therapist style

This week was one of the worst, most stressful, overall weeks that I've had at my job in the short 6 1/2 months I've been working.  I think I've mentioned before that I "travel" a bit during the week... I wish that meant that I fly to cool locations and do therapy on the beach... but it just means I have to get in and out of my car 2-3 extra times per day (and starting now, when it's 80-something or more degrees outside) to drive to different facilities to fill in the therapists that are on vacation, short staffed, or sick.  I don't mind all the variety... but this week just happened to be extra stressful, and by Wednesday I was feeling burnt out.

The challenges of being a traveler: I never know my schedule ahead of time, where the patient's rooms are, what their goals are, how much help they need with mobility, what type of assistive device they use, or how they "transfer" to and from their wheelchair.  More often than not, I have to wander the halls looking at all the name plates, asking the nurses (some are more friendly than others...), then essentially ask the patient what they have been doing in therapy.  I spend the first 5 minutes just deciphering exactly what they need from me in the remaining 60-minutes, so I can give them the best possible treatment that day.  Every day in SNF is one more day a person is away from their home, their family, and their independence... every day and every treatment session matter greatly, and I want to make sure I give them the best care I can give that day.  But, with the fast pace and pressure to be thinking on your feet all the time, it takes a whole new set of skills to be a floater therapist!  I don't get time to pore over their medical chart, examine their evaluation, or read through the treatment notes from previous sessions, let alone build rapport with the person so they trust me enough to help them move their body.  Some days, that rapport comes easily and I am able to quickly come up with a couple fun activities to address their goals.  For some patients, having a different therapist is a good change of pace and added variety, by having a new set of eyes to help address their disabilities or challenges.  For others, it's taking a step back; people are complex, and it takes more than 5 minutes to completely understand all of their needs.

Thursday, my day starts out at the skilled nursing facility where I've filled in a bunch of times.  As it turned out, my patient schedule was more of the latter type: difficult cases that I had to figure out on my own in a few minutes.  My first patient, scheduled for 9am, was still eating breakfast.   I went on to the next one, who was scheduled for 30 minutes.  She refused to get out of bed, but had a 10-day report due (which I had to write).  I run back to the therapy gym and grab a laptop to sit with her while I write up the report .  She still refuses to get out of bed.  I do some bed-level activities with her, to get to the 30 minute mark with her that I can "bill."

By now, it is about 9:55, and I get the warning that the power is going to shut off at 10. I was warned about this the previous day, but told I would be able to take the stairs to do in-room treatments, and that the only real restriction was that patients wouldn't be able to travel between floors.  10:00 rolls around... I am unable to save my report I just wrote on the laptop. Perfect.  I surrender, grab a couple therabands and some cones, and start heading to the second floor for the next patient.  The stairwell doors are blocked by facility staff: "Didn't you know about this?  What's your name? [guy writes down my name] And you're with the rehab department?  They didn't tell you about this?"

"Yes, I mean I knew about this, but I thought I'd still be able to go and see patients..."

"Uuuh, NO.  You can't SEE..."

I've been at the building 1 hour and 15 minutes by this point, and have a solid 30 minutes of treatment logged.  Great start.

I give up, leave the facility and go to see patients at my home site, a retirement community with high level residents, who I know everything about, I know exactly what their 60-minute treatments are going to be that day, and I know I can get in and out. Everything went relatively smoothly from there on out; just stressed by the anticipation of all the remaining work I had the rest of my afternoon.  Calculations in my head told me I wouldn't be leaving before 7pm.  Awesome.  That and I completely forgot my lunch at the other building.  Great Thursday.

By 2:45, I have wrapped up everything at my home site, and I'm ready to go back to the SNF.  I gather up my coffee mugs, water bottle, handbag, notebook, etc. and walk out to the car.  As I'm sitting the drivers seat placing all my stuff in the cupholders and the passenger seat (like I do 3-5 times a day every single day)...  I feel........

Wetness.

What.....  the...

OH MY GOD IT'S COFFEEEEE.

.....All over my crotch.  Of my light khakis.

All I can do is laugh.  Apparently God decided I needed to laugh, and this was just the start of how he chose to make it happen.  It worked.  I haven't laughed like that in soooo long......  And he must have also decided my coworkers and patients that afternoon were going to need a laugh too...

