my poor orange kitty in california has passed away

And now, a moment of modesty…and by modesty I mean "bragging"

My blog was created 4/19/2007…I'm at about 91,000 page views right now….my two-year blog anniversary is in a few months…I'll be (based on statistical trends) probably hovering at around 100,000 page views by then…and well over 1,000 blog posts.  Wow. Just sayin.

Midterm week coming up…and I survived last Thursday….

Friday was better than Thursday…the patient I was worried about was okay (ie the incident report thing). Plus, I felt better when the awesomely experienced beefy man tech admitted he practically cried too that Thursday afternoon, because things WERE so insane. He thought about quitting! So it validated my intense stress levels to know I wasn't the only one way overwhelmed. Poor guy.

Hmmmmmm, I'm trying to think of Friday, but honestly it's blurring up on me…I was kind of in a daze. I was really gun-shy about going back to that unit after Thursday's experience. Luckily we were more fully staffed and with good workers and so it wasn't so bad. Plus the hardest (for me) to handle patient, group-wise, had gone to a “real” hospital for medical reasons, so it was a little quieter. I did make a few documentation mistakes in the computer so I had to write the same note THREE TIMES – ugh, lol. My OT let me go a little early –
I left 45ish minutes early (I stayed an hour late Thursday). My OT warned me she grades low – she gives mostly a score of 2, Needs Improvement, at Mid-term, and usually a 3 at Final….yay. Low scores, just what I need to boost my confidence lol. No, I guess it's good. And I do need a lot of improvement. Although I think OVERALL – considering how crazy things are – so understaffed, her running the neuro day program and me running a currently high-census area – that I'm doing a pretty good job for the most part!!!!

My patient who scored sooo low – in way severe dementia range – scored almost three times higher – now in moderate dementia range – and was much more in it. I'm getting deja vu, I feel like I must have already written this all up? She is in a different unit…another patient came up to me and asked me something utterly outlandish…I was like….ummmmmm…..lol.

This is midterm week coming up…..week 6….six more weeks of rotation…wow. I need to start figuring out what next, SOON, huh….:x

Soon to come: My cat and the ACLS…a perfect match.

AUUUUUUUUUUUUUUUUUGHHHHHHHHHHHHHHHHHHHHHHHHHHHh

This afternoon SUCKED. SUCKED. SUCKED.

This morning I got to see the CAM done – did a group on discharge planning/leisure activities (9 in first group!!). Did a few ADM placemats. Tried to do an eval with a really nasty (ie mean) lady who refused…

Went back after lunch to do an eval etc.. AND IT WAS CHAOS AUGHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH. AUGHHHHHHHHHHHHHHHHHHH
AUGHHHHHHHHHHHHHHHHHHHHHHHH
AUGHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
AUGHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHh
AUGHHHHHHHHHHHHHHHHHHHHHHHHHHH

The worst part of the day I can't share …let's just say an incident report was filed and it was partially my fault. My OT was really understanding though….and I learned an important lesson.

So….the census is almost double as high as normal….and this afternoon we were short a tech for whatever reason, and it was just overly busy…I coulda been like “No I can't help you…or you…or you…or you…” because none of it was billable, but it was a conscience thing. In good conscience I couldn't turn my back on these people….like the restless fall-prone guy who was getting out of bed by himself…but just needed his jacket off because he was hot…and then another lady was so restless and jumpy-out-of-her-skin because she was desperate for a sense of control and wanted her clothes…which were lost…blah blah blah…we finally found them in her OLD room…but I spent easily 30ish minutes with her…she was NOT doing well and I knew she really needed someone to give her some attention and at least a modicum of sense of control and that finding her clothes wasn't high priority, obviously, to busy nurses/techs. But I know her well enough as my patient to know she really needed this. This poor lady needs a lot more than meds to keep her from coming back – she needs a lot more coping skills/strategies. While I could have turned into a treatment, I was stressed and busy and trying to do a thousand things, so it wasn't a treatment, lol. Then I was helping a mean lady's diaper get changed, stuff like that. Then a wheelchair seat belt alarm went off and I went to the guy who had taken it off, he was cursing and tried to hit me when I went to try and re-do it so the alarm would go off. I turned it off a second to spare us all the high-pitched screech. I tried again slowly but he was still mean and angry and swiping/cursing. I had to get the insanely busy man-tech to help me. Then there is the lady spitting out her meds onto the floor next to me, the lady stopping me to ask this, the man wanting this, blah blah blah. It sounds like it wasn't a big deal, but it was REALLY stressful to see so many of my patients having issues…these people have so little control, so when the techs/nurses are too busy to listen to them or help them with low priority things (high priority being injuries, medicines, admissions, discharges, etc), that the people get upset…..and that incident I can't discuss in detail (just for self/hospital protection) REALLY stressed me out…I was sure I'd be in soooo much trouble…luckily I think it's all going to be okay…did I mention AUGH?

