Shoes

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My twin, Elle, visited me for several days and she walked me to the door this morning as I left for a half day work before spending the rest of the day with her.

She looked me over. Grey-blue Grey's Anatomy scrubs

Love these scrubs!

down to my Mary Janes

 Most comfortable shoes around!

"Hhhmmmm, I like your shoes!"

I told her, "So does my 93 year old patient. Every time she looks down and sees my feet, which is at least three times a treatment session, she breaks out in her wicked-witch-of-the-west voice,

"Now you can just put those shoes right in my closet!"

(little deeeaarrriiiee)....really, she could have been on the Wizard of Oz...

and Elle said,

"You need to write about shoes!"

I've procrastinated tonight, having spent the evening with Elle and another wonderful little sister, Kate, so I'm going to make this short and sweet.

Choose the right shoe!

I had gotten to the point a couple years ago when I was limping by the time I got home. I was wearing expensive running shoes. They didn't work for me! By fluke, I was in a uniform store in northern California that carried a brand called

Alegria (the emphasis is not on the leg  but on the gri .) Click on the link and it will take you to their website.

Check them out. Really! Within a day, I realized that I had no  foot pain. I have been brand loyal since then. Not only do they feel wonderful, they look great. Someone comments on those shoes every day.

We healthcare providers spend too much of our days on our feet - and you know the saying - we need to take care of ourselves before we can take care of others....

so, take care of your feet...

More Than Lions and Tigers and Bears, Oh No! Storms in Kansas...

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I'm in Kansas...

in Spring...

Kansas Spring Storm, March 28, 2012

and reliving childhood fears of taking cover during tornado weather!!

I had forgotten (during the length of my storm-free 18 months in California) the dreadful, yet exciting, feeling of anticipating the outcome of developing storm clouds in the sky.

This evening, I went to the pharmacy to ask for some labeled medication bottles to practice medication management with my patients prior to discharging home. When I walked out, voila! The photo above.

WOW.

I picked up dinner and headed to my new "home." The clouds continued to evolve into different shapes.

Please don't let that tail turn into a funnel!!



I grew up on a farm without a basement. We only had a detached cellar that was used to store canned goods and harvested vegetables in the cool climate underground. The difficulty of taking shelter in there was that there was an occasional black snake that squeezed its way through two loose bricks.

My two greatest fears in one moment - a funnel cloud and a black snake. I don't know which was worse.

The funnel cloud won the "fear" category. When black clouds began to swirl, I would pack my aqua blue floral suitcase (thanks, Grandma), and set it by the back door of the mudroom. Change of clothes, underwear and a pair of socks. Just in case.

Tonight, I made my way around the building in which I am renting to find the door to the basement. I stuck the key in the door and turned.

Didn't turn. Won't open.

The key won't work.

Darnit!!

I am on top of a hill. During a storm in Kansas!

Welcome back to the Midwest!

Peace

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Peace be with you...

Peace is something many of my patients cannot capture.

I see several reasons why people can't reach this place:

• Pain
• Lack of sleep
• Psychosocial or behavioral issues
• Impaired cognition (decreased insight/attention/high distractibility)
• A general lack of self awareness.
• A simply "bad day!"

It's a difficult task for each of us at times to be peaceful. It was especially so for Tom yesterday. He arrived the day I returned to work last week following a total knee replacement at the smacking young age of 93.

thanks, Mayo 

Most of the time we don't see total knee replacements done in the 90's unless the person is very active with good physical strength and sharp cognition.  This guy checked out out fine on all the above.

Tom came in planning to leave on day #2. However, a team meeting with him and his daughter delayed his departure because of impaired posture, balance and activity tolerance, all of which put him at risk for falling and doing more damage. When he would go from sit to stand, you could hear a chorus of crepitus throughout his body.

crepitus: a medical term to describe the grating, crackling or popping sounds and sensations experienced under the skin and joints (thanks, Wikipedia).

