Pt unable to be a writer

Pt is unable to be a writer

GOAL:

short term- Pt will demonstrate legible and comprehensible writing for at least 2 sentences in 2 months.

long term- Pt will write an article for the Voice weekly in 1 year.

INTERVENTION:

• Pt will practice writing daily starting with simple concepts and then progressing to following directions of what to write.

• Pt will practice using his typewriter.

patient unable to walk

Pt is unable to walk

GOAL:

short term- Pt will walk one lap around the floor using an assistive device twice a day in 3 months. 

long term- Pt will walk independently in one year

INTERVENTION:

• Pt will be assisted to stand at the edge of the bed daily thus increasing weight bearing through the legs and improving his strength and endurance.

• Pt will then progress to ambulating with a walker as tolerated.

Hallucinations

patient unable to sit

Pt is unable to sit for prolonged periods of time

GOAL:

short term- Pt will sit for 5 minutes unsupported for 2 out of 3 feedings in a day in 2 months

long term- Pt will sit unsupported for 30 minutes or longer in 6 months

INTERVENTION:

• Pt will receive NDT handling for trunk stability, including weight shifting, pelvic tilts and posture facilitation.

Weak neck extensors

Weak neck extensors

GOAL:

short term- Pt will hold his head in midline unsupported while sitting for 2 minutes 3 times a day in 2 months.

long term- Pt will hold his head up unsupported in sitting and standing during ADL’s in 6 months

INTERVENTION:

• Pt will receive PNF Hold Relax Active Movement technique for neck extensor strengthening. He will then be progressed to Rhythmic Stabilization techniques as strength improves. 

• Pt will be gradually increased from inclined lying in his wheelchair to an upright position as strength and head control increases.

Manuka honey

Cytomegalovirus

page 236 - the mini gym

I paid my first visit to the ambulation room, a kind of mini-gym with an oval track. Round and round they went, pale and spectral, like the condemned in one of the circles of Dante's Inferno, the halting and the infirm, doing laps, with walkers or crutches, their faces strained with effort.

page 221 - corpus

... to reside in a twilight world, to never quite have the energy for eating, or reading, or talking, for days on end. I remembered the way you begin to look upon your body in the third person- it's an object, out there, with which you're fascinated, transfixed. You treat yourself as if you were a wounded bird, listening to your own breathing, stroking your feathers, taking your pulse hourly. A kind of fetishism occurs in which your whole life is gathered into your body and the obsessional contemplation of it; your symptoms absorb you utterly, screening out the robust emotions and appetites of the well.

PT

pg 136

It was now, in one of thos ironies of hospital life, that a physical therapist showed up. Andrew weighed 154, having lost over 30 pounds, and was weaker and more incapacitated than ever, yet there appeared on the threshold an attractive, blond, muscular man looking like a yuppie Tarzan, bearing the hospital equivalent of a barbell- a small metal triangle that hangs on the bar over the patient's head. He was all ready to put Andrew through his paces. Unlike psychotherapy, physical therapy is at least on the menu of the hospital, bit it is honored more in the breach than the observance. Every 3 or 4 days, an overworked young mand or woman will show up, offer a half hour of instruction, leave the patient with a sheet of exercises to be followed, come back in a day, or a week, or a month. Exercise and movement of any kind are immensely important, a preventive measure against bedsores, pneumonia, and other infections to which patients in their debilitated state are especially susceptible. ...

They talked in such dire tones of muscles atrophying that I was afraid that even if he got well, his head would plop forward permanently. He could barely  talk, much less flex his muscles, when this blond gym teacher, fairly glowing with health and optimism, showed up, a huge grin on his face and the breathlessly winning manner of one who is constantly having to apologize for missed rendezvous with disappointed patients. ...

137

Once the triangle was installed on the longitudinal pole overhead, he took a fancy to it: he would grab hold of it, pull heroically a few times, and then stop, exhausted, his agitated mind on to something else.

207

Andrew had gained 12 pounds now, and was up to 142. But the weariness was mind-boggling: he couldn't read at all, to watch television was an effort, and sitting in the chair remained an inhuman ordeal. It was also one to which he did not submit with grace. As usual, he was not responding enthusiastically to physical therapy. His laziness was by now legendary, and his evasions had become a sore point with the nurses.

228

He was certainly not what a doctor or physical therapist would have desired at the Rusk Institute for Rehabilitation. His face would never grace one of the institutional brochures on which were pictured gung-ho patients, smiling bravely, struggling gallantly to walk.  Andrew was surrounded by go-getters and overachievers, by people who were truly courageous or at least tried to get brownie points by seeming so, and his lack of camp spirit stuck out like a sore thumb.

page 135 - shame

Doctors, with limited time, need to deal with things you can see, touch, feel rather than states of mind. The abscess, the perforation, the fever, the suppuration, the bacteria, the thing you can X-ray, chart, pursue. To stenches their senses appear numb; of vomit, sweat, blood, feces, death, halitosis, they are no more aware than they are of the flowers on the bedside tables.

Yet for the patient, stripped of the roles and outer garments that give him his dignity, his body, and whatever respect it's allowed, is all he has left. He doesn't see the tumor in his head or the infection in his liver, but he does know if he soils the bed or if his odor is offending other patients. Andrew's state of selective awareness- in which obtuseness combined with acute sensitivity- made this particular horror a mortification. Freud points to the beginning of civilization, of cultural consciousness, as the moment when the infant, hitherto happy with his own fecal smells, realizes they are offensive to others. Andrew was crossing this painful threshold over and over again.

page 109 madness

Milan Kundera wrote something that, like actors without a script, we're constantly going on "cold," maneuvering through life feeling helpless and exposed. On the contrary, we spend out lives arming ourselves against precisely that feeling-that nightmare- of being caught off-guard, in the spotlight, our scripts lost or forgotten. Madness is but an extreme version of the character armor we employ to give ourselves a sense of control, to keep chaos at bay. Our roles and the selves we exhibit are collages, as we collect bits of personae like artifacts-from books, movies, real-life characters-and keep them groomed for the unexpected. We arrive on the scene as actors, authors, and directors all in one, equipped with phrases, prejudices, attitudes, mannerisms, props, all burnished and shiny and ready to be placed around, like cherished personal possessions in a hotel room, to render the unfamiliar familiar, to stave off being overwhelmed by too many possibilities.....

Andrew's madness seemed like the ultimate defense, as hard and as unyielding as granite as it converted everything, everyone, into an enemy. He was like Leontes in Shakespeare's, A Winter's Tale, who, having suspected, then convinced himself of, his wife's treachery, seeks out proof of her perfidy everywhere, a confirmation of his malignant vision in which he takes a positive relish. Her beauty itself becomes evil, an instrument of betrayal.

page 58 - communication

One suddenly realizes how much communication is a business of shared rules, a give-and-take that is conveyed less in actual words than in emotional tonalities, the expression of the eyes (keen or glazed over), gestures, one mind's leaning toward another in empathy and good faith. When communication between two people breaks down, the rupture can rarely be conveyed by the simple reporting of what was said; everything has to do with tone of voice, the presence or absence of humor, the quality of listening, of hearing and being heard in a very particular way. 

Testing

Here I am at lunchtime posting on a blog to test this out..

Wow!
Heres a picture!