Everything is Simple

Yesterday & Today: Lowlights

Yesterday, I evidently got cussed out by a black woman and didn’t realize it. One of the ladies I work with gets really testy at the end of every shift. She started opening the dishwasher, so we could clean it out, and I figured I’d help her clean, so she wouldn’t have as much to do. All I heard was, “(mumble mumble mumble) Don’t wait on me (mumble mumble mumble) to do this shit, just do it, don’t wait on me (mumble mumble mumble).” BUT, according to my BFF in the dishroom and another one of the workers, all of those mumbles included words like “fuck,” “shit,” “bitch,” etc. In FACT, my BFF called our supervisor (who had already gotten off of work) to tell her what happened. When I spoke to the supervisor, she told me that my BFF is just overprotective because she likes me. D’awww… If I get cussed at again, shit’s gonna hit the dish-a-washer, though.

Today, TR Client was much more aggressive toward herself than she’d ever been before. She missed Tuesday and came in today with a scab on the bridge of her nose. She’s notorious for breaking her nose and causing it to swell, but she’d evidently never broken any skin. She also does this thing where she bites her hand really hard. Once her teeth meet her skin, it’s near impossible to separate the two. This usually happens once or twice in a session, but today it happened at least 15 times and, finally, her mother decided to cut the session short.

They don’t know exactly what’s wrong, but are hoping to conduct some neurological exams to see if they can figure it out.

There’s always tomorrow…

Therapy: Day 19 Recap

MW Client arrived almost ten minutes early, today. We knew because we could hear him growling and yelling from the hall. This time, his mom didn’t bring him. His “caretaker” brought him. She’s kind of like an adult babysitter, but a badass. She’s a former prison guard. The clinical supervisor told us that she’s considering going back to the prisons.

…because it’s easier.

Therapy: Day 17 Recap

Got punched twice and cursed at once. The third time MW Client attempted to hit me, I raised my voice and said “Do not hit me, MW Client.” And he didn’t even try the rest of the session.

In other news, the Indian neurology professor is a badass. MW Client was being unruly, the professor hissed at him, and MW Client became immediately obedient.

Awesome.

Therapy: Days 11 & 12

Alright. So, both Monday and Tuesday were rough.

Yesterday, MW client was really tired and got easily agitated repeatedly throughout the session. By the end of the session, both the clinician and I had gotten hit or slapped, and the clinician got stabbed with the little end of her graphite mechanical pencil. Luckily, he hit my hand with the marker, which only left a little mark. He also tends to grab ahold and squeeze your hand, stabbing into the outside the hand with his fingers. The scariest moment, for sure, is when he “bucked” at the clinician. [Aside: “Buckin’” is what my roommate called it. It’s that motion when you make a fist and rapidly lean in and back out from someone in a threatening manner.] At that point, I kind of stopped taking data for a moment and made sure he didn’t follow through with that threat. Needless to say, the clinician was pissed after that.

Then, today with TR client, we attempted to finish the administration of the TASP assessment, which ended up being as big of a behavioral disaster as Thursday, if not moreso. TR client continually got very frustrated and one of her ways of coping with her frustrations is to hurt herself. She continually bites the sides of her hand, puts intense pressure on her teeth with her fists, and she’s been known to break her own nose, at times. She hasn’t attempted to hurt her nose, yet, this semester, but it is very obvious that she has some permanent physical damage from when she used to do that. But yeah, she was frustrated through most of the session and when she wasn’t attempting to inflict pain on herself, she was making loud noises that resembled that of someone being tortured.

On a lighter note, at the beginning of therapy, TR client’s mom told us that she was “very gaseous, today.”

So true. She ripped a huge fart.

Therapy: Day 10 Recap

Today, we deviated from the usual therapy procedures, to administer a standardized test for TR Client. Instead of sitting next to her, I sat across the table from her and the clinician was at the head of the table, with the test.

And… she got a little anxious toward the end of the session and began kicking under the table.

I wasn’t sitting completely back in my chair.

Think about it.

Therapy: Day 8 Recap

Today was rough.

Before the session began, I was briefed on what activities we were going to do by the clinician. We were really excited to see MW Client, because he missed both days last week and one day the week before. In the briefing, I was told that the clinical supervisor didn’t want us to imitate his head-bobbing, anymore.

