I think it is very important for the pt’s family and friends to be involved and helpful, especially in times of brain injuries or serious hospitalizations such as organ transplants, near end-of-life, new cancer diagnosis.

What do you do when the family or friend of a pt is just a little to pushy during your treatment? There’s a difference between being a pt’s advocate and being overbearing and rude. Being an advocate is helping the pt navigate the system and to make it easier on the pt. Hassling the medical staff will get you nowhere.  Something you have to understand is that you don’t know what the pt or family is going through. Some people have better support systems than others. Some families are tight like glue, others are non-existent, by choice or circumstance.  Someone who the pt does have is you.

The big thing to remember is to have empathy. Look it up in the dictionary. Read it, understand it and be it. You will be a better therapist just by doing that.

It should be common sense that you do not date your patient. However, I have heard stories of therapists having inappropriate or sexual relationships with patients. Seeing as that I am married, I doubt I could have an inappropriate relationship with a pt….or could I?

When you think about the population that the Veterans Affairs hospitals serve, it was no surprise that some pts were really inappropriate. It is mostly men and a majority of them are single, varying in age range from World War II-era to Operation Iraqi Freedom-era. A lot of them have frontal lobe brain injuries, which affects your impulse control and inhibitions.  If you think about it:  you are a young therapist, willing to assist the pt to reach maximum independence….the pt starts to grow on you and like you (for various reasons). I made a point of wearing a wedding band (which I do not normally wear even though I am married) just so that I could have a subtle hint to say, “stay away!” So, yes, pts at the VA did try to hit on me and ask me out on dates, which I politely refused. Yes, the pts were hurt, but would I risk my job and license for a guy? No way!

Alternatively,  I made friends with one of my former pts. This is a different kind of pt/therapist relationship. She is young and had a stroke. She was seeing me to regain function in her previously dominant hand. Part of occupational therapy is therapeutic use of self.  During our therapy sessions, we talked about things and I cheered her on and we ended up having a good pt/therapist relationship.  I suggested things to her to help her acheive her goals, and she complied. Everyone wants a pt like that! Well, medical insurance has a funny way of working. We got to the point that her insurance would no longer pay for visits, and I needed to make sure she could excel in a home exercise program. After her last visit, I didn’t know what happened to her. We had exchanged email addresses some time during our therapy sessions, I think for therapy homework or something like that. Well, since she was no longer my pt, we met for lunch. I was curious to see how she was doing and by that time, we were genuinely friends. Now, I see her a few times a year and we just pick up right where we left off. She is a former pt who I consider one of my good friends. Yes, Disney princess, I am talking about you!

I don’t think being friends with someone who is no longer my pt is wrong.  I do think that going on a date with someone, who you are actively treating, is wrong. If someone wanted to date you, they shouldn’t be your pt. It’s about ethics. What do you think? This goes back to understanding that as a therapist, you are put in a lot of ethical dilemmas (not just pt/therapist relationships), so you always have to think what is right and what is not?

I have really been mulling this over. I work in a somewhat physical job. I have to get people from supine to sit, sit to stand, on the toilet, in the shower. It can be quite demanding on your body. One of the reasons I became on OT is because I’m just not that into going to the gym all the time. I like getting my physical activities through other, organic things like walking to the grocery store, yoga, dancing. I’m definitely not a gym rat. However, as I mentioned in other posts, I have issues with my neck and back. So moving pts really works my muscles but I have come to the realization that I NEED to work out..regularly. I need to do something else, beside work my 40-hour-a-week job. I need to stay healthy. Because, like I’ve posted before, if I don’t take care of myself, no one else will.

My co-workers all love to run. I hate running. I can’t relate when everyone talks about whatever race they are doing next. Someone else swims, some play tennis, some lift weights, some bike. One guy surfs. I do yoga. That really is the thing that I do that helps me with myself, my body, my life. I don’t do the Americanized version of yoga, where you try to do all these crazy poses in a limited amount of time. I like to do gentle, restorative yoga. I like to calm my mind. I like to lie on my back, do spinal twists, breathe, stretch my muscles that get worked out from doing maximum level assistance transfers. It’s important to have good posture and breathing techniques, especially as a therapist. For 2012, I look forward to deepening my yoga practice and taking care of myself more than I take care of my pts. It sounds selfish, but it’s the only way I’m gonna make it to be an old OT. I have to make sure my body can last in this type of physically demanding job. I don’t want to end up like one of my pts and have spinal surgery or a hip replacement. I want to stay as healthy as I can.

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.

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!

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.