Things I've discovered since beginning fieldwork:

- Even though I'll be in debt forever, OT is definitely the job for me.
- It doesn't take long for a patient to crawl into your heart.
- The snowbelt is not for me.
- I cannot live without cable forever.
- I miss Charleston.
- Working with older adults is not that much different from working with children.
- I love having a washer and dryer in my house.
- It's amazing the type of friendships you can create while spending ALL day in a classroom for 19 months with 40 people. I miss them.

Mr. Inappropriate

Luckily my inappropriate patient is being discharged tomorrow. Here are some excerpts from our conversations today:

First session:

Patient: You look different today.
Me: My hair is wavey.
Patient: So, what you're saying is that you got out of the shower and didn't do anything to it, just let it kinda dry naturally (while shaking his head as if to toss his hair).
Me: Yeah, I guess...
Patient: Yeah, my wife does that sometimes, she says its easier.
Me: It is.

Second session of the day:

Me: I want to work on your standing tolerance. What would you like to do while you're standing?
Patient: I don't know. What do you want me to do? Dance? ...No, if you were older I'd tell you what I'd really want to do.
Me: Rob** that is not appropriate. We don't talk like that in therapy.
Rob to another patient: What can I say? I like women, thats what go me so many kids.
Me: ROB! That is inappropriate.
Rob: What, I'm not even talking to you, I'm talking to him!
Me: I know, but I heard what you said and it's inappropriate.
Rob: Everything to you is inappropriate. College kids talk about it all the time... you know that.
Me: Yes, but we're not at college. We're at therapy, and we don't say those things here.

**Pt's name is changed for his protection. ha


Rob ended up making designs on a peg board while standing. He dropped one. Because he has bad balance I told him not to get it, that I would get it for him. As I was bending over to pick it up he said "Can I have your cell phone number? That way when I drop something at home you can be there to pick it up for me?" I looked at the therapist that was sitting nearby and just gave her a look. I then told Rob that "I don't make house calls."


Rob is 79. Has had a "whole handful" of wives- those are his words, and "every one of 'em had a kid." He has 9 children. The youngest of which is 24. His wife is 22 years younger than he is, and they have been married for 30 years. I don't care if I'm 27 and single, you couldn't pay me to marry a man who is 49. Especially a man like Mr. Inappropriate.

What a day...

Patient 1: Did you have a nose job?
My thought: Is that a compliment?


Patient 2: "Are you Holly?"
Me: "No, I'm Beth. Don't you remember me from this morning? I did your eval with Meghan."
Patient 2: "Of course I remember you. How could I miss you? You could be a dancer."
Me: "uhhmmm..."
Patient 2: "You know some girls do that in college because they think it's funny."
Me: "Well, not me..."
My thought: Is it the color of my shirt, my boobs, or my size?

Later on:
Me: Ok, sir, I'll see you in the morning, have a good night.
Patient 2: Who are you? Are you Holly?
Me: No, I'm Beth.
Patient 2: Who the hell is Holly then?
Me: She's the PT who evaled you right before we did this morning.
Patient 2: Oh, is she overweight?
Me: ...uhhh....
Patient 2: Is she bigger?
Me: ...Yes.... but so am I...
Patient 2: Yeah, but you are in all the right places, if you know what I mean....
Me: Goodnight, Sir.
Patient 2: You know, you could lose about 20-30 pounds real easy if you try.
My thought: Why do old people think they can say what they want. And was that a compliment, or should i be offended ?

Funny how one day your patients can make your day, and the next they make you want to go to bed at 6:00.

My week has been made, and it's only Tuesday

It's only Tuesday, and my patients have already made my week.  I didn't have a patient at the end of the day, so I was observing some other therapists who had decided to have their patients do therapy together. Before they came the therapists alluded to the fact that this would be interesting.

One patient is a white woman in her 70's. I'll call her patient 1. The other patient  is a black male in his 50's. I'll call him patient 2. Patient 1 has a rehab diagnosis of LE weakness (She also happens to be the patient I referred to last week about forgetting her teeth- she's kind of crazy). Patient 2 has had a CVA and is a L hemi. Here is how the afternoon went.

The therapists tried a few things with the patients before finally deciding to have them bounce a ball back and forth to each other, (functional... i know...). Before they could bounce a ball to the other person they were supposed to say a type of ice cream.

Patient 1: What am I supposed to do? (bounce)
Patient 2: butter pecan (bounce)
Pt 1: (bounce)
Pt 2: chocolate (bounce)
Therapist: Wait, before you bounce the ball you are supposed to say an ice cream flavor.
Pt 1: Huh? (bounce)
Pt 2: Strawberry
Therapist: You need to say a flavor of ice cream and then bounce the ball.
Pt 1: Oh ok (bounce)
Pt 2: Double chocolate (bounce)
Therapist: Now you have to say two flavors.
Pt 1: Oh I do. Two flavors of what?
Therapist: Ice cream
Pt 1: Oh.... Lemon?
Therapist: ...It's a stretch... sure...
Pt 1: chocolate peanut? (bounce)
Pt 2: vanilla (bounce)

Therapist: Why don't we try fruits and vegetables instead?
Pt 1: Broccoli
Therapist: We're on to something now!
Pt 2: apple
Pt 1: celery
Pt 2: banana
Pt 1: did i already say celery? I did, ok... how bout broccoli. ...all the ones i don't like
Pt 2: strawberry
Pt 1: grapes... i'm trying to think what comes in my fruit cup
Pt 2: pineapple
Pt 1: how bout pecans, i don't like pecans
Pt 2: Pecans aren't a fruit or vegetable. Watermelon.
Pt 1: Drugs
Pt 2: (Pt laughs) Did you just say drugs? Ok... marijuana.

