Sorry. Another crazy busy week, and tomorrow I'm going shadowing again, so the least I can do is fill you in on last week's shadowing before everything gets mixed up in my scrambled brain. It was actually shadowpalooza...the day started at 8:30 at the office and ended 30 miles away at 3:10. Total daily observation time was 6 hours, 40 minutes, bringing total time observed thus far to 15 hours and 10 minutes.
I observed three clients with Kay. The first was the lovely Lottie from last week. Her talking book machine had tapes this time, so we were able to use it. Wow! I was amazed at the sound quality. Going digital must have really helped. I wonder if there are people with full-time jobs who do nothing but read the books onto tape? It's not a computerized voice, and the "opening credits" include the line "Read by John Smith" or whoever the voice talent was. They also seem evenly divided between male and female readers. The reading is very pleasant and enjoyable to listen to. Lottie was equally impressed with the machine, and we had a good time using it. Kay also worked with her on some exercises to help with her posture and core strength.
The second client was a gentleman with Parkinson's who lived in a lovely older home with his daughter to look after him. I'll call him Lewis. He was just getting used to his rollator (a walker with wheels) around the house and was pleased at the additional stability and mobility it provided him. Kay had to get him a pediatric-width rollator because there were some very narrow doorways he needed to get through...most older homes are not exactly what you would call handicapped-accessible.
But on this day, the big event was that a wheelchair ramp had finally been built onto the back of Lewis' home, so he could finally get out of his house without having to be dragged up and down the steps. His daughter said he hadn't been outside for over 6 months (!!). Kay was there to make sure he could safely navigate out of the house and observe him getting up and down the ramp. Kay took Lewis' daughter and me outside with the rollator and had us wheel up and down the ramp once so we could get a feel for it. It was actually quite difficult to get the rollator to move in a straight line while descending the steepest part of the ramp. The rollator had hand brakes on it like a bicycle, but it was hard to grip both brakes with equal force, and the rollator tended to angle right or left as a result. For Lewis' first attempt, they made a little parade: Kay in front, Lewis in the middle with the rollator, and his daughter behind him. I watched safely from the ground. Lewis made it to the bottom in good order and was clearly happy to be outside despite the sweltering heat and humidity. After resting for a minute at the bottom, the train of people went back up and returned to the blessed land of air conditioning, followed hastily by yours truly, who was only too happy to shut the door on the heat.
Kay and I stopped and had lunch before heading on to client #3, a woman with muscular dystrophy who wanted a wheelchair evaluation. Normally, people tend to keep wheelchairs for at least five years, but this woman wanted a new chair after two years because she was having some back problems due to the way the current chair was built, and because she was losing strength in the hand she used to steer her power chair. She was even thinking about switching to a manual chair and having someone else push her around, but Kay tried to talk her out of it, saying that she shouldn't give up the independence she did have unless it was unavoidable. Kay got one of her trusted local wheelchair guys on the phone and discussed the woman's case with him. Apparently there are ways to control a chair using a straw or a device placed around your neck that you toggle with your chin. Pretty cool, no? The woman had an appointment with a doctor at a muscular dystrophy clinic later that week, so they agreed to wait until she could ask the MD doctor for his advice on the matter.
Communication with the woman was a bit difficult. She could form words perfectly well, but she lacked the power to amplify her speech with her vocal cords, so what came out was a very, very quiet whisper. We all pretty much had to lipread. Kay and the woman's nurse were pretty good at it. I, on the other hand, was an embarrassment. But it did ensure a nice quiet environment--no TV blaring like we see at most clients' homes.
Sunday, July 24, 2011
Saturday, July 16, 2011
A quick update
It has been a busy week. My second Abnormal Psych exam was Monday the 11th, so I spent the whole weekend beforehand studying. The exam seemed pretty easy--on one of the fill-in-the-blank questions, the prof even gave us the first letter of the answer, which I thought was extremely generous (and unnecessary for anyone who actually bothered to study).
Tuesday I went shadowing, but I was only able to observe one client. The OTs have to get permission from their clients before they can bring me along, and understandably, not everyone wants to have an extra person cataloging their vulnerabilities. And you definitely don't want to have someone observing the first time you meet with a client. Such was the case this week, so I met Kay a little later in the morning outside the building of a client who was okay with the extra eyeballs. The client, Lottie, was a lovely woman in her 80s, laughing at her shortcomings and telling jokes the whole time we were with her. Her main issue was low vision, so Kay was going to work with her on operating the player machine she had gotten from the state library for the blind and physically disabled. Unfortunately, we couldn't find the little discs to go in the machine. Lottie is careful not to move things around because she knows she will have trouble finding them again, and she was sure they were on the table, but we couldn't turn them up. After a phone call or two, Kay discovered Lottie's daughter had sent them back, thinking they were overdue! Oops. So we worked on other things instead, including climate control. I never realized this before, but do you know how hard it is to adjust a thermostat when you have a severe vision impairment? Lottie has a digital thermostat with a simple slider for warmer/cooler, but she never uses it because she can't read the temperature on the digital display. It's way, way too small! When the weather gets hot, as it did this week, it's a major concern if your client is just leaving the window open because she can't use her thermostat to set the air conditioning. (Whatever happened to Universal Design??) So it was a short 1 hour and 15 minutes this week, bringing my total observation time to 8 hours and 30 minutes.
