Sunday, October 18, 2009

Substitute Grandparents

I always imagined myself in a career where I would work with children. When I was a child myself, I wanted to be a teacher someday. I couldn't wait until I was old enough to babysit and then when the time for college came, I took on any job I could that involved kids. I was a behavior teacher to kids with autism and a respite care worker for families with special needs.

Life led me down a different path. After school I worked in a rehab facility because they paid for my schooling. But I was the lead therapist if we ever had any pediatric patients (we had one while I was there). Then Tom and I got married and decided to move east. The job offers came easily for skilled nursing facilities and I took one with the paycheck that could support us until he got his business off the ground, always thinking someday I would venture into the pediatric world where I really belonged.

Life again took over. . .I actually found pleasure working with the geriatric population and stuck around until my first child was born. Then I quit the job and went to work for Tom for awhile until after Kylie was born. It wasn't until the RHCI Children's Center opened that I considered going back into OT. That's what I became an OT for, right? It was the kids.

So for 2 years I worked with children, both in the rehab setting and in the schools. But something kept leading me back to the geriatrics. Maybe it's their stories about their rich, fulfilling, sometime difficult lives that I can't get enough of. Maybe it's the challenge of trying anything and everything to get them home again where they want to be - to help them not give up and give into the process of aging - not yet. And the rewards I would experience when we as a team of therapists, nurses and doctors would be successful.

Two patients of mine that I have had over the years really stick with me. I will change their names to protect their privacy, but if any of my co-workers read this, they will surely recognize them. First is George. He is a sweet, loving man in his 90s that has lived alone ever since his wife passed away. He still managed all his own household and yard duties, still drove and still made all his own meals. What brought George to us was an accident on his riding lawn mower. He had gotten his leg stuck in between the wheel and the engine and had been there for several hours before a neighbor happened upon him and helped him. He had broken his leg and surgery (due to his age and heart trouble) wasn't really an option. So in he came for rehab with his knee immobilizer on - needing us to make him strong and safe again to go home.

George was extremely hard of hearing and I usually have difficulty communicating with someone very deaf. I have a soft voice and sometimes even if I feel like I'm shouting I still can't get the person to understand me. But somehow George and I could communicate with each other. He had soft, penetrating eyes and a fearless expression on his face at all times. While I would be working with him in therapy, we would talk extensively about his life, about my kids, about books, the news headlines and about why it was so important for him to get home and be independent once more. He was strong and feisty and I looked forward to all our sessions together. I often thought of him as a grandparent figure. If either of my grandfathers had still been alive, I imagined these were the kinds of conversations I would have with them. When we sent him home, I was sad to see him go, but satisfied that he would be safe - for now anyway.

Then there was Kathryn. 92 years old and mentally sound and competent. She had been shopping at Stop and Shop for a family picnic and had lifted a large watermelon (she always brought the watermelon) to put into her cart. But the watermelon had slipped from her hands and instead of letting it smash to her feet, she instinctively reached out to catch it. In doing so she tore the rotator cuff muscles in her shoulder. Being healthy, the doctors decided to give her the surgery necessary to regain some of her function.

Kathryn came to us in a lot of pain and needed some TLC and encouragement to participate in the rigorous rehab of her shoulder. She reminded me of my own grandmother before she had started to lose her memory. Grandma had been a patient of mine in Kansas after she broke her hip. She hated pain!! Had no tolerance for it. But she was fiercely independent and don't you dare ever suggest she needed to slow down or stop driving or carrying a watermelon! So I would very, very gently range Kathryn's arm during therapy, thinking of Grandma. And to distract her, she and I would talk about her husband who resided on our long term Alzheimer's unit. I was intrigued by her stories of her life before he had become sick and how she had witnessed his slow decline from successful respected businessman to someone who couldn't remember his the names of his children or eventually how to feed himself. Kathryn was sad to have lost him in such a way, but at the end of each of our sessions she would ask me if I could wheel her down to sit with Al downstairs. I would oblige and would even stick around to watch as he ignored his own wife, or when he would acknowledge she was there, would say something mean and spiteful toward her. She would never give up in her devotion to him, would explain to those around us, "This isn't Al talking. It's the Alzheimer's. He was never anything but kind to me in our lives."

Kathryn's spirit and determination was inspirational to me. I found a deep respect for her and a certain kinship. I was determined that we would get her back home independent again and one day she would be shopping and driving just as before.

Al passed away shortly after Kathryn was discharged home. It made me feel sad for her, but I knew the Al she had known and loved had been gone long before his death. Now, maybe, I thought to myself, she could live without worrying about whether he was eating right, or not being aggressive toward the staff or not falling out of bed and breaking a hip. Now Kathryn could focus on her own health.

