Christmas festivities

My Christmas celebration this year began by working over 5 hours on my last day at UPS. On a normal day I pull 110-130 packages for Grand Rapids and International Falls. Christmas Eve is not a normal day in the shipping industry and I ended up with over 400 packages. I could have stuck around for at least one more plane, but decided to make my exit about 10 so I could get to Iowa in time to shower and be ready for the 4 pm Christmas Eve service.

The family celebration at Christmas time has always lasted at least a week with my brother, Andrew, being here from Texas from at least Christmas to New Year's. Mom's side of the family arrives on the 26th and stays a couple of days and around New Year's Dad's side gets together. This year was no different except we have the addition of Andrew's new wife, Vicky, and her mother who is here from Mexico. It's been a joy to have them as part of our family and blend some of their traditions with our own. Homemade tamales were on the menu for Christmas Eve because it isn't Christmas in Mexico without tamales. The Christmas ribbon salad has the added meaning of having the same colors as the Mexican flag. The Mexican tradition of having a turkey dinner on New Year's Eve (at midnight) has been moved a day earlier and at a more reasonable time for the Hibma family.

We have done other things besides eat. The weather has been warm enough (for Iowa) that we've been out for a walk most days. Vicky and our Louisiana family made a snowman in the backyard. The next day was so warm that the head fell off. (Or did Calvin and Hobbes pass by?) We also visited the local "natural science museum" down the street in a neighbor's living room. He has hunted big game since the late 1980s and fascinated us for over 90 minutes with his knowledge and stories about his numerous trophies. We've also played lots of games together since that is something you can do without being able to speak the same language. We all learned a new word, schadenfreude, since cousin Jake was rather gleeful every time someone else failed to get a big score in farkel. Another family tradition is working on a puzzle. We've finished the new one for the year and begun another which should take us through the parades and bowl games on New Year's Day. Then I can begin sorting my things for my trip up north where the next adventure will begin.

Most important lessons

Over the last few weeks I've been rather nostalgic when I think of leaving the Twin Cities. There's enough farm girl in me that I won't miss the city but I will miss the friends I have made and I will especially miss my church. Over three years ago I wrote about why I chose to be a part of Twin Cities Church. Since then I've come to appreciate this group of believers on a deeper level. My main regret in moving away is not being able to continue to be a part of this family and what God is doing among and through them. I'm especially thankful for the people who have been a part of my house church. We've eaten a meal together each week and shared our lives together. That includes the good and the bad, the struggles and the victories. We have prayed for each other through the mundane of school, jobs, and housing issues as well as through painful losses and long periods of waiting. This is a very generous group of people. Calls to meet practical needs are always abundantly met. For me personally, when I needed a place to stay for a month I had three offers before the end of the day. They have walked with me through the transition back to the US and gone from being new friends to family. They grieved with me when my brother died and rejoiced when I finally finished my studies.  

During my time with this house church we spent a year in Ephesians, the next in Colossians before spending most of the past year in Ephesians once again. That seemed like lots of repetition at times but I needed it as I've been a rather slow learner. I grew up hearing gospel themes so maybe it takes longer for them to really sink in. I've come to appreciate that it is not enough to simply articulate the gospel. It also needs to be internalized and lived. My house church leaders often repeated two key gospel ideas. One is that we shouldn't hide or hold on to our sin because sin is no longer who we are; it doesn't define us. Because of this we should expose it to the light of the gospel. The other is that because Jesus lives in me I can __(fill in the blank)_. I may think that there is no way I can forgive or be filled with gratitude in all circumstances instead of coveting. But Jesus can and he lives in me, which means that I can. I've spent a lot of my life trying do what God requires while hiding my failures. It's been healing for me to be in a community where the grace and redemption of the gospel are central so sin is both taken seriously and addressed with grace and redemption. Though being a student was my primary occupation during my entire time in the Twin Cities, the most important lessons I learned weren't in the classroom. Rather they were learned from the Spirit in the midst of a family of believers while studying the word.

Graduation! and next steps

After 66 credit hours over 4 semesters and more hours spent staring at a computer screen than I care to count, I've reached the end of the classroom portion of the occupational therapy program. Even though we won't get our diploma until sometime in July, we went through a graduation ceremony. My memories of the day include being the 2nd to last of my class to arrive. At least by then they had figured out how to attach our "ink" colored hoods to our gowns. The one-size-fits-all mortar boards fit none of us. Ben felt like it was so small it would pop off his head while most of the rest of us thought it was too big. The speaker agreed with us that they were rather silly and eventually removed his. I barely recognized some of the professors in their academic garb. The most joyous part of the afternoon was as we went to line up and high-fived each other all down the line as we whooped it up. I will also remember the sense of pride most of our family members expressed as they knew better than anyone else how much work had gone into reaching this point. I say "most" because when I asked one of my classmates 7 year old son if he was impressed with his mom he responded, "No," with a look that said, "Why should I be? She's just Mom." Later that evening I was honored to celebrate at a nice restaurant with people from the significant parts of my life: my parents, friends from my time in France and a family from here. I've been blessed in so many ways.

So what's next? Though I'm done with the classroom part of my program, I still have 6 months of level II field work which entails working under the supervision of an OT who will help me transfer the learning from the books to real life practice. I will be at the hospital in Fergus Falls from January - March and the VA in St. Cloud working in the area of mental health from April-June. In August I'll be able to take the national licensing exam so I can begin working. (It is possible to get a temporary license before that if I have a job offer.) I hope to be able to get a job in Sioux Falls so I can be closer to family. All of that means leaving the Twin Cities. Saturday morning we loaded a trailer with my things. Mom shook her head wondering where this would all fit in her house while Dad calmly said there was plenty of room. As soon as they pulled away and I had cleaned up the dust bunnies, I had a two hour nap. I'll be staying here until the 24th to finish up peak at my UPS job, wrap up things here, and get a chance to spend some time with friends.

Poster Defense

Friday afternoon most of my class gathered in the atrium of Hasselmo Hall for our poster defense as a culmination of three semester's work on our scholarly projects. One of the adjunct professors told us that back in her day these were individual affairs with an hour long defense. I'm thankful that has changed and it is now a group project with a 30 minute defense. Despite that benefit, there was still some nervous tension in the room as we set up our posters and checked note cards again. I looked around the room and saw the best dressed bunch of OT students I'd seen in four semesters. Two of the men even wore a tie.

My group was scheduled to be the last to defend which actually turned out to be a benefit. We had numerous opportunities to explain our project to potential OT students, 1st year students in the program, and a couple of doctoral students who have helped with our classes. The best one was the woman who introduced herself as Emily's mom. She was paying no attention to Emily as her group presented to their committee which I later found out was the only way Emily would allow her to come. Another classmate said she didn't even tell her mom it was happening because she didn't want her to come. The event also allowed me to meet three of my classmate's husbands.

My group's project consisted of doing a program evaluation of an adult day service program using a quality of life framework developed by our professor. The basic idea is that the activities offered by the program over the course of a week should promote specific aspects of quality of life such as autonomy, individuality, functional competence, enjoyment, social interaction, meaningful participation, dignity, and spirituality. We expected to see each of these indicators promoted by at least a few of the activities and we did. The strongest aspects of the program were the areas of enjoyment, dignity and social interaction. From our observations the weakest were spirituality, functional competence and autonomy. We also realized that some that was due to weaknesses in the form we used for the observations.

After the event, 9 of us went out to eat where more stories came out. One group had received their data from the statistician on Tuesday so had to put everything together after that. Another group realized on Wednesday that their poster was based on a false premise and they had to rework their data and come up with a completely new poster by Thursday morning so it could go to the printer on time. I was thankful for a simple project where the stats that only required addition and division.

NDT - good or bad?

One of my favorite classes this semester has been neurorehabilitation. I've always been interested in working in rehab and many people needing intensive inpatient rehab have some type of injury to the central nervous system whether that be because of a stroke, a spinal cord injury or a traumatic brain injury. It is fascinating to me to learn more of how the brain and nerves work and what can be done to help people return to doing the things they need and want to do. Over the course of the semester different OTs have taught specific topics based on their area of practice and expertise. Last week the reading was on Neuro-Developmental Theory (NDT). Our textbook called it an outdated theory based on an outdated understanding of movement that has very little evidence to support it. Evidently we were studying this theory so we would have an understanding of what older therapists may be doing with their patients.

