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.