In Memory of Joan

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You guys who work in healthcare know when you're getting burned out. You feel itchy under the skin, the slightest irritants make you check the clock for when the hell you can get out of the building, and you realize you're not your usual patient self with the poor recipients of your treatment.


By last Friday afternoon, I was there. I canceled my evening plans, knowing I was a wrung out sponge with absolutely no energy to engage in fun. What a shame!


I was all the more understanding of my need to isolate when I got home and checked my text messages. I received a message that did me in.


My absolute favorite patient at my last assignment, Joan, with whom I spent a few minutes almost every evening at dinnertime, passed away Thu. I can use their real names because I have permission from her husband, Monty. And I want to show you who they are and were to me because they touched my life so beautifully.

My dear friends, Joan and Monty

Joan and Monty  have meant the world to me. Anyone who worked with us at the facility knew of the beautiful bond and the chemistry that occurred when the three of us were together. There would be songs, memories and laughter. Joan would often be cognitively clearer and able to converse appropriately.


Our connection was magic.


Monty would travel 45 minutes one-way every day to have dinner with Joan. He would show up about 3:30 or 4 with cookies from Whole Foods, and Joan would reach out with her arthritic hands to attempt to share every time I found them tasting their treats. She was so generous even in her cognitive decline.

Some days they would find me in the rehab department. Other days, I would traipse down the hall from one of the nurses' stations to find them exploring the far hallways in the building. The one thing that was consistent was that we would make sure to connect before I left for home.

There were many conversations of her travels to Europe as a singer with the Armed Forces Network during WWII, her experiences singing with traveling orchestras, her life as a young single mother and their touching "how-we-met" story.

One day before I left my assignment there, "Mont" began to sing to Joan. I had the great fortune to record just a snippet of it.

AUD0003 by travelingotr


It was a song created from the following poem:

Believe Me, If All Those Endearing Young Charms

by Thomas Moore

Believe me, if all those endearing young charms,
Which I gaze on so fondly today,
Were to change by tomorrow, and fleet in my arms,
Like fairy-gifts fading away,
Thou wouldst still be adored, as this moment thou art,
Let thy loveliness fade as it will,
And around the dear ruin each wish of my heart
Would entwine itself verdantly still.

It is not while beauty and youth are thine own,
And thy cheeks unprofaned by a tear
That the fervor and faith of a soul can be known,
To which time will but make thee more dear;
No, the heart that has truly loved never forgets,
But as truly loves on to the close,

As the sunflower turns on her god, when he sets,
The same look which she turned when he rose.

I never paid true attention to the words until now....how fitting that such a wonderful man would sing to his bride this song. 

Joan and Monty,

I love you both to the ends of the earth and back again...

Lesson of the Day: Manage Daily Stress

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I was a little surprised at myself today when I realized that I had been a real "b" last night when I talked to my twin sister. What I hadn't connected at the time was that I was dreading to start the work week. It was stressing me out!

What has happened?! I've always said I love what I do!

I still do. I just don't always love where I do it.

I asked myself most of the day, "What am I doing here?" when what I really wanted to do was stay home out of the cold rain, put on a pot of chicken soup and roll up in my favorite fuzzy blanket.

This is one of those assignments where you would absolutely not want to be a brand new therapist who took the travel route to make the higher wage.

October 1st was a new day for Medicare changes in skilled nursing facilities.
I am supportive of the change because I believe every government agency should be analyzing how to cut costs. It does, however, put a lot more pressure on therapists in small buildings to manage their patient caseloads with consistency (stressful!). Bottom line: it affects the income to the building.

I'm trying to help my building manage these changes during the two-week absence of the physical therapist.

Ilene is my first patient of the day. I evaluated Ilene the day I arrived in this new building just 3 weeks ago, and since then, she has been my star pupil. She walks down to the therapy room with her walker, back and neck nearly straight, a 180 degree difference from the day I met her. We have worked hard to improve her posture and core strength! Today, she lays a lovely little scarf on the table.

"I donated 30 of these to the building. I love to knit, and they are going to give them to residents who don't have any family members to give them gifts at Christmas. I want you to have this one."

I pick up the scarf. How sweet this lady is. The tension in her stitches is just perfect. I tell her that. I have a keen eye for crafts, having been taught most of them by both of my grandmothers.

