OT Quotes

This little entry was gathering dust in my drafts queue, and though it's past OT month and likely past many graduations, here are some randomly collected semi-inspirational quotes. Feel free to share additional gems in the comments.


"Great leaders are almost always great simplifiers" -Colin Powell

"Sometimes leadership is planting trees under whose shade you'll never sit." -Jennifer Granholm

"Your life is an occasion. Rise to it." -Mr Magorium's Wonder Emporium

"Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? And, what is the effect on the least privileged in society? Will they benefit or at least not be further deprived?" -Robert Greenleaf

"If you have come to help me, then you are wasting your time. But if you have come because your liberation is bound up with mine, then let us work together." Aboriginal Proverb

"Aspire, break bounds. Endeavor to be good, and better still, best." –Robert Browning

"Don’t you know, things’ll change, things’ll go your way if you hold on for one more day." –Wilson Phillips

"Everyone has a moment in history which belongs particularly to him." -A Separate Peace

"It's what you learn after you know it all that counts the most." -Phil Jackson

"The time to hesitate is through." -The Doors

"In valor, there is hope." -Police Officers Memorial

"Only those who dare to fail greatly can ever achieve greatly." -Bobby Kennedy

"You can't help someone else up a hill without getting closer to the top yourself." -Norman Schwarzkopf

"The journey is the reward" -Greg Norman

"Stone walls do not a prison make, nor iron bars a cage." -Lovelace

"Here’s hoping that all the days ahead won’t be as bitter as the ones behind you. Be an optimist instead and somehow happiness will find you." –The Kinks

"You've lived your life to become the person you are right now. Was it worth it?" -Richard Bach

"Yes, the past can hurt. But the way I see it, you can either run from it or learn from it." -Lion King

"Dream your dreams, be happy, find something you like to do, and do it well." -Mrs. Wood, my kindergarten teacher

(if this collection does not deserve the adjective "random," then I don't know what would)

Interesting OT Connections threads

I've been trying to spend a little more time on OT Connections, especially in the posting department as opposed to lurking. Here's some topics that I have found interesting in the past few days.

You will have to be logged into OT Connections for the links to work- membership is free, you oughta be a member!

Food for Thought- a really good student project involving nursing home residents having greater control over meal time

Documentation on PDAs- a home health group is going paperless

OT Practice Discussion Forum- anyone can post topics now, I will probably x-post some thoughts on articles both here and there

Oncology Research Articles- I am looking for good rehab research relating to pts w/ cancer

Activity Book for Alzheimer's Patients- Barbara Smith shares her method for creating an activity book, some good suggestions on the thread

SI for Geriatrics- some good information about bringing sensory strategies to the older adult population

Hope that this is a good jumping in point for anyone who hasn't taken the leap into the OT Connections networking pool. Anything else captivating your interest on the site?

Things I am currently thinking about...

Longer updates to come soon, I've had a couple of busy weeks and have to work this Sunday. But here's some thing's I've been thinking about.

• Contemporary Motor Control theory
• Best practices for home residing people w/ dementia
• The kid on Breaking Bad
• Reading more AJOTs
• Branching into NICU?
• A couple of interesting case studies- pt. w/ ABI and another w/ multiple complex brain issues
  
• Customer service
• Energy Conservation
• Changing layout on the blog?
  

Might have some free time tomorrow, hope to get some updates on here soon.

Stories

One of the amusing things about working in a field that lets you interact with lots of different people is simply the stories that you come across. It is a well known adage that to be a writer, you must read, but I think that listening to other people's original stories is the way to go- you can't make stuff like this up.

For instance, a man with COPD and schizophrenia had a vision that if he smoked more, he would get healthier. He was later admitted to the ER with persistent cough and shortness of breath.

I've had several people who've had quick reentries to the hospital, which is always lousy. I had one lady that I evaluated in my first week of real work, and I remember her because I have an aunt with the same name. Most people, in meeting someone, would be at least mildly interested by that sort of anecdote, but this lady was thoroughly not amused. She needed to go to short term rehab since she'd had compression fractures and a pacemaker placed. 2 days after she got home from rehab, she fell at home and was even less happy to see me the second time around.

One of the downsides of working in acute care is that you see SO many people that it's hard to remember all the stories. The COTA has asked me once or twice about Mrs Soandso and I'll say 'can you refresh my memory?' Even with the response, 'yeah she's the frail little lady' I am usually struggling to remember. :)

An old story from my last job that I never got around to writing up- 102 year old man was taking a mini-mental. I stick out my arm and say, "what's this on my wrist?" trying to get the response "watch." Instead he says, "oh that's some kind of growth. A mole. I big mole."

Recently evaluated a man w/ very advanced Alzheimer's and Parkinson's diseases. Per the chart review, he was basically wheelchair bound at home, largely nonverbal. Yet he somehow managed to 'take his family hostage' (though no weapon was mentioned) and he was brought to the ER in handcuffs. He was far too combatitive on day 1 for me to work with- throwing things and slapping at people. When I saw him on Day 2 he was a little more calm and the PT and I were able to get him into a chair, he was able to state his first and last names, but other than that we couldn't get him to follow any simple commands or tell us anything else. Later that day, while working with his roommate, he had decided to remove all his clothing and sheets and was requiring one person's complete attention to keep him from crawling out of the bed.

I do not envy our case managers and some of the placements that they have had to pursue recently. It is probably just 'the way things are' but it is very difficult having people with lousy home or medical situations come in, but not have rehab needs to qualify them to go elsewhere. I am trying not to get overly bummed out about that part, since I end up with a role in the drama. It also makes me think about what choices I would make in some of these situations, which is also a downer.

Though I have tried to hide it, my coworkers have figured it out (even quicker than last time) that I am a techie. We are encouraged to do point-of-care documentation and get notes in ASAP after an eval, so we all have little tablet laptops. I had been using mine as a regular laptop, but using a touchpad all day at work and then at home was making my wrists go into agony. So I resolved to figure out how to manipulate the tablet software (despite not having regular access to preferences) so that it would suit my needs, and for the most part, I have. I attempted a few evals Friday using this strategy to document in the room, and plan to hit it hard next week and make it work. Even with just trying it out on Friday, I got comments from a lot of excited coworkers who wanted to learn how to do it too. I may need to prepare a how-to guide since I don't mind sharing but definitely didn't get out on time on Friday. My current home computer is too newly purchased to talk about such things, but a tablet wouldn't be a horrible next purchase, however, the only thing I can see it really helping with is blog entries, so it's not really worth it as yet. Suppose I could eventually look into a tablet PDA, but the smaller screen would take a longer time to make work. I may also have a problem with mine at work since one section of the screen seems to have difficulty responding to my inputs... might have a dead zone.