Both of these patients I had worked with about a year ago. Now they are both back at our facility once again. They have both declined significantly over the last year. George's knees will no longer support his weight at all and he has to be transferred with a sliding board in and out of his chair. He is awaiting surgery - the surgery that the doctor a year ago didn't advise because of his heart condition - but now without it he will never walk again. He is not on therapy services as he waits for his operation, but I find myself in his room every single day checking on him and sitting at his bedside, falling into the easy conversations we once had. Now his breathing is labored and he wears oxygen most days and I worry that if they do the surgery he might not wake up. I worry that if they don't do the surgery he will pass away from loss. . .the loss of his independence and future.

Kathryn had fallen at home and broken some vertebrae in her back. She wears a back brace and has a lot of pain and discomfort with walking. She doesn't remember me or our conversations we had the last time she was there. Her mind, once sharp as a tack was now leading her to be forgetful - forgetting our names and why she is there, again reminding me of my own grandmother's decline. I look at her with sadness, wondering if losing Al was more than she could handle. Maybe she needed him alive, to keep her own mental status in check - because she had something to focus on - he needed her so she maintained herself for him. I still stop in and chat with her even though she doesn't know who I am. I see the confusion in her eyes and the wish that she could grasp onto some sort of memory that would link me to her.

There are many other patients I have worked with over the years that also stick with me. There's Mary who had a stroke with complete right sided flaccidity, but she never lost her sense of humor. She was a difficult transfer and once I found myself sitting on her bed with her in my lap (the only way I could have kept her from hitting the floor) both of us erupting into a serious case of the giggles before another therapist happened along and untangled us.

There is Frank who survived a submarine explosion in WWII, lasting for 2 days in the frigid water until a cargo ship happened along and rescued him, taking him to New Zealand where he recuperated for 2 weeks until going home to a family who had already had his funeral.

Who can forget Stan who had a stroke that left him unable to speak with his voice, but had an amazing ability to get his point across with his facial expressions, stomping his foot, and pointing rigorously to his communication board.

Then there was the one patient in Kansas - Paul - the young stroke patient who had at one time played for the Harlem Globetrotters. He also was aphasic (unable to speak) and had severe neglect of his right side of his body. The sadness and helplessness in his eyes was difficult to bear with at times. I would find myself constantly praising him and encouraging him even though his progress was extremely slow and hopeless.

And Tim. Oh, Tim. He was the 19 year old spinal cord injury patient who dove into a pool at a party and had broken his neck. I was only 22 when I worked with Tim and he used to look at me with such determination and hope that he could overcome this. His parents wanted him transferred to a top spinal cord injury center in Hawaii, sure that something could be done to progress his therapy even faster. He was destined to a life in a wheelchair and I often wonder where he is now. Did he succumb to the complications that can arise from such an injury? Or is he still out there looking for a miracle to get him walking again? Or maybe he became a spokesperson for spinal cord injuries. I'm sure I'll never know.

And there is Eliza who wants to go back to her house so badly and live alone, but is battling fiercely with her children who think they know what's best for her and want her to move to an assisted living. But she won't budge in her stance and I worry that if her children are successful in getting her to move from her beloved home she will slowly wither away and be consumed by her own depression.

Each person I see has a story - a long, rich, complicated story that led them to the point in their lives that they needed my help. I am there to try to assist them through this phase in their lives. Assist them to return to some kind of functional life where they can live out the rest of their days in peace and happiness. So the reward, although not what I expected to be doing when I started this career, is satisfying and complete.

Thursday, October 15, 2009

Mary, Mary

A shout out to my friend Mary who informed me about this great query contest done by another Mary from . .check it out all you writers! Deadline for entries is October 31. Hmmm, now which one should I submit??

Monday, October 12, 2009

Being 6

I am the proud mother of a 6 almost 7 year old. Inside a 6 year old's mind must be a truly happy place to be. To be able to dance through life on a whim would be purely magical.

My 6 year old is one that has a hard time focusing on what she "supposed" to be doing. It's not ADD. . .she can focus fine in school - in fact almost too well. But unfortunately the rigors of 1st grade don't allow for a whole day to be spent on getting the googly eyes on her sock puppet positioned just right, so that leads to frustration and tears (I think less this year than last, so she's learning to adjust).

