A Good Epithet

To do this bit of writing, I visited an old Episcopalian cemetary in the town where I live. The beautiful old trees, architecture, and markers dating back to Confederate War times always make me feel peaceful and philosophical. One of the things that fascinates me most about this place are some of the epithets, of which I'll share a few of my favorites:
~"Trust, honor, reverence, self control
Gave to his life a sovereign power
And made him one of God's and nature's noblemen"
~"He was a planter, and a Major in the Confederate State's Army. Brave, gentle, generous, and kind."
~"Resting now in her mother's arms
Her spirit lives with us, wherever we find beauty"
I guess one of my personal definitions of a good death is being remembered for living a good life. Reading these epithets makes me want to let go of worrying with the trivialities of life and use my energy for the things that really matter. The kinds of things that will earn a person an epithet of "brave, generous, gentle, and kind". I can think of no greater aspiration, than to leave a legacy such as these 4 words convey.

Views on dying

As a CNA, I worked with several clients who were near death or dying. I had the privilege of being with them, holding their hands, wiping their brow as they took their final breathes. And in the end, I would prepare them for viewing for the family, brushing their hair, put clean gowns on them and make the enviroment as pleasant as possible.
I did find it interesting how many of the CNA's had problems dealing with their actively dying patients, they thought it was "creepy". I thought it an honor to be with them, as my mother in-law says "God will put you where you need to be". I figured God had put me there to comfort people, even when they were dying.
I was with my mother when she died. She was surrounded by her 4 daughters, each crawling into bed with her; like we did as kids when she woke from her Sunday nap. When I die that's the way I want to go. I don't want a funeral per say, I'd like a party, I always liked parties... eat, drink, be merry and celebrate my life.

Being forgotten!

A "good death," to me, would be a party. I do NOT want people crying over a lost love, friend, or family member. Even if I died tomorrow, have some fun people!!! I know, others would think of a good death in other ways, and I have thought about that too. But, in all actuality I know a truly good death would be dying pain free, with no guilt or wanting re-do's. I would rather be alone with my thoughts. But, I grew up that way, so it is very natural to me. I might want 1 other person there just to make sure someone knows that I am dead. I could not imagine someone laying there for an hour, let alone a week or a month without anyone knowing they were dead.

I think talking about dying comes pretty natural for a lot of people, me included. But, I know it would be hard to talk about if it were someone that would be passing before they think it's "their time." But, depending on the patient, I would go either with a straight talk, or with a sugar coated. They may think their family or friends will forget them. You may want to think about having the patient do change of address letters, or postcards as part of their therapy. This way they know the people they care about know where they are, and what is happening in their life, which is huge!.

In making the decision to move to a hospice, that really just depends on the individual. If someone does not want to go, I will try everything in my power to keep them at home. But, if they do not have someone to take care of them, or are unable to hire in someone, they I would really need to push them into making that decision. And that is when straight talking can some times be the better decision. If you sugar coat things, the patient may not fully understand the benefits that would be available for them at a hospice. Then on top of dealing with yet another move, the patient is taken away from another place, and have to re-acclimate yet again! They patient may withdraw from social situations because they don't know anyone. And it will be our job to get these people to feel comfortable enough to engage in the hospice. Which, depending on the person, may be easy or hard. But, that is one reason why I became an OTAS, I have that natural ability to talk to just about anyone, as long as it is in their best interest.

And, that comes full circle. Because you will need to acclimate someone to hospice, means you will also have to get them, or their family ready, as much as possible for the inevitability that is hospice. Doing a memory book with happy times, from the patient's perspective may give the family something to look back upon when the time comes. This would be a great asset to the grieving process for the family, as well as the patient. It would give them closure on their life. They can tell their story to their family, in their own words, and they won't be forgotten. No one wants to be forgotten!!!

Althazagoraphobia-The Phobia of Being Forgotten

Dying at Home

Dealing with the end of life of a loved one is never easy. One of my grandmothers suffered a massive stroke at 98 years old and never woke from a coma. Despite being pretty healthy and independent in most things, she had often said she was ready to go since all her sisters were gone. So when the doctor said there was no hope for recovery, my family chose to stop all life sustaining measures and bring my grandmother home to die. Home hospice came in to check on her and monitor if she was in any pain and to give her a bath every few days. My family consisting of my parents, siblings, aunts, uncles, cousins, nieces, and nephews either stayed constantly or visited daily. We came from all over the U.S. We talked to her, touched her and kept telling her it was OK to let go but she held on until my cousin Stephanie, who my grandmother raised, was able to get there. It was especially hard for Steph to see our grandmother that way and she was very upset we were not doing anything for her. It really helped to have hospice there to talk to her and be an outside voice of reason.

