ramblingsofanot

[ramblingsofanot]

When God Tells You To Go To Hell

I went to go to see Jacob (aka God) for our first session one day. Since we had such a great interaction upon his initial evaluation, I was expecting good things. 

Turns out God was having a bad day.

I came to his room where he was furiously zooming around with his walker, muttering angrily to himself.

I knocked on the door frame. “Hey Jacob, I wanted to see if you were ready for OT today!”

“No!” God thundered. “I was already supposed to be picked up. He’s late! He was supposed to be here by now!”

Jacob’s partner (who I had met at evaluation) had not shown up to the facility despite having promised that he would be there to take Jacob to lunch. What Jacob didn’t know was that at his admission, his partner had confided to me that he was semi-tricking Jacob into being admitted there. Being in a relationship with him had been too much for him to handle but he knew that Jacob was not safe any longer to live on his own. The partner, despite telling Jacob that he would be visiting all the time, was in fact planning to move to take care of his own family members elsewhere.

“Since he isn’t here yet though,” I suggested, “why don’t we do a few things for OT while you wait?” I hated the idea of him sitting there waiting for someone who would never come.

“No!” he continued. “I’m not doing anything until he gets here. I don’t want to miss him when he gets here.” 

And with that God and his walker zoomed out to the front lobby and he sat squarely in an armchair facing the door.

I followed Jacob to the lobby. “Alright, how about I come back in a little to check on you.”

An hour later, God was still sitting there waiting. It was clear that no one was coming. I approached quietly and sat down next to him in the adjacent armchair. He looked furious, staring with unblinking rage at the door in front of him.

“Jacob, are you ready to do OT now?”

He snapped into life. “NO! I AM NOT LEAVING THIS SPOT UNTIL HE COMES! HE’S COMING!” I could hear the desperation in his voice.

“Well, Jacob, why don’t I bring the OT session to you? I can bring everything right here to the lobby and we can work here. And that way you won’t miss him.”

“NO! I DON’T NEED THERAPY! I SHOULDN’T BE HERE! I WON’T BE KEPT  HERE!”

“Jacob, I just want to help you so that you can go back home and do things yourself,” I explained. “Since right now you are here, we might as well work together-”

“I SAID NO! LEAVE ME ALONE!”

“But Jacob-” 

“GO TO HELL!!!!”

And that was the day God told me to go to Hell. 

**All names (aside from omnipotent ones) were changed to protect patient identities. 

[ramblingsofanot]

Meet God

Yes, you read that correctly. One of my patients was God. Or rather, he thought he was God. Also known as Jacob.

I’ll never forget evaluating Jacob. When I first began speaking with him and performing my routine evaluation of movement, balance, strength, mobility, etc. I wondered why he had been placed at a psychiatric facility. 

He eyed the saint medals I wore on a chain around my neck. “You’re Catholic then?” he asked.

“I am,” I smiled. 

He studied my face critically. “Good. I think you and I are going to get along,” he replied mysteriously.

Then we were interrupted by one of the managers with some routine paperwork.

“If you could just sign these, Jacob,” she said pleasantly.

Without a word, Jacob took the pen and promptly signed each line. 

“Alright that’s great,” said the manager, “I’ll just file these away - wait a minute.”

She was staring down at the pages. 

“Ok, sir, we’re going to need to get some new copies. I need your other name on these.”

Jacob had signed “God” on all of his paperwork. 

But to Jacob it was already official. God had just checked in. 

**All names changed to protect patient identities.

[ramblingsofanot]

Meet Carrie Ann AKA The Neglected Angel

I was told all about Carrie Ann before I met her.

“Good luck getting her to do anything. She’s sweet but she doesn’t want to do therapy, she just wants to talk.”

AND BOY, DID SHE TALK.

Carrie was weak from cancer and the regular chemotherapy and dialysis that accompanied it, but you would never know it from the way she spoke. Set up like a queen in her bed, Carrie Ann commanded the room. In a sassy, almost crazed tone Carrie Ann dictated how things were going to go. She was not unkind however, and even as she gave orders she cackled good naturedly to herself, her eyes bulging with every laugh. In short, Carrie Ann was a hoot.

