Week 12
Alright y'all, it is officially the LAST DAY OF FIELDWORK. One of my supervisors doesn't work Fridays, and I only have one kiddo today, so we did my eval yesterday, and I PASSED! Although I had no reason to believe I wouldn't (other than the little anxious voice that lives inside my head) it still feels crazy, overwhelming, and relieving to officially know that I am DONE with my very first level 2 fieldwork. This makes me (wait for it) 6/8 of the way done with this doctorate thing. SIX EIGHTHS.
This twelve weeks was a stressful one, I can't lie about that. Yesterday definitely brought things to a nice close and I feel confident about where I'm going in the fall. Just in case you need caught up to speed, I've been at a pediatric outpatient clinic for the last twelve weeks. I had around 35 kids total (but usually less than that during the week because kids travel/get sick/don't show sometimes ) so on average I'd see 3-5 kids on a slow day and 8-12 on a big day. To conclude this rotation, here's a few things I learned along the way....
1. LOL THE REAL WORLD IS NOT LIKE SCHOOL.
Don't get me wrong, Creighton BEYOND prepared me for rotation. There were countless times this summer my supervisor asked me a question to both see how much I knew about the subject and also to quiz me and I could tell my answer impressed her - not necessarily because of anything I did, but more so because Creighton taught me a lot. I was very blessed to attend a school where I had two full semesters of pediatrics classes. Other students I know only got about 8 weeks of pediatrics. Even then, there was a LOT I didn't know coming into this. A LOT. One of my last labs during peds class at Creighton, we had to plan and implement an hour long session about handwriting, and another one on fine motor. I learned VERY FAST here that even if you can think of an hour of activities to do with a five year old on handwriting or fine motor (and if you can, call me), the chances that your child, who likely has much more complex issues than fine motor or handwriting, will actually sit and work with you for more than 5 are slim to none.. I got 20 minutes of fine motor in a session, and maybe 10 minutes of handwriting, absolute max. Additionally, my site used three evaluations I had not previously learned much (if anything) about, so I studied them before I came. But... you can know an evaluation inside and out, and still fall flat on your face when trying to give it to a kid who cant even sit still, let alone get into quadruped so you can test his reflexes.
2. Snuggling is therapy and also so is playing.
When I started this summer, I had every session planned down to the minute. I did not want a single moment wasted, because kids should be busy and I only get them for two hours a week. However, throughout the summer, I had a handful of days when I had to learn the above. One of the most important things at this clinic was the relationship the kids had with each other and with the therapists - kids will work 100% harder for people they like when they are having fun. And just as I don't have my best day every day, neither do kids. Sometimes a kid came after a bad day at camp and he really needed to play a game he liked and feel like someone cared about him and wanted to know how his day was. Sometimes a child was struggling because dad was deployed and mom works a lot, and he needs some extra hugs. Sometimes, a child came in exhausted after a day at sports practice and the last things they want to do are things that are hard already. You adjust your session based on your kid, and your relationship with them is pretty close up there for one of the number one important things that exists.
3. Billing/Documenting/Notes
EVERY SINGLE CLASS I took at Creighton talked about billing, note writing, and documentation. These things did not bother me as much as they did my peers. I somewhat enjoy the paperwork, the managerial tasks. It helps me collect my thoughts and understand kids better to see them on paper. I would imagine that at least half of my time at Creighton was covering these things. Billing wasn't really something I did any of based on the nature of this clinic, but my documentation took less than 90 seconds per kid and was very non-descriptive, by request of the clinic. Consequently, most of my documentation looked nearly identical. Also, I wrote zero goals all summer. Nothing wrong with this, I'm sure it will change on my next rotation, but solely the nature of the clinic. At first this really bothered me. How am I supposed to be an excellent therapist if my notes aren't perfect and lengthy and beautiful? How am I supposed to help these kids if I don't write COAST squared goals that end in perfectly timed outcomes with beaming children? The answer, of course, is that I don't. Kids meeting goals is messy. They come kicking and screaming, but they will do it whether you write it down or not. Documentation is important, but it is way less important than what is happening during a session.
4. Seeing multiple kids at once.
This was another thing unique to my clinic that I learned how to do over time. This last week was probably the first time I actually felt CONFIDENT with it and ENJOYED it. Prior to this week I really enjoyed my one on one sessions and only put kids together if I had to - but I learned that my ability to multi task is important, but these kids learn from each other. They learn that it's okay for something to be difficult for you because that same activity might be difficult for someone else. They learn to see things they're good at because it's hard for someone else. They develop empathy and communication when they try to teach each other things. They do my job for me, and some days, they do it better.
