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.
Showing posts with label where the rubber meets the road. Show all posts
Showing posts with label where the rubber meets the road. Show all posts
Sunday, July 24, 2011
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
Monday, June 27, 2011
Morning at the Improv
Sometimes things don't go as you'd planned. Sometimes the plan and the reality are not even on speaking terms with each other. This is what OT shadowing session #2 was like.
I met Molly, who is Kay's partner OT, at their office. She introduced me to the facility owner, Bill, whom I did not get a chance to meet last week. He has been a therapist almost as long as I have been alive, and I am no spring chicken, so this gentleman has really been there, done that, and bought the T-shirt. Something about OT must keep you young, because neither Molly nor Kay nor the facility owner look anything like their chronological age. Molly and Bill were discussing some sort of legislation governing Medicare reimbursements in other states and most of it went sailing right over my head.
After faxing in some paperwork, Molly drove to the client's home with me following her in my own car. The client recently came to live with her daughter, and the daughter had just finished cleaning out her mother's old home. Molly was there to meet a contractor who was coming to discuss installing a wheelchair lift outside the front door so that the client would be able to enter and exit the house more easily. The contractor was supposed to come during a two-hour window.
While we waited for the contractor, Molly showed the patient, whom she's been working with for a couple of months, a pot and some baking supplies. "I thought since we've talked so much about how you love to make cookies, that we could bake some cookies while we wait for the contractor to come."
The client, who was warm and friendly, just a very nice woman, suddenly shut down. "No cookies!" she insisted.
Molly tried to persuade her, but the client was firm in her conviction that she wanted absolutely nothing to do with cookie baking today. Realizing the cookie thing was just not going to fly, Molly worked on getting the client walking around in her walker. The house had extra boxes and things lying around from the client's old home, including some lovely old-fashioned hat boxes (the round kind with fancy corded handles). The hat boxes were right in the client's intended path, so we started talking about them.
"I LOVE my hats," the client told us, and before you know it, we had an impromptu hat show in the living room with the client sitting in a regular chair rather than in her recliner. It was fun! The client opened each box, removed the paper from inside each hat, and told us about it--where she'd worn it, the outfits she had that went with it--it sounds silly, but it was a great exercise for her and fun for us. She even modeled a few of them. And the hats were gorgeous. Most of them were very elegant leather-trimmed suede or velvet pillbox hats from the early 60's. Very tasteful.
By the time the hat show was over, we had burned through a little more than half of the two-hour contractor window, so Molly called and left a message. Then we found a bag with wooden letter cutouts shaped like things that began with that letter (for example, the E was cut in the shape of an elephant). Molly asked the client to check and make sure the whole alphabet was there (we really weren't sure--another item from the attic of her old house), and the client laid the letters out in order on an adjustable rolling table placed in front of her chair. We talked about the items pictured on each letter (she apparently didn't play dominoes growing up!) as we went. Then Molly told her to close her eyes (I played along by turning my back) and removed a letter. The client had to find the gap and then name the letter that was missing. We did this 8 or 10 times, and then Molly noticed that the client was leaning toward her weak side, so she got to go back to her recliner after that.
Still no contractor. Molly left another message and then took me upstairs to show me the modified bathroom. It had a tub transfer bench with a cutout and an extra grab bar affixed to the outer edge of the bench. There were also three grab bars fixed to the enclosure itself and a nubbly bath mat inside the tub to prevent slippage. Molly demonstrated how to use the transfer bench, and then she showed me the chair lift on the stairway. You get in at the bottom of the stairs and flip a switch, and then you ride up the stairs to the top. I'd never seen one of these in person before and I was very taken with it.
Shortly thereafter, the two hours were up and the contractor was still nowhere to be seen. Oh, well. Molly had to go to another appointment, so I drove to a local BBQ place and took home some tasty pulled pork for lunch.
This visit: 2 hours, 15 minutes Total observation time: 5 hours, 15 minutes
Saturday, June 25, 2011
My Very First OT Shadowing!
