Gotta Eat at Christmas

Most of my colleagues at the hospital are younger and have families, or are just barely out of college....so I volunteered to work Christmas. Man, is it ever dreary out there today!  Not horribly cold as I drove into the wet parking lot - about freezing - but the chill I feel to the bone. Mississippi Winter. Wicked! I've had - 20F Christmases, but they don't affect me like that winter on the cusp of phase change. It's warm on the floors anyway....

(Usually I am here before the rest of the rehab staff, but today - Xmas - it is even more important to get to my patients early. Seems like most of the PT's and OT's focus on getting through their list of patients, and whooshing home to the holiday festivities. Some even have to do the cooking! I try to avoid that feeling - opening the door "knock knock knock" of my first patient now - of being a human pinball, by "may I come in? Thank you...."  - by good time management, by staying in the moment and by assuring my patients that our therapy will be a good time!)

"Hello! It's Christmas morning, isn't it? My present was getting to see you early; and yes, I showered and shaved! And - what good timing, here comes the staff with breakfast now. Yay!....OK, here it is; may I help set it up for you?.....There we go; but before you start, let's make sure you are doing all the things you can always do to help yourself eat without a struggle..."

(She is here for treatment of her congestive heart failure and chronic obstructive pulmonary disease, with aspiration of food and liquid being a recurring challenge for her. Her videofluoroscopic swallowing evaluation was just yesterday, and showed she had a mild trend towards leaking things she swallowed from her throat, into her windpipe. Being here with her at breakfast is one component of helping her improve her skills. Swallowing treatment is today thought of as predominantly muscle retraining, but in the case of this Christmas breakfast, it is also a social cognitive act.)

"Those eggs look good, don't they? They are nice and warm....yes, you're swallowing well. Let's keep the good swallowing going. Remember what we practiced? After you've chewed each bite, swallow HARD! That's right! Swallow so you can feel your voice box bobbing UP and DOWN for each swallow. I can show you if you're doing it well, by resting my fingertip very lightly on the protruding part of your voice box - if you swallow hard enough, that part of your neck will rise above, then fall below the spot I mark with my fingertip. And, yes, there you go! You're moving that well when you swallow your breakfast!".

There were quite a few strong swallows after that sequence, but that was enough to illustrate what worked for this lady. I found the woman's nurse on the floor and reviewed the patient's progress, then wrote my note to describe the visit. Given the patient's chronic disease, and her tendency towards lying in bed when not exercising, teaching caregivers to grade the validity of the procedure seemed our best bet to help this woman meet her goals. Only ten more patients on this Christmas! Ho ho ho -and we steal into the mechanized Christmas morning, like Boxing Day Ninja shoppers off on a trial run.