reacting to reality

being immersed in the TRUE rehabilitation setting puts everything we learned in the classroom into perspective. many things have been on my mind and every now and then i have to put myself in the shoes of the patients to realize that this is their reality. i will shed this perspective that i have gained for you:

imagine this: getting up each morning relying on nursing staff to get you up out of bed and bathed (depending on your activity level, balance, and assistance needed this can be bed-level/in-the-bed, edge of bed level, or seated at the sink level). you are then either put back in bed or put in your wheel chair for breakfast. throughout the day you will have various therapy staff and doctors/nurses running in and out of your room. occupational therapy treatment sessions, much like your bathing routine, will depend on your level, balance, and assistance needed. such treatment sessions i have witnessed with patients are practicing transfers to the commode (adapted toilet), shower with adapted equipment, dressing, meal preparations, light homemaking tasks, etc. as a patient you can count on therapists to be present during many intimate moments, varying from having your buttocks cleaned, being observed during a toileting/showering/dressing routine, pretty much exposed in every aspect. due to safety precautions many patients are confined to their wheelchairs/bed when not involved in therapy. so they can either sit in their room or in the common area and ultimately most clients (those without unit privileges) are completely reliant on the staff around them. patients with insight into their health issues/deconditioning/decrease in abilities are aware of their struggles and what they can no longer do that they used to be able to. at this state many of the joys and excitement that patients will experience might be over the triumph of completing a simple ADL (Activities of Daily Living: bathing, dressing, grooming, toileting), which to those of us able-bodied folk often take for granted. and in addition, many patients often struggle with daily depression from debilitation and lack of independence.

well that is somewhat a tiny bit of the perspective of the patient as i can best describe it. i am sure there is a lot i have not touched on. now for the perspective of the Occupational Therapist:

there is this one lady who had a stroke and lacks some insight into her condition. when she is out in the common room you can hear her over and over calling out: help! i want to go home! help! it is so hard to hear this because it is not possible for her to go home. therapy staff are pretty great with her and reminding her of this. but just reflecting on this patient reminds me of the reality of the life situation of this patient. she DOES NOT want to be here, she wants to GO HOME!

today a patient had her first shower since she has been to the hospital (~2weeks). she is a delicate anxious woman who although is very deconditioned and weak, has the motivation of a horse. her motto is: "i'll try" and boy is it awesome when she does try and succeeds. i am sure it makes her feel so great! she commented today that she was shocked that she was successful with her shower. upon return to her room she immediately called her husband and the first thing she said was: "i had my first shower today!" this really put me back into reality. this woman was so proud of herself. 2 weeks ago she was completely dependent for bathing and other ADLs and to have improved to the level where she can with assistance take a shower is so meaningful and rewarding for her.

there have been a few patients that come to us with a severe alteration of how they were before their injury, one being a tufts college grad and BU law school grad was working, gardening and taking his dogs for walks. now he is reliant upon therapy staff for ambulation with a walker and other ADLs. it also appears that he is experiencing expressive aphasia which limits his communication abilities. as we work with him and his family and i think about the reality of what they are going through as they observe this great change in this man they love, my heart aches. the other, a beautiful sweet thai grandmother who i love to talk thai with was gardening and very active before her stroke. as i think about that and then consider her need for moderate assistance with simple standing from sitting the reality is hard to swallow.

when reacting to this reality i need to remind myself about the importance of OT and to not get carried away with treating the illness solely, BUT... remember the famous 'scott' mantra that is this blog's title: be professional sprinkled with real, we need to treat the person too! i think i have the REAL part down and naturally i am working on the professional part as i gain more experience day by day. Occupational Therapy is important because we consider this human relationship with our clients. what does this sweet thai woman feel she needs to do? what is important or meaningful to her? does she want to get back out and garden? OR does she want to be able to go to the bathroom independently? and yes of course, the realness cannot get in the way of our professionalism... as i echo the second 'scott' mantra: STAND BACK... I AM A TRAINED PROFESSIONAL, i need to remember that all this hard work and dedication i have endured over the past 2 years has bound to leave me qualified for some professionalism... soooo with all that said, in conclusion: embrace the two! professionalism with that realness that IS OT!

that's all! i hope it makes sense. cowjai mai? (thai for do you understand?)