Poop

Some times, you just don’t want to think about it. A lot of times, I don’t even want to acknowledge it. But yes, it really is a part of my life. There is poop in my job! Literally. I am proud to be an occupational therapist. I think it’s great fun. It is so rewarding to help people achieve independence in their daily lives. But some times….poop happens.

I don’t typically spend my days wiping butts. It is not in my scope of practice. Part of my job, as an OT, is to train and educate people on toileting, toilet hygiene, safely getting to the toilet. It’s possible to educate someone who has had a stroke how to wipe with the other hand or advise a pt on assistive devices for wiping.

Today I wiped three butts. It’s a nursing thing to do that but some times, at work, the nurses and aides are so busy. I only have so much one on one time with my pt, I don’t want to waste it waiting for someone to wipe the butt. The thing that made me laugh today was that one of my pts had explosive bowel movements. One thing that delays pt discharge is whether the pt has had a bowel movement or not. This one pt had not pooped since Saturday. The MDs had ordered 6 different items to help with his poop. Metamucil, stool softeners, lactulose. Poor guy. He was so blocked up one minute, the next he’s rushing to the bathroom with explosions. I mean, he almost fainted, he was so tired from all the exertion! It could have been a real emergency if he had fainted in the bathroom after having all those bowel movements! Poor guy.

It was just part of my day.

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Large and in charge!

I’ve got a few pts on my caseload right now who probably weigh about 350 pounds each. That is about 3x my body weight. Something that I know is true when working with obese people is that they have decreased bed mobility. They have extra girth around their body that limits the ability to get in and out of bed. As an occupational therapist, this also applies to other activities of daily living. Some pts are so large that they cannot do post-toilet hygiene or tie their shoes. The hospital bathrooms are too narrow for the pt to comfortably use. I am not prejudiced against obese people. My whole immediate family is obese. I am simply acknowledging that as an occupational therapist analyzing the abilities of people to do activities of daily living, being morbidly obese hinders independence in occupational performance. It especially makes it more difficult to recover more easily from a life saving surgery.

One pt had abdominal surgery. He has a large belly, bigger than Santa Claus. It is getting in the way of getting in and out of bed. He has no problem walking. He’s steady on his feet.  Another pt has abdominal pain and bloating. She is also very weak from cancer. She is so bottom heavy that it’s hard to get the right momentum to get out of a chair. The extra poundage is hard to move against gravity and the less you move, the harder you have to work to get better. I’m doing my part by seeing these pts daily and encouraging to move around more. It’s working but not without its challenges. You can seriously injure yourself trying to move a heavy pt. Do not do it by yourself. I usually have the pts do as much as they can for two reasons: 1. it’s therapeutic for them and 2. I want to limit my exposure to injury as much as possible.  Nursing staff, on the other hand, feel they are limited in time so they try to do more of the work, instead of giving the pt a few minutes to do it on their own. As a healthcare worker, you need to protect yourself first, before the pt.  If you hurt your back trying to move someone, you would be no use to them or yourself.

It’s important to have good problem solving as a therapist, to be able to get yourself out of a jam when needed.

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Update on Mrs. M

Mrs. M was the pt that was having a stroke in the Rehab dept. Her brain and body haven’t been handling the shock so well. Her family put her on comfort care and PT/OT/SLP are no longer working with her. She is/was a very feisty, independent lady. We’re sorry that she is nearing the end of life. I think her family agrees that her 87 years were so full of life. No one ever wants to go, but it’s the circle of life. Some times, you just have to remind yourself that everyone dies and to make the most out of your life. She’s such a sweet lady. Those good memories are what help people go on.

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Student

My student started today! I was quite apprehensive because this person will be following me all day long, 40 hours a week for 12 weeks. She arrived today and it seemed to go okay. I think we get along and I hope I don’t intimidate her. I know that I make very direct comments. What can I say? I speak my mind. Some times I wonder if I have a frontal lobe injury, ha! I probably just have to figure out how not to overwhelm her. There’s a little bit of knowledge in my head that I like to share, but maybe it’s too much. Oh well. Let the fun times roll!

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What a way to end the day!

Usually, the end of the day is pretty mellow. I spend my time getting things in order and getting ready for the next day. Not today!

During the last hour of work, a person was literally stroking out in the bathroom. Here’s what happened (as summarized by a supervisor):

Mrs. M was referred to outpatient PT for a complete rotator cuff tear by Dr. M. She arrived via a transport van from her assisted living facility. She was evaluated by Julie, PT. The patient was able to participate in the evaluation, walk into the treatment room and actively move her left arm. After the evaluation, the patient was very tired and required maximal assistance to transfer to a chair. At this time Julie actually wrote Dr. M and recommend Home Health PT as this trip to outpatient PT seemed to really exhaust her. The ambassador team was called and DP arrived with a w/c in which the PT transferred the patient to. The lift team was paged by the PT department to assist the ambassadors with the patient’s transfer to the car. As the patient was waiting for her ride, she told the ambassadors that she had to use the bathroom. Ambassadors SS and BR decided it was best to bring the patient to the hospital’s PT/OT department because the bathroom was big and the therapists could help if needed. They did not know the patient actually came from outpatient PT.  Mariel, OT and Matt from the lift team were in the department when the patient arrived and kindly helped the patient go to the bathroom and get back in the w/c. It was then that Carter, PT and Resie, OT noticed that the patient was not talking and slumping to her left side. They evaluated the patient’s cranial nerves and noticed that the patient was drooling, exhibiting signs of left neglect and not moving her left arm. They paged Julie who came right over from the outpatient department and confirmed that there was a change in Mrs. M’s presentation from when she walked in to the department at 1:00. Mrs. M was immediately taken to the ED, conveniently located around the corner from hospital Rehab and a stroke code was called by the ED physicians. Mrs. M was found to have a hemorrhagic stroke and is now in the ICU.