But no, her focus is difficult to maintain at home. Brushing teeth is a perfect example. I tell her to go brush. . .then 10 minutes later I tell her again. . .10 minutes and so on until she's finally in front of the mirror. But wait, first she has to wash her hands, but the sink is all wet, so first she has to dry the sink off, but the towel is wet from Melanie who just washed her hands, so she needs a new towel, and so on. Finally she gets her toothbrush in her hand but then she catches sight of herself in the mirror. Oh, look at the funny faces I can make! "Mommy, come here! Look at my fish face!"

"Yes, yes." I say. "Come on. Let's brush." I hurry her along and give her the toothpaste. Oh, too much toothpaste, need to start all over. Finally get just the right amount of paste and wetness on the brush so I retreat across the hall to let her brush.

And then "AAAAAAA!!!!!!"



"What, Kylie? Why are you screaming?"

"There is a fly in here!!!! AAAAAAAAAA!!!!!!!"

I look to no avail. See no fly, anywhere.

"Kylie brush." It just by this points comes out of my mouth automatically for about the 3,000th time in a 5 minute period.

We have a rule that you stay in the bathroom over the sink while you are brushing your teeth. Does anyone else have to implement this rule? Well it's a rule that Kylie has successfully broken each and every time she brushes her teeth. She dances down the hall, comes to tell me a story about something that happened in school, goes through Melanie's things, etc, etc all while the toothbrush is in the side of her mouth brushing the same 2 molars.

Finally after 30 minutes from the first time I told her to brush, she is finished. Not sure if she actually got all the teeth, but maybe next time.

Then there are the times when we are all busy bees, cleaning, putting away clothes and so on. Melanie is quietly in her room doing what she is supposed to be doing. From Kylie's room I hear music and then. . .

"Turn, gallop, gallop, gallop, turn, plie'. Step to the side, turn, gallop, gallop, turn plie'." I open the door and see her eyes closed dancing around the room with a pile of shirts in her arms she is supposed to be putting away.

"Kylie. Focus please. Let's get your clothes put away, then you can dance."

"But Mommy, I'm working on my show for tonight. Watch." Then she proceeds to gallop, gallop, turn, plie'.

This past Saturday night, Melanie was at a sleepover and Tom didn't have to work. We had a rare night with just Kylie all to ourselves. Tom wanted to go for a run, so we decided to pack Kylie's bike in the car and all of us head to the canal.

"She has trouble going straight and getting herself started." I tell Tom.

Every time I try to get her to start herself, she has about 300 things to tell me. All non-bike related.

"Are those bats?" She says pointing to the Cormorants perched on the dock.

"No, honey, Cormorants. Ok. you need to put your foot down and push off as the other foot goes to the pedal."

"Is this the deep end?"

"Deep end of what?"

"The canal?'

"It's all deep, all the way through."

"What if I lose my jacket?"

I look at her. Her zippered sweatshirt in on her securely, zipped even.

"How would you lose your jacket?"

"If I fall in the water. What if my jacket falls off?"

"You're not going to fall in the water. You would have to drive off the sidewalk across 10 feet of grass and rock before you would even come close to the water. Ok, now push off with this foot and put your other foot on the pedal."

We finally get going and she rides on the left side of the yellow line. The side that is heading straight into the incoming runners, bikers, rollerbladers, etc. Luckily it's near dark and the canal is nearly deserted.

"Kylie you are supposed to stay on the right side of the line."

"I don't want to fall in the water."

Then she weaves. From one side of the sidewalk to the other.

"Try to go straight."

She giggles.

Tom is running in front of her, turning around, running backward.

"Follow Daddy." I tell her.

She giggles again then slams on her brakes. Tom comes to her to help her get started.

"Is there a such thing as bats, daddy?"

And so it begins again. . . .

When my cousin who is 10 years older than me was visiting with her family this summer, after having a chance to get to know the real Kylie, she commented to one of my friends, "I remember Kelli as a little girl at Grandma's house. She acted just like Kylie."

"What?? No way." I say.

But my friends laugh and grab onto that statement. Now everytime Kylie acts up around them they say, "she's just following after her Mama!"

Could it be? Did I act like that?

Every once in awhile, when I throw responsibility to the wind and forget about that ever ticking clock that is telling us we are way past bedtime, I'll find myself next to Kylie. . .

Gallop, gallop, turn plie'. . .all while making fish faces.

Friday, October 9, 2009

Beyond the surgery

Eighteen days post-op from gallbladder surgery and other than one itchy spot I feel like nothing happened.

I had no idea what to expect the recovery to be like. The doctor's description was vague, everyone I talked to who had it done had a different story to share. Some were down for the count for a month, others were back to work 4 days later. I would say for me it was about a week before I was feeling somewhat normal again.