The first session I was in, with MW Client, I moved my head from side-to-side at one point (probably accidental) and MW Client did it with me. We referred to it as a dance and it seemed to keep him happy. Today, not head-bobbing (or whatever you want to call it) was pretty difficult, but I figured it’d be best to follow the supervisor’s orders.

Early on, in the session, he did the head-bob and I painfully restricted myself to smiling and raising my eyebrows. These motions of his diminished and eventually he stopped head-bobbing, at all. He became increasingly aggressive as the session went on. The first victim was a sandal that was used to help him identify common objects. He threw it at me and it landed on the ground.

Not long after, he smacked the clinician’s arm out of the way, somehow got marker on my shirt (the clinician saw it, I didn’t), “soccer” kicked under the table, and punched my hand.

I gave him high-fives and the occasional thumbs up, as usual, but by the end of the session he wouldn’t even look at me.

Now, I’ve only taken two Psychology courses, but I feel like he may have been upset with me because I was neglecting “our” activity. Maybe. At the VERY least, the head-swaying kept him occupied and served as a calming agent… which would explain (in my view) his sudden rise of aggression in comparison to the last three sessions he’s been present for.

His mom told us that they’re going to miss on Wednesday. That means he will have TWO sessions out of SIX. ::Dislike::

In the middle of the session, my eyes drifted to the text on the front of his shirt. On the walk to the therapy room, I noticed the back of the shirt had a quote from the Bible on it. I don’t remember which quote it was, but on the front it read:

“Pray 4…” and then, his name.

I mentioned that to the supervisor and she told us that there were signs all over town, after the accident, encouraging people to pray for him. The clinician said she had heard he was engaged at the time of the accident, but the supervisor said that wasn’t true. We both let out a breath of relief before the supervisor told us more.

He has a 5-year-old son.

Therapy: Day 6 Recap

Day 6 (Tuesday) was pretty uneventful.

I feel like this is a testament to my “getting used to it.”

When TR client came in, she was very giggly. She wouldn’t stop laughing and would burst out with “I’m going to speech today,” randomly.

She wasn’t as touchy as usual (Thank God), though at one point she did put her hand on my upper thigh. I immediately took her by the wrist and moved her hand to the table where the activity cards were. It’s pretty uncomfortable, but I try to keep an open mind when it comes to her touching my beard or hugging my arm, but I have boundaries.

One of the activities we worked on was getting her to identify items on her DynaVox (AAC device) using descriptions. Example:

She would be shown a photo of a flower. The clinician would ask her what she saw. She would find “flower” in her device. The clinician would ask what color it was and she would find “red” in the device. Eventually, TR client began choosing “‘I see’ / color / object” etc. without being asked. It was very exciting.

We also played with bubbles, which is always fun. If you can imagine me in a small therapy room blowing bubbles…

I think, today, we’re gonna work on manners. She has “please” and “thank you” in her device and the clinician keeps hoping she’ll use them spontaneously, since she sometimes says “please” after “I want / coke.”

OH! And we played with Mr. Potato Head!!!

Therapy: Day 5 Recap

So, oddly enough, both clients canceled on Monday and Tuesday. I’m not sure of the specific reason MW client canceled on Monday, but TR client’s mom was getting their car repaired (and the clinician had some weird contagious sickness).

And, today MW client was back.

He seems to pretty consistently do very poorly on whatever activity we do first and get progressively better as time progresses. I almost feel like we should do some pointless task for the first five minutes of therapy and then go into the short-term goals.

Most of his stuff is identification. For instance, the clinician will show him two picture cards and then hold up an object and ask him to hand me the correct card that correlates with the object. I think he only missed one, on that. And, the one he missed was black gloves, where he picked up the photo of the white spoon on a black background (the only object with a black background).

Anyway, the highlight of the session was when the clinician was doing Melodic Intonation Therapy (MIT). The clinician would hum a sound, say a brief phrase with the same intonation, and the goal would be for MW client to finish the utterance when, on the third step the clinician stops short of finishing.