I run back to the clinic, and our office administrative assistant starts to call around other departments, asking if any of the nurses had packed an extra pair of scrub pants I could borrow.  She calls over to the other building to let them know I'm running behind.  She gets a call back from second floor assisted living: "I've got something up here for her... just tell her to come on up!"  Thinking it's a pair a scrubs, I wrap a sheet around my waist to cover my stain and run upstairs.... to be offered these:

"These used to belong to Mrs. B... and she's gone now... so if they fit you they could work!  Hey it's better than nothing!"

Mrs. B was the absolute CUTEST lady on second floor... she was 103 years old, about 4'11", walked all over the place, she had dementia and was a little bit of a wanderer (or a follower...she wanted to be where other people were), and her speech was kind of difficult to understand.  She passed away last week.  And these gems... these elastic-waist, pleated, tapered-leg "slacks".... got left behind in the laundry room.

I can't say these were what I was expecting... but what choice do I have?  I put them on... they're a little big so I fold the waist down... they're a little short so I cuff them at the bottom.  A little bit bright for the shirt I was wearing... But hey, at least they matched my pumas!

Like I said... God must have decided me and my patients and coworkers needed a laugh, because I rocked these babies for my last 4 patient treatments, had a dang great time telling my patients about my terrible "accident", had some really good treatments, and was out the door by 7!

And I'm keeping the slacks...

how i celebrated crossing the line to my "late 20's"

 The first weekend in May every year is always a triple celebration for my parents and I!  I am one of four children, so I feel pretty dang special that I have this kind of an annual bond with Mom and Dad, that my three older brothers do not share.

My dad's birthday is May 9, and mine is May 11... and hopefully you remembered that Mother's Day always falls on this time of year... in fact it seems like every other year it falls exactly on one of our birthdays.

The timing of my birthday with my school/fieldwork schedule the last 6 years has made for 6 years of pretty lame birthdays.  I think I've come to accept it at this point and cut my losses with low expectations for parties with actual people my age, nights out, cake, birthday shots, etc.  I can't even tell you what I did for my 21st because I don't remember.  (NOT because I was black-out, but because I was probably studying my precious young life away for a final exam the next day and choose to block such events from my memory).

I was originally (though tentatively) planning a trip to DC for my birthday weekend this year... but it ended up not really panning out.  Chalking it up to the bad timing I have every year- and officially decided that this weekend is just destined to be reserved for special time with my rents.

Back in April, I had already requested last Friday off from work... and when my DC plans fizzled out, I was trying to figure out exactly what I was going to do with a 3-day weekend.  Not only was it going to be a good opportunity to fly home to see my parents (they live in Ohio)...but a GREAT opportunity to completely surprise them!  Lately Mom has been saying how much she misses having me around to do things spontaneously, especially this time of year.  She has been begging me to come home for a weekend and saying she'd by the ticket if I would just show up! I found a Thursday night plane ticket, arranged an airport pickup with my aunt and uncle, and then got to planning my big surprise!

I special-ordered a cake for Dad, since I would be getting in on his birthday.  I made a reservation for a "couples" Mother/Daughter massage on Saturday (my mom has never gotten one), and dinner reservation at our favorite restaurant on Saturday night.  I had already mailed a birthday card, my Dad's birthday present, and a Mother's Day card to the house.  And I gave my mom (who I speak with nearly daily) absolutely no indication that I would not be working on Friday and led her on to believe I had way more important ways to celebrate my 25th.

My aunt and uncle picked me up at the airport Thursday night, took me to the grocery so I could pick up my cake, ice cream, and champagne.  On the drive to the house, my mom called.  I picked up the phone and just started chatting like we normally do.  Anyway, I continued leading her on, asking for Dad to wish him a Happy Birthday, and promising to call back again later when he was in from outside.  We continue chatting, and as we pull up to the house in the car, my mom says, "Someone's pulling up in the driveway... I wonder who it is...".  We change the subject, then as I open the door, Mom says, "Someone's getting out... I wonder who's here."  She is standing out on the back deck, sees me get out, and goes, "WHAT ARE YOU DOING HERE!!?"

Success!


Dad came in soon after, and I set up an impromptu party in the dining room with my aunt and uncle!  My parents had just had a quiet dinner that night (holding out for fancy birthday dinner Saturday), so I know it made him feel special to have the cake, candles, singing, and presents!

Surprise!

Friday, I treated myself to hair and nails, visited my mom at her office, and spent time with my cousins.  Saturday, I took Mom for her first full body massage-- which she BADLY needed, and absolutely loved!  We went shopping for flowers and plants and chatted the day away.  Saturday night, my parents already had plans for dinner with some other couple friends of theirs, and I just tagged along (fortunately it happened to be at the same restaurant where I made a reservation a month ago!).

