Happy OT Month!

Rather appropriate, considering Easter is this weekend. I am indeed resurrecting this blog--sharing a few OT thoughts for the first time in over two years. April is Occupational Therapy Month, so this seems to be a proper mode of recognition.

I started this blog as part of an OT-education project in my second to last semester of graduate school, and kept it going, intermittently, for about a year after. Then the real world sort of took over and this blog was shuffled aside. But enough of history. Point is, I'm back to share my thoughts in this one-time, exclusive, resurrection of a blog centered around what is, in my opinion, the greatest profession in the world.

Adaptability is a word that’s been running through my mind more than usual, lately.

Which is saying something, because adaptability is one of the foundations of Occupational Therapy. And, as an OT, I’m constantly considering, noticing, and discovering the adaptability of the environment, the adaptability of the tool or object, the adaptability of the action or task, and the adaptability of the human.

As an OT, on any given day, I might be trying to restore movement and function in my client's arm and hand after a stroke. Or educating and discussing with a client ways to manage their chronic pain, and the science behind it. Or helping an amputee manage and use their new prosthesis. Just to name a very few things OT's do-- and specifically in my setting. But OT's can be found pretty much anywhere and everywhere, with the primary goal of helping people maximize their quality of life by helping them get back to doing the things they want, need, and are expected-- to do.

Honestly, my clients do all the work. While we do employ hands-on treatments, I'm also there to offer feedback, encouragement, and education. I can (and do) offer them tools and strategies, but the ultimate goal is to empower them to find/make their own tools and come up with their own strategies to be successful.

Because human beings are fundamentally creative-- no two people will come up with the exact same method of doing something. But each one will find their OWN method that works best for them.

And along with that, human beings are fundamentally adaptable. Some more than others, of course, but we've all got it in us. I see it all the time, every day. People who have endured setback after setback. Pushed down so many times by various events and circumstances. But they're still here. Bouncing back, while still becoming accustomed to their "new normal". Adapting (see what I did there?).

Let's be real. We are constantly enduring changes in our lives-- day to day, moment to moment. Most of them are small, and their impact is small, and we don't notice them. Still requires some degree of adaptation on our part. And we're so good at these little changes that we adapt without even realizing it.

But then we've got the big stuff. Significant medical diagnosis. Moving to a new state to start a new life.

Living in isolation during a pandemic.

It's a lot. And most of the time, I don't even know how to feel about it. Really, there is so little we do know, except that there are so many unknowns.

But this has helped me-- maybe it'll help someone else...
(Tbh, it's nothing new, really, just another iteration of "go with the flow" or "take it one day at a time" so don't get too excited.)

We're human. We're used to change. We have the creativity and the adaptability to survive in our current situation. It may feel like an endless black hole sometimes, but ultimately, our bodies and brains will find ways to adapt to this temporary "new normal". We'll come up with and embrace alternative ways to connect with others, perform our occupations, and enjoy things. It may not be ideal, and some days will be great and magical, and other days discouraging and lonely, but it's also not forever.

(Some of this is similar to what I tell my patients with movement restrictions after surgery--when they have to use adaptive equipment for getting dressed, etc.)

We all have some pretty strict movement restrictions right now. But with the right adaptive equipment, it's possible to make this situation just a little more doable and survivable.
My current "adaptive equipment" includes Pippa the Pupper, reading, eating twice as many Cheezits as usual, prn Dr. Pepper cream soda, and attempting to learn the ukelele.
What's your adaptive equipment?

Also, please enjoy this photo of me, dressed as my spirit animal, Rex from Toy Story, holding a very common piece of adaptive equipment: the reacher (or grabber, as the majority of our patients call it). Also, please appreciate the pun of O-T-Rex and the fact that a reacher is legitimately something that a T-Rex would benefit from using.

The Job Hunt (published shamefully late)

So, the majority of this was written (and supposed to have been finished and published) on August 23, 2017. Unfortunately, things began to get busy, and I completely forgot. I am posting it now to include my experience in the world of looking for a job, which might be interesting/helpful to those that will be graduating this year.

This will be my last boring process-informational post. Hallelujah. But I felt it was important to address, especially for my readers who are going through the job hunting process right now (I feel your pain), and for those readers who will be going through the process in the next year or so.