We got a completely different take on NDT during our class session which was led by Theresa, an OT that I got to know when I was volunteering at HCMC. (You can read about some of what I learned from her here and here.) She talked about how she had felt ineffective as a therapist until she took a three week course on NDT and learned how to help patients regain movement that had been lost. By the end of our three hours together, most of us were wanting to sign up for that three week course. And we all would love to have Theresa as our Level II fieldwork supervisor. The passion and stories told by one OT convinced us the only reason the evidence doesn't support the effectiveness of NDT is because of the difficulty of designing a study that shows that it is those techniques that make a difference.

I left class that day thankful for God bringing me across Theresa's path. I contacted HCMC about volunteering in their OT department because it was close to where I lived. Theresa took me under her wing and got me involved in patient care as much as possible during the 9 months I was there one morning a week. She communicated to me her passion for her job and her patients giving me as many tips as I could absorb. My essay for the application to the OT program was far better because of what I learned from her. I asked if she would be a reference for me on my application because she was the only OT who might know me well enough to have an opinion. Later on I found out she was connected with the program at the U. I really couldn't have asked for a better person for a reference. It's a small thing that worked out really well. And as I look forward to all the changes that are coming in the next year, it is comforting to know that God is in control of the people I will meet, the therapists I will work with and learn from, and wherever I end up finding a job.

Pediatric clinic

A couple of weeks ago I spent a day with an OT in a pediatric clinic. Each child we saw is a story in itself, but I'll stick to just one. A 1st grade boy I'll call Marcus came in with his mother for the first time.  The four of us headed into a small room where the OT could get some information from his mom while observing what Marcus was like. I quickly observed that Marcus was a bright boy with a large vocabulary for his age. He also had a ton of energy, went at a faster speed than most and the volume was rather loud. The toy trucks and cars were flying across the floor and the table mat. I figured if the rest of us were going to remain sane, he might need some help staying somewhat in control so I got down on the floor to play with him. As we built several things with legos and played with the trucks, I was listening in on the conversation with the mother. Not surprisingly Marcus had a hard time paying attention at school. He also had a hard time getting to sleep.

After all the questions were asked we head out to the big room where the OT checked his coordination and ability to do things like hop, skip, stand on one leg, jump and run. She also verified that he could sense where his body was in space. Before she finished, she had him lay down on his stomach and she rolled an exercise ball up and down his legs and back as she put pressure on it. Marcus said she was being a masseuse. Then he sat up and the OT did joint compressions. That  involves pushing the two parts of the major joints together. You don't pull them apart, just push in 10 times fairly rapidly for each joint. (Google it for demonstration videos.) She did the shoulder, elbow, and wrist of each arm and then the hips, knees and ankles. When we headed back into the little room Marcus was a different kid. He actually crawled under the mat table and laid down. Somehow those last two activities had slowed him down.

I was telling one of my friends about my day. She has a daughter who has a hard time winding down at the end of the day and getting to sleep. For the past several evenings my friend has been doing joint compressions on her before she goes to bed and it's made a big difference. Nobody really knows why they work, but for those they help don't really need an explanation.

OT in the burn unit

Last Friday I spent the day with the occupational therapists who work in a burn unit. While the overall goal of OT is always to help patients do what they need and want to do in life, recovering from severe burns has some unique challenges. We usually don't think too much about our skin because it doesn't seem effect our ability to function. However, skin grafts tend to scar as they heal which means the skin becomes thick and hard rather than flexible and it also contracts. Much of what OT does for a patient in the burn unit is meant to counteract those tendencies.

One of the patients was a little three-year old I'll call "Andy." I met Andy as he was riding a trike down the hallway as he came to the OT room. His head was shaved and quite red since grafts had been taken from there to be used elsewhere on his body. He also wore a clear plastic mask which puts pressure on the grafts to prevent them from becoming thick and hard. He wore pressure garments on his arms and hands for the same purpose. For over an hour, Andy lay on his back with his shoulders propped up enough that his head was tilted back. This stretched out his neck where there were more grafts. If the skin in those grafts shrinks too much he won't be able to tilt his head back to catch a fly ball, guzzle a drink, look up at the stars or see what is on the top shelf. The OT sat on one side of him and worked on stretching out the skin around his shoulder and arm pit. At the beginning of the session he couldn't put his arm above his head. The grafted skin on the front of his shoulder became white as his arm stretched up. With some gentle massage and lots of lotion rubbed in, the whiteness went away and it could be stretched a bit further. By the end of his afternoon session he could put his arm straight above his head. This type of stretching needs to be done every day until the grafts are completely healed which can take over a year.

The most difficult thing for Andy was his mouth. To help stretch out his cheeks and lips, he put  different sizes of tubes between his cheek and teeth. He did alright with the smaller ones but he just held the bigger ones in his hand and said, "It's going to hurt." Yes, it would. It is hard to make a child suffer, but in this case it must be done. If it isn't he will end up having a mouth so small that he can't lick an ice cream cone or take a bite of a thick sandwich, and so inflexible that he won't be able to whistle or more importantly, use his cheeks to help move the food around in his mouth as he chews. I helped one of the adult patients stretch out his hands and when we finished he thanked me for helping to torture him. If a man in his 50s considers the necessary stretching to be torture (even if he was half joking) you can imagine what it is like for a child. One of the therapists I shadowed when I was volunteering told me she had worked in the burn unit for several years. Eventually she needed to move to another area of practice because it was so hard for her to work with children, who seem to be burned more often than adults.

I doubt I will work in a burn unit because there are fewer and fewer around the country. However, I'm thankful for the opportunity to learn from those who have learned to make "torture" manageable to even a three year old.

Beginning the 4th and final semester

I have finished week 3 of our final 15-week semester. So far I'm grateful that this this semester has not involved as much work as previous semesters. We are spending more time on campus with two full days (9-5) of class each week. One of my classes involves learning to make orthotics, more commonly known as splints. Over three weeks we will have 21 hours of practice making different kinds of splints for the hand and wrist. We are using different kinds of thermal plastics. These plastics need to be heated in water and can be molded to fit the person while still warm. Some of these have memory which means you can fix all kinds of mistakes by putting it back in the water where it goes back to its original shape. It's a little harder when it sticks to itself before you are ready for it to.

The first orthotic we made was for the wrist and would take a therapist about 15 minutes to make for a client. We were given an hour. You would think that would give a person plenty of time. In reality I had to hustle to finish on time. The process involves making a pattern, transferring it to the thermal plastic, heating it enough to make it easier to cut, heating it the rest of the way and molding it onto the clients wrist and hand while keeping the wrist angle right. Once that is done we get to smooth the edges, make sure there are no pressure points anywhere and then add the Velcro to hold it in place. One of these three strips had to be attached by a rivet. After being warned to double check we have the Velcro on right before pounding in the rivet, I made that mistake and found out how hard it is to get a rivet out. Mine ended up having 2 rivets to make it work. Other than that, it turned out pretty good for my first attempt. I did miss one of the pressure points and could have used more time to work on smoothing edges. Next week I'll get the opportunity to make it again and this time it will be graded.

Wedding memories

In our culture wedding planning is primarily done by the bride and her mother. The groom participates to some degree and usually has opinions about the food, a few ceremony details and most definitely the honeymoon. The bride takes care of the rest. This weekend my brother, Andrew, married Vicky, his Mexican girlfriend. The story of how they met 8 years, 6 months and 12 days before their wedding is too long to tell here. Suffice it to say that the planning fell primarily on Andrew since Vicky arrived in the US three weeks ago. He pulled it off with the help of friends who opened their homes, fixed the food, arranged the flowers, took the pictures, set up the chairs, and cleaned up after all of us left.

Since I knew there would be plenty of cameras, smart phones, and iPads snapping pictures, I left mine at home. However, here are some of my mental snapshots.

·      I asked Vicky if her mother was as excited for this wedding as Andrew’s mother was. “Oh yes. She loves Andrew very much.”