The birthday boy, birthday girl, and special mother!

After dinner, my good friend L from high school picked me up and took me out in Dayton for drinks and general fun times out as a couple single girls... I forgot how much I missed that. :)  Sunday, I struggled through church and nursed a pretty terrible hangover (I blame my strange and undying love for tequila shots, inability to turn down a drink offer from a boy, and forgetting that I'm 25 now).

Old & new friends tearing up small-town Ohio!

My parents and I had a quiet afternoon around the house (which is a lot more enjoyable than one might think!  I loooove just hanging out in the house I grew up in...), ate dinner together and then went back to the airport and home to Charlotte!

We had a great time together, and I really wanted the weekend to be more about them than about me- and I think the surprise helped make it that way!  I still got to have a little bit of a normal 20-something birthday celebration... but I'm thinking that the tradition of spending special alone time with my Mom and Dad to celebrate a new year is one that can't be beat!

"free time" is just available space for new opportunities

When I started my job in October, I was extremely overwhelmed.  It was my first job as an independent therapist, I had big shoes to fill from the previous therapists who had run my building before I got there, and I was on my own in my department as the only OT with some very experienced and established and intimidating physical therapists and speech therapist.  And outside of our tiny therapy world was the huge retirement community with a ton of needs, a ton of staff set in their ways, and a ton of change that needed to happen.  I had a challenging productivity goal, and an even more challenging caseload mix that represented every end of the spectrum of functional independence, disability, and rehab potential.  Not one patient I had on my first caseload as an official OT was aaanything like the 6 months worth of patients I had seen on clinicals.  I was in way over my head!

Now it is 6 months later, and I am kicking butt!  My PT boss, physical therapy/speech therapy team and our office coordinator listen to the things I have to say, ask me questions and respect me... even compliment some of my ideas and take my advice sometimes!  Not only that, but I have branched out to working at 3 other facilities in the area... further advancing the variety of types of patients and conditions I get to see, and giving me lots of opportunities to network and meet other therapists, see other styles, and learn... a LOT!  There were definitely times (a lot of them...) when I questioned whether this was the right first job for me... but now I realize it could not be more PERFECT and how truly lucky I am that I got this opportunity....... and how it also happened to be the first (and ultimately only) job I interviewed for.

Lately I have been wanting something new to challenge me outside of work and put some of my other skills to use.  I have gotten involved with a church choir here, which is great and all... but this essentially means I am spending the vast majority of my socialization during the week with people who are 70 and over.  I love them... don't get me wrong.  But it's about time I find some people who are more... in the same phase of life as I am.

I decided to explore the local chapter of a large women's service organization here.  I had been looking into it off and on since the winter, but this month it is finally the time of year where they are recruiting new members!  I just went to the informational session tonight, and I am so excited to get going with my application, attend all the meetings and requirements, meet the other members, and just get involved!  Basically it sounds like they connect members with a number of options of volunteer opportunities, equip you with the skills to do well at them, and provide a lot of networking and leadership opportunities. I got the feeling that the other prospective members who were there tonight were looking for the very same thing as me.  I got to talk to quite a few people tonight... just small talk... but it felt GREAT to genuinely interact with other women who I have a little bit more in common with!  I think it's going to be a good fit so I can't wait for it to really get started!

I had it in my plans before I even graduated, that I would try to have a secondary job when I first started out so that I could make extra money while I'm young and ambitious.  I also had ideals of working in more "traditional" OT settings so that I could strengthen my fundamentals and become comfortable with the working environments.  Since I started my full-time job, it was hard to picture ending a crazy stressful week only to go do it all over again somewhere else crazy and stressful for two days... without a break.  But, now that I am so much more comfortable with my full-time job, gaining some hospital-based OT experience is now something I really want to explore.  I did a job search and put in some applications online awhile ago, and I got a call today to set up a phone interview with one of the large hospitals here!!  They have a fantastic rehab reputation and a ton of locations around the city.  Thankfully, I am actually off on Friday this week, so I have some rare free time available that I can do the phone interview! With summer coming up and vacation time in demand, I am hoping there will be some easy weekend hours in acute/rehab up for grabs. I am nervous about having to learn another new whole system and work-environment again... but I am also really excited about the opportunity to grow more as a therapist and be challenged in a different way!