Some of my coworkers are very resistant to the computer documentation, I am still surprised that a lot of the departments at the hospital do not do computer documentation. Everything was computerized at my last hospital, and this one is considerably larger, so I assumed they would be more 'with the times' so to speak. I remember way-back-when, first year OT school when potential research topics were brimming in my brain and I had thought of doing a project on whether therapists with computer documentation were faster, now I am glad I didn't since it is such a hot-button issue for some. Can of worms, though it would still be interesting to see the results. Anyone else use tablet computers for point-of-care documenting?

My current metro-reading strategy of reading a paragraph as the train slows down and stops at a station is going well. Since I can't seem to time the shuttle departure right (don't know if it's possible to) I am also picking up 10-20 minutes reading time there too. I am officially CAUGHT UP on all my OT Practices that had piled up during the transition time and actually eagerly awaiting new ones since I have time to read!! I am working on responses to some articles too, hopefully will be ready to post those soon.

May is Stroke Awareness Month

Read the CDC feature on stroke

Make sure your friends and family know the signs of stroke so that they can be prepared to act in an emergency.

Check out these sites for more info:
American Stroke Association (a division of the American Heart Association)
Internet Stroke Center

OT by PT

Addressing the problem of professional crossover.

One of the downsides to having a profession with such a broad scope of practice is that there is overlap with other professionals. We share functional mobility and UE rehab w/ PT; feeding, swallowing and cognition w/ SLP; pursuit of leisure activities w/ rec therapy. But ADLs are our bread and butter, and I think that when there is an overstep into that territory that it strikes especially hard.

One PT coworker bragged that she does ADLs all the time, and just bills for functional standing activity. Another PT coworker had a penchant for instructing people who'd had shoulder surgeries on hemi-dressing, also was fond of giving UE fine motor and self ROM exercises to individuals post-stroke. One of the more blatant violations was when a PT walked into the OT office to get a sock aid and spent the next 15-30 minutes billing for ADL retraining for teaching a client LE dressing.

I know my response to these issues was not effective, since usually I was just dumbstruck. The most action I took was discussing the action w/ my OT coworkers. Another OT called a meeting to discuss this, but I don't know what came of it. I think what made it harder to address is that these scope of practice infractions were all perpetrated by practitioners who were holistic in their practice, easy to cotreat with, and my friends. I don't want to jeopardize those relationships, but I don't want my professional identity to get gobbled up by an overzealous therapist either.

I'm not trying to pick on my PT buds either. I have done stair climbing in acute care when evaluating a pt. and didn't have time to wait for PT and wanted to have a definitive answer when asked if they were safe to return home. Obviously, my understanding of gait and stair climbing is not that of a PT- I use phrases like "wobbly" instead of, I don't know, 'poorly-sequenced toe strike.'

I did get a good response from a PT coworker the other day. She had called me to ask about giving a sock aid to a person post-spinal surgery who was scheduled for discharge in a few hours. As we talked about the case, it became clear that this pt. was going to have significant problems dressing since she had spinal precautions and had never been instructed in AE use. We concurred that this pt's issues extended beyond a simple sock aid handover and that even though it would mean another evaluation at the end of the day, it was the appropriate thing for this pt. Turned out that the order had been written for both OT and PT, but the OT orders never came down the chute. (Metaphorically speaking... our chute is a computer system) So that was a good moment since she realized that there was a greater problem than she could quickly address w/i her scope and did alert an OT and pass it along.

Anyone have an idea on how to address this issue w/ coworkers? It's more than just smacking someone's hands back when they try to help a pt put on their socks, it's feels like a disregard for my expertise. I'm sure that we've all had this experience 10 times over, so if anyone has a good way to handle it, please let me know.

Sharing a Brain

I did not submit this card to Postsecret, but I share the sentiment...


I'm a metro girl though, not light rail.

My only complaint about the new way of commuting is that when I was driving if I left for work early in the morning and/or left work early in the afternoon, I could cut my driving time. Now the time is constant, but often longer than if I had been driving and not had traffic problems.

Other potential problems include that I have to leave by a certain time or my shuttle bus won't take me to the metro; and that it does not run on Sundays, and I work 2 of those a month. No major progress on the overcoming motion-sickness front either. Latest strategy is to read 1 paragraph at each metro stop, which is a little better.

Recession Job Market

For the third part in the little mini-series on job hunting (here's the links in case you missed searching or interviewing for an OT job) I would like to address the topic of job-hunting in the midst of a recession.

The recession is not making big headlines this week, perhaps because the doomsayers have realized that we are probably not going to end up in another great depression or a post-apocalyptic nation focused solely on survival. However, it is still a topic on people's minds, especially when discussing a job search.

Occupational therapy made the headlines by landing on Time's 150 Recession-Proof Jobs list. OTRs come in at #18, and OTAs at #72. Rehab/Healthcare jobs in general were well represented on this list- PTs, PTAs, Therapy Aides, SLPs, and also RNs, LPNs, Athletic trainers, Massage and Respiratory therapists were all in the top 120.

We now interrupt this entry with a quick little note about political advocacy here. It's likely that athletic trainers have climbed their way onto the 'recession proof' list through their efforts to redefine their scope of practice on a political level. Since any individual can now be considered an "athlete," they now have a much wider base of clients to work with and places to seek employment- like outpatient rehab clinics. Recreational therapists, on the other hand, are not on this list, perhaps because they have been cut out of some Medicare legislation affecting reimbursement and their necessity to be employed in certain environments. Right now, they're trying to become a covered, required service under Medicare for additional settings. Just a little word about how you can't live as a therapist in isolation- political action is required if you'd like to continue having a job and being relevant to the rehab world. As one of my teachers said, if you don't have the time to do it, at least kick some money to the people that are working on it at your state and national associations. We now return you to your scheduled blog entry.

One thing that surprises me about the job list is that OTAs are not higher on the list, or even higher than OTs. I would think using more OTAs could be more profitable for many organizations, as long as there are not a superfluous amount of evaluations to be done as opposed to treatments. My current job is obviously one of those places since we get about 1200-1500 orders for OT/PT/SLP evals each month, so there are only 2 OTAs and 1 PTA. OT Practice recently had an article celebrating 50 years of OTA education, and the associate's degree remains a cost-effective way to get into occupational therapy.

Despite the accolades the profession has been garnering, I think that the only people who say that OT is 'recession proof' are those not currently working in healthcare. Many sites are in the midst of a soft or full-on hiring freeze. Some hospital units are closing completely, orthopedic units are trying to step up the service due to decreased elective surgeries- My old hospital was trying to see acute orthopedic surgery pts 3x for PT and 2x for OT everyday; a friend at a hospital-based SNF was trying to see subacute ortho pts 2x for PT and 1x for OT each day, which is causing their depleted staff to work overtime everyday. (Obviously the second group is salaried, keep that in mind during your job search.) PRN (as needed) nurses and therapists are seeing a dramatic cutback in use of their services, which used to be a pretty lucrative way to earn money without a full time commitment.

