Poo and compassion, uniquely combined

Today involved a combination of poo and compassion.

I did several quick ortho evals, then went in to do a therapy session with an older lady who just had a hip surgery the day before, and also had COPD so she was on oxygen at all times. The physical therapist and I went in together to get her out of bed and into the chair, except she needed to use the restroom. The PT helped her use the rolling walker to get to the bathroom in her room, which has a bedside commode over it, meaning it was higher/had rails. She was untethered from her oxygen for this. The PT then left to give her some privacy and I stayed in the room as I was going to finish treatment with her. Unfortunately she was having difficulty completing her bowel movement and was in a lot of pain. I contacted nursing, nursing did what they could do without a doctor's order, and in the meantime, to make a long story short, the old lady was becoming increasingly short of breath, agitated, dizzy, and in a lot of pain – and still sitting on the commode. The nurse was doing a fabulous job but this lady needed to be back in bed with oxygen back on, asap. The PT was paged and he wheeled the hospital bed all the way to the bathroom door – the nurse and PT and I all kind of helped her transfer – she was somewhat, understandingly, feeling panicked at this time. We got the room back in order (ie oxygen back on, IVs plugged back in, etc), and the nurses prepared to do fecal unimpaction – ie, literally use their lubricated gloved fingers to scoop the hardened stool from inside her bottom. We rolled her onto her side which pained her greatly considering her recent joint surgery, not to mention the trauma she has just been going through. While I technically had nothing to do with the actual unimpaction, I was kind of an extra pair of hands helping with little things like communication, moving things around, etc – and the session had started with me thinking “Ok, in a minute this will be resolved and we can do our therapy” and eventually of course I realized that wouldn't be the case. While the lady was on her side, I sat next to her facing her and stroking her shoulders and hands, as the nurses did their thing behind her. It was one of those things where its productivity versus compassion and compassion wins. All in all I spent about 45 minutes in the room with her and 30 minutes of it was non-billable – but it was one of those times where “therapeutic use of self” and compassion and patient-therapist rappoire was more important than billing units. Now if I had like sixty patients waiting on me that would have been a different story, but my student schedule is such that I could spend that time with her. It was definitely a learning experience on many levels, and I know the lady appreciated having someone sit with her for the sole purpose of comfort. I went back and checked on her in the afternoon and she was feeling “100% better” and thanked me.

In the afternoon I had a quick session with a patient who had a CVA – stroke – with R. sided neglect. I asked his nurse if I could see him and she was like you can try, he says no a lot. That hadn't been my experience with him though in the last few days. I went in and he was lying in bed instead of sitting on the couch like normal, he looked sad. I sat down next to him and talked to him a little. He is aphasic but can get basic points across, and understands pretty well. He was able to communicate that he was feeling rather sad, and also that his arm was improving. I sat next to him and stroked his right arm for a while, just for some sensory input, as we chatted. I didn't want to push him and be cheery and be like let's get up and move! because I knew this patient well enough to know it would agitate him/potentially cause him to become combative, which he has become before. He allowed me to do some passive range of motion exercises with his arm – like shoulder flexion, shoulder abduction, elbow flexion, etc -and then after we had done a PROM a few times I would have him show me his ability to do the motion himself – I had to facilitate the movement because his control isn't very good – but it's improving.

After work today I went to the gym, went to my friend Kerri's to check on their cat (her husband's grandmother died so they were away for funeral, very sad), then met up at a Mexican restaurant for an OT meet-up. OT student Jason, Mary, Minda, Brooke, Virginia, Me, were there…plus Virginia's husband, Brooke's boyfriend, Minda's two roommates…so a big crowd. Very fun. Then I went to Walgreens to get my FIVE DOLLAR GENERIC DRUGS BABY! and then came home to my crazy cat….something is now wrong with his ears, he is like flicking at them buzzing around and it's really weird. I'm keeping an eye on him.

I have so much more to share but it's 11pm so I want to go to bed. I have like FORTY OT-related e-mails, many of them personal, that I'd like to respond to and/or post on this blog…ONE DAY I'll catch up. ONE DAY. Getting my AOTF scholarship done was a big deal, I did some banking tonight related to the financial issues of the break-in, and tomorrow night after work my goal will be going to the gym, going to Bingo, meeting a friend for dinner, and buying my San Diego tickets home for Christmas.

Maybe this weekend my goal will be to complete thank you notes from my birthday, catch up on gmail, aol mail, facebook mail, and blog entries. Yeah right. But I can dream.

Nov 13, 2008 | Category: Occupational Therapy | Comments: 1