Both of these things happening in the same day is a little ironic... as I came home and sat on my bed surfing the web and getting ready to veg out to a TV show before bed...  I have not been as busy as I am about to be (should these two opportunities pan out...) since my senior year of college.  And as I walked across that stage this month three years ago... I was BURNT. THE HECK. OUT.  I made a promise to myself to "relax" in graduate school and gave up the need to sign up for everything, stopped raising my hand, and quit writing my name down!  It felt great!  And let me tell you, being capped at 40 hours by my company and coming home to ZERO outside-of-work responsibility... is delightful!

But admittedly, I miss being busy all the time... just a little bit...

I said in college, I felt like I was more organized and on top of things when I had a lot going on all at once.  I was forced to be structured and focused so that I could get to everything.

It might be risky getting ready to take all of this on since I've been out of practice a bit... but I will say, there is one big difference between 19-year-old me and 25-year-old me.  I know that when I really need to, I can just say "no"!

"medically necessary"

Welcome Medical Mondays Hoppers!

My medical world connection recently got cut in half.  Update one week later: I am doing great!  I love him, I can honestly say I do, but it just feels so good to have the burden of long-distance-dating a third year med student (just starting surgery) with a stressful personal life and trust issues... lifted.  I feel free, and it definitely feels right.  Could we end up back together.....? I mean sure... but I am just not even considering it an option right now.  Because the clarity and sureness and exactness of "over" just feels so good.  No wondering, no questioning, so second-guessing.... like, ever. Taylor Swift and Kelly Clarkson are on repeat in my head.....

I did wonder a little bit about whether I still wanted to link up with medical mondays... after all it was because of that relationship that I stumbled upon some of you bloggers and this group and found so many of them interesting, and relatable and comforting to get through the hard times of being on the SO side.  I linked up so I would be sure not to miss anything..... and now I'm hooked.

While my work is medical-related, it's not blood/needles/discovery channel medical.... is it still medical? I'll let you all decide...

I'm an occupational therapist.  I get to wear nice, cute clothes to work and I get to take my time, stop and have a lot of conversations with really interesting people... but I also sometimes get pee/poop on my clothes/shoes, am in a hurry all the time to meet productivity quotas, and can only take so much story-telling.

I travel from an independent-living retirement community to a dementia/memory-support unit for folks with advanced Alzheimer's to a low-income assisted living facility to a skilled nursing center treating people from ages 50-something to 103.

I go from physically assisting a person to clean themselves after going to the bathroom, to training a lady how to use a power wheelchair when cooking a meal in her house, to engaging a resident with dementia in a craft project to curb their agitation, to teaching thera-band exercises and drawing stick figures on handouts so people can do them on their own, to measuring range of motion of every finger of the hand, to teaching a CNA the best way to help a non-ambulatory resident get into their shower, to enforcing hip or weight-bearing precautions following an ortho surgery.

My personality, tools, plan, and schedule changes every 45 to 60 minutes for 8 hours a day. I have to be articulate, detailed, and professional-sounding, and then I have to be simple, friendly, and personable so that people will understand what I'm saying.  I need to be assertive enough that other staff and professionals will listen to me, but I have to be approachable enough so I don't come off as cocky.

I have to be organized, systematic, logical, analytical, detail-oriented and critical... and I have to be creative, flexible, think on my feet, and ready to come up with an activity idea or change my plan at the very last minute.  I teach and instruct and educate and plan for a patient not to fall... but I have to be ready in a split second to catch them if and when they do go down.

On the evaluations, notes, reports and discharge summaries that I write (and write and write), there are always categories and questions relating to the "medical necessity" of the services I provide.  My creative mind mixed with my impatience for typing a lot of information makes me really good at quickly coming up with reasons for justifying 10 minutes I spent counseling a daughter on her father's transition to assisted living, or why it's meaningful for me to help the "pleasantly demented" lady to get to go to the sing-along (since she otherwise wouldn't know how to get there even though it's two doors down).  I get to justify why exercising all your fingers and squeezing putty is essential to a person being independent to brush their teeth or open their pill bottle... and I explain why installing a bed-rail to a person's bed is an essential that improves their quality of life.

Do you do anything in your life that is meaningful or matters to you?  What if you couldn't?  And what would all the medical stuff mean if the important (and some not-so-important) things you do every day still weren't achievable?  What if you got your hip replaced but still couldn't figure out how to put on your pants?  What if your doctor prescribed you medications that then kept you from being able to drive your car anymore?  What if you survived a stroke thanks to the miracles of medicine, but you had to depend on a caregiver to do everything for you?  Or would you?  With OT... maybe all those "couldn't"s would be "can"s and "do"s.

Are occupational therapists medically necessary?  I think you know my answer...