Life is never without irony. So, the day after I write up a nice thing on paperwork and goal writing, I discover that I had totally neglected to write goals for a child that I had seen for the eval and an additional session to do the Peabody. I rarely delay documentation and really don't know what I was thinking this time, but it had to be done today since he is on the COTA's schedule next. Must have some kind of treatment plan to begin the collaboration.
In other, crappier, news, we have had more ICU patients than usual. One of them had been doing pretty well and went into a coma. He died yesterday. One had gotten better, moved to the regular unit and even down to the transitional care unit. A few hours after his transfer to the SNF floor, he developed some additional cardiac problems and wound up back in ICU. One has been undergoing very limited treatment, mostly PROM, w/o much progress for 2 weeks or more. One was an outpatient who developed CHF and respiratory failure- her future is bleak.
One of the reasons I went into OT was because I didn't want to be dealing with life and death emergencies. I like my patients to get better, go home, stay out of the hospital. Unfortunately, in the hospital and/or SNF setting, that is not always the case. It's a little morbid, but fairly common, for hospital staff (therapy included) to be regular checkers of the local obituaries. And no matter how uncomfortable it makes us as therapists, there are moments that we do endanger our patients- not knowingly, but still. Several months ago, when I had the patient fall, we didn't know it at the time, but she had developed A-fib and was going into renal failure. She left the SNF floor for ICU no more than a day after we had the fall.
Sometimes the only thing standing between you and disaster is an experienced coworker. There's been a number of times when the rehab aide has taken a look at a patient and advised to lay off, or noticed diaphoresis early... she's probably stopped a lot of falls and other problems just from experience and observation skills. Mad props to her- and attention students- don't rule anybody out as a potential teacher. There are a lot times when your masters/doctorate degree doesn't mean a thing next to someone's experienced observations or practical skills they've developed over time. Make friends with these people, they will save you from being an idiot time an again.
One happy ICU story to mix in with all this sad stuff. Mrs. P was a middle age woman admitted w/ anoxic BI. When we first eval'd her, she was quite flat and making slow progress. Then she got bumped into ICU and was unresponsive for several days. Then... we got orders to resume therapy as she moved out to the regular floor. She was showing good memory, emotion, and moving so much better. It was as if she came out of the coma doing much better than when she went in. She's home now, and hopefully continuing to improve. If not, I guess I'll see it in the paper...