"I had an unexpected visit from two of my daughters this weekend, and they could not believe how great I am doing! I walked with them everywhere, even outside. They both noticed how well I can keep my head and shoulders up now. I told them I was doing so well because of you."

I glanced into her eyes, and I saw appreciation.  How did she know this was just what my tentative heart needed today?

I'm lucky because there are amazing older people who tell me every week how much of a difference I make in their lives. Not everyone receives kudos like that in their jobs.

Did you know that dissatisfaction with your job affects your health and the health of your children?

There is a lot of info on the internet about job stress and mental health; job stress and physical health, how to manage job stress, and how to practice stress reduction techniques.

Personally, I like chocolate, hot tea, meditation, a walk on the rocky beach above the ocean, or rubbing my hands with warm lotion, cooking and talking through the tough stuff with a couple trusted friends.

Research and numerous articles list breathwork, yoga, meditation, exercise and sex as good stress relievers. Some blogs discuss leaving jobs that are stressful and dissatisfying.

There's no question that if this was a permanent position, I would be fleeing out the door. I know I am temporary and that I will be leaving here in January. For others who may consider leaving a dissatisfying position, Anuradha Mayer for Excelle has some great advice:

1) Show professionalism no matter what.

2) Transition responsibly.

3) Be a class act.

4) Finish with style.

A nice reminder, I think, for when I may be tempted to say or do something that isn't professional, responsible, classy or stylish....

Lesson of the Day: Change...Embrace It!

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I have been in the throes of hard-drive preparation for another assignment. There’s no easy way to describe the period of time in which the window opens for another assignment. It requires patience, perseverance, and trust that you’ll end up

• in the right place
• with the right people
• doing work you enjoy.

In the back of my mind, I replay the thought that I am really going to miss this assignment. I have made such good friends and enjoyed many new experiences. I have spent one of the best years of my life here. But I’m just not ready to settle down and go "perm."

Here’s how it works.

My recruiter sends me a list of the openings in the locations in which I am interested. I want to see if there were openings near my parents in Missouri/Kansas and also in northern California. The list reveals no current openings close to Mom and Pops in the Midwest. One option down, I concentrate on California.

My recruiter submits my information to several skilled nursing facilities (SNFs). It takes time.

This is when patience is a virtue. Some managers are on vacation; some SNFs are interviewing other travelers who have submitted their backgrounds before me. There are days in which you think you will be interviewed, and then days in which you think you will have an answer.

Then you don’t!

After 10 days of cat and mouse, I've made a decision.

Where Am I Headed?

I will travel three hours north and west of my current location and settle in a small fishing town right on the Pacific Ocean!!

The harbor, minutes from my new place...

I am thrilled! I have always wanted to live near the Ocean…

The beautiful Pacific close to dusk

and they want an OT who can start a new program.

I am their girl.

This appears to be a SNF that hasn’t had an OT for a long time, if ever. The thought of that generates all kinds of questions in my mind. Will they be open to what it takes for me to build a program?

I ponder these questions while sitting at the Fish House overlooking the Bay eating a hot cup of clam chowder and watching the fog set in.

Surreal. Sitting on the bay under the bridge at the fish house...

....and, then, instead of worrying about the "what-if's," I take a deep breath of the cool, salty air and simply sink into the moment.

Change...embrace it!

What to Consider: IF YOU'RE A WANNABE TRAVELING THERAPIST

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No life lessons today.  Just some recommendations in case some of you are considering a medical, nursing or rehabilitation travel assignment.

Experience

I'm not yelling, but I need to put this part in caps:  YOU SHOULDN'T EVEN THINK OF BEING A TRAVELER IF YOU ARE FRESH OUT OF SCHOOL.

You could be put in ethical dilemmas you never dreamed of due to your lack of experience. Get some experience in the field, then travel in the setting in which you've become experienced. 2 years is good. You're a baby therapist until then.

These buildings benefit from experienced therapists who have the experience to make a positive impact.

This is to OT's, since we have a crazy shortage: It is likely in many locations that you will be the only OT.

Newbies need mentorship! The buildings need a confident expert!

Skilled nursing facilities (SNFs) need you to have knowledge of contracture management and wheelchair positioning. You shouldn't consider skilled nursing unless you can take a wheelchair apart and put it back together, eye a resident and tell your co-workers what size wheelchair width (s)he needs without pulling out a measuring tape.