Though it may be callous to gripe about cutbacks on perks, that too has become the reality. Sign-on bonuses (taxed very high anyway) are getting cut. CE money is often getting cut, which is a shame, because high intesity courses that give a lot of hours are more expensive. It stands to reason that therapists might choose to stick close to home and maybe go for something based less on the knowledge they will receive and more within their price range. I don't know that it's technically fradulent to pursue CEs outside your realm of practice, but it is professionally discouraged. It wouldn't fly in my current state, since they have to preapprove everything you go to. Money for therapy supplies is likely getting slashed in budgets, so you may have to appeal to grants to get the fancy new equipment. Another cutback is in the retirement arena- matching 401K funds are dwindling. My current company still has a pension plan, which I thought had all gone kaput long ago, but they are keeping that and tossing out the matching funds.

If you work for a hospital, then at least your healthcare benefits are fairly safe. After all, they can't just deny you admission to the hospital. However, I have heard of some places charging an extra fee if your spouse's employer also offers health insurance but you chose instead to go with the hospital's plan. The wording was that the hospital couldn't afford to subsidize the rest of the county's healthcare costs. The other issue related to healthcare is that it can be hard to job-swap since a person would face up to 3 months without any benefits, especially if you have a spouse or family depending on you for coverage. If you're single with a chronic health condition (especially including pregnancy) then the issue has to be weighing into your decision as well. Related to that, it's good to pick an area that has multiple job offerings, so that you don't have to pick up and move if you want to work somewhere new. In a related situation, it would be very difficult for my husband to find a new job, so when I accepted my new position, we had to live somewhere that would be a reasonable commute for both of us. Part of the reason that we chose to move to Baltimore instead of back where our parents live is so that he could keep his job- trying to move and find 2 new jobs is stress that we're not ready for yet.

Though this post is a bit of a downer, don't be mistaken, there are OT jobs out there. You may have to take a position that isn't your dream job, but there will likely be plenty of positions available in hospitals, SNFs, and large facilities. There will probably be fewer openings in schools (these are usually limited anyway since people tend to keep those jobs when they get them) and small private practice facilities. There are also likely to be fewer openings in OT college towns since there is always a fresh supply of therapists available. But when there is a legitimate opening at any location, the current therapists will likely be stressed by trying to deal with the workload and they will want to fill their position. And if you're just starting OT school, don't be put off by the cost of the degree. Student loan debt is better to have than other types, people have used those loans for international travel and buying cars and still come out ahead. And since there will be some type of OT job available when you graduate (not necessarily a perfect one, or one that pays $100,000/year) you will be able to pay back your loans.

The jobs are out there, good luck to everyone that's looking. I have to guess that they will be a little harder to land in May or December, so you may want to start your search pre-graduation if you're expecting to get a job right after school is out. Happy hunting, everyone!

Interviewing Tips

I am not an expert about getting jobs, but I have been through a few successful interviews recently. Here are some tips that I recently wrote out for a friend. This is not comprehensive, any of these topics could be significantly expanded.

Basic Interviewing Tips- I'm not going to really cover these since most OT students have probably gone through at least one interview in their lifetime, if only the one to get into school. Wear something nice, conservative, that you are comfortable in. Bring extra copies of your resume. Learn about the company before you go. Use positive body language. Etc.

Rule #1- You are interviewing THEM as much or more than they are interviewing you. So the questioning should be a 2 way street. You have questions, you deserve to get them answered before you make a decision. Make a list- If there's anything clinical that you really liked or didn't like at your fieldworks, you can form a question to devise whether a similar situation exists at the new place. You should get information about what they offer for 401K, health insurance, days off and other benefits from the HR department, and they should get you that information before you leave that day.

Questions they will probably ask you:
- about the experience and interest you have in their population
- about your goals for professional development/ what you want to get out of the job
- your strengths/weaknesses
- might ask you to describe a situation when you overcame an obstacle at work or resolved a conflict with a coworker
(Here are some more interview questions, I'd say the ones about coworkers and goals are most likely to appear in your future)

Be honest in your appraisal of your abilities. A recent job candidate rated herself "10/10" in dealing with all types of diagnoses, therapy techniques, and practice locations- despite only having a year of experience. Also, it can be good to pause briefly before answering a question, especially if you find yourself often making foot in mouth statements. If you're nervous about how you'll react to questions and handle things on-the-spot, many college campuses have a career center that will offer to do free mock interviews or resume workshops. Check it out, you're paying for it anyway. If that's not available, have a trusted friend or adult interview you and offer constructive criticism.

Another question that will definitely come up is what you expect to be paid. (this might even be on the job application) I'd encourage you to discuss this with your professors, but there are also other good resources. Enter your state into this page on the Career InfoNet and see the wage table for your target state and compare it to the nation as a whole. You can also look for your city or metro area on the left sidebar. This gives you a good idea of the range, although I don't know anybody getting paid in that 90th percentile area. Advance also has a salary calculator, but you have to sign up to play with that. In my experience, their sample size has been too low to be truly helpful. Don't get dazzled by the money though- you're looking for the best overall place, the money will come. Also, FYI- sign on bonuses are taxed VERY high.

You should also take time to point out anything awesome on your resume or portfolio and explain how you got the honor and why it's special. For example, "I wanted you to know that I was elected to the office of Grand Poohbah of the Water Buffalo by a group of my peers to coordinate volunteer efforts in our community." Nobody knows why you were honored or what the title means until you explain it.

In the post on searching for a job, I mentioned that you should look at several sites and try to do multiple interviews in a near time frame. You'll want to keep detailed notes of what you liked and disliked about each site, what their typical day was like, anything important that they told you. Keep the names of everyone you talk to- try to get business cards as that will make it easier. And remember that you should send a follow up thank you note after the interview- email is acceptable.

If you feel like the interview went well and the facility looks promising, you can ask to have a shadow day. I strongly recommend doing that. See what a normal day is like, what the expectations are for productivity, get a feel for the balance of the caseload. Among other things, you can ask your future coworkers what they really think about everything, see what kind of people they are.

You want to take your time to consider any and all positions that are offered you, but you should be timely and polite about it- your interviewers are trying to fill their positions quickly and will appreciate your honesty. Nobody is asking you to commit to a position on the interview day, but be timely.

After all that, if you decide to accept, you'll have to pick a start date and all that. So if you come out of the initial interview feeling positive about the place, or if you are definitely living/practicing in a certain state, you will want to start investigating the licensure procedure there. Figure out the timing, how long it will take to get a license. Consider whether you need to start work right away with a temporary, or if you want to take the NBCOT exam first. I didn't want to try to balance studying and working, but it depends on what you want. All that plays into the potential start date.