·      Since Andrew planned the rehearsal dinner, the hot peppers in the pork and beans were the only vegetable in sight. The main item on the menu was the best barbeque in the city.

·      Outside the home where the ceremony was held, there was a signpost pointing in multiple directions including the towns where Andrew and Vicky grew up. It fell to me to explain to Vicky’s mom and the bridesmaid why Wall Drug was included.

·      Elizabeth, presiding over the guest book, was recognized by everyone as Andrew’s favorite niece. Since she is 10 years old and it’s been 9 years since she visited Dallas, it can only be because Andrew is showing pictures of her.

·      Vicky was a nervous bride. The preacher said Andrew was the calmest groom he’d ever seen. As the Groom’s Honor Attendant, I had a clear view of their faces during the ceremony and Andrew’s calmness seemed to rub off on Vicky. The further it went along, the more she relaxed. She didn’t even blush when Andrew was finally able to kiss the bride.

·      We all had to use our imagination during the exchange of the rings since Andrew didn’t realize he had left them on his dresser until the preacher asked him about 10 minutes before the ceremony was to begin.

·      The Mexican part of the wedding included the presentation of a Bible (the foundation of all of life and marriage), a box with some coins (a symbol of God’s provision for them), and a lasso (a symbol of the two becoming one).

·      Ma and Pa Alexander and their three daughters are Andrew’s family in Dallas. One of them helped coordinate everything and they all pitched in to make the food for the reception that was held in their home. If anyone reading this happens to be living in Dallas, I’m sure they will be happy to have you stop by and help them eat the leftovers

I didn’t have to propose a toast to the bride and groom but if I did, my little speech would have included the following. Andrew, we’re proud of your quiet commitment to relationships that has resulted in all of us being here with you today. You don’t rush into anything but you do step up and take responsibility. Alexanders and Texas friends, thank you so much for being Andrew’s family from the time he moved here as a college student. You have had a big impact on the man he has become. Vicky, We are so glad to have you as part of our family. I don’t think I’ve ever seen Andrew so happy. I hope you have sensed that all of us here love Andrew and we love you too.

Vacation

The past two weeks have been my "summer." I had no school and no work. It's been a year since that has happened for more than a week. With that in mind, it makes sense that sometimes I wondered what to do with myself. I spent a week in Iowa with my parents and enjoyed some bike rides in the prairie winds. It took a bit for me to regain an efficient and smooth pedal stroke with my clip-on shoes. The best part of biking on the prairie is going 20 mph on the way home with the wind at my back. I've also been enjoying reading some books that I can actually hold while lying on the couch. I've read some Raymond Chandler and Charles Dickens.

As usual, I got in on some small town farming culture. The local co-op elevator association that serves 5 area towns provided a free meal in honor of their new 16,000 ton fertilizer plant. After a meal of pork chops, cheesy potatoes, baked beans and fruit, we were given a tour by one of my cousins who happens to be a board member. He gave us all the statistics regarding how many tons the different bins could hold and explained how a farmer's fertilizer order can be mixed to order and weighed before being put into the truck.

After my return to Minneapolis, a friend and I took an overnight camping trip near Cannon Falls. Bri is rather adventuresome and organizes a winter camping trip every year. I have always had school and work as an excuse for not going but in August I don't have to worry about being cold, especially not with Bri's tent that is made for winter camping. Ventilation is not its strong suite. However it did keep us dry during the afternoon storm. We ignored the deputy's invitation to go to the "concrete building at the beach" and stayed in the tent. Though we heard the constant roll of thunder it didn't get very close. We were glad when the rain stopped and we were able to get some fresh air. We slept well with our heads near the screen door and I actually needed a sheet by morning. After the sun burned through the clouds and it warmed up a bit we kayaked 8 miles on the Cannon River. It was a peaceful few hours with enough gentle rapids to keep things interesting and at times turn us around so we were heading downstream backwards.

This week I head back to work and I need to take care of some odds and ends before classes start again in a week. A friend commented today that I looked like I'd spent some time out in the sun. I've enjoyed being away from my desk while I could.

Occupational balance

Last Thursday around 1:00 I left campus wondering what to do next. After 15 weeks of living by due dates and the weekly rhythm of class it felt a little strange to have nothing that had to be done before I could go to bed. As an occupational therapy student I'm learning to "promote successful participation in everyday occupations, allowing people to remain engaged and to re-engage in meaningful, contributory roles." The irony is that as a student, about all I do is homework, sleep, eat, and work 10 hours a week. That isn't a very balanced life. Some regular exercise, socializing, and having time to help people would make it a more rounded picture. My housemate would probably appreciate it if I did more of the domestic tasks especially cleaning. I make it through by remembering that this is temporary and, with only one semester left, the light is at the end of the tunnel. In the meantime, I have three weeks to be completely unbalanced in the other direction. No homework and two weeks of vacation from work means I have time to spend with family and friends!

Last weekend my 10 year-old niece, Elizabeth, came to help me break out of the study mode. On Friday we went shopping (yes, for her I will brave the Mall of America) and visited the Mill Museum that chronicles the years when Minneapolis was the city that ground more flour than any other place in the world. By then I was exhausted and Aunt Alice had to have a nap. We finished the day with sweet corn from the farm and grilled brats followed by a lively game of Dutch Blitz with my housemate. Saturday morning we headed out for a bike ride around Lake of the Isles. After a shower, we headed to the big library downtown that is "4 stories tall!" Two book lovers should be able to find something good to read there. It was the first time I had been in the children's section. That afternoon and evening we attended a wedding. Sunday after church we spent the rest of the day with two different families from church. One had us over for dinner and Elizabeth played with their daughter and niece who are about her age. From there we headed east of St. Paul to ride horses. That adventure was followed up by Sebastian Joe's ice cream. There's nothing better than a kid to bring some perspective and balance back into one's life.

4 days in behavioral health

I've spent 4 days in the last two weeks at a small behavioral health hospital learning more about occupational therapy in that setting. Since my only exposure to psychiatric hospitals has come through books, TV and movies my rather vague expectations involved people who may be  unpredictable, a danger to themselves, possibly a violent towards others, or, at the very least, strange. In other words, they would be anything but normal and I didn't expect to be real comfortable. Reality turned out to be quite different from my expectations.

This hospital has 16 beds and at least 14 of them were full while I was there. The length of stay ranged from 7 months to new arrivals. It seems most people stay somewhere between 2 weeks and 2 months. Almost all of them are there by court order. It's not the kind of place one would want to spend a lot of time. Every half hour all night long someone is checking to see if you are sleeping. The only way to go outside is when a staff member unlocks the door to the patio, which is called the "dog kennel" by most of the residents. There are activities and groups during the day but pretty much there isn't a whole lot of structure to the day beyond meal times with food that comes from a local nursing home. There definitely isn't much opportunity to be productive. The most hated rule seems to be "no smoking." And often, the way out depends upon an opening in another setting and/or the funding to pay for it.

By the end of my time there I was thinking of the patients there as normal. That may sound rather odd. After all, one man said he was from Mars. A woman desperately needed the big handful of pens and pencils in her room for her CIA work and she needed extra linens for biopsies. Another woman was convinced the purpose of the medication she was taking was to drive all the Bible verses she knew out of her head. In reality that very low dose (2 mg when the doctor could go up to 100 mg) had calmed down the mania enough that she no longer needed to move furniture around or talk incessantly so you could actually have a conversation with her. None of that sounds very normal. But though these particular people weren't very connected to reality sometimes, they were nice people with a pleasant demeanor. The woman doing the CIA work was a sweet grandma who could tell you how to do canning and make sauerkraut. She could get a little intense/upset with those who checked her room and removed things that were "hers" and she "needed." But most of the time her blue eyes were gentle and she smiled readily. While there was one woman who made me uncomfortable because of her odd unpredictable behavior, I would have no problem sitting down and eating a meal with any of the others. They are all just normal people who happen to be dealing with a chronic illness that affects the brain rather than other organs of the body.

