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.

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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.

bleh

Today I got 29 productivity units, my world record. I had three evals, an hour long shower ADL, and 7 people in two groups. So I had to write 20 notes!!! My OT got 20 units, so we had 49 total!!!!!!! A new record for us….lol.

Interesting day…too bad I don't feel like writing about it right now, ha ha. But some key words to remind me when I do write. Severe dementia/delirium, catatonic to not, monopolizer, remember pop not 100%

ANYWAY……..I'm tired, yo. Maybe I'll post later this weekend.

END OF WEEK FOUR! ONE THIRD THROUGH MY FINAL ROTATION! UM, I SHOULD PROBABLY START STUDYING FOR BOARDS – AND/OR FIND OUT WHEN THEY ARE – AND/OR START FIGURING OUT WHAT STATE I WANT TO LIVE IN/WORK IN………..just a thought.

poo

Showers and mental health = there IS a correlation

A friend commented today, “I don't see what showers have to do with mental health”….ie why I “watch” people take showers.

First of all, I prefer to say I observe/assist (either with verbal prompts or hands-on physical assistance), rather than “Watch” lol. That sounds creepy. I try and be as discrete as possible, I know nobody wants to be observed… although most of these people don't seem to care at all.

Second of all, there really is a link. Showering and dressing are both activities of daily life (ADLs). ADLs are often greatly impaired in people struggling with mental health issues,
whether it's dementia or major depression or a psychotic disorder or who knows what. People struggling with mental health are not functioning at top cognitive potential, and often
struggle with basic things such as remembering to wash all body parts, sequencing correctly, safety, etc. We can get a pretty good grasp of someone's cognitive functioning level by how they shower/dress. Do they forget to wash major parts of the body? Do they not notice their t-shirt is soiled or inside out? Things like that. Plus if we do some assessments near the beginning of their stay, and then again regularly through the rest of the stay, we often – hopefully – see an improvement in function that can be concretely graded.

So…showers DO have to do with mental health. 😛

Hmmm

Well after speaking to switchboard operator and nursing supervisor who confirmed the outpatient area was closed, and no therapists around still by 820ish, I decided that since it was snowing, I should probably go home, instead of sitting around by myself. I almost slipped several times just walking to my car. The drive was scary. Around 830 when I was driving home carefully, I got a phone call from my supervisor, who was now at work and had just been running late. She was there to do the geriatric unit. I let her know I was on my way home although I could turn around, but she was okay with that since roads were a little iffy. Roads were scary to me a little bit, and then just walking down the hill to get into friend's house was also a little scary, I slid a few times. I feel bad that I didn't stick around longer, but I really felt certain things were closed and I didn't want to wait for roads to get any worse.

I couldn't have done anything without her there -and since outpatient is closed, she just has the ward, so I think she'll be okay (and she lives really close)…I just don't want her thinking I'm lazy!!!

I have her home phone number, but it's here at home. It never occurred to me I might be at work and need to call her at home. Now I know better.

ANYWAY….gonna go lie back down I guess. Hmm. b