We have several max assist stroke patients in there now – which I'm not really able to handle by myself – I guess really they are mod/max assist x 2 – and they would ideally get some therapy for their affected extremity along with everything else – and many of them would benefit from physical therapy – but there just isn't any to offer….ugh. It's frustrating to know some of these patients aren't getting all their needs met….and time is taken up with stupid stuff like finding or ordering more gowns, finding a diaper, waiting for more towels to be brought up, trying to find a pillow (never did find an extra)… to prop against the back of a stroke patient, etc…

I finally left the area ….after having been there an extra hour+ after the final billable piece…basically doing tech duties……to me, a person with major depressive disorder and no coping skills, who is restless and getting agitated and feeling no control, needs some immediate soothing and help, even if its a low priority thing….even if its not billable or productive…but just because it is in the best interest of the patient. Oh and while trying to leave there is the cursing and gesturing man blocking the locked door, bleeding, other elopement-happy patients near the door, etc…even trying to leave was kind of an ordeal.

I went down and called a friend quickly and cried…from all the pent-up stress and from the incident….I'm still kinda shaken up but once I go in tomorrow and see everything's okay, I guess I'll be okay again….learned a sobering lesson. Sorry to be so dire and mysterious, it's not like I massacred fifty patients or anything, just safer not to go into detail.

Ummmmmmmm………..anyway……luckily the friends I am staying with are nice…my friend that I cried to went and got yummy food like guacamole and yummy ice cream, and a few other little gifts, to make me feel better!!!

Gotta steel myself and get through tomorrow…gotta figure out groups….next week is Week 6…midterm evaluation……ummmmm

mini update

Oh my gosh, please kill me

A squirrel in the pants: I've got nothin'

Week 5, Day 3, Complete, of Geriatric Psych Inpatient, Level II OT Student Fieldwork, Third rotation, so Month 8 out of 9!!!

Funniest story of day: Lady convinced there is a squirrel in her pants, causing mischief….when the family called for an update, the nurse had to delicately explain the belief of a squirrel “in the vicinity”, leaving out the in her pants, part, lol.

Most yikes story of day: Lady telling me there are men in the cellar doing sexual things with the girls, and to be careful…she brought it up several times.

———————————

Today I only got 24 units (which pales in comparison to my 29 or so, but is better than the 20 I am supposed to aim for as a minimum).

I did one eval, several ADM placemats, several MMSEs, and several groups.

Eval: confused lady sure she was in the wrong place…frustrated with inability to handle questions….felt sorry for her.

ADM placemats: Its amazing how poorly do with copying a relatively basic heart-shape pattern.

MMSEs: this one lady in her 90s counted backwards from 7's from a 100 without trouble, but only got 2/10 basic orientation questions. Impressive.

Groups: Not so inspired today. Everyone was sleepy, and I wasn't overly excited about the topics. By the end it was a little like pulling teeth…not horrible, but not easy and fun…just kinda blah. Plus we had quite a few distractions. But the tech in the room – who I really like – praised the attempt at the end and everybody clapped and I was like awwwww…..lol. I thanked her later for her encouragement and she was really complimentary and sweet…my groups are improving although today was a regression lol. I think *I* have to feel the group has merit/good qualities, or they sense my unease. I really like overall the discharge planning/leisure group, relaxation group, exercise group, and somewhat Social Bingo group, but just about all the rest haven't really been so hot. Think think think lol.

I know I say this like daily, but I can NOT BELIEVE I'm sitting here running multiple groups of 4-9 people a DAY….it's like shocking to me.

