September Recap: Challenges of Changing OT Assignments

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


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: RECEIVE BLESSINGS FROM OTHERS

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

I have just unpacked a box filled with old papers I really need to unload! I am sorting out biking maps (keep), walking tour info (keep), and glossy magazines filled with restaurant and winery recommendations (keep) when I come across a small white envelope stained with coffee.

I have written on the back of the envelope the names of the patient and his brother who gave this to me. I immediately remember the patient's wit, grace and fortitude while fighting cancer. His brother was the same. They both shared a faith that could move mountains.

I open the thank you card. Out falls a beautiful gold framed picture of an angel.

I read the brother's carefully printed words. On the right side of the card is a poem:

I must remember

Ere I go

Through all my days

Both high and low

What I must always

Seem to be

To those whose lives

Are touched by me:

A harbinger of Hope!

A chalice of Mercy!

A pillar of Strength!

But, oh above all

God's most generous of blessings,

An ocean...of inexhaustible Love!

And on the left flap of the card were these beautiful, soulful words:

Tre!
may this little
verse of mine
be ever
your guiding light
throughout all the days
of your life,
and, one day, become
an imperishable crown
of glory
in the kingdom of God
evermore
(from....)

I am immediately reminded of the amazing gifts I receive not only from my patients but their families on a regular basis.

I fold the card, slip in the angel picture, and close the envelope.

...KEEP!!

Lesson of the Day: Live - and Die - Gracefully

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

Mabel has lived in our building for years. She is 91; about a year ago, when I came here, she began to lose steam. She went from walking to using a wheelchair. Then she began to have falls when she wasn't aware of the loss of her strength, and she still thought she could take herself to the bathroom.

Mabel had a stroke last month. She came "home" a different woman.

She has tried her best, we see that, but she has lost her will. In the past week, she has quit eating, taking her meds, and getting out of bed.

I have worked with her to see if we can get her to eat. I offer her half teaspoons of pureed food, and small sips of thickened liquid.

(When people have a stroke sometimes, they lose the ability to swallow normal foods. When this happens, the food must either be chopped up or ground into small, soft bites or pureed in a food processor, depending on how much of a problem it is to swallow. Same with liquids - if you start coughing on regular fluids, you go to what is called nectar thick, then progress to honey thick water, milk, juice, whatever you're having....in Mabel's case, she can either take it from the spoon or if the cup is held to her lips. )

My dear Anita, fellow therapist, tells me that Mabel is unable to get up in her wheelchair today. Her face is cloudy and eyes misty. "I hope hospice comes in soon," she says.

Me, too...

We have been tag teaming to see if we can get her out of bed and up in the wheelchair to prevent her from getting pneumonia. "I'll work with her in her room," I assure Anita. I pick up her lunch tray and walk quietly into the room.

Mabel is laying on her back in the bed, head and feet raised slightly, and eyes closed. I speak in a low voice to her - try to be soothing, anyway - and I stir her thickened water.

"Can you take a few bites, Mabel?"

Eyes stay closed. Her head sways slowly back and forth in a certain "no."

She refuses food. She takes a few sips of water.

That is it.  That has been it for over a week.

I put the glass on her tray. Suddenly, her hand shoots out and grabs my arm, runs down my forearm and squeezes my hand so tight.

Ever heard the term "death grip?"

"Mabel, are you afraid?"

And her sweet, old, wrinkled face nods yes.

I sit with her then, knowing how difficult it must be to lay in that bed alone, knowing that she is dying, and having not one person there who has known her in her former BNH (before-nursing-home) life to comfort her, tell her stories about their shared memories or give her TLC.

Wow.

I stay there as long as I can, but it's time to move on to work with other people. I ponder as I walked down the hall back to the rehab department...

I hate to bring this up, but we are all going to be there one day.

I've come to believe that it's not just about living gracefully. It's about dying gracefully, too.

In a Basics of Buddhism class last year, Lama Chuck told our diverse group that Buddhists believe that the state of a person's mind in their final moments is of utmost importance.

It takes a depth of awareness to move through this period by understanding
what your purpose in this world has been, to accept assistance from others when you can't care for yourself, to forgive yourself and others, and come to full acceptance that you are getting ready to close your own circle.

It is our opportunity to practice compassion with each person and each death. Joseph Goldstein writes about compassion that, "It is not the suffering itself that causes our discomfort; rather, it is our aversion to it and our sense of separation from other."

Rather than thrashing in fear and holding onto a lifetime of resentments that have separated us from the ones we truly love, we are challenged, as we close out our time here, to move gracefully and with trust into the transition, the outcome of which none of us can confirm.

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

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

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!

Lesson of the Day: Quit Perseverating About Your Illnesses!

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

I arrived at work to find a full caseload plus 3 evaluations....(shuffle, shuffle, shuffle my schedule...okay, I can make this work...)

My first evaluation was Rick, barely 60 years old, who could recite every little illness he had ever had. I was amazed at how enthusiastically he recounted every ache and pain.

About Pain

A pain scale assesses intensity of pain on a scale of 0 to 10. These scales are at times accompanied by the continuum of smiley-to-grimacing faces. If you have a patient with cognitive issues, you can point to a picture of the faces and ask, "How do you feel?" They are more likely to be able to point to a face than rate their intensity of pain with a number.

