Emotional de- attachment

By Mariel | Published February 1, 2012

I don’t know what it is about me, but I have never been so attached to my pts that I have cried at work or cried at home for them. Don’t get me wrong, I care deeply for my pts. It always makes me so sad when I hear of someone dying, or I know they have a terrible prognosis. I love my job and I love OT. I look at pts holistically, but I know that it can be a big emotional burden. I have written about this before. Thank goodness, I do not have as intense a caseload currently.

I was talking to one of the volunteers and she has never experienced death in her life. My grandpa died when I was 5, my uncle when I was 11, and my dad when I was 23. I know what value life has, the memories that someone leaves with you, the imprint they have on this earth. That being said, I mourn for my pts, but on the inside. I don’t outwardly show this to my co-workers and I don’t really talk to my husband about it. I internalize it, for better or worse. I belive in reflection, which I do often. I think about my dear pts that have passed away or have a terrible prognosis. I care for them with compassion, but I cannot let it bother me so much that I cannot go on living. I would be a terrible therapist if I let that happen. You need to be able to appreciate humanity but also respect the circle of life. It’s the only way you will survive being a therapist.

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Large and in charge!

By Mariel | Published January 12, 2012

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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Empathy

By Mariel | Published September 21, 2011

According to Merriam-Webster’s dictionary: empathy |ˈempəθē|noun   the ability to understand and share the feelings of another.

As a therapist, you need to have empathy. I feel like that’s a non-negotiable. However, there are tons of therapists who do not think that. If you had a therapist who didn’t have any empathy, he might just come right into your room and say “We’re getting you up now.” And you’re thinking, “Wait! I’m not ready!.” Obviously, part of being a therapist is educating the pt on how to work the body to their advantage and make things easier.

On the other hand, I just worked with a pt with metastatic prostate cancer. He sustained bilateral pathological fractures of his femurs requiring bilateral hip replacements. He was in great pain, literally coming from his bones. My job was to get him out of bed and into a chair so he could participate in some ADL. I understood that this man was in great pain. His wife was in the room and very encouraging. She wanted him out of bed, following doctor’s orders, doing more normal things than just staying in bed all day.

We started the session going very slowly. I educated him to take deep breaths and how to position his body to get him in the bed position to swing to the side of the bed. We were only able to move his legs about 5 inches before he started getting mean. Two RNs showed up to assist me and to change his bed linens after he was sitting in a chair. With the help of me, two RNs, the pt’s wife and a whole lot of mean things being said from the pt, he was able to sit at the edge of the bed for over 30 mins and finally stand up on his own two feet twice, post-op day 2. It wasn’t perfect but we had accomplished something. Needless to say, he was not very happy with me. He was in a lot more pain.  I remember telling him during the tx, “I don’t care if you hate me, but if I can get you back to sleeping in your own bed, it was worth it.”

To a certain extent, I feel like I was that therapist who just came in and said “We’re doing this.”  I know that my pt agreed to the therapy, otherwise, we would not have done what we did. That session was over one hour of me sweating, positioning the pt, educating his wife and the RNs on where to position their bodies so we could accomplish this task. I certainly had empathy and could appreciate that this man was in a great deal of pain.  But was I being too pushy? In my mind, I was helping this man. I know his attending MD and his wife wanted him out of bed. Was the means to the end justified here? I mean, he did agree to do therapy. I guess what I’m concerned about is that halfway through the tx session, he didn’t want to do it anymore. He just stopped working with us, which was really hard. And it made me feel like I was forcing him to do stuff. In a way, I had to force him, because I couldn’t let him just slide off the bed. I needed to end the session with him in a comfortable position.

Working with pts can be tricky and working with people who have cancer makes it that much harder.  I guess you just have to look at it from all the angles. What the pt feels, what’s best for the pt medically, what the pt and family want to do, what is meaningful to the pt. So many variables!