As students, we were advised to start applying for jobs about eight weeks before we would be ready to start working. Which, translated for me as in the last four weeks of fieldwork. Here's the thing: all the applications are online nowadays. And almost all of those applications have a yes/no question "Are you currently a licensed OTR in the state of Missouri?" Which, of course, I wasn't until two weeks ago. And you hate to lie on an application, but they also don't give you much of a choice. And I refused to lie, until I asked some experienced OTR's, who told me that I should just answer "yes". So, long story short, I followed their advice. I used primarily LinkedIn, and Indeed.com. But after signing up for alerts from them, I also somehow signed for for like a million other job search site notifications. Not a million. But it felt like it whenever I opened my inbox. Anyway, I had no luck. Either my applications were stuck in the "under review" category for all eternity, or I received an email a couple days after submitting the app, saying thanks, but no thanks. It was a bit discouraging. But, at the time, I was also studying furiously to take the NBCOT exam, and, as I said before, it took precedence over everything else. 

My first offer was, quite simply, out of the blue. I had received a request to share my resume and LinkedIn profile with a children's therapy clinic located in a small Missouri town. I was intrigued, so I said "yes", partially because I was thrilled to the gills to have someone who might actually be somewhat interested in hiring me. Four weeks later, I had all but forgotten about it. But then I received an email requesting a phone interview. Which I accepted, because the clinic was incredible. And I wanted to learn more. The phone interview was more of an informational conversation. No interview questions were asked of Audrey. I was slightly disappointed, because I had done some preparation and I was ready. One thing led to another, and I agreed to visit the clinic for an in-person interview. The drive there was about two and a half hours. The clinic was incredible. Mind-blowingly cool. They kept asking me if I was passionate about pediatric OT. Which, my response to that is, I'm passionate about OT. All OT. I'm just beginning my career, and my true love isn't a particular patient population yet, it's the profession itself. Long story short, they offered me the job. 

Now, this is important, I think for others who will be looking for jobs. The pressure to take this job was real. A fantastic opportunity to work at in an incredible setting and gain lots of cool experience. And it was my only job offer at the time. What if I didn't get anymore offers? Or didn't get any in the near future, and have to take a part-time position for a while? I needed to be thinking about paying back loans, and figuring out expenses, and all that fun stuff. Taking the job meant moving 2.5 hours away. Which isn't far at all. But at the same time, far enough to make the difference in my mind. Additionally, I would need to be finding an apartment and making all those kinds of arrangements within about a week's time. Which, I can totally roll with. I didn't decide I was going to Rockhurst until March of my senior year of high school. Anyway, I agonized over it. While simultaneously studying for the exam. I was grateful for the job offer, but I was also annoyed because it was making my life more difficult. But mostly I was grateful, as should be the case. I turned it down. And knew right away after doing so that it was the right choice. The past six months had been all kinds of crazy, and I made the executive decision that I was in no condition to make a major transition like this. I would take the exam, and then trust that I would find the right job here in STL, while also taking time to breathe and relax for the first time in a while. 

Aaand, I'm going to finish up the job stuff before I get to the fun part, which is, what I've actually been doing with my time off. Anyway, I still had a lot of rejection with no interviews, even after I was officially certified. My first real interview was with a rehab hospital. It went extremely well, and I instantly fell in love with the job. They had lots of other people to interview, so I ended up waiting two weeks to hear back from them. In which time, I received an offer for a full-time position with the contract therapy company that I finished up my fieldwork with. It was for a position at a skilled nursing facility. 

***This concludes the entry from 8/23***

Long story short, I was offered a PRN (as needed) position at the rehab hospital, with the expectation that it would eventually be full-time, but no guarantee. It was disappointing, but not a unique situation by any stretch of the imagination. With the knowledge of my impending loan repayments from school, I made the decision to take the full-time position at the SNF. I could have also taken the PRN position, but at the time, being a new grad, I didn't want to stretch myself too thin.

Now that I am rereading all of this 4.5 months later, I realize that I promised to include coverage of what I did with my free time. Which, I'm actually not entirely sure that I can remember any of that, but I will give it a try. I know that I did complete a 1,000 piece puzzle in the space of 4 days. I completed another edit on my novel that I wrote 2 years ago. I fell off a horse 2 times. I slept. Drank a lot of coffee. Basked in the glory that is not studying. Made a trip back to Kansas City to reunite and spend time with my best friends from college. Did some coloring. And that's all I can remember. It was heavenly. 