I am happy to say that I am no longer a strictly-theoretical-only-knowing-what-I-read-on-books-and-blogs aspiring OT. I have SEEN OT! With my own two eyes! And lived to tell (you) about it!
I spent a wonderful morning with OTR/L Kay. Despite being an OT for nearly 20 years, she's not much older than I am. We got along just fine. She had a domestic emergency, so we met a bit later than originally planned.
Kay starts by showing me around the office and introducing me to everyone. She just says I'm an OT student rather than explaining, "She's two years away from even starting OT school and is only a couple of weeks into her first prereq." (Plus her option is a lot quicker.) Then she shows me the room she and her partner OT Molly work out of. It's a good thing they work mostly in patients' homes because the place is a closet. It's smaller than the bedroom I use as an office at home. The windowless space consists entirely of two desks, a table with a phone, a filing cabinet, and some wall-mounted cabinets.
Kay has to call Molly and straighten out some insurance issue (we haven't even started and insurance is already rearing its ugly head!), so I amuse myself with the MVPT, the Motor-Free Visual Perception Test. It consists of a series of placards where you are shown a shape, number or three-letter sequence, and have to find the same one among four drawings below the test item or on the next page following the test item. (I guess we're also testing ST memory a bit there.) There are also items where the "match" may be smaller, rotated, darker, etc. and a few final items of "Which one of these is not like the others?" The test seems very easy, but I guess that's just soothing reassurance that I don't have a visual impairment.
Soon, we're walking to Kay's car to go see the client. She makes a quick call on her cell phone to tell them we're coming and programs the client's address into her GPS, noting that the cell and GPS are her two best friends. She hands me the client file and pulls out of the parking lot. I am pleased that I can actually understand the file. I check a few acronyms with Kay, but my guesses are all correct.
Kay is going to do a "wheelchair eval" -- to see if the client can get a scooter or power wheelchair. The client's insurance will pay for a chair if certain conditions are met. It is Kay's job to interview the client and see if he meets those conditions. As we drive, Kay explains how several components of the client's medical history speak in favor of a powered chair.
Soon, we pull into the driveway of an older small but well-kept home and walk up a long wheelchair ramp to the front door. A lady about my mom's age opens the door, cigarette in hand, and gestures us into her living room. The client, her husband, sits at one end of a leather sectional couch, gaze fixed on the TV tuned to some morning hosts chittering and laughing about nothing in particular. Pictures of adult children and cherubic grandchildren adorn the walls and the shelf above the TV. The client has a splint and some ice over one hand.
"Oh, no, what happened?" Kay says, immediately concerned with the man's injury. His wife tells us he fell yesterday and had to go to the ER. The man had a stroke a few months ago, so his speech is slurred and sparse, yet his wife is able to interpret his grunts and mumbles. He interjects himself into her narrative as she describes what happened, and she takes it with good humor. He even allows his wife to take off and re-apply the sling (quite a painful process) so Kay can look at the injury.
Kay takes some time trying to make the client as comfortable as possible: extra pillows behind his back, replacing the hard ice pack with some frozen vegetables (they don't have peas, but soon he's sporting a bag of California Blend), and pillows to rest his lower arm on so his hand isn't hanging down. The client's wife explains that she wants him to eat before she gives him his pain meds, but he can't eat right after he wakes up. This is why he's so uncomfortable right now.
Kay opens her laptop, balancing it across her knees, and begins her interview by discovering that both the patient's first and last names have been misspelled on the file. Heh.
What really impresses me is how amazingly well Kay multi-tasks. She's typing into her laptop, she's talking to the client and trying hard to understand his replies, she's talking to his wife, she's incorporating all the extra information they are throwing in that is not directly related to the question at hand, and the evaluation doesn't even feel like an evaluation. It feels like a conversation. Meanwhile, I have the important job of holding the client's cane. :-) He does actually say that he likes me the best since I'm the only one not causing him pain. He even asks me if I'd like a cold Pepsi from the fridge, which is so sweet. I politely decline, but thank him for being a good host.
