Thursday, November 27, 2008

Attitude of Gratitude

My first wake-up call today is the soft paw of Panther (our cat) on my cheek, accompanied by his rather loud "Nee-OW," which of course is referring to the moment in which he thinks he must get his breakfast. I assume that since my 6am cell phone alarm has not rung, then it must not yet be 6am. So it must not yet be time for Panther's breakfast. He has this habit of trying to weasle his breakfast out of his sleeping mistress at first light--recently, around 5:40am.

Instead of getting up, I grab Panther around his middle, hold him against my front like a stuffed animal, and start scratching him under his chin. His purr immediately becomes palpable against my chest. He settles in for a few minutes, and I guess I doze off, because the next thing I know, there's a paw in my face again, with another announcement of the time: "Nee-OW."

This time, I push him down toward my legs and start moving them back and forth, like I'm walking in my sleep. This sends him jumping off the bed. For 5 seconds. Then I hear him pounce back up, and I brace myself for another face rub. Instead, I hear my husband behind me let out a little grunt, and I know that Panther has launched his secondary attack plan. I am the morning feeder, and Panther knows it. When he starts trying to wake up my husband, I know he must be hungry. So I reach over and check the time on my phone: 5:45am. "Man!" I whisper, "okay, I'll get you food." Fifteen minutes is not worth battling wills with the cat, especially now that he's involving the innocent third party!


I climb back into bed, reset my alarm, and feel my feet begin to get warm again.
At 7am, my cell phone alarm goes off; I turn it off, and immediately roll over and tell my husband how much I don't want to go to work today. Then I remember that today is Thanksgiving Day. So in the next breath, I say, "Happy Thanksgiving!"
He replies, "Happy Thanksgiving to you!"

In that moment, God allows me to have an attitude adjustment.
"I'm very grateful that I have a job," I say to my husband. "So it's really okay that I'm going to work today."
"Oh, that's good," he says.


As I make my way from the parking deck to the hospital, I pass many nurses going in the opposite direction, just finished with their night shift. I pass my old roommate, who's listening to her voice messages on her cell phone, her glasses shielding--but not hiding--tired eyes. She flashes me a smile as we pass and calls out, "Happy Thanksgiving!"
I wonder if she's driving home to the coast today to be with her family. And I am suddenly grateful that I never have to work a shift overnight; that I'm not going home right now, exhausted and ready for bed, perhaps with a turkey in the refrigerator waiting to be cooked, perhaps with a long car drive ahead with bleary eyes and a weary body to see family. I'm grateful that I never have to start my workday at 7pm, but then start my day off at 8am.


I pass a lot of kitchen staff today at work. All of the patients' trays have a paper placemat on the bottom with a festive image of a cornucopia; they're serving turkey today for lunch, with green beans and mashed potatoes, yams, and cherry cobbler. I think about the patients in the hospital that have just switched from I.V. fluids to clear broth.... They won't be getting Thanksgiving dinner today. I look at the cafeteria workers, and I recall why I chose to go back to school to be a physical therapist. My mind flashes back to any year, Thanksgiving Day, 3pm, filling ice buckets and polishing wine glasses, moving tables, passing hors d'oeuvres and making cocktails, running my tail off all night to fetch extra gravy or make a cappucino...and then later, kicking back at midnight with the rest of the staff for a cold beer and some leftover turkey goodness from the restaurant kitchen. After that respite, then it was time to grab our stacks of cloth napkins (just up from the laundry) and the trays of clean silverware, and start rolling sets for the morning. No, I don't miss it. It was a great time in my life, but not for those busy holiday shifts. I'm glad it's over. I'm grateful that my job now is to spend time with individuals and their families, helping them recovery from illnesses, procedures, or accidents so that they can go home.

My husband pages me around 12:30pm and we plan to meet at 1pm for lunch. My co-worker has given me her holiday "free meal" pass for him to use, so we both get turkey dinner from the hospital cafeteria line.
We agree that it is the absolute worst "turkey dinner" that either of us has ever eaten. But I'm so grateful that we work so close to one another, that sometimes I get to see him during the workday, that he's sitting here with me today on a bench in front of the hospital. It's a beautiful day and we're sitting in the sunshine; I'm laughing at his imitation of the dog this morning, who apparently whined and yelped in distress at the change of morning routine, until my husband finally took him for a walk at 8:30am.