Having my grandmother at home was a much better experience for my family. A hospital or hospice center wouldn't have allowed the comfort and space for all of us to be together. Having the support of all the family around was wonderful and the little ones were included without having to worry about restrictions or other patients.

Not all families could or would want to do this. We were comfortable taking care of my grandmother and my cousin was experienced with having to give total care and she and I kept her clean in between CNA visits. We also had a hospital bed and a large house that accommodated the 15 or so of us that were there all the time and the 10+ that came to visit daily. We also knew this was going to be for a short period of time. I imagine a hospice center would be much like a home and for those with limited support, it would be a wonderful environment for a loved one's final days.

OT and Alzheimer's Disease

Up until recently, the realm of cognitive impairment has been intimidating to me as an OTA student. We recently had an in-depth classroom lecture and video on dementia and a competency where we were graded on our interaction with a patient suffering from dementia. I received positive feedback from my teachers and was surprised at the ease I felt when working with this patient. The feedback from the teachers as well as my newfound understanding of OT's role in working with these patients has caused me to become very interested in this practice area. I sought out articles this week regarding Alzheimer's disease and found a very interesting one on a Dutch study done regarding OT's influence on the AD patient's quality of life. The study found that OT sessions drastically influenced the functional level of the patient and the coping of the caregiver. According to the study, the involvement necessary by OT staff to affect this level of change is one that very few U.S. nursing homes are able to provide. The most significant finding, in my opinion, though, is that the decrease in close attention needed by the patient at home due to the OT interventions significantly decreases the total health care bill, in essence absorbing the cost of the treatments while dramatically increasing the quality of life of patients and caregivers. Here is the link to the brief article: http://mlive.com/health/index.ssf/2009/03/occupational_therapy_sessions.html

Oh, how I hate to sew!!

I was working with a client who had met all her goals and was being discharged the following week. The COTA that was working with her suggested that we should organize her rollator because it was becoming a safety issue. I had the brilliant idea to create a "reacher bag" for her rollator so she could store her reacher, long handle shoe horn and her beloved Chapstick (the cherry flavor). I have to say "it took a village" to make this reacher bag. If it weren't for my classmates sewing skills and my teachers ideas this idea would have never gotten off the ground. I needed to modify the length of the bag and add different handles; BUT when it was done it looked great and I was very proud of myself for finishing the bag. I especially liked it's front pocket for the Chapstick. I hope that will be one of many fabrications that I will do to help keep my clients safe.

Juggling

The past two weeks I have gotten to know a new patient. She is on oxygen due to COPD, and this week had another line to deal with because she was so dehydrated. I had never dealt with trying to move someone with any lines attached. But, this week I got my first chance. I was very happy to have my teacher with me! It really was a 2 person job since she was not stable on her own. I was nervous at first, but once we got into the room, all the nerves just went away. It takes a lot of forethought for these patients to know how to move with all of the lines they are attached to. Most people aren't used to dealing with IV lines or oxygen lines. It can be very tricky and very messy if the IV line is pulled out unexpectedly. Something I hope will never be my doing! I was thinking about IV's and found these couple pics. Just imagine if you are trying to use a walker, and have 2 lines attached and can barely hold your self up using walker, let alone drag an oxygen tank and an IV drip. Everyone should do that once, just to see what it really means to juggle. This first one is just funny, and I am sure anyone in the health field will see this more than once!

Team Support

This week at FW was a lesson in support from team members. Last week when I worked with my patient I was a bit discouraged that I didn't seem to be getting along with her. It seemed everything I said irritated her. I was not looking forward to seeing this lady again. I talked to my classmate who is also working with this same patient about her experience and I was relieved that it was not only me who had difficulty with her last week. She updated me on her treatment this week and how she interacted with her and said this lady was more pleasant this week. After looking over the OT notes I talked with the COTA who has been working with her regularly. She was very encouraging and explained that my patient hadn't been feeling well last week and that was the reason for her hostility. It really helped to discuss my apprehensions with my classmate and the COTA and hear their suggestions on how to approach this lady and get a better perspective on this lady. I was much more at ease about seeing her and it helped me to feel less defensive. Though this lady is still not on friendly terms with me, I was able to be cordial and get her to participate in therapy with very little complaints.