Joy and saddness

Over the last few months my family has been rejoicing. This week one of my cousins welcomed their 2nd child into the world. When I saw the announcement on facebook and the name they gave their precious little girl I cried. Suzanne Beth is named after her grandma and was born just a few days after what would have been Grandma-Suzanne's 53rd birthday. She would have loved spoiling little Suzie, her first grand-daughter, dressing her up in style and later on teaching her to cook.

My family is also rejoicing over the upcoming wedding of my brother, Andrew and his bride, Vicky. It's still two months away but the waiting for Vicky's visa is over and plans are far more concrete. A few weeks ago I called Andrew to coordinate travel plans and he informed me I would be part of the wedding party. "You'll be standing next to me." I'm greatly honored and more than happy to break tradition. But I've also shed some tears. That place next to Andrew belongs to our brother John. He would so have enjoyed celebrating with Andrew and Vicky and probably teased Andrew more than necessary.

John and Suzanne have gone on to heaven. We miss them in the midst of daily life. But, at least for me, I miss John most in the special moments, the big events and celebrations. The tears do not diminish the rejoicing; but they do remind me of the wonderful promise of a time when Jesus will set everything right again and will reign as King in a world where it is impossible for celebrations and joy to be tainted by sorrow and tears.

Highland Friendship Club

As part of my OT program I need to do some volunteering. The idea is to broaden my horizons and expose me to ages, conditions or ethnic groups with which I have little experience. This summer I wanted to do something that would allow me to be outside and/or be active. My search led me to Highland Friendship Club. This club was started by two moms who each had a son with disabilities. The older their sons became, the less activities were suited for their abilities. So they decided to create their own activities for teens and young adults. In the last 10 years it has grown and includes all sorts of activities from fitness to gardening to cooking to art to movie making and a monthly birthday bash.

I help with a fitness class on Monday evening and a water aerobics class on Saturday afternoon. I'm being active and I'm also enjoying getting to know the club members and the staff. Each member is unique. Some have cognitive disabilities; others have physical problems and some have both. Three of those who come to swimming come with a PCA (personal care attendant). They are not very verbal but enjoy the water. One of these young men was particularly cooperative on Saturday and he did some things I'd never seen him do before. His face glowed with pleasure at the praise and fist bumps he received from his PCA and some of the staff.

The woman who runs the water aerobics class is an OT so I've been observing how she meets each of the members at their level. For example, one of the young men has tight muscles since his arms and legs are almost never straight. It doesn't help that he spends most of his time in a wheelchair. The warm water in the therapeutic pool helps release the tightness but it still takes some work to completely straighten his limbs.  One of the neat things about this group is that each member is greeted by name and is accepted for who they are with their unique abilities.

Storm and MMT

Two Fridays ago I was visiting my friend at the nursing home. I had eaten supper with her and we were sitting in her room watching game shows on mute. She always watches TV with the volume turned all the way down so game shows are a good fit. At least she can follow what is going on. Sometimes I turn up the volume enough to hear. At one point she switched the channel to a local station that showed a radar of a large rapidly moving severe thunderstorm. I told her I better head on home before it started pouring. I'm so glad I did. It was sprinkling when I got home but within 10 or 15 minutes the rain was coming in ropes (the French expression for raining cats and dogs) and the power went out. The next morning we were still without power and on my early morning drive to work, traffic lights were completely out and and trees lay across the streets. Nine days later there is still a tree laying across our street a block up. Our power was restored about 11:30 on Saturday morning but it wasn't until late Sunday evening that our internet was restored so I spent part of my Saturday afternoon at a coffee shop finishing up the week's assignments.

This semester has been calmer than last but I have a feeling it will be picking up in the month of July with tests, presentations and 32 hours of field work in a mental health context. This coming Tuesday we have a practical exam on manual muscle testing (MMT). For this test we walk into the room where one of our classmates is acting as the patient. We pick one of 32 cards that have a joint and movement on it (such as wrist extension) and we are to test the "patient's" strength. We begin by placing the patient in the proper position so the joint will be moved against gravity (elbow bent at 90˚, forearm resting on a table with back of hand facing up). If the person isn't able to move the joint through at least 50% of the range of motion, then you have them switch to a gravity-neutral position (turn forearm so the thumb is facing up with the wrist slightly flexed) to see if they have enough strength to move the joint without having to fight gravity. If they can't move the joint at all we need to know where to palpate the muscle or tendon to see if there is a trace of a contraction. Most of the 32 scenarios aren't that difficult, but I do have some studying to do tomorrow so I can be confident going into the practical on Tuesday no matter which card I draw. Elbow flexion would be the easiest choice.

A day of hospital OT

This past week I spent a day with an occupational therapist at one of the hospitals in the city. Four different situations give a pretty good idea of the main things OTs do in a hospital setting.

Occupational therapists help people do the things they need and want to do in their lives. The things we need to do start with our morning routine of washing and dressing. Most of us do these tasks without much thought but they can be more of a challenge for someone in an acute hospital setting. One woman we worked with wanted to wash her hair and I was introduced to waterless shower caps. We heated the cap briefly in microwave. She put it on her head, massaged it for a couple of minutes and her hair was clean -- all without leaving her chair. This particular woman wasn't really sure she had the strength to wash up at the sink but we helped her out of her chair and she used the walker to maneuver around the bed. When she finished, we helped her get situated in bed which would allow for an easier transfer when they came to take her for a procedure.

A big part of any type of therapy in the hospital is to get people moving. Everyone has had the experience of feeling weak after spending a day or two in bed. The less a person is able to move, the weaker a person becomes. That's part of why we encourage people to do everything they can for themselves even if it is as simple as brushing your teeth. Movement helps blood flow, fluid drainage and the general healing process. One young man agreed to go for a walk. He got himself out of bed on his own, donned a second gown for a bit more modesty and together with his IV pole we made two laps around the unit. That was 10 minutes of walking. We left him sitting up in a chair looking like he was a bit more ready for whatever the day held for him.

Another part of the OT's role is to evaluate whether or not someone can benefit from therapy. The therapist I was with likes it to feel like a conversation of two people getting to know each other. The questions usually focus on three big areas. One is their living situation. How many stairs are there to get into the house? Do you have to go upstairs or downstairs on a regular basis? What's the bathroom like? We also ask questions about whether or not they were having difficulty with any of their daily activities before they came to the hospital and whether or not they expect to have problems when they leave. One woman we talked with had a good set up at her home. A walk-in shower was being put in while she was at the hospital. She had people that did some of the heavier cleaning and the only real concern she had was her balance and lack of endurance. We watched her get out of her chair and walk on her own in the hall. There were a few times she seemed a bit unsteady on her feet but there was nothing she needed OT for. Instead, the therapist encouraged her to do PT while she was in the hospital and to continue once she returned home.

One of the things we have learned to do this semester is moving people's joints when they aren't able to do it themselves. This is especially helpful in the ICU when patients are unconscious or sedated. Even though they can't move themselves, it is still beneficial to move all of their joints through the full range of motion for them to ward off some stiffness and swelling. I was hoping to have the opportunity to do that but the nurse said the woman on our patient list was too sick that day.

All in all, the day gave me added motivation to keep studying since I will soon have the opportunity to use what I'm learning in real life situations.

A more reasonable pace

I have written before of the intensity of the past semester. It seemed I studied all day Monday through Saturday every week. This semester is different. I don't know if it is because I'm used to the pace and have found ways to work more efficiently or if there really is less work. Either way I'm grateful to feel like I can take the time to stop and see a friend while I'm out running errands.

I continue to enjoy my classes. Neuroanatomy is all about the brain and is fascinating. We have learned a lot about how the brain works in recent years but there is still much we don't understand.

Remediation is a big part of occupational therapy practice as we help people recover function they have lost through injury or disease. Two weeks ago we had a practical test on measuring range of motion in different joints. I wasn't very confident in the one I drew, and I didn't place the goniometer correctly for the first measurement. My grade was fine because my error wasn't worth many points, but I definitely learned from the experience. I won't make the same mistake again. OT Practice in Work Contexts has quite a bit of overlap with Remediation which always makes life easier for students.

The final class, OT in Mental Health Contexts, is also interesting. I recently learned that one of my 3 month rotations (known as field work) will be in a mental health context so I need to pay attention. I will get my feet wet in July with 4 days of field work at a community mental health clinic. I've had little exposure to this type of setting, but my professor thinks I should consider working in mental health. We shall see.