We're not with either of our families this Thanksgiving, but we're together, and these are the beginnings of our own family. I'm grateful that we don't have children waiting at home for us while we both go to work today. I know that there must be families who have to deal with that today.

It's a busy work day. I'm supposed to work until 4:30pm. I finish seeing my last patient at 7pm. But I'm grateful that I don't have a room assigned to me here. I'm neither a patient, a patient's family member, or a resident on-call for the night.

I get to go home. With my unborn child, who's been bravely reminding me of his/her presence all day. To my "family"-- my husband, my dog, and my cat. To leftover beef chili. To plan my first turkey dinner tomorrow.

I am so grateful.

Tuesday, November 25, 2008

Joining Nutmeg...

What Your Height Says About You

You are a very vulnerable and spiritual person. Your emotions run deep.

You have a philosophical and poetic soul. You think things through and are a bit of a skeptic.

You tend to be very opinionated. You are a perfectionist with high standards.

You prefer to work alone. You work hard, and you don't like interruptions.

You are about as tall as the average Japanese woman.

Saturday, November 22, 2008

With this Magic Belt,...

Speaking of glimpses into my work environment, ...

Another of my essential pieces of equipment when I see adult patients is my Gait Belt. Mine has yellow and blue stripes on it. It's quite fashionable.

The gait belt is used to help patients "transfer;" yes, "transfer" is a verb in the rehabilitation world. It means to move successsfully from one surface to another. With a gait belt around a patient's middle, combined with a little physics and excellent body mechanics, a smallish therapist can help a patient of almost any size transfer. Such things as getting from the bed to a bedside chair (or a toilet, or a wheelchair) can be accomplished by bringing the patient's weight forward on his feet, pivoting toward the desired surface, then gently letting the patient's weight shift back down to his hips to sit. If the patient has use of his arms, I usually ask him to push from the surface behind them when getting up, and reach back for the surface behind them as he's lowering down.

Patient safety with a gait belt is also addressed during ambulation, or "gait." Hence, the term gait belt. In school, we practice "guarding" people using a gait belt during all kinds of activities, including ambulation on flat surfaces, up and down stairs, with crutches, with less than full use of 2 healthy legs, you-name-it. We also learn how to lower people slowly, safely, and gently to the ground if they so happen to fall while we're guarding them.

Anyway--back to my favorite use of gait belts: transfers.

I believe in the utility of the belt. Some nurses look at me a little funny when I give it so much credit, but when you know how to use it, it can make some "two person" transfers possible with just one person. Many times I will qualify my report to a patient's nurse: "He was a max-assist transfer of one to the chair, but I also had a gait belt. If you don't have a belt, you'll probably want two people to get him back to bed."

Many of my patients come to believe in the gait belt, too. Sometimes it's an unhealthy belief. Kind of like Dumbo's feather: they associate their ability to move from here to there with the belt. And if you don't have a belt, then it's NOT going to work.

True Story:

I knock on the hospital room door of a patient for whom the physicians have ordered a Physical Therapy consult. Apparently, this woman has been very sick for a few weeks, to the point where she has not been out of bed for a few weeks, either. Therefore, she is profoundly deconditioned.

She answers my knock, "Come in?"

"Hello!" I smile as I walk in the door, rubbing my hands with the sanitizing foam positioned directly outside the door. "How are you today Mrs. Deconditioned? My name is Sephora and I am a physical therapist. I'm here because your physicians have ordered a physical therapy evaluation."

I explain to her the role of physical therapists in the hospital setting (which is not, by the way, to give out deep tissue massages--nor is it to "walk" people, as if they are pets that need to do their business 3 times a day).

The role of physical therapists in the hospital setting is to assess patients' mobility. We help the medical team determine whether patients are safe to discharge home, based on their ability to perform daily mobility activities--one of which activities, is, YES, walking. One must almost always demonstrate safety with ambulation in order for a physical therapist to recommend discharge home. However, there are frequent exceptions to this rule: equipment, family members who can be of assistance, home modifications, and other outstanding factors must be taken into account. Every patient is different.

If I conclude from an assessment that a patient is not able to perform mobility activities, I help him as much as possible while he is in the hospital, and make recommendations for follow-up if he has not met the physical therapy goals by the time he is medically ready to leave. Some patients are finished with physical therapy by the time they are discharged to home.