Role play

I had an interesting experience on FW this week. My client that I have seen from the beginning was dc'd, so I got a new patient. My instructor and I went into his room, and right off the bat he was very willing to talk, articulate (as we found out he was a retired professor), and had a pleasant personality. The instructor and I talked with him for about 15 min., when we decided to do the treatment in his room so he could ice his swollen ankle. Ms. M headed back to get all my supplies that I had left in the activity room, where we had originally planned to do the session. Well, as soon as the teacher left, my client let into me! First thing he said was "do you know what I would have done if a student had come into my classroom without pencil and paper?" - and despite the fact that I told him more than once that all my supplies were a different room that we had planned to work in, he didn't take to kindly to it. Now, the original plan was for us to get to know each other and maybe play some cards for this first session; when I tried to make conversation he basically told me that socializing wasn't getting him anywhere and I needed to check the charts before I asked him these questions. When I asked him what kind of activities he liked, he basically said it didn't matter what he wanted to do, he was going to do what the therapists told him to. This went on for about 10 min. (but it seemed much longer!)

To make a long story short, I was very much caught off guard, and did not expect that. After I left I thought about what just happened? He is a man who very much likes to be in control, and I think he took on the professor/student role, since he used to be a professor. At the time it wasn't "fun", but looking back it is very interesting to see how past roles can influence someone's behavior. It was another reminder that really knowing our clients and their backgrounds can greatly influence how we approach and work with them. It was definitley a learning experience- and I have learned that the way I respond can just as well have as much effect on how the session will turn out.

The Power of Empathy

I just wanted to take this time to tell you about a rewarding and educational experience I had this week on fieldwork. I did not know who my patient would be when I got to the site this week. When I got my assignment, I went down to the patient's room with the intentions of having a brief conversation to see what she would like to work on. When I entered the room and introduced myself, the lady grew very agitated and started complaining about the disorganization of staff and did not want to work with me. There was a brief moment when I thought about accepting her rejection but instead decided that I would view this as an opportunity. The pt. obviously had alot of pent-up anger that she needed to get out as she didn't stop with the first complaint. She continued to express complaints for the next 20 min. -about the menu, the staff, her condition, etc. I stayed with her and used my empathy skills that we have reviewed so much in the classroom and it worked. It was obvious that she just needed someone to listen to her and validate her feelings. She didn't need me to fix anything, she just needed to feel my concern. After the 20 minutes of talking, it seemed the well had run dry and she treated me very differently. She was willing to do a treatment session and was very pleasant from that point on. I am sure that being a patient in any type of institution takes a psychological toll on an individual and has the potential to make them feel like their voice doesn't count. It was a lesson to me that as a therapist, you can't use your clinical skills to help a patient if you don't first use empathy and listening skills to break down the psychological barriers.

Memory Books

Doing a memory book assignment on myself has been very eye opening. It is clear how great an experience this could be doing this with an elderly client. Reminiscing with my children and husband about what they remember most about our lives together and telling them the events from my past that have stayed with me has been fun and rewarding. Looking at the old pictures brought back so many happy memories, emotions and stories. By focusing only on the positive events, the book makes me feel good about my life. I can see how an elder would have a similar experience and how important that would be if their memories were starting to fail them. Helping them to selectively remember would give them back their self identity as well as give family and friends a way to connect to the elder in a joyful way.

Changing times

Losing your friends is very difficult. All of us know this to be fact. But, how much do we think of this as a reality of every day living as we are young. The answer is not many. As I am living in a different state than where I grew up, and my life is changing every day I am thinking about this a lot lately. Yes, I have good friends here in North Carolina, but my family and childhood friends are still in Ohio. Being relocated is very difficult to handle, yet we expect our parents to up and move as soon as they can not take care of themselves. They lose touch with their friends, and before you know it, depression kicks in. Yes, senior centers have activities that you can participate in, but you are not playing, or dancing with your friends. You are participating in these activities with complete strangers.

Anything can trigger depression. Whether it is moving out of your home of 30 years, a spouse's, friends, or family members death. Or even just a change in the weather.

Here is a link that can give you some more information about depression in the elderly and seniors. I found it very helpful because it includes early warning signs, triggers, as well as action that should be taken.