5. Parents, parents, parents.
A lot of days, parents are actually harder than kids. Even if they are the nicest parent in the world (which they aren't always), they still ask hard questions. They make me explain things in ways that I have not previously had to, because for the last three years, I've been doing all my conversing with occupational therapists. You can't just throw around terms like 'sensory modulation' or 'vestibular system' with accountants (not that I would expect to, but trying to explain things in ways people can relate to and understand is a challenge). I can't count the number of times this summer that I was questioned by a parent or grilled about what I was doing and was it working. I am a tell it like it is kind of a person - I'm not going to sugarcoat evaluation results, but I'll tell you what I see and then all of the things that I know we can do to work on it. This was hard.
5. Your own style
One of my favorite things about my site was that they were very laid back and let me basically try whatever I wanted with kids. Kids are so much less 'by the book' than adults, so I felt like the whole summer was a gamble on whether something was going to work. I had a child coming in for feeding therapy and I learned that, unlike most feeding therapy patients, he does not work well to give him his preferred food first, because he eats it and then hides under the table. I learned the difference between a tantrum and a meltdown, but only after dealing with about six kids who screamed for a solid hour with no calming them down. I learned that I like to come in and let kids gravitate towards their first activity, I'll figure out a way to make it therapeutic, and then I'll redirect after. I learned that when they ask to do something, sometimes if I say 'I bet we'll have a few minutes at the end if we can get all our work done!" usually gets their little tooshie in gear to work hard.
6. A list of things I wouldn't have survived without
The hardest part of this rotation for me was without a doubt living in a place where I did not have any friends or family. I spent a LOT of mornings watching Netflix on my couch since I didn't generally start seeing kids until lunch time. My family and friends got a lot of FaceTimes when i'm sure they had better things to do. I'm an introvert and love living alone, but man, it would be nice to have another human to talk with sometimes that isn't a six year old trying to teach me about Pokemon. That being said, Mandeville is an adorable little town on the north shore of Lake Ponchartrain. This means I'm about a 45 minute drive from the French Quarter and all New Orleans has to offer, but still in a very quaint little town with some shopping and restaurants with a lake view. I spent more time running, sitting, eating ice cream, and looking at the lake than almost anything else this summer. It made me feel like I was at the beach, which is basically where I was made to be. I also wouldn't have lived without Tricia, the other student from Creighton who came down here to intern at a clinic on the south shore. (Look at me using these terms like a local. I only lived here for six weeks before I realized what that even meant) Trish and I weren't great friends before, but we spent almost every Saturday rotating between our houses at the pool and then going out to dinner and eating delicious foods. We were able to walk through treatment ideas together, vent about frustrating kids, or bounce ideas off of each other, and it made a world of difference to be able to spend our Saturdays together, and last night we said goodbye for the next six months. (Our last rotations are in towns about 2 hours apart so we're excited to continue our Saturday traditions then)
7. Loving what you do.
I didn't doubt this before, but my rotation has confirmed a thousand times over that I love occupational therapy and this is for sure what I want to do for the rest of my life. I called my mom during one of the first few weeks and said "I can't believe I'm so lucky that I get to do this forever!" Fieldwork is a HUGE learning curve. Healthcare is not like other professions in that it's just so vast. You cannot intern for a summer, go through orientation, or learn about it for four years and just 'have the hang of it'. Because of the constantly growing research in the medical field, the hundreds of areas where OT's can practice, and the million and a half different things I can do with each client every day, even an entire year of rotations will make me an entry level practitioner, barely. Not only is it learning to work with clients, it's learning how to document, bill, write progress notes, know the order that skills generally come, make it fun, explain what you're doing, evaluate and asses, help the family of the client understand what's going on, develop a home program for them, convince them they need to practice their skills ... the list goes on. That being said, there were a handful of times this summer when I knew in the moment that it was all totally worth it.
-The day that I watched a child take his first steps on his own
-The day that a child ate guacamole for the first time and actually asked for more
-The day that I bribed a child with dinosaur bones to eat a noodle, and he then asked for more noodles (and I had to buy a rotisserie chicken just to get the bones out. I feel 1% bad for lying to him)
-The day that my 2 and a half year old looked me in the eye for the first time
-The day that my 3 year old transitioned into the gym without screaming and kicking for mom for the first time after ten weeks
-The first good day I had with a really difficult sensory modulation kid, who generally spends his hour running circles around the room and destroying everything in his path.
-The day that I came up with an activity that my 'everything is boring and I hate everything you make me do' kid actually enjoyed.
-The day I got to watch my 2 and a half year old try ravioli for the first time (he gave it a 10/10)
-The many, many days I got to tell parents that we absolutely can help with their child's problems and we see good potential in their healing
-The day I watched a child sign for 'more' on his own for the first time
And finally...
