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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Penis…in your face!

By Mariel | Published January 25, 2012

It has come to my attention that I have been in the medical field long enough to take things for granted. For example, the hospital that I work in has plenty of volunteers that want to see inpatient therapy, so they can put these hours on their resumes for therapy school. I think it is great! I know that when I was in undergraduate school, I volunteered my butt off. I wanted to see as much as possible. Now, I encourage students to volunteer, so that they can really see what they might be getting themselves into.

This leads me to my headline. What I take for granted is realizing that in my everday life, I will probably see a penis and a butt. Maybe a boob. But, who cares? It just goes without saying that I will see that during my day. I forget that not everyone sees penises and backsides on a daily basis. My husband does not have anything to be worried about. These are not fine, anatomical specimens. I see wrinkles…lots of them. For example, last week, I was working with an elderly gentleman with Parkinson’s disease. We were working on standing. He was so weak that he couldn’t stand…not his baseline. Upon standing, I smelled an aroma. I informed my pt that I would be wiping his bottom when he stood up (he couldn’t do it himself, he was concentrating so much on just standing). He then stated to me, “In my age, there has been some shrinkage. There is a secret compartment there.” What?! What a strange thing to say, but not so strange if the medical team is working up for delirium. Anyway, it was funny. But his butt was wrinkly and shrunken. Woo hoo.

Another story I must share: a new volunteer had never been around inpatients. I took her with me. She wanted to help and reached down at the foot of the bed to move something. When she looked up, there was an old, wrinkly penis in her face! The patient’s gown had ridden up. She was shocked. She’d never seen that before. She didn’t know what to make of it. It makes me bust up laughing, just thinking about it! Despite all the body parts that I have seen in my career, I still try to allow pts to have as much modesty as possible. Some people are so sick though, that they just throw modesty out the window. I guess it makes for an entertaining therapy session.

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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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OT and OTA

By Mariel | Published September 14, 2011

WHAT IS THE DIFFERENCE BETWEEN AN OCCUPATIONAL THERAPIST AND AN OCCUPATIONAL THERAPY ASSISTANT?

There are a few differences between therapists and assistants. Schooling is one. You can be an OT assistant with an associate’s degree. Nowadays, you need to have a master’s to be an OT. Legally, OTs are licensed to perform evaluations and to interpret information. But under certain circumstances, OTAs can administer standardized evaluation tools.  There is more liability as an OT. The OT cosigns the OTA’s notes and must agree with whatever the assistant wrote. You have to be comfortable delegating tasks and communicating with others if you are the OT. I can’t even say that being an OT gives you more advantage for managerial positions because I have heard of therapy assistants being rehab directors in skilled nursing facilities. I think it just goes back to volunteering, asking questions and finding out what’s out there. You have to be informed to be able to make whatever choice is right for you.

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Oy!

By Mariel | Published September 12, 2011

Let’s pretend you have just had a total knee replacement. You are in pain because you just got hacked into! You have foreign bodies in your body now. You are doped up on pain meds. You haven’t eaten because the pain meds make your mouth really dry and nauseous. You feel like you will throw up. You really need to go to the bathroom. You have a catheter, but you want to get rid of it ASAP.  Oh yeah, you can’t even move your leg because it feels like weighs half a ton! You’re numb because the doctor convinced you a pain pump would be a good idea, so that means you have no idea that your foot is attached to your leg!  And here we go trying to move it for the first time. You might be really nervous because you don’t know what to expect. You don’t want to cause yourself pain and you definitely don’t want to throw up in front of the cute nurse.

This is what my part of my workday is like 2 days out of the week. The day after orthopedic surgery, the OT comes in to evaluate the pt for need of skilled therapy to return to prior level of functioning and to maximize independence. It gets interesting when pts faint, projectile vomit or almost fall when they try to get to the bathroom. It doesn’t happen every day, but all those things have happened to me at least once! And I still love my job! Am I nuts or what?

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Therapeutic use of self

By Mariel | Published September 1, 2011

In my miscarriage post, I mentioned therapeutic use of self. Does it sound weird? As a therapist, you can use yourself as a tool for therapy. And it’s true. You develop a rapport with your pts, you learn what they like, strive for, live for, what motivates them. And you use that to your advantage.  According to the “Pedretti’s Occupational Therapy, Practice Skills for Physical Dysfunction,” therapeutic use of self means that the OT uses own self and all that entails (knowledge, personality, and experience) conveying empathy, active listening, and establishing trust.

It’s quite fascinating how important it is for you to be confident in yourself and your skills to be an effective therapist. As one of my favorite psychiatrists said, “It’s all about the delivery.” If you exude that confidence, your pt will have confidence that the therapy will help him/her, in turn boosting the effectiveness of the therapy. It’s not just the physical part of therapy that will get results, it’s the mental component too.

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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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Brains update

By Mariel | Published August 25, 2011

I have great news! My pt (the one highlighted in the “brains” post) is doing so much better! He is going to transfer to acute rehab soon. Acute rehab is a great place! The pts get at least 3 hours of therapy a day there, usually a combination of physical, occupational and speech-language therapies. It’s pretty intense and it tries to simulate a home environment as much as possible. For OT, you could be cooking in a kitchen with the pt, doing golf, dressing, showering…more advanced tasks that you’d normally do in your daily routine. It is a pretty fun place to work too. Each facility has different features. The one my pt will be going to has weekly outings for community integration, pet therapy, a healing/meditation garden and a brain injury support group.

I am so proud of him. He has improved so that he is talking in 5 word sentences appropriately, he is using both upper extremities more often in bilateral integration, he is less expressive aphasic and has improved in his left sided neglect. Medicine is obviously helping him, but you cannot deny the impact that therapy is having on his life. Each time he performs a task, his brain is forging a neural pathway. I always tell my patients that “practice makes perfect.” I guess I should really be saying , “practice makes better,” but it just doesn’t sound as good.

All that marketing for brain games, puzzles, board games…it’s not baseless. Simple things like playing Connect 4, doing Highlights magazine puzzles, and naming objects are stimulating brain activity and motor coordination. Simple things that really make a difference. Just ask anyone who’s worked with someone with a brain injury. The brain is very plastic. It’s amazing.

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8/9/11

By Mariel | Published August 9, 2011

Thank you! Thank you to everyone who has read my blog. Thank you to those who have shared their miscarriage stories with me. Thank you to those with the unending support. I really have been going through a difficult time, but I feel so much stronger now, particularly because people have been so loving and supportive.

Life really is a kind of topsy-turvy journey, but if you go along with the ride, you’ll experience fun and fear, excitement and anxiety, joy and sadness. You can’t control everything, but you can control how you react. The beauty of life, the beauty of OT. Make it fun and worth living!

p.s. Before the American Occupational Therapy Association changed its slogan to “Living Life to Its Fullest,” it was “Skills for the Job of Living,” which I kind of like better.   :)

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