The End of the Beginning and the Beginning of the End.

Well, it's hard to believe it but today marks the start of my last week at my first fieldwork site!  (If you're confused, start again--at the title.)

Things became very busy for me the past few weeks.  I have not updated recently and I apologize to any of you who are just dying to hear about my experiences!  I'll share a couple "highlights" and then I'm off to prepare the house for family later this week.

I have experienced so many different things over the last 7 weeks.  One of the biggest learning experiences for me has probably been learning about seizures.  This is definitely not something we talked much about in my schooling, but is a VERY common issue with a number of my patients.  I've witnessed a few different seizures in the last couple weeks.  One happened at the end of a treatment session I was doing with a young 4 year old.  It was a relatively mild seizure but it was somewhat frightening to observe as I was holding her in my lap.  Her eyes darted to one side, she went into the asymmetrical tonic neck reflex (ATNR) and then became unresponsive for around 15 seconds.  It is pretty typical for the patient to become exhausted after experiencing a seizure and that is exactly what happened.  She curled up in a ball next to me on the ground and was totally out of it.

I witnessed another seizure just last week.  This was during a session that I was just observing with an 11 year old.  We were working on ADL's in the bathroom when she said she felt dizzy.  The next thing I know her mom (who was also with us during the session) steps in behind her just in time to catch her before she hit the floor.  She began shaking and all of the color went out of her face.  The girls mom and my CI coached the patient to take deep breaths so that she wouldn't hyperventilate.  She remained light headed for quite a while and then ended up vomiting a couple times.  The mom requested that we call 911 because she had never seen her daughter do this before.  I went to the office manager and quickly explained the situation and asked her to make the call.  My CI and I met the EMT's outside and they took her to the hospital to get checked out.  It was a very frightening situation for me.  I thought to myself "what would I have done if her mom and my CI had not been in the room?!"  I hope that gut instinct would have taken over, but honestly I don't know if I would have known what to do.  We weren't taught how to handle patients during a seizure!  At least now I have SOME clue what to do during a more instense situation though.

The last exciting story before I bring this to a close.  I had 11 patients on my caseload today!  One of them cancelled but regardless, it was a very busy day.  Of the 11, 2 were patients that I had never worked with one on one before.  All in all the day went really well.  I have no serious complaints.  I've had super busy days before but I was definitely more "on my own" today than I have been other days.  My CI gave me good feedback at the end of the day saying that she thought I did a nice job with all the kiddos that I saw as she was keeping one eye on me and one eye on her patients.  I worked nearly 10 hours today and with that--I'm tired so I'm going to get some work done around the house and call it a night!

Next Monday I will begin the end of this journey.  I start at my second site and I am pretty excited.

I've been thrown to the sharks...but I still have a life jacket!

I think I should cut to the chase and let you all know that I got high markings for midterm.  Both of the OTR's at my site agreed that I am doing really well but would like to see a little more confidence from me.  If you know me at all this should not come as a big shock.  My shyness typically comes across as low self-confidence.  I'm just not one to really put myself out there.  Last week, I mentioned my struggles with doing transfers.  This is something I have discussed with the OTR's at this site and they are pushing me to really work on it.  I am happy to say that my confidence is building and along with that, my ability to transfer the patients has improved as well.

I've been doing a lot more "independent" treatments.  The OTR's have in a sense thrown me to the sharks and allowed me to work one and one with a lot of patients.  As they see that I'm comfortable, instead of hanging over my shoulder, they retreat to the office and check on me periodically.  When they know a certain patient may be more difficult for me to handle, they hang out nearby just in case I start to get in over my head.  They won't let me fail and drown...they are there for me and I couldn't be more thankful for such great clinical instructors!

I've had an eventful week.  I was kind of working with a patient that has pervasive developmental disorder.  I mentioned this patient in my post on October 3rd.

"Seeing an older teen pulling the therapist's hair, slapping her and trying to bite her was hard to deal with! I feel like I need to be trained in some kind of self defense. I guess working in that situation is the only way I'll ever be able to figure out how to handle it"

After the situation that happened on my first day of fieldwork, everyone has said that the rule of thumb with this patient is to stay at arm's length away to avoid putting yourself in harms way.  I have done my best to always maintain that distance and have avoided rough situations.  Yesterday, this all changed.  While working with her, the OTR said that she was going to go grab a list of activities for the patient to pick out what she wanted to do.  Upon getting up and leaving, the patient proceeded to try and follow her.  I knew she needed to stay in the private treatment room so I moved into action.  The instructor from my mental health class told us to always keep ourselves between the patient and the exit to the room.  Just as this patient reached the door, my foot blocked her from opening it.  I did what I could to keep my distance but I was too close.  I got slapped a couple of times.  She then retreated momentarily and threw the toy that we had been using before the OTR walked out.  I asked her to pick it up and she headed for the doorway...which I was standing in front of.  She grabbed me and dug her nails into my arm.  Ironically...I stayed calm.  I pryed her hand off my arm and she did it again.  Then she threw a bottle of hand sanitizer and a box of kleenex.  She proceeded to throw a book and a small piece of plastic at me (though she failed to hit her desired target).  I was still calm but on the verge of losing my cool.  With patient's like this, we are told to have no reaction to the behaviors they display.  The patient is "looking" for the reaction and by responding, it will only get worse.  I'll have you know that I walked away from the treatment session, slightly shook up, but rather proud as well.  I still have claw marks on my arm, but the experience definitely taught me a lot!

Outside of that adventure, things have been very busy.  I'm treating around 6 patients a day as well as doing daily notes and progress notes.  I'm still loving every minute and look forward to each new day.  Nearly 5 weeks down with only 3 more to go.  Time's flying!