The scale is kind of lost in this picture. Two pints (English pints, which are larger than American pints) fit into this beer stein. Despite heavy peer pressure, I stuck to one steinfull! 

"Ici, on parle football!"

French because we watched an Arsenal game that took place in Paris last night, and I have just made plans to go to Paris! For those of you who are familiar with Arsenal football (soccer) club, I watched the European Cup final last night between Barcelona and Arsenal. It was heartbreaking, as Arsenal played most of the game one man short. They lost the goalie to a red card early on in the first half, after a slide tackle that was quite obviously intended to take out the man rather than retrieve the ball. I did comment at the time that I'd never seen a ref take away the advantage before (Barcelona scored, only to have the goal disallowed by the ref who had blown his whistle on the goalie and Barcelona then missed the free kick)...however, it did not end up being much a blow to Barcelona who went on to score two goals in the second half. Arsenal played their hearts out, but pretty much were run all over the field with only a substitute goalie and 9 men playing.

I have now puchased tickets to go back to Paris for the first time in...hmm, lord knows how many years. Probably since we were living in Italy. My friend Jo and I will be taking the Eurostar (yay!) and may try to check out some of the Da Vinci code irregularities. We will definitely take in the Louvre. This will happen the weekend of June 24, which means the week of June 26, I will only be working 1 day! (Will take the Monday off, and then will be on a training course Wed-Fri). And then I'm gone for two weeks, back to the States! Midge has been laughing at me for the way I've been arranging my travel plans to break up what has turned out to be a very slow-paced rotation. Speaking of Midge, though we tried, we won't get to meet up, as she didn't get her visa delivered until Tuesday, and has various family plans until she leaves. It's a shame, but then again, we've had some great phone calls last week and this one.

It's a dog's life

Being in dog country can be rather funny. I hope no one gets offended by this comment, as I'm certainly not the first to make it...I believe I've read this in various magazines, heard other people say it, etc. And especially with regard to the dog owners I see every day on my walks to or from the hospital, it amuses me to no end in its veracity. Some dog owners seem to choose their pets based on physical resemblance to themselves. There's a lady with shoulder length hair, dyed a reddish color, and rather dry and shaggy in looks. She has a ginger and white collie I always see her walking. Then there's a man who is very tall but with small, sort of scrunched facial features, and I don't know the name of the breed of his two little dogs, but they definitely have scrunched facial features. I could go on with examples, but you get my point. I wonder, does this tie in with the theory that we choose our romantic partners based on physical similarities? (I have often read that couples who could be mistaken for brother and sister are, generally speaking, the most compatible couples.) Do we naturally gravitate toward people and things that remind us of, well, us?

Just call me "the all-knowing, all-seeing Trash Heap!"

From Fraggle Rock?! Anyone? Anyone? Beuller...Beuller...

Sorry Midge, you've already heard this one...

I had a case conference meeting early this morning, with a consultant (doctor) who I have enjoyed "working with" since my arrival. I say "working with" because I only ever see him in case conference-- almost all of the patients at the day hospital are seen by SHO's (Senior House Officers - basically residents), and the cases are then reviewed by the consultants once a week. Or perhaps a bit more often if the SHO's consult with the consultant before case conference comes up. Anywho, the physio and I brought a case up this morning for a lady who had been declining functionally, with a previous medical history of stroke. She has shown some improvement in two weeks with two physio appointments, but the physios are only part time at the day hospital. They cannot see patients on a daily basis, and are able to only take on so many to be seen once a week for 4-6 weeks. This lady, it was felt by myself and the physio, had much to gain if she were willing to participate in a 6-week inpatient rehab program, which she did say she'd be happy to do.

The consultant's first retort was, well, why can't you see her more frequently here? Evidently in the past, the day hospital did function in a rehab sort of sense, and there was enough therapy staffing for patients to be seen on a daily basis. The trouble is, now there's not, and the consultant couldn't seem to wrap his head around the fact that the physios are struggling to keep up with patients for balance class and new referrals. In theory, it's ok that we aren't able to offer rehab through the day hospital because there are other hospital services to whom we can refer where they can get rehab. He gave up on arguing about what services the physios should be providing at the day hospital, and next wanted to know why we wanted to "bin" this poor lady by putting her in Intermediate Care (inpatient rehab), what has she done to deserve it. When you bin something over here, you're putting it in the garbage can. I cannot even begin to explain how offended I was that he was calling inpatient rehab services a bin. I have had most of my OT work experience in such a bin, I have helped many a patient regain functional independence in such a bin, and as with any medical agenda, if the patient didn't want to go to rehab and did themselves consider it to be a bin, they always have the right to refuse. If inpatient rehab is garbage, then I will happily self-profess myself to be a garbage-man. Er, woman.

Being a professional, I did not make a sweeping exit as I yelled back at the consultant "Bin this!!!" with accompanying obscene gesture.

Our only recourse is to refer this lady to a more short term therapy in the home, and tell that therapist we had wanted rehab for her, and hopefully that therapist will then make the rehab referral after their two-week time frame for working with the patient expires.

