Thursday, May 31, 2012

A "Listen To" on Forgiveness

Back to my blog home page:

I've been really working on forgiveness for the past 6 years. You know, when you focus on something like that, you're given opportunities in large and small ways to really experience it! In the past week, I've shared the Forgiveness Prayer with several people who were really struggling to move forward in their day due to emotional pain they felt at the hand of someone else's action.

This morning, I open my laptop, click the favorites tab on Krista Tippett's On Being page on the American Public Media, and what is featured?

A show on Getting Revenge and Forgiveness....

oh, Universe, you are always so timely!

Take a listen, folks, we are all here to learn these valuable lessons.

Thursday, May 24, 2012

Embracing Those Who are Different Than Us

Back to my blog home page:

I pull the chart to do a review prior to the evaluation. Embedded way back near the last page of the records sent by the hospital in the middle of the PMH (past medical history) is a diagnosis of mental retardation.

Hank has been in the building twice before  and has rehabbed home both times. I ask a coworker, "Do you know Hank? There is one little diagnosis mentioned once, but nowhere else!"

"Yep." He confirms the diagnosis. "He is married and they live in a community with a group of folks who are mentally retarded...but they get married, have kids, work and get support from the community."

My memory immediately reverses to 1993 when I was working with adults with developmental disabilities in group home and community settings while I was in OT school.

I absolutely loved working with these joyful people!

I also remember the discrimination they received. I remember the uncomfortable stares when I would lead a group of five or six adults with mental retardation to the movie theatre or even through the airport to pick up a fellow client who had spent the holiday with family outside of town.

There was not always a lot of this:

Why do people
have difficulty
embracing those
who are
different from them?

There are philosophical and ethical discussions all over classrooms and the internet discussing whether people with mental retardation should be able to marry and have children. When I was working with this group, there would occasionally be discussions on the rights of clients within our organization and about how to handle sticky situations related to dating, sex and marriage. There was not cut and dry answer. Every situation had its own set of complexities.

Anyway, in I go to Hank's room after lunch. I knock on the open door. He is sitting with his back facing me, a frail, thin man with sagging shoulders and a bony face, but I can tell he is absolutely precious the moment I lay eyes on him.

I hear rustling in the bathroom. The bathroom door is wide open. Someone is peeing! I don't have to ask who. I stand at the doorway so I give his wife privacy. I hear the toilet flush, but no water running in the sink. Out walks the sweetest little lady with a head full of messy gray hair and a cane.

"Hi, there!" After introductions, " Did you by chance wash your hands?"

"Sure did."

A few minutes later when I go in to set up Hank up for ADLs, the sink is dry. Oh, well...on come the gloves.

I spend the next hour learning about Hank and Marta. They have been married for 59 years, have three adult children all working jobs and contributing to society. They respect each other in their communication. They demonstrate the nuances of a couple who have taken care of each other for many years. They reach out with familiarity to finish what the other could not, like Marta instinctively buttoning Hank's sleeves.

We are talking about his medical history when Hank reveals, "...and they put in a spacemaker."  He is patting his collarbone area on the left side.

On my paper, I note, "pacemaker," all the while thinking, "I am going to love working with this man." He is so earnest.

Their daughter comes in before the treatment is done. Many years ago, people would have said that she is "not quite right."

You know what? She is just right. She is outgoing, funny, loving to her parents and contributing to a better society.

I have to admit something. When I was a senior in high school, our National Honor Society hosted a Valentine's Party for the state school students, students with severe retardation and physical disabilities.

I was terrified.

I had not yet come to understand they they are beautiful souls, just in a different body and mind than in what we arrived onto this Earth.

What I know now is how deeply we are all connected. We are all here to take care of each other. It doesn't matter what color, creed, religion, socioeconomic status or intellectual level.

Let me say it again!  We are all here to take care of each other. And that means encouraging every person to shine their own individual light, their I Am essence, as brightly as they can.

Wednesday, May 16, 2012

A Dash of Funny

Back to my blog home page:

I ventured upon an interaction today that tickled me, grossed me out a little, and just made me shake my head!

Those of you who work SNF (skilled nursing facilities) know that you always have a few residents in your back pocket who could benefit from therapy when the caseload wanes and you have the opportunity to treat some Med Bs.