It was great teamwork from everyone involved. As an inpatient therapist, I am now directly involved in Mrs. M’s care at the hospital. It was convenient that I was there when she was having her stroke because I witnessed it. It was an amazing day.

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Welcome 2012!

It is 2012 and I have so many OT goals for the year!

I am going to have my first OT student. I want it to be a success. I need to make myself complete my hands and physical agent modalities certifications. I have been procrastinating long enough! I will get LSVT-BIG certified. Big and expensive goals. But I can do it!
Yay, OT!

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12/20/11

Seems like lots of patients are always dying around Christmas time. Last year, one of my pts (who I will never forget) died. She had been battling leukemia on/off for two years and she had always bounced back. This time, it was too much. I wasn’t there when she died, but I was there during the process of her wanting to try and live….and her finally communicating that enough was enough and that she was ready to go. Today a pt passed away just before the end of our shift, a young lady with leukemia. It can be really hard because you get attached working with the pts.

Today, several therapists got together for a Happy Hour and that was very therapeutic for us. We work as a team, in life/death situations and we can be kind of intense in our daily work routine. We take our jobs seriously but really try not to let it overwhelm us. Going out and just talking about regular life was very good for us. It was one way of not letting emotions build up or get out of control. This is all part of the very important, work-life balance.

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Fainting

I know that this is a weird subject line, but for whatever reason….we had a bunch of volunteers faint while up on the floor! Most notably, they were with our pregnant OT. Weird.

Picture this: I walk into a room in the ICU. The volunteer is shadowing me, so literally, she’s like my shadow. This pt has just had his whole leg amputated! He has a drain coming out of his body, he has huge incisions and some blood. The volunteer is grossed out because he has eye mucus! She didn’t get grossed out by the missing leg, but the eye stuff! I thought that was hilarious. She said she almost vomited because of the eye mucus.

Fast forward several months. Same volunteer with the pregnant OT. OT is just finishing up with a joint pt. Volunteer is by the door. “I need to get some air.” Other OT is just outside the room at nurses station. Volunteer almost passes out, looks white and clammy because she didn’t eat breakfast! Not eating is a big no-no as a therapist. You are running around all day long. You’re moving your body, moving pts bodies, writing notes, on the go. It is very important to stay hydrated and keep something in your tummy. You do not want to be the person that wakes up with a nurse running towards you with a wheelchair and blood pressure cuff!

I can say all this stuff because I have fainted several times in my life. So like the Boy Scouts say, “Be Prepared.”

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Interview process

We have had a spate of OT interviews this past week. It’s been a very interesting process. I haven’t had to go on a job interview in 2 years, so it was interesting to remember what that was like. Having been an OT for a few years, it makes me think that you really need more than one interview with a person. I mean, how do you know if the applicant can handle stress well, or has good time management or has good clinical skills?  You just never really know so you have to make a gamble when you hire someone, I guess.

You’ve got to gather all the facts and variables you can.  It’s just like OT. You’ve got to break everything down. Is the grammar on the resume correct? Is the person groomed and dressed nicely? Polite? Thoughtful with the answers? Asking good questions? Glazed look over the eyes? Sweating because it seems overwhelming? I really appreciated that my boss had me sit in on the interviews. I feel that I work in a very good environment right now and I want to keep that even keel. In all, it was nice to meet OTs from other parts of the country.  I can’t wait to work with my new team member because… OT rocks!

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Clothes

I work in the acute care setting. This means that I am no stranger to foley catheters (urine bags), projectile vomiting (from post-anesthesia pain meds), diarrhea (from c-difficile), Dignacare (rectal tubes to collect feces), or other strange bodily fluids. I wear a lab coat at work, which I wash weekly. I also wear business casual clothes with shoes that I can stand around for 9 hours in. This is just because some times, I want to look cute. Other OTs wear scrubs to work, which are great because you can just throw them on and boom- you look professional. It’s true…you get down and dirty. I sometimes wish I could wear the new, cute clothes that office workers wear. They just sit on their butts and type all day long.  They can wear pretty jewelry, nice blouses, skirts, tights, boots. I would never wear that stuff to work because 1. I don’t want a pt to rip out my earrings! 2. I have to bend down and squat a lot. 3. I don’t wear anything that I can’t wash urine or poop off. I find it much more rewarding to not look so cute at work so that I can help someone get their activities of daily living on. But just like another co-worker, as soon as I get home, I take a shower so I can wash all the MRSA and skin flakes off. Ugh!

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