Audrey Fiudo, OTR/L

I have done it. That is my excuse for being shamefully remiss in maintaining this blog for the past month and a half. I didn't write anything at the time because I thought, "Well, I'm not working, so there's really nothing to blog about." And it's only now that I'm finally sitting down to write that I'm realizing just how much STUFF there is. So, here's the thing. I am going to have two separate sections within this post; The Exam and The Certification/License. So, feel free to skip to whatever interests you. My hope is that the this post can provide some insight to those readers who are currently studying, or will be studying for the exam. I also plan to do a job search post soon as well, but there are quite enough words to be said on these two subjects.

The Exam
Following the conclusion of my fieldwork and coursework for my Master in Occupational Therapy, I, of course, spent the next few weeks studying assiduously. Totally makes sense, right? Actually completely finished with school, and the first thing I do is study more than I ever have in my life. And it was so much fun, let me tell you.

That's actually not true. But, while it may not have been the most fun thing I have done in my life, it also wasn't terrible. I gave myself the weekend off after finishing fieldwork and let myself relax a bit and enjoy the 4th of July with my family. During that time, I was also waiting for my degree to be processed and sent to the National Board for Certification in Occupational Therapy, aka NBCOT. Once that went through, I got to sign up to take my boards exam to obtain my OTR status. This exam is 170 multiple choice questions, plus three multi-part clinical simulation questions to test the practitioner-to-be's clinical reasoning and overall OT smarts. My goal was to take the exam as soon as possible, while still allowing myself to study enough to be comfortable. Hahahaha. Take it from me, there is no way to feel comfortable about taking this exam, regardless of how much you study. But you can feel slightly better about your chances of passing by taking the time to study thoroughly and efficiently.

The earliest I could take the exam was July 16th, which I determined would be a bit too early for my liking. After that, my choice was between the 20th and the 24th. Here's the fun thing, the 20th is my birthday. And, with very little deliberation I decided that I would much rather take the exam and be finished on my birthday, than have to study on my birthday. So July 20th it was.

And so it began. I studied every day for about 3-5 hours. Not going to lie, some days were better than others. Some days my focus was like a unicorn horn, keen, sharp, and beautiful. Other days my focus was more like an Erumpent's horn (refer to Fantastic Beasts and Where to Find Them); clumsy and unpredictable (not quite causing things to explode, but close enough). I utilized the NBCOT online exam prep program, which provided me with 2, 000 practice multiple choice questions, and something like 80 practice clinical simulation questions. They also included some pretty sweet topic outlines. This program was both frustrating and helpful. It was nice to have the feedback and data on how my studying was working in regards to answering the test questions. Also, as I am a terrible multiple choice test-taker, it was extremely useful in just getting used to the questions format. And, to address my deficits in answering multiple choice questions, I actually began using the practice questions several months previous. I tried to take a 5-10 question practice test every day. And I think that helped a TON. Especially with my anxiety surrounding multiple choice questions. On the other hand, the program was incredibly frustrating because the grammar and sentence structure of the questions was horrendous. Some of the worst I've ever seen. So, for a good while, NBCOT Test Prep was getting multiple emails per day from me, reporting the errors. It was quite fun. But quite frustrating.

I also utilized my textbooks in my studying. While I may not have used them as often as I should have while in school, they were indispensable when it came to studying. And part of the fun of the studying process was that I felt like I was still learning new things, and discovering what an awesome resource my textbooks are. At the beginning, I made a rough outline of all the topics that I needed to study, prioritizing those that I had struggled with the most on the practice tests. It wasn't super specific, but it was enough to keep me on track.

All in all, I believe I studied for about 2.5 weeks. For the past few weeks, my family kept asking me what I wanted for my birthday. My answer was, "I have no idea. I won't be able to tell you until after I take the exam." And, everyone who knows me well knows that I generally have my birthday planned several months beforehand. The exam had consumed me. Nope, that sounds waaaaay too dramatic. And it wasn't necessarily terrible or agonizing, I just had a hard time thinking seriously about other things.

