Wednesday, 7/l6, Week 3, Day 3, Pediatric Level II Placement

Let's go back in time to chronicle this day of insanity. It is lucky it is 3 days removed or this blog would be WRITTEN LIKE THIS!! OMG AUGH!!!

Get to work. I see my two little girls and we work on our basic skills of cutting, gluing, coloring – we do a worksheet and they both seem to be improving. I was in a silly mood and so I kept singing the colors they were using – like “You're using the grrreeee——-eeeeeen mark—–errrrrrrrrrrrrr!!” They would laugh hysterically. I am an extraordinarily silly [read: weird] person, and luckily young children appreciate this more than anyone else, so it works out well that I am on a pediatric fieldwork placement. 😉

We hurriedly head to our tiny Mississippi town with a load of plants and toys for the clinic – me, my OT, and our boss/clinical director/speech therapist person. We go to several dollar stores there to see if we can find a slow-flow nipple, finally get one. Go to lunch.

Then we go do our home visit to see our little baby that is deaf/blind…we spend the entire session, working on feeding. I got to hold the baby and feed her – which made me a little nervous but also glad – since I wanted to do everything right – we were experimenting with different positions, different levels of stability, and the new slower-flow nipple, which made the baby work a lot harder for her meal – and she was frustrated. She was used to it coming out so quick she could hardly keep up, and now she was having to suck and suck and suck as hard as she could. At first the hole was so little it took her like ten minutes to get almost nothing…so we made it bigger…and then bigger enough…after 30 minutes she had probably only had about 1/5th as much as normal…we discussed with the mom about how it was really important she had to work so hard because it worked on her oral motor skills and that she should start with the harder nipple flow when the baby was hungry, make her work a while, and then if the baby got frustrated, switch back to a more normal flow so she could actually get all her calories. I held the baby most of the time, periodically getting reassurance from the ST and OT I was doing the right thing. Then we let the mom feed her so that the OT/ST could give her some tips on stabilization etc, so it worked out well. It seemed crazy I am sure to Mom that we spent entire time on feeding, but that's a big deal and it affects everything else.

She told us she had lost all her old paperwork on her baby's visits to the neurologist and such (she didn't even know who she had seen) so they are having to start over with the visits. To me that is crazy – it seems like a system should be in place so that it isn't possible for all that paperwork to fall through the cracks like that when it is at taxpayer's expense. Maybe I didn't fully understand what was going on though. The mom is doing her best to show she cares – she's been threatened by child services so she is scrambling. I was asking some friends why parents who don't want their kids would even care if the kids were taken away, and my friends said it's often a combination of pride and money. The mom did say the baby was turning 1 next month and she didn't want to have a party because “she can't do nuthin'.” Us therapists were aghast at this comment but we could understand why she was saying that. She said her mother was forcing her to have a party though like she did for the other two kids which we thought was good. Even if this baby is at about a newborn level and can't fully participate, it's important she get recognized and not be hidden away as a shameful thing. This baby has beads in her hair – you have to imagine that wouldn't be very comfortable for any baby that spends a lot of time on her back – but I guess it's common, I don't know. Okay anyway.

We head back to meet a first steps coordinator at the new clinic for an eval – so there is four of us alone waiting. And waiting. The eval is at 2pm and we have patients scheduled for 330pm back at the normal clinic and it's a 40 minute drive. Well, time goes and goes and goes and they are talking shop, I'm looking at my OT book because I want to get some ideas/refresh my memory, so that I don't have another horrid day like I did Tuesday. Around 2:45pm I'm like hmmm time to go back I should think. Well we are about to go walk out the door, and the eval shows up. Nice. The dilemma is that we came all that way partially for this eval, plus the first steps guy is there, plus this family lives 45 minutes away, and this is the second attempt at a visit…they decide we should try to see them for like, 15 minutes…and we would just be a little late heading back.

Nice thought, but life doesn't work that way…there is quite a bit of paperwork that has to be done with first steps and all that, and so we end up not leaving until 3:30pmish…meaning we will be 45 minutes late for our clients at the normal clinic. There are phone calls flying between office staff at normal clinic and boss and OT, and scrambles to figure out how to handle this, and then we find out a kid not on schedule showed up and was put on my schedule as a double treat (meaning I've had two kids at once for an hour, this new kid being one I knew nothing about, the other kid being the one that had freaked me out the day before), and we all got frustrated because as a student in my third week of my first rotation, they shouldn't just add kids to my schedule randomly and at the very last second, especially not a doubling-up,  plus the kid my OT has is severely autistic and needs consistency/experience, so it's not ideal to just switch our schedules, plus I am supposed to babysit at 530pm and my OT has to work at another hospital that night (ie, we both wanted to leave on time!)….anyway it is going back and forth between the two clinics as we drive, all of us stressed out for different reasons related to scheduling, and ends up with my OT frustrated enough to be sniffling, which was a bummer and I felt bad. It's just been so chaotic with all the expansion and the trips back and forth and then kids showing up and blah blah blah – true chaos and craziness. Anyway, we do end up switching – which is not ideal- so I have the severely autistic kid  – but we actually had a great session. This kid does really well with reinforcers – so if you are .like, 2 minutes this, then 2 minutes Spongebob (his obsession), he'll more or less do it. He is very auditory defensive and spends a lot of time with his fingers in his ears when he hears other children, and kids like this do best with simple speech – even though he is like, 10 or something. He also needs to hear his name instead of “You”, so it ends up sounding like unnatural speech you wouldn't even use with a baby. Let's call this kid Jonathon.