Now that I know where I'll be doing the final 6 months of field work, the end of my studies seems  much nearer. I can begin to plan for the next step. From January - March I'll be in Fergus Falls, MN working in a smaller hospital where I can do a little bit of everything. I have been invited to stay with a couple I know there. I'll be in St. Cloud April - June and it will take some creativity to find an affordable place to stay since I don't know anyone in that area. As to what comes after that, I'll have to wait and see what jobs are available. And I'll have to pass the board exam too. Even though I have another year to go, the end is in sight!

The Occupation of Sleep

A couple of weeks ago one of my professors gave us the following instructions for a discussion post.

Share something about yourself, your family or friends that to the outside world would look unusual. It might be a ritual, routine, a saying or "way to do something". How do you think what you describe could be interpreted by someone assessing you or your family? 

Since I think I'm rather normal I asked my housemate what I do that is unusual. Her immediate response was, “You go to bed at 8:00.” I can protest that I go to bed that early because I get up a little after 4 so I can get to work by 5, but in reality I’ve always valued my sleep. I come from a family where we often say, “It’s after 8:00 so we can go to bed now.” Some friends in college tried to get me to pull an all-nighter. They soon gave up realizing that sleep was far too important to me to do something so foolish. A few years back a New Year’s Eve party with some extended family ended at 11. We were all tired and figured it was the New Year on the east coast so that was good enough for us. More recently my brother set up a time to chat with his girlfriend online one evening while he was at my parents for Christmas. His girlfriend told him he should be spending time with his family to which my brother replied, “Don’t worry, they’ll all be in bed.”

Hopefully someone assessing me (or my family) would realize that we are just morning people. However, some people think I need to loosen up a bit, have some fun and realize that life won’t come to an end if I don’t get 8 hours of sleep. Others might assume that I lead a rather boring life. My early morning work schedule definitely has cut into my social life, but that is temporary. I do look forward to the day when 10 pm is bedtime instead of 8.

This week we read about the importance of sleep. We spend almost a third of our lives sleeping which may seem like an incredible waste of time. But if we don't get enough sleep or good quality sleep, it affects everything else we do. My housemate may think it odd that my family goes to bed so early and takes naps if we need them but I am thankful that I sleep well.

And now it's time to get to bed so tomorrow my brain is ready to study for a Tuesday morning test on the brain.

Celebrating Mary Pat

Last Thursday I attended Mary Pat's memorial service, a friend of our family for the past 30 years. She knew she didn't have long to live so she had planned her own service. A violinist played demonstrating her love of classical music. The tables were decorated with colorful balloons reminding us that she wanted this to be a celebration because she was now home. She chose the scripture passages that were read and the songs we sang. She had wanted to record an explanation of John 3:16 but it didn't work so a friend read exactly what Mary Pat had written - and it sounded just like her.

The tributes told of a fun-loving aunt who came every holiday and had a way of making you feel so special. The people from her church remember her as the lady who wore a hat, whether anyone else did or not. She was the one who loved missions and young people. (How many people over the age of 80 are known for the love of teenagers?) One of the women from her church said she had no idea that Mary Pat had traveled so much. "She didn't want to talk about herself. She wanted to hear about me and my children." Among those present at the service was a large group of women a few years younger than Mary Pat. She had mentored them while living in a discipleship house run by the Navigator's. They remember her as the woman whose love for Jesus was contagious, who taught them to study the Bible as well as how to cook, clean, and fold sheets. Stories were told of her spirit of adventure that took her to China in her 70s and of her love for Jesus that renewed her inner strength even as her body became more and more frail. As she had been an example in life, she became a great example of how to die.

As I listened to the tributes and reflected on what I knew of Mary Pat, I was reminded that I do not need to fear the future or wonder who will help me when I become old and frail. Like Mary Pat, I have no children to fill that role. Instead I have something far better: the promise that, It is the Lord who goes before you. He will be with you; he will not leave you or forsake you. Do not fear or be dismayed (Deuteronomy 31:8). In the end Mary Pat had several friends who helped her in so many ways. They were all people she had loved and given herself to and they were more than happy to give to her in return. As one of those who spoke said, "When I grow up, I want to be like Mary Pat."

Strength and dignity are her clothing, 

and she laughs at the time to come.

Proverbs 31.25  

Simple things mean a lot

 As I look back over what I've written in the last couple of months I realize that I haven't mentioned one of the most significant events of the semester. This particular story starts at a Graduate Christian Fellowship (associated with InterVarsity) meeting in February. The topic of conversation was how we could have a greater impact on the campus. As we talked I realized that grad students have some very practical needs but other grad students have very little time or energy to help meet those needs. It seemed the one thing missing from the conversation was the church. As a result, I wrote an email to my house church (small group) leaders and gave them an idea for a way to meet a practical need of the 24 people in my cohort. In our particular program, we are on campus one or two days a week from at least 9 to 4. I have written before of the pressure we all were under and how overwhelmed we felt. I felt like I was seeing my classmates age before my eyes. The idea I had was to have a few people bring the noon meal (that wasn't pizza) for the whole cohort. It seems like a small thing, but when you are feeling overwhelmed, not having to think about a meal makes the burden lighter.

Anna loved the idea and three other women volunteered to help. We chose a date which turned out to be the most intense week of the semester and they made three different kinds of chili and cornbread. Sarah also brought along some "brain food" like trail mix and raisins that we kept eating for several weeks. I told the class via our Facebook page that some friends from my church were bringing the meal the following Tuesday. The response was overwhelming.

• That is the nicest thing ever.
• When I saw your post I just cried. They don't even know us.
• You have some amazing friends. Thank you for sharing them with us.
• That was such a treat. It was the highlight of my day.

It was a simple thing. Sure it took some organization, the time to make the food, loading up the car, bringing all the bowls, plates... and a trip to campus. But it meant so much. Personally, I felt very loved. And a few days later I felt even more loved when I was given two grocery sacks of frozen homemade meals in individual serving sized containers. I didn't have to think about my lunches for the rest of the semester. It was wonderful! I do have some wonderful friends and I am glad to share them.

Ready to Start

Our third semester begins tomorrow. I have four classes: neuroanatomy, remediation (rehabilitation), occupational therapy in a work setting, and OT in a mental health setting. Those aren't the official names, but they work for me. The only other thing I know about the classes are the required books, which have all arrived. Everything else can wait until tomorrow morning. I may regret not getting an earlier start next Saturday if I'm scrambling to finish the assignments for Week 1, but I'll deal with that then. In the meantime I will be thankful for the blessing of a break that allowed me to rest and renewed my motivation. The summer-like weather this weekend gave me the opportunity to watch a couple of high school rugby games, wear sandals, and get in my first bike ride of the season.

One of the things I discovered over break is the reason for the tension and sometimes pain in my shoulders and hips. Because I spend so much of my time sitting with my head tilted forward, the muscles in the front of these joints have shortened causing the ones in the back to be overstretched resulting in intermittent pain. There isn't much I can do about the amount of time I'm required to read or stare at a computer screen. However, I've begun adding some stretching for my hip flexors, chest and neck to my routine. Hopefully that will make a difference. The chiropractor I found in Minneapolis said the people who need the most chiropractic care are students and people who work at a desk. That means there is hope for the future. Practicing OTs usually don't spend much time sitting!

Taking a Break

It was a great relief to finish off the semester over a week ago. It took a few days, but I was able to slow down while taking care of things that I've been putting off.  Saturday I did my taxes. Monday morning I went to the dentist at 7:00 and enjoyed leaving with clean teeth. Later that morning I went to the chiropractor while a simple recall on my car was taken care of. My neck and back were in great need of an adjustment after two semesters of grad school spent reading or staring at a computer screen.

My other main objective for this break has been to catch up on my social life. Last summer I helped a friend with an estate sale for her aunt and was given a cous-cousière because I actually knew what it was. Friday evening I finally put it to use and made cous-cous for these friends. Though I have often eaten cous-cous, this was my first attempt at making the dish myself. It turned out great. I made a huge pot and was able to serve four friends on Sunday and two others later in the week and still have a bit to bring to my parents so my family could have a taste. It has been wonderful to welcome some friends into my home and have the time to sit and catch up. A friend I talked to on Skype said I sounded busy. In reality the slower pace has also allowed me to take a nap almost every day.

