll be surprised at how flexible some of those 90 year old women are when it comes to getting clean. You're going to see it all.

4) You'll hear every word in the world to refer to private parts. My personal recently-heard favorites are "tinklebox" and "possibles". Be prepared! (By the way, the other day I discovered me and a geriatric patient had the same pair of Victoria's Secret underwear...slightly traumatizing, but mostly cool).

5) You will deal with ALL BODY FLUIDS. ALL OF THEM. BE PREPARED!

A few more thoughts on the matter:

1) Gloves. Just stick gloves in your pocket or whatever you carry around all the time. Boxes of gloves have a habit of being empty right at the minute you need them most. Just always have at least a pair on you.

2) Even if it's tempting to call someone else to deal with a mess - if it isn't a huge mess and you can take a minute, do what you can. It may take a while for someone to get to the person, and/or they will see you as not being a team player if you never help deal with it. You can argue it's not your job or it takes away from productivity, but any little bit of help you give will be appreciated by both patient and staff.

3) It really does get easier. If you had told me nine months ago that it would become common-place to give showers, help with toileting, deal with all manners of body fluid, adjust breasts from getting in the way of gait belts, etc - I would have said YEAH RIGHT. NEVER!!!! But it's true, you get used to it. I don't blink these days. And I'm not even done with fieldwork yet...so you get used to it pretty quickly, I promise.

Good luck on fieldwork!!

UPDATE: Great comment from a reader:
"I love your blog as always. It's really too bad that you didn't make the blog carnival. But on the gloves matter,... latex gloves are a huge issue. You want to be careful about that advice for paediatric settings (yes I use British spellings) or even non-elderly adults (ie gimps) because huge numbers of sb [spina bifida] adults/children have latex allergies."

Is it bad if me and my geriatric patients have the same underwear?

Today I got 19 units...so only one off from the 20 I'm supposed to have as a minimum. With the census low it can be difficult.

Have any of y'all heard private parts referred to as "possibles" among older generation?

I did groups today....all but one of my patients (so 4/5), plus two nursing students observing the unit for the morning, plus an extra aide doing a 1:1 with a particular patient. I always make everyone in the room participate some (ie not just patients). The first one was just a typical group, the second one was on exercise but it was extra fun because when did the actual exercise part we did a lot of silly moves like hula moves, hula hoop moves, etc...then we did the entire alphabet with our arms...like YMCA style, but from A-Z....on a lot of them we just had to do whatever we could think of, cuz who can really do a K??? lol. There was a lot of laughter and silliness, it was fun. :) The nursing students afterward let me know they enjoyed it. :)

Oh! And after group, one of our patients who used to sing, sang us all a beautiful song. It was wonderful. :) Before that, we had a singer and a chaplain who likes to sing...I get NO productivity during those times because I won't take patients out of the only truly fun experience they'll probably have that day so unless a patient refuses to join the group, I do other stuff.

I did a session on discharge planning...ie what to be prepared for after discharge in terms of having support systems in place, leisure activities and/or goals prepped, keeping doctor appts/taking medicines until told to stop [ so many behavioral patients start feeling better and think Oh, I'm cured, I can stop taking my meds!]...stuff like that.

Did a shower...some other grooming/random ADLs....oh...I've gotten better at handling intimate moments without even thinking about it...a few days ago I had to adjust a lady's urinary incontinence pad while it was already in her underwear that she was wearing  - long story as to why but believe me it was justified - so I literally had to put my (gloved) hand into her underwear, with her permission of course, because the alternative would have been much more fatiguing for the patient. Nine months ago I would have been like WHAT?!!!!!!!! Adjusting breasts? Sticking my hand in underwear? Oh hell no. But you really do get used to it.

Oh, and someone actually identified my molecular (serotonin) necklace today, she has a friend with a madewithmolecules necklace too!

Three highlights of my day!!!

1) One of the nurses (who I have spent a lot of time with the last few months) doing "checks" to keep tabs on all the patients, popped her head in a room where I was standing next to a pt, helping her go through clothes in prep for bathing. She smiled and said "You are such a good OT, you need a raise"..

2) A patient who I had spent a lot of time with today, most of it not billable, had started slightly frustrating me because she is slow and since the time wasn't billable [cuz it was stuff like walking her to the phone, listening to her talk about something, etc], I was a little like augh! But I hid it because I knew she needed it. And it paid off because she told me at the end of the day, "Thank you for talking to me. It helps. It's like it's a glowing light"  or something along those lines about light, lol. So it validated it all to me.

3) Helping a lady with grooming, adult daughter present. Lady told her daughter I was her favorite, daughter said I was kind and patient, blah blah blah...very nice!!!

