Chapter 2

I haven't done the late-night blogging entry since junior or senior year of college, especially since I started working and had to start going to bed at a reasonable hour. But I've had a lot of things on my mind of late and can't sleep anyway, so might as well. Go ahead and grab a snack before you click, I expect this will be a long post.


Over the past few months, I had decided to leave my current job. I had toyed with a lot of different choices for what to do next, looked pretty seriously into early intervention, also thought pretty seriously about moving back across the state to where the families are. In a serendipitous manner, many things came together to lead me to pursuing a new opportunity at a hospital in Baltimore, and that will be my new home shortly.

Like many of the children I have worked with, I struggle with transitions. My husband prodded me into completing an initial application, I was eager for an official offer, but now the emotions are in full swing. I am having a hard time adjusting to leaving, a lot harder time than I thought I would. I entered this job knowing that my time would be transient, but the attachment got well formed anyway. I've had the pleasure of working with several intelligent coworkers who have taught me some of their tricks of the trade and helped me see where my education was lacking. The group of inpatient therapists who've been working together for 20 years and more have worked hard to help me be less stressed by the job. It's taken awhile, but I feel like I have good friends that I work with, and boxing up those cards and photographs is really hurting... more than leaving high school, more than leaving OT school.

Though the decision to leave was fully my own, and did not make (most of) my coworkers happy, I believe it probably prevented some tough times for the department. Our SNF unit had a massive audit several months ago and we had all been waiting on tenterhooks for the professionals' suggestions to improve the quality and profitability of our unit. I was actually looking forward to this as I saw it as a chance for us to make some really positive OT changes. However, the powers that be have decided that it is best to shut the unit down within the year. A lot of really superb nurses and techs are out of a job and the rehab department is going to have to do some restructuring for things to stay copesetic. This all got announced the day before I gave my notice, and I think it contributed to my pregnant coworker deciding that she would leave as well. The future is still uncertain for the world of inpatient therapy... will they decide to make a very small inpatient rehab facility that can hopefully be more profitable? If not, the focus turns entirely to acute care, and it will take some major marketing before that can sustain the current employees for a full time workweek. I'm kind of sad that there's finally some change taking place and not only will I not get to be part of it, but my opinion in the matter is a moot point. All the changes are theoretical now though... no telling what will actually happen or how stressful it will be to get there.

As mentioned, my COTA coworker is leaving too. We were the entirety of the pediatric OT treatment team. Leaving the kids is literally tearing me in two. I would not have held onto this job this long if not for the kids. Pediatrics is the area I had the least skill and experience in when I started the job and it's the area that I have invested a lot of time in so that I could grow. And I do feel that I have grown as a pediatric therapist... I feel a lot more confident now in an evaluation, in spotting sensory processing problems, and in planning treatment sessions. I have spent numerous off the clock hours writing up sensory profiles (though I didn't get them all done today), reworking the computerized evaluation, and scouting the bargain stores for the perfect toys to elicit the just right challenge.

I have learned so much from the group of kids and parents that I have worked with, and have really become attached to them. I told Bob (a parent) at one point that working with his child and 2 specific others that are long-time consumers was very grounding for my life. No matter what else was happening in work, I could count on those specific 30 minute sessions to give me a routine that was often more fulfilling than the rest of the day, week, month. I have been worried sick about leaving the kids, especially since there will be a limbo time between therapists. My coworker talked about feeling territorial and resentful when an interviewee was brought in recently, because she didn't want to be replaced. I think I would feel better if I knew that there was someone starting right when I left (instead of 3 months later) and that I could talk to them and show them where everything was and present what I'd been doing with the kids and know that they would be ok, that there was someone to take care of everything after I go. I know it sounds terribly narcisstic- they will survive just fine without me and many will never remember me- but I just wish I could be assured that they would all be taken care of. In a selfish way, I also wish I could know that all the parts of the program that I have tried to build up would continue to build and not crumble. I don't want to feel like everything I did will be erased and of no consequence.

I don't worry about the adult patients in the same way. There is a revolving door on the hospital, many will be back again, and there will be a time that they don't recover. That is just something that I think you have to accept when working with that population. I do worry that with the shuttering of the transitional care unit that there will be people who get unwillingly pushed into a 'nursing home' stay and get very upset by that label. There were a lot of people who refused to go to an inpatient rehab facility or a long term community skilled facility until they had given rehab a try for a few weeks on the TCU floor. We took in a lot of joint replacement patients who would not meet requirements for an IRF, and who knows how many complications were prevented by allowing these folks with 'basic' surgeries a few extra days of supervised recovery. Enough that the orthopedic surgeons are not happy with the decision. To sum up, I worry in general about the adult patients, but their stays are so transient that I usually only worry my mind over them specifically while they are present or just recently discharged. There's no one adult who's fate will keep me up at nights, hopefully they will all be taken care of well despite the current flux.

There are other things I will miss... my COTA coworker gets more pregnant by the day, which is amusing and interesting, and I probably won't hear much about her baby. The SLP is finally getting settled into her humongus house, and I won't get a repeat visit there. Other babies are growing, my pediatric PT buddy is just coming off a honeymoon, my acute care PT buddy is growing a business and buying a house, there's a lot of personal things that I will miss. During my time here, I was able to see that when other employees left, their shadow did not remain... their names and antics were forgotten. It does hurt to know that people you've been close to will not remember you, and if they do, they will probably not care that much about the course of your life. It's normal, I know, because how could any person function if they were weighed down with the irrelevant future of every person from their past that they once were close to? That's why we facebook people we went to elementary school with, instead of writing detailed letters to them.

2 goofy things that I will miss:
- I am a number freak, always watching my car odometer and clock for palindromes and other patterns. It has always brought me a distinct feeling of success when our medical record numbers grows by a hundred thousand. I started working with people who were in the 1960000's, recently I have had a pt who had a 1999000 number. I will be really bummed if I don't see someone in the 2 millions.
- After a winter of carefully watching my step and dodging the nastiest smelling berries (?) from a tree in front of the door I use twice daily, hoping that I didn't step on one and bring the stench of vomit in on my shoes, they finally cut that darn tree down.

I know I am blessed to be leaving on my own terms, to another job, where my husband can keep his job, especially in the current economic situation. Truthfully, though I had talked of going home, it would have made it very hard to find 2 new jobs and a new place to live and go through that kind of transition in a recession. I likely would have had to be the sole provider for awhile, and I have seen the stress that has put on my coworkers. I wasn't forced to leave due to cutbacks, terrible treatment, or a need for more money, and I am thankful for that, and know that I am a little spoiled to be worried about these insignifcant things at a time when others are worried about having a job at all.

I feel that I did make the right decision, though it was very hard, and is making me do hard things like move, learn new things, and start all over in a big city. I will get some good opportunities at the new hospital, and be able to rotate to different areas every 3 months or so, which should help quell potential boredom/burnout. I will get my chance at a 'big place,' without having to move to Chicago, Atlanta, LA, etc... and see if that, which has always been something that I talked about wanting to do, is actually something that I enjoy doing. I will be able to get some more critical cases as city hospitals do get more of compared to their rural counterparts. I will get to be part of a large team of therapists who seem to be committed to personal improvement. Hopefully they are not reading this and wondering what kind of neurotic person is joining their team... I'm sure they will all find out soon enough firsthand. :-P

I do feel better now that this is all finally out in the open. I'll still be emotional, but hopefully the thoughts will slow down in my head enough for me to get to sleep. My last day at work is next week, I will follow that up by moving, acquiring a new OT license, and starting Chapter 2. Wish me luck.