Despite being highly skeptical of exercises, I convinced Carrie to do them daily. Granted the only reason she agreed to do them seemed to be to keep me there as a captive audience.

I would arrive with theraband and peppermints (a treat Carrie begged me to buy for her). She would pop a peppermint in her mouth, giggling as if she were doing something naughty, begin obediently stretching the theraband, and her stories began.

Carrie Ann talked and talked, telling me all about herself. She talked about her family and introduced me to those family members that came to visit. The more we talked, the closer we became. Carrie was so full of love and life. “Honey, one of these days you and I are going to go to lunch. And I’m going to buy us the full spread. Oh and we’ll have everything!” Carrie chirped cheerfully.

But as the days passed, I observed what no clinician wants to see in their patient. Carrie was making no progress. I begged her to let me sit her up at the edge of the bed, which she permitted on days that her sacral wound didn’t hurt as much.

Once while sitting up she lamented, “Well you know me honey, I don’t like to complain but I feel so mistreated.”

“Why is that, Carrie?” I asked.

“Well I go out for my chemo and dialysis and they forget to give me meals when I come back, and whenever something does finally come it’s so cold I can hardly eat it. And sometimes they just drop it off so fast they forget to give me a fork and I hit the call light, but they don’t come.”

I started monitoring the delivery of Carrie Ann’s meals and realized with horror that she was in no way exaggerating. Carrie would return and be promised a meal, but hours would pass and nothing had been brought to her. What finally was sent up to her room was a sad excuse for a meal. I intervened as much as I could and reminded staff of Carrie’s calls, but somehow because Carrie had been labeled “a needy patient”, that seemed to be an excuse to most staff to not attend to any requests, reasonable or otherwise, in a timely manner. Somehow, I ended up answering a good number of her call lights throughout the day.

One night I was about to leave but I caught something out of the corner of my eye as I passed Carrie’s room. I found Carrie Ann returned from a dialysis treatment, still sitting in her wheelchair though she wanted to get back to bed.

“How long have you been sitting here like this Carrie?” I asked her, thinking of her wound, especially as she sat in the chair without any cushion beneath her.

“Oh a couple hours I expect,” she sighed. “But you’re here now! Can you help me get back to bed? OH and actually honey- I want to be able to go to the toilet soooo bad,” she told me mournfully.  “They never let me go to the actual toilet and that bedpan just bites my butt! Can’t you take me?”

Carrie looked up at me with wide, pleading eyes. I knew that Carrie was typically a max assist x 2 to transfer (she was probably twice my size) but I also knew that Carly needed to get up. I went out into the hall to check to see if any CNA’s were available to help me. No one was there.

“I really need to go soon!” hollered Carrie from inside the room.

In my head little clinical alarm bells were going off that this was not a good idea, but I just couldn’t say no.

“Ok Carrie, it’s just you and me. Let’s get to the bathroom.” In my mind I was rationalizing this to myself- ‘It’s ok, the only reason the CNA’s need 2 of them is because they refuse to use a gait belt- you can do this.’ Or so my delusional thinking went.

I pulled Carrie Ann into the bathroom and set everything up. I literally do not know how I managed it but with all my and Carrie’s strength and likely a few guardian angels, Carrie and I made it to the toilet. Shaking and sweating I sat on the floor of the bathroom, while Carrie did her thing.

Never did I ever think I would have a heart to heart with anyone while they had a bm, but life is always surprising you.

“I’m sorry sweetie,” Carrie said. “But it does feel so good to sit on this toilet.”

“No no Carrie- you did good! We just need to practice this more often, that’s all.”

Carrie laughed and shook her head. Then she looked down at me with love. “You’re the only one in this place that has heart,” she told me. “Heart is everything.”

“Well Carrie, I’m learning from the best,” I said softly, gesturing to her.

Carrie’s eyes teared up, but she gruffly snuffed them back and snapped, “Alright enough of this chit chat, let’s get me off this toilet!”

Several weeks later, I came into work in a bright mood. It was my birthday and I was looking forward to being taken out by my coworkers that day.