I am currently at my parents for the first time since New Year's. Yesterday we enjoyed family game night with my 10 year old niece. A game of charades brought much laughter especially since Dad and I aren't very good at the game. Thankfully there are no video cameras to record our antics.

Finals

The usual posture for taking a test is sitting at a desk or table with head down and little if any looking around. The focus is on answering the questions. Too much looking around leads to distraction or suspicion that we are trying to get the answer from somewhere  besides our own head. Our cadaver lab final was a  different experience, which may be why I actually enjoyed it.

We have nine cadavers in our lab and during the exam, one student was allowed on each side of a cadaver at a time. That left at least 10 of us standing around as we waited a turn. This gave me ample time to people watch, which often proves to be quite interesting. In this particular case, I knew those I was observing. Over the course of two semesters with numerous group projects, I've come to appreciate the individuality and personality of each of my classmates. As I leaned against the wall waiting for my turn I noticed that no one looked their best. After all, this was cadaver lab so old clothes and pulled back hair was most appropriate. I saw a classmate bent over the forearm pulling on a tendon hoping that something on the other end would move so she could identify the correct muscle. Another was tracing a blood vessel or nerve farther up the leg so she could give it the right name. Through their actions I could see the logic they were using. I know the pressure we've been under and the amount of work we have done to get to this point. As I observed, I found myself rooting for each one, thankful that we were not in competition. A few days later the grades were posted and our professor included the highest and lowest grades in the class. I was pleased to know that not only had I done well, but so had everyone else in the class.

In the next three days I have three comprehensive finals. I've tried to be motivated to study and push through to the end of the semester but I'm far more excited about planning what I will do during our two week break. And even though I won't have the leisure to lean against the wall and watch my classmates, I'll be pulling for all of them. We are almost half-way done.

Learning from the homeless

Yesterday morning I went to "group." The meeting starts with check-in. Everyone knows the routine. You give your name, your mood on a scale of 1-10 and then answer the question of the day. Yesterday's question was, "What do you look forward to each day?" What would you say? It's not the easiest question to answer.

Several of these people said something to the effect of, "Just waking up and being alive."  Several others said, "Being sober. Making it through the day sober."

Those responses show that I wasn't with the type of people I'm usually with. My classmates and I may grumble and complain about our work load that results in a lack of occupational balance and some really look forward to a beer after a full day of class, but we don't have to worry about making it through the day sober. I think my favorite time of day is sunrise and thanks to my early morning job I usually get to see it and am thankful for that beauty, but I usually take for granted that I'll be alive tomorrow morning. 

This particular group of adults meets regularly in the basement of St. Stephens, a nonprofit organization that works to meet the needs of those facing homelessness. Those who come are dealing with long-term homelessness and substance abuse or mental illness. As I've participated over the past few months I've heard bits and pieces of their stories. Some of them have spots in a shelter. Others have an apartment. Some are or have been in treatment. Some aren't sober when they walk in the door and that's OK -- as long as they aren't disruptive.  Some likely come to group for breakfast. Others need the support as they try to make it through one more day sober. From what a couple people said yesterday, sometimes they come just to get away from a tough situation for a few hours. Some are working hard so they can once again see their children.

Yesterday three of us Occupational Therapy program led the discussion. We asked them to jot down what they normally do on a weekday and on the weekend. Then we gave them some categories of activities (occupations) such as personal responsibilities, work/productivity, leisure/play, social, and rest/sleep. Having a balance between all of these areas leads to a greater sense of well-being. During the discussion one of the men compared his past and his present. "Before all I did was drink and take care of myself. Now I'm doing all of those other things." When I asked him whether he was more satisfied with his past or his present he talked about how now his life isn't falling apart but it is so hard. He wants to drink so bad. He also has hope that it won't always be this hard. I applaud him for setting aside immediate satisfaction for a better life in the long-term.

I'm thankful for the opportunity to observe and listen to these men and women. I've learned a lot.

Field Work - round 1

Last week I had the opportunity to spend three working days with an occupational therapist. As part of field work there were some assignments associated with the experience but it was great to be out of the classroom and see how what we are learning actually applies in real life. All of my previous exposure to OT has been in a hospital setting so I didn't really know what to expect when I was assigned to home care. Home care is for those who are considered "home-bound." In most cases the client has recently come home from the hospital but it is exhausting to go anywhere so the additional care they need comes to them. Most of the people we saw were over 65. The diagnosis ranged from by-pass surgery to a fractured vertebra to chronic obstructive pulmonary disease to Parkinson's. Each visit could be a story in itself but that would go against confidentiality rules so I'll stick to some of the things I learned.

During one of our visits the first day, I found myself rather uncomfortable. I couldn't really put it into words but I found myself wondering if I really wanted to do this job. As the OT did a cognitive evaluation and tried to help the client figure out what had happened to one of her medications something didn't seem right. As we drove to the next appointment, the OT put words to my uneasiness when she said, "I know there is really nothing I can do that will make a difference in her life." I suppose that is part of every job that works with people and it is better to recognize it and focus on those you can help.

Another visit that first day left me flabbergasted. Instead of seeking medical help following an injury, this particular person had sat on the couch--for months--waiting for it to get better before seeking medical help. Sitting around that long leads to extreme weakness and muscle tightness that, in this case, made it almost impossible to stand. I was shocked. How could something like this happen?! The OT didn't really know what to do in the situation either. She could help the person obtain a wheelchair to allow movement around the home. But beyond that, "This one is going to take a team meeting (with the nurse, physical therapist, & social worker...) to figure out what to do."

Almost all the people we visited had simple home exercise programs. Some of them used the thera-bands for resistance but for the rest, gravity was enough. Just move the arms in and out, punch, walk in place and kick. In every case, people were making progress. One woman had gone from not being able to do any of the exercises standing to doing each for 1 minute while standing and recovering quite quickly. She needed to be at 2 minutes each before she was ready for cardiac rehab but she had already come a long way. The OT taught me that simple is almost always better.

Several people we visited had spouses who were doing a lot of work to help with care. It's can be a hard adjustment for them. The OT talked about how she can tell which spouses will burn out if they don't get help. We met one of man who is a good candidate for burn-out. It was obvious that he loved his sweet wife but he was also very aware of the new limitations that her illness brought to their life. He was mourning all the outdoor activities he loved to do that were no longer available to them.

One of the most encouraging things I saw was some great families: sisters, children, and grandchildren who came together to care for Mom/Grandma on a short-term or more long-term basis. The last day we did several evaluations to see if a particular person needed anything within the  new living situation. In the case of one great-grandmother, the doctor requested a cognitive evaluation. She was living with one of her children, was able to get around on her own and was rarely left alone and then only for a few minutes. The results of the cognitive evaluation wouldn't change anything the family was doing to care for her so the OT just asked her a few questions. In another situation, the client was in quite a bit of pain so the evaluation was more related to looking at what her kids were doing to make things work for their mom following a recent hospital stay. They were doing a great job. A few suggestions and a plan for when to return reassured the family. In home care, working with the family is just as important as working with the client.

What a morning

Tuesday morning I awoke to three or four inches of new snow on the ground. That meant trying to get out the door a few minutes early so I could get to work on time. There is little traffic on the streets at 4:45 but snow still slows one down. I went through my usual routine of putting on my work boots, my work coat, grabbing a stocking cap and my work gloves before heading out the door. Until the beginning of March three of us were living in the house with only two spots in the garage. February was my month to park on the street, so Tuesday was the first morning in awhile that I had headed out the back door. I locked the door on the inside and pulled it shut behind me and took several steps down the sidewalk before I realized that I had no keys whatsoever. My only option was to go around to the front of the house and ring the doorbell. (Actually there were other options: sit on the porch, get really cold and miss work, or go wake the neighbor who has the key.) Jan was my best option but I also knew that she was not likely to respond if I rang the doorbell only once or twice. After all, she is a night owl so 4:40 really is the middle of the night for her. So I rang the doorbell repeatedly waiting for a light to come on.