Bottom line- be honest, be you, and try to find the best fit for your personality and for your skills to grow. Good luck everyone!

Search for an OT Job

Spring is in the air, as signified by the inch thick of pollen on my car each day. That means that there will be more folks w/ respiratory issues in the hospital and more new OTs starting their first job search!! I'm not a career counselor, but I survived my first searches, and here are some tips to hopefully make your search more fruitful.


There are a few questions which frame the whole job search, but I think most people have this under control. You should know the constraints of your search. Are you getting married or otherwise needing to stay within a certain geographical region? Do you have others to support or just need to make enough to cover your own expenses? Do you need to start work immediately or can you take some time off after graduation? Thinking about what you need can help you narrow your focus and concentrate on what's important to you.

I think it's easier looking for a job in a specific geographical area than just looking for random jobs anywhere. And while you can do a good portion of your job search from far away, thanks to the wonders of the internet, it is easier to do after you have moved and settled in the area. Not a luxury everyone has, I didn't. I haven't had very good luck searching on the internet sites that cater to all professions (i.e. Monster) but when I was seriously looking it was in a more rural region. Even now though, searching for OT jobs in Baltimore only pulls up 9 options. What I do find on sites like this is info for contracting companies, services that run nationwide.

So you can use profession-specific search engines to assist the search. If I remember correctly, I found my first job on the AOTA sponsored OT JobLink. Will this get integrated into OT Connections? Don't know, but it remains a reliable source for finding and communicating w/ employers... like monster, it allows you to upload a resume and have it be searchable or not. If you're an AOTA member (and of course you should be!) then there's no reason not to use this tool. OT Practice has nice color ads organized by region and job type and Advance always has hundreds of ads in the print magazine, you can search their listings as well. 2 other sites come up in a google search, but I haven't used either- OTJobs.com and JobsOT.com. I don't have time to give them a full trial, but I suspect that they are likely to have more national staffing companies than location specific jobs.

If you have a location in mind, it's easy to find links to the Chamber of Commerce for the different areas, you can search for hospitals or nursing homes in the area to see if they list on their website that they're hiring. Also finding local newspapers online will often let you search the help wanted ads. I get a lot of emails and mailers w/ job opportunities (that's actually how I found out about my current job), the other way to find a job is to ask your friends and acquaintences what's open in their area(Hello Facebook!). I still get emails to my school email address from classmates who have job openings at their facilities. Going to conferences big or small will also provide you with a time to network and find out about openings.

Even if you don't see an opening on a company's website, don't assume their not hiring. (Unless it's for the feds, they're pretty clear about when there's an opening) You can always call the rehab department or submit a resume without a specific opening, you will probably have more luck with this if you're willing to do prn work.

Not much to say about choosing a setting, except to keep your options open. It is very possible that you could try something different and find out that you really like it. Going into my last job, I thought that I would prefer the SNF floor over the acute care since it would be more like rehab, and I had no expectations of even participating in pediatrics at all. I didn't know the way I would appreciate those different areas. If you can find a site to give you experience in several different populations and diagnosis types, I'd say that is very valuable. It is much easier to learn to be a specialist after getting a firm grasp on being a generalist, I think.

Once you've found a few places that look promising, go ahead and set up interviews. If you can do all your interviews within the same general time frame, that will be helpful, since each place will probably want to pressure you a bit to commit or decline the opportunity quickly. Just make sure you keep good records of the benefits, daily details, and pros/cons of the different jobs so you don't get confused about what facility had what. More details on acing the interview in another post.

Anyone else have tips for finding a job? Feel free to share. One of my professors used to say that you'd be innundated w/ employment offers once you had a job, so even if prospects look bleak, remember that Job 1 could allow you to find Job 2.

Learning to read without getting sick

I have canceled my parking pass and purchased a monthly metro pass, resulting in saving money on gas, reducing my carbon footprint, and increasing my free time in the day. A few days ago I posted about how my leisure time has been all off balance and that I would like to restore some activities, particularly reading books and my OT mags. But to do this, I would have to overcome carsickness...

OK, it's embarrassing, but true, I used to get carsick all the time. Honestly, it's probably all related to my sensory processing differences that were not identified as a child, but that's another story. I did progress in my teens to not needing Dramamine-induced sleep to make it through any trip with a curve in the road, and even was able to watch movies on the TV in our van (not a handheld) with great success. In the past few years though, I would say that I have taken a few steps backward. Fewer journeys out to rural locations for school and girl scouting events have put me out of touch with the country roads, but now at least I am able to drive when feeling ill and thus avert crisis. Never at any time was I able to overcome my vestibular problem and be able to read or operate a handheld device in a moving vehicle, and I can't even remember the last time I tried.

It never made sense to try- the risk was not worth the reward, and I could always talk to my companions. But now I have 30+ minutes of unoccupied silent time on the metro. It is a smooth ride in comparison to other transportation options. I thought that in order to make use of this time for my chosen pursuits that it would be worth it. I am not an expert on inner-ear issues or vestibular function, but it just seems that this system should be trainable. So I am trying-

Day 1- I read straight through my trip, with minimal nausea. On my return trip home, I got a nasty headache in addition to the nausea which persisted through the evening.
Day 2- I tried my husband's idea of reading in brief spurts and then looking up in the train. No discomfort during the trip, but afterwards developed low grade nausea and headache that lasted til bedtime and seemed to get worse through the day.

Neither day a success, obviously, and I am reluctant to try again in the morning as it was a very unpleasant day at work.

I have tried most every product and strategy to alleviate motion sickness in the past. I cannot find my Sea Bands. I cannot take Dramamine in the morning as I will fall asleep, can't take Bonine because it doesn't work for me. Club soda and gingerale are also ineffective. I am thoroughly disappointed by the LACK of information on the internet about anyone trying to overcome this problem and learn to read in the car, most information is on preventing motion sickness in general. The most relevant posting I could find was this monstrosity, and there wasn't even anything on metafilter. This reminds me of the internet of 1996, where it was not uncommon to not find anything on the topic you searched... you could just forget about finding obscure lyrics.

One of my new coworkers is a PT who works with people who have BPPV. (I had been informally tested for this in the past by a PTA and it was negative) But, she has a greater understanding of the inner ear than I do and believes that through some adaptation I should be able to achieve my goal. We are planning a consult for when we are not busy (ha. ha. ha.). Until we can meet and determine a plan of action, I am issuing a call for help from the internet.