“Ashley, I have some bad news…” My supervisor told me in a hushed voice, taking me aside. “Carrie Ann died this morning. Well, at least that’s when another patient found her. No one checked on her overnight. And it seems that no one tried to revive her when they did find her. She’s gone.”

At first I was outraged and I spoke my mind to my supervisor. Then I sat stupidly, silently until everyone had left the room for the morning. I didn’t know what to do with myself. Eventually I stood up and before I knew it I found myself standing in the hall outside her room. There was Carrie Ann, or at least her remains, in a body bag on a stretcher, forgotten again.

I stood there for the longest time, overwhelmed by the injustice of it. How had no one checked on her? Why had no one tried to revive her? Carrie deserved so much better than this.

That’s the tricky part about being close to your patients. They are ill, and that means that some may not make it. People say to keep a distance between you and your patients so as not to burn out and become emotionally drained. I cannot fully agree with this- as therapists we meet people at the most vulnerable moments of their lives- to detach and prevent emotion from seeping into your time with them is, to me, unnatural. I would rather err on the side of caring too much than not enough.

And, as I learned with Carrie Ann, people did not care enough. I often wonder whether or not I did enough to help her. If I had advocated more for her, maybe she would not have died the way she did.

I will never know for certain. All I do know is that now every time I am tempted to rush through things with a patient, I think of Carrie Ann and can practically hear her saying “Have heart.”

[ramblingsofanot]

Faith & Work

Each day as I get ready for work, I put on a chain of 3 saint medals. These saints serve as a reminder to be the kind of therapist, and in general, the kind of person that I want to be.

All 3 holy women remind me that my faith is not only something for myself, but something to share. This is another reason I wear my medals. Countless people I have worked with have asked me about them. They serve as an open invitation for patients to ask me about my faith or discuss topics like their purpose here on Earth or even death. Regardless of whether or not we agree on the subject, there has never been a time I regretted being able to share and discuss faith with people. 

A beautiful example that stands out in my mind is my experience with Dean. I previously introduced him as being the man with late stage Huntington’s Disease whom I feared. One day after psyching myself up to go see Dean, something very different happened in our session that changed our relationship.

I had come day after day trying to engage him in his self care or exercises with no success. That day I simply decided to come in and do them for him. And as I gently washed his face, changed his diaper and clothes, combed his hair, etc. I began to talk. I did not ask questions or say anything that demanded a response on his part, but simply continuously commented and told little stories as I went. 

For once Dean looked peaceful and he listened silently. Then I noticed him staring at my medals. Finally he broke the silence.

“How do I pray?” he asked softly. I couldn’t believe my ears. The man who tried to throw me was now asking me how to pray.

“Well,” I said, shaking off the shock, “there is no one way to pray. It’s really just talking to God. You can say prayers like a Hail Mary or the rosary but it doesn’t have to be like that. Just talk to God about what’s important to you.” I paused. “You can even be mad when you talk to him…just talk.”

I don’t know fully what Dean made of my hasty, lame explanation, but he seemed content as he remained quietly watching while I finished our session.

I became a therapist because I want to help people. I want to be a part of people’s lives and help them create positive changes in their own lives. As a therapist, I was not able to be that for Dean. But in this moment and many others like it, working to be a vessel of faith is what made the real impact. Through faith, Dean was able to find a little peace. We connected on a deeper, more human level and from that day on, we understood one another a little better.

[ramblingsofanot]

Patient Endangering, AKA The Day I Lost My Sh**

As therapists, part of our role is to make safety recommendations based on our patients’ physical and cognitive abilities. Much of our documentation explains how much help a person needs to do various activities.

Thus when I make a recommendation like “patient requires one on one supervision at all times”, I expect that to be taken seriously. And when the rehab supervisor and the entire nursing staff also recommend this I simply expect it to be done. However I was severely disappointed.

I previously introduced Nancy to you, the patient I worked with who was in a catatonic excited state. This recommendation was made for her as she was a danger to herself and others around her.

And yet I would find her wandering aimlessly down the hall alone, or screaming in another patient’s room. Frustrated, I would return her to her room where a staff member was supposed to be watching over her and several other “one on one” patients. The staff member was often unaware that she had been missing as he thought she was with one or another therapy discipline and in his defense, he was extremely preoccupied supervising at least 3 other patients who needed just as mention attention as Nancy.