Then, test day arrived. Also my 24th birthday, but that seemed pretty nonexistent at the time. I had purchased a protein bomb, or whatever they call it, from the grocery store the day before. I wanted something I could eat a very little bit of, and still get the necessary nutrients. I ate three bites before deciding that anything more would make my stomach extremely unhappy. Drank a small cup of coffee because I wanted that brain juice, but with my nerves already a bit frazzled, I didn't want my body to kick into a caffeine-fueled rampage that would interfere with my ability to think through the exam questions. There is only one testing center in St. Louis. And, because I like to be extra prepared, I had driven there the day before, just to give myself one less thing to worry about on test day. Ain't nobody got time for listening to a GPS when you're trying to remember everything you learned about Cubital Tunnel Syndrome and also pray for peace and success at the same time. My test was scheduled for 8 am, and I arrived around 7:10. Listened to Eye of the Tiger in my car two times, and then entered the building. Other poor souls were also there, each to take their respective exams. What exams they were taking, I do not know, but we shared smiles of commiseration and the knowledge that this too shall pass.

And, here's the thing. The exam itself was not terrible. I didn't feel super nervous at all while taking it. I did feel like I had, in fact, over-studied. The biggest factor for me was staying calm and taking my time with each question. The crazy thing was, that, around question 20, I started enjoying myself. Never thought I would say such a thing. But it's true. I realized that this was a challenge, and I was ready to master it, just like the Theory of Occupational Adaptation taught us. And I actually enjoyed breaking down the questions and trying to figure out the best answer. Which is proof that God exists and Divine Providence is a real thing.

Throughout the test, about ever 15 questions, I took a 1-2 minute break where I closed my eyes, did diaphragmatic breathing, and shifted my position. I think that was very conducive towards an overall cool-as-a-cucumber mindset (maybe cool as a cucumber is a bit strong, perhaps a cucumber that is more room temperature). Buuuut, by the 120th question, the fun was no longer there. And I could feel the brain start to falter. So, I gave myself longer breaks, because I knew I had about an hour and a half left (out of four hours). Which helped a bit. But it was mostly a fight. Which was okay. It's not supposed to be easy. And it's not supposed to be fun. I finished everything with about an hour left to review the questions I had marked to go back to. I reviewed those, and a few others, and submitted the product of 2 years of study and much blood, sweat, and tears, but also much fun and joy. Huge sigh of relief. Then I drove home and celebrated the end of the exam and my 24th birthday. All in all, not a bad day.

The Certification/License
My test results were scheduled to be released on the 27th, exactly one week after I took the exam. While my birthday was very enjoyable, despite my brain being quite numb, the euphoria of finishing the exam did not last. I did begin to have doubts about my performance in the days following. Nothing terrible, but enough to give me an uneasy feeling. Most prominent on the night of the 26th, when I was quite certain I had failed. For some reason, I expected the test results to be posted at 9 am on the 27th. Not sure why, but it was just my impression. I woke up before my alarm that morning, and truth be told, I hadn't slept much that night. And I thought, "Well, I'll check my email. Just in case. It's only 7:30, but who knows?" There it was, an email from NBCOT saying my results had been posted. Did they give me my results in the email? Of course not. So I journey to their website where, after attempting six different passwords, I finally managed to log in. And there it was. My certification number. And my test score. Pass. Happy tears. I was Audrey Fiudo, OTR.

Then, I set about obtaining my Missouri license. I printed out the checklist that told me everything I needed to send in, and checked it about six times before mailing everything. (Also, to anyone who will be getting a Missouri license, there is also a 20-question test you have to complete and send in. I was dismayed at the time because I thought I was finished with such things. But it's open book and not terrible.) Then, I journeyed to a random UPS store to get my fingerprints taken for a background check. And, for a week and a few days, I heard nothing. Pretty sure I was supposed to get a notification about my background check. Definitely sure that I was supposed to get an email from the state office with a tracking number so I could follow the progress of my application. None of that was received. But, yesterday, out of the blue, my license arrived. I am now Audrey Fiudo, OTR/L.

18 Years in the making

I just realized that my last post was more than a month ago. Tsk, tsk. In my defense, I have been a bit occupied elsewhere, what with finishing my career as a student and also beginning to study in earnest for the biggest exam I will ever take. For now, we're going to focus on the first thing. Today I finished my final fieldwork. This moment is 18+ years in the making, as it marks the end of my life as a student (for now, anyway!). (18+ years, because not sure if I should count preschool, which would make it more than 18 years, technically.) 

I passed this last fieldwork, by the way. That was implied, but I feel like I need to state it. Just because I'm still digesting it all. Like, not the part that I passed, I felt fairly confident about that, but the fact that I am not a student anymore. I imagine it won't REALLY sink in until I land my first job. But, more on that later. (And by later, I mean not in this particular blog post.)

