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.

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