According to Jan she wake up, wondering if a robber would ring the doorbell incessantly. Then she thought surely I'd still be there and I would answer the door. She did manage to get out of bed, find a sweater and cautiously come down the stairs. We can see the bottom half of the stairs from outside the front door so she wasn't sure what/who she would see when she came around the corner. I'm not sure if she was glad to that it was just me or not as I stood there mouthing to her that I needed my keys. She brought them to me and I headed off. I was halfway to work before I realized that I hadn't locked the front door behind me so I hoped Jan had been coherent enough to get her own keys and lock it. I wasn't going to call her to check.

Under pressure

I don't remember exactly who said it, but somewhere during my transition to France I heard that the problems a person has only become magnified when put under stress. The general sense among  expatriates is that they are living with more stress than the average person simply because they live in another culture, functioning in another language while the support of family and friends is on the other side of the ocean. During the fall semester my advisor seemed somewhat skeptical when I told her I had a good handle on how to deal with stress. After all I had 18 years of cross-cultural living under my belt.

Then came semester # 2. This stress feels far greater than anything I dealt with in France (though I may have a poor/short memory). This stress is pressure, constant pressure. I'm watching some of my classmates age before my eyes. The dark circles under the eyes can no longer be hidden. I don't know if people think I always look tired or not but I feel the constant pressure. It ties me to my desk and computer. I always have anatomy flash cards in my pocket so I don't waste any down time, especially at work. My housemates appear elated when I tell them I'm headed out to do something fun. The only break from the pressure is on Sunday when I'm often so tired the only thing I want to do when I get home from church is take a nap. Somehow I make it through each week. Friends remind me that this is only for a season. (December 13 can't come soon enough.) They also let me know that I am not alone. A couple of weeks ago some friends from church blessed me with two grocery sacks full of meals I could put in the freezer. It was really nice not to feel like I needed to be cooking on Sunday afternoon so I had something ready to take for the noon meal during the two days I'm in class all day this week.

All this pressure is giving me a first hand view of what I've heard about problems being magnified under stress. The things I've struggled with and the battles I face to believe truth rather than lies haven't changed. It's exactly the same issues as a year ago, just magnified. And it's not a pretty sight. I want to protest that the battles only compound the pressure I'm under. A few days ago I read the story of the nation of Israel running out of food a month and a half after leaving Egypt. Talk about stress! They had left the only place they had ever known. They had almost been slaughtered by the Egyptian army but God had miraculously saved them. Now they are out in the middle of the wilderness and there is no food. Put under pressure, what came out was grumbling and murmuring rather than faith in God who had taken care of them every step of the way. It seemed like a better idea to be a slave in Egypt than die of hunger in the middle of nowhere. I find it interesting that the Hebrew word translated grumbled in Ex. 16 also means to lodge, to dwell. It seems to me that I start grumbling when I mentally dwell on the wrong things. That's where my battle lies. Instead of dwelling on all the good and God's gracious provision in so many ways, I dwell on what I don't have. I think that if only z was different or I had x then the pressure wouldn't be so bad. I end up grumbling and murmuring just like the people of Israel.

As I was thinking about the pressure I'm under I remembered that pressure produces diamonds.

In this you rejoice, though now for a little while, 

if necessary, you have been grieved by various trials, 

so that the tested genuineness of your faith

--more precious than gold that perishes though it is tested by fire

--may be found to result in praise and glory and honor 

at the revelation of Jesus Christ. (1 Peter 1.6-7)

There is more at stake than my sanity and a degree. After all, a degree won't impress anyone in heaven. Praise, glory and honor from Jesus - that is something worth striving for. My gracious Father has deemed the pressure necessary. He'll get me through, and in the process, I can count on him to get rid of the impurities the pressure is revealing.

Mid-terms

Last Thursday afternoon during a kinesiology lab that had to do with different types of levers, I had the following conversation.
- Professor: What class of lever is this?
- Me: I don't know. 
- Professor: That's why I asked you read the chapter before you came to class.
- Me: I thought studying for the anatomy test we had this morning was more important. (same class and same professor)
- Professor: You could have at least read it.
At that point I decided it wasn't worth going into the details of the week and asking him what he thought I should left undone.

I spent Monday studying for a mid-term on Tuesday in our Occupation Through Compensation class. We only have 2 exams in that class so I figured I'd better study, even if much of it seems like common sense. Once I started reading the questions I'm glad I at least looked at the material on Monday and a bit on Tues morning during the slow times at work.

We got out of work a bit late on Tuesday since a plane was late and I had a spin out on the way home resulting in the passenger side of the car slamming against the curb hard enough that I got out to assess the damage. One rim looked seriously bent but the tire was intact so I headed on home. As shaky as the steering wheel was when I hit 30 mph, I was glad that was all the faster anyone expected me to go. By the time I got home both tires on that side of the car were half flat. Thankfully one of my housemates could take me to school as there was no time to take the bus. By the time I got home following two tests the only thing on my mind was getting my car into the shop. Thankfully the tires were still only half flat so I was able to drive it to a garage rather than calling a tow-truck. The rest of my evening was spent studying for the hardest anatomy exam of the semester (per our professor). I ran out of energy at 8 and went to bed on schedule.

Wednesday we had class all day after which I went to pick up my car. Thankfully the tires were fine, I just needed a new rim/wheel and a realignment. Back home again I kept working on muscles, nerves and arteries in the back, forearm, and hand. I normally go to house church on Wednesday evening but I stayed home and studied until 8:30

Thursday morning I went to work and then off to school again. We had our anatomy test and I actually did quite well - better than the first one. Once that was over, we sat through a lecture on statistics for our research class. None of us had done the reading for that class either. After a break at so we could eat, we had the kinesiology lab. No, I really didn't need to read that chapter before hand. I probably got more out of it after the fact because I actually understood what it was talking about.

The out-of-the-ordinary in the last few weeks

Life is rather routine for most people. My life seems even more routine than usual this semester. I go to work; I sit at my desk and study (or go to class); I find something to eat; I fall into bed at 8 pm so I can get up at 4 am and do it all over again. But every now and then something happens that breaks the routine.

• Yesterday a friend from France called me. It was great to catch up on her life and extended family. And it is always good to know that I can still speak French.
• I continue to visit Audrey at the nursing home once a week. We have become friends and she really appreciates my visits. Last week I noticed a book on her dresser with her name on it as the author. "Did you write a book?" "No," she responded, "my daughter did." It turns out that she had recorded the stories of her life and one of her daughters had transcribed them for her 85th birthday. She is now 98. Her story was my leisure reading last weekend. This week when I went to visit she was sound asleep but I got to meet one of her granddaughters.
• Valentine's Day is a great money maker at UPS. We had to be at work 10 minutes early and it felt a like a one-day Christmas rush. The packages are lighter and there were lots of boxes of flowers. A friend who lives across the street invited me and a few other friends for a special meal that evening. 
• One of my stressed out classmates gave us all a package of fish shaped candy with the message, "Of all the fish in the sea, I'm glad we swim in the same school! Happy Valentine's Day! P.S. Just keep swimming." Somehow she had the creative juices, time and energy to brighten our day.
• This week I went with two of my classmates to learn from some people dealing with long-term homelessness. We all came away with the sense that we have a lot to learn. We'll be spending time with them every other week for the next couple of months.
• After church today I went with a friend of mine to Holy Land restaurant. It's great to spend $10 for a buffet of Middle Eastern food and enjoy some good conversation.

Overwhelmed

There have been times this semester that I have felt rather overwhelmed. Sometimes I feel behind. Other times the weight of everything that needs to be done by the end of the week feels too heavy to carry and I wonder how long I can keep going. This semester has a rhythm of working on our own for one week followed by a week of being in class Monday afternoon, all day Tuesday, Wednesday morning and all day Thursday. That means two weeks worth of work needs to be done during our off week since there is little time to do much besides go to class during the second week. This past Monday when we gathered for cadaver lab, I was actually encouraged to know that everyone else is feeling overwhelmed as well. One gal said she sat at her desk and cried that morning because she didn't even know where to start. I can identify. Another classmate reminded us that it all would be done by the end of the week. I thought back to my days at Moody when one of my friends would remind us during syllabus shock week that all those assignments would be done by the end of the semester. I smile at that now because in this program we don't have the emotional energy to think beyond the next two week cycle much less to the end of the semester. Saturday afternoon I looked ahead at what is in store for the next couple of weeks and it includes a mid-term in one class and another anatomy test on the forearm and hand (among other things). If I can learn everything on a 3/4 inch stack of flash cards I will do just fine. Come the evening of Feb 21st, it will all be done but at the moment it seems like a rather tall mountain to climb.   