I know that reading exacerbates the problem, but it is a MAIN occupation of mine. Trust me, I have heard the suggestion to do audiobooks- it is not a viable solution for me. (for 1, I want to read magazines, 2- I don't process auditory information as thoroughly, 3- reading is a treat for me which is why I want to devote more time to it). So I am taking any sensible ideas for how I can read on the metro that don't have the word "audiobook" in them. If I ever do find something that works, I will post it here, so that at least on some little corner of the internet, there will be information. I can't be the only one who wants to overcome the issue.

Another week down

Ok, I'm sure there are people getting sick of hearing about how I'm adjusting to work, so those people should not click on the expander for the full story. Other details coming soon, I promise.

Made it through my second full week of work. It's been an interesting transition. At this point, I still have to ask occasional "how-to" questions of the other therapists or staff (often it's "what's the code to the supply room again?") but for the most part I am on my own. Reflecting back on when I started my first job and my fieldworks, I remember there being a longer period of easing in, getting comfortable, hand holding. I know that on my first licensed day at my first job that I did not pull my fair share in comparison to the COTA- I believe that I would look up 1 pt, formulate a treatment idea, go try to see them. If it didn't work out, I had to come all the way back to the office, and either look up the pt again to try to find something else, or look up someone new and start the process over. It's nice to actually feel that I have grown as a practitioner- I think I've been a lot more useful thus far to this job than I was in my first weeks at my first job.

I know I had talked before about trying to leave on time so that I wasn't working for free... obviously I don't have that down to a science yet. I found that if I left the house early (to try to avoid traffic, etc) and started work early, I still would not be able to drag myself away early at the end of the day. There's always more to be done at the end of the day, I just try to prioritize it. Sometimes a person only has to be cleared by therapy before they can discharge home- nobody wants the hassle and fees of another night in the hospital just because their therapist had worked their 8 hours already. Just trying to balance all that- it is the life of a salaried employee, which I knew coming in.

Learning the computer system has been pretty easy, since I used one of the programs at my previous job. Now I get to tote around a laptop so that I can slide in urgent notes immediately. I am a longtime laptop user (since 2002 my primary computer has been a laptop, and they have been used A LOT) but the added usage of the touchpad is trying to aggravate my RUE into RSI symptoms. Not happy about that, and of course don't want to cut back on personal computer usage, so it is a growing issue. My work computer is a notebook w/ stylus, however, the program we use for documentation does not communicate with the stylus program that lets you write with the pen and guesses your words. This is a major design flaw and I may need to bug my techno-savvy boss into finding something that will work with that documentation program. I will also need to bug her for a mouse, and just use that while at my desk.

I need to create a checklist for work because there's so many different things to do for each pt. in the computer system. Some of it is a little redundant, but it is important to the dept for their QI projects so I need to remember to remember.

I have access to the scrubs machine now, which presents a dilemma. Obviously, it's great to have access to free scrubs whenever, and I think that the experiences I have had with getting nasty stuff on my scrubs and having to sit in a locked OT office in my underwear while I ran them through the washing machine really make me appreciate that I could just get a new clean pair at any time. Hygenically, it seems that it would be best for my pt's and everyone I come into contact with outside the hospital if I wore only hospital scrubs in the hospital and changed into something else for the commute. Economically and time wise, it makes sense not to have to wash scrubs in my incredibly small apartment washing machine. BUT- the work scrubs are ugly icky green, worn by 60% or more of the staff in all departments. So I haven't decided how to balance my need for cool cute tops with everything else, and while this is an incredibly frivolous dilemma, it does affect me.

Hard to believe, but finals week is coming up for many schools, which should bring thousands of new OTs into the burgeoning profession looking for jobs. I will try to get some interviewing/job search tips up here soon, and will really try hard to do that since I forgot about the AOTA conference (again). :( I won't forget next year though- Orlando here I come!

Still adjusting, and occupational balance is out of whack

I am continuing to adjust to my new job, and it seems to be going ok. So far I have been able to get a fair amount accomplished without working free hours (oh the bane of being salaried...) so hopefully that will continue to go well. Having some other difficulties though.

Remember those "balance your life" worksheets, with the clock face that you colored in depicting how you spent your day- leisure, work, and uh... whatever the 2 other things are? Drudgery? Self care? I don't know, I haven't had a copy since school. Anyway, I have been feeling quite out of balance lately. I think that I have a decent amount of work and leisure time, but I could probably use more sleep at night. And the added commute is eating up time that could be spent in other ways, and adding a lot of stress as well. The biggest problem though, is that I don't think my various leisure activities are balanced. For example...

My leisure activities:
- reading internet sites, newspapers, blogs
- email, facebook
- video games (animal crossing has edged out all other competitors for several months, which is itself out of balance)
- exercise
- spending time with husband
- talking to family
- making blog posts
- reading OT magazines
- reading novels
- watching TV (House, Big Bang Theory, CSI are the only current shows. Cartoons when I remember)
- travels (day trips, weddings, parties)
- puzzles (crosswords, sudoku, jigsaw)
- outdoorsy stuff (camping, canoeing... it's been so long)

This is list different than last year and the year before. I have removed activities- no more fantasy baseball as it was eating my time; no softball or girl scouts since the move since I am trying to adjust to the new city. But I am finding that some of these things are not getting done at all (exercising! OT mags! what happened?!) and that I am wishing I spent more time doing other things, but am limited in the overall time that I have. I have tried doubling up and doing 2 things at once, or being really devoted to one item for awhile, but neither have been really successful. I am afraid I will have to cut again and feel like I'm missing out.

My current plan:
I. Eliminate driving by using public transportation
(this should reduce some stress, save some money, and that cannot be bad.)
1. Figure out bus, metro, and shuttle routes (mostly done)
2. take trial runs to figure out timing
3. cancel parking pass at office
4. Benefit from extra time
A. learn to read on public transit without getting carsick
II. Make better use of time at home
(limited to ~4.5 hours between work and bed)
1. Start exercising again
2. Cut down on worthless internet time
3. Decrease days playing Animal Crossing (it's just so darn addictive!)


It's hard because I have diverse interests and I hate telling myself 'no' when I want to do something relaxing or fun. Also I am near the point of elimination on some hobbies and internet things... I feel like I just need to get rid of a lot and start from scratch. It is so easy to spot the lack of balance in another person's life, but it is hard to fix it in your own. And now it's bedtime again (sigh) so I will have to call this to a close and just try to work in these directions tomorrow so that each day gets a little better.

Long Term Goals

This is a cross post from OT Connections, but I thought I might get quicker and more diverse responses here.

