Thursday, December 22, 2011

My Worst Experience in Healthcare

So this post has absolutely nothing to do with OT and it is a personal story, but it does have something to do with healthcare in general and I learned a lot from this experience.

I am 23 and I have had low back pain on and off since I was 14 years old. I have always managed it with exercise and yoga and it has very rarely been extreme enough to interfere with my functioning. This past Monday I experienced pain like I never have before in my life. I woke up with a mildly sore back, which was not unusual, and I went to tutor the kids I have been seeing. Throughout the session it got worse and I could not sit down. I was just meeting their Dad for the first time at the end of the session when I had a pain so bad it literally forced me to double over. I could not stand up straight, I could not walk, and I could barely breathe. I thought I was just having a mild spasm and it would pass, but it quickly became clear that was not the case. It took me an hour to get out of the house, down the five stairs, and into a car. I was in excruciating pain every time I tried to straighten my spine even slightly as well as when I tried to walk. It became so bad I literally could not move my foot an inch without screaming in pain. It took me another hour to get to an afterhours clinic because riding in a lowered car on the bumpy streets of New Orleans was almost unbearable.

The real story begins when I got to the afterhours clinic. I was literally crying and trying not to scream out in pain as I hobbled in the clinic and was brought back to the exam room. I clearly could not walk on my own and had to have my boyfriend assist me. I could not sit on the patient bed without severe pain, so I used one of the chairs to lean on and put weight through my arms to off-load the weight on my back. When the doctor walked in he did not introduce himself, he did however grab the chair out from under my arms forcing me to fall over and involuntarily scream some more. He did not apologize and instead sat in a laid back position in the chair with his feet propped out in front of him. He asked me why I was there and when I tried to explain what happened in my broken, in-pain speech, he interrupted me, and asked again why I was there. He said if I had ever experienced back pain before I should have been an orthopedist and not an afterhours clinic. I then tried to explain how my back pain has always been mild and this was completely different and he interrupted me again. He said I need an MRI from an orthopedic doctor because this was most definitely an underlying joint or nerve problem. I told him that I thought I was having severe spasms in addition to whatever was going on. He said I clearly did not know what I spasm was and that it was definitely underlying joint or nerve pain. I asked him what he could do for me today because I came there because I was in so much pain that I could not function. He said could absolutely not order me an MRI because I didn’t qualify for an emergency one since I was not having foot drop or bowel and bladder problems. He repeated this several times. He said an x-ray is pointless because I was not involved in an accident. He said if I was in “such severe pain” why didn’t I go to the ER? I said what would the ER have done differently than you? He said that they would have given me a shot and meds until I could see an orthopedic doctor to get an MRI since I did not qualify for an emergency one. I said what are you going to do? He said he would give me a shot and meds until I could see an orthopedic doctor. So I asked him why would I go to the ER and have a several hundred dollar visit and a longer wait vs a cheaper afterhours visit with less of a wait. He then said that protocol was to examine my reflexes even though he knew they were fine so he needed me to lay down. This was hard for me to do since I was literally having severe pain every time I moved. I told him I did not think I could lift my legs up alone and asked him if I could get my boyfriend to help me on the exam table. He (the doctor) then grabbed my legs quickly tossing them on the exam table causing me to burst into tears again. He then proceeded to tell me that his wife had this problem last week and that he had to “drag her out of bed.” He said it is common when you get even a little back pain to be like “oww oww ouch no I can’t move at all and then it will go away in a day.” (These are direct quotes I could not make this stuff up!!!) I then tried to explain again how this was WAY different than any back pain I’ve ever experienced and that I thought it was muscular. I told him I have always functioned through mild back pain and it literally took me 2 hours to get to this clinic because I was in so much pain and this had never happened. His response was to mockingly ask me if it took me 2 hours to get my shoes on. He said it 3 times. “Huh, did it take you 2 hours to do that? How could you bend over to get your shoes on if you were in so much pain?” I shut down. I literally stopped answering his questions I was hurting so bad and crying that I just did not want to waste my energy on this main that clearly did not intend to help me and point me in the direction of recovery. I believe he thought I was a med seeking patient and crying, screaming, and the inability to straighten or move my spine at all was not evidence enough that I was serious. He did not even look at or touch my back and did not do anything except check the reflexes in my feet. When I asked him what he thought was the underlying problem, he said all he could do is give me a shot and meds and tell me to see someone else. When I asked him what kind of shot and meds he was giving me (valid question – I was definitely not opposed, but wanted to know what was going in my body), he said “well what kind do you want? We have a limited supply of drugs here.” I then decided to quit speaking to him altogether and waited until I could ask the nurse questions about the medication.

I was horrified by this experience! This guy sees patients every day and treats them like crap! I know this because when I was explaining this to my classmate she said the same type of thing happened to her! He thought she was med seeking/faking pain as well and was completely rude and inappropriate to her. It was clear this guy has no insight into anyone else’s problems and in my opinion should not be practicing medicine if he can’t practice it right.