Kay gets to the part where she needs to measure the range of motion the client has in his hips, knees, elbows, shoulders, etc., so she pulls out her trusty goniometer. I've never seen one of these in action before--my inner geek is turning cartwheels. She carefully instructs him where to hold what and takes some measurements. She does a full set of measurements for his uninjured arm and shoulder, but obviously can't do a whole lot with his injured hand, so she mostly leaves that side alone.
Next, she helps him stand and sees how far he can walk. He is able to go about ten steps before turning and coming back to the couch. She makes some notes about how far he lifts his feet off the ground and the evenness of his stride, things like that, and then we take a little "field trip" with his wife to look at the bathroom doorway (wow, is it narrow) and the bedroom arrangements (tight turns required to get a chair in and out). Kay explains that a scooter requires better motor control and upper body strength because the controls are forward of the user on a handlebar-like arrangement. A scooter is also more difficult to mount and dismount and is longer than a power chair, so it has a wider turning radius. A power chair is controlled by a joystick very close to where the user's right hand would normally rest, so it doesn't require as much upper body strength or balance. Kay is leaning toward recommending a power chair for this client over a scooter.
We return to the living room. Next, the client's wife helps him get into the manual wheelchair he currently uses, and Kay asks him to wheel himself a few feet in the kitchen. He mostly uses his feet and is not able to make the chair move very effectively.
All the while, Kay is talking with the man and his wife and listening carefully to what they're saying, and the man just comes to life. His grunts and mumbles turn into words, then phrases, even a few full sentences. He enunciates clearly enough to make a joke as Kay finishes up his medical inventory. She says, "OK, so you have pain here, there, there, and there. Is there anything else giving you pain?"
"Yeah," the man says, a glint in his eyes, "that one (he points to his wife) and that one (he points to his home health aide)!" Everybody bursts out laughing.
We were there for about two hours. Kay had never laid eyes on the client or his wife before, but by the time we left, she had built a sincere rapport with them. And the client, whom the case manager had described in his file as "non-verbal," had shown himself to be a likable, charming man who could still speak fairly well. His speech improved quite a bit just while we were there.
I made sure to thank the client and his wife for allowing me to observe. It is a humbling thing to be welcomed into someone's home, and for a stranger to let you see his weaknesses and vulnerabilities--and still have the presence of mind to offer you a cold drink.
This visit: 3 hours
Total observation time thus far: 3 hours
I spent a wonderful morning with OTR/L Kay. Despite being an OT for nearly 20 years, she's not much older than I am. We got along just fine. She had a domestic emergency, so we met a bit later than originally planned.
Kay starts by showing me around the office and introducing me to everyone. She just says I'm an OT student rather than explaining, "She's two years away from even starting OT school and is only a couple of weeks into her first prereq." (Plus her option is a lot quicker.) Then she shows me the room she and her partner OT Molly work out of. It's a good thing they work mostly in patients' homes because the place is a closet. It's smaller than the bedroom I use as an office at home. The windowless space consists entirely of two desks, a table with a phone, a filing cabinet, and some wall-mounted cabinets.
Kay has to call Molly and straighten out some insurance issue (we haven't even started and insurance is already rearing its ugly head!), so I amuse myself with the MVPT, the Motor-Free Visual Perception Test. It consists of a series of placards where you are shown a shape, number or three-letter sequence, and have to find the same one among four drawings below the test item or on the next page following the test item. (I guess we're also testing ST memory a bit there.) There are also items where the "match" may be smaller, rotated, darker, etc. and a few final items of "Which one of these is not like the others?" The test seems very easy, but I guess that's just soothing reassurance that I don't have a visual impairment.
Soon, we're walking to Kay's car to go see the client. She makes a quick call on her cell phone to tell them we're coming and programs the client's address into her GPS, noting that the cell and GPS are her two best friends. She hands me the client file and pulls out of the parking lot. I am pleased that I can actually understand the file. I check a few acronyms with Kay, but my guesses are all correct.