There is a dead zone from like 915 to 10am where I don't necessarily see patients but should…but that is rec therapy time and I hate to pull them out of the one or two fun things that happen in a day!!

One lady told me during the ADM Placemat task how sweet I had been and how she was gonna tell the doc and I was like thinking yeah right! You have to remember who I am first! LOL! ahahahaha. I think (most of) the old ladies see me as a grandchild age and treat me accordingly…we finished it awfully quick and then she held my hand and we chatted a while about her passed away husband…her hands were cold and she has arthritis so I stroked her hand and listened to her chat a few minutes…it was nice. Some of them remind me a lot of my grandmother…the good parts of them, at least, lol. I love my grandma. (And my other grandpa, I need to call him!!)

I'm back to struggling with massive fatigue again…..it seems like if I don't sleep for at least an hour-hour and a half after work, I can't make it until even 8 or 9pm…and I'm just so tired the rest of the evening regardless if I sleep or not…it means I get very little done after work because I'm so foggy. Everything piles up…I need to pay bills, start studying for boards, work on final professional development evaluations, respond/handle the hundreds of e-mails I have stacked up, many of them OT related, and start planning for what happens after the rotation!! I've gotten several emails lately with great questions from potential future OT students…I may just ask them to call me. I've talked to several people on the phone who had questions about OT school and had emailed me. I have to be careful when I talk to them though since my calling plan is limited!!

Okay now I'm just rambling……..gonna go to bed I think…tomorrow I'm going to force myself to go to the gym after work since I skipped today….

I think there will be at least one eval tomorrow….2 groups….and then I really should do a bunch of LACLS and catch up on ADLs and ADMs and GDSs…..ooh alphabet soup lol.

Ok…um…groups tomorrow…hmmmm…..think, think, think….lol

Ummmmmmmmmmmmmmmmm

Today I did an eval, a CPT, 2 showers, and groups with 8-10 people in them at any time, including one lady coming in and out causing trouble. Got 26 units….

Group was actually….almost but not quite….fun….the first one was a Social Bingo game and my favorite is when they get a square that requires giving a compliment to someone on one side of them….

The next group was on relaxation….each of them talked briefly on if they relaxed or not easily, and how they currently tried to relax….some ideas better than others, lol. We did one quick guided meditation, some chair yoga, and listened to an native american flute CD with eyes closed/lights dimmed (Canyon Trilogy by R. Carlos Nakai I think)….it was kind of a quick “imagine the possibilities” on relaxation….most of them were pleased with idea of listening to CD. Afterwards we discussed the visualizations, etc, and what each person would consider trying as new form of relaxation. People seemed to enjoy the group, especially the music, and overall it was pretty fun.

I think tomorrow we're going to do one problem-solving group…and hmmm…

Short entry tonight. No very intriguing people today.

Week……..FIVE?

Today was very busy…4 evals and a census of 12 + 1…all mine…lol. I had NINE people in my first group….yep, nine. Me and 9 psych patients. In that group was a combination of people with psychotic features, mood disorders, major depressive disorder, and dementia……and two monopolizers. Ack. I keep marveling at the idea that I'm running these groups.

first group on self-awareness, second group on coping skills for depression. What irritated me is some pheblotomist or something came in during group and while I didn't mind that she obviously needed to do her patients, I minded that she ACKNOWLEDGED it was group and that I was doing it, yet stayed and talked to the patients in the room at a normal level. Either take them out of the room or at the very least, talk quietly! I was like WHY LADY WHY. Then she came up with the great idea of us getting a van so we could take the patients to an animal shelter to cuddle them. I was thinking…..these people are here like a WEEK with ACUTE issues….most of them combative/aggressive when confused…no way are group community outings appropriate for this population during this type of hospitalization. Anyway, I was rather surprised at her level of obliviousness in terms of being quiet even though she knew I was doing group and was actively loudly talking over her. My OT told me I should have asked her to be quiet, but I don't think that would have gone over well with her, seeing as how she was an employee.

One patient spoke up and told me I was a great speaker and she enjoyed group and I was like aw, thanks! Then the lady next to her was like “You said that to the last lady too!” and I was like….oh man, deflate my balloon or whatever.