For goal writing, I was taught that your STGs should be directly related to your LTGs, and that they should all be able to be achieved in the timeframe for the facility. In acute care, therefore, a LTG could be set for only 1-2 weeks. However, my new employer says that their policy is that the LTGs are the overarching goals for the pt when they are completely rehabilitated. This would include driving independently, resuming work, being completely independent. They claim that this is how Medicare wants to see the goals, but it doesn't make sense to me. A goal of driving independently in the acute care setting is not achievable, realistic, or fitting the timetable of therapy. I don't understand why my goals for a pt. in a short term setting would have to encompass the potential months of additional therapy that the pt. should receive, especially when there is no firm discharge plan. Has anyone else heard that this is the "preferred" way of writing goals? Is anyone using these as their only LTG? Thoughts please...

First week done, second week coming

Made it through the first week!
It's strange going back to work after an absence, especially when you're starting all over in a new place. Spent 2 days in orientation classes, learning about 'service excellence' and the ins and outs of all the benefits and whatnot. Sat next to another Cheryl, who has the same middle initial and a very similar last name as I do, which was amusing. Part of the difference between this job's orientation and my last, besides the extra day, was at my last job, we took a 30 minute tour around the hospital. For this job, I got multiple maps of the campus and a driving tour, and my boss has been orienting me to the things inside the hospital. I hope to one day know where I am going! :)

Navigating to the job has also been a challenge, tomtom has done a good job keeping me from being hopelessly lost in the big city. I kinda got pressured into buying a month's parking pass during the first 10 minutes of orientation and didn't have enough time to research all my options. Now that I have some time to look into it, I think that I will be able to commute for the same time or less using some combination of metro/bus/hospital shuttle. That would make my environmentalist side happy, and also my "I hate driving" side. I knew from my fieldwork in Arlington that cities with good public transit programs often have kickbacks through the employer and/or the local taxes if you use the mass transit. So I hope to get that figured out and the kinks ironed out before I would have to pay for another month. (and yes, I think paying to park at your place of employment is the pits.)

I was also really cheesed off about my flexible spending account from my last employer- I knew that you had to spend that money before the end of the year... I learned that if you terminate employment, you have to spend that money within 30 days. I learned this after that time had expired. I had attributed it just to that employer, but the new employer's HR people have the same policy, so it must be some federal rule or some such. Obviously, those things can be helpful, but I've been burned 2x over on them and probably won't get another one unless I'm planning LASIK, baby birth, or some sort of elective large procedure.

I spent the other 3 days of the week getting oriented to the rehab department, getting followed around while doing evals, learning the computer system, hoping that I was calling people by the right names. I am on a team of 7 therapists for the general medicine floor, and I know a couple of the nurses and case managers now too. A PA had concerns about sending one of her pt's home, said to me, "She doesn't really need PT, but she really needs OT. I need to know whether she can be safe at home. Page me as soon as you're done." So that was nice, since we usually hear the opposite of that, and it's nice to be able to just text page all the important people if you need anything.

So tomorrow I start being a real worker, which will probably mean at least 5 evals a day and trying to follow up with other pt's as well. I've been trying to balance my evenings with my leisure activities and exercise before my husband makes it home, I'm still working that all out. One of my goals in this switch from being an hourly employee to a salaried employee is to not wind up working a million extra free hours and lose all my free time. Also, if this week is any indication, I might actually be getting better at handling mornings. Whether this is the 30 minute shift of the work schedule, or the increased commute time, or the increased time that I am awake before being expected to work, I don't know.

Eve of New Things

New job starts tomorrow...
2 days of orientation and then it's back to work for me. I had some goals during this transition time... packing, moving, unpacking, exercise, make lots of updates. Ended up spending more time decompressing than anything else, and the past week I pretty much ground to a dead stop on the unpacking business. But all the boxes are gone, now it's just the more mundane decisions of where the t-shirts go and whether to unpack all the books. So that just couldn't achieve a high priority for me. With the busy week up ahead, don't know if I'll find a lot of blogging time, but here are some future updates that are officially "in the works" and should be out soon.

-Video on making a fidget bag
- Beginning the Energy Conservation series
- Preparing for a job interview
- Making the most of the AOTA conference
- What to do if you don't get into OT school

Though my original plan was to spend the last week getting up at "work time" with my husband, my love of sleep won out. I was good in that I didn't sleep in to the extremes (no 1130 wake up calls) but it will still be an adjustment. OT is hard on my nocturnal temperament.

Jobsite Analysis

So I did complete my jobsite analysis long ago, and it was actually simpler than I expected. I was evaluating a worker in the microbiology lab with a diagnosis of writer's cramp. I am finally getting this written up for the blog carnival on clinical reasoning, so make sure that you check that out. If you're new to this blog, perhaps forwarded from the carnival, please be patient since I tend to write long entries :)

OK, background information, since this happened so long ago. As a hospital OT, I was asked as a courtesy to perform a worksite evaluation of a woman ("Wilma") who was having difficulty at work due to a diagnosis of writer's cramp. Before I was asked to do this, I had no experience in work hardening outside of school classes, virtually no experience in hand therapy, or any idea what life was like in the microbiology lab. I was a little bored and willing to take on a challenge, so that's how the eval fell to me. Please note- there is a significant difference between the clinical reasoning used by novice, intermediate, and experienced practitioners; that was all fleshed out in a recent OT Practice CE article. I am not claiming to have an experienced level of reasoning, I just did my best.

My first thought was shock that "writer's cramp" was an actual neurological diagnosis. I mean, I have played Operation, and have had significant pain after essay tests in college filling up Blue Books, but I had no idea that this was real. So I looked online for information on the diagnosis from reliable sites, which included eMedicine, Merck Manual Medical Library, and Medpedia. I learned that this was a focal dystonia and a repetitive strain injury (RSI) that would likely cause increased pain and decreased grip force on small objects.

Next, I went back to my OT bookshelf. I still have many of my texts, but especially those for topics that I found interesting or complex. (I have found it unfortunate how much I have already forgotten from school in topics that have been outside my realm of practice) From my book, I was able to review environmental factors that exacerbate RSIs and go through case studies involving worksite evaluations for desk workers. My book was nice in that it also came with some ready-made forms to record measurements of various workstation pieces (example- depth of chair pan, height of chair from floor). I also asked my coworker if I could review a writeup that he had done for a different person, so I could get an idea of what was expected.

I was feeling more prepared, but still didn't know what to expect in Wilma's office. What does a person in a microbiology lab do? Where to find out? My favorite source for torturing my Girl Scouts when they're doing a career badge- The O*Net. If you haven't used the O*Net before, it's a great resource that has cataloged thousands of jobs, the skills required for each, the expected salary and job outlook for each. So I was able to pull up "Biological Technician," which gave me a few brief ideas aobut what to expect.

After gathering all this information, I spent some time trying to brainstorm possible problems that Wilma might be having. Writing, obviously, but I also thought that she might have some difficulty with manipulating other small-diameter tools, keyboarding, opening or stirring containers.