-All the days that I knew that for the rest of my life, I get to spend time with people who will celebrate small victories. For the rest of my life, I get to yell so loud when I see those first steps that it scares the child and he falls down again. I get to cry over a nonverbal child using sign language, and I get to yell 'did you see that?!' when he uses both of his hands together at the same time without my help. I get to spend the rest of my life teaching people to do things they never thought they would be able to do.
This twelve weeks was a stressful one, I can't lie about that. Yesterday definitely brought things to a nice close and I feel confident about where I'm going in the fall. Just in case you need caught up to speed, I've been at a pediatric outpatient clinic for the last twelve weeks. I had around 35 kids total (but usually less than that during the week because kids travel/get sick/don't show sometimes ) so on average I'd see 3-5 kids on a slow day and 8-12 on a big day. To conclude this rotation, here's a few things I learned along the way....
1. LOL THE REAL WORLD IS NOT LIKE SCHOOL.
Don't get me wrong, Creighton BEYOND prepared me for rotation. There were countless times this summer my supervisor asked me a question to both see how much I knew about the subject and also to quiz me and I could tell my answer impressed her - not necessarily because of anything I did, but more so because Creighton taught me a lot. I was very blessed to attend a school where I had two full semesters of pediatrics classes. Other students I know only got about 8 weeks of pediatrics. Even then, there was a LOT I didn't know coming into this. A LOT. One of my last labs during peds class at Creighton, we had to plan and implement an hour long session about handwriting, and another one on fine motor. I learned VERY FAST here that even if you can think of an hour of activities to do with a five year old on handwriting or fine motor (and if you can, call me), the chances that your child, who likely has much more complex issues than fine motor or handwriting, will actually sit and work with you for more than 5 are slim to none.. I got 20 minutes of fine motor in a session, and maybe 10 minutes of handwriting, absolute max. Additionally, my site used three evaluations I had not previously learned much (if anything) about, so I studied them before I came. But... you can know an evaluation inside and out, and still fall flat on your face when trying to give it to a kid who cant even sit still, let alone get into quadruped so you can test his reflexes.
2. Snuggling is therapy and also so is playing.
When I started this summer, I had every session planned down to the minute. I did not want a single moment wasted, because kids should be busy and I only get them for two hours a week. However, throughout the summer, I had a handful of days when I had to learn the above. One of the most important things at this clinic was the relationship the kids had with each other and with the therapists - kids will work 100% harder for people they like when they are having fun. And just as I don't have my best day every day, neither do kids. Sometimes a kid came after a bad day at camp and he really needed to play a game he liked and feel like someone cared about him and wanted to know how his day was. Sometimes a child was struggling because dad was deployed and mom works a lot, and he needs some extra hugs. Sometimes, a child came in exhausted after a day at sports practice and the last things they want to do are things that are hard already. You adjust your session based on your kid, and your relationship with them is pretty close up there for one of the number one important things that exists.
3. Billing/Documenting/Notes
EVERY SINGLE CLASS I took at Creighton talked about billing, note writing, and documentation. These things did not bother me as much as they did my peers. I somewhat enjoy the paperwork, the managerial tasks. It helps me collect my thoughts and understand kids better to see them on paper. I would imagine that at least half of my time at Creighton was covering these things. Billing wasn't really something I did any of based on the nature of this clinic, but my documentation took less than 90 seconds per kid and was very non-descriptive, by request of the clinic. Consequently, most of my documentation looked nearly identical. Also, I wrote zero goals all summer. Nothing wrong with this, I'm sure it will change on my next rotation, but solely the nature of the clinic. At first this really bothered me. How am I supposed to be an excellent therapist if my notes aren't perfect and lengthy and beautiful? How am I supposed to help these kids if I don't write COAST squared goals that end in perfectly timed outcomes with beaming children? The answer, of course, is that I don't. Kids meeting goals is messy. They come kicking and screaming, but they will do it whether you write it down or not. Documentation is important, but it is way less important than what is happening during a session.
4. Seeing multiple kids at once.
This was another thing unique to my clinic that I learned how to do over time. This last week was probably the first time I actually felt CONFIDENT with it and ENJOYED it. Prior to this week I really enjoyed my one on one sessions and only put kids together if I had to - but I learned that my ability to multi task is important, but these kids learn from each other. They learn that it's okay for something to be difficult for you because that same activity might be difficult for someone else. They learn to see things they're good at because it's hard for someone else. They develop empathy and communication when they try to teach each other things. They do my job for me, and some days, they do it better.
5. Parents, parents, parents.
A lot of days, parents are actually harder than kids. Even if they are the nicest parent in the world (which they aren't always), they still ask hard questions. They make me explain things in ways that I have not previously had to, because for the last three years, I've been doing all my conversing with occupational therapists. You can't just throw around terms like 'sensory modulation' or 'vestibular system' with accountants (not that I would expect to, but trying to explain things in ways people can relate to and understand is a challenge). I can't count the number of times this summer that I was questioned by a parent or grilled about what I was doing and was it working. I am a tell it like it is kind of a person - I'm not going to sugarcoat evaluation results, but I'll tell you what I see and then all of the things that I know we can do to work on it. This was hard.