My dear Lizzie had been on an all night performance of byyyyy-by-by-by-byyyyyy up and down the halls of the nursing facility. Poor residents. This happens occasionally when she stays up for about 24 hours and then sleeps 24 before getting back on track.

Tom, of course, got no sleep. He was new and every sound was unfamiliar, including that of a 99 year old lady singing all night. The natural progression of not wanting to be in a place like this,  listening to noise all night, terrific knee pain and overall frustration was the inability to participate in meaningful treatment.

"I can't do a thing. I want out of here. I can't take a shower until the staples are out, and it's making me crazy!"

Plans to take him to the gym for exercise? Out.

"I'll tell you what. You want to feel clean and fresh - I'm going to get some warm, soapy water and some linens. I'll be right back."

He gave himself a great clean up, just the way he does at home. (Many seniors can't make the step over the tub to take showers later in life.) I rubbed some lotion on his back and did a little manual therapy on his neck and shoulders (full of spasm which, I'm sure contributed to his feeling "out of sorts.")  I had the ability to assess his independence in bathing and dressing, his sitting balance edge of bed, his upper body range of motion and strength as well as his memory, sequencing, and safety awareness.

During this process, he began to talk. He was from the Midwest, too. He had loved to travel and spend time outdoors. He had built his own fishing boat. He was a terrific man!

Freshly bathed and dressed, his temper had softened. He smiled. He even felt up to some exercise.  He had returned to a place of peace.

I left him feeling peaceful as well.

How lucky that we, in our service to others, help transport others past their times of turmoil and reach a personal peace that sweeps us through our day.

Love and the Single Elderly

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I've been proposed to twice this week!

It's not an uncommon occurrence to have an elderly gentleman respond to our "working" relationship by wanting to make it personal. They usually start off with, "You have a husband at home?".....

"No," I usually reply. It's best to keep the answers simple sometimes. No need to turn the focus on therapy off of them.

Of course, even that one-word answer can give an old man hope!

"Marry me!"

I have to admit, it always makes me smile. I soften the blow by telling them that I'm like a bird flitting from place to place, not a good choice for someone who is settled down. They take the bad news graciously.

It made me think about being single, old and wanting love in your life. I can count on several hands only (from my 16 years as a therapist) the number of couples who have been married 50-60+ years who look at and treat each other as if they had just fallen in love. I have a patient right now who has that kind of relationship with her husband.

LUCKY!

Most single older people I know want to be connected intimately to a partner. I'm referring more to an emotional connection, though some want sex.

I worked with a new patient today.  Ginny is 90. We share the same birthday which created an immediate bond. She told me about her long, beautiful marriage to her husband which ended four years ago with his death.

"I have a boyfriend now.  Carl should be by to see me later."  Her eyes twinkled with joy and mischeviousness. "He is 38!"

"Wow!" I thought. I wouldn't mind a 38 year old boyfriend, either....then I laughed silently. That Ginny is spunky!

"So, Ginny, is Carl....a helper?"  I wondered if her intermittent confusion may have skewed the story.

"Oh, he helps me around the house, takes me to dinner. He's my love interest, too."

(Would you blame me for questioning this?)

I saw Ginny's son later in the day. He stopped by to see how her treatment was progressing. I asked him, "Is there a man named Carl in Ginny's life? She's telling me he is her love interest."

Her son replied, "Well, since she just introduced me as her husband, I'm not surprised!"  He told me that there was a Carl. He rents a room from Ginny, and he does, indeed, help around the house. He had already visited her at the facility.

I never really got the "skinny" on whether Carl really has the hots for Ginny, but I did find it supportive that this young man would visit an elderly lady at the nursing home.

I have witnessed the most interesting of relationships that grow, from residents who meet and marry in nursing homes, former staff and patients who come together after the treatment is over, and strange couplings of people who come in for short term rehab.

I'm not in any position to judge a person's relationships. There are relationships that outsiders may not understand, but it's not for anyone else to understand the bond except for the two people involved.