The morning of the evaluation, I got my tools together- a notebook, copies of the measurement forms from my book, digital camera, tape measure, and a goniometer.

I met with Wilma at the beginning of the day since that is when the bulk of her work was done. I asked her to describe the problem, describe the pain she was having, what made it better or worse and what she had already tried to do to fix the problem. I also asked about what she had done medically- neurologist visit, MRI, EMG, etc. Then I let Wilma go ahead and start her workday, trying to see as many of her essential job functions as possible, and asking her to report anything that caused discomfort or decreased grip. I observed the tools that she interacted with, and any time I saw something that was on my list of possible pain causers or looked like it would aggravate the RSI, I asked specifically aobut that. That included vibration, twisting, squeezing, of various tools including pipettes and cotton swabs. I also took some measurements (not a full spectrum of them) related to the position of Wilma's UE to the work surfaces.

My client was quite reticent throughout the eval, and had relatively few issues. She really only complained of difficulty writing, not with any of the other tools. I knew from my education on RSIs, phyical disabilities and assistive technology that to decrease problems from a tight grip on a small object, that the person would need to change the shape of the grip or the amount of force taken to maintain the grip. I tried to include a variety of high and low tech solutions in my suggestions, and also address other issues that I felt could potentially be a problem to Wilma.

I have the summary writeup in a google document (as always, please be respectful and do not plagiarize my work). All the photos are from Sammons/Preston to give the reader a better idea of the different tools. If it had been me, I would have pushed for a label maker, because I think that would be best for efficiency sake (that and I love labelmakers anyway). I also found a $0.49 pen shaped similar to the PenAgain in a drugstore months later, so there are other options out there in the mainstream. I didn't get any follow up from this client, so I don't know what she chose to do, but I did leave the door open so that if she had any questions or problems later she could contact the department.

So that's the thought process that carried me, an inexperienced practitioner, through my first worksite eval. If anything, I think it was worth it just to get the experience and learn that I do have the foundation for a different type of practice.

a human behavior refresher

The recent moving situation has been giving my empathy organ a refresher.
Basic psych/neuro instructs that our brain forms schemas to help us understand situations. Tied in there are the motor plans for different actions and the mental maps to help navigate the environment. When these systems work perfectly, we perform actions without even thinking about it- like sitting down in a chair, touch typing, or walking to the bathroom. This is how most people spend the majority of their days, performing routine tasks without being mentally or physically challenged in the least, not devoting even 1 additional brain cell to the task.

However, the people that I see in the hospital are experiencing disruptions in these schemas. It's easy for staff to forget that their patients are not always disoriented x2, struggling to sit down, struggling with walker usage, and just generally getting confused. But this is often just a variation of a person thrown into an unfamiliar situation. Example: I moved. Everything is in a different place. Our bathrooms have a marble threshold, which I am terribly worried about breaking my toes on. Because when you wake up in the middle of the night and walk without turning the light on, you're relying on those old brain maps to get around. And my brain map does not include marble thresholds!

Another recent situation is reminiscent of what pts with joint replacement are going through. I have started exercising again, and hopefully will stick with it, or else my friend may drive out here just to kick my butt. I have been in the Contemplation stage of the Transtheoretical Model of Change for some time, but have spent the past 2 days in Action! Action is a phase that makes muscles hurt and act in different ways... and trying to motor plan simple actions like sitting down, getting out of bed, or going down stairs when your quadriceps have failed to respond in a normal manner is very difficult! So as I require 2 handholds and a dramatically increased amount of time to accomplish sitting or navigating stairs, I think of those who have had surgeons hands pulling their muscles apart and shoving in new bone parts in the last 24 hours.

So I am resolving to start my new job with a renewed sense of empathy, considering that like my pts, I will be in an unfamiliar environment and unsure of things.

Product Review- Forearm Forklift

The big part of the move is over! Though the unpacking and organizing continues, the heavy lifting is done. And so follows the review for the assistive device we bought- The Forearm Forklift (as seen on TV!).

We bought our Forearm Forklift through Amazon.com, and had no trouble with payment or shipping. The straps are compact and can easily fit in a large toolbox. The basic premise is that you have 2 straps that go under your furniture, and you and a friend slip your arms into the straps to lift objects more ergonomically. That is pretty much all of the instructions that you will receive... we got one sheet of paper with back protection techniques and a few pictures of the product in use.

The straps are designed for objects that are large enough to require 2 people to carry, but they really only work well with a certain shape- either tall/long and thin. Short and squat things (non flat-screen TVs, rubbermaid tubs) don't work very well. Though there are pictures of people carrying mattresses, we had no luck with this. And though the instructions show people moving objects with their wrists in extension and hands flat against the object, we were never able to carry something with stability without grasping our hands around the edges. There was some minor pain and bruising from where the strap hits the forearm. Considering the rows of bruises I incurred on my legs from the move, they were VERY minor. They also tended to slip off our forearms and down to the wrists, which made it difficult to use.

The instructions also showed people carrying items up and down stairs, but this was particularly problematic. Our old apartment had 15 steps (no landings, thank goodness) but a very short ceiling. This is where the straps first failed, because we couldn't lift large objects very far off the ground due to the low clearance. The straps did a little better in our new place since we had fewer steps and higher clearance, but in our situation, it was easier to push things down the stairs in a controlled manner than to try to lift them.

We have 3 dressers, and to load them into the truck we carried each drawer individually and then carried the frame. Doubling the trips that took 2 people, this resulted in 20 total trips! To unload them, we tried the straps, and were able to carry fully loaded dressers using 2 people for a total of 6 trips. A definite time-saver, especially since some of the drawers were poorly made and falling apart when we tried to move them separately, causing us to take more time to adjust them later.

Using the straps increases the prep time for each object. It's hard to get used to the motion required by the strap, even if you're familiar with body mechanics. My brother and husband aren't great with body mechanics, and there were definitely times that they used inappropriate methods with or without the straps despite warnings from their resident OT. But my brother stated that he did feel that the straps kept his back from being "destroyed" during the moving process (he is a little dramatic). My husband reported that they were useful and would use again. He had an alternative way of using them, actually lifting by the straps, which he reported hurt less than grabbing sharp edges to lift.

So, overall, it wasn't a panacea, it won't force you to use proper body mechanics, and doesn't always work as you would like. But it's cheap, and for heavy stuff, it provides some extra assist and security. There were some comments on another site from people who use it regularly and get good results, fortunately, I don't have to move THAT often so it will take a little longer to get used to it. Even if the assist and security provided wasn't all I'd hoped for, it was enough to make it worth the low price. I have linked some other sources, and a couple of other products that other people referred to in those comments. I haven't fully evaluated those, but I included them in case anyone else is looking for a good moving solution.