Today was the day.

I walked up to Dot who was sitting in a Broda wheelchair.

(By the way, Brodas are great for people with dementia, head injuries, Parkinson's and especially Huntington's Disease.)

Dot had been tearful and anxious every afternoon into the evening. In the long term care world, we call that "sundowning."  In addition, she had become combative when staff attempted to provide care for her, especially when she had to be bathed.

As her OT, my role was to identify a plan of care that would decrease Dot's behaviors and increase the ease with which the caregivers could provide for her. I wrote about this last December (CLICK ME) in Three Tips for Dementia Management.

Today, my intention was to administer the Allen Cognitive Level Scale.

The ACLS is a 3-part lacing task that provides an estimate of a person's cognitive function. Believe me, when I first saw it, I thought, "How in the world could that indicate a person's cognition and functional levels?"  It has proven accurate time and time again!

In addition, I use the Global Deterioration Scale to further confirm my patient's cognitive level. This is a less objective scale, but I find it quite useful when documenting cognition.

I took Dot to her room where there should be no distractions. She shares the room with her husband. Before we could even begin the ACLS, she had begun to direct me, "Ooohhh, what is they-at on my bay-ed?? (a pillow) Can you please move it? Please! Take it off my bay-ed!" I took the pillow off her bed and put in on the chair. And on and on she went for about 10 minutes until she had me move everything around.

Because hindsight is 20/20, I should have stopped right away and taken her out of the room. There was another distraction besides everything in the room, however, and it was in her hand.

She had just been to the beauty shop, and she had a death grip on
 a hairpin.

I decided to forge on (mistake). The ACLS is standardized, so I had to sit on her left side and read from a script. The whole screen is read, demonstrated and cued the same way no matter who I am testing. Every tester should administer it exactly the same way.

 I presented Dot with the ACLS and asked if she had seen anything like this before. Could she see the holes? (part of the standardization of the test).

"Yes, somewhere (to part 1). Yes, I can see the holes."

"Good job," I thought. Now, I'll read the script....

The moment I started to read the script and introduce the running stitch, I lost her. Out flicked the hairpin, and you know where it went?

Just her

"Oh, no, Dot! Not there!" I could just see her punching out her eardrum. Memories of my mom's voice cautioning me not to stick the Q-tip too far into my ear returned full force.

Out she fished the hairpin and in a flash she had it in front of her lips.

"Oh, no, Dot! Not in your mouth!"

Before I could even get the words out, she had blown a hunk of wax right off the hairpin.

And I thought.....only here in long term care in the dementia unit...

I stopped reading the script. To hell with the script. She did not have the focus to complete this screen, which put her at Stage VI on the Global Deterioration Scale (during which: an individual cannot carry a thought long enough to determine a purposeful course of action) -

unless it is to clean out your ear with a hairpin...

I'm confident I will identify some activities to modify that Dot once loved, activities in which she can engage when she becomes anxious. But for today, I waved the white flag.

I surrender, Dot!
Let's try again tomorrow.

Tuesday, May 8, 2012

Moments of Lucidity

Back to my blog home page:

So, you know how birds of a feather flock together?

Well, no matter where you go, you can find someone with whom you resonate!

I have been cycling on my way home through the historic Square of this little town in which I am living, and I have discovered an art gallery/coffee house that is open til 8 every night! I am so surprised!

I walked in tonight to a darling place that would rival those in any little American town, with a sizeable contingency of locals chatting with the owner. The art on the walls was captivating. The people were very friendly!
I love it that anywhere you go, you can find creative people...
you just have to look!

So, anyway, I am sitting in the coffee shoppe/gallery at this moment drinking an iced chai tea and feeling supremely happy that I have found a new place to spend my early evening hours.  This is just enough to get my creative writing juices going, so watch out!!

I'm also happy because I was inspired today by one of my patients.

I walked into Constance's room, my arms loaded with elbow splints, to reverse her elbow contractures.

I've explained contractures before, but let me tell you what is happening with this patient. Constance has dementia. Many people with dementia simply quit moving. When they quit moving, their muscle tone many times still feels normal, but their tendons become tight and joints become very stiff,  causing a loss of range of motion. You will usually find contracture formation in patients with dementia who experience it in multiple joints, i.e. both knees, both elbows and/or both hands.