That was a little wordy… Here’s an example:

1. The clinician hums: “Hmm-hmm hmm” (The goal is for the client to hum along with her)
2. The clinician says: “O-pen up.” (The goal is for the client to repeat what she says)
3. The clinician says: “O-pen …” (The goal is for the client to finish the utterance, even though the clinician didn’t)

One of the phrases was “I am hot.” When the clinician said, “I am hot,” MW client looked at her, looked at me, and looked back at her and started laughing.

At the end of the session, the clinical supervisor came in and joked around about how MW client was laughing at that. I said, “Well, you know why he started freaking out, right? …because, [she] is hot.”

And she is. I may or may not have had a crush on her a few years back, when we were both undergrads.

Now, it’s strictly professional.

Therapy: Day 4 Recap

So, at the end of the session (with Tuesday-Thursday (TR) Client), the client’s mother came into the room and said:

“So…I think Max feels a little molested, don’cha think?”

Yep.

Therapy: Day 3 Recap

Today, I assisted with the 30-year-old Brain Injury patient (mentioned in Therapy: Day 1 Recap). I’ll start referring to him as the “MW (Monday-Wednesday) Patient.”

He was MUCH better behaved, today. I gave many more high-fives and initiated a head-sway dance which kept him both amused and calm throughout most of the session.

There was one point where he wanted to grab my hand and lock fingers. I sort of went along with it, because I wasn’t sure what was going through his mind, but he clearly tried to crush my hand, so I got out of that one really fast. The clinician said, “…we don’t do that,” and by the next round of high-fives, he was back to his usual high-five-giving self.

Also, after the first series of tasks (which he did poorly on), he began to show more-than-considerable improvement. I don’t have the data on me, but I’m pretty sure he exceeded 80% accuracy for the second series of tasks, which is much higher than his 3/20 correct on the first series.

He got a little irritated a few times, but I tried to interject with something, or the head-sway and he calmed down a bit.

The only time he got anxious and tried moving the table was right before we were about to dismiss. He calmed down, finished the tasks successfully, and was then permitted to go.

His mom remarked, outside of the therapy room, that she was glad he started laughing, because “he sure wasn’t laughing this morning.”

Also, the clinical supervisor said to me, “He LOVES you.”

Therapy: Day 2 Recap

So, today I had “Head Start Orientation,” which was followed six hours later by my second client.

I didn’t work with anyone at Head Start, but my second client was very interesting.

She’s a 10-year-old ginger girl with Autism, who uses an AAC device, which is like a computer that provides visuals and associated terms with which the user is able to create their own sentences. It’s like a less-advanced version of what Stephen Hawking has, and is geared toward individuals with disabilities.

She was rather calm, in comparison to the first client I experienced (who I will also see tomorrow). She was fairly cooperative with the clinician, struggling with focus because she enjoyed looking at herself in the mirror too much.

Twice during therapy, she looked at me and grabbed my left hand. I’m not sure if she was attempting to flirt, or not, but both times I took her hand and used it to point to the picture cards she was being presented with.

Day 2 was interesting, but compared to Day 1, it was a walk in the park.

Therapy: Day 1 Recap

No one got hurt.

When the client walked into the therapy room, he stopped, looked at me, and immediately pointed his left index finger at me and proceeded to laugh for about a minute. The clinician and her supervisor weren’t sure how to react, so the first few moments of therapy were, “let’s-laugh-at-Max time.”

On the other hand, I have a theory that my presence in the room allowed for the client to develop some sort of male camaraderie. The speech-language-hearing sciences is very much so a female dominated field and part of me wonders how many males he’s had in the therapy room with him.

Either way, he was far less disruptive than when I observed last Wednesday. This time, he finally started breaking down and getting anxious about thirty-seven minutes into the session, whereas he was upset through a lot of the session last week. I asked the clinician how she thought it compared and her response was, “..like 98% better.”

She also commented that she’s glad he likes me and she’s glad I’m her assistant. One of the major concerns I had going into therapy was making sure he didn’t hit her or cause her any physical harm. The way this is partly ensured is by seating him in a corner and sort of pinning him in with the table so he isn’t able to get up or make any unwanted advances (he’s notorious for a time last year when he put his clinician in a headlock). Last week, I think he hit her twice. This week, none.

She also suggested we take some Krav Maga classes.