I've heard of OT's who say,  "I don't do wheelchairs!"

I say, "Shame on you."

Research

Do your homework!

Go onto the state website for any state in which you wish to travel. If you want to go to a state that takes months to get a license (like California), start the process on your own before you contact the recruiter. You can negotiate their reimbursement of the license.

In my case, I took a fun trip to California in December 2009 to get the required Live Scan fingerprints completed. I pulled everything together by March 2010 (not in a hurry, since I was not at that point mentally ready for the change), and I received the license in early July 2010. By the end of July, I was feeling an itch  that had to be scratched (though I loved the therapy team at the building in which I was working). I was certain of my assignment in California by mid August 2010.

For me, it was all about the recruiter. I was working for a different travel company two years ago when I received a call from Med Travelers. The recruiter presented me with an opportunity to work with them in Fall 2009, but I chose another option and ended up in Kansas City.

It was while working in Kansas City in Spring 2010 that he called me again, and this time, I knew I wanted to work with him. He had been so professional, so patient. I want to highlight this recruiter sometime, so I won't say any more, but to keep it simple, working with Med Travelers has been a very positive experience!

Gut Feeling

Test your gut feeling when you talk to each recruiter. Trust your intuition! The one with whom you feel most comfortable and trust the most is your future recruiter.

It doesn't matter if they aren't paying quite as much as the other guys, believe me!!

My first recruiter from another company was a guy who always seemed to be on the beach or rescuing puppies. He didn't return calls. He didn't do squat to provide options for my next assignment, even though the pay was stellar. In the end, it wasn't worth it.

Most travel companies, in fact, offer very similar packages. So, beware the ones who offer you the moon, the sun and the stars!

Details

Ask recruiters for names of therapists on current assignments so you can interview them. Make a list of things you need explicitly written into your contract. For instance, make sure you write any planned vacation time, reimbursed travel or guaranteed hours per week into your contract.

Make sure you clear all tax questions about living and working in different states with the company with whom you wish to work before you start, especially if you own a house and will not occupy it.

...and FYI, your assignment needs to be greater than 50 miles from your home of record, or your per diem benefits (lodging/food) are taxable.

If you stay in the same assignment for over a year, your per diem benefits become taxable, which is why I am leaving my current beloved assignment after September 7.

If you wish to get relocation reimbursement, keep in mind that it will come out of the same pot of funds from which your weekly salary is paid.

For example, if you want full reimbursement for driving cross country and staying in hotels for 3 days, you'll end up with a slightly smaller salary on a weekly basis over the course of a 13-week contract than if you took a smaller sum. It depends on what you want, just be aware.

The Interview

When you interview with your particular assignment, ask:

• Why they have an opening
• How long it has been since they had a permanent OT
• How long their current traveler has been in place
• The size of the building For example, if you are asked to be the only OT in a 150-bed building, you should know you are going to be absolutely swamped, doing documentation after hours and probably crying when you drive home on Friday nights. Just ask!
• Don't be afraid to ask about the building's issues (every SNF has some issues)...

I can tell you that if you have solid experience promoting joint integrity and postural stability through contracture management and positioning programs, they will want to snatch you up.

Granted, that is not all that you will be doing. It's likely you'll have a variable caseload of Medicare A, HMO and Medicare B patients. If you have questions about this, send me a comment, and I will outline it for you.

Due Diligence

If you want to be a real star, go onto the Medicare website and check out the skilled nursing facility for which you are interviewing.

From this tab, type in the name of the building and check out the number and type of deficiencies (aka "tags") the building had from the last posted state survey.

This will fulfill your due diligence, as you may be able to discuss clinical issues and determine what programs you may be able to initiate or assist with to improve quality of care.

Again, trust your gut.

When I interviewed for my current post, I was rock solid after an hour talk with the regional director of ops that I would love this building. In addition, I found she was the only other OT in 15 years of practice that clinically problem-solved the same way I did with long-term care patients.

Wow! She has turned out to be an incredible ally and peer.

If you're hesitant to be alone, travel to a location where you have friends or family. Don't be afraid to explore! That is the great advantage of going various places...it's a big, wide, wonderful world.

Tre

P.S. If you're thinking of traveling and have questions, write me!  I'd be glad to help you through the process.