These little things mean a lot to me. I spend pockets of time EVERY SINGLE DAY doubting my skills, wondering if I'm too easy on patients, wondering if I'm accomplishing real goals, wondering if I'm too nice about non-billable time/productivity by not hurrying things too much, etc etc. But then I tell myself that even with all those issues, if I give the patients a sense of control, or give them a few extra minutes, or give them a laugh...that's good too. It's still important. So I may not get the best productivity, but I'm still being helpful!!!! In a way that the techs/nurses don't have the luxury of being, most of the time...they've got to go go go.

Oh....me and one of my patients..(GERIATRIC)....have the same pair of underwear from Victoria's Secret!!!!!!!!!!!! I told her and she said "That's how I will always remember you" AHAHAHHAHAA

Yay a psychiatrist thinks I'm good

So today my OT followed me some since she only had one patient. I have been telling her about the chaos that a few of my patients have been causing, so she was interested to see. Unfortunately, although fortunately, medicines had been adjusted so things were much calmer. I still ended up with my butt patted again though.

So when my OT was sitting in on my group for first time in a long time, one of the psychiatrists walked by, came to the door and was quietly trying to get my OT's attention. She left the room with him and my heart sank. She hasn't been around much on the unit in a long time so I was like uh-oh...what could he want from her.

It TURNS OUT...the psychiatrist had pulled her out to tell her what a great student I was and how I was one of the best students he has worked with! Maybe it just means he has had crappy students, ha ha.

But it meant a lot to me that he pulled out my instructor to praise me! Especially since in a lot of ways I'm not so great, lol.

Today I was trying to deal with getting a patient to come with me for an evaluation. The patient was confused and I was patiently trying to get them to come on their own accord. A tech nearby butted in and was like firmly "We're going so this lady can ask you questions" and wheeled them down the hall. That's just not my style - my way takes a little longer, but usually has the same answer, with the patient feeling more in control....you could argue that a confused patient won't know the difference, but *I* know the difference and I don't like to be a bully. I think I'm way too sensitive though.

The other day I helped quickly with a shower on a new patient. Things were chaotic and I hadn't been able to do the eval (you can't charge stuff for a patient until after the eval) so I ended up just assisting like a tech instead of it being a billable thing. I think the nurse was a little irritated with me because I was slow about helping the patient, but that's what OT is about - sitting on your hands and letting the patient do as much as possible. I typically tell the patient, I'm here, "do what you can and let me know if you need help"...or I'll step in if it's obvious the patient needs help. But if the patient can do it and is just slow, I don't hurry the process much since then I can't accurately gauge their ability. The nurses/techs on the other hand, even if the patient can do a lot of it themselves, are typically used to whisking patients in and out as quickly as possible by having the tech/nurse do everything without waiting. I realize that with their job descriptions, a quick bathing experience is important, so we have different perspectives in mind. Just means that I have learned the OT ability of NOT helping if not necessary....not to be mean, just a different philosophy.

I wish I could do more exercise with the patients. A lot of them sit in wheelchairs all day although they can walk with assistance, and so they enter the unit walking at least a little, and then leave a few weeks later entirely in a wheelchair because they've gotten weak. I asked my OT about it and since we are treating for cognitive reasons, we can't really charge for exercise. Boo.

Um....I guess that is it. I still have a lot of decisions and stuff to deal with in the next few weeks...and I need to work on my professional development evaluations...and my study review book for taking the boards, is coming soon.

I've been cleaning out my email box...blogging blizzard really coming soon I promise.

Tomorrow will hopefully be a somewhat early day...ie 330ish...though realistically 415-430. Planning to go to a dance party tomorrow night.

A chaotic day...

Today I did a 1:1 session on healthy expression of anger. We talked about (healthy) physical, spiritual, and/or mental ways of dealing with anger. I thought it evolved to be pretty cool!!

Also did groups - one on self-awareness, one on reading of non-verbal emotion.

Also did a 1:1 using safety cards....ie determining the safe situation versus dangerous situation. Most people with dementia, even mild, do pretty poorly at figuring out the more subtle stuff. Unless there is a big ol' fire being shown, they tend to comment on little things, like "Look at those bangs!"

You know, even with a low census, it can get really chaotic on the ward. All you need is 1-2 people
making a fuss all day long to make it a REALLY HARD DAY.

It was very hard to get productivity/units today because there were so many disruptions from
some patients having an extra hard time for various reasons.

On one hand, I want to be like FOR THE LOVE OF GOD STOP IT, AUGH YOU SUCK! as I struggle to keep my train of thought with constant disruptions...and then on the other hand, compassion kicks in as I realize these people can't help it - whatever they are confused about and feeling is 100% real to them. Just like pain, just like emotion - it doesn't matter what anyone else thinks - it is about what that person perceives.