The focus of this blog is on my learning experiences in the field of OT, so I am going to limit my nebulous reminiscing and focus on the stuff that happened. Which is probably much more interesting to my readers.

I had my first experience with cooking-as-an-intervention a few weeks ago, and, let me tell you, it was a doozy. My patient was planning on returning home alone, and taking care of all the cooking, cleaning, etc. So, of course, we addressed some meal prep and baking in therapy before her discharge. We made chocolate chip cookies in the activities department kitchen. Now, we had been warned prior to beginning that the oven hadn't been used in a long time, and it might give off an unpleasant smell. The cookies only had to bake for 8 minutes, so it would be fine. Or so I thought. Up to about 6 minutes into the actual baking of the cookies, all was well. My patient did all the preparation and was ambulating in the kitchen safely and efficiently. In fact, we even had a brief spiritual interlude when the priest came in to give her communion, since she had missed the service earlier that day. And, just as the priest finished the final prayer, the fire alarm went off. So, yes, the warning from before was partially true. There was a smell. And that smell was smoke. Thankfully, the word got passed along that it wasn't actually a fire, it was just the oven. Not before a large group of nurses and aides arrived on the scene, fire extinguishers in hand. But, by the time the fire chief got there, everyone was up to speed on the situation. Turns out that someone was supposed to have cleaned the oven a long time ago, but didn't. Classic. The most important thing is that, despite this kerfuffle, the cookies emerged unscathed. And, my patient was discharged at the end of the week and returned home successfully and happily. And she will probably never forget the time the OT student had her make cookies.

One of the greatest things about being an OT in a rehab setting is that you get to work with people for quite a long time, anywhere from 2-8 weeks, generally. And, you get to see all the awesome progress that they make in that time! One of my patients will always be particularly memorable, we'll call them C for the purposes of confidentiality. I evaluated C about a month ago. C arrived at the facility after undergoing surgery for a hip fracture. On the day of the evaluation, it took 2 people to get C up and out of bed, C was reporting a lot of pain, and C was not pleased with us. Or anyone. And, I ended up working with C almost every day. And, to be honest, I wasn't thrilled about this. Upon entering C's room, I usually got several orders to "do this" or "help with this". And, more than once, I was told I should be doing my job differently. And, progress was slow. We were working towards getting C as independent as possible with daily tasks, and C did not appear overeager to BE independent. But, that was not completely true. While it did take a lot of coaching and encouragement to get C to participate in therapy, I soon realized that some of the lack of motivation came from doubt. C had been very used to doing things independently prior to injury, and was now having a difficult time imagining getting back to that. Which was, I think, quite discouraging and depressing for C. But, this also meant that, in order to get that motivation, C needed to see that progress was happening, and that attaining that goal of independence was possible. Which did eventually occur. It was almost like it happened overnight, although I know it didn't. C was getting out of bed and getting dressed with very minimal assistance from me. And, C realized it too. It was like C had made it to the top of the mountain, and could see everything more clearly. After that, C was enthusiastic and cheerful during therapy sessions. In fact, C would come, unasked, to the therapy gym immediately following breakfast, ready to work. And, the whole thing wasn't just encouraging to C, it was incredibly encouraging to me as well. Work as an OT can be stressful and frustrating at times, just like any other job. But seeing progress like this is reassuring and soothing to those anxious feelings because you know that what you're doing is making a difference.

Being at a SNF was, in many ways, on the opposite end of the spectrum from being in a school setting. In the schools, I was working on handwriting, coloring, cutting, social skills, visual tracking, etc. Here, I was working on dressing, going to the bathroom, grooming, etc. And cooking. Or baking, rather. Funny story about that in a few sentences. But, both settings I loved dearly. Because I love OT. 

Stronger than I look

I love proving people wrong. It's probably one of my favorite things. Politely and delicately, of course, proving people wrong. "Honey, you can't lift me, you're too small", "Are you sure you're strong enough?", or my favorite, "Isn't there a man around here that can help us?". To which I respond with just that, "I'm stronger than I look".  I find myself getting asked these questions at least twice a day. When I'm helping my patients transfer from bed to their wheelchair, or from the wheelchair to the toilet, or just standing up to put on their pants. At first, I believed them, and I doubted whether I could move a 170+ lb adult who is non-weight bearing on one leg (and poor balance even without the weight-bearing restrictions) successfully. But, let me tell you, body mechanics and momentum are magical things. And, after a few successful trips, I found that I was indeed strong enough. I'll try not to get drunk with this kind of power.