Official Site
More Reviews from Amazon
Other Products: Shoulder Dolly and Teamstrap Moving Straps

Not mad at Obama.

I haven't really ever done a post in response to another, and not a lot on specific political events. But here is my take on the recent Obama Special Olympics comment.


First of all, let me say that yes, it was inappropriate for him to compare his lack of bowling skills to the Special Olympics. I think we all know that, and there's no need to start a flame war over that. And his comparison was quite off the mark- there's been several posts about athletes in the Special Olympics who bowl MUCH better than he does, my uncle-in-law being one of them. If anything, he should have compared himself to my friend Joanna, who regularly scores in the 20-50 pt range if not using bumpers (love you Jo!).

I read Chris's post, and he is understandably upset about the fact that someone in a leadership position would make a disparaging comment about a disability group. But I cannot condemn Obama for the comment, nor do I believe that this is revealing his "true world-view" and I also don't extrapolate this to how the administration will respond to disability issues. Why not? Because I have said stupid things too. I can think of several times that I said hurtful things to people who were my close friends because I just said the wrong thing. These statements didn't cost me those friendships because it wasn't a long term pattern and wasn't indicative of how I routinely treated them.

I don't think that this slip of the tongue, inappropriate and regrettable though it was, is evidence of the overall disability policy. The quick turnover in news cycles has turned every comment and minute action of politicians and celebrities into major news, which is great news for Jon Stewart, but a pain for those seeking sanity. At this point, I think it's more logical to wait and see how Obama acts on disability related policy than to rush to condemn him for one off comment. I would think that the recent stem cell decision fits into that column. Actions speak louder than words, or at least they should.

Doonesbury and Disability

Doonesbury is a comic strip that I read occasionally, waiting on an interesting storyline. Well, they just found one.
Doonesbury deals frequently with war and issues affecting soldiers, including disability. Awhile back, there was a series where B.D. lost his leg and was going through rehab, I remember an exchange where his OT was trying to get him to motor plan taking out the trash and his plan was to let the wife do it. How often does OT make it into the comics? and in a situation that is similar to what we deal with everyday, no less.

Anyway, the current storyline features Toggle, a soldier who incurred a TBI and continues to struggle with aphasia, entering a relationship with Alex Doonesbury. I don't really know the characters very well, but I am interested to see how this plays out. (Story starts 3/14/09, you can follow it here)

My only gripe is that there was a little rip on Toggle using facebook to meet people, but I think that the internet is one of the most valuable tools for a young person with a new disability. A guy that I worked with while on fieldwork was a 24 y.o. war veteran who had an SCI after returning home. His wife left him, he had to move back into his parent's house, but he was able to get online, find information about the personal/physical/emotional problems that he was dealing with, and make friends that way. It's hard to get out when you can't drive, and though he was working toward that with outpatient OT and PT, he needed to have those personal connections with other people. This was also pre-facebook times... nowadays, I have a hard time disconnecting from the internet for any length of time, it is the tool for most everything. OK, off the geek girl rant.

I think that there have been several realistic depictions of disability in comic strips. The other example that I can think of off the top of my head is when the grandfather in For Better or For Worse had a stroke. (Story starts 9/26/06, you can read month by month here) They continued to touch on issues of hospital care, rehab, caregiving, and patient frustration right up to the end of the strip when he was rehospitalized. Lynn Johnston also worked with her niece to construct the character of Shannon Lake, who has a learning disability, though I'm not sure of all the particulars since I didn't read that series all the way through.

Interesting Idea for Travelers

Traveling therapists, that is, and the kind that hop state to state as opposed to place to place within a big town. I am not a traveling therapist, though the boxes in my living room might suggest otherwise. But I was reading unclutterer and they were discussing Earth Class Mail, a virtual P.O. box that will scan your mail to your email account and then allow you to choose what to do with it- shred, send to you, archive, whatever. You can check out the prices here... I don't know how that compares to other mail forwarding options, but it sure sounds better than the cruddy service I've had at this apartment (numerous pieces lost or delayed up to 3 weeks).

Packing a moving truck today, which will be tiring, but I should also have enough info for a product review of the supposedly ergonomic Forearm Forklift (as seen on TV)!

Mind warp

I was very confused when I woke up this morning (about 10 minutes ago). I said to myself, "ok, it's Thursday, what do you need to do?" Then I realized, it's not Thursday, I'm just not working. a little more after the click ->

I think most of the tears are over now. I am trying to get excited about my new exciting job, but first I have to get through the aggravating task of moving. Moving is very frustrating to me for all the questions it raises- How did we get so much stuff? Why are we moving here? Where is this/that/the other in our new place? How will we move again if we get any more stuff?! After seeing the apartment, I know that we have to get more lamps, as there are 3 rooms w/o overhead lighting.I am also unsure how the laundry situation will work out as our washer is approximately the size needed for a week's worth of socks. UGH.

It's also interesting that we are moving into a predominantly Jewish area, judging by the multiple synagogues, kosher eateries, and the "Kosher Assisted Living" across the street. The kosher Subway is down the street, but I think that this is the oddest restaurant that I noticed near the apartment, just for the combination of different cuisines.

Ok, got a little sidetracked from OT things, but this is bringing a change in my OT-ness too. I have 300 unread messages from the pediatric AOTA listserv that I have been putting off addressing since I know I won't be using it so much. Need to unsubscribe from that. I have to get everything ready for my license to be reviewed, since this state only reviews once a month. It's good to take a good look at the license requirements before you give your start date to your new job, FYI. I've done all I can do, now I'm just trying to facilitate other organizations doing what they need to as well. Got to change address for all my subscriptions and such. Very busy in box-town.

Have plenty to update about if I ever sit down to do it. Last week was too emotional, hopefully this week won't be too busy. Have to figure out how to transport my violets, which are fragile and blooming again.

Oh, and free giveaway- I have AJOTs from 2005, I think, to now. I will mail them wherever, if not, they're heading to the recycling center. So if you want them drop me an email with your address and I'll gladly send them to a new happy home.

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.

I live in the Procrastination Station

I am up to my eyeballs in stuff to do... need to be writing up 2 sensory profiles and 2 sensory diets for Monday and Tuesday. Have to leave town this weekend, which will make that harder. Lots of other things to do, but I feel that shouldn't really be discussed until I can write a major entry here, which I have also been putting off. I have difficulty with transitions, and currently with organization. My thoughts have also been very transient, jumping to inane topics such as how death is dealt with in Dexter and Pushing Daisies, 2 shows that I like and which have nothing in common.The randomness and procrastination are possibly my coping strategies for stress, but it's making it hard to do what I have to do. Hopefully I will get all I need to done (finally) and can address some of these important issues soon. It's 4... can I get that stuff written up by 6? I hope so...