I explain to Mrs. Deconditioned that I understand she has not been moving very much recently, and that I am here to see how strong she is, and to help her get stronger so that she is ready to leave the hospital when the medical team is ready to send her.

"YOU're going to help me get up?" she asks, incredulous. "But you're a such a tiny little thing. I don't want to fall."

Next comes my memorized--but sincere--mini monologue, where I explain to her that I am a physical therapist and that means that I am a professional who is specially trained to help her move, even if she is not strong. I explain to her that this is an assessment, and that we are not going to do anything that she is not ready for, or that might be unsafe.

"Besides," I add to every such encounter where I determine it appropriate, "I have a magic belt here. With this belt, I have helped many patients who are much larger than you."

That gets them, one way or another, almost every time. Sometimes the patients are so confused, they don't remember that I just introduced myself as the physical therapist, and so they give some non-sequitor response such as, "Libby, you look so much like your mother in that outfit" or "I wonder why the bubbles are moving up and down the wall again." But most of the time, they're willing to try out the magic belt. Even if it's to challenge the truth of my claim.

In the case of this particular lady, she was super-weak. She had been through it all, and had seen much more across the span of healthcare than I ever wish to discover, even as a healthcare provider. But throughout my examination I continually explained everything we were going to do, along every step of the way, which is always appreciated by people who are apprehensive.

Incidentally, I have found apprehension to be a common denominator among patients in the hospital who are moving for the first time after a long sickness, with the assistance of someone they barely know...)

The end result was that this lady stood for a few seconds next to her bed before having to sit down again. There were plenty "tricks of the trade" that were utilized, but the most visible one was the use of the gait belt.

This patient was now a believer in the gait belt.

I knew for sure that she was convinced, because the next day when I went to see her again, and this time, one of her daughters was in the room. I greeted my patient and introduced myself to her daughter. Before I could proceed, my patient turned to her daughter with these words:

"Sephora might look like just a sprite of a thing, but she can do wonders with that belt!"

Friday, November 21, 2008


Hurray for Month-versaries :).

And this week also marks 20 weeks of pregnancy. Strangely coincidental.

Some--no, many--of my contemporaries or senior co-workers offer, or at least agree with the common wisdom, "wait at least year" after marriage to have children. They have a variety of reasons that all seem plausible:

"Marriage is such a big adjustment, you need to get used to it first..."

"You want to make sure that you're stable emotionally and financially before you intorduce another dimension into the relationship..."

"Treasure this time together, because when children come, it will never be the same..."

My husband and I were bantering about this the other day, and laughing about the fact that the same people were sooo excited when they found out we were expecting. I don't think I wear my Faith or my beliefs on my sleeve, at least not as much as I should. But those same co-workers who would nod in affirmation to the advice listed above, said to me in giddy tones, "Oh, that's awesome! Great! So wonderful--you're so ready to be a mom!"

Polar opposite reaction.

Yes, there are plenty of children in my family--immediate, extended, and among close friends. Yes, I've done my share of babysitting and there is no doubt that I want to raise several children of my own. But, really, any tips you may have of coming attractions would be appreciated!

Sometimes, I'm super-excited to hold this little one, to watch my own child grow into an adult like I've watched even my youngest sisters.

Other times, honestly, I'm scared to death.

My work environment feeds both of these emotions.

The little babies I get to see are all so precious; I can't imagine that soon, I'll be holding one that comes from my husband and myself. Our child. Wow.

The things kids say...

"What is the name for a baby horse?" I ask one of my kids while we're doing her exercise for the day.
"Pony!" she yells.
"Right! Now, what is the name for a baby cow?"

But then there is the reminder, all the time, of the hardships that parents face.

I meet many teenage girls with scoliosis that need rods placed in their backs--only after years of trying to manage the curve with bracing. The pain of recovery, even though it is temporary, is felt by the parents, and especially by the mothers.

Some of the notes written about my pediatric patients have phrases such as "patient is well-known to this physician, now admitted for x, y, or z." These are children with chronic disease, or recurring infections, or complications from past treatments, or what have you; the parents go through so much more than the children, in some ways. Their level of control of their children's happiness slips through their hands when they run through the doors of the Emergency Room. It is heartbreaking to see their heartbreak.

