Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Monday, May 07, 2012

11 years, so much happened

I've written about how 11 years is such a short time to have a career, yet it is hard to believe that it is all I had because I saw so much.  I'm going to keep writing these as I keep adjusting.

  • One of the hugest changes I saw was in death.  When I started working death was handled by the nursing home.  I remember the first time a family brought hospice in.  The nursing home staff was kind of offended and felt it was generally stupid.  Until this woman had the most peaceful, painless death after several years of pain from a disease that was challenging but not fatal.  By the time I stopped working in nursing homes it was generally expected that hospice would be involved at the end and Medicare tracked this as a sign of good care.
  • Another massive change was in restraints.  I hate this, but part of my job early on was to restrain people, which was thought to prevent falls.  It was always something that could happen but by later in my career it was much more specific what could be done, in what order, and many things we did in the early days like strapping trays onto wheelchairs then sewing the straps to tightly buckle in the back, or putting people in these chairs that were sort of like padded upright kitchen chairs with a tray and wheels that prevented the patient from being able to move themselves.  I used even worse restraints in the years I worked in psych but those restraints were so heavily justified that I did not feel guilty.  
  • Once in psych we were in the store room digging for a rarely used wheelchair restraint and found a straightjacket.  Those we did not use; it was there from  long before.
  • I found I really enjoyed quality improvement.  I worked very, very hard to get people to use the equipment I ordered, like splints, wheelchair cushions, and special utensils.  I liked tracking compliance and trying to raise it.
  • I learned a great deal about Amish clothing.  Remember, Ohio has the 2nd largest Amish population in the US.  I had numerous Amish patients over the years.  I also learned that in cases where their clothing was impacting their independence like by pressing on an incision that I could request that the church give permission for my patients to wear sweats (men).  It always always granted.
  • The most difficult patient for me to tolerate was a retired physician who had delivered several thousand babies but did not believe in pain until after he had surgery. He was resistive and asked me why I'd be an OT when being a PT ASSISTANT (emphasized by him) was so much more respectable.
  • Once I kept telling someone "the doctor says not to put weight on that fracture.  Don't use it to push your wheelchair or it won't heal".  A few months later he came to see me and to say "you were right". I said "huh?" and he held up a malhealed fracture.
  • I once over 18 months treated a woman with a non-surgical shattered upper arm.  It didn't heal.  By the end she could wash her hair with both hands, even though her broken arm bent just like it had an extra elbow.  That took a lot of prayer because I was as afraid as she was.
  • Being an OT you work on dressing, showers, bathroom skills, all that stuff.  In my career I:
    • clogged more than one toilet with using wipes improperly.  I never admitted this.
    • managed to pretty well coat a bathroom in feces once
    • got sprayed from head to toe with a spray shower, numerous times.
    • asked a patient to pull down his pants.  He grabbed mine.  I had lost weight and this could have been a disaster.
    • spilled a patient's big old thing of perfumed powder all over the nursing home bathroom.  I cleaned up the best I could, but again, best to not share who made that mess.
    • learned that many people are VERY obsessive in how much toilet paper they use and how it is folded, wadded, whatever.
    • learned to tell myself I did not really have someone else's urine on my pants and believe it.  It was not true.
    • undertook one shower where the patient developed explosive diarrhea so I got covered in poop, soaked by the shower, spent over an hour cleaning the floors and had to leave work because I was so gross
    • Learned that many people are very specific about what end of the shower curtain they use to step in and out and how far they will open it
  • Grew to appreciate good nurses.  Happy nurses' week!

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