Kay is going to do a "wheelchair eval" -- to see if the client can get a scooter or power wheelchair. The client's insurance will pay for a chair if certain conditions are met. It is Kay's job to interview the client and see if he meets those conditions. As we drive, Kay explains how several components of the client's medical history speak in favor of a powered chair.
Soon, we pull into the driveway of an older small but well-kept home and walk up a long wheelchair ramp to the front door. A lady about my mom's age opens the door, cigarette in hand, and gestures us into her living room. The client, her husband, sits at one end of a leather sectional couch, gaze fixed on the TV tuned to some morning hosts chittering and laughing about nothing in particular. Pictures of adult children and cherubic grandchildren adorn the walls and the shelf above the TV. The client has a splint and some ice over one hand.
"Oh, no, what happened?" Kay says, immediately concerned with the man's injury. His wife tells us he fell yesterday and had to go to the ER. The man had a stroke a few months ago, so his speech is slurred and sparse, yet his wife is able to interpret his grunts and mumbles. He interjects himself into her narrative as she describes what happened, and she takes it with good humor. He even allows his wife to take off and re-apply the sling (quite a painful process) so Kay can look at the injury.
Kay takes some time trying to make the client as comfortable as possible: extra pillows behind his back, replacing the hard ice pack with some frozen vegetables (they don't have peas, but soon he's sporting a bag of California Blend), and pillows to rest his lower arm on so his hand isn't hanging down. The client's wife explains that she wants him to eat before she gives him his pain meds, but he can't eat right after he wakes up. This is why he's so uncomfortable right now.
Kay opens her laptop, balancing it across her knees, and begins her interview by discovering that both the patient's first and last names have been misspelled on the file. Heh.
What really impresses me is how amazingly well Kay multi-tasks. She's typing into her laptop, she's talking to the client and trying hard to understand his replies, she's talking to his wife, she's incorporating all the extra information they are throwing in that is not directly related to the question at hand, and the evaluation doesn't even feel like an evaluation. It feels like a conversation. Meanwhile, I have the important job of holding the client's cane. :-) He does actually say that he likes me the best since I'm the only one not causing him pain. He even asks me if I'd like a cold Pepsi from the fridge, which is so sweet. I politely decline, but thank him for being a good host.
Kay gets to the part where she needs to measure the range of motion the client has in his hips, knees, elbows, shoulders, etc., so she pulls out her trusty goniometer. I've never seen one of these in action before--my inner geek is turning cartwheels. She carefully instructs him where to hold what and takes some measurements. She does a full set of measurements for his uninjured arm and shoulder, but obviously can't do a whole lot with his injured hand, so she mostly leaves that side alone.
Next, she helps him stand and sees how far he can walk. He is able to go about ten steps before turning and coming back to the couch. She makes some notes about how far he lifts his feet off the ground and the evenness of his stride, things like that, and then we take a little "field trip" with his wife to look at the bathroom doorway (wow, is it narrow) and the bedroom arrangements (tight turns required to get a chair in and out). Kay explains that a scooter requires better motor control and upper body strength because the controls are forward of the user on a handlebar-like arrangement. A scooter is also more difficult to mount and dismount and is longer than a power chair, so it has a wider turning radius. A power chair is controlled by a joystick very close to where the user's right hand would normally rest, so it doesn't require as much upper body strength or balance. Kay is leaning toward recommending a power chair for this client over a scooter.
We return to the living room. Next, the client's wife helps him get into the manual wheelchair he currently uses, and Kay asks him to wheel himself a few feet in the kitchen. He mostly uses his feet and is not able to make the chair move very effectively.
All the while, Kay is talking with the man and his wife and listening carefully to what they're saying, and the man just comes to life. His grunts and mumbles turn into words, then phrases, even a few full sentences. He enunciates clearly enough to make a joke as Kay finishes up his medical inventory. She says, "OK, so you have pain here, there, there, and there. Is there anything else giving you pain?"
"Yeah," the man says, a glint in his eyes, "that one (he points to his wife) and that one (he points to his home health aide)!" Everybody bursts out laughing.