So even when I am frustrated, stressed, I try to remember that. It's clearly not an enjoyable experience to the people acting out - they are in stress/anguish themselves. I also try and remember that when another patient gets irritated with the constant disruptions and wants to discuss the disruptive patient (in general terms, not HIPAA violations). I typically just stick to something like "Yeah, seems like that person must be having a rough day"...which I'm proud of because I can be a mean gossip in normal life!! LOL

I had to step between two patients today yet again. It's instinctive...not a "hmm do I want to risk getting hurt by stepping in between two angry patients?" But rather a "Oh crap, better get in there quick before one of them gets hurt". Let's see if I can make it through this entire rotation without getting hit hard...so far I've only been slapped and fondled! ahahahaha

Tomorrow my supervisor has a really quiet day - quietest day she's had in the last 9 weeks or however long it's been with me there - so she will spend a lot of time observing me on my unit. I'm nervous!

The girl in the window

Really intriguing, haunting story about a neglected little girl, Dani, rescued at age 6, with "environmental autism"....now receiving speech and OT. Article is very in-depth, also a short video to go along with it

http://www.tampabay.com/features/humaninterest/article750838.ece

Bleh.....

Well, my personal space has been violated repeatedly the last few days...sexually inappropriate behavior is a relatively common issue among older patients with dementia - it's one reason someone might end up in a psychiatric ward. I got my butt fondled recently and I've had to stave off a lot of kisses.

I've discovered that one good/bad thing about coming off really "lax" and not demanding things get done (instead just suggesting...more flies with honey than vinegar or whatever....a luxury the techs don't always have), is that I can build up friendships with them and be more of a "good guy"...so that when that person gets angry, I am more likely to be able to calm them down by being the "friend" they recognize...that's good. The bad part is, when a patient is repeatedly upset, it makes it hard to get my productivity units because I'm helping re-direct.

I've realized that while I'm not brave per se, I do stand up for patient safety at risk to myself. Two patients got upset recently and even though it looked like a blow might be imminent, I stepped in between them. Remember this is a geriatric ward so it's not as dangerous as say, two healthy strapping men about to fight.

The chaplain came in after rec therapy today and was singing to them. She was about to leave when I came in (because she isn't supposed to interfere with my time slot although I always give her extra time in my slot since I think her presence is important), and I asked her to play a little piano music for us, because I've heard her practicing in the chapel before. I think it really meant a lot to her! She ended up asking if she could stay a few minutes for my session...I said of course. There were also two nursing students in the room and a tech, so I had more non-patients than patients in there. Plus most of the patients in there weren't mine - only two of them were mine so really it wasn't worth it, productivity wise, to hold group, but since it's been a while since I've done group, I went ahead. It was on discharge planning/leisure activities. Now that I think about it there was 9 people in the room and only 2 of them were mine. AHAHAHAHA. I always make staff members, nursing students, janitors, whatever, answer questions, same as everyone else, if they enter the day room during group. Not like the entire time, just will ask them the current question to answer quickly as they come in/out....ie "what's your favorite type of exercise?" Some of the aides are particularly good about giving nice thoughtful answers with a good explanation.

Today some patients were playing with a blown up glove as a balloon, and it popped. I tried to blow up a new glove and I failed miserably, it looked like some one's hand had swelled badly instead of being a big ball. My lungs couldn't handle it.  I asked the people in the small nursing station and the social worker saved the day, blowing up a beautiful glove ball for us, LOL. 

I feel like this is a really really stupid boring blog post today. I don't have anything too exciting to share. Giving showers, evaluations, cognitive assessments, re-directing aggressive or sexually inappropriate behavior, blah blah blah....same old stuff right now. The coolest or most interesting stuff I can't share because it's too specific, HIPAA wise.

Oh, and insurance is evil. I hate to see patients leave who are SO NOT READY just because of their crappy insurance :(

I had my ballroom dance yesterday....getting better at foxtrot, waltz, rumba, push-pull swing...I have my final private lesson tomorrow and then a "dance check" on Thursday

Wow my cat just flipped out.I think he had a nightmare. Poor Lester.

This afternoon I was writing a list of assessments I might try on the new patient and it was MMSE, ADM, LACLS, GDS, SLUMS, CPT, MADRS, etc....and I was like hmm no wonder my non-OT readers are recently always complaining that I use too many acronyms!! I'm trying to do better on the acronym front for my non OTers.

I'm re-reading this and I sound like a snobby do-gooder who thinks she is oh so perfect. I totally have a bazillion flaws and do lots of things poorly and at times cause more problems than solutions, as is a students perogative, haha. I just prefer to focus on the good stuff I guess, so I can get through the next - and final -  month with my sanity at least partially intact. :) I guess I should start working on professional development evaluation due next month....