Tonight, I raise my tea mug

to all those lucky old people

who have spent a lifetime

with someone they cherish.

I raise a prayer for those who are sad and lonely.

I appreciate those who reach out to others around them

with companionship and a smile.

What will it be like for us when we are old?

With whom do we want to be?

Reminiscing Can Heal our Childhoods

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I had a playful discussion with Bertie yesterday. We were sitting on the mat in the gym trying to "open up" her shoulder blades. (When people lose range of motion in their shoulders due to injury (like a rotator cuff tear) or disease process (like arthritis), they also lose motion in their shoulder blades. You have to  get the scapula (shoulder blade) moving in (rotating) in order to get the arm moving above shoulder height. Just a little fyi.

We were chatting as I mobilized the scapula. She started telling me about how she spent summers in New York with her grandmother. There were no little girls to play with there, but there were two naughty little boys who really didn't want her around.

http://www.photos-public-domain.com/2010/12/15/apples-closeup/

She got tickled when she related a story about throwing apples into a cider press, a contraption that squeezed out the juice and made cider. The little rascals turned a hose from the cider press on her, the way a fireman points a hose at a fire.

"I can still feel the way it knocked me down!" she exclaimed, laughing. "Those boys got in such trouble!"

We had such a delightful session, with me asking bunches of questions, and Bertie sharing from her past. I asked her, "Bertie, do your children know these stories from your childhood?"

She paused...."no, they don't!"  She paused again.

    "Bertie, have you thought of telling them all the stories you just told me?"

"No, but I really should."

     "I think they would really enjoy knowing this side of you!"

And from there, she formed a plan. When she is with her daughter and son this weekend, she is going to start telling her stories.

Of course, this made me think of my own parents. My parents both experienced traumatic events that affected their childhoods, which always made me and my siblings hesitate to ask them about details of their growing-up years. I can count the number of fond memories they have shared with us on one hand.

It's been a closed book.

As a healthcare professional, I think that it's time to open the book.

We therapists have animated discussions among ourselves about how our parents will listen to other therapists but not their own children who are experts in the field! My parents may not agree with my opinion, but here it is:

When people have experienced great grief, trials or heartbreaks in early life, it's as if a piece of them splinters off to protect themselves. Some people hold that part of themselves tightly guarded without ever reintegrating and healing that part. I'm not saying people disassociate, like multiple personalities! I'm saying that we lose a bit of ourselves when we experience some loss as a child.

We have the opportunity to heal ourselves when we come to understand our childhood from an adult perspective, when we allow ourselves to be in touch with our Inner Child, when we laugh at all the things we thought were hilarious when we were little, and when we revisit what life was like.

It's important to remember both the good and the bad.

Why?

The good reminds us that there was, indeed, good in our lives, that we had friends, that we laughed, that we were (and still are) beautiful souls on this earth learning our way. It helps us remember the kindness of other people, whimsical events, magical moments and joy.

Sorting through the bad allows us the opportunity to surround the incident with love, forgiveness and healing, to let it end, to diffuse its potential to hurt us again. We are free to release it, to stop carrying it with us like rocks in our pockets. It's okay to let it heal!

Some people do not want to let go of what pains them. They want to carry it like a visible scar. They want others to know they are a victim.

Let me ask you this:

Does it serve you to be a victim?
No.







Does it serve you to forgive? To let go?

Yes.

Is it difficult to revisit painful events?

Yes.

It is necessary to "close the circles" as we age. The earlier we can do it, the better. We live more life with greater joy and less anger, bitterness or depression. When you go to the places that have held you back, sit in those places, heal them and move forward, you take off at warp speed.

It changes your life.

Who were you as a child?

What made you laugh?

Who made you cry?

Have you told your children your stories?

Have you asked your parents to tell you theirs?

September Recap: Challenges of Changing OT Assignments

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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...

Goodbye
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:

"yooooouuuuuu--hoooooooooo"

"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!

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!