Therapist: (laughing) NO!!! We're doing fruits and vegetables! Let's keep this "G" rated!!

Therapist: Ok lets try something else. How bout places to vacation?

Pt 1: I haven't been many places,  but my son lives in vegas. So, vegas.
Pt 2: California
Pt 1: Ashtabula (For anyone who is not from here, that is a teeny tiny town in ohio that has NOTHING)
Pt 2: New York City
Pt 1: What was i just thinking? I had one in my head. I can't remember. What one did i just have in my head?  I don't know...
Pt 2: (interrupting pt 1) ...I give up.

Needless to say, myself and the other two therapists were dying laughing. It was hilarious. I hope it was at least a little bit funny while reading it. I also find it necessary to note that Pt 1 is crazy. She is fully capable of doing the activity. She is there for LE weakness... not for a neuro/cognitive reason.

Other reasons why my week has already been made?

-An MS pt that I transferred yesterday told me "You do that good." (Maybe its because I don't transfer her by pulling on the gait belt... just sayin.)
-The transverse myelitis patient who is paralyzed from her waist down walked yesterday. Granted- It was with a lite gait (a machine that supported her about 95%)- But she was able to use her hip flexors to move one foot in front of the other. Seriously one of the coolest things I've ever seen.
-I only had to work 1/2 a day since I had a doctors appointment this morning.

Hope everyone is doing well!!

The things they say.

My favorite quotes from today:

"He's my nephew." -My aphasic patient.
"I'm going to miss you." -My central cord syndrome patient who is leaving to go to a SNF tomorrow.
"Good luck to you. You have a way with patients that will take you far. You'll do great." -The first patient I saw by myself from eval to discharge.
"It's hard to talk when you forget your bottom teeth in your room." -My crazy patient.

That pretty much sums up my day. Glad its finally Friday. It's not even 9:00 and I've been in bed for an hour. Time for the weekend.

Always Learning

I now have three of my very own patients. We have a low census at the IRF, so my CI went home this afternoon. I was supervised by another therapist, but I treated the last three patients of the day by myself. I came up with the activities and carried them out on my own. Right now, coming up with the actives is the hardest part. I second guess myself, and I'm frustrated because they are not "functional" activities. In school they always stressed function- but sometimes you need to use the bean bags, or the weights, or the arm bike to  build strength, endurance, and ROM in the patient before you can get them cooking in the kitchen, or dressing themselves. I feel like school prepared me as best as possible- but its still unbelievable how much I'm learning. I know how to do an eval, and I know how an aphasic patient presents- but school doesn't tell you how to eval an aphasic patient. I know the difference between supervision and modified independent- but when you are in a facility and watching the patient preform a task (supervising)- how do you know when they are at a MOD I level?

I love to learn. Even during breaks from school I've missed learning. So I'm making it my personal goal to educate my patients as best as possible. If I can't make an activity functional, I'm going to at least explain to the patient why I'm doing it. There is a patient I have right now. She has Central Cord Syndrome- essentially the middle of her spinal cord was stretched when she fell, and because the the motor tracks to her upper extremities are in the center part of the spinal cord, she is unable to use her arms and hands very well. She has significant pain, swelling, and decreased ROM. She has been in the IRF for 5 weeks. Monday when I was working with her, I was trying to explain to her why her thumb was painful when she moved it, but not when I moved it. I said "When you fell and hurt your neck, you hurt your spinal cord too..." I didn't get a chance to finish my sentence and her eyes got big and her jaw dropped. She had no idea that she had injured her spinal cord. Tell me how she has been in rehab for 5 weeks and NO ONE told her WHY she couldn't move. I don't understand that. I have her do "silly" things like use a peg board, or stack one inch blocks. But I explain to her that I'm working on her pinching grasp, and the more that she uses it the sooner the motion will come back. I explain that she is strengthening it. I explain that using it decreases the swelling, which in turn, will help to decrease the pain. It blows me away that no one has taken the time to do this.

My aphasic patient is doing better. She is VERY emotional, and cries frequently during therapy. She is unable to express why she is upset- but I tell her that I understand that she is frustrated by not being able to talk. She tries so hard to use her right (effected) upper extremity. She tries so hard to talk. So far I've heard her say yes, no, well, I don't know why I'm here, and I don't remember her. It's a huge break through. I'm so excited for her- knowing that came only 3 days after she was admitted; she's frustrated that she can't say more. I don't blame her.

