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.

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!

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.

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.”

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!

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!

I’m grateful for my career. I’m grateful for all the experiences with my pts that have enriched my life, better or worse. I’m grateful that I’m able to grow and expand my OT skills. Happy Thanksgiving!

Today was awesome! I had a pt who came via ED. The neurology team was doing all the tests to rule out stroke or transient ischemic attack (TIA). The physical therapist had already cleared him because he had great balance and gait. The patient felt pretty good. He even told me, “I’m making your hospital a lot of money with all the tests they’re doing on me.” Hmm…what was I supposed to do? He felt completely fine.

I talked to him. I asked him specifically about his symptoms. He had some weird heaviness going on with his head but also, he had tingling coming down his right arm, from the elbow down.  I have experience in outpatient hands. I’m used to looking at the hypothenar and thenar eminences to look for flattening. I do quick coordination tests. I check for sensation. I typically ask my hand pts about their sleeping habits. I asked this pt about his work situation. All the things he was telling me seemed to point to cubital tunnel syndrome or ulnar neuropathy. I thought in my head that he was having 2 different things going on, not one scattered phenomenon. I educated him on sleeping habits, ulnar nerve gliding and answered his questions regarding his arm tingling. I saw the attending neurologist and let her know my theory. Leave it to me to forget to use other important diagnostic tests to really determine if it was ulnar neuropathy. Well, that’s okay, because the neuro residents had fun doing the tests on my pt. It turns out I was right! Ha, he does have ulnar neuropathy! It was so satisfying to know with all my education, skills and training, I am an integral part of the team.

Some times, it just gets repetitious and I don’t feel mentally challenged. So today was a good day.

It is somewhat crazy at work. I think the fact that the holidays are just around the corner is a big factor. I’ve got a big caseload in the ICU again. One lady…I thought she was gonna die. But miraculously, she is getting stronger and doing better every day. She still has obstacles. She can’t eat, walk, talk or clean herself. She is a very good example of someone who needs physical and occupational therapy plus speech-language pathology. She is making headway and it is rewarding to see that progress.

Another pt is a young father who has a malignant brain tumor. It’s so heart-breaking. He’s not even 50, has a young son, his wife might be pregnant again. He has a terrible brain infection and his body isn’t regulating the cerebrospinal fluid properly. All we can do is get him up and see if he can follow commands or answer simple questions. It is very challenging when you have pts who cannot communicate with you.