We managed as best as we could until one day I again found Nancy ambling down the hall. I was assisting another patient to walk back to her room when I saw with horror that Nancy was about to walk straight into another patient who sat helplessly in his wheelchair. Nancy, completely unaware of her surroundings, continued to plow forward even though her leg was caught about the wheel. She keeled forward.

Forced to abandon my other patient, I reached out for Nancy and caught hold of her before she fell and before she could latch her hands onto the patient in his chair.

Furious that no one was with her again, I instructed one of the nurses to assist my other patient back to her room while I returned Nancy to safety.

Scratching and pulling at me the entire way, I slowly led Nancy back to her room.

“Why was no one watching her?!” I cried to the nurse at the station.

The nurse was clearly just as fed up as me. “We were told that we couldn’t spare any staff to watch her! No one is going to be sitting with her anymore!”

“Are you serious? This is not ok! She’s not safe by herself!”

“I know that’s exactly what I said too but apparently that doesn’t matter!” the nurse lamented.

“Who decided this?” I fumed.

“The director of nursing.”

“Come on Nancy,” I said, “we’re going to go talk to her.”

I took Nancy all the way to the office with me, afraid to leave her alone again. With every step I took I grew more and more enraged.

By the time I reached the DON’s office, I had morphed into the hulk. Without a warning I barged straight in and began to shout questions at the DON. After the surprise passed, I could see on her face she knew I was right but was going to give me her rehearsed answer anyway.

“We cannot afford to have staff here only to be supervising patients.”

“But she is not safe without it!”

“We are not legally required to provide patients with one on one supervision at this facility.”

“Then she should never have been accepted here if we can’t provide the care she needs!”

Another visiting manager frowned at me. “Who the hell is this?”

The DON continued however. “Well we had open beds that need to be filled and she is here now so we can’t change that.”

At this point I was so far gone that tears had accompanied my rage and my hands shook. “Right! She is here! So while she is here she has to be safe!”

The other manager jumped in. “She has no record of any falls.”

“That’s because we keep preventing them! I just stopped her from falling in the hall!”

“We have no evidence to show us she isn’t safe,” the ignoramus persisted.

I could see I was getting no where. “Well come on Nancy! I guess I’ll leave you to start that fall record!”

The next day, someone was watching Nancy again.

I know I didn’t handle myself well in this situation. Shouting at people generally solves very little. However as I neared the end of my 3 month contract I had already used up every last shred of my patience. I was tired of the unacceptable excuses like this. I was fed up with the mistreatment and neglect that I saw every day. So while I behaved poorly, I ultimately do not regret it because I knew was right and the DON did too.

[ramblingsofanot]

Occupation has previously been positively linked to well-being because it fulfills a basic human need to do, provides a sense of purpose, provides a means to organize time and space, and is a medium for the development and expression of identity.

(Christiansen, 1999; Yerxa, 1994)

[ramblingsofanot]

OH WOW. OT has come a long way!!

intro to occupational therapy, 1954

via class facebook

[ramblingsofanot]

Little Moments with Bill Part II

One day after returning Nancy to her one-on-one supervisor, I caught something strange out of the corner of my eye.

There was Bill as usual in his wheelchair with his eyes closed, but this time he was shirtless!

His scrawny frame sat hunched and shivering.

“Cold...cold,” he muttered. I was horrified.

“Oh Bill!” I cried. “Here let me help you get a shirt on!”

I retrieved his white shirt which sat beside him and I began to put the shirt over his head. 

Suddenly Bill came to life and he valiantly began fighting off the shirt. Taken aback, the shirt and I retreated. 

“Cold,” Bill said again.

“Well Bill if you’re cold you need to put a shirt on. I’m going to help you ok?”

I advanced with the shirt once again. This time I was quicker than Bill and I slipped the shirt over his head. However, before I could even begin to worry about the arm holes, Bill was adamantly attempting to remove the shirt once more, grunting and grumbling as we struggled.

“Bill. Bill. Don’t fight me Bill!” I begged. But it was no use.