The skilled nursing facility (SNF) life goes well. I am currently managing a full caseload, with less and less direct instruction from my supervisor, which is exciting. In the moment, things can feel chaotic and like you're on constant information overload, but at some point it magically starts to abate and things fall into place and you finally start to feel competent. I'm reaching that point. Not quite there yet, but approaching it. And it's not that the work itself is stressful and chaotic, SNF's tend to be a little chiller than, say, the hospital, but it's just the state of being a student. We're constantly learning things and the goal is to forget as few of them as possible, while still carrying out what is essentially a full-time job. I have a mental checklist of about 8 different things I need to do when I'm filling out the paperwork for a new evaluation. And I'm beginning to rely less and less on that mental checklist as it all becomes more natural. 

So, as I think I mentioned before, OT's (and PT's) in SNF's often mainly focus on patient evaluations and discharges, and they have assistants that carry out the majority of the actual treatment sessions. The OT assistants are called COTA's, for Certified Occupational Therapy Assistant. COTA's are certified after attending an accredited COTA education program, completing fieldwork, and passing a certification exam, much like an OT. They can be found in as wide a range of settings as OT's, and their roles differ slightly according to setting. As assistants, they ultimately answer to the OT, and are not able to complete evaluations and discharges. They are invaluable because they carry out most of the treatments, and are masters at coming up with new and creative intervention activities for their patients. They are a wealth of knowledge when it comes to treatments, and, because they see the patients more than the OT, they can provide vital information about the patients' functioning and progression towards the goals. I am very thankful that I get to work with not one, but two awesome COTA's, and I have learned a ton from them about interventions and patient interactions. 

And, I love my patients. They are completely delightful, each one in their own way. One of my patients gives us something--usually a soda or snack of some kind--after each therapy session. Another of my patients has a wonderful husband who comes and spends most of the day with her, everyday. And this same patient has quite the attitude, and it's fantastic. If we ask her to do something, like stand up and complete a functional ambulation task, or do some upper-body exercises with the free weights, she'll say, "Oh, now just wait a minute," in a protesting kind of way, followed by a lengthy explanation of why she can't do whatever it is we're asking her to do. Or, earlier this week, she informed us that both her legs were hurting. Previously she had reported pain in only one leg, so we mentioned this, and her reply was, "Oh, I've got news for you. Have the nurse bring me two pain pills. One for each leg." She is lovely. 

In other news, this past weekend, I returned to Kansas City to graduate with my MOT (Master's in OT, of course). Totally makes sense, right? I graduate when I still have 7 weeks left of education. That's actually one of the things that one of my professors told us several semesters ago, "Every time you graduate, it's kind of fake. You graduate from undergrad, and then you have grad school. You graduate from grad school in mid-May, but you won't actually be finished with school until the end of June." But, as odd as it is, and, at times, slightly frustrating, it's also pretty great. I mean, I got the chance to see all my classmates again, and discuss fieldwork trials and triumphs with them, before we actually finish fieldwork. Which was incredibly refreshing and re-invigorating. And the whole graduation thing is pretty motivating too, not going to lie. 

The Final 10

This is my second post in 2 weeks! Such productivity! But, if I'm completely honest, this post probably wouldn't have happened had it not been an important milestone. Well, important to me, anyway. Important to my career as a grad student.

So, here's the thing, you may remember me mentioning that my first semester of graduate school was the summer of 2015. As a summer semester, it was 10 weeks as opposed to the typical 15-week semester during the regular school year. 10 weeks filled with gross anatomy, mostly. Hanging out in the lab with the cadavers. And by hanging out, I mean furiously working to memorize the origin, insertion, actions, blood supply, and innervation of every muscle of the body, in addition to being able to actually recognize them in a real body. Of course, we had other classes that summer, but gross anatomy is the one that really stuck out, probably because it was the most time consuming. But, it was lots of fun! Really!

But I have shamefully digressed. So, first semester of OT school = 10 weeks. Well, this week, I will be beginning the final 10 weeks of OT school. Where has the time gone? One never knows. So, in my mind, as someone who likes to memorialize and place significance on various dates, this week marks the beginning of the end of my career as an OT student. Yikes. But also, yay!