The first 24 hours were tough. I learned that my stomach is much weaker than I thought. I always prided myself in my iron stomach. The sight of blood doesn't bother me. I made it easily through dissection cadaver lab (a whole summer of dissecting a human body that had been eaten away by cancer - saw things that could make your head spin. We had to actually abandon our body and join another group because the organs were so badly damaged). I work with patients who have open wounds and varying continence levels (do get a little nauseous when they brush their teeth though - can't really explain that one).

But give me a drug of any kind and my stomach goes into protection mode. After my c-sections I couldn't keep anything down for awhile. After this gallbladder surgery, I was afraid to take the pain pills right away because the anesthesia itself had made me nauseous. I finally gave in and had the nurse give me something. After all my shoulder was killing me.

My shoulder? I expected my abdomen to hurt, but not my shoulder. After researching it, I found out that when they pump you full of air to get a better look at the organs inside, the result is terrible shoulder pain. That was the worst. I couldn't take a breath.

And then there was the bladder issues. My bladder went to sleep with the anesthesia and took it's time in waking up. Like 36 hours worth of time. Bladder pain, shoulder pain, abdominal muscle pain. . .and then the nausea.

I went home about 4:00 on the day of surgery. I was uncomfortable at the hospital. Had to get out of that environment. I felt much better at home, but it was a long, rough night. And the next day was rough too. I was starting to regret having the surgery done.

But day 3 dawned and the pain wasn't quite as bad. I decided time for a shower and some ibuprofen. Now the shoulder pain was lessened, I could actually go to the bathroom (finally) and the muscles weren't screaming at me. I cringed at the sight of the morphine and knew I was done with narcotics.

Day 4 was even better than day 3. But on day 5 the incisions started to hurt. I hadn't felt anything from them until then. The doctor had told me that he put a long lasting anesthetic on them. I think I felt it the moment that it wore off. More ibuprofen and I decided I was ready to drive again. Mom and I met my girlfriends at the canal and despite windy, chilly conditions and pants that were a little uncomfortable across my swollen belly I walked the entire 4 miles with them. Woo-hoo! What an accomplishment!

But that night the fatigue hit me like a ton of bricks sometime during the pizza/bingo night at the school. Every year that is an exhausting, over-stimulating night for me. I don't know why I thought I could handle it 4 days after surgery. I was ready to go home and lay on the couch again.

Saturday was recovery day from Friday. Other than Kylie's soccer game, we pretty much laid low the whole day. Sunday back to church and then by Monday I was ready to re-enter the world full-force. So one week. . .for all of you out there who may have to have this done sometime. One week to feel normal again - but give yourself that 2nd week to ease yourself back into life, make sure you're ready to tackle the crazy schedule and routine. Have your mom there to lean on if you need extra help or need to take a break. That would be my advice! But we are all different. If your bladder doesn't decide to take a long siesta and you don't have any trouble with nausea, you could be fine even quicker. But if you have complications or an infection it could take longer.

Oh, and when the glue falls off sometime in the 3rd week. . .it's not pretty and it hurts like a band aid. . .a really stuck band aid on a really sensitive spot.

The doctor says I'm recovering perfectly and gave me one tidbit. . ."the only side-effect with eating from here on out is that now that you can eat anything you want to, you may gain weight."


"Often times my patients are so used to staying away from the high fat foods, that now that they can eat them they over-indulge."

Great, so the pint of Ben and Jerry's I had this week wasn't a good idea?

But the thought of some fried food and pizza and ice cream keep nagging at me. . .I stayed away from that stuff all summer and didn't lose a pound. Not fair. Since the surgery I am down 4 pounds, but I expect that to go back up now that my appetite is back (and with a vengeance!).

I have to say a big THANK YOU to my mom. She took care of me, rubbed my back when I was sick and kept the girls quiet, fed and entertained.

Tom was great too. . . stayed with me all that day at the hospital. . .didn't leave my side even to get himself some lunch, drove all over creation to find the horrible drugs that I didn't end up taking more than a couple of.

And the girls. . .I think they learned compassion and understanding for how to behave when someone doesn't feel well. I have two wonderful, strong daughters. Kylie asks a lot of questions about it all - the drugs, the pain, the incisions, the anesthesia. She worries she will have to have surgery too some day. A friend of hers just had a kidney removed (and back in school 8 days later!!!), so it seems she's surrounded at the moment and is having a bit of anxiety about it. But if she does end up having surgery someday, I hope that my and her friend's example she will know that she can be just as strong and healthy as she was before and not to be afraid.