At some point, I know I will experience my children's pain. It is likely that there will be hospital visits, but even if there are none, there will be real pain. I am reminded of it every day at work; some days, it frightens me.

My automatic defense is to respond to myself, "You work in a hospital. And not just a hospital, but a Level 1 Trauma Center, a State Hospital, and a specialized Children's Hospital. Of course, what you see everyday is a concentrated collection of the worst cases in the state, sometimes in the southeast."

But I know that every one of those cases could be anyone. My child could be one of the 3 in 10,000 births to have this specific complication or that chronic disease.

Am I strong enough to handle it?

Am I "so ready" to be a mom?

I told my husband that because we're not "waiting a year" before having children, we'll really only have one huge adjustment to make, all at once! A few decades down the road, I continued, it might be hard for us to even remember this time before children.

"OH, no it won't! I will NEVER forget this," he replied. He wasn't being romantic or anything--he's just under a lot of stress right now, trying to complete his graduate work. "I will remember this as the most miserable time of my life," he continued.

How sweet.

Happy fifth month of marriage, and bring on the children!

Thursday, November 20, 2008

Have you seen my walker?

An essential piece of equipment that is with me whenever I go to see an adult patient: The Rolling Walker, or RW, for short.

Many patients that come to the hospital and require the services of a physical therapist benefit from the short-term or long-term use of said piece of equipment. Many are also very distressed when, after you let them try yours out, you have to take it with you to see your next patient. They are a hot commodity, as they give otherwise off-balance or immobile patients the freedom to "move about the country" as the SouthWest ad goes. Therefore, these RW's, when spotted in the hallways of a large hospital, will inevitably be covered with colored tape, stickers, labels, stretchy bands, or other various pieces of "flare" in order to distinguish it as some therapist's individual property.

On the weekends, when different therapists cover for the regular weekday therapists, there is an unwritten but extremely serious rule that if you borrow someone's walker for the day, you return it to the exact spot at the end of the day. Nothing is quite so tragic or soul-crushing as the sound of that fateful Monday morning groan from an acute care therapist:
"Have you seen my walker?"

True story: It was the end of the day, and I had just seen my final patient for the day--and allowed that patient to use "my" RW, complete with a big orange sticker with my name taped to its front. After we were finished and the patient was safely back in his room, I collapsed the RW and set it against the outer counter of the nurses' station, then went around the counter to grab the patient's medical chart. Since our department is not included yet in the hospital-wide conversion to computer documentation, I had to scribble down my note describing the treatment session on one of our paper documentation templates. It may have taken me up to 5 minutes (but not likely) and definitely no more than 5 minutes.

When I walked around to the outside of the nurses' station again to grab my RW and be on my way, I stopped and cocked my head to the side, a frown forming across my brow. There was no RW to be found. The entire counter was free of leaning-against-it objects. Thinking I may have mistakenly left it in along the hallway near my patient's room, I wandered down in that direction. But no luck. So I began asking around--to the nurses, to the NA's (nurses' aides), to the HUC's (Head Unit Coordinators)--"Have you seen my walker?" No one could give me any clues. But they all knew what I was searching for. And I believe they could feel my soul being crushed.
Finally, the nurse manager overheard my question, and said, "As I was walking by room #12 down there, a woman was carrying a walker into the room. It might have been yours." "She was carrying it? Not using it, right?" I asked, clarifying that I was not looking for a walker that someone needed in order to be ambulatory.
"Yes, she was carrying it."
"A woman, you say--a staff member? Or a family member of a patient?"
"I don't know if she's family, but she's not staff. She was just carrying the walker into the room, and as she entered, she said to the patient, 'Look what I found!'"
"What??!!" I laughed. "'Look what I found!'?? What the...?"

I marched down the hallway to Room #12, peeked in, and saw a scene in which I did not want to involve myself.
There was an older gentleman, one leg out of the bed, upper body raised off the pillow as if to get up, with his nurse in front of him, both hands on his shoulders, trying to convince him to get back into bed. Meanwhile, I could hear and partially see a woman in the patient's bathroom across from the foot of the bed, running the water from the faucet, apparently cleaning out a container of some sort, and talking to the gentleman in the bed as if the nurse was not there. My RW was neatly propped against the wall. I made quick eye-contact with the nurse, quickly determined that she had the patient's safety under control, and whispered as I quickly snatched my walker, "This is mine; ok, I'm out."
"Is this your patient?" the nurse asked, assuming I had left the walker in his room after my treatment session with him.
"No--but this is my walker!" I responded, quickly exiting before the woman could completely emerge from the bathroom to reclaim her stolen goods.

