Have you ever seen the plaque “Don’t make me call the flying monkeys”? Today was one of those days…
Bryn Mawr called to inform us that our insurance company had not evaluated Corey’s progress notes sent in last week. The review awards us additional covered visits. This is not A-typical. What is inexcusable is the reasoning that there is a “backlog of submissions” that has caused the delay.
After several phone calls explaining that the “paperwork” sitting in a pile on their desk is actually related to a real person. That person, in our case, has a condition that requires long term rehabilitation. An interruption in services will cause a significant set back. Is the company aware and willing to take responsibility for jeopardizing their clients physical progress?
We headed up for our scheduled sessions; however, the additional visits remain pending based on a conference call tomorrow. That’s a problem we’ll deal with tomorrow…today was the real issue…
Monday’s are very difficult for Corey. She does not remember Bryn Mawr, the team, or why we need to go for therapy despite the usual mantra.
We begin Monday’s with Kate. She was impressed with a new technique we’ve started at home. Due to Corey’s short term memory loss, she asks the same questions repeatedly in the same way. For instance, “where is my brother, where is my sister”? I decided to write the answers to her questions on a large lined index card. I call them “reminder cards” and place them in front of her. When Corey asks her question, I point to the card and encourage her to tell me – “Caitlin is at school” and “JohnPaul is teaching”.
Kate chose “emotion” words and wrote them on smaller index cards hoping Corey would utilize them as a memory tool if she could not express herself.
The words Kate chose were; Angry, Anxious, Sad, Happy, Frustrated, Scared, Overwhelmed and Excited.
Corey struggled reading some of the words but found it more difficult to define them. Within minutes, Corrine was with us. When Corrine is in the room she refuses to look at or speak with Kate. She screams, kicks, hits me and hides her head.
I switched gears immediately.
M – Corey, these words represent feelings. Your feelings are not wrong. You can help us understand what you can’t tell us by using these words.
(Using our new strategy)
Which word best describes Forgetful Fran?
C – (timidly points; Scared)
M – Which word describes Nervous Nellie?
C – (Overwhelmed)
M – Corrine?
C – (Scared)
M – Impatient Patty?
C – (Angry)
M – Worrying Wanda?
C – (Anxious)
M – Negative Nancy?
C – (Sad)
Do any of these words describe you?
C – (Happy)…”but I’m not now, I want to go home”.
M – Can you tell me why?
Corey’s eyes became very sad. “I want all these feelings to go away”.
My chest felt heavy. I paused, trying to hold it together to keep the session going, mind racing as to how I could relieve her pain.
M – Okay, let’s think of happy words. Name any words that make you think of something happy
Corey was silent
I began streaming random words…
M – Amelia, cooking, fireworks
C – beach
M – singing, chocolate
C – Easter
M – Birthday’s,
C – Sparkling Cider
This was a tough session but incredibly informative. Corey identified and gave insight to her present emotional state. Although Corey had a global injury (each section of the brain was affected by the force of her injury) the association of emotions comes from the Temporal Lobe which regulates memory, emotions, language and learning. The Frontal Lobe, one of the most damaged parts of her brain, regulates control of purposeful behavior, consciousness and emotions.
Her happy words not only identified long term memories (fireworks=beach, chocolate=Easter) but a NEW memory. She had sparkling cider at her birthday party this month! That was not a tradition.
This afternoon Corrine also joined us with Natalie. We had to go to a private room to separate her from other patients. We talked through her objections to using the word EXERCISE. We decided to use a full length mirror and put on her favorite music station to “workout” instead.
Natalie was behind Corey and I was in front physically mimicking the same workout steps. She quickly caught on to the bait and switch and began stomping her feet (not to the beat of the music). I continued to mimic her, stomping my feet, hitting my leg etc. She laughed at me as she watched me have my own temper tantrum (I was silently thinking of my morning calls).
She stood perfectly still, staring at me with a small smile. She was calm and distracted by my behavior. Natalie seized the moment and let go of Corey’s shoulders; she began to count aloud “1,2,3,4,5,6,7”. Corey lost her balance, leaning to the left. Natalie helped her secure her stance and asked if she could beat 7 seconds. Without hesitation I called, “GO”! Natalie counted as Corey looked at her reflection….15, 16, 17, 18. Corey leaned back against Natalie. “Do it again”, I challenged.
I stood silent (holding my breath), Natalie counted, Corey concentrated. Natalie’s hands were moving as if a force field surrounded Corey prepared to catch her if needed, …42, 43, 44 … I was speechless, …58, 59, 60… As I watched them I remembered Natalie strapping Corey to the tilt table when she was unable to move, …”you made a minute Cor”… Natalie, smiling as she counted, kept glancing at me; my eyes were filled with tears, the lump in my throat was to large to swallow, …21, 22, 23, 24, 25. Corey broke her stance. Natalie announced, “one minute twenty five seconds”…Corey corrected her, “85 seconds!”
This is why we fight.
This is why we don’t give up, especially when it gets hard.
This is why we don’t accept what is.
This is why we expect everything is possible!
Imagine if we didn’t go for therapy today?
Tomorrow the flying monkeys will be ready for whatever comes! xoxo