Tuesday, May 8, 2012

Moments of Lucidity

Back to my blog home page: http://travelingotr.blogspot.com

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.

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