I now keep my RW inside the nurses' station when I am writing notes--or at least in my direct line of sight!

Monday, November 17, 2008

Things to keep in mind...

...while at work.

I am, as has been previously stated, a physical therapist. Currently, I work in the realm of acute care--that is, the hospital setting. I see many different people for relatively short durations. In the hospital, patients do not tend to stay under my care for weeks at a time. Those who do are generally very sick, but also are the patients that I automatically become closer to, as I experience their struggles, their pain, and hopefully, their eventual recovery with them and with their families. But I usually see most patients only for a very few days, before they move on to a less "acute" level of care. And many times, I will only ever have one encounter with a patient.

I have a quotation from Mother Teresa posted on my desk at work, to remind me to imitate her example to see Jesus in each person she served:

"Let us bring peace into the world by love and compassion,
by respecting life, the most beautiful gift of God. Let us love each person
- the unborn, the young, the old, the sick and the poor -
with the same love with which God loves each one of us,
a tender and personal love."
With the volume of people that I see in a given month--even in a given week, the temptation is there to "check them off" my list and move on without making a personal human connection with them. There is the temptation to get my part of the business of their care complete so that I can move on to the next floor, to the next patient, to the next order of business.

At the same time, part of what I love about my job is the opportunity I have to make connections with many different people. Some of those connections are more easily made than others. Some of the challenging ones energize me to try harder, while others discourage me.

Easier Connection: A mother of six children, whose youngest at 3 years old is lying in the Pediatric Intensive Care Unit, breathing with the help of a ventilator through an endotracheal tube, barely conscious from all of the sedation meds he's being given so he doesn't "extubate" himself. As I percuss my cupped hands on his chest wall to loosen the patches of pneumonia in his lungs, Mom and I chat. I ask her about her other children and we talk about the happy times of big families. She tells stories about this little one in front of me and I feel the love of this mother toward her entire family.

Challenging Connection: A teenager who last month was a track star, a violin and piano player, the one in the family and at school that "everybody loved." Due to what the physicians think might be viral encephalitis, she is now bed-bound with arms that become stiff, legs that move without her will, and a half-awake expression on her face as her mouth and eyebrows twitch. But we've been working with her, and last week, she definitely made eye contact with me. Definitely tried to raise her hand toward mine when I asked for a "high five." Definitely tried to move those twitching lips into a smile when her mom started teasing her. And it motivates me to work harder, to think creatively, in order to help this person recover her body--her current prison--to its prior role of self-expression and the actuality of her soul.

Discouraging Connection: Another teenager. They don't know what is wrong, but her foot hurts. She is being transferred to the Psych floor to manage her anxiety, her pain, her outbursts of anger. I feel for her, and I want her to know that I'm here to help her. But the pain is so bad, she does not want to try to move. I want her to know I see her pain, but I also want her to know the real dangers of keeping her leg so protected, and in that position in the bed. She hears but does not listen. I remind myself that her foul language is not directed at me, that her mind is as sick as her body. But I'm discouraged as I sit and document in her chart that I did nothing for her today.

That is when more of Mother Teresa's healing words give me encouragement:
"At the hour of death, when we come face to face with God
. . . we will be judged on love . . .
on how much love we have put into our actions . . .
and not how much we have done.
We cannot see Christ to express our love for Him,
but we can see our neighbor
and do for her/him what we would do for Christ."

Friday, November 14, 2008

Life comes at you fast...

We're already experiencing a bursting household, with the dog taking up most of the territory in the kitchen/living room area, and the cat romping everywhere at all times of day and night, from the dog's half of the house into our bedroom, sharing our bed--yes, sometimes even our pillows--with us!

Now we are preparing to make room for another little being, this one the most precious among us. It's such a mystery: that this little one exists inside of me, yet apart from me; that 30 years after I am given the gift of birth, my firstborn will receive the same gift; that the cycle of life is inevitable, yet still so exciting every time another opportunity for that cycle arises.

Please keep us all in your prayers.