One monopolizing lady with lots of pain issues was like “I have pain, I should go lie down…but I think Satan is the one trying to get me to do this. Satan, I rebuke thee in the name of the Lord! I'm going to stay.” …..several times she rebuked Satan. I was like ummmmmmmmmmmmm. lol. She reminded me SO much of the lady on Trading Spouses or whatever, the Christian lady who went crazy and said THE EXACT same thing  (I rebukee thee…) as she screamed at cameramen in her house.

What else…..during an eval today a lady with hallucinations who was perfectly sweet and appropriate said “Oh, there she is waving at me, I hope she realizes I'm busy”….and yet it was just her and me in the room. It was one of those “Am I crazy or did she just say that?” blink-and-you-missed-it kinda moments. You know how we blink and miss it? What happens when we miss it with our ears, since ears don't blink? Hmm, earblinks.

WHAT ELSE……..we were listing coping skills for depression and one lady said “eat a lot!” and snickered. Her normal answer is “smoke” so I guess that's a slightly better response. She cracks me up.

Um…..one patient went down on the floor today and they went and got a Hoyer lift to get him back up..at the same time another patient vomited, and another patient who requires 2 people for help, needed to use the bathroom that was currently being mopped…lol. Chaos.

I got 29 units again today….had to write FIFTEEN notes for group alone lol…and have to type out objectives/goals for EACH one since their systems are so old/DOS-based there is no copy/paste!!!!!!!!!

Um, a patient got agitated today and grabbed onto the unit clerk….they verbally took her hands off the clerk, then redirected her verbally….and they casually mentioned she got agitated around this time each day. That is an occupational therapy mystery as to what sets that lady off then. Hmmm. My guess is she had some kind of errand or chore she did around that time previously, and/or that having more than a few hours of down-time with no entertainment, agitates her….since the last group of day is rec therapy from 1 to 130.

Oh….one last backtrack…I did an eval on a lady Friday in another unit than my normal one…..the unit is connected to the acutely psychotic unit. I went into the nursing station which is enclosed in something like Plexiglass and encloses both units. Some guy started banging on the window and yelling and pointing at me. I was like AUGH!!! Luckily my lady was not in that part since no way was I going through there. This lady was WHACKED OUT….young but not a lot of teeth and she got a SIX out of THIRTY, scoring in the SEVERE dementia range…I'd ask her questions like, what month is it? and she'd take like five minutes to ponder it….”Oh…gee whiz….oh….brother….I don't know….”

I think the “What floor are we on?” question is really stupid. If you are in a psych hospital and all messed up, the last thing you remember is what elevator floor button got pushed as you were taken to your floor….”AUGH THE SCORPIONS ARE EATING MY BRAIN OH LOOK FOURTH FLOOR” lol….maybe I don't get the point and I write this in ignorance. It wouldn't be the first time.

Okay….I know this is too long and most people didn't read it all…but now it's all out of my head and I can go to sleep. I gotta figure out my groups for tomorrow though. I'm thinking a social bingo game to work on social interaction, and then maybe a relaxation group….with a mini array of possibilities….I could read one guided meditation, play one flute relaxing music, discuss deep breathing, and maybe do a few basic chair yoga like things. I dunno. Hmm.

Thurs/Fri

So…when I don't write for even a day, I lose it all. Let's recap the very little I remember from Thurs/Friday.

1) Shower with man with dementia, aphasia. Learned the hard way about poo everywhere. And getting wet from the shower. And sweating from transfers. And being cursed at. “G*d-damnG*d-damnG*d-damnG*d-damnG*d-damnG*d-damnG*d-damnG*d-damnG*d-damnG*d-damnG*d-damn”. I was WORN out from that experience. But the nurse told me later he won't even shower for most people (and he curses a lot), so I was glad I did it I guess….good experience, but holy cow.

2) Dealing with monopolizers in group….the constant “Oooh let me tell a funny story”……

3) Lady with depression – more alert than most – always present for my groups – who told me at discharge (I walked past as she was waiting for husband to pick her up) that “You are a great occupational therapist. Remember you are not going to get 100% from these people, maybe even not 50%, but it's not you, it's them”. I thought that was a very insightful and interesting remark on her part…I really liked her. I tend to really like the older depressed ladies.

[I didn't think that was a good time to reiterate I was a student, lol]

Okay….now on to TODAY.