I gave up for fear of hurting the old man. Bill victoriously pulled the shirt off again.

“Cold...cold,” he resumed.

I sighed. “When you change your mind about the shirt Bill you let me know.”

“Yep.”

Bill- 1, Me- 0.

**All names changed to protect patient identities. 

[ramblingsofanot]

[ramblingsofanot]

But seriously..

[ramblingsofanot]

Indifference

Thus far in my career I have worked with a wide variety of personalities. Everyone has their own approach to their patients and their work, and for the most part I have no problem working with people whose approach is different from my own. 

However, there is one thing that I absolutely cannot and will not tolerate: indifference. It is, in my opinion, the epitome of evil.

I have thankfully only met one therapist who truly embodied this, but it took all of my willpower not to scream at this woman.

She was an evening registry therapist at my first job and from the beginning I was baffled as to how she was able to leave so quickly. I thought surely I must just be incredibly inefficient with my time if she can see multiple patients and write notes that quickly.

Then I did a little digging. Turns out the trick was not only being lazy but flat out committing fraud. She wrote her notes BEFORE seeing the patients and almost every note was the same copied and pasted generic piece of crap. 

For one man who had had a CVA (stroke), she wrote (as she did for everyone) that he did bilateral AROM exercises in all planes. As that man was hemiplegic- NO HE DID NOT. He was unable to lift his left arm out of his lap let along actively move it in full range!!

I also noticed that patients scheduled with her seemed to be complaining they didn’t receive therapy. In fairness, many patients had dementia and were not considered accurate historians, but I went even further and I began to quietly monitor who she went to see. I couldn’t believe what I saw.

The lying bitch (pardon my French) would go upstairs as if to see her last patient or two and instead walk straight out the door. Or when she did see a patient she had them perform arm exercises while she lazily sat in a chair on her phone! 

I never confronted this woman because I didn’t want to make things miserable between us. However I came home many a night to my fiancé (now husband) and endlessly rant about the injustice. 

I will never understand it. I cannot imagine making the conscious decision to deny another human being the care that they need, and not only that, but the care that they are paying to receive! I get the reality of being burned out, especially at a facility like that one, but shame on you for putting your lack of interest before the needs of your patients. Shame on you for abandoning them. Who do you think you are that you think you can leave someone waiting for you, knowing that without your help they may not recover? The level of indifference for those patients’ fate makes my blood boil. 

The only positive that could be drawn from this was that her faults set me that much more on fire to make a difference while I was there. It quite honestly became a sort of crusade for me. Though without her I was the only OT and I had next to nothing for equipment, I knew that I could at least ensure that the patients knew that someone there cared about them.

First and foremost, ALWAYS CARE.

[ramblingsofanot]

[ramblingsofanot]

[ramblingsofanot]

Meet Nancy, AKA When You Are Unable To Help Your Patient

There have been many times as I’ve started my career that I’ve felt inexperienced or that my knowledge was lacking, but none so much as when I met Nancy.

Nancy had a severe form of early onset dementia. Despite being in her 40’s she was reduced to a catatonic excited state.

She could not functionally communicate with us. She had no control of her bowels. While she could walk and move, every action she performed was purposeless because there was no one behind the wheel. All that seemed to be left was the most basic of instincts- to eat and to fight off danger. Thus, Nancy attempted to eat anything that her hand found and anyone that tried to guide or help Nancy was interpreted as a threat.

This poor woman was unlike anything I had heard of. It was readily apparent to us that she required one on one supervision at all times. Without this, Nancy would endlessly shuffle down the hall, unblinking, head tilted to the side with her long dark hair hanging over her face. And as she went she shrieked. So much so, that her fellow residents called her “The Banshee”. She was unable to “turn off”. Without someone forcibly laying her down in bed, she never would have slept.

I had no idea what I could do for her. Even without any experience with this diagnosis I could see that there was little I could hope to do for this woman, but I was determined to try.

I tried various forms of executive functioning training to try to get Nancy to purposefully interact with the world around her. My only thought was that maybe if I focused on one single activity, that with enough sensory cues and repeated performance she could make progress. But no matter what I did, Nancy showed no sign of improvement.