We were there for about two hours. Kay had never laid eyes on the client or his wife before, but by the time we left, she had built a sincere rapport with them. And the client, whom the case manager had described in his file as "non-verbal," had shown himself to be a likable, charming man who could still speak fairly well. His speech improved quite a bit just while we were there.
I made sure to thank the client and his wife for allowing me to observe. It is a humbling thing to be welcomed into someone's home, and for a stranger to let you see his weaknesses and vulnerabilities--and still have the presence of mind to offer you a cold drink.
This visit: 3 hours
Total observation time thus far: 3 hours
Wednesday, June 1, 2011
She's a super geek...super geek (she's super geeky)
I am the biggest geek ever. (Just thought I'd warn you now.)
Since my class starts in less than a week (aaagghhh!), I went up to Local College today to get my Student ID, an item I have not possessed in more than a decade. Technology has made this chore much easier than it used to be, although the pictures still suck. They just suck a lot faster now.
Then I...went and found my Abnormal Psych classroom. I'm so embarrassed to admit I did that. I can't remember the last time I went somewhere in advance just so I was sure I knew where it was. But yes, this Super Geek did just that. It is a windowless room with no notable qualities whatsoever. I've seen coffins with more personality than this place. However, I did notice that just behind it, there is a closet-looking thing. I couldn't help but wonder if our class will be secretly observed or experimented on in some weird way. We are in the Psych building, after all.
To top off my geekery, I am printing out directions and gathering business cards for a half-day seminar I'm going to tomorrow. When I saw the title, I knew I had to go. It's called "Brain Injury 101." How awesome is that?! The only way you could make it any more welcoming is if you called it "Everything You Ever Wanted To Know About Brain Injuries But Were Afraid To Ask." (Although that wouldn't fit on a poster very well.)
I expect I will be doing a lot of scribbling and post-seminar clarification since I had to look up half the initials after the presenter's name, but eeeeeeeeee! I am excited to go learn about brain injuries!
Since my class starts in less than a week (aaagghhh!), I went up to Local College today to get my Student ID, an item I have not possessed in more than a decade. Technology has made this chore much easier than it used to be, although the pictures still suck. They just suck a lot faster now.
Then I...went and found my Abnormal Psych classroom. I'm so embarrassed to admit I did that. I can't remember the last time I went somewhere in advance just so I was sure I knew where it was. But yes, this Super Geek did just that. It is a windowless room with no notable qualities whatsoever. I've seen coffins with more personality than this place. However, I did notice that just behind it, there is a closet-looking thing. I couldn't help but wonder if our class will be secretly observed or experimented on in some weird way. We are in the Psych building, after all.
To top off my geekery, I am printing out directions and gathering business cards for a half-day seminar I'm going to tomorrow. When I saw the title, I knew I had to go. It's called "Brain Injury 101." How awesome is that?! The only way you could make it any more welcoming is if you called it "Everything You Ever Wanted To Know About Brain Injuries But Were Afraid To Ask." (Although that wouldn't fit on a poster very well.)
I expect I will be doing a lot of scribbling and post-seminar clarification since I had to look up half the initials after the presenter's name, but eeeeeeeeee! I am excited to go learn about brain injuries!
Friday, May 27, 2011
An Actual OT Moment!
[Note: Identifying details have been changed to protect the patient's privacy. Yup, I know about HIPAA.]
At a moment when I least expected it, I actually got to do something OT-like today. Woot!
My dog and I have been visiting patients at the local children's hospital for about three years now. We were there today and saw a burn unit patient before heading for the elevators to the upper floors to do requests. (Anyone who really wants as many doggie visits as possible can call the office and get themselves put on a special request list. Every team that comes in checks the list and picks up some requests if they can.) I was stopped in the hallway by a nice lady asking if I could visit her son. "Sure!" I said, and borrowed a pen to add the child's name and room number to my list.
I finally made it to the little boy's room at the tail end of my shift. After introducing my dog to him, I noticed was that the boy's left foot and ankle had a brightly colored brace on it. "Wow, you are seriously stylin'!" I said to him. "That is possibly the coolest-looking brace I have ever seen." (And it really was!)