Another thing that happens with people with end-stage dementia is that they quit talking. They simply become nonverbal. Constance is not completely nonverbal, but at this point, the other therapists tell me that she just doesn't talk much at all.

Constance was being treated for hand contractures when I arrived, but I discovered when I saw her for the first time that her elbow contractures had not been documented and treated. Hence, the splints.

Back to today...I had seen Constance earlier in the afternoon as the nurse aide wheeled her out of the shower room. She was doing what she does when she is feeling anxiety - breathing in and out quickly and whistling on the intake. I could tell she was stressed. (Check out my former blog entry that includes Bathing Without a Battle).

When it was time for her treatment, I went to her room.  It was time to fit the new elbow splints. I was really hoping that she was going to be relaxed.

Constance was reclined in her lift chair with a neck support

and covered with a colorful afghan, no doubt crocheted by a family member.

isn't that sweet? Makes me want to make one!

Anyway, what was on the tv, but the Ellen show.

I turned to Constance. "Oh, Ellen! Doesn't she just make everyone dance!"

Constance got a huge smile on her face. "Yes!"

I told her what I was going to do next. "Constance, I'm going to pick up your arm, gently shake it until it relaxes a bit and stretch it a bit at the elbow...then I'm going to put on this splint."


And that is what I proceeded to do. Constance and I were both actively interested in Ellen's introduction, during which Ellen revealed that a coveted guest, Johnny Depp, was going to finally be on her show. Of course, Constance didn't know this guy, but guess what?

She knew the older version of the movie he was pitching! Anyone know what it is?

Dark Shadows!

(BTW, Jonathan Frid, the guy who played Barnabas Collins died on Friday, the 13th of April - just a few weeks ago!)

"Constance, do you remember Barnabas Collins?"

"ooohhh, yes!" She was fully engaged!

"I do, too! I remember being about 4 or 5 and watching Dark Shadows when my mom was ironing my dad's work shirts. I was so scared of him!"

"Me, too!"

We went on to talk through the rest of her treatment, and she was able to converse within context and with emotion. She, delightfully, was full of smiles and eye contact.

This was a special day with Constance. These days are few and far between. I was the recipient of a lovely moment in her life. I don't know how much of her response was due to therapeutic use of self (aka bedside manner) or just a good day, but I guess I will find out tomorrow.

My goal is to activate her awareness, to engage her in reciprocal conversation and to even to dig up a few remote memories. If I can do that, it is undoubtedly a successful day.

Monday, May 7, 2012

Words of Wisdom Shared

Back to my blog home page:

I receive a daily email called The Morning Blessings by a gal named Reverend Angela Peregoff. Her words touch me every morning.

A couple days ago, she wrote about St. Francis. Take a look at her Morning Blessing for May 4:

During these challenging times, each of us has the opportunity to inwardly introspect on what may be our own aggressive tendencies.  Sometimes we think, "Oh, I'm a very peaceful person.  I just love everyone!"  Try this: Walk down the street and look directly into the faces of others.  Objectively observe how your mind chatters about appearances.  You will be amazed at the overt and subtle ways in which aggression manifests.

Aggression of thought has its own vibratory potency, and it begins and ends with us.  It is good to often pray the prayer of Saint Francis, "Lord, make me an instrument of Thy peace."  Mean it.  Saint Francis' lesson was to heal the struggle he had with his vision of God. After a strong and powerful illness he came to an understanding. He saw that he had tried to equate "goodness" with "love of God," and they were not the same. Early one morning as the dawn began to break, when all was very quite and still, he heard a bird outside his window -- in a totally new way. In the power of the song of that bird he understood! The way to love God and the only way was to hear God's voice in everything.  In the mist of his physical healing he realized You love God through loving God, and not from anything else. He knew, absolutely, that there was no separation between the sounds of the world and the "Voice of God."  The birds that sang, the cries of the dying, the scream of the mad, in the despair of the leper, in the moans of the abandoned child. From that moment on, Francis could never again separate out any call for help from the God Source he knew to be Real.

The only difference between you and Saint Francis is that he came to know God was absolutely real and that he could be in touch with that reality at any time. He knew it, with all the power of his being. You also have that same potential. Go out today and be touched by the life and lessons of Saint Francis -- know that every moment you are speaking, you are not speaking to others; you are speaking to God.