 

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Eye sea ewe

By Mariel | Published September 7, 2011

These last two weeks I have been spending a lot of time in the intensive care unit. More than half of my patients are there; with tubes sticking out of every orifice (or newly made ones!). It can be kind of scary and intimidating to walk into the ICU. The nurses there are very passionate about what they do. They love their patients and love their jobs. Medical doctors are talking a mile a minute about what’s wrong with pts.  Someone’s CPAP’ing here or she’s draining there, wound vac here, he’s extubated today, sprinting (it’s not what you think!), too many drugs and catheters, Fentanyl, hospice consult….that’s just part of what’s going on in the ICU.

It’s possible that the pts just look like blobs laying in bed. Respiratory therapy is trying to get pts to breathe on their own while the pts are trying not to lose hope that one day they will walk out of the hospital. Sprinting is after extubation-when respiratory therapy is trying to get the pt’s intercostal and respiratory muscles to work how they used to, before the pt was intubated. So, try to imagine that in your mind: You had a tube shoved down your throat so that you could breathe. They pulled the tube out. Now your mouth and throat are sore and your lungs, ribs, chest are so weak, that you can’t even breathe on your own. You need to exercise your respiratory muscles! I don’t know about you, but I just breathe. Some times, I tell myself to take a deep breath, but I can breathe without really thinking about it. Breathing doesn’t really bother me. I just do it. For my ICU pts, breathing is a workout that needs to be finely balanced with other exercises.

So what role does occupational therapy play if the pts can’t even breathe? This is where it can get confusing because occupational therapy can start to look like physical therapy here. Preparatory methods of intervention are used to prepare the pt for purposeful or occupation-based activity. How can someone start dressing himself or transfer herself to the toilet if he/she can’t even sit up on the edge of the bed without help? This is when OTs just start with rolling in bed, bed mobility, range of motion and general strengthening. It’s not very glamorous and it gets kind of boring, but you have to do it to get to the end goal. Usually people want to be independent, which is why OT is so important.

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It’s kind of like a show

By Mariel | Published August 29, 2011

One day, I was talking to my father-in-law about work dynamics and he made a really good comment. “Well, we all have multiple personalities, don’t we? We’ve got our work personality, our family personality, the friends personality….” I never really thought of it like that, but I think he’s right. When I am at work, it’s on! It’s kind of like being on stage. The pts and their families will scrutinize you: how you look, talk, dress, present yourself, your personality. They want to know if you’re competent to work with their family member. If you have a stain on your shirt, say “um” a lot, have messy hair, or can’t articulate, they might have a hard time believing that they should trust you. In my non-work life,  I definitely am not smiling 24/7. Just ask my husband. I think he might even say I’m grumpy! (Can you believe that?) But if I had a dollar for every time a pt asked me, “Do you ever have a bad day?” I would have paid off my student loans by now! But just because my home personality is more subdued and my work personality is kind of manic, doesn’t mean I’m insincere to my pts. I think it just means that I know they’re going through some rough times and they need that bright light. It is really nice to have pts tell you, “You brighten my day.”  or  ”I look forward to therapy because of you.” It just kind of melts your heart.

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:(

By Mariel | Published August 18, 2011

In a previous post, I mentioned that I work with a lot of pts with cancer. I see blood and bone cancers like leukemia, multiple myeloma, Non- Hodgkin’s lymphoma. I also see colon, pancreatic, lung cancers. Then there are brain tumors like astrocytomas, glioblastomas, gliomas. Part of my job is working with pts, some times almost until death. This post is to remember some of my favorite pts who I have worked with and have passed on, and others who are still fighting the good fight.

To my friend 07- I will miss you! It was always fun working with you and doing your beauty routine. I now know, Shiseido is a good cosmetics brand!

03- You were so young and strong. It is so unfair. I’m sorry for everything you had to go through. Your family loved you so much, maybe too much.

05-I’m glad I brightened your day. I hope you’re enjoying the mountain air.

11- Keep fighting!

81- I know you’re watching over your family now. I miss you and I’m sad I just found out you passed away.

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You know what they say: when you assume, you make an a – - out of u and me!

