Connecting the Dots

I changed jobs almost a year ago; after 19 years of working as an occupational therapist in a large school district, I moved over to the world of academia, joining the faculty at a university in the heart of the city in which I live.

I continue to provide OT services for patients, but now part of my job also includes helping to shape the education – and the perspectives – of future occupational therapists.  I weave into what I teach many of the things I learned as a result of what my dad, my family, and I experienced after his diagnosis of brain cancer.  I feel compelled to impress certain things on the group of fledgling healthcare professionals before they enter the clinical arena, in hope of maximizing the positive impact they will have on their future patients and the families of their patients.  In the medical world, these tips are sometimes referred to as “clinical pearls.” 

I think there are a lot of lessons for the OT students to carry forward into their interactions with patients from things I saw (or didn’t see) when I was with my dad while he was in rehab.  On one such occasion, the occupational therapist came to my dad’s room and escorted us to the rehab gym, where she set him up at a big table.  She brought over a bowl of many small items which she dumped onto the surface in front of him, and she instructed him to use his left hand to sort the items into piles according to their similarities.  Before Dad could get started, she turned around and walked over to another patient on the other side of the gym, presumably to check in on that patient while Dad got going on the assignment he had gotten from her.

It was odd for me to be there in that setting as a caregiver instead of a service provider; I tried to make a conscious effort to let the therapist take the lead and not to prompt my dad too much during the intervention.  I watched him as he sat in the wheelchair that the OT had positioned at the table.  He looked at the stuff on the table for a minute, glanced around the room for a couple of minutes, and then looked at me.  “I guess she wants me to clean out her junk drawer,” he said to me in a stage whisper.  “If it was up to me, I would just throw all that crap away, but I guess if I do help her she will do something to help me get better so I can go home.”

Of course, I knew that what she wanted him to do was for his benefit, not to help her organize her junk drawer, but what I also knew was that Dad hated junk and that he hated to do things that he saw as a waste of time.  The OT had not explained to him why he was supported to perform the task.  I tried to explain it to him, but he was way past the point of listening at that point; he just wanted to get done with what he saw as the worthless job she had given him so he could get the hell out of there.

After about five minutes, the OT turned around and saw that Dad hadn’t started on the activity.  She came back over to us, and I waited to see what would be communicated between the two of them.  “Bill,” she said, annoying me with her assumed familiarity, “What did I tell you to do?”  And then I was annoyed with her tone and her attitude.  Dad, in maybe the first time in my life that I’d ever seen him do such a thing, offered an excuse to get out of doing the work: “I have to go to the bathroom, and I have a headache,” he told her. 

She seemed all-too-eager to take the bait.  “Oh, no problem,” she told him.  “We can go back to your room so you can use the restroom in there and then you can take a break.”

“Take a break from what – sitting on the sidelines with a task he sees as a complete waste of time while you chat it up with another patient??” I wanted to yell at her.  I knew what Dad was doing, but I also knew from past experience since he’d been sick that if I started raising a stink it would either embarrass him or scare him or both. 

I tell this story to the OT students now because I want them to see the big picture in the interventions they provide for their patients.  “Always connect the dots for the patient and for their caregivers,” I tell them.  “Don’t leave them to wonder why you are asking them to do something.  Talk to them about what their priorities are; explain the purpose of the activity and clearly identify what the patient will gain by putting forth effort in the session. Find out what their carrot is - what motivates and interests them - and incorporate that into your treatment plan.” 

There are several more clinical pearls that can be taken from this story, too, lessons that I think are important for healthcare professionals to know.  Through telling stories about people with injuries or illness like my dad, I hope to cultivate the compassion these students have so that they are able to connect the dots to effectively serve the needs of their patients for many years to come.

World Autism Awareness Day

There are many people who played a role in my career choice many years ago, and I regularly think about the fact that I am so lucky to have found a profession that is fulfilling, challenging, and rewarding on a daily basis.

Once I decided on and then entered the Occupational Therapy program at Washington University in St. Louis, Missouri, though, there were still several different career paths within the field of O.T. that I could choose, based on various demographics of the patients with whom I would be working in the future - from very young to very old, by diagnostic grouping like "hand therapy" or "neuro rehab," and/or in different treatment settings such as an inpatient hospital or a school system.  In fact, the diversity of the options within my chosen field was one of the main things that drew me into Occupational Therapy initially.

