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Day One:
KC to Toronto to Madrid....arrive at 4 am tomorrow.
Backpack is stocked. Passport and money ready. Hiking shoes are worn in.
I arrive within an hour or so of my twin and her family. We'll enjoy Madrid tonight before taking a train to Leon to start that section of The Way...
I am a little nervous!! This is a little more physical and a little longer walking vacation than I have done in the past.
3 weeks.
Wow.
I'll try to post photos if I can download them from the internet cafes.
Hasta luego, amigos. I'll be in touch.
Tre
Monday, July 2, 2012
Sunday, June 24, 2012
Considerations for Families of Terminally Ill Patients
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I am in the last week of this assignment! I absolutely cannot believe it. It has flown.
I have some grand plans on my break between this assignment and an extension at the same building into September. I am headed to Spain to walk a pilgrimage called El Camino de Santiago. You may have seen a movie called The Way which was directed by Emilio Estevez and whose main actor was his father, Martin Sheen. It's this path on which I will be trekking next week!
Anyway, I am working my last week on the initial contract at this facility, which I have come to appreciate....the therapy team, the residents, many others in the building, from the nurses to the dietary staff to the housekeepers.
They are good people.
So, my work week this week is Sunday through Thursday. Saturdays are always a great day to treat patients, but Sundays are sometimes a bit tough. Patients don't always want to work on Sundays.
I walked into Robert's room today. It was my first treatment with him. By the end of 45 minutes, I was pondering how amazing it is that people with terminal illnesses are able to achieve a level of intimacy with strangers like me that they are not always able to achieve with their own families with whom they have lived and loved for years.
Robert had dialysis yesterday.
I asked him about it. He was exhausted.
A word I have heard from dialysis patients often is WEARY.
Within five minutes, he shared with me that he was so tired that about six months ago, he had decided to go off dialysis and onto hospice. He could not take the strenuous schedule and the exhaustion he felt after each appointment.
Robert called a family meeting. His children could not accept it. He continued on dialysis. Because of them. Not his own needs. Theirs.
This is what so many people do. They hold on because their family members are not ready or willing to let them go. They hold on out of fear of what will happen to their elderly spouse if they pass. They just hold on.
And suffer.
I cannot judge this situation one way or another. I only know that I see so many older people suffer because they do not want to let their families down. I also know - and maybe this is because I work around long term care - that I would never want my parent to hold on because I didn't want them to die.
So, a note to family members of people with terminal illnesses:
Consider letting your family member know that
Can you imagine how much less suffering there might be if we could all just do that.....
I am in the last week of this assignment! I absolutely cannot believe it. It has flown.
I have some grand plans on my break between this assignment and an extension at the same building into September. I am headed to Spain to walk a pilgrimage called El Camino de Santiago. You may have seen a movie called The Way which was directed by Emilio Estevez and whose main actor was his father, Martin Sheen. It's this path on which I will be trekking next week!
Anyway, I am working my last week on the initial contract at this facility, which I have come to appreciate....the therapy team, the residents, many others in the building, from the nurses to the dietary staff to the housekeepers.
They are good people.
So, my work week this week is Sunday through Thursday. Saturdays are always a great day to treat patients, but Sundays are sometimes a bit tough. Patients don't always want to work on Sundays.
I walked into Robert's room today. It was my first treatment with him. By the end of 45 minutes, I was pondering how amazing it is that people with terminal illnesses are able to achieve a level of intimacy with strangers like me that they are not always able to achieve with their own families with whom they have lived and loved for years.
Robert had dialysis yesterday.
I asked him about it. He was exhausted.
A word I have heard from dialysis patients often is WEARY.
Within five minutes, he shared with me that he was so tired that about six months ago, he had decided to go off dialysis and onto hospice. He could not take the strenuous schedule and the exhaustion he felt after each appointment.
Robert called a family meeting. His children could not accept it. He continued on dialysis. Because of them. Not his own needs. Theirs.
This is what so many people do. They hold on because their family members are not ready or willing to let them go. They hold on out of fear of what will happen to their elderly spouse if they pass. They just hold on.
And suffer.
I cannot judge this situation one way or another. I only know that I see so many older people suffer because they do not want to let their families down. I also know - and maybe this is because I work around long term care - that I would never want my parent to hold on because I didn't want them to die.
So, a note to family members of people with terminal illnesses:
Consider letting your family member know that
- you love them!
- you do not want them to suffer!
- if they feel they need to go, you support them on their journey beyond!
Can you imagine how much less suffering there might be if we could all just do that.....