By Mariel | Published July 28, 2011

I’VE LEARNED NOT TO ASSUME

One day, I walk into the room of a pt. She was probably 70 and had her knee replaced. I see this somewhat bedraggled lady sitting in the corner and I say, “Are you her sister?” It was her daughter! I felt so bad, especially because during the hospital stay, I built a rapport with the family and realized that how you look was very important to this mom and her dtr. Whoops! My bad. So now, whenever I walk into a pt’s room and someone is in there, I ask what role the person plays in the pt’s life. Some times, the person totally looks at me like I’m a complete moron, but I’d rather not assume anything.

Another thing I’ve learned is that physicians do not know everything. They might know blood levels, different diseases, the latest research or every prescription drug available, but I can almost guarantee that they do not know how to move a pt. They wouldn’t know how to move a really sick person to get them to the edge of the bed. If a pt was walking to the bathroom and suddenly fainted, the physician might not even help, because they don’t know what to do. And also, not everyone has learned about body mechanics in school, including the nurses!

I have also learned to never assume that the nurse did something. There have been a few too many important times when I felt like my pts were overlooked by nursing staff. Once in my career, I had a pt who was put into an ankle foot orthotic. He was in the hospital for several weeks and unfortunately, he had that orthotic on for a few weeks without anyone checking his foot or ankle! I had seen him every day for about 2 or 3 weeks, and one day I was asking him about his pain and his ability to put on socks. During this interaction, he told me he had some pain in the other ankle. He told me no one had taken off that orthotic since it had been put on! Thank goodness he did not have any kind of pressure sore, but still…the thought that the physicians, nursing and therapy staff all overlooked this detail…it was so eye opening. That’s when I learned never to assume that another discipline will do something. The physicians assumed the nurses or therapy staff looked at the orthotic, the nurses expected other nurses or staff to do it and therapy staff thought the same. It was just a vicious cycle that did not benefit the pt at all, and it could have harmed him.

So- Don’t assume!

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It pays to volunteer!

By Mariel | Published July 26, 2011

WHY DO I NEED TO VOLUNTEER BEFORE I GO TO OT SCHOOL?

I think it’s a great idea to volunteer before you fully decide that you want to be an occupational therapist. I’ll share my story.

I took human anatomy and physiology in high school.  I thought this was such an amazing class. It was so awesome to me to learn all the muscles and organs of the human body. I went into undergrad thinking I wanted to do something humanities based. But 3 weeks into my freshman year, my dad got diagnosed with colon cancer. The physician had drawn a picture on the whiteboard in my dad’s hospital room, showing where the tumor had grown and where they needed to re-sect it. I saw that drawing and thought, “Oh my gosh! I know where that is! This is so cool!” So that one incident made me realize I wanted to change my major and learn the human body more. The college I went to had a kinesiology program, so I decided to change my major to kinesiology with an emphasis in pre- physical therapy. Lucky for me, there was an acute rehab hospital just down the street from my college. I signed up to volunteer. I stuck to the physical therapists like glue. I was their shadow. I saw everything they did with their patients. Of course, I had to do boring things like make copies and file home exercise programs, but who cares? I was seeing real patient contact. I was seeing sick people and watching them get better. I saw a lot of strokes at acute rehab. I then moved to outpt physical therapy. That was so different. I felt like I was at a gym. There were a lot of machines. I thought it was boring. I did get to observe the certified hand therapist, who was also an occupational therapist, while I was there. I couldn’t believe there was a therapist who only focused on hands! The injuries she saw were kind of gnarly. After that, I decided I needed to find out what occupational therapy was all about. How was she able to focus only on hands?

It was in OT where I observed so many different compensation techniques, functional activities, observed functional transfers. I just thought, “Man, this is really cool!” Plus, the OTs had all these cool toys and things to use for therapy. That’s how I made the switch. I am really happy I decided to study occupational therapy. In what other job could I be playing Connect 4, gardening, or educating a pt on showering? Seriously? I get paid for this? I love my job.

 

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