"The Trash Heap has spoken! Nyeah!"

OT rules!

First of all, a big thank you to everyone who checks out my blog, all you regular visitors, as I've now had over 1,000 hits! Secondly, I think I am going to delete my second OT blog, as I tend to write about everything here, including the OT stuff. To that end...

I walked into the day hospital office manager's office, which I do rarely when I need to send off a fax, and happened to see a letter from one of the consultants (doctors) lying on her desk from a woman we recently did a Continuing Care Assessment on...I was intrigued to note that the letter he had dictated to be sent to the woman's GP and social worker was practically word for word what I had written in the medical notes. After having seen the patient who was so demented I had to get all my information from her carer (the patient is already in residential care, they are now petitioning to have her moved to a nursing home), I jumped at the chance to talk to her daughter who showed up in the afternoon. There were several discrepancies in the stories offered by the carer versus the daughter, such as the carer said there is no longer any difference in the behavior exhibited by the patient whether family members are present or not, while the daughter adamantly states the patient definitely still recognizes her and her brother. The daughter also told me she had recently taken her mother home for a two night/1 day visit, during which time the daughter stated her mother seemed to be much more herself, and became more demanding (which the daughter took to be a good sign, given that her mother was a strongly-opinionated, very vocal school teacher previously). The daughter is horribly conflicted, because her mother said to her many times over the years, "I don't ever want to be in a home." And the daughter was inquiring as to whether her mother would basically be bed-bound if she were moved to a nursing home (to which I had to answer, most likely, yes)...it's horrible but the minute people enter an institution their functional skills are pretty much sure to decline. And her mother wanted to know if they moved to a house built for someone who's disabled, arranged 24-hour supervision with various family members, and got carers and all home adaptations, could they care for her at home? To which I was happily able to say yes, you have power of attorney, they cannot place her in a nursing home without your consent, and you should consult the citizen's advice bureau for your mother's and your legal rights. I was the only one to gather this info from the daughter, which I dutifully reported in the medical notes, and as I said, it was repeated virtually word for word in the consultant's findings letter. He finished by stating that this family needs extensive social services input as there are obviously complex social issues at work that need to be resolved before the continuing care process can proceed. How vindicated and purposeful did I feel after seeing that letter!

Below you'll find some more Cinco de Mayo photos that Nicole (Tufts Nicole) shared with me today...

Tufts Nicole and Allison take on "Bob's your uncle" in our back garden. 

I know, you're all green with envy of my smile... 

Somebody stop us! Or at least cut off the alcohol...the three roommate amigas laughing at lord only knows. 

American OTs get into the spirit... 

Happy Mother's Day, Mom...

I made an essential error in that I did not buy a card while it was Mother's Day here back in March. And now there are none to be found in the UK. However, I did leave behind a gift before I left, and will be calling home in a bit, so at least I didn't completely screw up!

Time is flying...weekend after next I'm in Italy! Which is the last weekend in May, and Memorial Day Weekend. For those of you in the States, the official start of summer!! I will be thinking of everybody in Vermont, opening up Wissahickon for the summer season, and of all you beach-goers making the first of many trips to the shore this summer. I definitely envy you all!

Happy Mother's Day to Mom, Caitie, Grandma J, Jinny, Jean, Rita, Amanda, and Chris.

Pear-shaped

It's days like these where I remember why I am an OT, and why I love being an OT, but it's days like these that also burn me up. We had a patient come in for a Continuing Care Assessment...which essentially means, someone is petitioning for the person to be admitted to a nursing home. As in the US, this requires the person's consent if they are mentally competent. So he would need to be informed at some point that his wife and social worker are trying to place him in a nursing home. Actually, he is supposed to be informed that the interdisciplinary assessment process he went through today is one to assess whether he cannot be cared for other than in a nursing home. But he had no idea that he was being assessed for a nursing home! As far as he is aware (because we didn't bluntly say, oh well, we're trying to see if a nursing home would be appropriate for you), there are no plans for him to live anywhere but at home with his wife.

I did my assessment in conjunction with the physios, or at least, the functional part (and yes, this is unusual unfortunately)...and discovered he was able to do sit to stand transfers from his wheelchair independently, and stand independently with a rolling walker! Beyond that, he could move about 5 feet with a slow shuffling gait, a rolling walker, and contact guard assistance. The difference between nursing homes here and those in the States is that a nursing home here is for people who are totally dependent for all care, and once they enter a nursing home, they will pretty much be bed-bound (that's how it's been explained to me).

Meanwhile, this man told us he hasn't walked in about 18 months- ever since he broke his leg. He does have a degenerative neurological disease, but the physios and I definitely see room for functional improvement! He deserves a trial of rehab at least, and as he only has carers twice a week for 30 min (crime), no wonder his wife feels like she can't cope! They don't have the support they need. While I'd like to call up and scream at the social worker, what I will do is discuss the case with his assigned doctor at the day hospital on Monday, and ask to make a referral to inpatient rehab ASAP- meaning Monday. Hopefully they will accept him for rehab (those therapists have to do their own assessment first), and hopefully he will improve with some intensive rehab. Meanwhile, his wife can get some needed respite.