This past week we spent a morning going through a simulation of what it is like to work in an acute care setting. Other than the rooms being at least twice the size of a normal hospital room, it was a realistic situation and gave us at least some exposure to working with patients who are connected to tubes and monitors. Two occupational therapists who work in a hospital shared some of their expertise with us and then evaluated us as we took turns having a 10 minute interaction with a standardized patient (i.e. an actor taking that role). They were impressed with our overall interaction skills. Some other tidbits from last week:

• 20 to 25% of people don't have the palmaris longus muscle in one or both of their forearms. 
• We practiced teaching one-handed dressing techniques to each other as well as how to put on pants, socks and shoes while not bending past 90 degrees at the waist following a hip replacement. We will be tested on this by having to correctly teach one of our professors taking the role of a stroke patient or someone who has had a hip replacement.

The Hawkeyes vs. the Gophers

I grew up during the Dan Gable wrestling era at Iowa. From my perspective as a kid, the only names in wrestling were Iowa, Iowa State, Oklahoma and Oklahoma State. In fact, from 1968 until 2000 only one other school won the national championship. In the last 12 years, Minnesota and Iowa have both won three national championships which can only add some spice to the animated rivalry between the two schools. Though I have never seen any wrestling in person, I'm enough of an Iowa fan to want to go see them, especially when I can use my University of Minnesota student ID to get in free.

I arrived at the end of the introductions and found a place to sit next to some Iowa fans. Shortly afterwards some Minnesota fans sat on the other side of me. Even though wrestling is a pretty straight forward sport (get your opponent on the mat and if possible on their back), I still felt like a novice and learned some from listening the comments of those on either side of me. The two teams were evenly matched with Minnesota ranked 4th and Iowa 5th. Both wrestlers were ranked in 8 of the 10 bouts. That meant there wasn't much action at times since neither wrestler could find a good opening. There was little chance of seeing a pin. These wrestlers were just too good. Sometimes the fans were so quiet that I could hear the instructions the Iowa coaches were giving. The quietness may have had something to do with Iowa winning 4 of the first 5 bouts. The crowd was much more animated when Minnesota turned the tables and won the last four bouts resulting in a 15 to 15 tie. That felt very unsatisfying to me. Neither team should have to settle for a tie after all the work that they put in. When I got home I discovered that Iowa won 16 to 15 since they outscored the Gophers 41 to 33. That gave them the extra point and the win. In the past three years I've seen the Gophers beat the Hawkeyes two times in football. It was nice to see Iowa come in and get a win.

Cadaver lab

Anatomy class gives us the option between cadaver lab and Anatomay TV, an online virtual experience. I chose the cadaver lab for several reasons. I spend enough time staring at my computer screen that I'm glad to have the excuse to be studying with no screen in sight. I also like the hands on learning experience. Being able to touch and feel helps me remember things. My housemate, Jan, has learned not to ask any questions when I get home from lab since she thinks I give too much information. I'll try not to give too much information here.

We are working with 8 different cadavers that have already been dissected by med students. Our lab instructor shows us the structures we are to be looking for and then our job is to find them all on each of the cadavers. That isn't always possible but it does give us a good idea of how each of us are different. We know that people come in all sizes which means bones and muscles are different widths and lengths. In addition blood vessels and nerves branch off in a little bit different places. We spent quite a bit of time trying to sort out the brachial plexus, the area between the neck and the arm pit where several nerves branch off, join and branch off again. The major artery that supplies the arm runs in the same area. I was surprised that the nerves and blood vessels are about the same size. Somehow I always thought that nerves were quite small. The lab exam isn't until close to the end of the semester but our first test in class is on Thursday. My anatomy flash cards are never far away.

Home

One of my classes this semester is on occupational therapy and family. At first glance family doesn't seem to have anything to do with OT but many times, people receiving OT greatly benefit from the help of family members.

Last week our professor led us through a short visualization exercise of the kitchen in our home when we were 5. Some of the things she asked us to remember were easy to recall while others were more difficult. The L-shaped kitchen of 1972 was later remodeled into a square so there are sometimes two competing images in my mind. I do remember the cupboards, the window above the sink, and the placement of the stove and the refrigerator. At the same time, I have no memory of what was in the refrigerator. I know there was a telephone somewhere in the room but I don't really remember where. However, I do remember the location of the 1970's-green Kitchen Aid on the counter. That could be because Mom was patient enough to let me help with the baking and we all came running when the mixer was at work because we wanted to lick the bowl and beater. I think the floor was yellow (though I'm not sure that was when I was 5). I do remember playing hockey with Andrew using 2 yardsticks and a lego as we waited for breakfast to be ready. I remember the table sitting in the nook with windows on the east and south sides. Considering how we all have assigned seats now, I'm sure we did then too and I think mine was in the SE corner. I also remember the old grinder that would attach to the cutting board and used to grind up meat for sandwiches. Did we not have sliced deli meat back then?

This whole exercise was part of a section on what home means to different people. My parents moved to town from that house about 6 years ago. I was in Iowa and helped with the move and I don't remember it being difficult. My sense of home seemed to be more attached to Mom and Dad than to the place. However, I was surprised by how emotional this little journey back in time was. Originally, John was going to move to the farm and even though he never did, he was the one farming the land. That all changes this year. The machine shed and barn are empty and the house will become home to a young couple getting their start in farming. Dad still owns it all, but in a way it's not really ours anymore. Though it is not what we had planned, I know it is a good thing for this couple. Yet I am left with a sense of loss. Maybe it is also related to not really having my roots down yet. I feel  more at home here in Minneapolis than I did a year ago but I don't know where I will end up once I am done with my schooling. I am thankful I grew up on a farm with a mom who didn't work outside the home. That allowed all of us to work alongside both my parents which is the best way to learn. After all, values and character are far more likely to be caught than taught.

Let the semester begin

After a few weeks of not thinking about school work beyond ordering my books, we officially started back in on Thursday. I feel for any of my classmates who didn't begin at least on Wednesday as I did. The first few weeks are always rather overwhelming and this has been no exception. It didn't help that our online platform was down all day yesterday and most of today.

I began by downloading each syllabus and noting key assignments and dates on my calendar. Last semester we didn't have any exams. This semester our first exam is in three weeks - in Anatomy. I sure hope everything I learned during the fall of 2011 comes back quickly or it will be overwhelming. Functional Anatomy & Kinesiology is one of the classes that will require the most study. As occupational therapists, we focus mainly on the upper body so that is where we begin. Tomorrow I need to plug away on the bones, muscles, nerves and blood supply in the shoulder and arm.

Another class that will require a lot of time is a 5 credit class called Occupation Through Compensation. This is where our studies get very practical since we will regularly be using what we learn in our practice. I really need to learn this material for more than the test. It looks at ways people can compensate for weakness or the loss of ability to do something. It might be temporary such as the man who had a hip replacement and can't bend at the waist past a 90˚ angle for six weeks but still wants to be able to put on his pants, shoes and socks. Others face permanent changes such as the woman who becomes paralyzed and finds she must learn new ways to do many daily activities from her wheelchair. This class includes 24 hours of practical experience which will be my first taste of actually doing occupational therapy as opposed to simply observing.

One big change this semester is that we will be on campus in class every other week for two full days. In addition I have a cadaver lab every other Monday for a couple of hours. However, since this is the first week, we begin tomorrow with the lab and have class on Tuesday, Wednesday and Thursday. It will be great to have more interaction with professors and classmates but the extra time in class as well as all the professors expect us to do before class time add to the pressure of these first two weeks. It will get better and come April 10, everything will be done!