We got our Abnormal Psych exams back on Friday, and guess who got ANOTHER perfect score? Yup. There were five perfect scores, so the exam really was easy peasy, but this puts me in great shape for exam #3. As long as I don't completely bomb it, I should be able to start filling in my prereq sheet with a big fat A.
Tuesday I went shadowing, but I was only able to observe one client. The OTs have to get permission from their clients before they can bring me along, and understandably, not everyone wants to have an extra person cataloging their vulnerabilities. And you definitely don't want to have someone observing the first time you meet with a client. Such was the case this week, so I met Kay a little later in the morning outside the building of a client who was okay with the extra eyeballs. The client, Lottie, was a lovely woman in her 80s, laughing at her shortcomings and telling jokes the whole time we were with her. Her main issue was low vision, so Kay was going to work with her on operating the player machine she had gotten from the state library for the blind and physically disabled. Unfortunately, we couldn't find the little discs to go in the machine. Lottie is careful not to move things around because she knows she will have trouble finding them again, and she was sure they were on the table, but we couldn't turn them up. After a phone call or two, Kay discovered Lottie's daughter had sent them back, thinking they were overdue! Oops. So we worked on other things instead, including climate control. I never realized this before, but do you know how hard it is to adjust a thermostat when you have a severe vision impairment? Lottie has a digital thermostat with a simple slider for warmer/cooler, but she never uses it because she can't read the temperature on the digital display. It's way, way too small! When the weather gets hot, as it did this week, it's a major concern if your client is just leaving the window open because she can't use her thermostat to set the air conditioning. (Whatever happened to Universal Design??) So it was a short 1 hour and 15 minutes this week, bringing my total observation time to 8 hours and 30 minutes.
We got our Abnormal Psych exams back on Friday, and guess who got ANOTHER perfect score? Yup. There were five perfect scores, so the exam really was easy peasy, but this puts me in great shape for exam #3. As long as I don't completely bomb it, I should be able to start filling in my prereq sheet with a big fat A.
Thursday, July 7, 2011
If I complain about anything this week, just slap me
This week's shadowing was quite an eye-opener. Things were a bit chaotic due to the July 4th holiday and the resulting change of schedule (I observed Tuesday this week instead of Monday). I went to bed Monday night thinking I needed to be three towns over at 10:30, so I set my alarm for the normal time. Once I got up and checked my mail Tuesday morning, it turned out I needed to be at the office at 10:00 instead. I was about five minutes late, but since Molly was still with her previous client, no harm done. This up-in-the-air quality seems to be an inherent part of home health, so you just have to roll with it.
We had to drive separately, since I was heading home straight from the client's house while Molly was driving on to her next client. Molly actually pulled over on the way there and got my cell number so she could brief me during the drive. I felt a little less than law abiding listening to her talk about the case while we were driving, but in hindsight, I'm really glad she did.
Have you ever had a friend or family member with ALS? It's a degenerative neurological disease where the motor neurons that control voluntary movements slowly die off. Basically, over time, your muscles waste away, and you gradually lose the ability to make voluntary movements. Your mind, bowel and bladder function remain intact, as does your heartbeat, but your body becomes less and less responsive, and eventually most people are unable to breathe on their own and die of pneumonia, infections, or other respiratory problems.
[Note: As always, the client's identifying details have been changed.] I wouldn't know this to look at Janet, the woman who opens the door to us with a smile. She is neatly dressed and put together and has kind, intelligent eyes. Molly introduces me to her, and her handshake is not very firm, but it is there. I also meet Janet's mother, who is helping take care of Janet.
We sit down at the table, and Janet reaches for a small whiteboard and a black Sharpie and starts writing with a neat, controlled hand to ask Molly a question. Janet's symptoms started with difficulty swallowing and slurred speech. Less than a year later, she had to give up a much-loved job. Once the neurologist diagnosed her with ALS, his only interest was in documenting her decline with quarterly visits. He didn't even think to suggest OT to her. She was already dead to him.
Her speech may be gone now, but her wit and intelligence are intact. She and Molly are discussing her left index finger, which seems to be stuck in flexion (bent inward toward the palm). Molly fashioned a cast for night wear to see if tight ligaments were the problem, but they were not. Molly and Janet work with some kinesio tape to get the errant finger to stay in extension. After a little practice, Janet is able to apply the tape herself, and is pleased not to have to ask someone else to do it for her. They then discuss stretches to keep the relevant muscles from tightening up, and Janet writes in frustration, "Why didn't the dr or the VSN recommend this??" All Molly can do is shrug.
