The goings on

I have 3 interesting stories I have to get off my chest.

There is a patient of mine that told me her amazing story that I want to share with you. I'll call her CK to protect her identity. I was very curious what had happened to her hands that resulted in such deformity. The other day she unveiled her story to me. I was shocked and amazed. Here's the backstory: All of her the joints in her fingers are contracted (meaning she can't open her hand fully), and she has sever deviations of her knuckles (ulnar drift). Also her ankles and feet are severely affected. I've been splinting her fingers to maintain and increase her range of motion (ROM). She was originally on Prednisone for swelling in her joints. At the time, CK was happily working as a certified nursing assistant (CNA) in emergency care. She was living the good life, making money and liking her work, and was pretty and young. The doctors tapered her Prednisone intake too drastically that sent her into a coma. She was in a coma for 3-4 YEARS. She says she can't remember the exact time. While in the coma she was on life support (she had a tracheostomy to supplement her breathing). At the hospital she they did not do any range of motion of her joints. Her joints became contracted over the years that she was in a coma. Her mother would come in and move her joints so she didn't loose all range of motion. After 3+ years in a coma the doctors were thinking that they would try one more procedure before letting her go. They needed to transfer her to the LA hospital to do it. They put CK on a gurney to go to the airport. According to CK's story, the sun hit her face and she could feel its warmth and she sat up in the gurney and said, "Where are you taking me?" Everyone was shocked. Here is a woman that was in a coma on life support and suddenly she sits up and asks where she's going?!
She continues to take Prednisone and apparently that adds to her overall weight. Prednisone has such a bad reputation. I believe it helps people though. So I don't want to just say things that will steer people away; just be informed about the drugs and treatments that doctors prescribe. We have to be our own advocates. Regardless, an amazing story.

The next little antidote from working in skilled nursing is just to document my awe of the human brain. I have a new admit patient that has moderate dementia. She had a hip fracture and that is why she is in rehab. When people with dementia and undergo anthesis their condition is more acute and they become more confused. When I saw her, the second day after her surgery, she kept trying to go back to her room at the assisted living place she lives. She would take off her leg brace and attempt to get out of bed. It would take 2-3 people to get her to transfer from her bed to her chair. I saw her in the morning, I was to help her get dressed and groomed. I asked if she wanted to brush her hair. She stated that she did, reached for her purse and grabbed a notepad and used the notepad to comb her hair. This is the first time that I have seen the condition of ideational apraxia. This is something that we learn about in school and can be seen with traumatic brian injuries (apparently, dementia too). This condition is when someone uses an item that is intended for a different purpose inappropriately. Later that day, she was in her chair taking off her leg brace when I went over there to stop her, I noticed her pillow. I had put a pillow under her leg to support and elevate her leg. She had somehow slit the pillow and was putting items inside the stuffing of the pillow. I realized that she thought it was her purse from where she was keeping the pillow (on her lap). Very interesting. This is another ideational apraxia event I was witnessing.

The last little note is just an example of the stuff that happens to people in working in the medical field. I have been helping a man who has had a stroke (or left-side CVA). His right side is paralyzed and contracted. I am splinting and trying to decrease the tone (spasticity that creates muscle weakness) by doing some massage and range of motion. I thought he was very appreciative of my good work since he cannot speak other than mumbles and he would hold my hand and give me a nod with his head and eyes, and a little smile. The past couple days he has given me a little kiss on my hand. Harmless, in fact I felt good about the work that I'm doing. Then on Friday, he tries to suck on my finger. I pulled my hand back, stated, "Ok, that's enough today." He chuckles. Then I state, "Inappropriate" and walk out. I'm not too worried about it or anything. I think it's kind of funny that I thought oh he likes the work I'm doing, I'm such a good therapist. I'm so naive.