In addition to going off on long sentimental digressions, I also want to say a few words (haha, a few words) on my second fieldwork experience thus far. Two weeks in, and I am quite enjoying it! It's definitely been an adjustment, though. Going from the school setting where I worked with kids on academic occupations, to skilled nursing facilities where I'm working with older adults on ADLs.
I think the most difficult part has been adjusting to the documentation style, and the concept of productivity and having to balance treatments and interventions with evals, progress notes, and discharges. I'm finding that it's really easy to get caught up in the paperwork side of things (while it does require detail and attention, because insurance), and forget about the occupation-based foundations of our profession, especially because of the rehab-heavy nature of the setting. However, I am determined to keep all my treatments as occupation-based as possible, because, as we know, nothing really beats actually doing the occupation to improve safety and independence in that area.
And, really, I've done mostly evaluations and discharges thus far, because both SNF's that I am at have certified OT Assistants (COTA's), who carry out the majority of the treatment interventions. But I think I'll address COTA's in my next post, as it could take a while, and they are an important part of our profession, and I want to do them justice!

But, for now, just a little bit about my typical day and the patients I have been working with. I start my day at a SNF that's a bit of a drive from my house. So I generally get up at 5:30 and am on the road by 6, to make it there by 7. Which, despite feeling less-than-thrilled at 5:30 am, I do really enjoy. First of all because I'd rather start early and end early at 3, and second because I enjoy seeing the sunrise. Third, because the drive is a beautiful journey through the countryside, and there are lots of baby cows. We see patients at that location, and then we drive back in the direction of my house about 25 minutes to another SNF, where we also see patients. And we're usually finished around 3.

A skilled nursing facility (SNF) is kind of a step-down setting for people who have undergone recent hospitalization and are not yet ready to return to their prior residence because they require therapy to get them back to their prior level of functioning. Most of our patients have things like joint replacements (hips, knees), strokes, falls, etc., and most of them are in the older adult population. And, they are lots of fun! I had one lady offer me a can of V8 juice when we were doing her evaluation, "Honey, could you pass me a V8 juice? Would you like one? Let's all have some V8 juice!". I declined, of course, not being a particular fan of V8 juice, but it was a kind thought all the same.

I imagine I'll have plenty more stories to tell in the coming weeks, but for now, I must bid you adieu! I have to go study for the certification exam (so much fun.). Haha.

Entry-level school OT

I am happy to report that I passed my first 12-week fieldwork placement. Which means I have the competency, when I pass the OT licensing exam, to be an entry level school-based OT practitioner. Whew.

It blows my mind how quickly the past 12 weeks have gone. I do wish I had published a few more posts during that time, but what with the busy-ness of fieldwork itself, and unforeseen family circumstances, it just didn't happen. Ah well, I can just write a lot right now to make up for it (I can almost hear your gasp of dismay, and while I'm tempted to be merciful, the writer's egotistical need to write all the words is stronger). Haha.

The truth is that it's rather sad to have to say goodbye to the students, teachers, and staff that I have met, worked with, and befriended these past three months. Willy Shakes (William Shakespeare, to clarify) really hit the nail on the head with "parting is such sweet sorrow". Because it's also true that I have had a blast these past three months, and I've learned loads and loads of new information and new skills, and learned things about myself that I didn't even know existed. And, additionally, I am incredibly excited to move on to my next fieldwork site (you'll have to keep reading until the end to find out more about that, I'm afraid).

What have I learned? What haven't I learned? The list on the latter is quite a bit smaller than the former. But I would like to focus on a few things. The first is something modest and unassuming, and, to be honest, something I wasn't so hot on in school. And that is activity and task analysis. As one of my professors was so fond of saying, "It is the bread and butter of OT." And we (my classmates and I) were all like, "Yeah, sure, whatever. Moving on." But, as much as I hate to admit that I was wrong, I was wrong. I was completely wrong to discount activity analysis. There. I've said it.

Activity analysis is a special skill/superpower that OT's have that enable use to look at any activity or task and break it down into individual steps to facilitate identification of the strengths, weaknesses, issues, challenges, and basically develop a target area for creating goals and interventions for treatment. Back in school, we we were like, "Why are you making us write a list of all the steps that make up filling your car with gas?" But it's real! If you're not able to fill your car up with gas, you could just say, "I can't do it", or you could identify exactly which parts of the task you are struggling with, and then figure out a way to fix it.