"He got to pick the colors himself," the mom said. "He sure has a good eye!" She brought out a pair of nice-looking kid-sized sneakers. "And he picked these out too, red and blue!"
"Cool!" I said. "Do those come in my size? 'Cause I would totally get a pair."
The boy seemed pleased to be told he had good taste. I asked if he wanted to give my dog some cookies, and he nodded eagerly, feeding my dog using his right hand.
"He had a stroke," the mom said abruptly. [Note: I NEVER ask why the child is in the hospital. People often tell me, but I never ask. It's not important and also none of my business. I don't need to know a child's medical history to cheer him or her up, which is my actual job.] "Eight years old, and he had a stroke. Can you believe it?"
The mom told me the whole story, and I shared that I too have some experience in that area (a TIA four years ago).
Of course, now that I knew the whole story, the brace and the mom's urging her son to speak all made sense. And then I got an idea. I walked my dog around to the boy's other side, the side with the weaker arm and leg. "Would you like to feed my dog some more cookies?"
"Yes," the boy said happily, and stuck out his unaffected hand.
"Let's try the other hand," I suggested. "You can do it."
He wasn't thrilled, but agreed to let me put a cookie in his weaker hand. He worked to open his hand a little so my dog could take the cookie. Success! We repeated this four or five more times, the boy happily making the effort and smiling every time my dog's tongue lapped across his hand to take the treat.
It was a very cool moment.
At a moment when I least expected it, I actually got to do something OT-like today. Woot!
My dog and I have been visiting patients at the local children's hospital for about three years now. We were there today and saw a burn unit patient before heading for the elevators to the upper floors to do requests. (Anyone who really wants as many doggie visits as possible can call the office and get themselves put on a special request list. Every team that comes in checks the list and picks up some requests if they can.) I was stopped in the hallway by a nice lady asking if I could visit her son. "Sure!" I said, and borrowed a pen to add the child's name and room number to my list.
I finally made it to the little boy's room at the tail end of my shift. After introducing my dog to him, I noticed was that the boy's left foot and ankle had a brightly colored brace on it. "Wow, you are seriously stylin'!" I said to him. "That is possibly the coolest-looking brace I have ever seen." (And it really was!)
"He got to pick the colors himself," the mom said. "He sure has a good eye!" She brought out a pair of nice-looking kid-sized sneakers. "And he picked these out too, red and blue!"
"Cool!" I said. "Do those come in my size? 'Cause I would totally get a pair."
The boy seemed pleased to be told he had good taste. I asked if he wanted to give my dog some cookies, and he nodded eagerly, feeding my dog using his right hand.
"He had a stroke," the mom said abruptly. [Note: I NEVER ask why the child is in the hospital. People often tell me, but I never ask. It's not important and also none of my business. I don't need to know a child's medical history to cheer him or her up, which is my actual job.] "Eight years old, and he had a stroke. Can you believe it?"
The mom told me the whole story, and I shared that I too have some experience in that area (a TIA four years ago).
Of course, now that I knew the whole story, the brace and the mom's urging her son to speak all made sense. And then I got an idea. I walked my dog around to the boy's other side, the side with the weaker arm and leg. "Would you like to feed my dog some more cookies?"
"Yes," the boy said happily, and stuck out his unaffected hand.
"Let's try the other hand," I suggested. "You can do it."
He wasn't thrilled, but agreed to let me put a cookie in his weaker hand. He worked to open his hand a little so my dog could take the cookie. Success! We repeated this four or five more times, the boy happily making the effort and smiling every time my dog's tongue lapped across his hand to take the treat.
It was a very cool moment.
Friday, May 13, 2011
A Shadowy Experience
Part of the application for the MOT program reads as follows:
The wording makes it sound like you have to actually work in the healthcare field, but fortunately for me, this is not the case. It refers to a practice that seems fairly common in the healthcare field called job shadowing. Basically, this means that you watch the healthcare professional (occupational therapist, physician assistant, physical therapist, etc.) do his or her job for a certain number of hours--you act as that person's shadow. Sort of a pre-approved and welcome stalker, if you will.