Molly and Janet discuss hair-washing and hair care for a bit, and Janet writes that she is having trouble getting many of her pants and blouses on and off. After some discussion, Molly suggests adding hidden velcro closures to the sides of the pants. She demonstrates how the velcro can be added without changing the pants' outward appearance (I think this is absolutely brilliant!), and Janet agrees to let Molly take a test pair to a tailor and have them altered.
Next, Molly writes that she is concerned about her gait and that she feels she is getting more awkward. Molly watches her walk a bit and says the problem is that her movements are very straight-ahead and that there is little lateral movement in her neck and spine. Molly shows Janet some exercises to help maintain her lateral trunk and neck movement.
Janet is exceedingly grateful for Molly's help and worriedly asks, "Is there a limit on # of visits?" Under current rules, the answer to that question is, thankfully, no.
Back out in the hot sun, walking to our cars with bottles of cold water Janet insisted on giving us, I can't help but remark to Molly, "I think you're the only healthcare professional that even gives a darn about her any more." Molly reluctantly agrees. How sad is that?
Molly said OT is considered palliative, and thus not really necessary, in cases like this. That attitude makes me want to scream and throw things. It's easy to write someone off when you're not that particular someone, the thinking, cogent, fully aware human being who is trying to keep getting up and showering and dressing and LIVING every day, probably for at least a few years. All I know is, Janet deserves to live as much as she can for as long as possible. Isn't that obvious??
Observation time this visit: 2 hours
Total observation time thus far: 7 hours, 15 minutes
We had to drive separately, since I was heading home straight from the client's house while Molly was driving on to her next client. Molly actually pulled over on the way there and got my cell number so she could brief me during the drive. I felt a little less than law abiding listening to her talk about the case while we were driving, but in hindsight, I'm really glad she did.
Have you ever had a friend or family member with ALS? It's a degenerative neurological disease where the motor neurons that control voluntary movements slowly die off. Basically, over time, your muscles waste away, and you gradually lose the ability to make voluntary movements. Your mind, bowel and bladder function remain intact, as does your heartbeat, but your body becomes less and less responsive, and eventually most people are unable to breathe on their own and die of pneumonia, infections, or other respiratory problems.
[Note: As always, the client's identifying details have been changed.] I wouldn't know this to look at Janet, the woman who opens the door to us with a smile. She is neatly dressed and put together and has kind, intelligent eyes. Molly introduces me to her, and her handshake is not very firm, but it is there. I also meet Janet's mother, who is helping take care of Janet.
We sit down at the table, and Janet reaches for a small whiteboard and a black Sharpie and starts writing with a neat, controlled hand to ask Molly a question. Janet's symptoms started with difficulty swallowing and slurred speech. Less than a year later, she had to give up a much-loved job. Once the neurologist diagnosed her with ALS, his only interest was in documenting her decline with quarterly visits. He didn't even think to suggest OT to her. She was already dead to him.
Her speech may be gone now, but her wit and intelligence are intact. She and Molly are discussing her left index finger, which seems to be stuck in flexion (bent inward toward the palm). Molly fashioned a cast for night wear to see if tight ligaments were the problem, but they were not. Molly and Janet work with some kinesio tape to get the errant finger to stay in extension. After a little practice, Janet is able to apply the tape herself, and is pleased not to have to ask someone else to do it for her. They then discuss stretches to keep the relevant muscles from tightening up, and Janet writes in frustration, "Why didn't the dr or the VSN recommend this??" All Molly can do is shrug.
Molly and Janet discuss hair-washing and hair care for a bit, and Janet writes that she is having trouble getting many of her pants and blouses on and off. After some discussion, Molly suggests adding hidden velcro closures to the sides of the pants. She demonstrates how the velcro can be added without changing the pants' outward appearance (I think this is absolutely brilliant!), and Janet agrees to let Molly take a test pair to a tailor and have them altered.
Next, Molly writes that she is concerned about her gait and that she feels she is getting more awkward. Molly watches her walk a bit and says the problem is that her movements are very straight-ahead and that there is little lateral movement in her neck and spine. Molly shows Janet some exercises to help maintain her lateral trunk and neck movement.
Janet is exceedingly grateful for Molly's help and worriedly asks, "Is there a limit on # of visits?" Under current rules, the answer to that question is, thankfully, no.
Back out in the hot sun, walking to our cars with bottles of cold water Janet insisted on giving us, I can't help but remark to Molly, "I think you're the only healthcare professional that even gives a darn about her any more." Molly reluctantly agrees. How sad is that?
Molly said OT is considered palliative, and thus not really necessary, in cases like this. That attitude makes me want to scream and throw things. It's easy to write someone off when you're not that particular someone, the thinking, cogent, fully aware human being who is trying to keep getting up and showering and dressing and LIVING every day, probably for at least a few years. All I know is, Janet deserves to live as much as she can for as long as possible. Isn't that obvious??
Observation time this visit: 2 hours
Total observation time thus far: 7 hours, 15 minutes
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