In my experience, we'll have parents who come to us and say, "My kid can't tie their shoes. My kid can't write a sentence." etc. What information can you glean from that? Not much. As OT's, we observe the performance, or attempted performance of these tasks, and we can identify exactly where they are having struggles. When one of my students was struggling with filling out a crossword puzzle, I was watching him, so I knew that it was the vertical vs. horizontal aspect that was tripping him up. While this was something I wanted him to work on, I also wanted him to be successful in the activity. Instead of only having him write the horizontal words, I provided him with the correct words. So he didn't have to worry about figuring out the answers to the clues, he just had to worry about writing them in the correct orientation. Which was totally fine, because I wasn't working on answering clues, I was working on visual-spatial perception and reasoning.

Which brings me to Thing Number Two that I learned. The importance of grading activities. Grading refers to adapting the activity to make it easier or more difficult, depending on the student's skills and abilities, and success with the activity. Like my student with the crossword, I realized that I needed to grade it down (make it simpler) for him to be successful, while still being challenging. Some of my other students needed things to be made more difficult to challenge their skills. That's where the whole concept of the "just right challenge", that is so integral to the OT profession, comes into play. We want to challenge our clients just enough so that they become more skilled, knowledgeable, strong, etc. But we also don't want to make it so hard that it's impossible, or just very demoralizing to attempt to attain success. Thus, we want the challenge to be "just right". Difficult enough that it's a challenge, while not being impossible.

The third thing that I have learned is the value of a cool head and calm demeanor. Now, these are not attributes that, if you asked my family to describe me, they would use. But that's just because in my non-professional life I tend to be dramatic and sometimes go into long tirades of righteous anger towards some systematic injustice or other. And I most certainly do have a flair for drama, but that's something I indulge in for fun. Not part of my daily life. Just a personality quirk that many would label as obnoxious. But yes, I believe I am a fairly level-headed individual. And I never really realized it or thought about it until I began working with a student on my caseload that is quite physically aggressive. Keeping a cool head was absolutely necessary, both to redirect the student, and prevent any lasting effects of the behaviors on my confidence as a practitioner. All in all, I realized I could deal with a lot more than I thought I could. Which was quite gratifying.

Another thing I learned was to appreciate the baby steps. Each client, or, in this case, student, has their own unique skills, needs, and background. And, consequently they all progress through OT at different speeds and levels. So, I found myself getting super excited when one of my students made a perfect uppercase "B". Like, really excited. All the enthusiasm and cheering (but quiet cheering, because we share our OT room with the resource teacher, so we have to contain the noise level). And I was equally enthusiastic when another of my students figured out a really complex jumbled-picture puzzle. It's all relative. And it's all good.

And now I've come to the most important part. And that is the amount of gratitude that I have, for the experience itself, but most of all for the students, staff, and teachers that I have gotten to know and learned from these past 12 weeks. I can't imagine a better Level II experience in a school setting. I was very blessed to have had an extremely knowledgeable fieldwork supervisor who, while being an excellent OT practitioner, also cares boundlessly for the students she works with. She was flexible and adaptive with her supervision style-- as the weeks progressed and I became more competent, I was given more responsibility and expectations were increased. Because of her, I have the confidence in my own competence as an entry-level school-based OT practitioner. The rest of the staff and teachers at my school(s) were equally welcoming and supportive throughout my time there, and I am forever grateful for that. And, of course, the students. It is perhaps from them that I learned the most. I will never forget them.

Enough soppiness for the present. Now comes the next adventure. The next 12 weeks of my life, I will be a Level II OT student at two different skilled nursing facilities. "Working with grandma's and grandpa's" is what I have been telling my students, since it's very difficult for them to understand why I'm leaving. (One of the kindergartners was like, "So, you're retiring, Miss Fiudo?"). But yes, for the next 12 weeks I will be dividing my time between two different skilled nursing facilities (SNF). This Monday, I will be arriving at one location at 7 am. It is a 50-minute drive from my house. Yay for long commutes! The great thing is that my school fieldwork was a good 30-40 minutes away, so I'll just be slightly extending that time for this one. I am a little nervous because I haven't done hard-core physical medical stuff in a while. But I'm planning on reviewing my course material over the weekend! I'll try and post again in the next 2 weeks to give a first-impressions-rundown. Cheers!