Nancy did not know I was trying to help her. No matter how I approached her she fought me. If I was not quick enough, Nancy would grasp me by the wrists and shake and pull and twist and scratch my arms screeching all the while in my face.

As I drove home in the evenings I would look down at the scratches on my hands and arms and wonder what I was doing wrong. I was convinced that my lack of experience was why she was not improving. Several nights a week I used to break down crying for her and for all the patients I could not help. I cried out of guilt that I was not skilled enough and I cried out of frustration at feeling so powerless to change these people’s lives.

I have always been a “where there is a will there is a way” sort of person, so it was hard for me to learn the harsh reality that you cannot help everyone. With time, you learn that it’s not your fault, but it never gets easier each time you meet another Nancy.

[ramblingsofanot]

Meet Dean, AKA The Patient I Feared

Working at these psychiatric skilled nursing facilities there were many times I experienced moments of hesitation and fear. But one patient more than any other truly frightened me.

Dean was a tall middle aged man with late stage Huntington’s disease. For those unfamiliar with this progressive neurodegenerative disorder, at this stage Dean was bedridden. Unable to control a majority of all voluntary movement, his arms and legs often flailed uncontrollably, he could not safely swallow the food you or I would eat, his speech was largely unintelligible, and he had lost control of his bowels. As is co-morbid with Huntington’s Disease, Dean also experienced psychological symptoms as well. A majority of the time he lay there in bed with a flat affect, depressed. However there was also a volatile side to Dean- this was the part I feared.

Every day was pretty much the same. I came to Dean’s room and knelt beside his low bed. I would explain what I wanted to work on with him and why. Dean nodded and responded in a haunting tone “OK”. Then as soon as we would begin Dean became infuriated, howling and thrashing his long arms and legs toward me like he wanted to do me harm. I scrambled backwards to avoid his reach.

I immediately backed down, trying to calm him.

“I’m sorry, Dean. We don’t have to do this activity. You said “ok” so I thought you wanted to do it.”

He calmed (sometimes) and I would return to his side.

“If you don’t want to comb your hair, that’s fine, I’ll help with that. Do you want to wash your face?”

“Yes,” he moaned.

But it was the same thing over again. Dean furiously launched himself at me as best as he could.

By this point my hands shook nervously. Approaching him began to feel like a trap. I was unsure if his fearsome aggression was out of frustration with his condition or purely with me.

“Dean I know this is hard but if we work on it together, we can find ways to make it easier.”

“Yea,” he replied.

“Ok, why don’t we switch gears and work on a few arm exercises?”

I approached again. I explained the exercise and Dean nodded approvingly, but each time after performing a single repetition, he would pull away angrily.

I was about to throw in the towel. Then suddenly Dean offered both his hands to me with a contrite expression.

Encouraged, I smiled and took his hands. Dean’s face suddenly returned to a snarl and I immediately realized I had been tricked. With alarming strength Dean yanked at my arms, trying to throw me to the side.

I don’t even remember what I said to Dean as I scrambled out of that room.

I may have understood why Dean behaved the way he did, but I still didn’t know what I was supposed to do. All I knew was that I was going to have to go back in that room again the next day.

***As always, the names of patients have been changed to protect their identities.

[ramblingsofanot]

[ramblingsofanot]

When Weird Becomes the Norm

One day I was working with Zara, a feisty woman who only spoke Russian. I wanted her to use the arm bike, but she wanted no part of it. 

“Neyet,” (No) she told me. 

“Da, Zara, da,” (Yes, Zara, yes),” I encouraged.

“Neyet, neyet!” she insisted.

What I didn’t notice meanwhile was that another resident named Gerry had slunk into the room. 

That is, until suddenly I heard the PTA shout in alarm. I whipped my head round quick.

There was Gerry standing right beside me with his pants down with everything below the belt exposed in full glory. He stared at me unblinkingly. 

“WAH!!! GERRY!! YOUR PANTS!!” I cried. 

With horror I also saw that Gerry had not only let his pants down, but his adult diaper was also fully loaded to boot. 

In typical Gerry fashion, he continued to simply stare and clicked his tongue. 

Just another typical day at work! 

**names, as always, have been changed to protect patient privacy