Wednesday, September 28, 2011

September Recap: Challenges of Changing OT Assignments

Back to my blog home page:

My laptop is finally back from Dell, 2nd repair in its seven-month life. Glee's on in the background, and I've settled in with a bag of Hershey's Nuggets left behind by friends last weekend.

A recap is in order...

September 7: Goodbye wishes from aides, nurses, therapists, residents, family members. Tears. Gratitude.

It's been one of the best years of my life!

The Move
September 8-9: Subaru nosed in the direction of northwest,
two loads of accrued comforts in the Forester with the futon frame and mattress secured tightly on the roof rack. 

I was resigned to the truth during this transition that if I happen to gather any more stuff, then I'll have to have a garage sale, donate to charity or put some belongings on the curb in about 18 weeks!

My friend, Susanne, helped me settle in. We had a few days to explore the new area, including local rocky beaches, new restaurants and window shopping.

Oh, and by the way...every sunset is amazing.

This little town is an unusual concoction of upscale artistry, former fishing and logging interests and medical marijuana growers.

I can honestly say I've never experienced a place like this.

...And Work...

September 12 - present

Let me repeat, I can honestly say I've never experienced a place like this.

The people who work here are very kind and enthusiastic to have me here, and I'm committed to spending 18 weeks helping build a program.

I'm floored, however, to viscerally feel as if I've bounced out of a time machine right into the 1960's when I see the residents of this home.

They're all lined up outside their doors with very little stimulation all day. Many of them are older women with dementia who chime in every few moments:


"dum de dum de dum, (higher pitch) dum de dum de dum"

"what do I do now? what do I do now?"

...over and over and over and over again all day long.

I feel frazzled and am experiencing near migraine headaches by the end of every work day. It's time to start checking my blood pressure more regularly.

Sigh. It's not like the assignment I just left.

But there's even more opportunity to make positive change here than most places I've worked. They're hungry to know what to do to make things better. They just lack the basic understanding of how to cater to a majority population of elders with dementia.

I pull out my clipboard. I start a list. By day four, I've evaluated a full caseload and written a waiting list to keep me busy until I leave in January. The whole building needs treatment. I'll have to do it 8-10 residents at a time. 

By the way, if you have children with nurturing personalities of college age who want a guaranteed job when they graduate, steer them toward occupational therapy!

These residents need all the help they can get. So do I!

Monday, September 5, 2011


Back to my blog home page:

I have just unpacked a box filled with old papers I really need to unload! I am sorting out biking maps (keep), walking tour info (keep), and glossy magazines filled with restaurant and winery recommendations (keep) when I come across a small white envelope stained with coffee.

I have written on the back of the envelope the names of the patient and his brother who gave this to me. I immediately remember the patient's wit, grace and fortitude while fighting cancer. His brother was the same. They both shared a faith that could move mountains.

I open the thank you card. Out falls a beautiful gold framed picture of an angel.

I read the brother's carefully printed words. On the right side of the card is a poem:

I must remember
Ere I go
Through all my days
Both high and low
What I must always
Seem to be
To those whose lives
Are touched by me:
A harbinger of Hope!
A chalice of Mercy!
A pillar of Strength!
But, oh above all
God's most generous of blessings,
An ocean...of inexhaustible Love!

And on the left flap of the card were these beautiful, soulful words:

may this little
verse of mine
be ever
your guiding light
throughout all the days
of your life,
and, one day, become
an imperishable crown
of glory
in the kingdom of God

I am immediately reminded of the amazing gifts I receive not only from my patients but their families on a regular basis.

I fold the card, slip in the angel picture, and close the envelope.


Friday, September 2, 2011

Lesson of the Day: Live - and Die - Gracefully

Back to my blog home page:

Mabel has lived in our building for years. She is 91; about a year ago, when I came here, she began to lose steam. She went from walking to using a wheelchair. Then she began to have falls when she wasn't aware of the loss of her strength, and she still thought she could take herself to the bathroom.

Mabel had a stroke last month. She came "home" a different woman.

She has tried her best, we see that, but she has lost her will. In the past week, she has quit eating, taking her meds, and getting out of bed.

I have worked with her to see if we can get her to eat. I offer her half teaspoons of pureed food, and small sips of thickened liquid.

(When people have a stroke sometimes, they lose the ability to swallow normal foods. When this happens, the food must either be chopped up or ground into small, soft bites or pureed in a food processor, depending on how much of a problem it is to swallow. Same with liquids - if you start coughing on regular fluids, you go to what is called nectar thick, then progress to honey thick water, milk, juice, whatever you're Mabel's case, she can either take it from the spoon or if the cup is held to her lips. )

My dear Anita, fellow therapist, tells me that Mabel is unable to get up in her wheelchair today. Her face is cloudy and eyes misty. "I hope hospice comes in soon," she says.

Me, too...

We have been tag teaming to see if we can get her out of bed and up in the wheelchair to prevent her from getting pneumonia. "I'll work with her in her room," I assure Anita. I pick up her lunch tray and walk quietly into the room.

Mabel is laying on her back in the bed, head and feet raised slightly, and eyes closed. I speak in a low voice to her - try to be soothing, anyway - and I stir her thickened water.

"Can you take a few bites, Mabel?"

Eyes stay closed. Her head sways slowly back and forth in a certain "no."

She refuses food. She takes a few sips of water.

That is it.  That has been it for over a week.

I put the glass on her tray. Suddenly, her hand shoots out and grabs my arm, runs down my forearm and squeezes my hand so tight.

Ever heard the term "death grip?"

"Mabel, are you afraid?"

And her sweet, old, wrinkled face nods yes.

I sit with her then, knowing how difficult it must be to lay in that bed alone, knowing that she is dying, and having not one person there who has known her in her former BNH (before-nursing-home) life to comfort her, tell her stories about their shared memories or give her TLC.


I stay there as long as I can, but it's time to move on to work with other people. I ponder as I walked down the hall back to the rehab department...

I hate to bring this up, but we are all going to be there one day.

I've come to believe that it's not just about living gracefully. It's about dying gracefully, too.

In a Basics of Buddhism class last year, Lama Chuck told our diverse group that Buddhists believe that the state of a person's mind in their final moments is of utmost importance.

It takes a depth of awareness to move through this period by understanding
what your purpose in this world has been, to accept assistance from others when you can't care for yourself, to forgive yourself and others, and come to full acceptance that you are getting ready to close your own circle.

It is our opportunity to practice compassion with each person and each death. Joseph Goldstein writes about compassion that, "It is not the suffering itself that causes our discomfort; rather, it is our aversion to it and our sense of separation from other."

Rather than thrashing in fear and holding onto a lifetime of resentments that have separated us from the ones we truly love, we are challenged, as we close out our time here, to move gracefully and with trust into the transition, the outcome of which none of us can confirm.