“Jonathan writes letter D. Good job Jonathan. Not done Jonathan. 1 minute. Draw D. Draw D. Spongebob later.” Okay loud noise, 5, 3, 2, 1. Spongebob time.” So we worked on things like basic puzzles and writing D's….but he has lost that skill, he makes half circles if left to his own device while spelling his name. Then we'd play with Spongebob for 2 minutes, then back to something else. Near the end we actually went into straight work on social interactions where we worked on closing circles of communication and would have both Jonathan and Spongebob go to sleep and turn off the lights, turn them on and have it be morning, etc…so to some extent we were playing together/interacting/communicating, which is big considering his SEVERE autism. He has interesting neurological deficits – he fumbles with his lips a lot with his finger, he does weird jerks and makes odd noises, and is just an interesting case overall. I was pleased with what he did overall, Greenspan (who wrote my favorite book called The Child With Special Needs, on the concept of Floortime, play therapy), would have been proud.

Anyway,
I finally got done a little bit after 5pm –  so I went straight to go babysit. The kids and I played with the sprinkler outside and they got my scrubs DRENCHED – not that I wasn't expecting it – so I ended up in a towel skirt for a while, LOL. We had pizza for dinner – and the kids had feta and blue cheese as their sides because they are PSYCHO awesome kids who like bitter cheeses :), and then we messed around a while before it was bath time. The older kid who has sensory issues balked when he saw I had added some soapy bubbles to the bath – it turns out he hates soap in his eyes and bubbles are a threat to that apparently – so I convinced him he could sit in the bath and wash his body and then we'd do his hair under the faucet instead of his typical thing of just kneeling over to get his hair wet. Then the other kid decided he wanted to shower, so I let him, putting his shampoo down low so he could reach it. Well instead he apparently grabbed some invigorating minty shampoo and used a ton of it and so it got in his eyes and made us both cough from his strength, lol, it was actually amusing. But now I know he can't take showers alone without a little coaching/help on the shampoo aspect! ANYWAY, I get them in bed by 830pm and then the parents come home shortly after. I spent some time with them because they are awesome. My OT called me around 10:15 to let me know what time to be there Thursday (1pm, phew) and then I called Doug, my good friend who had just gotten back into town and only had a few days left before going back to England, to let him know I was on my way home. He met me at my house around 11pm. By now I was feeling really sick since I wasn't being distracted  anymore- on the drive home I realized I had not eaten nearly enough food that day considering I had been active starting at 7am – so I was hypoglycemic and now had a really bad headache. I really wanted to give him some time since he had had a traumatic week with his father being air-lifted to a hospital in FL after he wrecked his bike – with five broken ribs, a broken pelvis, and a pneumothorax, along with a bunch of contusions – he would have been dead if he hadn't been wearing his helmet. So we lay on my giant foambag while I was in my twilight zone in delirious exhaustion until around 2am and then he left. Looong day.

Speaking of long day, this blog is ridiculously long…I just got a call from my landlord Jim. His mom died last week (I am so sad for him :(:(:(:( ) and they are dispersing her furniture. I just got a really nice wall hugging lazyboy chair to keep and then a hutch that needs to stay in family but I can use while I live here, it has glass doors and would be perfect for my snail collection! I'm excited. Plus I might get her guest bedroom mattress which is like new, plus some of her Ethan Allen furniture. She also had a bunch of kitchen stuff I can have – I don't personally need it, but since I'm working at a clinic that caters to Medicaid, I'm thinking I can find people who can. 🙂 Yay now I have two Lazy Boys, but I have to figure out what to do to fit them all in my house! That will be hard.

Okay anyway. Time to move onto Thursday. Another long entry. But Friday shouldn't be long, and then my other stuff should go faster, so that's good…I want to wrap this up within an hour so I can move onto dancing and other stuff! But this blog is for my memory and for my therapy and so I refuse to get behind or neglect any days.

Jul 19, 2008 | Category: Occupational Therapy | Comments: 1

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