I did follow up with an orthopedic doctor, but his opinion was completely different. He listened to what I had to say about previous back pain and my current episode. He gave me a thorough examination: he looked at and palpated my spine, tested all my reflexes, measured my range of motion by having me bend forward in flexion and arch back in extension as far as I could without pain (not far) he also measured my internal and external rotation and knee extension which I could not perform at all in a seated position without pain. He took x-rays to make sure there was no underlying problem that he could identify by that form of test. He had me look at the x-rays with him and explained my situation. My x-ray straight on of my spine was so curved because I was having severe muscle strains and spasms. He explained that with my history of pain and family history of spine and joint problems there may be an underlying spinal abnormality that could be detected by an MRI, but hopefully not. He said the best thing to do is try PT and muscle relaxers for 3-4 weeks and if it not better go from there. He was kind, a good listener, and an excellent doctor. This is how medicine should be practiced.

The reason I am sharing this is because it probably happens all the time! People in the healthcare field should, in my opinion, have a passion for helping people with a minimum of tolerating and listening to them! Sure a text-book diagnosis can tell you what a person should and shouldn’t be experiencing, but I think it is important to remember that A) if you have not experienced something yourself it is hard to have insight into what that person is going through and B) every person ‘s experience is different regardless of the diagnosis. That is why I love that in OT (there's the one tie in for this blog post) the client is the expert on their condition and not the therapist. The person experiencing the problem should always be the expert of the problem and the healthcare profession be it a doctor, nurse, PT, or OT should be the expert in working with the client towards a solution.

I will definitely use this experience to make myself a better therapist and a better listener in general in the future. One of my New Year’s resolutions is to talk less and listen more. It is secondary, of course, to my first resolution which is to get super fit preferably doing P90X --- which may have to be pushed back to mid-January due to PT which I start tomorrow. Hopefully I will progress quickly! I am already walking better, but I am still in a lot of pain because I am quite the opposite of a med seeker and don’t like taking my pain meds unless I really, really have to. I am compliant with the other meds and am more than ready to be complaint with PT and get back to normal (no pun intended.)

P.S - I also gained insight into what it is like for several complete strangers to stare at you while you are trying to move in extreme pain. I know they were just worried and trying to be helpful, but they kept staring and it made me so incredibly uncomfortable that at the time, I wanted to reach out and pop them! I think this is a relevent experience to have given my future career as an OT where I will be watching people in pain most every day.

Wednesday, December 14, 2011

OT Student Blog - Google Search

I googled "OT student blog" and mine was on page 2!! I am moving up in the world of google!! Maybe this is why more and more people have been contacting me. I'm excited! Oh the little things.

Mental Health Facility

A few weeks ago I got to observe/participate in several groups at a mental health facility – what an experience! I am very lucky in that my program finds ways to give us hands on experience in addition to our fieldworks. We just went for the afternoon, but it was still a great experience. I participated in two group activities. In the first group, we did a leisure card activity. Everyone in the group got a card that had questions about leisure on it. When it was their turn, they had to read their card and answer the question. Other group members then had the opportunity to give feedback or answer the questions themselves. It was great for social participation and communication, conversation initiation, emotional regulation, social appropriateness, and it gave the group members an opportunity to reflect on activities they enjoyed as well as an opportunity to explore the idea of new activities they might enjoy. The OT and recreational therapist (RT) also led a group discussion on the importance of leisure activities. The second group I was in focused on the serenity prayer. Each group member talked about things they could change, things they could not change, and what wisdom meant. I think it was great particularly because some group members were having a difficult time living with other residents at this facility. We talked about how you can only control your own behavior and that you cannot control what others do. We talked about how you can’t change the past, but that you can control the future. We talked about how you can control your attitude and actions. We discussed things that we learned in our lives that made us wise. I think it was a great group several of the members wanted to write down the prayer to take with them.

I believe most of the clients in the group had a diagnosis of schizophrenia. Some of the clients did so well in group it was hard to tell they had a mental illness at all. Others gave signals such as poor grooming and hygiene, mismatched clothing, poor eye contact, and repetitive behaviors. I only saw two people out of the fifteen or so I came across that were actively hallucinating. Something one man in particular said really struck a cord with me. He was clearly hallucinating and telling me wild stories throughout the group activity because I was sitting by him– when it was his turn to speak he said his response to the question, then he talked about how he just wanted someone to believe him because he was telling the truth. I’m sure to him he was telling the truth – after all, he was only saying what he was seeing. I know you don’t encourage the delusions, but I think there is a way to say things and a way to handle things and I definitely it is important to be sensitive to the client and the situation. The OT’s and RT’s at this facility did a great job with this and I feel they treated all their clients with dignity and respect.