I admire St. Francis.  He left a life of luxury to found the Franciscan Order. He lived in poverty. Many people thought he was mad, and I don't mean angry.

I walked outside at lunch and sat down on a park bench. I heard the birds with new ears; I watched the squirrels with new eyes. I thought about my patients who challenge my patience or get under my skin.

How do I open my heart to see theirs as voices of God?

St. Francis gave us the roadmap:

Lord, make me an instrument of your peace.
Where there is hatred, let me sow love;
where there is injury, pardon;
where there is doubt, faith;
where there is despair, hope;
where there is darkness, light;
and where there is sadness, joy.

Yes, I know it's tough.  No one said it was supposed to be easy.

How much change could we effect
 if we all put this into daily practice?

Thursday, May 3, 2012

Inspire Creativity in your Life

Back to my blog home page:

I walk down B Hall toward the nurses' station, and there is one lady that I have noticed since day one. I try to catch her eye from where she sits inside her room or at the doorway. I have learned her name, and I call out as I pass by:

"Good morning, Susan!"
"Good afternoon, Susan!"
"How are you?"

No answer. In fact, if you look in her eyes, you will notice that she is absolutely absent.

She's young for a nursing home resident. She's nonverbal, except for a very occasional word. I don't have her on my caseload, so I can't go peeking at her chart to take a look (HIPAA, remember! We have a Privacy Act we must follow!) ....

By the way, when one of my patients points across the room and asks, "What's wrong with (that patient)?" I reply,

their information is private, just like yours.
That means if someone asks about you, I can't tell them anything. But... if you want them to know you can tell them. If you want to know about him, you'll have to ask him.... and he may or may not tell you."

So, this gal. She puzzles me. Her look is soooo vacant. I am spurred to make a connection, but she is not making it easy.

I am thinking about her tonight as I write. My message isn't really about her; it's about what happens when you go through a period that feels as if you are walking through molasses in a swimming pool, or waking up endlessly fatigued.

Yes, it's personal. I sometimes wonder if I have recently drawn the energy of the people like Susan who seem like they are just waiting to die.

I'm not sure what it is, but I'm choosing to look at it as a "rest period." After all, towering oak trees grow through spurts (my creative time in California), then they need some rest time (here).

At any rate, I feel like I am coming out of the rest period and moving into a more creative place lately. I have been searching for activities and ways of spurring my creativity. Honestly, some of it has just bumped into me. (Being "lost" isn't always a negative thing!)

So, today I want to share some methods that help me on my creative path. Maybe one or two will move you, too.

Create an inspiring space.

Since I am in temporary living space, I can't quite decorate the way I did at my home:

my favorite room to rest and regenerate at the "Tre House"

so I bring together some of the notes, momentos, photos and small pieces of art together on a bulletin board.

These things are a constant reminder that each of us can make a difference!

Take a walk or a bike ride.

I can honestly say that when I ride my bike to work (9.5 miles) and back, I feel better! I see the which flowers are blooming, smell when someone has cut their grass, look up at the clouds and feel more thankful to be alive.

Shasta Daisies from the Tre House garden

Try a new food or drink that you've never tried before.

Our prn PT Tracy brought in some foods from Trader Joe's yesterday that many of my coworkers and I had never tasted. It was such fun! Then again, everything Tracy does is fun. She is uplifting.

Visit with a friend you haven't seen for a while, especially a positive one!

I spent last evening with a very special friend, Angela. We used to teach Reiki CEU courses together, and she is one of the most amazing healers I know. When we get together, we can solve the world's problems, stimulate our appetite for creating and manifesting whatever we want in our lives. When I leave her, I feel "right on track."

Turn off the boob tube.

I know it's easy to get sucked into a series, but much of our lives do we need to lay around watching senseless reality shows? There are so many amazing things we can do.

Make your list!

So, this is how the Universe works for me much of the time. I wrote, Make your list...then I thought, let's check out You Tube for a good video. Click on this one, and the first thing you see is

Make lists....   : )

This is a great video. So great, in fact, that I think it's a good place to pause and have a refreshing, positive, creative day at work...

You guys have a great day!!