That's all I can think of to update now. Hope you are all doing well.

Speachless...

I did another eval on a patient today. She has expressive aphasia. How is it, then, that I'm the one left searching for words? She has a history of depression, and I'm worried about her. She's 84, and was completely independent, living on her own, and even driving before her stroke. I could see the frustration on her face as we asked her questions and she tried to answer. A tear rolled down her cheek as she tried to tell us her name. I had to continue with the evaluation despite it. It's hard to be "the therapist" and put my feelings aside. I wanted to stop everything and just sit and talk to her. As heartbreaking as it is, I have to remember that this is why I went into this field. To help people regain what they've lost. I just hope she can get back what she lost.

Found the energy for an update...

Today was a big day. A weird, but big day.  I couldn’t get out of bed this morning and got a late start. I then left for the hospital 15 minutes later than normal, and got to the hospital with only 2 minutes to spare- literally. Then I realized I forgot my ID and wallet. I couldn’t think straight today. But I survived.

Another patient with a very rare disorder was admitted today. I did her eval; my first solo eval. It went well, I only forgot a few things, and I was much less nervous than I was the last time my CI required me to do only MMT.

I also was given my first confidence boost by a patient. She is a 71 y.o. in rehab after a cerebellar CVA. She has a tremor in her right (dominant) hand, a below the knee amputation and prosthesis on her right leg, and her stroke affected her left side. Oh, and when she was in the hospital, she forgot to take out her dentures when she went to bed, and they fell on the floor and broke. The poor thing is falling apart, but she is as sweet as can be. I wrote my first note on her. I did my first solo treatment session on her, and I got my first confidence boost from her. But before I get there, I have to give you some background information. She relies on her son to do most things, basically because she can, not because she needs to. So she doesn’t like cooking because “my son will do that for me when I get home, why do I have to do it here?” She doesn’t like games, and she HATES theraputty.

Well, last Friday she got up in her room alone, and fell. She banged up her arm, tailbone, and head pretty bad, but she is ok. So this week I decided to work on walker mobility and safety in the kitchen; reviewing the precautions with her. I thought we’d throw some balance in there too, so I had her unload the dishwasher. Because of her tremor when she went to put the coffee mugs away they were really rattling.  My CI suggested that she use her left hand to put them away instead, but she couldn’t get her left arm above her head. Ok, she’s admitted for a stroke that affected her left side… so up until this point why has no one addressed her left shoulder ROM!? The next day I decided to do passive ROM on her shoulder while she was lying down. (My CI told me to use pulleys! {My goal is to get through both fieldworks without using cones or pulleys.}) J So, on to my confidence boost. Today I didn’t have her as a patient, but I saw her in the gym and asked how she was doing. She said, “I’m ok. But you know, those stretches you did on my arm, I could really feel it. It feels good, and so much better today.” I did that. I saw a problem. Addressed it. And helped her. I did it. It’s not monumental. It’s nothing that any other therapist couldn’t have done. But the thing is- no one else did it. I identified it as a problem and treated it.

Last week a man was admitted after a TIA. He has a previous diagnosis of dementia as well. When he was in therapy he said that he was hungry. My CI asked him if he had eaten lunch, and he said “not to my knowledge!” So my CI decided to call his nurse to see if he could have a snack. She told the nurse what he said, and started laughing hysterically on the phone. When she hung up she told me that the nurse had said that he ate about  ¼ of his lunch, and said he was finished. Nursing came in, moved his tray, readjusted him in his bed, and put the tray of food back in front of him before leaving. The man said “Oh, lunch came!” (not remembering that he had already eaten some of it!) So, not only had he eaten lunch once, but he ate lunch twice, and didn’t remember either time. Needless to say, we gave him some pudding, and he was happy.

Ok. I need to go to bed. This 40 hours of work a week stuff is killing me.

One of these days...

I promise- as soon as I have more time (and energy) I will give a more detailed update of my experience thus far. I have some pretty good stories already. Suffice it to say that I am at a great facility, with great people, seeing things I have learned about but that I really didn't think existed. So far I have seen both cerebral and cerebellar strokes, TIA's, Central Cord Syndrome, Transverse Myelitis, Left neglect, and amputations. Being at a hospital in the Cleveland Clinic network is exposing me to rare diagnoses and giving me an amazing opportunity to learn.

In the beginning....

It is my hope that over the course of the next 24 weeks, I will be able to keep track of my experiences as an occupational therapy student. I have officially been on fieldwork for 7 days. Day two of week two is successfully finished, and I have already experienced and learned so much. I'm finding that one of the hardest things to do is "forget" about my patients when I come home. I feel so guilty that I am able to come home every night and relax; that I'm able to leave the hospital behind and go on with my life. I get a chance to talk with my family, be with friends, and take care of myself all while the patients I have been helping all week are still in the hospital, still struggling, still relying on others for their most basic needs. I hope in time, with experience, as well as the opportunity to see patients through until discharge and recovery, I will be able to let them escape my thoughts while I'm at home. For now though, I continue to think about them, worry about them, and for now, that is giving me the determination and strength to be the best student I can be.