After our visit we had to write an activity analysis about one of the activities we did in group using the OT practice framework. I can usually crank out an activity analysis related to a motor activity, but it definitely took me a little time to write up one about a mental health activity. Although I am fascinated by mental health and enjoy it, I think it is an area I have more difficulty with because of my kinesiology background. I think it is vital to being a good OT in every setting though, so it is something I look forward to gaining more experience in.

I finished my first year of OT school!

Last week I took my last final of the semester, which means I am done with my first year of school! I cannot believe how fast it went by! I learned so much, yet I am acutely aware how little I know in the big scheme of things. One thing I do know is that I am extremely thankful for the month break we get before starting a new semester.

I had all these great ambitions about observing at clinics on my own during the break, but I am not sure if that is going to work out. I did not realize how many things in my personal life I put on the backburner while school was going on – I have been busy for a week straight trying to get things done!
One cool thing that I have been doing is tutoring. I actually started this job a few weeks ago before school let out. I really needed a job over break to avoid taking out the extra high interest loans and I think this job is the perfect solution. It is also great experience for OT. I know I sometimes struggle explaining things and explaining how to do things/tasks/activities/exercises/etc is a huge part of OT. I am tutoring a few children that are homeschooled. Several of the kids are in their early teens and I am teaching them algebra, and there is a younger one that I am teaching to read. I actually find it much easier to teach algebra than basic reading skills! I have been looking online for ways/tricks/tips to teach reading and it has helped. I have also been helping him with his handwriting because it was clear he needed some help with that too. I would love to disclose more information because this is a unique and fascinating experience for many reasons, but I don’t want to post identifiable info about people I come into contact with even if it is not OT related – just not polite.

I have also been catching up on Christmas stuff! I have become considerably more crafty since I started OT school (it used to be bad) so I am attempting to do craft/handmade since I am a poor grad student. A few things I am doing could definitely be activities to keep in my big activity/OT box I have started. Maybe I will post some pictures after Christmas. I will definitely post my two activity bags I did for class soon!

I continue to get more comments and e-mails, so I just wanted to say thank you for the encouragement, questions, and suggestions – I truly appreciate the support!

I read someone’s (I think OT student or perspective OT student) blog awhile back that listed my blog as a good OT student blog to go to (thanks!) and it said something like “great mix of OT and personal stories” which made me think about how I used to write about my crazy dog a lot because she literally consumed my life in her puppy phase when I first started school. I actually went back and read some of those and they made me laugh. They also made me want to do another crazy puppy update. One of the most memorable puppy moments of the year was when she ate part of my homemade zombie mask/skin on Halloween. It was made out of glycerin suppositories and gelatin. I read the bottle for the suppositories, flipped out, and gave her hydrogen peroxide to make her puke it up since it was toxic (this is what the vet told me to do when she ate something toxic before). She did not puke. I gave her more. No puke. I then called the vet and had to explain what happened – this took several times because they did not understand the whole glycerin suppository zombie mask explanation. They thought I was crazy – I thought I was crazy – Ellie (the dog) thought I was crazy. It turns out it was non-toxic to dogs even though the bottle says toxic. She was fine but I was a hysteric zombie mess - Halloween is serious business.

One other personal story before I end this rather personal blog update is my P90X challenge! I am posting it here to further hold me accountable. My boyfriend and I have made a pact to do P90X from January 2, 2012 to March 31, 2012 and I am doing it!! I took a lot of exercise classes in college so I know I know I know what some of you are thinking. It is over the recommended ACSM guidelines for some things, they don’t tailor the work outs or nutrition plan individually, and they encourage use of supplementation and products such as their “recovery” drink when all research has shown is that a small amount of protein helps recovery so you might as well drink a glass of milk. I am going to take my knowledge of nutrition and exercise and combine it with P90X to make it work for me. I NEED something to kick start a strength program. I maintained (barely) my health and minimum level of fitness this first year of school (exercising twice weekly), but my exercise routine needs a big kick start to get back on track. I realized during my first one week fieldwork I needed to be stronger. My CI told me one of the best pieces of advice she could give me is to get in shape and stay fit and I really want to! What it does have going for it is “muscle confusion” basically changing up work outs to avoid plateau and reduce the risk of injury so I think this helps sneak around some of the ASCM recommendations its breaking. I think the biggest challenge for me is going to be not being able to go to a yoga studio for 13 weeks. Thankfully yoga is in the program – I’m just going to have to custom tailor that to my liking too! If anyone reading my blog is interested in taking the P90X challenge with me let me know! We can e-mail, encourage, and hold each other accountable!! I think I am more likely to stick with it since my boyfriend is doing it with me – we have also made a deal to put up $10 a day that we don’t do the program (unless due to illness) and then we are donating the money. It is all about accountability!

I have several OT related things I want to post on now that I have time on break. I want to do a post on my two activity bags, my experience visiting a mental health facility, the suicide class I went to, and maybe find some pics from random things this year.