Coworker

I look in her eyes and I know. She is reveling in it. The smallest detail like fluency in only one language, paperwork done different (in her opinion wrongly), even unfamiliarity of the area. Sometimes I despise her for it. For her condescending questions and stares of disbelief. Other times I despise myself when reality crashes in on all four sides and I have to listen to the humiliating taunt and know that she is right. And then there are moments like these. Moments when I am thinking the clearest of all. No emotions of anger, shame, embarrassment, despair, flooding my mind. I look at her and I know I am right. I see her ignorance behind her mask of superiority that so thinly covers her. How has she fooled so many? Am I the only one who knows? Ask her and you’ll see. Ask her and you’ll find any intelligent answer is quickly deflected into questions of disbelief of your own ignorance. Watch as her sword immediately comes up and lashes out at you to protect the weak foundation of knowledge that has long since been dated. Then as you withdraw don’t take your eyes off her. From lowered head, peer out the side of half closed eyes and see the sparkle of satisfaction shine in her eyes. Is this what she lives for? What a sad hollow existence. The happiness in her life has been so easily discovered and can so easily be controlled by me. Someone who is supposed to inferior in knowledge and wisdom by lack of age and experience. She may find joy in the battles she has one. Of making me the fool. But now I control her fate. She will win only the battles I allow her to. And I guarantee you. She will not win the war.

Therapy

The other day someone asked me why I said I was not a fan of being a therapist and I was actually stumped. I couldn’t remember why, only that I wasn’t. So I was thinking about it and trying to decide if it was just because I am lazy or if it was actually the job and this is the explanation I came up with.

In the therapy world, nursing home jobs are normally the easiest to get and also somewhat higher paid. The reason for this is how overworked the therapists are. On my first day of work as a therapist I treated 9 patients. I was given a brief tour and then asked to start treating. No observation period or on the job training. In a nursing home they ask for a certain productivity from their therapists. The nursing home I was working at asked for at least 88% productivity. That means 88% of your time has to be spent in direct patient care which doesn’t count paperwork.

Every morning I would get to work and the first thing I would do would be to make my schedule which is a nightmare in itself. You have to plan out who you will see at what time without overlapping with the times physical and speech therapies are going to see them. You also have to work around doctors appointments, care plan meetings, and the patient’s preferences. Some patients with only give you and the other therapies about a two hour window that they will allow you to see them and then they will complain about having one therapy session after the other. Occupational therapist have a huge emphasis on ADL goals in the nursing home. ADLs are pretty much the basic things people due on a daily basis to survive like get out of bed, bath, brush hair and teeth, and get dressed. The only time you can work on these goals is in the morning. If you have a caseload of 7-9 patients the chances are that more than half of them will have ADL goals. With treatment session being from roughly 45-75 minutes long it is impossible to see more than a couple of people before breakfast. And even for that you have to start pretty early in the day which most patients will hate and grumble and possible refuse. And then you have a schedule that actually works and you approach a patient about an already agreed upon time and they will refuse and you have to change your entire schedule for the day. If a patient refuses you can’t just say oh well either. You have to approach them at least three time and document the exact time of each approach and why the patient refused.

I was normally scheduled for 7 hours and 15 minutes of treatment time. That leaves 45 minutes to do paperwork, go from one patient to the other because you document to the exact minute (take 5 minutes to walk from one floor to the other and you’re screwed), clean equipment between patients, answer call lights, stop to help that person who is standing up in their room even though they are not supposed to put weight on their leg and are a huge fall risk but are not cognitively with it enough to stay sitting for more than 20 minutes and will fall and possible die or break a bone and go to the hospital where their physical status will slowly decline while they lay in a hospital bed getting too weak to even roll from one side to the other without help until they die but no CNA would stop to help them get that thing that was just out of reach or help them to the bathroom after they have been waiting an hour even though that is their job, help that sweet little old lady out who said “It will just take a minute”, and so forth. If you can’t tell it is impossible but you are not allowed to work longer than 8 hours because they don’t want to pay you for the overtime.

And then you spend the majority of your treatment time in the bathroom wiping people’s butts because you have to pick your battles and if wiping their butt means they will stay standing for 5 minutes to accomplish a standing endurance goal without knowing it while you are meticulously trying to draw out wiping someone for as long as possible. Or you are treating that patient with diarrhea so bad that every time they stand up they have an explosion in their pant but their family doesn’t care enough about them to bring them a new pair so they are stuck in their room for weeks because all they have to where is a backless hospital gown and you can’t go to breakfast in the dining room half naked.

And of course no matter how hard you try the patients don’t like therapy. Before every treatment session you have to mentally prepare yourself for a fight that may come in the form of manipulation by them always complaining of excessive pain, tiredness, headaches, nausea, and such even though you saw get up and walk around right before you came in the door. Some patients are hitters. This is more rare but it’s a good idea to always be on guard. Some will make inappropriate comments to you. Some will tell you to f*** off and how sh**-y you are and right where you can go. I had one patient turn to me and look me right in the eyes after calling me several names and say, “It must be really hard having everyone not like you.” I had trouble not laughing right then. It still makes me smile because you know what, sometimes it is hard having everyone not like you. This patient had a talent for hitting the soft spot of her physical therapist who could normally handle herself through all kinds of verbal abuse and sending her from the room crying. Sometimes the worst patients are the ones who really try but don’t have enough money to stay or a good place to go afterward so you know they are just going to go home and fall and come back anyway.

And then the lovely healthcare system that we have will somehow make sense of putting someone who is on hospice (which means they are dying) on therapy and you will have to spend an hour with a person who should be spending their last several days doing whatever they want making them do the last thing they feel like or are able to do which is exercise. And if you have ever tried to make a dying person exercise, it’s not easy. Half the time is spent keeping them awake and it’s normally a losing battle. And then you find out what a horrible person you are because you literally are wishing they would die because spending an hour with them is physically, emotionally, and mentally exhausting. And I have had patients die that were on my caseload. To be 100% honest I was always relieved at first. After a little I would go from being relieved to being excited that I got to go home a little earlier.

And if you even dare to ask a nurse a question they will simply glare at you, give you a sarcastic response, or get all defensive and tell you they are too busy. Also you have to go to care plan meetings which are supposed to involve the patient, the patient’s family, a social worker and every therapist treating the patient. The purpose of these meetings are to educate the family on what therapy has been working on and how to prepare for the patient’s return to home or recommend more help if needed. It gives each discipline of therapy a chance to explain the purpose for the exercises and activities and the family member a chance to ask questions directly to them. Occasionally if an impossible scheduling conflict came up (like you only work from 6 to 11 and the meeting is scheduled for 2) then you can have someone else report for you. Ideally this would be someone from the same discipline who has worked with the patient before. As a new grad I have had to go to care plan meetings where I am the only therapist and I have to report on physical and speech therapy as well as occupational for reasons as poor as them not wanting to rearrange an already printed out schedule.

And then there is the paperwork where you have to justify to an insurance company why therapy is helping them when you don’t even believe it just so they can bill the already financially struggling patients.