Wednesday, June 6, 2012
Sending Constance Beyond
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Remember my first patient who really inspired me at this assignment?
Constance, my 3pm appointment, with whom I loved to laugh during the Ellen Show...
She went out late last week to the hospital. She came back Monday with hospice services. Ohhhhhhh.....for all you who work in skilled nursing, sometimes those older folks you just love come home from the hospital ready for their life graduation.
Constance was laying still in her bed, covered only with a white sheet, white as a sheet herself, nasal canula supplying much needed oxygen to help her breathe. My own breath did a sharp intake.
"Oh, Constance!"
I could tell her life force was dwindling. Family had been called in. Most of the day, the room had been filled with family members. Two daughters stood outside the room.
I turned to them. "I just want you to know what a blessing your mom has been. I have enjoyed her so much!" I went on to tell them about what happened when we got together to prepare her arms for splinting.
They smiled broadly. I could tell it brought them some sense of relief from their grieving. They encouraged me to go tell her goodbye.
I walked into the room. The hospice nurse aide was there at the bedside. I went to the other side of the bed and leaned into her ear.
I told her all the beautiful ways that she had touched my life. I wished her a lovely journey.
As I walked out of her room, I could almost close my eyes and transport myself to a building about 2 hours from here in which I had worked in the past, a building whose people handled death more lovingly, attentively and Christly than any I had ever seen.
The building had a special cart of cold and warm drinks and food. They had beautiful low music playing in the background. When the loved one passed, the body was escorted out of the building with a chaplain, followed by a member of each department, in prayer and honor to the one who had passed.
I will never forget the respect and honor that was paid to those graduates of life. I can only hope that I provide some sense of positivity to those who are preparing for their journey here.
Remember my first patient who really inspired me at this assignment?
Constance, my 3pm appointment, with whom I loved to laugh during the Ellen Show...
She went out late last week to the hospital. She came back Monday with hospice services. Ohhhhhhh.....for all you who work in skilled nursing, sometimes those older folks you just love come home from the hospital ready for their life graduation.
Constance was laying still in her bed, covered only with a white sheet, white as a sheet herself, nasal canula supplying much needed oxygen to help her breathe. My own breath did a sharp intake.
"Oh, Constance!"
I could tell her life force was dwindling. Family had been called in. Most of the day, the room had been filled with family members. Two daughters stood outside the room.
I turned to them. "I just want you to know what a blessing your mom has been. I have enjoyed her so much!" I went on to tell them about what happened when we got together to prepare her arms for splinting.
They smiled broadly. I could tell it brought them some sense of relief from their grieving. They encouraged me to go tell her goodbye.
I walked into the room. The hospice nurse aide was there at the bedside. I went to the other side of the bed and leaned into her ear.
I told her all the beautiful ways that she had touched my life. I wished her a lovely journey.
As I walked out of her room, I could almost close my eyes and transport myself to a building about 2 hours from here in which I had worked in the past, a building whose people handled death more lovingly, attentively and Christly than any I had ever seen.
The building had a special cart of cold and warm drinks and food. They had beautiful low music playing in the background. When the loved one passed, the body was escorted out of the building with a chaplain, followed by a member of each department, in prayer and honor to the one who had passed.
I will never forget the respect and honor that was paid to those graduates of life. I can only hope that I provide some sense of positivity to those who are preparing for their journey here.
"Waiting On An Angel"
Waiting on an angel
One to carry me home
Hope you come to see me soon
Cause I don' t want to go alone
I don' t want to go alone
Now angel won' t you come by me
Angel hear my plea
Take my hand lift me up
So that I can fly with thee
So that I can fly with thee
And I'm waiting on an angel
And I know it won' t be long
To find myself a resting place
In my angel's arms
In my angel's arms
So speak kind to a stranger
Cause you'll never know
It just might be an angel come
Knockin' at your door
Knockin' at your door
And I'm waiting on an angel
And I know it won't be long
To find myself a resting place
In my angel's arms
In my angel's arms
Waiting on an angel
One to carry me home
Hope you come and see me soon
Cause I don' t want to go alone
I don't want to go alone
Don' t want to go
I don't want to go alone
Thursday, May 31, 2012
A "Listen To" on Forgiveness
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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.
http://being.publicradio.org/programs/2012/revenge-forgiveness/
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.
http://being.publicradio.org/programs/2012/revenge-forgiveness/
Thursday, May 24, 2012
Embracing Those Who are Different Than Us
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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:
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
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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.
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.
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?
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 guess.......in 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
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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!
(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!"
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 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
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."
"O.K."
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.
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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