If you have no pain at all, you're sitting at zero.

If you...

• Think you need to go to the ER
• Are unable to suppress a scream
• Are writhing in pain or spasms

you're sitting at a 9 or 10.

In between is "hurts a little" to "hurts a whole lot."

This guy, like many of my patients diagnosed with chronic pain syndromes, demonstrated absolutely no nonverbal signs of pain. He was smiling and talking nonstop when he rated his pain at 8/10, then,
...6/10 in another area,
...5/10 in another,
and...9/10 in another.

In my 15+ years of experience, men generally rate pain higher. (Am not sure why, but I'm thinking, "Could they ever make it through childbirth?")

So, I want to say two things...

First, I acknowledge that for each patient, their pain is real. Whether we as health care providers believe the intensity or not, it's real to the patient.
Second, there's a line of thought that says:  What you think about, you manifest into your life. If you think about illness all the time, if you think about pain all the time, you are more likely to experience it.

What do you believe? 
And what would you tell your patients? Or your family members? 

Let me hear from you...

Make Your Day Sweeter...

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

Last week, I walked into a new patient's room. His lovely wife had set up the most beautiful tray to brighten his day... a china cup and saucer filled with coffee and cream (nearly unheard of in a skilled nursing facility except maybe in the doctor's lounge). Beside it was a china plate holding the most enticing sweet! I asked what it was.

"A florentine!" she said, and proceeded to tell me which boulangerie she had visited that morning. (Love the bakeries in northern Cal!)

The florentine she brought her husband was actually rolled with a light cream filling inside. I couldn't resist. Yesterday, I walked over and picked one up at the bakery.

It was...melt-in-your-mouth delicious!

So, imagine this:

http://allrecipes.com/recipe/milk-chocolate-florentine-cookies/detail.aspx

rolled and injected with a cream filling...

Yum! 

Lesson of the Day: Mr. Charlie Taught Us to "By-Grab-It!"

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

Have you ever had a week of days where it's a victory just to get through each day? Last week was just that...No one who works in healthcare can consistently feel compassionate, patient and giving all the time.

During those hard-to-take moments, when we really wish we could go home, take a walk, eat a pint of sorbet or just take a nap, all we can do is

"By-Grab-It!"

Do any of you know what that means?  I tried to define it on Google, and all I come up with is a description of some new technology. My family members know what it means.  Whoa, do we know what it means!

A crusty, old WWII vet tobacco farmer in my home state introduced this word to my 6 siblings and me; he turned out to be one of our greatest life-lesson teachers.

MR. CHARLIE.

Mr. Charlie was the sole survivor of his company during the Battle of Normandy, shot full of shrapnel. In what we thought (in our youth) was a ripe old age, he stood 5'2" tops in his bib overalls and  flannel shirt. And he moved faster than most men a quarter of his age.

The man was a machine!

If you needed something done, Mr. Charlie had it done before you could blink. He finished his tobacco harvest long before all the other farmers and headed out to help his neighbors.

We were lucky recipients of his time and wisdom, though, at the time, we didn't necessarily see it as such!  You see, he always seemed to show up late in the evening, 10 or 15 minutes before it was quittin' time. Right before we planned to head in to the house to finish homework.

The dogs would begin to bark. The slice of headlights would light the starry sky in the otherwise black night. His truck tires would crunch down the snow-covered, quarter-mile lane.

Mr. Charlie would hop out of his truck as if he had downed a double espresso. The door to the stripping room would fly open. Now, what do you think that means?  Sound naughty?  Well, it's just the place tobacco farmers call the place they remove the leaves from the tobacco stalks.

We'd turn to greet him as we stood in line at a long table covered with tobacco plants, stripping cured tobacco leaves off the stalk, grading and separating them by quality.

"Well, Byyyyy-Grab!" he'd exclaim, closing the door. His weathered and whiskered face taking in the sight of us. His wide smile revealed shiny, pink gums. Not one tooth. "It's a good night for strippin' some tabaccer!"

Inside, we would groan, knowing it would now be at least another hour, or two, until we'd feel the warmth of the house and be able to sit down to finish our homework.

What's with the "by grab?" we'd ask each other early on. We never asked, and he never told.

But...what happened over time is that it became a verb.
           -
verb \bi-'grab-it\  sink your heels in and don't look back. Just get 'er done. As in, "You're just going to have to by-grab-it. Tough it out!"

Then, it morphed into an adjective.
                   -
adjective \bi-'grab-it\  an attribute characterizing perseverance, strength, initiation and reliability all rolled into one. As in, "He's a real by-grab-it kind of guy. He gets the job done!"

Today, 9 years ago, Mr. Charlie left this earth. When I attended his funeral, I was struck by the impact this sprite, tough, little man had on our lives. He still comes up frequently in conversation and so does his life lesson.

Mr. Charlie taught us how to keep on going, even when you want to quit:

Continue to put one foot in front of the other, even on the worst of days...

Keep moving...

Keep your head up...

Look only to the next step so you're not overwhelmed...

Keep going until you're DONE.

Nike said, "just do it!" Mr. Charlie said it even better.

Every day last week, that seemed to last 120 hours each, when fatigue and impatience were itching my skin, I thought about Mr. Charlie.

I sunk my heels in...

....and just By-Grabbed-It.