5. Your own style
One of my favorite things about my site was that they were very laid back and let me basically try whatever I wanted with kids. Kids are so much less 'by the book' than adults, so I felt like the whole summer was a gamble on whether something was going to work. I had a child coming in for feeding therapy and I learned that, unlike most feeding therapy patients, he does not work well to give him his preferred food first, because he eats it and then hides under the table. I learned the difference between a tantrum and a meltdown, but only after dealing with about six kids who screamed for a solid hour with no calming them down. I learned that I like to come in and let kids gravitate towards their first activity, I'll figure out a way to make it therapeutic, and then I'll redirect after. I learned that when they ask to do something, sometimes if I say 'I bet we'll have a few minutes at the end if we can get all our work done!" usually gets their little tooshie in gear to work hard.
6. A list of things I wouldn't have survived without
The hardest part of this rotation for me was without a doubt living in a place where I did not have any friends or family. I spent a LOT of mornings watching Netflix on my couch since I didn't generally start seeing kids until lunch time. My family and friends got a lot of FaceTimes when i'm sure they had better things to do. I'm an introvert and love living alone, but man, it would be nice to have another human to talk with sometimes that isn't a six year old trying to teach me about Pokemon. That being said, Mandeville is an adorable little town on the north shore of Lake Ponchartrain. This means I'm about a 45 minute drive from the French Quarter and all New Orleans has to offer, but still in a very quaint little town with some shopping and restaurants with a lake view. I spent more time running, sitting, eating ice cream, and looking at the lake than almost anything else this summer. It made me feel like I was at the beach, which is basically where I was made to be. I also wouldn't have lived without Tricia, the other student from Creighton who came down here to intern at a clinic on the south shore. (Look at me using these terms like a local. I only lived here for six weeks before I realized what that even meant) Trish and I weren't great friends before, but we spent almost every Saturday rotating between our houses at the pool and then going out to dinner and eating delicious foods. We were able to walk through treatment ideas together, vent about frustrating kids, or bounce ideas off of each other, and it made a world of difference to be able to spend our Saturdays together, and last night we said goodbye for the next six months. (Our last rotations are in towns about 2 hours apart so we're excited to continue our Saturday traditions then)
7. Loving what you do.
I didn't doubt this before, but my rotation has confirmed a thousand times over that I love occupational therapy and this is for sure what I want to do for the rest of my life. I called my mom during one of the first few weeks and said "I can't believe I'm so lucky that I get to do this forever!" Fieldwork is a HUGE learning curve. Healthcare is not like other professions in that it's just so vast. You cannot intern for a summer, go through orientation, or learn about it for four years and just 'have the hang of it'. Because of the constantly growing research in the medical field, the hundreds of areas where OT's can practice, and the million and a half different things I can do with each client every day, even an entire year of rotations will make me an entry level practitioner, barely. Not only is it learning to work with clients, it's learning how to document, bill, write progress notes, know the order that skills generally come, make it fun, explain what you're doing, evaluate and asses, help the family of the client understand what's going on, develop a home program for them, convince them they need to practice their skills ... the list goes on. That being said, there were a handful of times this summer when I knew in the moment that it was all totally worth it.
-The day that I watched a child take his first steps on his own
-The day that a child ate guacamole for the first time and actually asked for more
-The day that I bribed a child with dinosaur bones to eat a noodle, and he then asked for more noodles (and I had to buy a rotisserie chicken just to get the bones out. I feel 1% bad for lying to him)
-The day that my 2 and a half year old looked me in the eye for the first time
-The day that my 3 year old transitioned into the gym without screaming and kicking for mom for the first time after ten weeks
-The first good day I had with a really difficult sensory modulation kid, who generally spends his hour running circles around the room and destroying everything in his path.
-The day that I came up with an activity that my 'everything is boring and I hate everything you make me do' kid actually enjoyed.
-The day I got to watch my 2 and a half year old try ravioli for the first time (he gave it a 10/10)
-The many, many days I got to tell parents that we absolutely can help with their child's problems and we see good potential in their healing
-The day I watched a child sign for 'more' on his own for the first time
And finally...
-All the days that I knew that for the rest of my life, I get to spend time with people who will celebrate small victories. For the rest of my life, I get to yell so loud when I see those first steps that it scares the child and he falls down again. I get to cry over a nonverbal child using sign language, and I get to yell 'did you see that?!' when he uses both of his hands together at the same time without my help. I get to spend the rest of my life teaching people to do things they never thought they would be able to do.
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