During my final year as an O.T. student, I landed a part-time job working for my favorite professor, the woman who taught the pediatric-focused courses in our program.  Some of the work I did was data input, mainly typing the treatment notes that she had recorded on a mini-tape recorder and entering appointments into her schedule on a brand-new Mac Classic computer that seemed so high-tech and cool to me at the time.  I liked that work; it allowed me to learn a lot about computers and my teacher's clinical practice from the sidelines.  A second part of my job was to go to the medical library and research topics about which my instructor needed more information; through this, I learned to love research and to how to be organized in my approach to finding out what scientific studies and data said about a particular subject.

There was one more part of my job, though, and it was the part that I thought was the best: going with my instructor to clinical visits.  I primarily served as a hauler/transporter/equipment cleaner at the treatment sites, but, rather than feeling like a grunt who was limited to schlepping and scrubbing, I felt like I was a sponge, soaking up knowledge and inspiration from all around me.  Two of the children in particular who were being treated by my teacher that year ended up influencing my decision to set a goal of practicing in the field of pediatrics as an O.T.; after getting to know each of them, I was certain that my future was in working with the younger population.  

One of these kids was a boy named Johnny who had cerebral palsy that affected all four of his limbs, his trunk, and his speech.  A couple of month after I'd met him, my instructor had me sit with him while she left the room to take a phone call.  I had to focus and listen closely to make out what he was saying as he chatted away about his love of the Cardinals, St. Louis's major league baseball team.  After a couple of minutes of that, he abruptly changed the subject by asking, "What does it mean to be handicapped?"  His question took me off-guard; I spent several seconds trying to think of the best way to respond.  He beat me to the punch, though, blurting out the answer to his own question before I could say anything: "Oh, I know: it means you have to work harder to do things,"  and then he went back to talking about baseball.  I thought his answer was perfect, and I knew at the time that I would never forget this exceptional child or his profound words.

The second child was a girl named Casey who was at a different facility than Johnny.  Casey was a six year-old girl who had been diagnosed with autism.  She was verbal but had many social and other challenges that affected her ability to interact with the world in what is considered to be a "typical" manner.  Casey wasn't as touchy-feely as Johnny was; in fact, she didn't like to be touched at all, but I still found her to be very lovable and sweet.  She had some "quirks" - some habits and patterns of behavior that I found to be both interesting and endearing during the year that I knew her; one of these idiosyncrasies was that she coped with stress by pretending that she was interacting with a cat that she kept in her pocket.  Cleverly, I thought, she used this as a way to divert attention to something other than herself whenever she felt like she was being put on the spot; instead of answering a question or completing a task that she didn't feel like doing, she often emulated taking the cat out of her pocket and petting and talking to it.  

I was fascinated by this tactic; I thought the fact that she had devised such a creative strategy for gerrymandering was brilliant in many ways.  Some of the people who worked with Casey scolded her for talking about or to her pretend cat; I, in my squeaky-clean lab coat and with my very limited knowledge base and experience in the clinical world, tried to find out more about her and her world by playing with her and by asking her about the imaginary creature.  In turn, she often made better eye contact with me, and she talked and talked about things that were on her mind, all while pantomiming holding and/or petting the make-believe cat.  

Not long after my job working with Casey ended, I decided to get a kitten, and, as I looked through the want ads in the newspaper, I knew already that I wanted to name this cat Casey, after the child that first drew me into the world of autism, a condition about which I was sure I wanted to learn much, much more.  I ended up getting a male cat instead of the female I had envisioned, but I still went with the name Casey for the first pet I had as an adult, the cat that was with me as I graduated from college, found my first job, moved into my first apartment, met and later married my now-husband, and had both of my children.  

Like Johnny and his words of wisdom, I will never forget the girl named Casey, the child who drew me into one of the main fields of interest in my profession.  Today, on World Autism Awareness Day, and on many other days, I will think of her and the cat in her pocket and hope that she is somewhere doing something she enjoys.