Blast the social workers who always take the easy route, and assume we will rubber stamp people into nursing homes if they're sent to us for continuing care assessments!!

Phrase or word of the week: "Pear-shaped" as in, this poor man's world will go all pear-shaped (upside down) if he realizes someone is trying to place him in a nursing home, and that his wife is aware of the possibility.

Remember Mr. Rogers?

It's a beautiful day in the neighborhood, a beautiful day in the neighborhood, won't you be mine, won't you be mine, won't you be my neighbor.

Not much happenin' today. I had a good supervision meeting with my supervisor, where I was able to show how I'm working to accomplish my objectives and my personal development plan. She told me she's happy with the work I've been doing, and she's impressed with how I've taken on the falls education group as my own. I'm hoping to pick up all the supplies for updating my portfolio this weekend.

It's Thursday, so I've been happily watching House and Grey's Anatomy, and looking forward to tomorrow being Friday!! It should be another beautiful day, with 3/4 of it spent inside, and it will turn colder and rainy, just in time for the weekend...figures.

Anyone seen Mission Impossible III yet? I'm not a fan of Tom Cruise at this point, but I've seen the other two and am thinking I might still enjoy it as a summer blockbuster.

You're in Blighty, Love!

Highly amusing...I just had a phone call from Midge on my *mobile* who is in the country to get a new work visa for her passport. She's stuck at "home" for the next couple of days while she waits for her passport to be returned with the new visa, so we've tentatively planned to get together next week. Well, tentative in the sense that we don't know what day or what time or where yet, because she has to be at home every day until her passport is returned to her. It was really crazy to hear her voice on the phone, as she reminded me we hadn't spoken since a bunch of us went for JP Licks (ice cream) in Davis Square about a year ago, around graduation time. However, we both have been keeping up with each other via our blogs, and Midge has been very helpful in gently correctly me when I've gotten things unwittingly wrong...such as it's not Thaught Park, it's Thorpe Park. According to Midge, I have really picked up a "British twang" which she thinks may sound so obvious to her since we haven't spoken in a year. Because my friends and family I have spoken to on the phone haven't said anything about it. And I have been conscious of trying not to pick up an accent. But I'm ready and willing to call Midge the expert, and I guess my accent reflects that I'm living in Blighty! We had fun making comparisons- I've been envious of her productivity and opportunities to really work with patients and develop therapeutic rapport, she has on occasion been jealous of my opportunities to plan trips and blog from work because I don't have enough patients to see. I am really looking forward to seeing her next week, it really made my day to hear her voice! Oh, and Midge, turn about is fair play - you do sound a bit more American than I remember ;)

Additionally, I found out today I will be going to a three-day training on Assessment of Perceptual and Cognitive Dysfunction, which makes me very happy. I put my name on a list to be considered for a 6-day Bobath course (the physical aspects of working with stroke patients, it's a specific theory and specific physical interventions), but we won't know for another couple of months who will actually get to go on the course. We were just recently offered a choice among 5-6 other 2-3 day courses, and told if we didn't want to work in rehab or with stroke patients as a career, we might be better off going to one of these courses, as Bobath is quite intensive. I was really interested in the course I mentioned at the beginning of this paragraph but afraid I wouldn't be allowed to do both. So I wrote an email to Barbara, my overall manager and Head OT, explaining that I do intend for my career to be in rehab with a speciality in working stroke patients, and could I possibly attend the Perception and Cognition course, but still be considered for the Bobath, since the two courses cover different aspects of working with stroke patients. And she said, yes, that's fine! So I've killed two birds with one stone...I've gotten permission to attend this course June 28-30 (coincidentally, I have a flight back to the US for two weeks on the night of June 30), and I've made it clear to Barbara that my interests lie in working with stroke patients. Hopefully she'll remember that when it comes time for the next rotation. Finally, I feel like I'm accomplishing something professionally, at least as far as continuing education goes!

I've posted some pictures below from all the various events of this past weekend...

Unfortunately, this is my best picture of the Wincester Cathedral in Wincester, Hampshire, which was absolutely amazing.  

I am such an OT... 

And yes, I did try it out. 

You can make out the bones casket in the upper middle right of the photo...containing sacred bones, relics. Incredible stone and woodwork in this part of the cathedral. 

Beautiful original tiling on the floor of the cathedral. Didn't see a pamphlet on these, but I'm pretty sure the design is a fleur-de-lis. 

A pretty little chapel within the church, with frescoes/paintings inside from the 11th century if I remember correctly. 

The original painting, which is what you are looking at here, evidently had Magdalene in the robes of an important person...I don't know if any of you are fans of the Da Vinci code, or a student of matriarchal societies of old, but it was interesting to learn the painting that had been done over the top and has now been stripped away left Magdalene out.