The exciting news is that I have gotten approval to do 40 hours of job shadowing with an OT at a local children's hospital! Even better, I already volunteer at this hospital anyway, so I don't have to worry about getting fingerprinted, background checked, references checked, etc. I'm already in the system, so it will be easy to reclassify me as an OT department volunteer. I'm scheduled for half-days (some mornings, some afternoons) for the first three weeks of August. EEEEEE!! I am so excited about this. It's a children's hospital, so obviously it will be pediatric OT. I'm not sure if it's all outpatient or if they also do some inpatient (though I am sure I will find out quickly enough). The OT mentioned that they also have feeding groups, something I have read about and am eager to see for myself.
When I asked the OT what I could do to prepare beforehand so that I get the most out of my shadowing experience, she said I should read The Out-of-Sync Child by Carol Kranowitz and review my developmental milestones. (And in this case, "review" actually means "learn on my own from the ground up," since I won't have my lifespan course until the fall, too late to help with this placement.)
At this point, I have no idea what population I want to be working with as an OT. We can work with anyone from newborns to elderly patients in hospice, so we truly work across the entire lifespan. I think shadowing is a good idea, both to give yourself a reality check ("Is this really how I want to spend my days for the foreseeable future?") and to try and narrow down your preferences. This shadowing will let me sample both a population (kids) and an environment (hospital setting). I definitely want to do at least one more shadowing experience next spring or summer. I will obviously want either adults or the elderly as my population and a non-hospital setting (skilled nursing facility? rehab center?) as the environment. But first things first--in a few months, I will get to see what I think of working with pediatric OT patients.
Although not mandatory, it is strongly recommended that applicants volunteer and/or work under the direct supervision of an occupational therapist in at least two areas of practice.Given the insane competition for spots in the program, I translate that as "You don't have a flaming snowball's chance of getting in unless you do this, you twit."
The wording makes it sound like you have to actually work in the healthcare field, but fortunately for me, this is not the case. It refers to a practice that seems fairly common in the healthcare field called job shadowing. Basically, this means that you watch the healthcare professional (occupational therapist, physician assistant, physical therapist, etc.) do his or her job for a certain number of hours--you act as that person's shadow. Sort of a pre-approved and welcome stalker, if you will.
The exciting news is that I have gotten approval to do 40 hours of job shadowing with an OT at a local children's hospital! Even better, I already volunteer at this hospital anyway, so I don't have to worry about getting fingerprinted, background checked, references checked, etc. I'm already in the system, so it will be easy to reclassify me as an OT department volunteer. I'm scheduled for half-days (some mornings, some afternoons) for the first three weeks of August. EEEEEE!! I am so excited about this. It's a children's hospital, so obviously it will be pediatric OT. I'm not sure if it's all outpatient or if they also do some inpatient (though I am sure I will find out quickly enough). The OT mentioned that they also have feeding groups, something I have read about and am eager to see for myself.
When I asked the OT what I could do to prepare beforehand so that I get the most out of my shadowing experience, she said I should read The Out-of-Sync Child by Carol Kranowitz and review my developmental milestones. (And in this case, "review" actually means "learn on my own from the ground up," since I won't have my lifespan course until the fall, too late to help with this placement.)
At this point, I have no idea what population I want to be working with as an OT. We can work with anyone from newborns to elderly patients in hospice, so we truly work across the entire lifespan. I think shadowing is a good idea, both to give yourself a reality check ("Is this really how I want to spend my days for the foreseeable future?") and to try and narrow down your preferences. This shadowing will let me sample both a population (kids) and an environment (hospital setting). I definitely want to do at least one more shadowing experience next spring or summer. I will obviously want either adults or the elderly as my population and a non-hospital setting (skilled nursing facility? rehab center?) as the environment. But first things first--in a few months, I will get to see what I think of working with pediatric OT patients.
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